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Acute Medicine > Headache > Flashcards

Headache Flashcards

1
Q

Two classifications of headache

A

Primary

Secondary

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2
Q

What is a secondary headache?

A

Due to another pathology

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3
Q

What is a primary headache?

A

A syndrome in itself

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4
Q

Secondary causes of headache

A 
Tumour
Increased ICP
Infection (meningitis/encephalitis)
Bleeding
Inflammatory (SLE/sarcoid etc)
Temporal arteritis
Posterior circulation strokes
Venous sinus thrombosis
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5
Q

What does SAH stand for?

A

Subarachnoid haemorrhage

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6
Q

What do SAH usually bleed from?

A

Berry aneurysms

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7
Q

Types of bleeding that can cause headache

A

Subarachnoid
Subdural
Extradural
Intracerebral

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8
Q

Features of subdural haemorrhage in the young

A

Front of head - due to small communicating arteries

Acute presentation

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9
Q

Treatment of subdural haemorrhage in young

A

Treatment within 2 hours of presentation - emergency decompression

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10
Q

Features of subdural haemorrhage in elderly

A

Occur anywhere in head
Chronic, insidious, progressive onset
Fluctuating consciousness
May not need decompression

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11
Q

Features of extradural bleeding`

A

Acute

Usually trauma

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12
Q

Example a intracerebral bleed

A

Haemorrhagic stroke

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13
Q

Who gets primary brain tumours?

A

Children

Young adults

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14
Q

What are the two commonest cancers to metastasise to the brain?

A

Breast

Lung

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15
Q

What is a false localising sign in and what does it indicate?

A

Ipsilateral nerve palsy - indicates decreased consciousness

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16
Q

What does a primary brain tumour look like on a CT?

A 
Singular
Moderate oedema
Increased vascularity 
More solid / cystic 
Less inflammation to surrounding brain
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17
Q

What does a secondary brain tumour look like on a CT?

A

Brain shift
Oedema
Bigger tumour

18
Q

Treatment of acute brain tumours

A

High dose dexamethasone

Debulking

19
Q

What does high dose dex do in acute treatment of a brain tumour?

A

Reduces inflammation / swelling

20
Q

If find a mass in the brain on a CT, what must be done?

A

Full body CT

21
Q

Triad of meningitis

A
  1. Neck stiffness
  2. Headache
  3. Fever
22
Q

What is the single most important thing of a LP indicating a bacterial cause?

A

WCC elevated

23
Q

What do lymphocytes in an LP indicate?

A

Viral

24
Q

What do neutrophils in an LP indicate?

A

Bacterial

25
Q

What are immunosuppressed patients more likely to have in terms of meningitis?

A

More likely to have space occupying infections so will have meningitis but this is more likely to form an abscess

26
Q

Contraindications against a LP

A 
Increased ICP signs
Seizures
Focal neurology 
Immunosuppression 
Known tumour
27
Q

What type of meningitis does necessarily need treatment and what is the exception to this?

A

Viral meningitis if NO encephalitis present

UNLESS if caused by HSV as high rate of complications

28
Q

Is meningoencephalitis different to encephalitis?

A

Yes

29
Q

Signs of encephalitis

A

Drowsy

Confused

30
Q

Do you treat encephalitis caused by a virus? What with?

A

Yes

IV acyclovir

31
Q

What does the brain drain through?

A

Venous sinus

32
Q

What are the RFs for venous sinus thrombosis?

A

Same for any venous thrombosis

  • pregnancy
  • OCP
  • immobilisation
  • long haul travel
  • obesity etc
33
Q

Investigations for venous sinus thrombosis

A

CT venogram

MRI

34
Q

Treatment of venous sinus thrombosis

A

Anticoagulation (DOAC e.g. rivoroxaban for 6 months)

Dalteparin in pregnancy and continue for 6 weeks after birth

35
Q

Possible presentations of SAH

A 
Drop down dead
Stroke like symptoms
Headache
Collapse
Can have a pure headache with no focal neurology
36
Q

Where is the pain typical of SAH but not always?

A

Occipital

37
Q

Features of the pain in SAH

A

Peak onset of the headache is at 15 MINUTES

38
Q

Investigations for SAH

A

Non contrast CT within 6 HOURS of headache onset

LP (>12 hours)

39
Q

What is CT very good at detecting?

A

Blood, unless bleeding into a fluid space as the blood gets diluted

40
Q

Treatment of a berry aneurysm

A

Coiling (using wire)

Clipping (open surgery)

41
Q

Complications of SAH

A

Death by rebleeding
Non obstructive hydrocephalus (blood blocks the reabsorption)
Vasoconstriction and vasospasm causing stroke like symptoms in the early hours after
Cerebral salt wasting syndrome / SiADH (hyponatraemic syndrome)

42
Q

Treatment of vasoconstriction etc as a Cx of SAH

A

Superhydration

CCBs

Acute Medicine (4 decks)

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