Case 4- Headache Flashcards
What is cortical spreading depression?
Spreading depolarisation: a wave of electrophysiological hyperactivity followed by a wave of inhibition- this is implicated in migraine aura
Why is CSD dangerous?
It may spread within brainstem tissues involved in regulating crucial functions- it may increase the possibility of migraine patients suffering from strokes
It has also been indicated with sudden death in epilepsy (Dravet syndrome)
What is papilloedema and how could it be identified by examination?
Papilloedema is optic disc swelling caused by raised ICP- fundoscopy would be used to identify it
Haemorrhagic changes around the optic discs as well as blurred optic discs would suggest it
What is a symptom of meningitis that distinguishes it from other headaches?
Fever
What are the risk factors for meningitis?
Living in close contact with other people (student halls), travel to places it is prevalent and places where there is antibiotic resistance
Immune suppression
Not vaccinated
How do patients with encephalitis present?
Acting completely unlike their normal selves- changes in behaviour, drowsiness, loss of consciousness, seizures
What is the typical symptom of a sub-arachnoid haemorrhage?
‘thunderclap’ headache- this is the worst pain a person has usually experienced
What signs and symptoms would you look for in someone who you suspect has meningitis?
The classical triad in someone with meningitis: headache, neck stiffness and photophobia
- Fever
- Unblanching rash
- Kernig’s sign- stiffness of hamstring
- Nuchal rigidity (stiffness of neck)
- Photophobia
How would you treat someone diagnosed with bacterial meningitis?
cefataxime 2g qds + dexamethasone 10mg qds
How would tumours of the brain present?
As a space occupying lesion- would usually cause raised ICP
How would primary and secondary brain tumours differ in their presentation?
Primary- personality and behavioural changes, seizures, papilloedema- these would be more focal neurological signs
Secondary- conduct a systems review to check for cancers, weight loss, previous history of cancer
What frequency of migraines would be prescribed prophylaxis and what is the prophylaxis treatment?
More than 2 headaches a month
Beta-blockers (propanolol) or tricyclics are generally used first.
Topiramate and valproate are both effective migraine drugs
What would be seen on an arterial biopsy from someone with temporal arteritis (TA)?
localised skip regions with giant cells
How is temporal arteritis diagnosed and treated?
Blood test for ESR and CRP- if these are raised a high dose of steroids should be given as an emergency- as there is risk of the sight being lost this must be treated with urgency
How does giant cell arteritis/temporal arteritis present?
Headache, scalp tenderness (felt when brushing hair), jaw claudication (cramping), visual disturbances, weight loss
What type of headache typically presents one-sided and with eye watering as an associated symptoms?
Cluster headaches
How are cluster headaches treated?
With oxygen and triptans
What is the most appropriate first line test for a suspected sub-arachnoid haemorrhage?
CT scan of brain
What is the normal opening pressure on a lumbar puncture?
Between 10-20cm; this should be measured as a raised opening pressure may indicate bacterial meningitis (raised ICP)
How are bacterial and viral meningitis distinguished?
- Bacterial will have a raised opening pressure
- Bacterial: turbid CSF with low glucose (bacteria metabolising the glucose) and very high protein- more neutrophils in the CSF (polymorphs)
- Viral: clear CSF with normal glucose and raised protein
