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BRS 1b > Headache > Flashcards

Headache Flashcards

1
Q

What are the two main patterns of headache?

A

Acute single headache and Dull headache

Triggered and recurrent headaches

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2
Q

What the typical causes of an acute single headache?

A

Following a head injury
Subarachnoid haemorrhage,
Meningitis,
Tumour, drugs toxins, stroke

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3
Q

Which pattern of headaches are clinically more concerning?

A

Acute single headaches

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4
Q

What type of acute single headache is considered to be a sudden onset?

A

A thunderclap

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5
Q

What is a dull headache?

A

Unchanged over months

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6
Q

what are the main causes of a dull headache?

A 
Usually benign
Overuse of medication (e.g. codeine)
Contraceptive pill, hormone replacement therapy
Neck disease
Temporal arteritis
Benign intracranial hypertension
Cerebral tumour
Cerebral venous sinus thrombosis
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7
Q

What is a triggered headache?

A

A headache commonly trig-erred by coughing, straining, exertion, coitus (Sexual intercourse). food and drink

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8
Q

What type of headache is a migraine?

A

A recurrent headache

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9
Q

What type of headache is a cluster headache?

A

A recurrent headache

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10
Q

What type of headache is associated with atypical facial pain?

A

Dull headaches

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11
Q

Give four examples of a recurrent headache:

A

Migraine
Cluster headache
Episodic tension headache
Trigeminal or post-herpetic neuralgia

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12
Q

What three headache onsets suggest a red flag?

A

Thunderclap
Acute
Subacute

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13
Q

What are the common symptoms of meningism?

A

1) Photophobia
2) Phonophobia (Fear of sound)
3) Stiff neck
4) Vomiting

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14
Q

What are the red flags for headaches?

A 
Onset
Meningism
Systemic symptoms
Neurological symptoms or focal signs
Orthostatic- better lying down
Strictly unilateral
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15
Q

What are some systemic red flag symptoms of headaches?

A

Fever, rash and weight loss

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16
Q

What are some neurological red flag symptoms of headaches?

A

Visual loss, confusion, seizures, hemiparesis, double vision, 3rd nerve palsy, Horner Syndrome, papilloedema

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17
Q

Which nerve is responsible for a third nerve palsy?

A

Oculomotor nerve

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18
Q

Which cerebral artery can rupture leading to a third nerve palsy?

A

Posterior communicating artery aneurysm –> Haemorrhage

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19
Q

What are the symptoms of a third nerve palsy?

A

Droopy eye-lid (ptosis) Depressive- abduction (Superior oblique and lateral rectus are functional)

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20
Q

What is Horner syndrome?

A

The sympathetic innervation to the eye is affected, subsequently leading to miosis (pupillary constriction), ptosis and absence of sweating.

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21
Q

Which headache describes a characteristic one sided pain?

A

Unilateral headache

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22
Q

What is a possible cause of a thunderclap headache?

A

Subarachnoid haemorrhage

Ruptured berry aneurysm

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23
Q

What are the common symptoms of meningism?

A

Stiff neck and photophobia

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24
Q

What is meningism?

A

Meningeal irritation, post subarachnoid bleed, blood irritates the meninges within the subarachnoid space.

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25
Q

What clinical investigation can be used to identify an aneurysm?

A

Angiogram

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26
Q

Which calcium blocker is used for subarachnoid haemorrhages?

A

Nimodipine

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27
Q

What is the treatment for a subarachnoid haemorrhage?

A

Nimodipine and BP control

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28
Q

What physiological response attempts to prevent a subarachnoid bleed?

A

A vasospasm is the narrowing of the arteries caused by a persistent contraction of the blood vessels, which is known as vasoconstriction. This narrowing can reduce blood flow.

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29
Q

What clinical investigations are conducted to diagnose a patient with a subarachnoid bleed?

A

CT scan

If there are uncertainties with the diagnosis, conduct a lumbar puncture (RBC and xanthochromia)

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30
Q

How can an aneurysm be treated?

A

Inserting a platinum coil

31
Q

Which cerebral structures are considered to be weak points?

A

The falx cerebri and the tentorium cerebelli

32
Q

What phenomenon occurs with a raised intra-cranial pressure?

A

Coning

33
Q

What is coning?

A

A rise in intracranial pressure forces the brain to herniate (tentorial), distoting the struture, and forcing it’s descent through the foramen magnum

34
Q

What can be seen in the optic disc due to a raised intracranial pressure?

A

Papilloedema

Optic disc swelling

35
Q

Which arterial dissection is concerned with an occipital headache?

A

Vertebral artery dissection

36
Q

What is the pain distribution in a carotid artery dissection?

A

Phantom of the opera mask distribution around the eye and forehead.

37
Q

What is the most common form artery dissection?

A

Carotid artery dissection

38
Q

What is a carotid artery dissection?

A

Turbulent flow within the lumen of the carotid artery results in the splitting of the arterial wall, subsequently forming a false lumen, with subsequent blood accumulation within.

Causes: Trauma, tear, Ehlers Danlos syndrome

39
Q

Which drugs increase the chance of an individual suffering from a carotid/vertebral dissection?

A

Aspirin

Anticoagulation

40
Q

Which location is a chronic subdural haemorrhage headache associated with?

A

Frontal headache

41
Q

Which blood vessels are associated with a chronic subdural haemorrhage?

A

Sheer cortical veins leading to a collection of blood.

42
Q

Why do subdural haemorrhages appear black on a radiograph?

A

Hypodense blood (degradation of blood, age can be determined depending on hypodensity).

43
Q

What is the common age for temporal arteritis?

A

Over the age of 55

44
Q

In which demography is temporal arteritis most common?

A

Three times commoner in females

45
Q

What are the presenting symptoms of temporal arteritis?

A

1) Constant unilateral headache
2) Scalp tenderness
3) Jaw claudication
4) 25% polymylagia rheumatica-proximal muscle tenderness.

46
Q

Which arteries are involved in patients with temporal arteritis?

A

Posterior ciliary arteries (causes blindness)

47
Q

Which inflammatory markers are involved in temporal arteritis?

A

C-reactive protein

ESR

48
Q

What does a biopsy reveal in patients with temporal arteritis?

A

Inflammation and giant cells (Plethora of nuclei)

Disruption of the internal elastic lamina

49
Q

What does an ultrasound reveal in temporal arteritis?

A

Halo’s around the temporal arteries

50
Q

How can temporal arteritis be treated?

A

Using NSAIDs (3-4 years)

51
Q

Which sinuses and veins are affected in cerebral venous thrombosis?

A

Thrombosis in dural venous sinus or cerebral veins.

52
Q

What are the symptoms of a cerebral venous thrombosis?

A

Cortical vein blood clots, accumulation of blood elevates intracranial pressure.
Veins can infarct

53
Q

Which patients are at risk of cerebral venous thrombosis?

A

Thrombophillia
Pregnancy
Dehydrated patients
Behcets

54
Q

What are the common bacterial forms of meningitis?

A

Meningococci, Pneumococci, Haemophilus

Tuberculous

55
Q

What are the common forms of a granulomatous meningitis?

A

Sarcoid, Lyme, Brucella, Behçet’s, Syphilis

56
Q

What are the 7 main presenting symptoms of meningitis?

A

1) Malaise
2) Headache
3) Fever
4) Neck stiffness
5) Photophobia
6) Confusion
7) Alteration of consciousness

57
Q

What type of smear is conducted in patients with suspected bacterial meningitis?

A

CSF smear identifies gram-positive cocci bacteria

58
Q

Which cerebral lobes are classically affected in patients with herpes simplex encephalitis?

A

Temporal lobes, haemorrhaging changes are induced

59
Q

How should patients with suspected meningitis be treated?

A

Antibiotics (Pathogen-specific)

Blood and urine culture

60
Q

How are patients diagnosed with meningitis?

A

Blood culture,
Blood glucose,
Lumbar puncture: Increased white cell count, decreased glucose, antigens, cytology, bacterial cultural

Neuroimaging: CT or MRI scan (Cerebral oedema with effacement of ventricles ad sulci, inflamed meninges)

61
Q

What does a CT scan indicate in a patient with bacterial meningitis?

A

Cerebral oedema with effacement of ventricles and sulci
Inflamed meninges
Decompression occurs with the high pressure, thus the brain herniates through the foramen magnum.

62
Q

What is sinusitis?

A

The symptomatic inflammation of the mucosal lining of the nasal cavity.

63
Q

What are the common presenting symptoms in patients with sinusitis?

A

Malaise, headache, fever, blocked nasal passages, loss of vocal resonance
anosmia
nasal or postnasal catarrh
Local pain and tenderness

Frontal pain starts 1-2 hours after rising and clears up during the afternoon

64
Q

What does radioimaging show for patients with sinusitis?

A

Opacification of paranasal sinus

65
Q

What is a glioblastoma multiforme?

A

A tumour derived from astrocytes and oligodendrocytes,

Oedema around the tumour, - swelling is hyperdense on a a CT scan.

66
Q

What is idiopathic intracranial hypertension?

A

Idiopathic intracranial hypertension (IIH) is a disorder related to high pressure in the brain. It causes signs and symptoms of a brain tumor (pseduotumor cerebri)

67
Q

What are the symptoms of an idiopathic intracranial hypertension?

A 
Headache
Visual obscurations
Diplopia (Double vision)
Tinnitus 
Papilloedema
68
Q

Which drugs are commonly associated with idiopathic intracranial hypertension?

A

Hormones, steroids, antibiotics, vitamin E, combined oral contraceptive pills

69
Q

What is the treatment for a psedotumor cerebri?

A

Treatment: weight loss, diuretics, optic nerve sheath decompression, lumboperitoneal shunt, stenting of stenosed venous sinuses.

70
Q

What does an MRI reveal in a low pressure headache regarding the meninges?

A

Meningeal enhancement

71
Q

What causes a low pressure headache?

A

CSF leak due to tear in dura

Traumatic post lumbar puncture or spontaneous

72
Q

What are the common forms of treatments of low pressure headaches?

A

Rehydration
Caffeine
Blood patch

73
Q

What is a chiari malformation?

A

Cerebellar tonsils descending through the foramen magnum. Descend further when patient cough and tug on the meninges causing cough headache.

74
Q

What does an MRI scan show for patients with a chirari malformation?

A

MRI scan with a contrast injection, intense meningeal enhancement characteristic of a low pressure headache;

BRS 1b (62 decks)

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