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3MB Neurology > Headache and Intracranial Bleeds > Flashcards

Headache and Intracranial Bleeds Flashcards

1
Q

List red flag symptoms/signs related to headache

A 
New onset in over 55 yr old
Known/previous cancer
Immunosuppressed
Early morning onset
Exacerbated by valsalva
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2
Q

What is a migraine?

A

Severe throbbing pain on one side of the head

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3
Q

Migraine affects males more than females. True/False?

A

False

Females more than males

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4
Q

What is the difference between migraine with and without aura? Which is more common?

A

Migraine with aura: warning signs before migraine begins, e.g. flashing lights
Migraine without aura is more common

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5
Q

What is the criteria for diagnosing migraine without aura?

A

At least 5 attacks in 72 hours
Moderate/severe unilateral throbbing pain, worse on movement
Autonomic features or photophobia/phonophobia

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6
Q

What is the pathophysiology of migraine?

A 
Vascular and neural influence
Stress triggers serotonin release
Trigeminovascular system activation
Blood vessel constriction-dilation
Substance P irritates nerves and vessels, causing pain
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7
Q

How long do auras typically last in migraine?

A

20-60 mins

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8
Q

List some visual auras

A

Central scomata
Central fortification
Hemianopia

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9
Q

List triggers of migraine

A 
Sleep
Diet
Stress
Physical exertion
Hormones
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10
Q

List non-pharmacological treatment for migraine

A

Trigger diary
Education
Stress management

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11
Q

List pharmacological management of migraine

A

NSAID + anti-emetic if vomiting

Triptans (rizatriptan)

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12
Q

When should prophylaxis be considered for migraine?

A

More than 3 attacks in a month or very severe

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13
Q

List prophylactic therapy for migraine

A 
Propranolol
Topiramate
Amitryptilline
Gabapentin
Sodium valproate
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14
Q

What type of drug is topiramate and what are its adverse effects?

A

Carbonic anhydrase inhibitors

Weight loss, paraesthesia, impaired concentration

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15
Q

What are trigeminal autonomic cephalgias?

A

Headache disorders characterised by unilateral pain in a trigeminal distribution with ipsilateral cranial autonomic features

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16
Q

List some ipsilateral cranial autonomic features

A 
Ptosis
Miosis
Nasal stuffiness
Nausea, vomiting
Tearing
Eyelid oedema
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17
Q

List the 4 main types of trigeminal cephalgias

A

Cluster headache
Paroxysmal hemicranias continua
Hemicrania continua
SUNCT

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18
Q

Who gets cluster headaches more - men or women?

A

Men

Typically 30-40 yr olds

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19
Q

When do cluster headaches typically come on?

A

Around sleep time

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20
Q

Describe a cluster headache

A

Severe unilateral headache lasting 20mins-3hrs

1 to 8 episodes a day

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21
Q

Outline management of cluster headache

A 
MRI scan
High flow oxygen
Sumatripan
Steroid
Verapamil for prophylaxis
22
Q

Who gets paroxysmal hemicranias continua more - men or women?

A

Women

Typically 50-60 yr olds

23
Q

How would you distinguish paroxysmal hemicranias continua from cluster headache?

A

Shorter duration, more frequent

24
Q

Which drug provides absolute response to paroxysmal hemicranias continua?

A

Indomethicin

25
Q

What is a SUNCT trigeminal cephalgia?

A 
Short
Unilateral
Neuralgia
Conjunctival injections
Tearing
26
Q

What is the treatment for SUNCT?

A

Gabapentin

27
Q

Who gets trigeminal neuralgia more - men or women?

A

Women

Typically elderly

28
Q

What typically triggers trigeminal neuralgia?

A

Touch in V2/V3 region

29
Q

How long does an episode of trigeminal neuralgia usually last?

A

1-90 seconds

10-100 episodes a day

30
Q

List treatment for trigeminal neuralgia

A 
Carbamazepine
Gabapentin
Phenytoin
Baclofen
Surgical decompression
31
Q

List the 3 main spontaneous intracranial haemorrhage disorders

A

Subarachnoid haemorrhage
Intracerebral haemorrhage
Intraventricular haemorrhage

32
Q

Where does bleeding occur in a subarachnoid haemorrhage?

A

Into subarachnoid space that encloses CSF

33
Q

What is the most common underlying pathology in a subarachnoid haemorrhage?

A

Berry aneurysm

Otherwise arteriovenous malformation or no identifiable cause

34
Q

List typical clinical features of a subarachnoid haemorrhage

A

Sudden onset “thunderclap” headache
Collapse
Meningism - vomiting, photophobia, neck pain

35
Q

Subarachnoid haemorrhage can occur whilst having sex. True/False?

A

True

36
Q

Which cranial nerve can be particularly affected in subarachnoid haemorrhage?

A

CN III

37
Q

What may be seen on fundoscopy in someone who has had a subarachnoid haemorrhage?

A

Retinal or vitreous haemorrhage

38
Q

CT scan of a brain may be normal in subarachnoid haemorrhage. True/False?

A

True
Depends on delay
Once blood spills out bleeding may stop

39
Q

If a CT scan of a person with suspected subarachnoid haemorrhage is normal, what is the next best investigation?

A

Lumbar puncture

40
Q

Describe CSF appearance on lumbar puncture in subarachnoid haemorrhage

A

Xanthochromatic or bloodstained

41
Q

What investigation is gold-standard for identifying bleeding location of a subarachnoid haemorrhage?

A

Cerebral angiography with/without CT

42
Q

List some complications of subarachnoid haemorrhage

A 
Re-bleeding
Hydrocephalus
Hyponatraemia
Seizure
Delayed ischaemia
43
Q

How is re-bleeding in the brain addressed?

A 
Endovascular repair (mainstay)
Surgical clipping
44
Q

When might delayed ischaemic neurological deficit occur post- subarachnoid haemorrhage? What is the drug of choice to treat?

A

3-12 days

Nimodipine

45
Q

What is the H triple therapy used for delayed ischaemic neurological deficit?

A

Hypervolaemia
Haemodilution
Hypertension

46
Q

How does hydrocephalus arise?

A

Increase in intracranial CSF pressure

47
Q

How is hydrocephalus treated?

A

CSF drainage - lumbar puncture, ventricular drain, shunt

48
Q

Why should you not fluid restrict someone with hyponatraemia as a complication of subarachnoid haemorrhage?

A

Will cause hypovolaemia, predisposing to vasospasm and cerebral ischaemia

49
Q

What is the most common aetiology/risk factor for intracerebral haemorrhage?

A

Hypertension leading to microaneurysm

50
Q

Typically where does a hypertensive intracerebral haemorrhage affect anatomically?

A

Basal ganglia (haematoma)

51
Q

List the main investigations for intracerebral haemorrhage

A 
CT scan (urgent if decreased consciousness)
Angiography

3MB Neurology (17 decks)

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