Headache

Question 1

Indications for hospital referral in cases of head injury?

Answer 1

loss of consciousness
amnesia
neurological symptoms
evidence of skull fracture
worrying mechanism

Question 2

What are the signs of a basal skull fracture?

Answer 2

Panda eyes
haemotympanum (bruised ear drum)
Bruising over the mastoid (Battle sign)
CSF leakage from nose

Question 3

NICE ED head scan rules

Answer 3

Loss of consciousness/amnesia >5 mins
abnormal drowsiness, GCS <15
3+ discrete episodes of vomiting
non-accidental injury
post-traumatic seizure
basal skull fracture
dangerous mechanisms - high speed, fall from >3m
slow/asymmetrical pupil reactions

Question 4

Management of meningitis?

Answer 4

IM Benpen - 1.2mg

IV Abx (Ceftriaxone 2mg/12hrs) + IV Dexamethasone

Question 5

Investigations in SAH

Answer 5

CT scan to confirm bleed
CT angiography to find source

consider LP if CT negative and suspicion high - blood in CSF is indicative

Question 6

Management of SAH

Answer 6

Urgent neurosurgery referral
Keep BP >160 to maintain adequate cerebral perfusion
Nimodipine may reduce vasospasm and permanent CNS deficit

Question 7

Clinical features of a space occupying lesion?

Answer 7

Raised ICP - headache worse on bending/lying/waking/coughing
Papilloedema is a late sign of ^ICP
Seizures, ataxia, cerebellar signs

CN 6 palsy is a false localising sign due to long intracranial course

Question 8

Management of SoL

Answer 8

Imaging and surgery - CT/MRI +/- biopsy
seizure prophylaxis - phenytoin
opioid analgesic - codeine
^ICP - Dexamethasone, Mannitol

Question 9

Clinical features of temporal arteritis

Answer 9

Headache, scalp tenderness over temporal artery - inflamed, pulseless, beaded
+/- tongue/jaw claudication
+/- amaurosis fugax - transient uni/bilateral visual loss due to retinal ischaemia

Question 10

Investigations in temporal arteritis

Answer 10

Bloods - ESR and CRP ^^^, platelets ^, HB low

Temporal artery biopsy to confirm

Question 11

Management of temporal arteritis

Answer 11

High dose, long term steroids - Prednisolone 40mg, daily
+ Aspirin 75mg daily + PPI cover

Patients may be on steroids for 2 years - relapse common

Question 12

management of venous sinus thrombosis

Answer 12

elevate head to 30-40 degrees to relieve ^ICP
anticoagulation - LMWH/Heparin –> Warfarin
Decompressive hemicraniotomy may be necessary if ICP rises too high