Module 8 Flashcards
Trigeminal Neuralgia
- Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.
- “Tic douloureux”
- V2, V3
- S/S:
- Hemifacial spasm
- Extreme burning or shock-like face pain
- One sided
- Episodic (days, weeks, or months)
- Causes:
- Not definite
- Once believed that the nerve was compressed in the opening from the inside to the outside of the skull
- More likely enlarged or lengthened blood vessel – most commonly the superior cerebellar artery – compressing or throbbing against the microvasculature of the trigeminal nerve near its connection with the pons
- Compression can injure the nerve’s protective myelin sheath and cause erratic and hyperactive functioning of the nerve
- Tx:
- Drugs (not opioids, crabemazapine)
- Surgery
Headaches:
Sinus, cluster, tension, migraine
Sinus: Pain is usually behind the forehead and/or cheekbones
Cluster: Pain is in and around one eye
Tension: Pain is like a band squeezing the head
Migraine: Pain, nausea, and visual changes are typical of classic form
Headaches and Migraines
- Causes - DDx
- Underlying pathology: meningitis, tumor, trauma, TIA, temporal arteritis, HTN, dehydration, referred pain
- Testing
- Clinical
- Laboratory tests/hormones
- CT
Cluster headaches
- Cluster HA : Severe pain around or behind the eye
- Unilateral
- More common in men
- Cluster headaches occur in cyclical patterns or clusters — which gives the condition its name. Cluster headache is one of the most painful types of headache. Cluster headache is sometimes called the “alarm clock headache” because it commonly awakens you in the middle of the night with intense pain in or around the eye on one side of your head.
Cluster Headaches
Bouts of frequent attacks — known as cluster periods — may last from weeks to months, usually followed by remission periods when the headache attacks stop completely. During remission, no headaches occur for months and sometimes even years.
Tension Headaches
- Bilateral
- Usually can trace headache to back of skull & top of neck
NSAIDS can help
Can last a couple of hours – couple of days
Some people can suffer from tension headaches daily.
Cause: search for timing to find the cause
Tension HA - Precipitating Factors
- Emotional - anxiety, depression, anger
- Poor posture, close work under poor lighting conditions, or muscle cramps
- Arthritis, particularly cervical arthritis
- Abnormalities in neck muscles, bones or discs
- Eye strain caused when one eye is compensating for another eye’s weakness
- Misalignment of teeth or jaws
- Noise or lighting
Migraine Headaches
- Migraine HA : Vasodilation/vasospasm and stretch of nerves: inflammation
- Unilateral (70%), women
- N/V, photophobia, pain, visual changes (aura), hours to months
- Scintillations
- Can be more cyclic – could get 2 or 3 migraines in a week, then nothing for several weeks
- Most migraine medicine includes caffeine – why?
Caffeine
- Vasoconstrictor
- According to the National Institutes of Health, caffeine is considered a vasoconstrictor. Caffeine constricts blood vessels, which may help migraine sufferers. Blood vessels increase in size during a migraine. Caffeine may help blood vessels return to a normal size, improving the headache. Caffeine is often a vital ingredient in headache medication.
Migraine Triggers
- Lack of or too much sleep
- Skipped meals
- Bright lights, loud noises, or strong odors
- Hormone changes during the menstrual cycle (estrogen-withdrawal HA)
- Stress and anxiety, or relaxation after stress
- Weather changes
- Alcohol (often red wine)
- Caffeine (too much or withdrawal) – study: constricts blood flow
- Foods that contain nitrates (processed meats)
- Foods that contain MSG
- Foods that contain tyramine, such as aged cheeses, soy products, fava beans, hard sausages, smoked fish, and chianti wine
- Aspartame (nutrasweet and equal)
Sinusitis
- S/S:
- Nasal congestion and discharge
- Loss of smell
- Fever
- Headache – pressure
- Sore throat and postnasal drip
- Pain over sinuses
- Causes:
- Common cold
- Allergies
- Deviated septum blocking the sinus opening
- Tx:
- Apply warm moist washcloth over face
- Drink plenty of fluids to thin the mucus
- Nasal spray
- Surgery for septum
- Antibiotics
Meningitis
- Meningitis: most cases: bacterial or viral
- Risk factors: crowded living quarters (dorms, barracks), basilar skull fractures, otitis media, sinusitis or mastoiditis and systemic sepsis
- S/S: fever, HA, photophobia, irritability, clouding of consciousness, and neck stiffness (nuchal rigidity).
- Milder S/S in viral, usually self-limiting
- Meningococcal meningitis (caused by Neisseria meningitidis) usually causes a petechial rash
- Other bacteria - Streptococcus pneumoniae, and Listeria monocytogenes – usually no rash
- Testing:
- Culture of CSF
- CSF:
Bacterial>cloudy, ↑neutrophil and protein levels, ↓ glucose levels
Viral> ↑ Lymphocyte count, mild to mod. protein elevation, normal glucose levels
Kernig’s Sign & Petechial Rash
Positive: Pt cannot extend leg due to pain
Irritates inflammation
Meningococcal meningitis: Petechial rash
Encephalitis
- Encephalitis: acute inflammation of the brain, most commonly viral
- S/S: mild to severe, fever, HA, increased ICP, stiff neck, photophobia, progress to seizure
- EBV
Rabies
Herpesviridae (2 is genital sores, 1 is genital sores), VZV is varicella zoster causes shingles in older adults and chicken pox in kids
WNV West Nile Virus from misicotes
Temporal Arteritis (AKA Giant Cell Arteritis)
- Inflammation of temporal arteries
- Causes
- Mostly unknown > immune response effecting arteries
- Signs and Symptoms
- > 50 y/o
- Throbbing pain, visual changes, weakness, loss of appetite, jaw pain/fatigue while chewing
- Often mistaken for tension HA
- Can lead to irreversible vision loss
- Testing
- Inflammation >
- ↑ CRP
- Biopsy for definitive Dx video
- Inflammation >
- Tx:
- Corticosteroids (1-2 years)
*Inflammation of temporal arteries NOT vein
Usually guys
Tough diagnosis to make
Look for CRP it is a non specific chronic marker
Longer term corticosteroids suppresses the immune system and they might look like poufy and get cushin’s syndrome, their skin will be thin, GI bleeding from thinning of GI tract, do blood work it will show microcytic hypochromic RBCs, at risk for osteoporosis (bone thinning/reapsorption)
Intracranial Hematomas
- Epidural/Extradural- bleeding in epidural space fast
- Subdural- bleeding in subdural space fast/slow
- Causes
- Head trauma
- Anticoagulants /anti-platelet - increased risk
- Age – increased risk
- Congenital malformations – increased risk
- Skull fracture
- Aneurysm
- Head trauma
- Signs and Symptoms
- HA, N/V, visual changes, seizures, ALOC, hemiparesis, speech disorders
- Testing
- CT/MRI
*Classified where the bleeding is taking place in the place
Epi means on top
With an epidural hematoma the blood is sitting on top
Sub is beneath the blood is pooling below the duramoder and collecting on the brain
Anticoagulants like heparin, warfarin, plauix
Congenital malformation is?
Ruptured aneurysm can be a cause
N/V because pons medulla region could be compressed
Visual changes because the optic 2 could be compressed
Go over cranial nerves
Hemiparesis is?
Epidural Hematoma
- Accumulation of blood between dura and skull
- Almost always results from skull fracture (temporal bone) & middle meningeal artery laceration & bleeding
- Underlying brain usually minimally damaged; neurological deficits & HA begin within hours
- Usually bleed fast
Almost always from a skull fracture
s/s will come on fast within hours
Middle meningeal artery
Epidural Hematoma
Subdural Hematoma
- Accumulation of blood beneath dura, covering surface of brain
- Usually due to laceration of veins that penetrate dura
3 types: Acute, sub-acute, chronic - Causes inc ICP, herniation may result Look in the eyes, what might you see?
- Effects begin 48 hrs post trauma: HA, confusion
- Blood that is pooling beneath the dura
The brain gets smushed
Caused include increased ICP
If it smushed the optic nerve you will see visual changes and if motor nerve you will see motor changes
Epidural Hematoma
- Also called an extradural hematoma, this type occurs when a blood vessel — usually an artery — ruptures between the outer surface of the dura mater and the skull. Blood then leaks between the dura mater and the skull to form a mass that compresses the brain tissue.
- Some people with this type of injury may remain conscious, but most become drowsy or comatose from the moment of trauma. The risk of dying of an epidural hematoma that affects an artery in your brain is substantial unless you get prompt treatment.