Colloquium: Severe Headache Flashcards
Which headaches are typically unilateral?
Migraine
Cluster
Red flags for headache?
Fever
Nausea, vomitting
Morning headache
Sudden onset
What predisposes someone to cerebral aneurysms?
Polycystic kidney
FHx
Connective tissue disorders
Smoking, HTN
What is a sentinal headache?
A small haemorrhage causing a milder headache
Precursor to a more severe subarachnoid
What are some causes of sudden death?
Sudden cardiac death
Aneurysms
Not to miss headaches?
Subarachnoid haemorrhage
Meningitis/encephalitis
Subdural haematoma
Space occupying lesion
Giant cell arteritis
Glaucoma
What causes focal neurological signs in subarachnoids?
Intracerebral component of bleeding
Local pressure of the aneurysms
Cerebral vasospasm
What do you do if CT is clear when SAH is suspected? What would you find?
LP
RBC
Blood breakdown products
- Xanthochromia (yellow CSF)
What pain management is safe for a patient with SAH?
Small IV doses of morphine
- Don’t want to sedate as it will prevent the use of GCS to monitor patient
Why is it ok to LP someone with SAH hydrocephalus?
Because the pressures in the cranium and cord are the same
How does CSF get absorbed into venous system?
Via arachnoid granulations
Why does hydrocephalus occur in SAH?
Blood blocking the arachnoid granulations
Symptoms of raised ICP?
Nausea and vomiting
Headache - non-localised, morning headache
Blurred vision
Changes in conscious state
Blown pupil
Cushing reflect
Why do you get morning headaches with raised ICP?
Venous system is at the same level as the heart
Hypercapnia causes arterial vasodilation
How to reduce raised ICP?
Elevate head
Diuresis to reduce cerebral oedema (manittol)/extracellular fluid
Hyperventilation/avoid hypoventilation - can’t do that too much
Sedate/paralyse
Remove Mass
Drain hydrocephalus
