16. Clinical Approach to Headache Flashcards
Primary HAs are benign disorders while secondary headache are a sign of organic disease. A headache history is important to determine the cause, along with pain, prodrome (aura, muscle aches, fatigue), associated symptoms, behavior such as pacing rocks or retreats to a?
Dark, quiet room
Along with characterizations of the HA, ask about previous medications used, surgical history, family/social history, good general exam including vitals, cardiac status, extracranial structures, ROM and presence of pain in the?
C Spine
HA neuro exam includes neck flexion, bruits over head and neck, optic fundi, pupils, visual fileds, cranial nerve exam, motor power in limbs, muscle reflexes, plantar responses, sensory exam, coordination and ?
gait
Some worrisome signs of a pathological HA includes, “worst HA”, onset of HA after age 50, atypical HA for pt, HA with fever, abrupt onset, subacute HA with progressive worsening over time**, drowsiness, confusion, memory impaired, weakness, ataxia, loss of coordination, paresthesias, sensory loss, paralysis and an abnormal medical or?
neuro exam
What is inflammation of the meninges surrounding the brain and SC, sometimes with assoc encephalitis (brain tissue inflam), typically caused by virus or bacteria, but other rare causes are possible?
Meningitis
What kind of meningitis can progress quickly to become serious with complications including hearing loss, memory difficulty, learning disabilities, brain damage, gait problems, seizures, kidney failure, shock or death, MCC in adults infants and young children is *****Streptococcus Pneumoniae?
Bacterial meningitis
H. Influenza used to be the MCC of bacterial menginigits in children but the vaccine has decreased that, N. meningitidis is a high contagious cause in teenagers and young adults in close quarters, what is the MC bacterial meningitis in the elderly?
Listeria Monocytogenes
Viral meningitis is usually benign and MC due to enteroviruses, HSV, HIV and west nile. What type fungal meningitis can be acute or chronic, smoldering over months to years, esp in DM and immunocompromised?
cryptococcal meningitis is the MC** in DM older than 50
Note: if there is a pos Gram stain on CSF in adults, continue dexamethason and add a *targeted antimicrobial, if there is a neg gram stain on CSF in adults, continue dexamethasone and start a?
embiric antimicrobial therapy
Signs and symptoms of meningitis in pts over the age of 2 include sudden high fever, stiff neck, severe headache that seems different than normal, headache with N/V, confusion or difficulty concentrating, seizures, sleepiness, sensitivity to light, no appetite or thirst, and?
Skin Rash (meningococcal meningitis)
Signs and symptoms of meningitis in newborns includes high fever, constant crying*, excessive sleepiness, irritability, inactivity or slugishness, poor feeding, stiffness in babys body/neck and a bulge where?
in the soft spot on top of a baby’s head (fontanel)
With bacterial meningitis suspicion, if there is immunocompromise, hx of CNS disease, new onset seizure, papilledema, altered consciousness, or focal neurologic deficits or delay in performance of dx LP, what should NOT BE DONE?
Lumbar Puncture (just do blood cultures STAT)
IDSA defines encephalitis as the presence of inflam process of the brain in assoc with clinical evidence of neuro dysfunction, of the pathogens reported to cause encephalitis, the majority are what?
Viruses are MCC of Infectious encephalitis**
Infectious encephalitis is caused by viruses, in an adult it is commonly caused by HSV1 or 2, HIV, West nile, Varicella zoster and?
treponema pallidum
What viral encephalitis presents as rapidly progressive neurologically devestating illness with combination of fever, HA, impaired consciousness, seizures, and focal neuro symptoms, MRI/EEG = focal abnls in TEMPORAL lobes, tx with acyclovir, 1/4th develop recurrent neuropsychiatiric symptoms?
Herpes Simplex 1 Encephalitis
Autoimmune causes of encephalitis commonly mimic infectious encephalitis, most autoimmune causes are associated with seizures, intractable epilepsy, and should be considered in pts with rapidly progressive (less than 6 weeks), encephalopathy or psychiatric disturbance, especially if what is present?
SEIZURE (+/- fever)
PROMPT ID of suspected AI cause with initiation of treatment is important
Autoimmune Encephalitis are typically treated with a combination of high dose steroids, IVIg, plasma exchange, rituximab, cyclophosphamide or other immunosuppressants, the 2 MC etiologies of AI encephalitis include LGI1 = leucine rich glioma inactivated encephalitis and NMDA which is?
Anti-N-Methyl-D-Aspartate Encephalitis
NMDA Encephalitis MC affects young or middle aged WOMEN and presents with rapid onset (<3mo) of at least four of the 6 folloiwng sx…. 1) abnormal behavior/ cognitive dysfunction 2) speech dysfunction 3) seizures 4) movement disorders/dyskinesias/rigidity 5) 6)?
5) decreased level consciousness
6) Autonomic Dysfunction or central hypoventilation
