Neuro Flashcards
Headache Paraesthesia
List the red flags for headache?And what do they suggest?
Fever, meningism
Meningitis
Scalp and temple tenderness, amaurosis fugax
Temporal arteritis
Change in consciousness, focal neurological deficit, seizures
SOL, tumour
Thunderclap onset
SAH
Red eyes, halos around light
Acute closed angle glaucoma
Which drugs can cause analgesia induced headache?
Which are worst culprits?
Paracetamol NSAIDs Opioids Ergotamine Triptans
Codeine
Triptans
What are these drugs used for?
- Ergotamine
- Triptans
E: cluster headaches and migraine
Triptans: to treat migraines
Presentation of analgesia induced headache?
What’s the diagnostic criteria?
Daily or almost daily headache
Peculiar pattern, mixture of migraine-like and tension-type
Often worse in morning and after exertion
Diagnostic criteria of analgesia induced headache?
15 or more days per month
Or 10 or more if ergotamines
In someone with pre-existing headache disorder (that set it off)
Regular overuse for more than 3 months, with at least 1 headache drug
Management of analgesia induced headache?
Explain why they’ve got the headache
They need to withdraw, so expect a withdrawal phase
They should stop taking the medication for at least 1 month
The headache will likely get worse before it gets better
Arrange follow up to provide support
List some differential diagnoses of headache?
Primary:
- tension
- cluster
- migraine
Secondary:
V: stroke (ischaemic or haemorrhagic), SAH
I: meningitis, encephalitis, sinusitis, viral illness
T: head injury, sub-dural, extra-dural
A: temporal arteritis
M:
I: analgesia induced
N: brain tumour, mets
D:
Other: Low CSF, raised ICP
Go on ILA week 2 - headache document
To go over causes, presentation, investigations and management of headaches!
Go through the dermatomes of upper limb?
C4 shoulder
C5 upper arm lateral
C6 lower arm lateral and thumb
C7 1st and 2nd finger
C8 3rd and 4th finger
T1 upper arm medial
T2 axilla
What are the dermatomes of the
- nipple
- umbilicus
- groin
- knees
- big toe
- small toe
T4 at teat
T10 belly butTEN
L1 groin
Down on L4s (knee)
L5 large toe
Small toe S1
Which nerve roots control these reflexes?
- biceps
- triceps
- supinator
- patellar
- ankle
- plantar
Biceps: C5, C6
Triceps: C6, C7
Supinator: C5, C6
Patellar: L3, L4 keep the foot off the floor
Ankle: L5, S1
S1: plantar (Babinski)