Neuro Flashcards
tension headache presentation
generalised, bilateral
non-pulsatile
tight band, pressure like
can radiate to neck and shoulders
episodic, chronic
tension headache ix
none specific to tension headaches
normal neuro exam
pericranial or neck muscle tenderness possible on examination
is a recent fall a red flag
yes for subdural haemorrhage
what do you need to be aware of when prescribing analgesia for headaches
medication overuse headaches (aka rebound headaches)
cluster headache presentation
unilateral
episodic
sudden onset
excruciating pain
lacrimation, rhinorrhea, partial Horner’s
cluster headache ix
no ix specific for cluster headaches.
MRI- exclude anything more sinister
ESR - exclude giant cell arteritis
pituitary function tests - exclude pituitary adenoma
cluster headache mx
acute
-subcutaneous sumatriptan
-high dose, high flow O2
prophylaxis
-verapamil (CCB)
migraine presentation
unilateral
comes on gradually
pulsating, throbbing
4-72 hrs
exacerbating: activity, stress, phonophobia, photophobia
relieving: quiet, dark room
associated symptoms:
aura. n+v, visual changes, tingling, numbness, migraine interferes with current activities
migraine ix
mostly ix of exclusion
- MRI - exclude smth more sinister
- ESR - exclude giant cell arteritis
- LP - haemorrhage, meningitis
migraine mx
conservative:
- headache diary
- avoid triggers
- relaxation techniques (CBT, mindfulness)
acute:
- simple analgesia
- triptans
- consider anti-emetic
prophylaxis:
- propanolol
- topimarate
- amitryptiline
DO NOT GIVE OPIATES
trigeminal neuralgia presentation
unilateral pain along trigeminal distribution
paroxysmal, lasting seconds, recurrent episodes
stabbing, shooting pain, like electric shock
exacerbated by moving jaw
risk factors for trigeminal neuralgia
increased age
female
multiple sclerosis
management of trigeminal neuralgia
1st
acute - anticonvulsants (eg carbamazepine)
long term - microvascular decompression or ablation surgery
raised ICP headache presentation
bilateral, gradual, throbbing
vomiting
confusion
worse in mornings
severe pain
papilloedema
Cushings triad - increased systolic BP, irregular breathing, bradycardia
raised ICP Ix
urgent CT head
never do lumbar puncture, can cause brainstem herniation
raised ICP mx
management of risk factors
analgesia
treat underlying cause
what layers of brain does meningitis affect
arachnoid and pia
causes of meningitis
bacteria - e.coli, h.influenzae, strep pneumoniae, neisseria meningitidis, listeria monocytogenes
virus - enteroviruses, HSV, VZV, HIV
tuberculosis
meningitis signs and symptoms
meningism: neck stiffness, photophobia, headache
fever
n+v
seizures
malaise
hypotension
tachycardia
Kernig’s sign
Brudzinski’s sign
petechial non-blanching rash
meningitis Ix
obs
VBG
lumbar puncture (most important)
2 sets of blood cultures
CT head before LP
CSF analysis in bacterial meningitis
appearance - cloudy
cells - increased neutrophils (polymorphs)
glucose - reduced
protein - increased
CSF analysis in viral meningitis
appearance - clear
cells - increased lymphocytes (mononuclear)
glucose - normal
protein - normal/increased
CSF analysis in TB meningitis
appearance - fibrin web
cells - increased lymphocytes (mononuclear)
glucose - reduced
protein - increased
meningitis mx
at GP: benzylpenicillin IM & urgent referral to hospital
at A&E: broad spec ABs (ceftriaxone IV, benzylpenicillin IM) acyclovir if viral
targeted ABs
consider dexamethasone
manage close contacts