Neuro Flashcards
Acute headache (?occipital) with photophobia but not neck stiffness
CT Brain (if normal, check CSF for xanthochromia but has to be post 12 hr)
Subarachnoid Haemorrhage
Most are caused by berry aneurysms (APKD, Ehlers-Dalos)
Can also be trauma, tumour and AV malformation
Tonically dilated pupil
Slow reactive to light with more definite accommodation response.
Commonly seen in females, accompanied by absent knee or ankle jerks.
Adie Pupil
Caused by parasympathetic damage due to viral or bacterial infection.
Relative afferent pupillary defect
The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye.
Marcus-Gunn pupil
Caused by damage to the optic nerve or severe retinal disease.
Mitosis
Ptosis
Anhidrosis
Apparent exophthalmos
Horner’s Syndrome
Ipsilateral sympathetic trunk damage
Unilaterally dilated pupil unresponsive to light
Hutchinson’s Pupil
Compression of the ipsilateral oculomotor nerve due to intracranial mass e.g. tumour, haemorrhage
Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
Small, irregular pupils
No response to light but there is a response to accommodate
Argyll-Robertson Pupil
Diabetic neuropathy and neurosyphilis
Symmetrical, ascending polyneuropathy
Other features
areflexia
cranial nerve involvement e.g. diplopia
autonomic involvement: e.g. urinary retention
Guillain-Barre Syndrome
Immune mediated demyelination of the peripheral nervous system often triggered by an infection
Classically Campylobacter jejuni.
Recurrent, non-disabling, bilateral headache.
Often described as a “tight band”
Not aggravated by routine tasks.
Tension Headache
Episodic pain occurring once or twice a day
Lasts 15mins - 2hours each time
Intense pain around one eye; patient is restless
Redness, lacrimation, lid swelling
More common in men and smokers
Cluster Headache
Unilateral eye pain
Red eye
N+V
Acute glaucoma
Pain in posterior and side of head
Quick onset; severe.
Associated with neck pain and low grade fever
Subarachnoid Haemorrhage
Headache worse in mornings and exacerbated by bending
Focal near signs
Vomiting, seizures, papilloedema
Late signs; bradycardia and HTN
Raised intracranial pressure
Recurrent, severe, unilateral and throbbing
Can occur with menses
Aura, nausea, photosensitivity
Aggravated by, or causes avoidance of, ADLs.
Patients go to bed.
Migraine
Typically >60 years
Rapid onset unilateral headache and jaw claudication
Tender over lateral forehead
Raised ESR
Temporal arteritis
Present for 15 days or more per month
Patients using opioids and triptans are at most risk
May be psychiatric co-morbidity
Medication over-use headache
