Neuro 3 Migraines

Question 1

What’s a stroke

Answer 1

Damage to brain by interrupting blood supply, can be from ischaemic or haemorrhaging causes

FAS

Question 2

What’s a TIA

Answer 2

Stroke symptoms and signs that resolve within 24hrs - usually an hr

IMPORTANT as high risk of stroke after

Question 3

What’s amaurosis fugax

Answer 3

Sudden monocular vision loss that occurs usually over50 and vasculopathic risk factors

Usually goes away in 10min to an hr

Question 4

Differences between amaurosis fugax and other neuro

Answer 4

No neck pain or neck injury

No symptoms of GCA

Normal ophthalmological exam but can see emboli

Normal neuro exam - no horners

Question 5

Differentials for TIA

Answer 5

Migraine aura

Hypotension or syncope

Drop attacks - sudden transient loss of postural tone causing falls

Hypoglycaemia

Etc

Question 6

Management of occipital lobe lesions

Answer 6

All patients with any homonymous hemianopia need an MRI

treatment depends on cause - usually vascular lesions

Question 7

What’s a concussion

Answer 7

Form of mild traumatic brain injury MTBI causing

abnormal accomodation, stereo and motility

more convergence

sluggish pupils as takes time to construct or dilate

Question 8

Difference between a primary and secondary headache

Answer 8

Primary - migraine/tension type headache and cluster headache

Secondary - HAs associated with trauma, vascular or mass lesions etc
- in optom wud be acute angle or pseudo myopia

Question 9

What’s migraine without aura

Answer 9

Recurrent pulsating headaches lasting 4-72hrs

Unilateral location

Gets worse with physical activity

Associated with nausea, photphobia and phonophobia

Question 10

What’s migraine aura

Answer 10

Neuro symptoms that happen before a migraine (can happen during or after but rarer)

Usually binocular and develop over 5-20min, last less than an hr

If monocular, usually tunnel vision or diff patterns coming from side

Assoc pins and needles or numbness

Question 11

What’s migraine with aura

Answer 11

N

Question 12

Migraine aura is positive or negative

Example of positive

Answer 12

Flashes in diff locations

Kaleidoscope effects

Fragmented vision

Scintillating scotomas - images moving in and out

Question 13

Migraine aura “negative” symptoms

Answer 13

Homonymous hemianopia

Tunnel vision

Transient monocular vision loss

Cortical blindness

Question 14

Cortical disturbance and efferent symptoms of migraine aura

Answer 14

Déjà vu, Jamais Vu,
Macropsia and micropaia
Dysachromatopsia

Ptosis and diplopia

Question 15

Retinal migraine

Answer 15

N

Question 16

Differentials to migraine aura

Answer 16

Photopsia from traction

TIA from retinal emboli

TVO from papilloedema or GCA

Question 17

Differentials to migraine headache

Answer 17

Arteriovenous malformation

HZO - pain 2-3 days before rash

Trigrminal neuralgia - multiple sharp severe pain staring along 5th nerve

Question 18

How to treat migraine

Answer 18

Avoiding triggers

• wine cheese chocolate as has tryptophan
• oral contraceptives
• stress

Meds at aura to prevent headache, if during he ache then relieves it, or if after give prophylactically to prevent recurrence