MKSAP Neuro

Question 1

The International Classification of Headache Disorders categorizes headaches into what 3 major groups?

Answer 1

Priamry, secondary and related to a cranial neuralgia

Question 2

Define primary headaches and list the 4 major categorizations for them:

Answer 2

Biologic disorders of the brain that are differentiated on the basis of clinical criteria. 
Migraine
Tension
Trigeminal Autonomic Cephalgias
Other primary headache disorders

Question 3

List some red flag symptoms that categorize secondary headaches:

Answer 3

first or worst headache; abrupt onset or thunderclap; progression or fundamental change in headache pattern; abnormal physical exam; neurologic symptoms lasting greater than an hour; new headache is someone younger than 5 or older than 50; new headache in patients with cancer or immunosuppressed; association with AMS or LOC; triggered by exertion, sex, or Valsalsva

Question 4

When is neuroimaging indicated in headache and what modality?

Answer 4

Indicated in secondary headaches, rarely in primary headache disorders; MRI preferable except in trauma related injury

Question 5

Define episodic and chronic in terms of length of time of headache disorders

Answer 5

Episodic means # headche free days > days with a headache over a given length of time; chronic means # headache free days < days with a headache

Question 6

Define the term thunderclap headache and what is the most common serious intracranial disorder it is associated with?

Answer 6

Severe headache that reaches maximal intensity within 1 minute. “ Worst headache of my life” Subarachnoid hemorrhage

Question 7

What is the diagnositic workup in suspected SAH?

Answer 7

Emergent CT head. If negative, LP is mandatory.

Question 8

Risk of rupture of cerebral aneurysms greater than __ mm and those located in ____ circulation

Answer 8

5; posterior

Question 9

What are the LP findings in SAH?

Answer 9

Elevated opening pressure, hgih protein levels, and erythrocyte count > 10,000; xanthomchromia

Question 10

Carotid artery dissection can result in heaches in what region?

Answer 10

Frontotemporal

Question 11

Vertebral artery dissection can result in headches in what region?

Answer 11

Occipital

Question 12

Amaurosis fugax, diplopia, or Horner syndrome can indicate what artery involvement for dissection?

Answer 12

Carotid

Question 13

Ataxia, vertigo, nausea and vomiting can be associated with what artery involvement for dissection?

Answer 13

Vertebral

Question 14

Pain exacerbation with the Valsalva maneuver, pulsatile tinnitius and diplopia can indicate what syndrome?

Answer 14

Thrombosis of the cerebral veins or dural sinuses which can also present with abrupt-onset headache

Question 15

What is the treatment for thrombosis of the cerebral veins or dural sinuses?

Answer 15

LMWH inpatient and warfarin for 3-6 months

Question 16

Recurrent thunderclap headaches that usually occurs in women occurs in what syndrome?

Answer 16

Reversible cerebral vasoconstriction syndrome

Question 17

What is the management of RCVS?

Answer 17

Normalization of blood pressure and elimination of any triggering drug or substance. Nimodipine and verapamil.

Question 18

How does PRES present?

Answer 18

Headaches are common but not thunderclap. nausea, vomiting, AMS, seizures and visual compromise are all frequently noted. Brain MRI reveals areas of white matter edema in posterior brain regions and vasoconstriction may not be present.

Question 19

Define idiopathic intracranial hypertension and what demographic does it typical affect?

Answer 19

IIH aka pseudotumor cerebri is characterized by increased intracranial pressure without identifiable structural pathology. From elevated venous pressure and increased resistance to CSF resorption. > 90% of patients are female, obese and of childbearing age.

Question 20

Treament of choice for IIH?

Answer 20

acetazolamide. or topiramate for added weight loss.