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(C) - Y4 Neurology and Special Senses > 5 - Common Neurological Disorders 2 > Flashcards

5 - Common Neurological Disorders 2 Flashcards

1
Q

All dementia syndromes and stroke will be covered in detail in…..

A

OPIC

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2
Q

When somebody presents with a headache, what differentials should you think of?

A

IMPORTANT

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3
Q

How do you take a history for the present complaint of a headache?

(NB - OSCEs)

A
  • Site: Band like, unilateral, temporal
  • Onset: Sudden, gradual
  • Character: Throbbing, stabbing
  • Radiation: Ear, neck, back
  • Associated Symptoms: Eye pain, blurred vision, jaw claudication, lacrimation, aura, photophobia, non-blanching rash, rhinorrhea, fever, N+V
  • Timing: Recur? Seconds? Hours? Progressively worsen? Head trauma at the time? What else doing at time?
  • Exacerbating/Relieving Factors: Analgesia, Sex, Food (e.g cheese, chocolate, coffee)
  • Severity: 1 to 10
  • RED FLAGS
  • Systems Review: General, Neurological, Fundoscopy
  • PMHx: Cancer, HTN, ADPKD
  • DHx + Allergies: COCP
  • FHx: Migraines
  • SHx: Stress, smoking alcohol
  • ICE
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4
Q

What differentials should you think of for a rapid onset headache and a gradual onset headache?

A

Rapid: SAH, Meningitis, Encephalitis

Gradual: Venous sinus thrombosis, Sinusitis

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5
Q

If a patient has a chronic progressive headache, what differential should you consider?

A

Raised ICP, especially if worse on waking/bending forward/coughing and papilloedema

LP contraindicated until CT

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6
Q

What are some red flags with a headache that mean there may be an underlying sinister pathology? e.g raised ICP or Intracranial Haemorrhage

A

SSNOOPPPP

  • Fever, photophobia or neck stiffness (meningitis or encephalitis)
  • New neurological symptoms (haemorrhage, malignancy or stroke)
  • Dizziness (stroke)
  • Visual disturbance (temporal arteritis or glaucoma)
  • Sudden onset occipital headache (subarachnoid haemorrhage)
  • Worse on coughing or straining (raised intracranial pressure)
  • Postural, worse on standing, lying or bending over (raised ICP)
  • Severe enough to wake the patient from sleep
  • Vomiting (raised intracranial pressure or carbon monoxide poisoning)
  • History of trauma (intracranial haemorrhage)
  • Pregnancy (pre-eclampsia)
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7
Q

What examinations should you do when a patient presents with a headache?

A

General: Rashes, Bruising

Neurological: see image

Fundoscopy: May show Papilloedema if raised ICP from tumour, bleed or BIH

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8
Q

What are some primary and secondary headaches?

A

Secondary headaches give a similar presentation to a tension headache but with a clear cause. They produce a non-specific headache secondary to:

  • Underlying medical conditions such as infection, obstructive sleep apnoea or pre-eclampsia
  • Alcohol
  • Head injury
  • Carbon monoxide poisoning
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9
Q

What are the following for Cluster headaches (primary headache disorder):

  • Symptoms
  • Epidemiology
  • Diagnosis/Ix
  • Mx
  • Prevention
A

Can also try steroids and lithium for prevention

If refractory after treatment can try deep brain stimulation, greater occipital nerve blocks and trigeminal nerve compression

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10
Q

What are trigeminal autonomic cephalalgias?

A

Collection of primary headache disorders with unilateral headache and parasympathetic autonomic features

Causes: cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache and hemicrania continua

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11
Q

What is the diagnostic criteria for cluster headaches?

A
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12
Q

What are the following for Tension Headaches:

  • Symptoms
  • Epidemiology
  • Diagnosis/Ix
  • Mx
  • Prevention
A
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13
Q

What are some red flags associated with headaches?

A
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14
Q

What is a medication overuse headache?

A

Headache occurring on 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more days/month, depending on the medication) for more than 3 months. It usually, but not invariably, resolves after the overuse is stopped

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15
Q

What is a hormonal headache?

A

Related to low oestrogen and produce tension headache:

  • Two days before and first three days of the menstrual period
  • Around the menopause
  • Pregnancy. It is worse in the first few weeks and improves in the last 6 months. Headaches in the second half of pregnancy should prompt investigation for pre-eclampsia.

COCP can improve!!!

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16
Q

What are the following for Trigeminal Neuralgia (Primary Headache Disorder)

  • Symptoms
  • Epidemiology
  • Diagnosis/Ix
  • Mx
A

Red flags requiring referral:
* Sensory changes
* Deafness or other ear problems
* History of skin or oral lesions that could spread perineurally
* Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
* Optic neuritis
* A family history of multiple sclerosis
* Age of onset before 40 years

17
Q

What is primary, secondary and idiopathic Trigeminal Neuralgia?

A

Primary trigeminal neuralgia (80-95%)

  • Vascular compression
  • Compression leads to demyelination and abnormal electrical activity in response to stimuli.

Secondary trigeminal neuralgia

  • Compression may be caused by other lesions (e.g. vestibular schwannoma, meningioma, cysts)
  • MS can also lead to secondary trigeminal neuralgia due to demyelination of the trigeminal nerve.

Idiopathic trigeminal neuralgia

  • Unidentifiable cause.
18
Q

What are some important eye pathology headaches you need to look out for?

A
  • GCA
  • Glaucoma
19
Q

What is the diagnostic criteria for a migraine?

A

Clinical

Aura: Confirms diagnosis. At least 2 attacks

No Aura: 5 or more headaches lasting 4-72h with nausea/vomiting or photo/phonophobia AND 2 of: unilateral headache, pulsating character, impaired or worsened by daily activities.

20
Q

What are the following in migraine:

  • Symptoms
  • Epidemiology
  • Diagnosis/Ix
  • Mx
  • Prevention
A

Acupuncture can be done over 10 session if propranolol and topiramate not working

Transcutaneous Nerve Stimulation may help

21
Q

What are some examples of aura?

A
  • Scotoma
  • Paraesthesia from fingers to face
  • Dysarthria and ataxia
  • Hemiparesis
  • Dysphasia
22
Q

What is the definition of chronic migraine?

A

Headache on more than 15 days of each month, 8 of which have features of migraine.

23
Q

What is a hemiplegic migraine?

A

Can mimic stroke. It is essential to act fast and exclude a stroke

  • Typical migraine symptoms
  • Sudden or gradual onset
  • Hemiplegia (unilateral weakness of the limbs)
  • Ataxia
  • Changes in consciousness
24
Q

If a headache is triggered by Valsalva manoeuvre what pathologies should you consider?

A

“Cough Headache”

Could indicate raised ICP from Chiari or Posterior Fossa Lesion

25
Q

What are the 5 stages of a migraine?

A

Some patients may only experience one or two of the stages

  • Premonitory or prodromal stage (can begin 3 days before the headache with yawning, fatigue, mood changes)
  • Aura (lasting up to 60 minutes)
  • Headache stage (lasts 4-72 hours)
  • Resolution stage (the headache can fade away or be relieved completely by vomiting or sleeping)
  • Postdromal or recovery phase
26
Q

What is the mechanism of action of triptans?

A

5HT serotonin receptor agonists that act on:

  • Smooth muscle in arteries to cause vasoconstriction
  • Peripheral pain receptors to inhibit activation of pain receptors
  • Reduce neuronal activity in the CNS
27
Q

What vitamin supplement can be even as prophylaxis for migraines?

A

Riboflavin (B2)

28
Q

What prophylaxis can be given for menstrual migraines?

A

NSAIDs (e.g. mefanamic acid) or Triptans(frovatriptanorzolmitriptan)

Taken 2 days before bleeding and up to 3 days after starting bleeding

29
Q

Why should you not take COCP if you have migraines with aura?

A

Risk of ischaemic stroke, use POP instead

ONLY IF AURA!!! If no aura can use low dose COCP

30
Q

What are some complications with a migraine?

A
  • Status migrainosus: longer than 72 hours.
  • Persistent aura without infarction: refers to symptoms of aura for one week or longer with no evidence of infarction of imaging.
  • Migrainous infarction: describes a cerebral infarction that occurs during an aura whose symptoms then persist, imaging demonstrates an ischaemic infarction.
  • Migraine aura-triggered seizure: migraine with aura that leads to a seizure.
  • Ischaemic stroke: migraines are risk factor for stroke, avoid COCP, lose weight
31
Q

What often happens with migraine disorders during pregnancy?

A

Often improves, if not seek help as may be pre-eclampsia

Give paracetamol, AVOID NSAIDs and Triptans

32
Q

What is the likely underlying pathology?

A

Small Cell Lung Cancer

SCLC - SIADH, Cushings, LEMS, Cerebellar degeneration

This is Lambert-Eaton Myasthenic syndrome. Ascending weakness that gets better on use of the muscles

33
Q

What autoantibodies are often found in GBS?

A

Anti-GM1

(Anti-ganglioside)

34
Q

What mnemonic can you use to remember the features of Wallenburg Syndrome?

A

PICA Infarct

DANVAH

D - Dysphagia

A - Ataxia Ipsilateral

N - Ipsilateral Nystagmus

V - Vertigo

A - Anaesthesia (Ipsilateral facial numbness and contralateral loss of pain)

35
Q

What anti-emetic should you prescribe alongside a triptan for a migraine?

A

Metoclopramide

Always prescribe a pro-kinetic as enhances the analgesia

36
Q

What are the four grades of hypertensive retinopathy?

A
37
Q

What are some primary and secondary headaches?

A

(C) - Y4 Neurology and Special Senses (23 decks)

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