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Head Flashcards

0
Q

Examining Fontanelles: Elevation = ______ , Depression = _____

A

Elevation = intracranial pressure, depression = dehydration

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1
Q

LMNOPQRST

A

Location, Mechanism, New, Other Symptoms, Provocation/Palliative, Quality, Radiation, Severity, Timing

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2
Q

Severity of a closed head injury is based on:

A

1) LOC or not

2) Presence/absence of neurologic signs

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3
Q

What is the grading scale for mild traumatic brain injuries (simple concussions)?

A

Grade 1: sxs < 15 min, no LOC
Grade 2: sxs > 15 min, no LOC
Grade 3: LOC for seconds to minutes

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4
Q

What is the difference between a mild traumatic brain injury and a moderate diffuse traumatic brain injury?

A

A mild TBI is characterized by none-to-brief LOC, whereas a moderate diffuse TBI is characterized by LOC for up to 1 hour.

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5
Q

What are the RED FLAG symptoms post-concussion?

A

LOC, altered mental status, convulsions, persistent headache, extremity weakness, bleeding from ear(s), loss of hearing

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6
Q

What is the age-related prognosis for a moderate diffuse TBI?

A

Complete recovery < 40, possibility for permanent effects > 40; worse for drug/alcohol abusers

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7
Q

How is a severe diffuse TBI characterized?

A

By patient response; severe brain edema, ischemic infarction, hemorrhages, deep unconsciousness, respiratory obstruction, brain stem damage (bilateral pupillary fixation, slow responses to light, and anisocoria)

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8
Q

What is Post-concussion syndrome and what are some of the symptoms?

A

Continuing symptoms including headache, fatigue, anxiety, dizziness, memory problems, attention problems, sleep disturbance, irritability

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9
Q

What are some causes of secondary brain injuries that can exacerbate primary brain injuries?

A

Hypotension, hypoxia, infection, hematomas

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10
Q

What are the most common types of headaches seen in clinic (most to least common)?

A

Migraine, Tension-type, Post-traumatic, Tumors, Miscellaneous

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11
Q

What is a primary headache?

A

A benign headache not caused by an underlying medical condition (90% of all headaches)

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12
Q

What are the types of primary headaches?

A

Migraine, tension-type, cluster, medication overuse, hemicrania continua, benign exertional headache, headache associated with sexual activity

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13
Q

What is a secondary headache?

A

A headache with an organic cause, due to a disease or a medical condition (<10% of all headaches)

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14
Q

What are some features or concomitant symptoms suggestive of a secondary headache?

A

progressively worsening HA, “worst HA ever,” progressive vision loss, CSF rhinorrhea, focal neurological sign, fever, high blood pressure, metabolic imbalance, chronic malaise, memory loss, change in typical HA, onset w/ exertion, coughing, sex, valsalva

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15
Q

How is the quality of pain typically described for a vascular headache?

A

throbbing, pounding, sharp

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16
Q

How is the quality of pain typically described for a non-vascular headache?

A

steady, constant, dull

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17
Q

Questions to ask in addition to LMNOPQRST questions?

A

change in vision?, environmental factors?, stressors?, triggers/aggravations?, relationship to food/alcohol?, prodromal symptoms?, family history?, age of first HA?, first/worst HA?, medications?

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18
Q

What are the RED FLAGS for patient history?

A

Onset after age 50, increased frequency/severity, sudden onset, pain radiates to lower neck/thoracic spine, history of head trauma, history of HIV/cancer, change in mental status/personality/level of consciousness

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20
Q

What are the RED FLAGS on the physical exam?

A

Fever, neck stiffness/rigidity, papilledema, focal neurologic signs, signs of systemic illness/infection

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21
Q

Unilateral or Bilateral - Migraine? Tension-type? Cluster?

A

Migraine - 70% unilateral, Tension-type - bilateral, Cluster - always unilateral (eye/temple)

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22
Q

What are the types of auras associated with migraines?

A

a) visual - flashes of light, b) sensory - numbness/weakness on side of headache, c) dysphasic - speech disturbance (aphasia)

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23
Q

Quality - Migraine? Tension-type? Cluster?

A

Migraine - pounding, throbbing, Tension-type - steady, dull, Cluster - boring, lancinating

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24
Q

Associated Symptoms - Migraine? Tension-type? Cluster?

A

Migraine - aura, nausea/vomiting, photo/phonophobia, scotoma, Tension-type, Cluster - autonomic symptoms (lacrimation, rhinorrhea, sweating, ptosis, miosis, eyelid edema)

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25
More common in men or women - Migraine? Tension-type? Cluster?
Migraine - women (in childhood, equal), tension-type - women, cluster - men
26
What are some co-existing/commonly associated medical conditions for migraines?
epilepsy, asthma, sleep disorders, tourette's, raynaud's, chronic fatigue syndrome, depression/anxiety, atrial septal defect, hypertension, ischemic stroke
27
The diagnostic criteria for a migraine without aura includes 2 of the following 4 symptoms:
unilateral, pulsating quality, mod-severe pain, worse with routine activity
28
The diagnostic criteria for a migraine without aura includes one of the following 2 symptoms DURING the headache:
nausea/vomiting, photophobia/phonophobia
29
What are examples of prodromal symptoms for migraines without auras?
food craving, fatigue, heightened perception, fluid retention
30
Onset - Migraine? Tension-type? Cluster?
Migraine - gradual, crescendo pattern, Tension-type - pressure that waxes/wanes, Cluster - quick onset, quick crescendo
31
Pt appearance - Migraine? Tension-type? Cluster?
Migraine - Pt prefers dark, quiet room, Tension-type - Pt may be active/at rest, Cluster - Pt remains active
32
Duration - Migraine? Tension-type? Cluster?
Migraine - 4-72 hours, Tension-type - 30 min to 7 days, Cluster - 30 min to 3 hrs
33
Age of onset - Migraine w/ and w/o aura?
Migraine w/ aura - childhood to young adult, Migraine w/o aura - early to 40-50s
34
What are examples of prodromal symptoms for migraines with auras?
hyperactivity, lethargy, depression, cravings, frequent yawning
35
Migraine w/ Aura subtype: Hemiplegic migraine
temp paralysis or sensory changes on one side of body, onset - sensory, dizziness, vision, often familial
36
Migraine w/ Aura subtype: Retinal migraine
temp monocular scotoma/blindness followed by headache, blindness a rare complication
37
Migrane w/ Aura subtype: Aura w/o headache
Confused for transient ischemic attacks in the elderly
38
Migraine w/ Aura subtype: Status migrainosus
HA lasting 72 hrs or longer, hospitalization often required
39
Migraine w/ Aura subtype: Ophthalmoplegic migraine
affects CN III, IV, VI, pain around eye, ptosis, diplopia, EMERGENCY
40
What is the most common precipitating factor for migraines?
emotional/physical stress
41
In addition to stress, what are other precipitating factors for migraines?
hormones, skipped meals (hypoglycemia), sleep disturbances, changing weather/altitude/temperature, neck pain, odors, exercise, food intolerance (tyramine-containing foods)
42
What are some common tyramine-containing foods (migraine trigger)?
aged cheese, onions, olives, pickles, avocados, raisins, canned meats, soups, nuts
43
What is the self-administered screening test that is 90% effective in detecting migraines?
1) Has headache limited your activities for a day or more in last 3 mos? 2) Are you nauseated when you have a headache? 3) Does light bother you when you have a headache?
44
Common diagnostic errors - thunderclap headaches and migraines
thunderclap HAs can be diagnosed as migraine because triptan relieves pain
45
Common diagnostic errors - migraines and sinuses
migraines can be diagnosed as sinus HA or eyestrain due to autonomic and visual symptoms
46
What are the 3 types of tension-type headaches?
Infrequent episodic (< 1 day/mo), Frequent episodic (1-14 days/mo), Chronic (15 or > days/mo)
47
The diagnostic criteria for TTH requires 2 of the following 4 features:
bilateral pain, steady/non-throbbing quality, mild-mod pain, no aggravation by normal physical activity
48
Age of onset: TTH
Most pts are young adults, but all ages susceptible
49
If pt reports that TTH headache never goes away, R/O ___.
depression
50
Age of onset: Cluster
Mean age - 30 yo for men, later for women
51
Triggers: Cluster
seasons
52
An important risk factor for cluster headaches is ____
smoking
53
Cluster headaches most likely result from stimulation or activation of the ______
hypothalamus (cluster HAs tend to occur the same time each day, 47% have circadian regularity)
54
What autonomic symptoms of cluster headaches are specifically associated with sympathetic and parasympathetic systems?
sympathetic (Horner's syndrome, forehead sweating), parasympathetic (lacrimation, rhinorrhea, nasal congestion)
55
What is the diagnostic criteria for an episodic cluster headache?
cluster periods lasting 7 days - 1 year with pain-free periods lasting greater/equal to 1 month
56
What is the diagnostic criteria for a chronic cluster headache?
cluster periods lasting for more than 1 year w/o remission or w/ remission < 1 month
57
What type of headaches are "alarm clock headaches" associated with?
cluster headaches because they can wake a patient from a sound sleep
58
What is the distribution of cluster headaches?
1st and 2nd divisions of the trigeminal nerve
59
What type of primary headache warrants initial imaging to rule out brain or pituitary pathology?
cluster headache
60
DDx for cluster headaches?
paroxysmal hemicrania, trigeminal neuralgia, headache with intracranial lesion, SUNCT syndrome
61
Quality of Pain: Trigeminal neuralgia
lightning-like pain (sudden, intense, sharp, superficial, stabbing, burning), usually from 2nd-3rd branches of trigeminal nerve
62
What is the major (80-90%) pathogenesis for tic douloureux?
compression of trigeminal nerve root
63
More common in men or women: Trigeminal neuralgia
women
64
Age of onset: trigeminal neuralgia
> 40 yo in 90% of cases
65
Location: trigeminal neuralgia
86% unilateral, right side more often than left, V2/V3
66
Triggers: trigeminal neuralgia
chewing, yawning, shaving, washing, wind blowing on face, trigger pts on lip/angle of mouth
67
When there are bilateral symptoms with trigeminal neuralgia, R/O ____.
MS
68
What are three conditions that could be described as unilateral primary headaches with autonomic symptoms?
cluster headache, SUNCT syndrome, hemicrania continua
69
For what condition is indomethacin an effective treatment?
hemicrania continua
70
How are cluster headaches distinguished from hemicrania continua?
hemicrania continua have a higher frequency, but shorter duration
71
What does hemicrania continua have in common with SUNCT syndrome?
unilateral, concomitant ipsilateral autonomic symptoms
72
How is hemicrania continua distinguished from SUNCT syndrome?
SUNCT syndrome will have periods of remission while hemicrania continua is continuous
73
What is the diagnostic criteria for medication overuse headaches?
HA > 15 days / mo, regular use of analgesics, HA developing/worsening during medication overuse
74
What symptoms often coexist in patients with medication overuse headaches?
depression and sleep disturbances
75
Tightness of skin on the head and GI problems could be indicative of what substance causing dietary-related headaches?
MSG
76
What is the classic symptom triad for meningitis?
nuchal rigidity, change in mental status, fever
77
Quality of Pain: meningitis
throbbing, explosive
78
What are two physical exams to evaluate signs of meningitis?
Kernig's sign and Brudzinski's sign
79
How is Kernig's sign performed?
Pt hip/knee flexed to 90 degrees; Doc extends knee; +sign guarding in hamstrings
80
How is Brudzinski's sign performed?
Hold pt thorax steady and flex head; +sign involuntary flexion of hip/knee w/ neck pain
81
What are some associated sxs for meningitis?
seizure, collapse, LOC, vomiting, petechial rash, bruits
82
With which condition might you have pain in the upper teeth?
sinus headache
83
When dental pain is causing headaches, what should you check for?
abscesses in the gingiva
84
What are the concomitant symptoms with hypertension headaches?
tinnitus, nose bleed, bruits
85
With which condition is pain worse when sitting upright and better when lying down?
intracranial hypotension
86
Papilledema, vomiting, and slowly progressive signs of cerebral dysfunction are all signs of?
intracranial hypertension
87
Compression of the sella turcica could be due to ____.
pituitary tumors
88
How is giant cell (temporal) arteritis characterized?
chronic vasculitis of large/medium-sized vessels in the elderly; possible thrombosis at sites of active inflammation
89
Age of onset: temporal arteritis
mean age = 72
90
Location of pain: temporal arteritis
unilateral/bilateral, temporal/occipital/frontal-occipital
91
What are associated symptoms of temporal arteritis?
fever, anorexia, weight loss, visual problems, jaw/arm claudication, polymyalgia rheumatica, chronic cough, blindness (complication)
92
With temporal arteritis, what will be found in the physical exam?
palpable nodules over the artery, absent pulse
93
Lab findings: temporal arteritis
increased ESR, elevated CRP, elevated liver enzymes, serum albumin
94
What test is diagnostic for temporal arteritis?
arterial biopsy
95
An abrupt alteration in intracranial pressure is indicative of _______
subarachnoid hemorrhage
96
What condition needs to be R/O when a patient describes their headache as the "worst ever (and worsening)"?
subarachnoid hemorrhage
97
What condition could be characterized by a gradual onset, steady aching, gradual personality changes, altered consciousness, and hemiparesis?
subdural hematoma
98
Sex: TMJ
More likely in younger women, men more asymptomatic
99
What tests can be done to check for TMJ?
3 vertical fingers in the mouth to check range of motion, slowly open/close jaw to check for midline deviation, palpate over TMJ for clicks/pops
100
What is strabismus?
crossed eyes
101
If there's a fever, consider ____
infection
102
If there's a sudden onset of headaches, consider ____
vascular problems
103
If there's vomiting, consider ____
migraines and increase intracranial pressure
104
If there's rhinorrhea that is purulent, consider ___
sinusitis
105
If there's rhinorrhea, consider ___
CSF leak, cluster headache
106
If there's lacrimation and facial flushing, consider ___
cluster headaches
107
If there's a preceding aura, consider ____
migraine
108
If there's syncope at headache onset, consider ____
subarachnoid hemorrhage
109
If there are seizures, consider ___
encephalitis, tumor, or other mass lesions
110
If there's myalgia and/or vision changes (in pts > 55), consider ___
temporal arteritis
111
What are the symptoms of TMJ?
popping/clicking, usu unilateral pain in TMJ/jaw, pain radiates to ear, tenderness in masseter/temporalis, limited ROM, bruxism
112
What ocular symptoms are associated with temporal arteritis?
ptosis, transient blurring, diplopia, blindness

CPD (8 decks)

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