Headache

Question 1

Two classifications of headache

Answer 1

Primary

Secondary

Question 2

What is a secondary headache?

Answer 2

Due to another pathology

Question 3

What is a primary headache?

Answer 3

A syndrome in itself

Question 4

Secondary causes of headache

Answer 4

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

Question 5

What does SAH stand for?

Answer 5

Subarachnoid haemorrhage

Question 6

What do SAH usually bleed from?

Answer 6

Berry aneurysms

Question 7

Types of bleeding that can cause headache

Answer 7

Subarachnoid
Subdural
Extradural
Intracerebral

Question 8

Features of subdural haemorrhage in the young

Answer 8

Front of head - due to small communicating arteries

Acute presentation

Question 9

Treatment of subdural haemorrhage in young

Answer 9

Treatment within 2 hours of presentation - emergency decompression

Question 10

Features of subdural haemorrhage in elderly

Answer 10

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

Question 11

Features of extradural bleeding`

Answer 11

Acute

Usually trauma

Question 12

Example a intracerebral bleed

Answer 12

Haemorrhagic stroke

Question 13

Who gets primary brain tumours?

Answer 13

Children

Young adults

Question 14

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

Answer 14

Breast

Lung

Question 15

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

Answer 15

Ipsilateral nerve palsy - indicates decreased consciousness

Question 16

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

Answer 16

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

Question 17

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

Answer 17

Brain shift
Oedema
Bigger tumour

Question 18

Treatment of acute brain tumours

Answer 18

High dose dexamethasone

Debulking

Question 19

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

Answer 19

Reduces inflammation / swelling

Question 20

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

Answer 20

Full body CT

Question 21

Triad of meningitis

Answer 21

1. Neck stiffness
2. Headache
3. Fever

Question 22

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

Answer 22

WCC elevated

Question 23

What do lymphocytes in an LP indicate?

Answer 23

Viral

Question 24

What do neutrophils in an LP indicate?

Answer 24

Bacterial

Question 25

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

Answer 25

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

Question 26

Contraindications against a LP

Answer 26

``` Increased ICP signs Seizures Focal neurology Immunosuppression Known tumour ```

Question 27

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

Answer 27

Viral meningitis if NO encephalitis present | UNLESS if caused by HSV as high rate of complications

Question 28

Is meningoencephalitis different to encephalitis?

Answer 28

Yes

Question 29

Signs of encephalitis

Answer 29

Drowsy | Confused

Question 30

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

Answer 30

Yes | IV acyclovir

Question 31

What does the brain drain through?

Answer 31

Venous sinus

Question 32

What are the RFs for venous sinus thrombosis?

Answer 32

Same for any venous thrombosis - pregnancy - OCP - immobilisation - long haul travel - obesity etc

Question 33

Investigations for venous sinus thrombosis

Answer 33

CT venogram | MRI

Question 34

Treatment of venous sinus thrombosis

Answer 34

Anticoagulation (DOAC e.g. rivoroxaban for 6 months) | Dalteparin in pregnancy and continue for 6 weeks after birth

Question 35

Possible presentations of SAH

Answer 35

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

Question 36

Where is the pain typical of SAH but not always?

Answer 36

Occipital

Question 37

Features of the pain in SAH

Answer 37

Peak onset of the headache is at 15 MINUTES

Question 38

Investigations for SAH

Answer 38

Non contrast CT within 6 HOURS of headache onset | LP (>12 hours)

Question 39

What is CT very good at detecting?

Answer 39

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

Question 40

Treatment of a berry aneurysm

Answer 40

Coiling (using wire) | Clipping (open surgery)

Question 41

Complications of SAH

Answer 41

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)

Question 42

Treatment of vasoconstriction etc as a Cx of SAH

Answer 42

Superhydration | CCBs