MKSAP Flashcards
Name 3 Headache Red Flags
First or Worst Abrupt or Thunderclap Headache Change in Headache Pattern Neurologic Symptoms/Deficits > 1 hour New Headache
Suspect secondary causes in patients > 50 yo, immunocompromised patients, triggered by exertion, sexual activity or valsalva maneuver
What causes the Thunderclap Headache?
or the worse headache of my life
Subarachnoid Hemorrhage due to rupture of sacular aneurysm
Xanthochromia in CSF
What size and location of a cerebral aneurysm has the highest risk of rupture?
> 5 mm and posterior circulation
How long do you treat central vein thrombosis or dural sinus thrombosis?
3-6 months of antiocoagulation
What is reversible cerebral vasoconstriction syndrome?
transient failure of cerebrobascular autoregulation with trigger to adnergic/serotonergic drugs, triggered by exertion, valsalva, or abrupt head movement
Angiography showing multifocal areas of cerebral vasoconstriction
Tx: control BP with Nimodipine/Verapamil
What is posterior reversible encephalopathy syndrome?
Sx, Dx
cerebrovascular regulation disorder
Sx: HA, N/V, change MS, seizure, visual changes
MRI: white matter edema in posterior brain (posterior occipital or parietal lobe)
Name 5 risk factors of Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Female, Obese, child-bearing age, Vitamin A toxicity, use of tetracycline Abx, Isoretinoin, pregnancy, steroid use
Diagnose Idiopathic Intracranial Hypertension
- Papilledema
- Visual Field Obscuration (increased blind spot and decreased peripheral field)
- MRI showing normal/small ventricles, partially empty sella turcica, flattened optic globe
- CSF opening pressure > 250
(You can do an LP because of cerebral compliance- no risk of herniation with increased ICP- Ani)
Treat Idiopathic Intracranial Hypertension
Acetazolamide
or Topiramate (for carbonic anhydrase inhibitor)
If refractory, CSF decompression by optic nerve fenestration or Lumboperitoneal shunting
Treat Intracranial Hypotension
improving symptoms while supine
Iatrogenic- LP, surgery or trauma
bedrest, analgesia, fluids, 10-15mL homologous blood in epidural space, IV caffeine, epidural saline, surgically correct dural tear
Treat Trigeminal Neuralgia
What blood tests do you need to monitor with medication?
Carbamazepine or Oxcarbamazepine (check for agranulocytosis or hyponatremia)
2nd line: Gabapentin, baclofen, lamotrigine, clonazepam
Diagnostic Criteria for MIGRAINE
Onset: 5 attacks lasting 4-72 hours Must have 2/4: 1. Unilateral 2. Pulsatile 3. Severe, Debilitating 4. Aggravated by exertion
Must have 1/2:
- Nausea/Vomiting
- Photophobia/Phonophobia
In which type of migraines should you AVOID triptans?
Brainstem aura and hemiplegic (motor weakness)
Why should you avoid OCP in Migraine with auras?
Increased risk of STROKE
First line therapy for Migraines
NSAIDS, triptans
Treat Status Migrainosus
IV dihydroergotamine
Treat Chronic Migraine
Topiramate or botulinum toxin A
Treat Refractory Migraine
Prochlorperazine (antidopaminergic)
Prevent Migraines
Valproic Acid Metoprolol Propranolol Timolol Topiramate Divalproex sodium/ Depakote
Diagnostic Criteria for Tension Type Headache
10 attacks lasting 30 minutes-7 days Must have 2/4: 1. Bilateral 2. Non pulsatile 3. Mild-moderate Intensity (Not Ridic Severe) 4. Not aggravated by exertion
Must have 1/2:
- No nausea/vomiting
- No more than 1 episode of photophobia/phonophobia
ITS NOT A MIGRAINE HA!
First line Therapy for Tension Type Headache
NSAIDS, Acetaminophen, ASA
Prevent Tension Type Headache
Amitriptyline
Venlafaxine
Mirtazapine
Diagnostic criteria for Cluster Headache
5 severe attacks of unilteral orbital, supraorbital or temporal
Lasting 5-180 minutes (NO MORE THAN 3 HOURS)
Must have 1 of the following:
conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial sweating/flushing, miosis, ptosis, eyelid edema)
OR
restlessness/agitation
Treat Acute Cluster Headache
Subcutaneous Sumatriptan
O2
Prevent Cluster Headache
VERAPAMIL
after steroid transition
Timing & Diagnosis of Chronic Paroxysmal Hemicrania
5 times daily from 3-20 minutes
INDOMETHACIN
Timing & Diagnosis of SUNCT
Extra Credit: What does SUNCT stand for? =)
10-100s times daily from 1 second- 10 minutes
Lamotrigine helps, but nothing definitive
Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing- HAH!
What causes Epidural Hematoma?
Temporal Bone fracture with middle meningeal artery laceration
LUCID INTERVAL
What causes Subdural Hematoma?
Bridging Vein between cortex/dura
INDOLENT COURSE
Broad spectrum treatment of seizures
for generalized and partial epilepsy
Lamotrigine, Levetiracetam, Topiramate, Valproic Acid, Zonisamide
Narrow spectrum treatment of seizures
Carbamazepine, Oxcarbazepine, gabapentin, pregabalin phenobarbital, phenytoin
Which AED to give pregnant patients?
Lamotrigine (and folate!!)
Which AED cause nephrolithiasis?
Topiramate/Zonisamide
Which AED causes weight gain, increased cholesterol or PCOS?
Valproic Acid
Which AED do you need to routinely check levels because it can cause arrhythmias?
Phenytoin
Which AED is notorious for causing hyponatremia?
Carbazepine
Which AEDs are safe in the elderly?
Lamotrigine (in preggos too!)
Levetiracetam
Gabapentin
Estrogen containing contraceptive can lower which AED level?
Lamotrigine
