Clinical- 6 Flashcards
Which nerve innervate the anterior/middle fossa?
V
Which nereves supple the posterior fossa?
IX and X
What are the common causes of acute headaches?
SOMATIC DYSFUNCTION UP IN THIS BITCH Subarachnoid Hemorrhage Other Cerebrovascular diseases Meningitis/encephalitis Ocular Diseases (glaucoma)
What are the common causes of Subacute headaches?
Giant Cell (temporal) arteritis Intracranial Mass (tumor, subdural hematoma, abcess) Pseudotumor cerebri (benign intracranial hypertension) Trigeminal neuralgia Glossopharyngeal neuralgia Postherpetic neuralgia Hypertension Atypical Facial Pain
What are the common causes of chronic headaches?
Migraine Cluster Headache Tension headache Cervical Spine Disease Sinusitis Dental Disease
Subarachnoid hemorrhage (SAH)- causes
ruptured berry aneurysm from sites of branching arteries. can be from AV malformations too. polycystic kidney disease is assocaited with berry aneurysms
SAH- Sx
Worst headache ever. new headache. ↑ BP, global Sx (except AVMs and PCA aneurysms).
SAH- Dx
CT for confirmation, CSF has blood, u can do a cerebral arteriography
SAH- Tx
↓ BP. Nimodipine blocks Ca channels to reduce vasospasm. Surgery for mild cases
SAH- complications
recurrence, intraparenchymal extension, ischemia from arterial vasospasm, hydrocephalus, szrs
SAH- prognosis
60% die within the 1st day, but survivors can be either in a coma or Sx free. 1/2 have brain dmg.
Giant cell arteritis (GCA)- cause
granulomatous inflammation of the external carotids (sup temporal a.), women > 55
GCA- Sx
pain in jaw during chewing, blindness in 50% of pts
GCA- Dx
Bilateral biopsy for patchy inflammation, ESR is ↑↑↑
GCA- Tx
initially it’s prednisone (antinflamm)
GCA- consequences
blindness is irreversible
Intracranial mass- Sx
headaches with different Sx depending on where the mass is and what the mass it.
Key: bifrontal pain, worse ipsilaterally, worse when u change position, worse when you INCREASE ICP (pooping, sneezing, coughing)
Intracranial mass- Dx
CT/MRI right away
Intracranial mass- Tx
removal of the offending lesion via surgery, radiotherapy, chemotherapy.
Idiopathic intracranial HTN (IIH)- cause
unknown, so u gotta rule out other disorders that cause intracranial HTN
IIH- Sx
headache, papilledema, visual loss, floaters, blurring, diplopia, pulsatile tinnitus
IIH- Dx
rule everything out by CT/MRI/LP. optic nerve sheath dilation is key.
IIH- Tx
acetazolamide or furosemide
Trigeminal neuralgia- cause
vascular compression of V
Trigeminal neuralgia- Sx
pain in V2/V3 region of the face, super hyperalgesia
Trigeminal neuralgia- Dx
nothing really. the vascular structures are too small to see
Trigeminal neuralgia- Tx
use of carbamazepine, or phenytoin (IV for acute attacks, oral for regular use); Lamotrigine or baclofen for refractory cases
Postherpetic neuralgia- cause
Herpes Zoster reactivation of VZV, specifically in a dermatome fashion, occurs mostly in older >70 patients
Postherpetic neuralgia- Sx
severe buring pain in a dermatome, usually V1, scarring
Postherpetic neuralgia- Dx
Hx of VZV infection, decreased sensations
Postherpetic neuralgia- Tx
ACV, corticosteroids, tricyclics for the pain
Migrane- cause
intracranial vasoconstriction and extracranial vasodilation, pulsatile headaches that have premonitory symptoms (mood, appetite), affects mostly women, and has familial history
Migranes- Tx
simple analgesics (ASA, otc stuff), ergot preparations (ergotamine, caffeine), narcotics, 5HT agonists
Migraines- prophylactics
NSAIDS, tricyclics
Migraines- precipitating factors
foods, tyramine containing foods, hotdogs, cheeses, nitrites, food additives like MSG, and a variety of other
Migraines with aura- pathogenesis
migrane preceeded by aura, called a classic migraine
Migraines with aura- Sx
throbbing, unilateral headache with signs of N/V, etc. gradual onset
Migraines with aura- Dx
Increased white matter lesions
Migraines w/o aura- Dx
compression of ipsilateral carotid or superficial temporal artery
Transformed Migraine- pathogenesis
episodic migraine that changes into a daily occurance over a period of months/years
Transformed Migraine- Sx
varies between migrane-like or tension headache
Cluster headache- epidemiology
more men than women, at around 25, no familial history, and are always unilateral, and seems to originate from the hypothalamic grey area
Cluster headache- Sx
burning sensation over lateral aspect of nose or pressure behind the eye, conjunctival injection, ptosis, lacrimation, nasal stuffiness, and horner syndrome also present
Cluster headache- acute Tx
sumatriptan, Zolmitriptan nasal spray, dihydroergotamine
Cluster headache- prophylaxis
verapamil sustained release, ergotamine, prednisone, lithium
Cluster headache- preceipitation
alcohol
Tension Headache- cause
unknown
Tension headache- Sx
tight band of pain around head, contraction of neck/scalp muscles,
Tension headache- Tx
same as migraine - Acute Attack - aspirin, NSAIDs, acetominophen, ergotamine, dihydroergotamine; prophylaxis - amitriptyline or imipramine (DO NOT use SSRI’s)
Tension headache- precipitation
stress/hunger
