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Neurology Year 3 > Headaches > Flashcards

Headaches Flashcards

1
Q

Pyramidal distribution

A

A two-neuron system consisting of upper motor neurons in the Primary Motor Cortex and lower motor neurons in the anterior horn of the spinal cord. Each of these neurons have extremely long axons.

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2
Q

Functional weakness

A

No wasting, normal tone, normal reflexes, erratic power, non-anatomical loss

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3
Q

Neuromuscular junction symptoms

A

Fatigable weakness, normal or decreased tone, normal tendon reflexes. No sensory symptoms!

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4
Q

Motor symptoms of median nerve neuropathy

A

Unable to abduct thumb

Thenar atrophy

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5
Q

Sensory symptoms of median nerve neuropathy

A

Thumb, 2nd, third and lateral one half of 4th finger

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6
Q

Motor symptoms of ulnar nerve neuropathy

A

Unable to adduct finger and thumb

claw hand

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7
Q

Sensory symptoms of ulnar nerve neuropathy

A

Fifth and medial one half of fourth finger

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8
Q

Motor symptoms of radial nerve neuropathy

A

Unable to extend wrist, thumb and fingers (wrist drop)

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9
Q

Sensory symptoms of radial nerve neuropathy

A

Sensory loss in dorsum of hand

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10
Q

Motor symptoms of sciatic nerve neuropathy

A

Ankle doriflexors and plantar flexors (flail ankle)

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11
Q

Sensory symptoms of sciatic nerve neuropathy

A

Buttocks, lateral calf and most of foot

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12
Q

Motor symptoms of femoral nerve neuropathy

A

Paralysis of knee extensors

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13
Q

Sensory symptoms of femoral nerve neuropathy

A

Anterior thigh and medial calf

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14
Q

Motor symptoms of fibular nerve neuropathy

A

Paralysis of ankle dorisflexors &foot evertors

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15
Q

Sensory symptoms of fibular nerve neuropathy

A

Dorsum of foot and lateral calf

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16
Q

An example of a median nerve neuropathy

A

Carpal tunnel syndrome

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17
Q

An example of a radial nerve neuropathy

A

Saturday night palsy

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18
Q

An example of a fibular nerve neuropathy

A

Foot drop

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19
Q

Myoclonus

A

sudden, brief involuntary twitching or jerking movements

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20
Q

Chorea

A

rapid jerky involuntary movements

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21
Q

Dystonia

A

Unintentional sustained muscle contractions leading to abnormal postures e.g., clenching teeth

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22
Q

Hypomimia

A

Is a reduced degree of facial expression

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23
Q

Hypophonia

A

Weak voice due to incoordination of the vocal muscles.

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24
Q

Ataxia

A

Lack of muscle control & coordination of voluntary movements.

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25
Dysdiadochokinesis
Clumsy fast alternating movements
26
Cerebellar signs
``` Cerebellar gait is broad-based & unsteady Intention tremor Dysdiadochokinesis Nystagmus Dysarthria ```
27
Paratonia
Inability to relax muscles
28
Paraparesis
Partial paralysis of lower limbs
29
Exacerbating features to ask about in headache history taking.
Posture, Valsalva (sneezing, coughing, straining etc). Diurnal variation.
30
Valsalva manoeuvre
A breathing method that may slow your heart when it’s beating too fast. To do it, you breathe out strongly through your mouth while holding your nose tightly closed.
31
Phonophobia
Called ligyrophobia or sonophobia, is a fear of or aversion to loud sounds
32
Miosis
Excessive constriction of the pupil of the eye
33
Red flag symptoms in headache history taking
1. New onset headache >55 2. Known/previous malignancy 3. Immuno-suppressed 4. Early morning headache 5. Exacerbation by Valsalva
34
Migraine symptoms
Recurrent, severe headache which is usually unilateral and throbbing in nature May be associated with aura, nausea and photosensitivity Aggravated by, or causes avoidance of, routine activities of daily living. Patients often describe 'going to bed'.
35
Tension headache
Recurrent, non-disabling, bilateral headache, often described as a 'tight-band' Not aggravated by routine activities of daily living
36
Cluster headache symptoms
Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks Intense pain around one eye (recurrent attacks 'always' affect same side) Patient is restless during an attack Accompanied by redness, lacrimation, lid swelling More common in men and smokers
37
Cluster headaches are more common in what people?
More common in men and smokers
38
Temporal arteritis
``` Typically patient > 60 years old Usually rapid onset (e.g. < 1 month) of unilateral headache Jaw claudication (65%) Tender, palpable temporal artery Raised ESR ```
39
Medication overuse headache
Present for 15 days or more per month Developed or worsened whilst taking regular symptomatic medication Patients using opioids and triptans are at most risk May be psychiatric co-morbidity
40
What drugs are associated with medication overuse headache?
Opioids and triptans
41
Epidemiology of migraine
3 times more common in women | Prevalence in men is around 6%, in women 18%
42
Common triggers for a migraine attack
1. tiredness, stress, alcohol 2. combined oral contraceptive pill, 3. lack of food or dehydration 4. cheese, chocolate, red wines, citrus 5. menstruation, bright lights
43
Non-pharmacological treatment for migraines
1, Education- avoid triggers 2. Headache diary 3. Diet- regular intake, avoid triggers 4. healthy balanced diet 5. Hydration- at least 2 litres day, 6. decrease caffeine 7. Stress- decrease 8. Regular exercise
44
Acute pharmacological treatment for migraines
Combination therapy of NSAIDs and Triptans NSAIDs 1. Aspirin 900mg, 2. Naproxen 250mg 3. Ibuprofen 400mg Triptans 1. Rizatriptan= eletriptan > sumatriptan 2. Frovatriptan for sustained relief
45
Prophylactic treatment for migraines
More than 3 attacks month or very severe consider prophylaxis 1. Amitriptyline 2. Beta blockers – propranolol 3. Topiramate
46
Side effects of Amitriptyline
Dry mouth, postural hypotension, sedation
47
Topiramate mechanism of action
Carbonic anhydrase inhibitor (Na/ GABA)
48
Topiramate side effects
Poor side effect profile- start slowly Weight loss, paraesthesia, impaired concentration, enzyme inducer
49
NSAIDs used in migraines
1. Aspirin 900mg, 2. Naproxen 250mg 3. Ibuprofen 400mg
50
Triptans used in acute management of migraines
1. Rizatriptan= eletriptan > sumatriptan | 2. Frovatriptan for sustained relief
51
Management of tension-type headache
Acute treatment: aspirin, paracetamol or an NSAID are first line Prophylaxis: NICE recommend 'up to 10 sessions of acupuncture over 5-8 weeks'
52
Management of Cluster headaches
Acute: 100% oxygen (80% response rate within 15 minutes), subcutaneous triptan (75% response rate within 15 minutes) Prophylaxis: verapamil is the drug of choice.
53
Paroxysmal hemicrania (PH)
Defined by attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region. These attacks are often associated with autonomic features, usually last less than 30 minutes and can occur multiple times a day.
54
Hemicrania continua
A chronic and persistent form of headache marked by continuous pain that varies in severity, always occurs on the same side of the face and head and is superimposed with additional debilitating symptoms. on the continuous but fluctuating pain are occasional attacks of more severe pain.
55
Treatment of Hemicrania continua
indomethacin (Only NSAID that works)
56
SUNCT Headaches
* S= Short lived (15-120 secs) * U=unilateral * N= neuralgiform headache * C= conjunctival injections * T= Tearing
57
Treatment for SUNCT Headaches
Lamotrigine, Gabapentin
58
Drugs that cause Idiopathic intracranial hypertension
``` > combined oral contraceptive pill > steroids > tetracyclines > vitamin A > lithium ```
59
Risk factors for Idiopathic intracranial hypertension
o obesity o female sex o pregnancy o drugs*
60
Features for Idiopathic intracranial hypertension
``` o headache o blurred vision o papilledema (usually present) o enlarged blind spot o sixth nerve palsy may be present ```
61
Management of Idiopathic intracranial hypertension
``` o weight loss o diuretics e.g. acetazolamide o topiramate is also used, o repeated lumbar puncture o Optic nerve sheath decompression o Lumboperitoneal or ventriculoperitoneal shunt may also be performed to reduce intracranial pressure ```
62
What diuretic is used in Idiopathic intracranial hypertension
acetozolamide
63
What are ways to reduce intracranial pressure?
Lumboperitoneal or ventriculoperitoneal shunt, repeated lumbar puncture

Neurology Year 3 (22 decks)

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