HEADACHE

Question 1

red flag conditions headache

Answer 1

bleed in brain , epidural,subdural
raised intracranial pressure, stroke!!

Question 2

defintion of concusion

Answer 2

mild traumatic brain injury that results in temporary loss of brain function

Question 3

symptoms of concsuion

Answer 3

headache
difficulty concentrating
photophobia
feeling foggy
loss of consciousness after the event but in many cases people do not lose consciousness!
can affect memory - usually before or after the incident
visual disturbances- seeing stars
balance

Question 4

whats important to know about the development of a concussion

Answer 4

it doesn’t necessarily have to occur straight after the event it can happen hours, days after (bruise on a brain takes time to form)

Question 5

someone comes in with a concussion what do you examine

Answer 5

NEURO
musle power
sensation
eyes
gait

Question 6

Migraine features

Answer 6

Unilateral but can be bilateral
4~72 h
Nasusea vom
Photophobia /sound phobia

Question 7

Cluster

Answer 7

Unilateral
Red eye
Watery eye
Runny nose or blocked nose
Ptosis

Question 8

Causes of a subarachnoid haemorrhage

Answer 8

Can be traumatic or spontaneous
Like aneurysm

Can be non aneurysm( caused by a small vein expeeience similar symptoms

Question 9

How to diagnose a sub arachnoid acid haemorrhage

Answer 9

If they present within six hours CT head, if later than six hours lumber puncture should be done

Question 10

Management of a subnet haemorrhage

Answer 10

Pain relief
Nimodipine
Refer to neurosurgery e.g if aneurysm

Question 11

Symptoms and signs of subarachnoid

Answer 11

Thunderclap
Followed by signs of meningism (stiffness and photophobia )
Stroke symptoms
Vision problems
Nassau and vomitting

Signs
Kerning
Stiff neck
Seizures
Cranial nerve palsies (oculomotkr)

Question 12

Why are subarachnoid haemorrhages dangerous?

Answer 12

Because they can cause a stroke !!!

Question 13

Risk factor for spontaneous SAh

Answer 13

Hypertension
Smoking
Having an aneurysm

Question 14

What can be a trigger for an aneurysm to burst

Answer 14

Straining
Lifting heavy
Sex heavy exercise
Having Marfans ehlers Danlos
Cocaine
Blood thinners
AVM
Excessive alcohol

Question 15

Why does alcohol increase the risk of bleeding?

Answer 15

Because it thins the blood, making it hard to clot
So alcoholics are more likely to bleed from minimal trauma
Alcohol, also increases the risk of T.I. bleeding and in females can make their periods heavier

It reduces the number of platelets in the blood, and also makes them less sticky

Question 16

Can a migraine cause focal, neurological deficits

Answer 16

In some cases, yes

Such as visual problems like in aura
Some migraines known as hemiplegic (rare type of miraine)can cause unilateral weakness

Some migraines such as brain stem migraines can cause vertigo and ataxia

Question 17

Primary sexual headache

Answer 17

Can cause a thunderclap headache that occurs during sex but usually other symptoms are not there

Question 18

Dx SAh

Answer 18

Meningitis
Other bleeds like epidural Sunderland
Migraines
Sexual headache

Question 19

Why should you perform a CT head quite quickly if you suspect a subacid haemorrhage

Answer 19

Because if sufficient time has passed, you won’t be able to see the blood in the subarachnoid space because it would’ve resolved , hence why you would do a lumber puncture

Question 20

If you suspect a sub rapid haemorrhage, what kind of imaging would you order?

Answer 20

Non-contrast city head, so you can actually see the blood

But ct angio to actually localise which vessel Is affected

Question 21

What is xanthocromia

Answer 21

Where you see blood in the cerebral spinal fluid because the red blood cells have broken down and produce bilirubin

Question 22

Cerebral salt wasting syndrome

Answer 22

Is associated with an insult to the CNS most commonly associated with SAH

It’s debated whether it’s actually a form of SIADH or a it’s own category

You get hyponatdemia
A lot of sodium in pee

Question 23

Complications of SAH

Answer 23

Cerebral salt wasting
sIADH
Stroke
Rebleeding (most likely in 24 h )
Spasm of the vessels due to blood irritating
Seizures
Hydrocephalus (the blood prevents the drainage of csf

Question 24

What’s the difference between between ct head and ct angiography in relation to bleeding

Answer 24

Ct head just tells you if there’s a bleed or not

But angiography is more detailed as it tells you what is bleeding so only once you’ve confirmed the bleed by ct head do you do angio