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Year 3 > Headache TCD > Flashcards

Headache TCD Flashcards

1
Q

‘Worst ever headache’

A

Subarachnoid

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2
Q

Neckstiffness and …. sign indicated meningeal irritation

A

Kernig’s sign

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3
Q

Headache with generalised aches and pains in the elderly

A

Giant cell arteritis

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4
Q

three causes of hydrocephalus in children

A

Congenital - Arnold-Chiari malformation
meningitis
Haemorrhage

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5
Q

Causes of hydrocephalus in adults

A 
Late presentation of congenital 
cerebral tumours in posterior fossa or brainstem 
Subarachnoid haemorrhage 
Head injury 
meningitis 
Third ventrical colloid cyst 
Normal pressure hydrocephalus
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6
Q

Recurrent prostrating headaches with episodes of lower limb weakness

A

intermittent hydrocephalus due to a third ventricle colloid cyst

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7
Q

Clinical features of hydrocephalus

A

headache, vomiting, papilloedema caused by raised intracranial pressure. Ataxia and bilateral pyramidal signs

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8
Q

Indication of brain imaging in headache patient

A 
Sudden onset
New headache in a patient over 50 
Abnormal neurological signs 
Headache changing with posture - ICP 
Headache made worse with coughing, bending ect - ICP 
Fever 
HIstory of HIV 
History of cancer
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9
Q

Jaw claudication headache

A

giant cell arteritis

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10
Q

What are most chronic daily and recurrent headaches?

A

Tension headaches

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11
Q

Symptoms and treatment of tension headaches

A

pressure or tightness all around the head and scalp muscles, treat with reassurance, analgesic withdrawal and maybe TCAnti-D

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12
Q

Age of onset and gender of migraines

A

usually before 40, more in females

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13
Q

Which cranial nerve nucleus is most affected in migraines?

A

Trigeminal nerve

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14
Q

Three types of migraines

A 
Migraine with aura (classic) 
Migraine without aura (common) 
Migraine variants (Look scary, resemble strokes)
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15
Q

Describe the headache in migraine

A

Unilateral, throbbing, builds up.

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16
Q

Symptoms in migraine

A

Photophobia, phonophobia, nausia, vomiting.

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17
Q

Do auras come on before or after the headache in migraines

A

Before

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18
Q

Differetial diagnosis in migraines

A

Meningitis, SAH, thrombotic TIAs (TIA maximum deficit is immediate and visual symptoms are negative - negative visual symptoms not positive)

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19
Q

Oral contraseptive and migraines

A

contraindicated with migraine with focal aura

20
Q

Management of mild migraine

A

paracetamol, NSAIDs, aspirin and anti emetic such as metoclopramide

21
Q

Management of moderate/ severe attacks

A

Triptans, CGRP antagonists e.g telcagepant for acute

22
Q

What are triptans and when are they contraindicated?

A

Examples: sumatriptan, almotriptan, eletriptan.
Mechanism: serotonin agonists
Contraindicated when there is vascular disease and in migraine variants

23
Q

When is migraine prophylaxis indicated?

A

frequent attacks more than two per month, or poor responce o acute attack treatment

24
Q

Types of prophylaxis for migraines

A

valporate, b-blockers, amitriptyline, botulinum toxin.

25
Q

Which cranial nerve could be the causes of facial pain?

A

Trigeminal nerve - trigeminal nerve lesions, trigeminal neuralgia.

26
Q

What sort of headache classification are cluster headaches?

A

Trigeminal autonomic cephalgias

27
Q

Describe cluster headaches

A

Rapid onset, severe and short. Come in clusters - over weeks and then a long time of none. More often in men. Start around the eyes or temple. Autonomic features - lacrimation and redness of eye. Horner’s syndrome. Medication - acute - 100 oxygen, nasal triptans

28
Q

Giant cell arteritis type of arteritis

A

Granulomatous arteritis

29
Q

What arteries are mainly effected in GCA

A

extradural arteries

30
Q

GCA is closely related to

A

Polymyalga rheumatica

31
Q

Symptoms of GCA

A

Headache, scalp tenderness, on combing hair. pain in jaw and mouth which is worse on eating . SUPERFICIAL TEMPORAL ARTERY MAY BECOME TENDER AND PULSELESS.

32
Q

Optic consiquence of untreated GCA

A

inflammation and occlusion of the ciliary and or central retinal artery, can cause blindness

33
Q

Investigations in GCA

A

ESR elivated about 50 mm/H Liver enzymes elivated too
Normochromic, normocytic anaemia

Temporal artery biopsy - granulomatous changes

34
Q

Management of GCA

A

Prednisolone initially 60-100mg daily ASAP. reduced guided by ESR

35
Q

Cluster headache prophylaxis

A

verampamil

36
Q

CSF appearance, glucose, protein and white cell in bacterial meningitis

A

Cloudy, low glucose, High protein, highest white cells 10-5000 polymorphs.

37
Q

CSF appearance, glucose, protein and white cells in viral meningitis

A

clear/cloudy, 60-80% of plasma glucose, normal/raised protein, 15-1000 lymphocytes

38
Q

CSF appearance, glucose, protein and white cells in TB meningitis

A

Slightly cloudy with fibrin web, Low glucose, high protein, 10-1000 lymphocytes.

39
Q

Meningitis in elderly and immunosuppressed

A

Listeria monocytogenes

40
Q

Alpha haemolytic streptococci that can cause meningitis

A

Streptococcus pneumoniae

41
Q

Triad of symptoms for normal pressure hydrocephalus

A

The classic triad of symptoms is dementia, incontinence and disturbed gait.

42
Q

What is obstructive hydrocephalus and what are the causes?

A

Blockage of flow of CSF, causes dilatation of ventricles superior to block

Causes: tumours, acute haemorrhage (e.g. subarachnoid haemorrhage or intraventricular haemorrhage) and developmental abnormalities

43
Q

What is non-obstructive hydrocephalus and what are the causes?

A

Abnormal production (Choroid plexus tumour) or abnormal re-absorption of CSF (meningitis or post-haemorrhagic)

44
Q

First line investigation of hydrocephalus

A

CT head, followed by MRI

45
Q

In what type of hydrocephalus is lumbar puncture contraindicated?

A

obstructive

Year 3 (26 decks)

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