HEADACHE Flashcards
red flag conditions headache
bleed in brain , epidural,subdural
raised intracranial pressure, stroke!!
defintion of concusion
mild traumatic brain injury that results in temporary loss of brain function
symptoms of concsuion
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
whats important to know about the development of a concussion
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)
someone comes in with a concussion what do you examine
NEURO
musle power
sensation
eyes
gait
Migraine features
Unilateral but can be bilateral
4~72 h
Nasusea vom
Photophobia /sound phobia
Cluster
Unilateral
Red eye
Watery eye
Runny nose or blocked nose
Ptosis
Causes of a subarachnoid haemorrhage
Can be traumatic or spontaneous
Like aneurysm
Can be non aneurysm( caused by a small vein expeeience similar symptoms
How to diagnose a sub arachnoid acid haemorrhage
If they present within six hours CT head, if later than six hours lumber puncture should be done
Management of a subnet haemorrhage
Pain relief
Nimodipine
Refer to neurosurgery e.g if aneurysm
Symptoms and signs of subarachnoid
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)
Why are subarachnoid haemorrhages dangerous?
Because they can cause a stroke !!!
Risk factor for spontaneous SAh
Hypertension
Smoking
Having an aneurysm
What can be a trigger for an aneurysm to burst
Straining
Lifting heavy
Sex heavy exercise
Having Marfans ehlers Danlos
Cocaine
Blood thinners
AVM
Excessive alcohol
Why does alcohol increase the risk of bleeding?
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
Can a migraine cause focal, neurological deficits
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
Primary sexual headache
Can cause a thunderclap headache that occurs during sex but usually other symptoms are not there
Dx SAh
Meningitis
Other bleeds like epidural Sunderland
Migraines
Sexual headache
Why should you perform a CT head quite quickly if you suspect a subacid haemorrhage
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
If you suspect a sub rapid haemorrhage, what kind of imaging would you order?
Non-contrast city head, so you can actually see the blood
But ct angio to actually localise which vessel Is affected
What is xanthocromia
Where you see blood in the cerebral spinal fluid because the red blood cells have broken down and produce bilirubin
Cerebral salt wasting syndrome
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
Complications of SAH
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
What’s the difference between between ct head and ct angiography in relation to bleeding
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
worrying signs of a headache
red flag symptoms
photophobia
stiff neck
vision problems
headache triggered by coughing or straining (can be a sign of raised iCP)
SNOOPA- pneumonic
(age)
aura
comes b4 a migraine
birght lights
auditory
tingly feeling
prophylactics for headcahes
proponolol, amitrptline , toperimate (child bearin)
risk factor GCA
potential complications
> 50
females
polymyalgia rheumatica
blindness
stroke
what do people with GCA also take
aspirin as increased for stroke due to thrombus
gold standard diagnosis GCA
Temporal artery biopsy is the gold standard investigation to diagnose GCA, but this may be normal if a “skip lesion” is biopsied and so cannot be relied up
whats the most importnat blood marker in GCA
ESR
