Head / Neurological Flashcards
Red flags of headaches that raise suspicion of worrisome secondary causes
- New onset or change in HA
- Onset after 50 years
- Acute onset “worst HA of my life.”
- Elevated BP
- Rash or other signs of infection
- Cancer, HIV, Pregnancy
- Vomiting
- Head trauma
- Neurologic deficits/persistent visual disturbance
- Fever, chills, unintentional weight loss (systemic illness).
- Papilloedema
- Positional, brought on my physical exertion
Meningeal signs
- Kernig’s sign
- Brudzinski’s sign
- Nuchal rigidity
Clinical suspicion of raised ICP
- GCS
- Focal neurological signs
- Papilloedma
- New seizures
If you suspect raised ICP, perform which test first?
CT first. (Raised ICP is a contraindication to LP).
Suspicion of acute intracranial pathology means immediate CT scan. If any of 5 symptoms are present…
- Decreased GCS
- focal neurological deficits
- New-onset seizures
- History of a recent head injury
- Anticoagulation or coagulopathy
Frontal HA + Nasal symptoms. Sinusitits if frontal HA and 2 of…
- Nasal blockage/congestion
- Rhinorrhea/discharge
- Loss of smell
- Facial pressure or tenderness
Diagnosis of a primary HA relies on patterns of presentation. Diagnostic criteria for migraine:
- HA duration 4-72 hours
- > =2 unilateral location/pulsating quality/moderate to severe intensity/disabling
- > =1 nausea, vomiting, photophobia, phonophobia
Diagnosis of a primary HA relies on patterns of presentation. Diagnostic criteria for tension-type HA
- Duration 30 mins - 7 days
- > =2: Bilateratl location, tight pressing, mild to moderate not aggravated by or cause avoidance of physical activity
- None of: photophobia, phonophobia, nausea, vomiting
Focal neurological deficits
Impairments of nerve, spinal cord, or brain function that affects a specific region of the body
Likely a migraine with aura
Unilateral headache that
is preceded by flashing lights or zigzag lines and is associated with light hurting the eyes (photophobia)
A generalized headache that is worse in the
morn ing and is associated with drowsiness or
vomiting may reflect
Raised intracranial pressure
Tension HA
this is
commonly bilateral, occurs over the frontal, occipital
or temporal areas and may be described as a sensation
of tightness that lasts for hours and recurs often.
There are usually no associated symptoms such as
nausea, vomiting, weakness or paraesthesias (tingling
in the limbs), and the headache does not usually
wake the patient at night from sleep.
True or False: Most aneuryms are asymptomatic until they rupture.
True
Occasional patients with aneurysm have which symptoms prior to a massive SAH? (Warning leaks:
HA, nausea, neck stiffness
Physical exam maneuvers for nuchal rigidity
Kernig and Brudzinski signs(Don’t assess for Brudzinski’s sign without ruling out cervical trauma or injury).
