Neuro Flashcards
red flags for secondary HA?
S: systemic s/s eg fever, immunocomp, known malignancy, autoimmune dz, coagulopathy,
N: neuro signs, new HA
O: sudden onset
O: age over 50
P: positional, papilledema, pulsatile tinnitus
define thunderclap HA
pain that reaches 7/10 in less than 1 minute
thunderclap HA ddx
bleeds: ICH, sentinel aneurysmal bleed
vascular: carotid dissection, RCVS, cerebral venous thrombosis, PRES
other: acute angle closure glaucoma, acute hydrocephalus,
criteria for LP without CT
normal sensorium, no focal neuro deficits, not immunosuppressed. can get LP before CT
RF for cerebral venous thrombosis
basically anything promoting hypercoag:
peripartum, OCP, recent surgery, protein c or s deficiency, factor 5 leiden etc
cerebral venous thrombosis presentation
variable: from progressive over weeks to thunderclap
can have benign presentation or also pt can have s/s raised ICP, seizures, coma etc
CT for cerebral venous thrombosis
CT venogram and NCCTH
4 types of HA pt who get neuroimaging (NCCTH) in ED
- HA and abn neuro finding (inclu aLOC)
- new sudden onset severe HA aka thunderclap
- HIV + with new HA
- new HA and age > 50 with normal neuro exam
what is PRES
a hypertensive emergency, pts have HTN, encephalopathy and severe HA or visual changes, seiures
what dx needs to be ruled out before dx of RCVS?
SAH
age at which GCA needs to be considered?
> 50
criteria for cluster HA
5 attacks that are:
sevre, unilateral, last 15-180 mins, have circadian or circannual pattern
POUND for migraines?
pulsatile, onset 4-72 hours, unilateral, n/v, disabling
also photo/phonobia
migraine cocktail
toradol, NS and maxeran.
can consider dex, benadryl,
occipital neuraligia? symptoms and cause
shooting/electric pain at posterior of head in distribution of occipital nerve, caused by chrnoic neck tension
can try occipitla nerve block
3 findings of IIH aka pseudotumour cerebri
HA, papilledema, normal neuro exam
most effective tx for post LP HA
epidural blood patch
carotid vs vertebral artery dissection symtptoms
both have HA, neck pain etc,
carotid will have anterior circ stroke s/s
vertebral will posterior stroke s/s
multiple ppl from same area presenting with HA, consider?
CO
ct findings of pituitary apoplexy?
cellar mass (it is a hemorrhage of pituiatary adenoma)
Post LP headache presentation and tx
Occurs within 2 days of LP, worse sitting/standing,
Give simple analgesics, give caffeine, or blood patch if refractory
Happens about 10% of LPs
2 types of hemorrhagic stroke
spontaneous SAH and intrcerebral hemm (aka intraparenchymal)
causes of spont SAH
75% aneurysm rupture, idiopathic, AVM, sympathomimetic drugs
SAH risk factors
HTN, smoking, excessive etoh, PCKD, famhx of SAH, marfan’s Ehlers-Danlos,