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TCD Neurology > Headache and Funny Turns > Flashcards

Headache and Funny Turns Flashcards

1
Q

Which hemisphere of the brain controls most aspects of language function?

A

The dominant hemisphere - this is usually the left.

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2
Q

Where is Broca’s area located?

A

The inferior left frontal lobe (on the posterior inferior frontal gyrus)

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3
Q

What is Broca’s Area responsible for?

A

Speech production

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4
Q

Which areas of the brain are required for executive functioning?

A

Both frontal lobes

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5
Q

Where is Wernicke’s Area located?

A

In the posterior, superior left temporal lobe (posterior superior temporal gyrus)

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6
Q

What is Wernicke’s Area responsible for?

A

Understanding language (visual or auditory)

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7
Q

Which areas of the brain are required for episodic memory?

A

Both medial temporal lobes

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8
Q

What is episodic memory?

A

A type of long term memory which involves memories related to experiences or episodes in life.

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9
Q

Which part of the brain is critical for both calculation and writing?

A

The left inferior parietal lobule.

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10
Q

Which part of the brain is important in all aspects of visuospatial awareness?

A

The right parietal lobe

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11
Q

Which lobe of the brain is the main balance/coordination centre?

A

The cerebellum - it receives inputs from several other areas.

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12
Q

How can we distinguish between a visual cortex lesion and an optic tract/radiation lesion?

A

With a visual cortex lesion there is macular sparing of vision - this does not occur with optic tract/radiation lesions.

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13
Q

How can we distinguish between facial palsy due to upper motor neurone (UMN) lesion and lower motor neurone (LMN) lesion?

A

Forehead sparing - if the patient retains some function of the forehead muscles, this is indicative of an upper motor neurone (UMN) lesion.
If entire side of face, including forehead, is paralysed, this is indicative of lower motor neurone (LMN) lesion.

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14
Q

Which muscles of the eye are innervated by which cranial nerves?

A

Lateral rectus muscle - 6th cranial nerve
Superior oblique muscle - 4th cranial nerve
The rest of the extraocular muscles - 3rd cranial nerve

[LR6 SO4]

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15
Q

What is ataxia?

A

A loss of balance and coordination

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16
Q

What is dysmetria?

A

Inability to control the distance, speed and range of motion necessary to perform smoothly coordinated movements. A sign of cerebellar damage.

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17
Q

Why does dysdiadochokinesia occur?

A

Due to ataxia

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18
Q

Describe the nature of the pain seen in subarachnoid haemorrhage.

A

Sudden onset, severe pain; reaches maximal intensity within a few minutes.

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19
Q

Describe the nature of the pain seen in trigeminal neuralgia.

A

Recurrent, brief jabs of pain in one side of the face; may be triggered by touching the affected area.

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20
Q

Describe the nature of the pain seen in a cluster headache.

A

Recurrent unilateral pain around the eye and temple on one side; rapid onset over minutes, brief duration (15 minutes), may occur several times a night.

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21
Q

Describe the nature of the pain seen in raised intracranial pressure.

A

Progressively worsening headache over days/weeks; worse with bending over and lying down.

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22
Q

What are the red flag symptoms you must ask about in a headache history? (4)

A

-Pain triggered by cough/sneeze/valsalva (concern for raised ICP)
-Fever (infective causes of headache)
-Transient visual obscuration (can be symptom of raised ICP)
-New onset of seizures (can suggest structural brain disease)

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23
Q

What is ‘transient visual obscuration’?

A

Episodes of transient visual loss when changing posture (e.g on standing).

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24
Q

What signs on examination are indicative of raised intracranial pressure (ICP) when accompanying a new headache? (3)

A

-Papilloedema
-Restricted visual fields
-Oculoparesis (can indicate sixth nerve palsy which can be a sign of raised ICP)

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25
Q

What does the presence of nystagmus suggest?

A

Localisation of the lesion to the cerebellum or its connections.

26
Q

What is pyramidal drift (aka pronator drift)?

A

A downward, pronating movement of the outstretched arm seen in lesions of the contralateral cerebral hemisphere.

27
Q

What is a ‘thunder clap headache’?

A

A sudden onset headache reaching maximum intensity within 5 minutes - indicative of subarachnoid haemorrhage until proven otherwise.

28
Q

How is chronic migraine defined?

A

Headache on more than 15 days of each month, for more than 3 months.

29
Q

What acute treatment options are available for migraine management? (4)

A

For patients with <4 disabling attacks per month:
-Paracetamol
-NSAIDs
-Antiemetics
-Triptans (oral, nasal, injections)

30
Q

What preventative treatment options are first line for migraine management? (3)

A

For patients with >4 disabling attacks per month, or chronic migraine:
-Beta blockers
-Tricyclics
-Topiramate

31
Q

What is oral hairy leukoplakia?

A

Fuzzy white patches that look like folds or ridges, that are usually found on the lateral surface of the tongue and cannot be scraped off (unlike oral candida). Can be triggered by EBV but only usually in immunosuppressed patients, therefore indicative of immunosuppression.

32
Q

What is livedo reticularis?

A

Mottled discolouration of the skin caused by low blood flow and reduced oxygen tension; may be a sign of antiphospholipid syndrome, vasculitis or vessel obstruction.

33
Q

What preventative treatments can be given for migraine under specialist care if first line options are ineffective? (2)

A

-Botulinum toxin (cranial botox)
-Anti-CGRP antibodies (monoclonal antibodies)

34
Q

What clinical features can distinguish a cluster headache from a migraine? (4)

A

People with a cluster headache may be restless and moving around lots, as well as having autonomic features such as a red/watery eye; they often have a shorter duration and occur multiple times within a day.

35
Q

How are cluster headaches treated? (4)

A

Specialist care:
-High flow oxygen (in acute setting)
-Injectable triptan for headaches with longer duration
-High dose steroids at start of cluster
-Verapamil (prophylactic)

36
Q

How is trigeminal neuralgia managed? (3)

A

Specialist care:
-Investigate cause (to rule out lesions)
-Carbamazepine OR oxcarbazepine (antiepileptics)
-Surgical management may be option if non-responsive to medication

37
Q

How are tension headaches managed? (3)

A

-Non-pharmacological measures (first line)
-Simple analgesia
-Tricyclics

38
Q

What are the common causes of raised intracranial pressure (ICP)? (5)

A

-Space occupying lesion (i.e tumour)
-Intracranial bleeding
-CSF flow alteration
-Brain swelling
-Venous sinus thrombosis

39
Q

What vision related symptoms are seen in raised intracranial pressure (ICP)? (4)

A

-Peripheral field loss
-Blurred vision
-Transient visual obscuration
-Diplopia (due to 6th nerve palsy)

40
Q

What neurological symptoms are seen in raised intracranial pressure (ICP)? (4)

A

-Focal dysfunction (problems dependent on the location of the lesion, if there is one)
-Confusion
-Reduced GCS
-UMN signs

41
Q

How is suspected increased intracranial pressure (ICP) investigated? (3)

A

-Brain imaging - CT or MRI depending on urgency of case
-Venography
-CSF testing (pressure and constituents) if scans aren’t helpful (done via lumbar puncture)

42
Q

What is subarachnoid haemorrhage?

A

Release of blood onto the surface of the brain, under the arachnoid meninges.

43
Q

What are the common causes of subarachnoid haemorrhage? (4)

A

-Trauma (most common)
-Aneurysmal (generally around circle of Willis)
-Perimesencephalic (bleeding around circle of Willis but no aneurysm detectable)
-Other (i.e underlying arteriovenous malformations, vasculitis, etc.)

44
Q

How does subarachnoid haemorrhage usually present? (5)

A

-A thunderclap headache, with photophobia and vomiting (due to meningeal irritation).
-In severe cases, may be reduced GCS and focal neurological deficits.

45
Q

How should a subarachnoid haemorrhage be managed? (4)

A

-Stabilise (some patients may need intubation due to low GCS)
-Use CT scan to confirm diagnosis (can be negative if delayed so do asap)
-If late presentation (>12hrs) lumbar puncture performed to confirm diagnosis.
-Refer to neurosurgery for angiography.

46
Q

What is meningitis?

A

Inflammation of the meningeal tissues lining the brain, caused by infectious or non-infectious triggers.

47
Q

Name the three layers of the meninges, from superficial to deep.

A

Dura mater
Arachnoid mater
Pia mater

48
Q

What are the most common bacterial causes of community acquired meningitis in the UK? (3)

A

-Streptococcus pneumoniae
-Neisseria meningitides
-Listeria monocytogenes (in patients >50 or immunocompromised)

49
Q

What are the most common bacterial causes of hospital acquired meningitis in the UK? (2)

A

-Staphylococci
-Aerobic gram negative bacilli

50
Q

What are three potential viral causes of meningitis?

A

-Enteroviruses
-Mumps virus (and other paramyxoviruses)
-Herpes simplex virus (primary HSV infection or disseminated HSV)

51
Q

What is the most common fungal form of meningitis?

A

Cryptococcus neoformans

52
Q

How can clinical signs of meningitis be tested for? (3)

A

-Neck stiffness - passively flex the patient’s neck; resistance indicates a positive sign
-Kernig’s sign - position patient on their back with hips flexed to 90 degrees; pain on passive leg extension at knee joint is a positive sign.
-Brudzinski’s sign - position patient on back and passively flex neck; involuntary bending of knees is a positive sign.

53
Q

What is encephalitis?

A

Inflammation of the brain itself.

54
Q

When in suspected meningitis should a lumbar puncture be performed?

A

Within 1 hour of arrival at the hospital if it is safe and the patient is hemodynamically stable. (Antibiotics should be commenced immediately after.)

55
Q

What should be done in suspected meningitis when a lumbar puncture cannot be performed safely? (3)

A

Blood cultures should be taken, antibiotics started, and a lumbar puncture should be performed when safe.

56
Q

Which intervertebral space should you aim for when inserting a lumbar puncture needle? (2)

A

Between L3-L4 or L4-L5, because this is below the level at which the spinal cord terminates.

57
Q

Why should opening pressure in a lumbar puncture be documented?

A

It can be raised in bacterial meningitis.

58
Q

What should a CSF sample be sent to the lab for? (5)

A

-Cell count and differential
-Glucose concentration
-Protein concentration
-Gram stain, bacterial culture and PCR
-Viral PCR

59
Q

How should bacterial meningitis be managed? (2)

A

-Urgent IV antibiotic treatment with agents that penetrate the CSF well and cover the likely pathogens (according to the patient’s age, surgical history, travel history, immunological status, and allergy status).
-Dexamethasone IV 10mg four times daily for four days can be started within 12 hours of antibiotics commencement.

60
Q

What are the differences between a CT scan and an MRI scan? (3)

A

-CT scan is x-ray based imaging system, whereas MRI scans utilise magnetics waves.
-MRI scans provide a better spatial resolution of soft tissue lesions than CT scans
-MRI scans are more expensive to perform and are often associated with a longer waiting list.

61
Q

How are brain tumours classified? (2)

A

-Primary brain tumours: arise from intracranial structures such as meninges (meningioma) or glial cells (gliomas or astrocytomas).
-Secondary metastases: from primary tumours usually arising from bronchus, breast, stomach, prostate, thyroid or kidneys.

62
Q

What is Giant Cell Arteritis (GCA)?

A

An inflammatory disease that affects medium and large blood vessels, classically the extracranial branches of the external carotid arteries.

TCD Neurology (2 decks)

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