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Common Conditions, Management and Imaging > Common Conditions of the Head and Neck > Flashcards

Common Conditions of the Head and Neck Flashcards

1
Q

What is the aetiology of infection headaches?

A

Presence of infection
Activated immune and supporting cells
Release of inflammatory mediators
Direct effect of microorganisms

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2
Q

What are the clinical features of infection headaches?

A

Temporal region
Relationship to onset of infection
Has either worsened or improved in relation to the infection
Fever, malaise

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3
Q

What is the aetiology of sinus related headaches?

A

Infection
Allergy
Predisposing factors for chronicity

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4
Q

What can sinus headaches be mistaken for?

A

Migraine or TTH

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5
Q

What are the clinical features of sinus headaches?

A

Temporal relationship to onset of sinusitis
HA either worsened or improved in parallel with sinusitis
HA exacerbated by pressure applied over paranasal sinuses

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6
Q

What is the aetiology of tension type headaches?

A

Peripheral and central mechanisms at play
Psychogenic component

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7
Q

What do TTH need at least 2 of?

A

Bilateral
Pressing or tightening quality (non-pulsatile)
Mild to moderate intensity
No aggravation with routine PA

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8
Q

What must TTH not be accompanied by?

A

Nausea or vomiting
No more than one of either photophobia or phonophobia

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9
Q

What structure are usually affected by TTH?

A

Pericranial: frontalis, temporalils, masseter, pterygoids, SCM, splenius, trapezius

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10
Q

What is the pathophysiology of migraine?

A

Often menstrual relationship
Vascular dysregulation
Spreading cortical depression
Neuronal sensitisation

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11
Q

How long to migraines typically last?

A

4-72 hours

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12
Q

What symptoms do migraines bear at least 2 of?

A

Unilateral
Pulsating
Moderate to severe
Aggravation by PA

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13
Q

What symptoms are migraines associated with at least one of?

A

Nausea and/or vomiting
Phonophobia and photophobia

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14
Q

What differentiates migraines with and without aura?

A

Focal neurological symptoms
Prodromal symptoms (begin hours or even 1-2 days before symptoms)
Postdrome symptoms (persist for up to 48 hours)

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15
Q

What is the aetiology of cervicogenic headaches?

A

Convergence of cervical afferents and trigeminal sensory fibres in the trigeminocervical nucleus

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16
Q

What is the pathophysiology of cervicogenic headaches?

A

Occipital region
Can radiate to parietal region, vertex of skull or behind the eye
Accompanied by dysfunction in the upper cervical segments (reduced ROM, tissue tenderness)

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17
Q

What are the clinical features of cervicogenic headaches?

A

Typically unilateral
Relationship between onset of cervical disorder and HA
Reduced ROM
HA made worse by provocative manouevres
HA abolished following diagnostic blockage of cervical structure or nerve supply

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18
Q

What is the aetiology of TMJ related headaches?

A

TMJ muscles of mastication and/or associated structures

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19
Q

What are the pain generators of TMJ headaches?

A

Articular disc and joint capsule
Articular surfaces e.g. OA
Myofascial structures

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20
Q

What clinical features must TMJ headaches have at least two of?

A

Relationship to onset of TMJ disorder
Aggravated by jaw motion, jaw function (e.g. jaw motion, etc.), and/or jaw parafunction (bruxism)
HA provoked on physical exam by temporalis muscle palpation and/or passive movement of the jaw

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21
Q

What is a CAD?

A

Tear in the carotid or vertebral arteries

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22
Q

What is the cause of pain in CAD?

A

Tunica adventitia is innervated with nociceptors

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23
Q

What is the aetiology of CAD?

A

Most are spontaneous 61%
Some are due to trauma 30%
Few associated with spine manipulation

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24
Q

What are the risk factors for CAD?

A

History of cervical spine trauma
Recency of trauma: immediate > 5 days post trauma
HTN or other risk factors for CVD
Past history or family history of migraine
Relationship with cervical manipulation

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25
Q

What clinical features must CAD have 2 of?

A

Sudden onset unilateral headache
Affecting frontal, temporal, occipital or supraorbital regions
Unilateral neck and facial pain
Constant and severe pain (ache, throbbing, sharp)
Unlike anything they have experienced previously

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26
Q

What are associated symptoms with CAD?

A

Horner’s syndrome: cranial neuropathy e.g. hypoglossal
Upper and lower limb neurological symptoms - weakness, ataxia
Pulsating tinnitus

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27
Q

What are the viral agent aetiologies of meningitis?

A

Viral: echovirus, adenoviruses, coxsackiviruses, herpes, measles, mumps, HIV

28
Q

What are the bacterial agent aetiologies of meningitis?

A

Meningococcal and pneumococcal species
Babies: L streptococcal, E. coli, listeria

29
Q

Which cranial nerves supply the meninges?

A

CNV - trigeminal
CNX - vagus

30
Q

What must meningitis headaches have at least two of?

A

HA related to onset of meningitis or encephalitis
HA either worsened or improved in parallel to the meningitis or encephalitis

31
Q

What is meningitis head pain like?

A

Either or both of:
Holocranial
Located in nuchal area and associated with neck stiffness

32
Q

What symptoms are related to meningitis?

A

Fever, neck stiffness, light sensitivity and nausea/vomiting

33
Q

What is the average age for cluster HA?

A

20-40 years

34
Q

What are cluster HA classified as?

A

Trigeminal autonomic cephalgia
Activation of hypothalamic grey matter seen in acute attacks

35
Q

Are cluster HA unilateral or bilateral?

A

Strictly unilateral

36
Q

What factors may provoke cluster HA?

A

May be provoked by alcohol, histamine or nitroglycerine

37
Q

How long do cluster HA last and up to how many times a day?

A

15-180 minutes up to 8x per day

38
Q

What are the clinical features of cluster HA?

A
  1. Lacrimation or rhinorrhea
    Eyelid oedemaa, forehead or facial swelling
    Miosis and/or ptosis
  2. Restlessness or agitation
39
Q

What is the aetiology of cervical facet pain?

A

Traumatic or degenerative processes are usually involved

40
Q

What are the traumatic processes of cervical facet pain?

A

Can be due to obvious trauma
Fracture &/or dislocation injuries e.g. blood to head
Whiplash

41
Q

What are the trivial factors of cervical facet pain?

A

Repetitive, unaccustomed postures (gardening, painting)
Sleeping on twisted neck for prolonged period of time

42
Q

What is the mechanism of cervical facet pain?

A

Excessive compression of facets
Excessive capsular ligament strain beyond the physiologic limit

43
Q

What is the degenerative process of cervical facet pain?

A

Spinal osteoarthritis (spondylosis) is thought to affect intervertebral discs first
Loss of disc height increased blood on facet joints
These changes eventually lead to degenerative changes in the facets

44
Q

What are the clinical features of cervical facet pain?

A

Localised unilateral tenderness on palpation of affected joint
Reflex muscle spasm of paravertebral mm and myofascial tenderness
Neck stiffness – ROM limitation due to pain +/- sensation of locking with certain movements
Cervicogenic headache

45
Q

How can discs cause pain?

A

IVDs can be a source of nociception even in the absence of involvement of nerve roots

46
Q

What is the aetiology of cervical discogenic pain?

A

Acute disc injuries – younger populations
Trauma e.g. whiplash, football, rugby, gymnastics
Insidious onset of symptoms possible

47
Q

What is the most common cause of cervical disc injuries in older population?

A

Degenerative processes at play
Herniation less likely with advanced age

48
Q

What are the classifications of cervical discogenic pain?

A

Normal
Disc bulge
Herniation (protrusion
Sequestration

49
Q

What are the clinical features of an annular fissure cervical disc injury?

A

Constant, deep-seated, dull or aching Cx pain
Note: radiculopathy due to chemical irritation has been described
Mediated by inflammatory cytokines and pain-inducing chemicals

50
Q

What are the clinical features of herniation cervical disc pain?

A

Radiculopathy
Myelopathy

51
Q

What structures can be injured with non-specific neck pain?

A

Muscles
Fascia
Ligaments
Joint capsules
IVDs
Bone

52
Q

What are clinical features of cervical radiculopathy?

A

Myotomal weakness
Dermatomal sensory loss
Reflex changes
Muscle wasting

53
Q

What is cervical myelopathy?

A

A serious and disabling condition arising from cervical cord compression

54
Q

What is the aetiology of cervical myelopathy?

A

Cervical spondylosis

55
Q

What is the pathophysiology of cervical myelopathy?

A

Osteophyte encroachment in the central (+/- lateral) canal
Disc calcification and loss of disc height
Ligamentous buckling (LF) or ossification (PLL)

56
Q

What are the clinical features of cervical myelopathy?

A

Hypersensitivity and clumsiness in the hands and feet
“Tightness” in the legs
Signs are initially subtle, but UMN signs predominate below the level of the lesion

57
Q

What are the UMN signs that predominate below the level of the lesion in cervical myelopathy?

A

Hyperreflexia, clonus, Babinski
Weakness, ataxia

58
Q

What may the clinical picture of cervical myelopathy be complicated by?

A

Radiculopathy, if there is lateral canal stenosis at the level of the lesion
Dorsal Column involvement
Low back pain, leg pain

59
Q

What are the grades of whiplash associated disorder?

A

Grade 0: No neck complaint, no physical signs
Grade I: Neck complaint involving pain, stiffness or tenderness only, no physical signs
Grade II: Neck complaint AND musculoskeletal signs
Grade III: Neck complaint AND neurological signs
Grade IV: Neck complaint AND fracture or dislocation

60
Q

What are the clinical features of whiplash associated disorder?

A

Tinnitus, deafness
Visual problems, dizziness
TMJ pain, dysphagia
Depression, anxiety, sleep disturbance, memory loss

61
Q

What is thoracic outlet syndrome?

A

It is an umbrella term that encompasses a group of disorders

62
Q

What are the most common sites that the thoracic outlet structures might get entrapped in?

A

Rib 1 and clavicle
Pectoralis minor
Anterior scalenes

63
Q

Where can pain from thoracic outlet present?

A

Usually upper limb, and may be reported in the head, neck, face and chest wall

Remember, most patients present with a mixed clinical picture

64
Q

What is the most common form of thoracic outlet?

A

Neurogenic

65
Q

What are the clinical features of neurogenic thoracic outlet?

A

Pain: upper vs. lower roots?
Paraesthesia
Early fatiguability, dyscoordination
Atrophy, weakness, intermittent cramping, paresis

66
Q

What are the clinical features of arterial thoracic outlet?

A

Ischaemic pain, exertional fatigue
Paraesthesia, coldness
Pallor, skin changes
Atrophy, weakness, cramping

67
Q

What are the clinical features of venous thoracic outlet?

A

Pain, heaviness, fatigue
Upper limb oedema (non-pitting)
Cyanosis, ecchymosis
Engorgement of superficial veins

Common Conditions, Management and Imaging (7 decks)

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