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Flashcards in Signs and Symptoms Deck (17)
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What is aura?

Neurological features that precede a headache or occur at headache onset. This involves visual and sensory disturbances.


What are the symptoms of a migraine?

- Severe, pulsating recurring, unilateral headache that lasts around an hour
- Often visual/sensory 'aura' (happens just before onset)
- Photophobia (patient prefers dark room)
- Be wary of silent migraine - aura or other symptoms that develop without a headache


What is the triad for meningitis?

- Headache
- Neck stiffness
- Photophobia


How would infective meningitis present?

Usually with a fever. The more rapid the onset, the more likely the bacterial cause.


How does meningococcal meningitis present?

Rash or purpura
Medical emergency so urgent treatment with antibiotics is recommended and should not be delayed for dignostics. Purpura in a febrile child is meningitis until proven otherwise.


What are the most important signs to look for in meningitis?

- Purpuric (non-blanching) rash
- Signs of sepsis
- Shock
- Record observations for the GCS


How do you assess for neck stiffness?

Ask patient to touch their chest with their chin. If unable to do this attempt with your assistance.


What are the signs of meningeal irritation?

- Kernig's sign: stiffness of hamstring causes inability to straighten the leg when the hip is flexed to 90 degrees
- Brudzinski's sign: neck stiffness causes patient's hips and knees to flex when neck is flexed
- Nuchal rigidity: difficulty flexing neck
- Holt accentuation: moving patient's neck quickly increases discomfort
These signs have low sensitivity but high specificity


How do you test for purpuric rash?

Press clear glass tumbler against rash, if it doesn't disappear with pressure then this indicates septicaemia. It can be difficult to identify purpura on darker skin so also examine soles of feet and palms of hands.


What are the symptoms for raised ICP?

- No previous headache history (>55 years)
- Headache (could be worse in the morning)
- Nauseous/vomiting
- Transient visual obscurations - vision becomes blurred or black when there is a change in posture
- Headaches worse by straining or bending over
- Deterioration of consciousness level


What are the symptoms for intracranial space occupying lesions?

- Symptoms due to raised ICP
- Neurological deficits due to compression/damage of adjacent structures
- Symptoms of coritcal/meningeal irritation
- Hormonal effects
- Systemic effects/generally unwell


What are the signs of raised ICP?

- Bradycardia
- Hypertension
- Papilloedema
- Respiratory depression


What are the symptoms of ICP?

- Headache
- Vomiting
- Visual problems - blurring of vision
- Deterioration of consciousness level


What are the unilateral cranial autonomic features of a cluster headache?

Tearing, red conjunctiva, ptosis, miosis, nasal stuffiness


What are the symptoms of a tension headache?

- Band-like ache
- Mostly featureless
- Can have mild photo/phonophobia
- No nausea
- Similar treatment to migraines


Signs of 2ndary headache and red flags

- Papilloedema
- Visual field loss (peripheral) - raised ICP
- VIth nerve palsy (false localising) - raised ICP
- Extensor plantar
- Ataxia
- Hairy leucoplakia
- Meningococcal sepsis - purpuric rash
- Livedo reticularis


Red flag symptoms of headaches

- Headache rapidly increasing in severity and frequency despite appropriate treatment
- Undifferentiated headache of recent origin and present for >8 weeks
- Recurrent headaches triggered by exertion
- Orthostatic headache (occurs in upright position, suggesting low CSF pressure)
- New onset headache in: <50 yrs old (consider GCA) or immunocompromised/HIV