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4th Year Neurology > Headache and Non-traumatic Brain Bleeding > Flashcards

Headache and Non-traumatic Brain Bleeding 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 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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3
Q

How long do auras typically last in migraine?

A

20-60 mins

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4
Q

List triggers of migraine

A 
Sleep
Diet
Stress
Physical exertion
Hormones
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5
Q

List non-pharmacological treatment for migraine

A

Trigger diary
Education
Stress management

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6
Q

List pharmacological management of migraine

A

NSAID + anti-emetic if vomiting

Triptans (rizatriptan)

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7
Q

When should prophylaxis be considered for migraine?

A

More than 3 attacks in a month or very severe

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8
Q

List prophylactic therapy for migraine

A 
Propranolol
Topiramate
Amitryptilline
Gabapentin
Sodium valproate
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9
Q

List the 4 main types of trigeminal cephalgias

A

Cluster headache
Paroxysmal hemicranias continua
Hemicrania continua
SUNCT

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10
Q

Who gets cluster headaches more - men or women?

A

Men

Typically 30-40 yr olds

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11
Q

When do cluster headaches typically come on?

A

Around sleep time

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12
Q

Describe a cluster headache

A

Severe unilateral headache lasting 20mins-3hrs

1 to 8 episodes a day

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13
Q

Who gets paroxysmal hemicranias continua more - men or women?

A

Women

Typically 50-60 yr olds

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14
Q

How would you distinguish paroxysmal hemicranias continua from cluster headache?

A

Shorter duration, more frequent

2-45 minutes 1-40 times a day

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15
Q

Which drug provides absolute response to paroxysmal hemicranias continua?

A

Indomethicin

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16
Q

What is a SUNCT trigeminal cephalgia?

A 
Short
Unilateral
Neuralgia
Conjunctival injections
Tearing
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17
Q

What is the treatment for SUNCT?

A

Gabapentin / lamotrigine

18
Q

Who gets trigeminal neuralgia more - men or women?

A

Women

Typically elderly

19
Q

What typically triggers trigeminal neuralgia?

A

Touch in V2/V3 region

20
Q

How long does an episode of trigeminal neuralgia usually last?

A

1-90 seconds

10-100 episodes a day

21
Q

List treatment for trigeminal neuralgia

A 
Carbamazepine
Gabapentin
Phenytoin
Baclofen
Surgical decompression
22
Q

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

A

Berry aneurysm (polycystic kidney disease)

23
Q

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

A

True

24
Q

Which cranial nerve can be particularly affected in subarachnoid haemorrhage?

A

CN III

25
Q

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

A

Retinal or vitreous haemorrhage

26
Q

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

A

True

27
Q

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

A

Lumbar puncture

28
Q

Describe CSF appearance on lumbar puncture in subarachnoid haemorrhage

A

Xanthochromatic or bloodstained

29
Q

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

A

Cerebral angiography with/without CT

30
Q

List some complications of subarachnoid haemorrhage

A 
Re-bleeding often fatal
Hydrocephalus
Hyponatraemia
Seizure
Delayed ischaemia - 3-14 days following haemorrhage
31
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

32
Q

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

A

Hypertension leading to microaneurysm

33
Q

Typically where does a hypertensive intracerebral haemorrhage affect anatomically?

A

Basal ganglia (haematoma)

34
Q

List the main investigations for intracerebral haemorrhage

A 
CT scan (urgent if decreased consciousness)
Angiography
35
Q

Arteriovenous malformations (AVMs) are typically clinically silent. True or false?

A

True - they are clinically silent until haemorrhage

36
Q

Where is the bleeding in a subarachnoid haemorrhage?

A

Bleeding in the subarachnoid space between the pia and arachnoid membrane

37
Q

If a subarachnoid haemorrhage shows up on CT is shows up as a ____ signal in the subarachnoid space?

A

Hyperdense

38
Q

Which well circumscribed benign vascular lesion shows up as a focal lesion with a “popcorn-like” appearance surrounded by a ring of hypo-intensity consistent with hemosiderin deposition on MRI?

A

Cavernous malformation

39
Q

Most aneurysms arise in the posterior circulation. True or false?

A

False - 90% arise from the anterior circulation

40
Q

Intracerebral haemorrhage always causes focal neurological deficits. True or false?

A

True

41
Q

Idiopathic intercranial hypertension typically affects what type of patient?

A

Young, obese females

4th Year Neurology (13 decks)

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