042315 headache Flashcards
HTN pt, extremely elevated BP-what are most concerning
stroke
aneurysm rupture
differential for headache
subarachnoid hemorrhage migraine tension headache cluster headache pseudotumor cerebri (idiopathic intracr HTN) temporal arteritis cerebral venous and sinus thrombosis sichemic stroke acute angle closure glaucoma mass lesions trigeminal neuralgia hydrocephalus drug or toxin infection (meningitis, ecnphalitis) HTN emergencies CO poisoning trauma (epidural, subdural hematomas)
worst headache of my life
subarachnoid hemorrhage (can be due to trauma or spontaneous as in aneurysm)
tx of HTN in subarachnoid hemorrhage
avoid reducing BP too quickly
initial drugs:
- labetolol (beta blocker)
- hydralazine
- nicardipine (Ca ch blocker), nimodipine
- esmolol (beta blocker)
AVOID NITRATES (they increase ICP)
if suspect subarachnoid hemorrhage, but CT negative, what do you do?
lumbar puncture to look for gross blood (also xanthochromia can be caused by SAH)
Cushing’s reflex
increased ICP-triad:
increased BP (sympath-vasoconstriction) decreased HR (parasympath-reflex bradycardia) irregular breathing (compression of brainstem)
tx for increased ICP
osmotic agents (mannitol doesn't cross BBB) loop diuretics
complications of subfalcine herniation
comrpession of ACA, resulting in infarction
complications of transtentorial uncal herniation
ipsilateral CN III compression with pupillary dilatation
compression of brainstem (containing corticosp tracts) against edge opposite the direction of the herniation can lead to ipsilateral hemiparesis–Kernohan’s notch
PCA compression
Duret hemorhage (mibrain, upper pons)
complications of cerebellar tonsillar herniation
meduallary compression-cardiorespiratory arrest
headache-PE?
nuchal rigidity observe head-trauma? shingles? neuro exam a MUST (gait, handslapping, finger to nose) lungs (pneumonia) fundoscopy (increased ICP?) skin (petechiae? purpura?) reflexes? (spinal injury?)
neck (Brudzinki and Kernig)
meningitis by time period
hyperacute: meinigococcal menigitis
acute (2-7 days): usually bacterial
subacute/chronic: TB, syphilis
aseptic (viral)-less severe symptoms, summer or early fall
meningococcemia has what symptom in 40-80% of cases
rash
most common pathogens for meningitis and tx: in under 3 months old
Strep agalactiae
E coli
listeria
staph aureus
ampicillin plus ceftriaxone or cefotaxime
most common pathogens for meningitis and tx: in 3 month to 18 year old
Neiss mening
S pneumoniae
S aureus
Haemo influenzae
cefotaxime or ceftriaxone plus vanco
