Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neuro > Headaches / Raised ICP > Flashcards

Headaches / Raised ICP Flashcards

1
Q

What is a primary headache

A

No underlying medical / structural cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are examples of primary headaches

A 
Tension type = most common
Migraine
Cluster = only one you need to know
Trigeminal neuralgia 
Drug overuse
Post-coital / exertional - can be thunderclap
- Require CT to exclude structural brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are secondary headaches

A

Have a structural cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are examples of structural causes

A 
SAH 
Stroke / TIA 
Carotid dissection 
Tumour 
GCA
Meningitis
Venous sinus thrombosis 
Intracranial hypotension
Head injury
Acute glaucoma
Metabolic - CO poisoning 
Drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a thunderclap headache

A

High intensity reaching max in <1 min

Can be primary or secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do all thunderclap headaches get

A

CT and LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What must you rule out

A

SAH !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is important in Hx of headache and give example

A

Onset
SAH = instant
Meningitis = subacute
SOL = progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes acute single headache

A 
Meningitis / encephalitis 
SAH 
Head injury
Sinusitis
Glaucoma
Tropical illness e.g. malaria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes chronic

A

Raised ICP / SOL
Psychological
Paget’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is important in Hx of headache

A 
SOCRATES
Sudden or gradual 
Better sitting up or lying flatt 
Any N+V
Vertihgo
Vision / eye pain / photophobia
Neck stiffness 
RED FLAGS
Examination for papilloma suggesting raised ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is important in PMH

A

Previous episode
HTN?
Vasculitis / inflammatory flare
Hx malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is important in drug Hx and social Hx

A

Anti-coagulant
Anti-hypertensive
Any Rx tried
Medication overuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is important to examine

A

Neuro

  • Limb power, tone, reflex
  • Pronator drift
  • CN
  • Visual fields
  • Fundoscopy
  • Cerebellar
  • Gait
  • Calculate GCS
  • PEARL ?

If normal neuro and not a thunderclap headache = usually no more investigations
Otherwise = CT to rule out secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are red flags for secondary headache requiring urgent imaging

A 
New onset
Thunderclap 
Increasing in frequency and severity 
>50
<20 
History of malignancy 
Vomiting with no other cause
Immunosuppressed - HIV 
Change in freq / characteristics + fever  
New onset neurological deficit
Focal neuro signs 
Papilloedema 
Visual disturbance 
Impaired consciousness 
New onset cognitive / personality change 
Recent head trauma 
Neck stiffness / fever / photophobia 
Low pressure - precipitate standing up 
High pressure - worse lying down / cough
Wake from sleep 
Any RF for cerebral venous sinus thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the stages of migraine (don’t have to go through all)

A 
Pre-Aura
Aura
Early headache
Advanced headache
Post headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What causes aura and what can it present with

A 
Cortical spreading depression evolves over 5-60 minutes 
Mood changes
Fatigue
Muscle pain
Cravings 
Visual loss
Sensory paresthesia
Motor Sx
Speech disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do you get post head

A

Fatigue

Muscle pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is acephalic migraine

A

No headache occurs after aura

Common in elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What causes migraine and what can trigger

A 
Primary brain = sensitisation of trigeminal system 
Stress
Hunger
Sleep disturbance
Dehydration
Diet
Alcohol
OCP 
Changes in oestrogen
Bright lights
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the symptoms of migraine

A 
Headache lasting 4-72 hours
Aura
Nausea
Photo / phonophobia
Functional disability
Confusion / ataxia / aphasia in young
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What must headache in migraine have

A 
2+ of
Unilateral
Pulsating
Moderate - severe
Made worse by activity

So can have bilateral and still be migraine if meets other criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What must migraine attacks have

A

5+ headaches with features above lasting
4-72 hours
At least one of N+V / photophobia / phonophobia
No other cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can aura be confused with

A

TIA

Migraine tends to have more +ve sx e.g. tingling rather than loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When would you further investigate aura
``` Motor weakness Double vision Only one eye Poor balance Decreased GCS Migraine tends to have +Ve Sx where as stroke = -ve ```
26
How do you treat migraine
Paracetamol / NSAID / aspirin Triptans (5HT3 agonist) - MAXALT MELT If <18 nasal Anti-emetic
27
When are triptans CI
IHD
28
What is used as prophylactic medication
If 2+ attacks per month Propranolol - not if asthma Toperimate - not 1st trimester as cleft lip / women child bearing Canderstartan ``` 2nd line AED TCA - amitryptilline = off-license Venlafaxine Acupuncture ```
29
How do you treat migraines in pregnancy
``` Often improves Paracetamol = 1st line NSAID in 1st or 2nd trimester Avoid aspirin / opiates Propranolol or amitriptyline ```
30
What is CI in migraine with aura
Combined OCP due to risk of stroke | CVS RF worsen risk
31
What is tension type headache
Bilateral headache No associated features Not worsened by exercise
32
What is episodic vs chronic
Chronic if >15 days per month
33
How do you treat
Paracetamol / aspirin = 1st month NSAID Amitryptilline / sodium valproate for long-term Acupuncture if chronic
34
What causes medication overuse
Simple analgesia used >15 days Triptans / opioids >10 Caffeine overuse
35
How does medication overuse present and who is prone
Headache >15 days Usually migraine like Improves when analgesia stops Common if get migraine
36
What are the trigeminal autonomic cephalgia's
Cluster headache Paraoxysmal hemicrania SUNCT Trigeminal neuralgia
37
What are the autonomic symptoms
``` Conjunctival haemorrhage / injection Nasal congestion Eyelid oedema Sweating Miosis Ptosis Facial flushing ```
38
How do cluster headaches present
``` Intense sharp stabbing pain Orbital + temporal (around one eye) Usually unilateral Restless / agitated Can be thunderclap Cluster into bouts which usually occur once a year Circadian rhythm Autonomic Sx = common ```
39
How long do attacks / bouts of cluster last
15minutes - 3 hours Rapid cessation Get 1-8 per day Lasting 4-12 weeks
40
Who is at risk and what triggers
Men Smoking Alcohol FH
41
What should you do
Refer for neuro imaging | Beware of acute angle closure glaucoma but usually eye signs
42
How do you treat
Triptan nasal spray SC triptans OXYGEN = respond to high flow Long term Avoid trigger eg. alcohol Verapamil for long term Depomedrone injection on same side during bout
43
What do paroxysmal hemicranial headaches present
``` Orbital and temporal headache Unilateral Migraine Sx Autonomic Sx No circadian ```
44
How long do they last and how many
2-30 minute Rapid onset and cessation Usually 5. day
45
How do you treat paroxysmal
Indomethacin
46
What causes trigeminal neuralgia
``` Something touching trigeminal nerve Blood vessel ? Aneurysm Tumour Chronic inflammation MS ```
47
How does trigeminal neuralgia present
``` Unilateral stabbing pain - extreme pain Lasts seconds Maxillary more common than opthalmic Autonomic uncommon Refractory period present If no refractory - may be SUNCT ```
48
What can trigger
``` Wind Cold Touching Washing area Shaving Eating ```
49
What investigations
MRI to exclude secondary causes
50
How do you treat
Carbamazepine = 1st line prophylaxis Other AED - gabapentin / lamotrigdine Refer to neuro if don't respond Decompressive surgery
51
What are red flags of underlying cause
``` NEURO DISTURBANCE Sensory change Deafness Hx skin / ora lesion Pain bilateral or only in ophthalmic region Optic neuritis FH MS <40 ```
52
Meningitis / encephalitis
SEE INFECTION
53
What are common infectious causes of meningitis
Nesseria meningitides S.pneumonia Enterovirus
54
What are non infectious causes
Sarcoid Drugs Malignancy - leukaemia / lymphoma
55
How does meningitis present
``` Unwell Gradual onset / thunderclap headache Neck stiff Fever Flu like symptoms / viral illness Vomiting Photo / phonophobia Rash - purpuric GCS <14 Confusion CN palsy / seizure / focal Sx may occur ```
56
What signs if meninges involved
+ve Kernig
57
How do you investigate
General exam + neuro Blood culture LP CT prior to LP to look for SOL
58
What are CI to LP
``` Focal deficit suggest brain mass Seizure Papilloedema Abnormal consciousness suggesting raised ICP Immunocompromised Unstable bleeding disorder ```
59
What can meningococcal disease cause
Thrombocytopenia so don't LP if meningococcus
60
How do you Rx
IV Ax - ceftriaxone (give without delay) Add amoxicillin if very young or old Fluids Oxygen Viral = self limiting Add IV acyclovir if any suggestion of encephalitis e.g. cerebral signs
61
What are complications of meningitis
``` Sepsis Permanent brain / nerve damage Sensorineural hearing loss - screen Visual loss Epilepsy Paralysis Abscess Brain herniation Hydrocephalus ```
62
What does CSF show if bacterial
Increased opening pressure High neutrophil Reduced glucose High protein
63
What does CSF show if viral and encephalitis
Increased pressure High lymphocytes Normal glucose Slightly increased protein
64
Wha is encephalitis
Inflammation / infection of brain substance
65
What causes encephalitis
HSV Arbovirus if travel related Autoimmune
66
Where does typically affected
Temporal lobe
67
What are the symptoms of encephalitis
``` Headache Fever Meningism Flu prodrome Vomiting Altered mental state Altered consciousness Focal S+S Seizures Psychiatric ```
68
How do you Dx
Blood cultures LP inc PCR for HSV CT / MRI may show changes
69
What do you give if suspect
IV acyclovir
70
What causes raised ICP and how does It cause headache
``` Malignancy / tumour SOL Haemorrhage Aneurysm Abscess Chronic haematoma Cyst ``` Headache - Raised ICP - Vascular - Meningeal involvement
71
What can tumour be
``` Metastatic Astrocytoma Glioblastoma Olidogendroglioma Mengioma Primary CNS lymphoma ```
72
Where are mets common from
``` Lung Breast Colon Kidney Melanoma ```
73
What are symptoms of raised ICP
``` Gradual progressive headache Worse in the morning Worse lying flat or with valsalva Vomiting Paplloedema - bilateral Falling GCS Seizures Bheaviour change Focal neuro Pulsatile tinnitus 6th nerve palsy 3rd nerve palsy due to uncle herniation - Dilated pupil Cushing's reflex ```
74
What causes vomiting
Compression of VRZ | No nausea
75
What are focal signs
Hemiparesis Dysphasia Hemianopia CN palsy
76
What are symptoms of Cushing's
Hypertension Tachycardia Irregular breathing Bradycardia
77
How do you Dx raised ICP
``` Neuro exam Fundoscopy Assess for primary CT head Consider biopsy LP Routine bloods ```
78
How do you assess for primary
CXR? Biopsy of LN to find tumour type Easier than biopsy intra-cranial lesion
79
What should you avoid before imaging
LP as risk of coning
80
What is 1st line
CT head
81
What are new methods of monitoring raised ICP
Brain tissue oxygen monitoring - o2 levels drop before ICP goes up Micro-dialysis to investigate brain metabolism
82
How do you initially manage raised ICP
``` Analgesia Mannitol Dexamethasone - if oedema Raise head 45 Hyperventilate so less blood needed Maintain O2 sats Low CO2 as acidic = oedema Reduce metabolism = coma ```
83
How do you treat
``` Shunt to relive pressure Remove tumour if possible Surgery RT Chemo ```
84
What suggests benign cause
Progressive headache with no other signs
85
What makes up ICP / Munro Kelly
``` Volume intracranial = V Brain tissue V Blood V CSF = a constant ```
86
How do adapt to raised ICP
Shift in CSF Autoregulation Will eventually fail causing swelling, ischaemia due to decreased CPP, internal shift / herniation as strictures displaced
87
What is subfalcine herniation
Cingulate gyrus moves under falx cerebri
88
What is uncul tentorial herniation
Uncus of temporal lobe herniates under tentorium cerebelli | Brain stem compressed
89
What happens if brain stem compressed
3rd CN palsy - ipsilateral fixed dilated pupil | Spinal tracts affected = contralateral paralysis
90
What is tonsilar herniation / Coning
Tonsils move down crushing brain stem through foramen magnum Death due to cardiorespiratory centre involvement Neurosurgical emergency
91
What causes Cushing's reflex
``` Arterioles compressed Autonomic sympathetic activated Causes hypertension and tachy Irregular breathing Hypertension picked up so vagus = bradycardia ```
92
What makes up CPP
MAP - ICP
93
What is CBF regulated by
``` CPP Conc of CO2 and O2 Neurohormonal Cerebral metabolism Autoregulation - ability to maintain CPP over a wide range of pressures ```
94
What happens if CPP low
Arterioles dilate so more blood | Will constrict if high
95
What happens if CPP falls too low
Arterioles can't dilate anymore so no flow
96
What happens if CPP becomes too high
Cannot compensate anymore
97
If this auto regulation fails what happens and when does it happen
Raised ICP and decreased CPP Vasogenic and cytotoxic oedema Usually first few days after brain injury
98
What causes cerebral / brain abscess
Head injury Spread from dentist / sinus / ear infection Bacteraemia Neurosurgical
99
Common organism
Strep | Fungal in immunocompromised
100
What are symptoms
``` Fever Headache Focal signs Raised ICP Menigism if empyema ```
101
How do you Dx
``` CT - 1st line Hard to distinguish between abcess and tumour MRI Bloods Biopsy to drain ```
102
How do you treat
Surgical drainage | IV Ax
103
What is differential
Tumour | Subdural haematoma
104
What is GCA
Inflammation of large arteries in brain
105
How does patient present
``` >50 New headache Jaw claudication / pain Visual disturbance 2 to ischaemic neuropathy - unilateral blidness / amuorisis fujax (pale optic disc on fundoscopy) Systemically unwell Prominent beaded temporal arteries / tender PULSELESS as occluded Nausea Anoreixa Features of PMR ```
106
What is associated
Polymyalgia rheumatica
107
How do you Dx
Raised ESR / CRP / platelet / WCC as autoimmune Temporal artery doppler replaced biopsy as biopsy could miss skip lesions Fluorescein angiography may confirm CK / EMG normal
108
How do you Rx
Opthamalogy High dose prednisolone - 1mg/kg If amaurosis fujax = give IV as risk of vision Drugs to lower intraocular pressure Also give calcium / biphosphonates/ PPI for bone protection if on steroid
109
What causes cerebral venous sinus thrombosis (occlusion of venous channels)
Infections in mastoids or orbit = common cause of cavernous sinus thrombosis Other infection - TB / sepsis / endocarditis Trauma Head injury Hypercoagulable state - preg / OCP / steroid / post-partum Intracranial hypertension Post LP dural puncture Severe dehydration
110
What are signs
``` Consider in all patient with subacute headache presenting with a seizure Headache - usually diffuse and progressive but can have thunderclap N+V Focal neuro Reduced GCS Papilloedema Dilopia Seizure Stroke CN palsy ``` Cavernous sinus - Reduced acuity - Proptosis - Opthamolplegia - Absent corneal reflex
111
Who is at risk
``` OCP Dehydration Malignancy Sepsis Pregnancy Post-partum Vasculitis IBD SLE ```
112
How do you Dx and Rx
``` Exclude SAH Thrombophilia screen MR venogram = 1st line - Empty delta scan MRI > CT if suspect - Hyperdense vein ``` Phenytoin if siezure Anti-coagulation with heparin = Rx of choice If deteriorating consciousness = radiologically guided catheter to delivery thrombolytic therapy due to risk of haemorrhage as blockage leads to cerebral oedema with haemorrhage risk Shunt if raised ICP After acute episode = DOAC
113
What causes spontaneous intracranial hypotension
CSF leak post LP or epidural | Very rare
114
What are the symptoms
Headache | Worse sitting up
115
How do you Dx
MRI
116
How do you treat
``` Conservative Best red IV fluid Analgesia Caffiene Epidural blood patch if fails ```
117
Who is at risk
Connective tissue | Marfans
118
What causes disruption to BBB and what does it lead too
Increased ECF causing vasogenic oedema | Tumour / abscess / trauma
119
What causes membrane failure
Cell damage | Causes influx of Ca and swelling = cytotoxic oedema
120
How do you Rx BBB failure
Mannitol + steroids
121
How do you Rx membrane failure
Mannitol
122
What are rare variants of migraine
Basilar Hemiplegic Opthamoplegic
123
What is basillar
``` Bilateral visual disturbance Dysarthria Ataxia Vertigo Nystagmus Diplopia ```
124
What is hemiplegic
Aura of hemiplegia / ataxia Can persist after headache gone Can present like stroke
125
What is opthalmolpegic
Extra-ocular nerve palsy | Acute CN III palsy, pain, and dilated pupil
126
What are symptoms of idiopathic intracranial hypertension
``` Daily headache - Bifrontal temporal - Worse straining Blurred vision Papilloedema Enlarged blind spot 6th nerve palsy = most commonly focal sign May cause cerebral thrombosis Present like mass with none found ```
127
Who is at risk
``` Young Female Obesity Pregnancy OCP Anabolic Steroid Tetracycline Lithium Retinoid / vit A ```
128
How do you investigate
CT shows no focal LP shows raised ICP with normal composition Fundoscopy
129
How do you Rx
``` Weight loss Prednisolone Repeat LP to drain CSF Surgery VP sunt ``` ``` If evidence of visual damage Urgent opthamology Diuretic Carbonic anhydride to reduce CSF Optic nerve decompression as can lead to permanent blindness ```
130
When do you suspect acute glaucoma
Eye pain and reduced vision
131
When do you suspect GCA
>50 with headache thats lasted a few weeks
132
What headache features should get urgent CT
``` Vomiting >1 New neuro Reduced conscious (GCS) Valsalva or positional Progressive with fever ```
133
What do exertional headache require if new onset / 1st presentation
CT to exclude structural brain abnormality
134
How does carotid artery / vertebral artery dissection present
Abrupt onset unilateral headache Can be precipitated by trauma HTN / aneurysm - but consider if stroke and no CVS RF Neck or face pain Horner syndrome may be seen Brain stem and cerebellar signs if vertebral
135
What are known association
Hypertension | Marfan's
136
When do you consider and how do you Dx
Any young patient presenting with Sx of a stroke | Dx = CTA or MRA
137
What should anyone with headache in ED be asked
Any exposure to CO
138
Important to remember
Headaches can present with a combination so can be confusing What is most likely

Neuro (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions