Headache

Question 1

IIH workup

Answer 1

see pt with hx of HA, dull pain, no auras, or trigger. sneeze- lose vision for a few sec, papilledema= suspect
get LP to record IC OP= temporaly relief sx. can be due to excess Vit A

Question 2

acetazolamide

Answer 2

carbonic anhydrase inhibitor. decr CSF production in IIH pt.

Question 3

temporal arthritis

Answer 3

arteritis of extra cranial carotid artery and its branches. commonly present in pt >60 with an indolent HA in temple or jam claudication, associated with polymyalgia rheumatic. pain is constant, worse with chewing. path- giant cell in blood vessel
tx: prednisone
most feared complication if no tx is unilateral visual loss

Question 4

temporal arteritis dx

Answer 4

elevated ESR, CRP, biopsy of temporal artery. may be skip lesions so biopsy multiple areas.

Question 5

cluster HA tx

Answer 5

tx: 100% O2 10min. prophylactic- Ca ch blocker-verapamil, steroids, lithium

Question 6

cluster HA dx

Answer 6

A at least 5 attacks of severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180min untreated + 1 or more of the following IL as pain: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, mitosis, ptosis, eyelid edema,
B: freq of attacks from every other day to 8/d

Question 7

migraine dx criteria

Answer 7

A) >5HA 4-72hr +2/4 sx: unilateral, pulsating, impair func, aggravated by routine physical activity
B: during Ha 1/2: phono/photophobia, N/V
C: >1 aura: homonymous viaul disturbance, unilateral paresthesias and or numbness, unilateral weakness, aphasia or unclassifiable speech difficulty

Question 8

basilar migrane

Answer 8

sx referable to basiar A- visual disturbances, vertigo, confusion, brainstem dysfunc

Question 9

familial hemiplegic migraine

Answer 9

auto dom migraine variant manifest by hemiparesis during migraine aura. accompanied by other sx- ataxia or changes in consciousness

Question 10

ophthalmoplegic migraine

Answer 10

retroorbital pian and CN palsies- CN3/4/6

Question 11

triptan

Answer 11

abortive tx for migrane. ex sumatriptan

CI- CAD bc triptan meds have vasoconstrictive properties, and in pt with hemiplegic migraine bc concerned about stroke

Question 12

migraine prophylaxis

Answer 12

I: >2/mo+ disturbe lifestile
antiepileptic, tricyclic antidepressants, ca blocker, beta blocker. topiramate=most common, amitriptiline, depakote, propranolol, riboflavin

Question 13

CNS neoplasm v HA

Answer 13

red flags- HA in an older person wo hx HA. HA associated with focal near deficit or personality changes. HA in an IC pt. HA worse in morning. associated with signs of systemic disease- fever, wt loss

Question 14

glioma

Answer 14

tumor that arise from goal cells- astrocyte, oligodendrocyte, ependymal cells, cells of choroid plexus. 1/2 of primary brain tumor

Question 15

astrocytoma

Answer 15

2/3 are glioblastomas.

Question 16

WHO grades

Answer 16

I: juvenile pilocystic astrocytom, giant cell astrocytoma (associated with tuberous sclerosis), pleomorphic xanthroastrocytoma. cure with complete resection. most in children
II: diffuse or fibrillary astrocytoma, oligodendroglioma: 7-8y
III: anaplastic astrocytoma, anaplastic oliodendroglioma: 2-3y
IV- glioblastoma 9-12mo
single tumor may have dif grade at dif sites. mitotic activity correlate with prognosis

Question 17

CNS tumor sx

Answer 17

4 types
1) progressive, focal neuro deficit- weakness, visual loss, aphasia
2) HA worse in recumbency, associated with N/V, other sx of ICP
3) seizure if irritate cerebral cortex
4) gradual slowing and personality changes
sx dep on location of tumor and rate of growth

Question 18

medulloblastomas

Answer 18

most common tumor of childhood. in cerebellum. present with ataxia+ sign of IPC (HA, vomiting). type of PNET

Question 19

grade IC astrocytoma tx

Answer 19

evacuate mass +radiotherapy

Question 20

tension HA

Answer 20

A: 30min-7d
B: at least 2: pressing/tightening (nonpulsatile), mild or moderate-inhibit but not prohibit, bilateral location, no aggravation by routine physical activity
C: both: no N/V, 1 or neither photo/phonophobia

Question 21

intracranial hypotension

Answer 21

HA improve when lay down. tx: autologous blood patch

Question 22

intraventricular tumor

Answer 22

cause sx by block CSF. cause positional HA and loss of consciousness due to sudden incr in ICP if acutely obstruct. ex colloid cyst, meningioma, central neurocytoma

Question 23

closed angle glaucoma

Answer 23

30mmHg, N/V,. pupil dilated and fixed. oval pupil sometimes. emergency- need timolol drops