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5th year countdown > Headache and stroke > Flashcards

Headache and stroke Flashcards

1
Q

What score is used to determine the severity of stroke?

A

NIHSS

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2
Q

Differentials for weakness - i.e. stroke mimics

A 
Stroke/TIA
Seizure
Sepsis
Toxic/metabolic
Space occupying lesion
Syncope
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3
Q

How to clinically differentiate between stoke and seizure?

A

Seizure will be postical and drowsy

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4
Q

What is the most important investigation

A

CT Head
White - haemorrhage
Dark - ischaemia - unlikely to see new infarct

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5
Q

Describe the Bamford Classification

A

TACS:
All three
1. Unilateral weakness (and/or sensory deficit) of face, arm, legs.
2. Homonymous hemianopia
3.. Higher cerebral cerebral dysfunction (dysphasia, visuospatial disorder)

PACS:
Two of:
1. Unilateral weakness (and/or sensory deficit) of face, arm, legs.
2. Homonymous hemianopia
3.. Higher cerebral cerebral dysfunction (dysphasia, visuospatial disorder)

POC:
One of 
1. Cerebellar or brainstem syndromes
2. LOC
3. Isolated homonymous hemianopia

LACS:
Subcortical stroke due to small vessel disorder. No evidence higher cerebral dysfunction
One of
Unilateral weakness (and/or sensory) of face and arm, arm and leg or all three.
Pure sensory stroke
Ataxic hemiparesis

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6
Q

Describe blood supply to brian

A
  • Internal carotid → anterior circulation

* Veterbral artery → posterior circulation

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7
Q

Mgmt of acute ischaemic stroke

A

ABCDE

Thrombolysis - 4.5 hrs and not CI

or

Aspirin 300mg 14 days

Bloods: FBC, U&Es, coagulation, HbA1c and cholesterol

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8
Q

How to manage BP - how dif in iscahemic and haem strokes

A

BP < 180 for ischaemic
BP < 140 for haemorrhagic
Oral/BG amlodipine or labetolol infusions

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9
Q

Causes of haemorrhagic stroke

A

HTN (majority!!)
Aneurysms/ AV malformation
Anticoagulation
Recreational drugs

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10
Q

Causes ischaemic stroke

A

AF - emboli
Atherosclerosis
Dissection - young person for message

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11
Q

What medications to give - embolic (AF) vs thrombotic

A

Embolic: NOAC/warfarin
Thrombotic: Clopidogrel 75mg

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12
Q

Why do you NOT give LMWH in the acute mgmt of ischaemic or haemorrhagic stroke?

A

Risk of haemorrhagic tranformation

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13
Q

Long term Ischaemic stroke mgmt

A

admit to stroke ward

Clop/NOAC/warfarin (unless ↑ hasbleed)
Atorvastatin 80mg
IPC stocking - as use LMWH
SALT
PHYSIO
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14
Q

What next investigation of choice 24 hours?

A

Diffuse weighted MRI head

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15
Q

Common complication

A

Aspiration pneumonia
Seizures (15%)
Depression, anxiety, pseudobulbar effect
DVTs

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16
Q

After 24 hours in anterior stroke

A
  • ECHO
  • Carotid doppler if anterior circulation
  • Consider 24 hour tape if AF
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17
Q

CT criteria

A 
GCS < 13 on injury 
< 15 2 hours after admission
Open or depressed skull fracture 
Basal skull fracture 
post-tramutic seizure 
Focal neurological deficit 
> 1 episode vomiting
18
Q 
Describe Extradural haem
Where and how?
Presentation?
Mortality 
What type of person 
How does the CT criteria help you?
A

Head injury + LOC
‘Lucid internal’ → pt degeriates
30% mortality
Acute (60%), subacute (30%), Chronic (10%)
Temopral or parietal bone fracture → damages meningeal artery
Less common in small children and ppl > 60 years.
Blood between dura mata and skill

→ think about cervical spine
→ the associated symptoms can be any of the CT criteria

19
Q

Mgmt extradural

Complications?

A
  • ABCDE + imaging
  • Reverse coagulopathy + cushing’s response
  • Small → asymptomatic - regular obs + scans
  • Surgery: focal signs, large, ↑ICP, midline shift

Surgery - emergency craniotomy or clot evacuation

Complications:
Death - cerebellar herniation
↑ ICP 
cerebral oedema 
Seizures
Permanent neurological or cognitive deficit due to pressure effects on brian
coma
20
Q

Subdural haematoma
Aetiology and cause :
Time courses:

A

Tearing of bridging veins in subdural space
• Blunt trauma (most common)
• Spontaneously

Acute, subacute (3-7 days), chronic  (2-3 weeks)
Blunt trauma (most common)
21
Q

Which high risk group

A

Infants - physical abuse
elderly - cerebral atrophy causes tension on veins. Consider anticoagulation
Alcoholics - RF for thrombocytopenia, ↑bleeding time, ↑head injury, cerebral atrophy

22
Q

Mgmt and complications for subdural

A

Same as extradural

23
Q 
Subarachnoid 
Causes 
Mean age
Risk factors 
Associated disorder
A

Berry aneurysm otherwise traumatic brain injury

Mean 50 years

RF: HTN, cocaine, smoking, alcohol XS

associated: Ehlers-danlos, NFM1

24
Q

CF

A

Sudden onset headache
Pulses to occiput
Ass vomiting, seizure delirum
Neck stiffness → late sign

25
Q

What do 10-15% experience before the SAH

Common CF

A

Sentinel bleeds - small bleed or expansion of aneurysm

Headache, dizzy, orbital pain, diplopia, vision loss, ↓consciousness

26
Q

Inv

A

CT without contrast - positive in 95% - do ASAP

LP at 12 hours for xanthachromia

27
Q

MGMT

A
  • CT angiography - find bleeding site
  • start nimodipine (prevent vasospasm)
  • Surgical Tx - endovascular embolisation or surgical clipping

Comps → the same as other bleeds

28
Q

Red flags for headache

What headaches do you always wanna rule out

A 
Worsening of headache 
Sudden-onset reaching max intensity in 5 mine
New neurological deficit
New onset cognitive deficit 
change in personality 
↑ consciousness 
Head trauma 
painful or red eye - acute angle glaucoma
↓ vision - temporal arteritis 
jaw claudication 
vomiting

• Bleeds, giant cell arteritis, acute angle glaucoma, meningitis/encephaltiis

29
Q

Things in the pmhx to son cider

A

↓ immunity

cancer Hx

30
Q

Giant cell arteritis

  • Typically patient
  • CF
  • Investigation
A

60 , europeans

recent onset temporal headache, myalgia, malaise fever, jaw claudication

+- systemic symptoms = fever, anorexia, wt loss, sweats, malaise, temporal artery maybe prominent, tender and pulseless

Bloods: ESR + anaemia
Biopsy → shows vasculitis

31
Q

Tx for giant cell

A

40mg prednisaoline (60mg if claudication present)
IV methylpred if vision loss
75mg aspirin + PPI

32
Q

Complication

A

Loss of vision
Aneurysm, dissection and stenosis of the aorta due to vasculitis
Steroid related complications → osteoporosis + cushing’s

33
Q

Acute closure glaucoma

What is it?
RF?
CF?

A

Obstruction of anterior chamber angle (lens catches on cornea) → ↑ pressure in anterior chamber

RF: ↓ Age (lens grows with age), genetics, hyperopia (long-sightedness)

CF
• Pain (severe and rapid progressive) 
• blurred vision, visual loss
• Coloured haloes
• Systemic malaise (N+V)
34
Q

3 most common primary headaches

A

Migrane
Tension
Cluster

35
Q

What is the most common recurring headache - describe it
How many do you have to have a month for it to be considered chronic
Tx

A

Tension headache, bilateral, feels tight, not aggravated by routine activities.

  • episodic <15 days a month,
  • chronic > 15 a month

Tx: headache diary, ensure not medication induced or associated with depression analgesia

36
Q 
Migrane 
Features 
Tiggers
Mgmt
- when to give prophylaxis
A

• unilateral, pulsating, moderate-severe, aggravated by routine activities, sensitive to light/sound +- vomiting

Trigger: choco, wine, alcohol, exercise, COCP

Prophylaxis if 2/3 attacks producing disability for 3+ days

1) BB +-Amitryptalline - if associated with pain, depression or insomnia
2) Topiramate or sodium valoprate
3) Pitozifen

Acute - NSAIDS + antiemetics → if these fail triptans

37
Q 
Cluster headache 
CF
When do these typically occur?
Triggers?
How many must you have for a diagnosis?
Tx?
A

Unilateral, sharp, burning, severe, restless, red/watery eye, nasal congestion, swollen eyelid

Occur at night, 1-2 hour after falling asleep
Lasts for 45-90 mins

trigger alcohol, heat, exercise, sleep deprivation

Must have 5 for diagnosis.

Episodic (7D in 1 year)
Chronic (1 year or more with remission < 1 month)

Tx actually with triptans and oxygen

38
Q

Most common presentation of metastasis

A

Seizure

39
Q

What is a UBO

A

unidentified bright object associated with migrant

40
Q

What is the cushing’s triad

A

Response to ↑ICP - ↑BP, irregular, ↓HR

5th year countdown (17 decks)

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