Headache Flashcards
Two classifications of headache
Primary
Secondary
What is a secondary headache?
Due to another pathology
What is a primary headache?
A syndrome in itself
Secondary causes of headache
Tumour Increased ICP Infection (meningitis/encephalitis) Bleeding Inflammatory (SLE/sarcoid etc) Temporal arteritis Posterior circulation strokes Venous sinus thrombosis
What does SAH stand for?
Subarachnoid haemorrhage
What do SAH usually bleed from?
Berry aneurysms
Types of bleeding that can cause headache
Subarachnoid
Subdural
Extradural
Intracerebral
Features of subdural haemorrhage in the young
Front of head - due to small communicating arteries
Acute presentation
Treatment of subdural haemorrhage in young
Treatment within 2 hours of presentation - emergency decompression
Features of subdural haemorrhage in elderly
Occur anywhere in head
Chronic, insidious, progressive onset
Fluctuating consciousness
May not need decompression
Features of extradural bleeding`
Acute
Usually trauma
Example a intracerebral bleed
Haemorrhagic stroke
Who gets primary brain tumours?
Children
Young adults
What are the two commonest cancers to metastasise to the brain?
Breast
Lung
What is a false localising sign in and what does it indicate?
Ipsilateral nerve palsy - indicates decreased consciousness
What does a primary brain tumour look like on a CT?
Singular Moderate oedema Increased vascularity More solid / cystic Less inflammation to surrounding brain
What does a secondary brain tumour look like on a CT?
Brain shift
Oedema
Bigger tumour
Treatment of acute brain tumours
High dose dexamethasone
Debulking
What does high dose dex do in acute treatment of a brain tumour?
Reduces inflammation / swelling
If find a mass in the brain on a CT, what must be done?
Full body CT
Triad of meningitis
- Neck stiffness
- Headache
- Fever
What is the single most important thing of a LP indicating a bacterial cause?
WCC elevated
What do lymphocytes in an LP indicate?
Viral
What do neutrophils in an LP indicate?
Bacterial
What are immunosuppressed patients more likely to have in terms of meningitis?
More likely to have space occupying infections so will have meningitis but this is more likely to form an abscess
Contraindications against a LP
Increased ICP signs Seizures Focal neurology Immunosuppression Known tumour
What type of meningitis does necessarily need treatment and what is the exception to this?
Viral meningitis if NO encephalitis present
UNLESS if caused by HSV as high rate of complications
Is meningoencephalitis different to encephalitis?
Yes
Signs of encephalitis
Drowsy
Confused
Do you treat encephalitis caused by a virus? What with?
Yes
IV acyclovir
What does the brain drain through?
Venous sinus
What are the RFs for venous sinus thrombosis?
Same for any venous thrombosis
- pregnancy
- OCP
- immobilisation
- long haul travel
- obesity etc
Investigations for venous sinus thrombosis
CT venogram
MRI
Treatment of venous sinus thrombosis
Anticoagulation (DOAC e.g. rivoroxaban for 6 months)
Dalteparin in pregnancy and continue for 6 weeks after birth
Possible presentations of SAH
Drop down dead Stroke like symptoms Headache Collapse Can have a pure headache with no focal neurology
Where is the pain typical of SAH but not always?
Occipital
Features of the pain in SAH
Peak onset of the headache is at 15 MINUTES
Investigations for SAH
Non contrast CT within 6 HOURS of headache onset
LP (>12 hours)
What is CT very good at detecting?
Blood, unless bleeding into a fluid space as the blood gets diluted
Treatment of a berry aneurysm
Coiling (using wire)
Clipping (open surgery)
Complications of SAH
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)
Treatment of vasoconstriction etc as a Cx of SAH
Superhydration
CCBs