Headaches

Question 1

First step in idiopathic intracranial hypertension (pseudotumor cerebri):

Answer 1

LP: document an opening pressure, which will be elevated. It will also temporarily relieve symptoms.

Question 2

What is Acetazolamide and how is it used?

Answer 2

A carbonic anhydrase inhibitor, used to decrease CSF production in idiopathic ICH patients.

Question 3

Excess intake of which vitamin has been shown to lead to pseudotumor cerebri?

Answer 3

Vitamin A

Question 4

Idiopathic ICH presentation:

Answer 4

Young, obese females, due to impaired absorption of CSF. Headache, transient episodes of visual loss due to increased pressures (sneezing/coughing). Papilledema.

Question 5

MRI findings of idiopathic ICH:

Answer 5

“Slit-like” ventricles; empty sella (flattening of the pituitary due to pressure).

Question 6

Initial treatment for temporal arteritis:

Answer 6

Prednsone

Question 7

Most feared complication of untreated temporal arteritis is:

Answer 7

Unilateral vision loss

Question 8

What is temporal arteritis?

Answer 8

Arteritis of extracranial carotid artery and its branches, patients >60 with indolent headache in the temple, jaw claudication (pain with chewing), associated with PMR. Elevated ESR/CRP, biopsy.

Question 9

Treatment for cluster headaches:

Answer 9

100% oxygen

Question 10

Criteria for a cluster headache:

Answer 10

At least 5 attacks of severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 min untreated, with 1+ signs on same side:

1. Conjunctival injection
2. Lacrimation
3. Nasal congestion
4. Rhinorrhoea
5. Forehead and facial sweating
6. Miosis
7. Ptosis
8. Eyelid Edema

Question 11

T/F: Migraine HA pain is bilateral.

Answer 11

False

Question 12

A migraine without an aura is called a _____. A migraine with an aura is a _____.

Answer 12

common migraine; classic migraine

Question 13

What is an ophthalmoplegic migraine?

Answer 13

Associated with retroorbital pain and cranial nerve palsies (3, 4, 6).

Question 14

Which medication is indicated as an abortive treatment in migraines?

Answer 14

Sumatriptan

Question 15

In which patients are triptans contraindicated and why?

Answer 15

CAD - they are vasoconstrictive, concern for stroke.

Question 16

When is prophylactic migraine treatment indicated?

Answer 16

> 2/month, or when causing disruptions to the person’s lifestyle by missing school or work. Topiramate is the most commonly used medication, SSRIs are not acceptable.

Question 17

What are headache red flags?

Answer 17

HA in older person with no history, HA associated with focal neuro deficits/personality changes, HA in immunocompromised, HA worse in the morning, HA associated with signs of systemic disease (fever, weight loss, etc.).

Question 18

A glioma is a tumor that arises from the glial cells of the brain, what are they?

Answer 18

Astrocytes, oligodendrocytes, ependymal cells, and choroid plexus cells.

Question 19

Most common tumor of childhood:

Answer 19

Medulloblastoma. Occur in the cerebellum and present with ataxia as well as signs of increased ICP (headaches, vomiting).

Question 20

Cerebellar masses in adults are what?

Answer 20

Mets

Question 21

Non glial tumors include:

Answer 21

Meningiomas and Primary CNS lymphomas.

Question 22

Where is it thought that meningiomas arise?

Answer 22

The arachnoid

Question 23

Multiple meningiomas can occur as a feature of what?

Answer 23

NF2

Question 24

Most common source of mets overall:

Answer 24

Lung tumors

Question 25

Which tumors are well known to bleed?

Answer 25

Melanomas, renal cell cancers, choriocarcinomas.

Question 26

Where are most mets found in the brain and why?

Answer 26

Junction of gray/white matter, they spread hematogenously.

Question 27

Enhancement of the meninges on imaging is:

Answer 27

intracranial hypOtension

Question 28

Tumors that can grow in the ventricles (and how they present):

Answer 28

Colloid cyst, meningioma, central neurocytoma: they can block the flow of CSF and cause positional HA and LOC due to sudden increases in ICP with acute obstruction.

Question 29

Characteristics of closed-angle glaucoma:

Answer 29

More common in asian countries, sudden ocular pain, halos around lights, red eye, very high intraocular pressure, n/v, decreased vision, and a fixed, mid-dilated pupil. This is an emergency needing timolol drops to the eyes.