Headache And Lymphatics Flashcards
Headache prevalence
30% general population
Primary headache
. W/o underlying pathology
. 90% headaches
. Categories: tension, migraine, cluster, chronic daily headache
Sinus headache
. Pain behind browbone and/or cheek bone
Cluster headache
. Pain in and around eye
. <1%, more common in men
. Sharp, continuous pain, severe intensity
. Abrupt onset, peaks in minutes
. 15 min-3 hrs
. Episodic, clustered in time w/ several times a day for 4-8 weeks, relief for several months
. Lacrimation, rhinorrhea, miosis, eyelid edema, conjunctival infection
Tension headache
. Pain like band squeezing head
. Bilateral upper neck, frontotemporal region
. Steady non-throbbing, mild to moderate intensity
. 30 min-7 days
. Episodic but can be chronic
. Sometimes photophobia, phonophobia, no nausea
. Triggers: sustained muscle tension, stress, sleep issues
. Relieving factors: massage, relaxation
Migraines
. Classic (has aura) vs common (no aura)
. 10% headaches
. Unilateral in 70%, bilateral/global 30%
. Throbbing, aching, severe in intensity
. Rapid onset, peak 1-2 hrs
. Durations 4-72 hours
. Recurrent course
Migraine symptoms, triggers, and relieving factors
. Nausea, vomiting, photophobia, phonophobia, visual or sometimes motor auras
. Triggers: alcohol, certain food, stress, period, high altitude
. Better w/ quiet, dark room, sleep, pressure on involved a.
Secondary headache
. From underlying cause . People over 50 y/o . Either type worst or. First headache . Fever, night sweats . Vomiting preceding headache . Local tenderness . Recent head trauma . Papilledema, stiff neck, abnormal neuro findings on exam
Differentials for thunderclap headache
.subarachoid hemorrhage . Cerebral venous sinus thrombosis . Pituitary apoplexy . Cervicocephalic dissection . Sentinel bleed . Spontaneous intracranial hypotension . Acute hypertensive crisis
Meningitis
. Viral/bacterial infection of meninges
. Steady or throbbing, very severe
. Onset rapid (less than 24 hrs)
. Viral lasts less than a week, bacterial persists until treatment
. Symptoms: fever, stiff neck, photophobia, change in mental status
. Star empiric antibiotics until diagnosis of viral v. Bacterial is confirmed
Brain tumor
. Lesion causing displacement or traction on pain-sensitive aa., vv., or nn.
. Aching, steady, dull pain worse on awakening, better after hours
. Intermittent but can progress in intensity over days
. Assoc. w/ seizures, hemiparesis, personality changes, nausea, vision change, gait changes
Giant cell arteritis (temporal arteritis)
. Transmural lymphocytic vasculitis w/ multinucleated giant cells that disrupt internal internal elastic lamina of large aa.
. Localized near involved artery (temporal most often)
. Can have fever, fatigue, weight loss, new headache, visual loss, jaw claudication
. Assoc. w/ polymyalgia rheumatica
. Give steroids
Cranial neuralgia
. Pain that follows nerve distribution
. Paroxysmal
. Max at onset, electrical shock, lancinating quality
. Can be single sharp pain or repetitive pains
. Last second to several seconds
Trigeminal neuralgias
. Common cause of facial pain
. Occur in paroxysms
. Max at or near onset
. Electric shock, stabbing
Occipital neuralgias
. Paroxysmal jabbing pain in greater, lesser, and/or 3rd occipital n.
. Accompanied by diminished sensation in affected area
. Tenderness overlying n. Present
Lymph function
. Removal of interstitial fluid from tissues
. Absorption and transport of FA and fat
. Formation of defense for body
. Thymus, bone marrow, lymph nodes, tonsils, and spleen
Lymphadenopathy
. Lymph node enlargement
. 1cm or less normal (2cm inguinal normal)
. Need over 2cm in abdomen
. Need over 1cm in chest
Right supraclavicular node is a classic sign of ___
Intrathoracic process
Lymphadenopathy causes
. Infections . Cellulitis, abscess, pharyngitis . Zoonosis: plague, tularemia . TB . Fungal . Viral (mono, CMV, HIV) . Parasitic
Tests to order for lymphadenopathy
. Labs: CBC, ESR, blood culture, EBV/CMV, HIV, quantGold
. Imaging: CT, US, MRI, PET
. Procedural: FNA, core needle biopsy, excisional biopsy
Advantages and disadvantages of FNA
. Advantages: easy, painless, office-based very small needle
. Disadvantages: requires expert, unable to evaluate histology
Advantages and disadvantages of core needle biopsy
. A: easy, painless, office-based, standard histopathology, able to obtain receptor status and assess tissue architecture
. D: slightly larger needle
Excisional biopsy advantages and disadvantages
A: standard histopathology, able to assess tissue architecture and obtain receptor status
D: requires operating room, larger incision, more painful
Characteristics of lymphangitis
. Inflammation of lymph channels
. Causes infection at site distal to channel
. Shows as red streaks on skin
. Prognosis good when treated w/ right antibiotics
Characteristics of lymphadenitis
. Localized infiltration of inflammatory cells in response to infection of lymph nodes
. Generalized response from lymphocytes and macrophages to viral/bacterial infections
Characteristics of lymphedema
. Primary or secondary blockage of lymphatics
. Secondary: from malignancy, global, primarily filariasis
. Different from venous insufficiency
Acute lymphedema
. Reversible
. Pitting
. Mild
Chronic lymphedema
. Irreversible . Non-pitting . Severe . Scarring, hardening, ulceration . Elephantiasis
