headaches Flashcards
red flags of headache
raised ICP neurological deficit sudden onset, does not get better weight loss, fever, confusion, seizures constitutional symptoms (fatigue, weakness)
elderly: jaw claudication - think tumours and temporal arteritis
types of sinister headaches
venous sinus thrombosis hydrocephalus idiopathic intracranial HTN space occupying lesion temporal arteritis dissection meningitis/encephalitis subarachnoid hemorrhage
all cause neurological deficits
venous sinus thrombosis features**
raised ICP
rapid onset (minutes)
- seizures
- possibly thrombophilia
hydrocephalus features
raised ICP
variable onset
idiopathic intracranial HTN features
raised ICP
weeks-mths
- visual obscuration: affects CN2
- diplopia: affects CN6
usually affects overweight females
space occupying lesion (tumour) features
raised ICP
really long onset (wks/mths/yrs)
- seizures
- constitutional symptoms (fatigue, weakness, weight loss)
temporal arteritis features
normal ICP
onset: hours-days
- tender temporal artery
- amaurosis (vision loss not caused by lesions) - bilateral blindness
test: temporal artery biopsy, but beware skip lesions
treatment: high dose steroids
affects elderly (>50)
(carotid artery) dissection features**
normal ICP fast onset (sec/min) - tearing pain in neck and behind eye - possibly presents w/ horner syndrome (decreased pupil size, a drooping eyelid and decreased sweating on the affected side of face) - hypoglossal nerve palsy
treatment: anticoagulation, angioplasty
meningitis/encephalitis features
ICP may be normal/raised onset in hours - fever - confusion - meningism : irritation of the meninges - infection (bacteria, viral), foreign stuff in CSF (blood, tumour) encephalitis: tend to be HSV virus - present w/ fits - presents w/ stiff neck
complications: seizures, CN deficits, deurological deficit
subarachnoid hemorrhage features**
ICP may be normal/raised
sudden onset (seconds)
- thunderclap headache**: as through hit by a baseball bat
cause blood invade parenchyma -> irritate the arteries -> vasospasm and stroke
blood in CSF, seen by CT scan / lumbar puncture (look for bilirubin NOT RBC cause rbc can be just contamination from traumatic tap)
- neck stiffness
ICP -> 6th nerve palsy
CN6 vulnerable to being squished cause it emerges from the lip of foramen magnum
(also CN2,3)
hemorrhages not associated w/ headache
- epidural: caused by trauma -> rupture of MMA
- subdural: rupture of bridging veins (affect elderly w/ small brain esp). low pressure + non-irritating -> no headache. can cause confusion + neuro deficit
