Neuro

Question 1

List the red flags for headache?And what do they suggest?

Answer 1

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

Question 2

Which drugs can cause analgesia induced headache?

Which are worst culprits?

Answer 2

Paracetamol
NSAIDs
Opioids
Ergotamine
Triptans

Codeine
Triptans

Question 3

What are these drugs used for?

• Ergotamine
• Triptans

Answer 3

E: cluster headaches and migraine

Triptans: to treat migraines

Question 4

Presentation of analgesia induced headache?

What’s the diagnostic criteria?

Answer 4

Daily or almost daily headache

Peculiar pattern, mixture of migraine-like and tension-type

Often worse in morning and after exertion

Question 5

Diagnostic criteria of analgesia induced headache?

Answer 5

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

Question 6

Management of analgesia induced headache?

Answer 6

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

Question 7

List some differential diagnoses of headache?

Answer 7

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

Question 8

Go on ILA week 2 - headache document

Answer 8

To go over causes, presentation, investigations and management of headaches!

Question 9

Go through the dermatomes of upper limb?

Answer 9

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

Question 10

What are the dermatomes of the

• nipple
• umbilicus
• groin
• knees
• big toe
• small toe

Answer 10

T4 at teat

T10 belly butTEN

L1 groin

Down on L4s (knee)

L5 large toe
Small toe S1

Question 11

Which nerve roots control these reflexes?

• biceps
• triceps
• supinator
• patellar
• ankle
• plantar

Answer 11

Biceps: C5, C6
Triceps: C6, C7
Supinator: C5, C6

Patellar: L3, L4 keep the foot off the floor

Ankle: L5, S1

S1: plantar (Babinski)