Neuro Dr Vidhya Flashcards
Headache: Cluster or Migrainous Neuralgia CLINICAL FEATURES
TRIAD:
* Retroorbital Headache
* Rhinorrhoea
* Lacrimation
Unilateral headache
Occurs nightly or in the early hours of
the morning
No visual disturbances or vomiting
Hallmark : Cyclical nature of the attacks and at least 5 attacks. Occurs typically in males; Rare in childhood.
Headache: Cluster or Migrainous Neuralgia ACUTE Management
1st line: 100% O2 15 L/min for 15 minutes
2nd line: Sumatriptan sc injection or intranasally
Headache: Cluster or Migrainous Neuralgia PROPHYLAXIS (once a cluster starts TO PREVENT FURTHER ATTACKS)
- For control of attack – Naratriptan
- Methysergide
- Prednisolone
- Lithium
- Verapamil
Headache: Tensional Clinical findings
Symmetrical bilateral tightness (muscle contraction headaches)
Lasts from 30 minutes to 7 days
Non-pulsating, mild to moderate intensity
No nausea, vomiting, photophobia, or phonophobia
Headache: Tensional Management
Relaxation techniques
Lifestyle modifications
Avoid tranquilisers and stronger analgesics
Headache: Tensional Treatment
- CBT
- Mild non-opioid analgesics – aspirin, ibuprofen, paracetamol
Headache: Migraine Clinical Features
MC triggered by Stress
Headache lasts 4- 72 “hours”
Unilateral, Pulsatile in nature.
Moderate or severe intensity, inhibiting daily activities associated with nausea, vomiting, photophobia, or phonophobia
Not attributable to another disorder
Headache: MILD
Acute Migraine Management
1st line: ASPIRIN OR
PARACETAMOL + METOCLOPRAMIDE
ADVISE LYING DOWN
IN A QUIET DARK COOL ROOM.
COLD PACKS ON THE FOREHEAD OR NECK.
AVOID: COFFEE, TEA, MOVING AROUND TOO MUCH, READING, WATCHING TV
Headache: SEVERE
Acute Migraine Management
1st line: TRIPTANS (BEST AT START OF ATTACK)
AVOID IN:
- CORONARY ARTERY
- DISEASE
- ANGINA
- UNCONTROLLED HYPERTENSION
- PREGNANCY
Management of Acute Migraine attack during pregnancy
Paracetamol is the preferred non-opioid analgesic.
Avoid NSAIDs and
Aspirin in the first trimester and after 30 weeks of gestation
Management of severe refractory Acute Migraine attack during pregnancy
- IV fluids
- Short course of IV
- MgSO4 or oral steroids.
NOTE: Beta blockers can cause IUGR and should be weaned off before labour to prevent Fetal bradycardia.
Migraine Prophylaxis
1st line: Avoidance of known trigger factors.
Indication: 2 or more
severe migraine attacks per month attacks disrupting the
patient’s well being/lifestyle.
Drugs:
* Beta blockers (Propranolol)
* TCA (Amitryptyline)
* Sodium valproate
* CCBs ( Verapamil, Nifedipine)
* Candesartan
* Sumatriptan
* Gabapentin
* Botulinum toxin into the muscles of the face, scalp or neck
Headache: Temporal
arteritis (Giant cell arteritis) CLINICAL FEATURES
Persistent/intermittent unilateral throbbing headache in the
temporal region and scalp sensitivity with localized thickening
With or without loss of pulsation of the Superficial temporal artery.
Age > 50 years
Intermittent blurred vision
Tenderness on brushing hair
Jaw claudication on eating
Hypertension
Polymyalgia Rheumatica
Headache: Temporal
arteritis (Giant cell arteritis) MANAGEMENT
1) Very responsive to corticosteroids- start treatment immediately to prevent permanent blindness.
2) Aspirin to prevent ischemic events
Headache: Subarachnoid Hemorrhage CLINICAL FEATURES
Presentation: Acute severe headache “thunderclap” (in 75% patients); Loss of consciousness in the remaining 25%.
TRIAD
* Occipital Headache
* Vomiting
* Neck stiffness
Also:
- With or without seizures
- Kernig sign positive
Headache: Subarachnoid Hemorrhage INVESTIGATIONS
Dx: 1) CT Head – investigation of
choice
2) Lumbar puncture is used if CT scan is
negative – Homogenous blood staining of CSF
and Xanthochromia are diagnostic of SAH
Headache: Subarachnoid Hemorrhage CT Imagen
Areas of hyper density within the cisterns and sulci
Headache: Subarachnoid Hemorrhage Management
URGENT REFERRAL!!
Headache: Trigeminal
Neuralgia CLINICAL FEATURES
> 50 yo
Almost always unilateral
Presentation:
* Brief paroxysms of pain 1-2 minutes (upto 15 minutes)
* Excruciating burning knife or electric shock like pain.
* Precipitated by talking, chewing, touching trigger areas on face, cold weather, and wind.
Headache: Trigeminal
Neuralgia. Associated diseases
- Multiple sclerosis
- Neurosyphilis
- Posterior fossa Tumours
Headache: Trigeminal
Neuralgia Investigation
MRI
Headache: Trigeminal
Neuralgia MANAGEMENT
1st line: Patient education and reassurance.
2nd line: Carbamazepine (from onset of attack until resolution)
3rd line: Surgery. Just if medical treatment is ineffective: Decompression of the Trigeminal nerve root
CLINICAL FEATURES Idiopathic Intracranial Hypertension (Pseudotumour cerebri)
- Obese young patient
- Headache
- Nausea
- Visual obscuration or blurring (main concern
from high ICP) check papilledema.
FIRST INVESTIGATION Idiopathic Intracranial Hypertension (Pseudotumour cerebri)
CT and MRI are normal.
Pseudotumor Cerebri, also known as Idiopathic Intracranial Hypertension (IIH), is a condition where the pressure inside your skull (intracranial pressure) is increased without any obvious reason, like a tumor or brain swelling. The symptoms mimic those of a brain tumor, but no tumor is actually present.
-
Increased Intracranial Pressure:
- The main issue in pseudotumor cerebri is high pressure inside the skull. This can cause headaches, vision problems, and other symptoms.
-
Symptoms:
- Headaches: Often severe and persistent, typically worse in the morning or when lying down.
- Visual Disturbances: Blurred vision, double vision, and in severe cases, temporary or permanent vision loss due to pressure on the optic nerves.
- Whooshing Sound in the Ears: Some people hear a pulsating sound in their ears, called pulsatile tinnitus.
- Nausea and Vomiting: Due to the increased pressure.
- Neck or Shoulder Pain: Sometimes, pressure can cause pain in the neck or shoulders.
-
Risk Factors:
- Obesity: Particularly in young women of childbearing age.
- Certain Medications: Such as oral contraceptives, steroids, and some antibiotics like tetracycline.
- Other Medical Conditions: Including sleep apnea and certain endocrine disorders.
-
Diagnosis:
- Lumbar Puncture: Measuring the pressure of the cerebrospinal fluid (CSF) through a spinal tap helps confirm the diagnosis.
- Imaging: MRI or CT scans are done to rule out other causes of increased intracranial pressure, like tumors.
-
Treatment:
- Weight Loss: For overweight patients, losing weight can significantly reduce symptoms.
- Medications: Such as acetazolamide, which decreases CSF production, or diuretics, which reduce fluid buildup.
- Surgery: In severe cases, surgical options like a shunt to drain excess fluid or optic nerve sheath fenestration to relieve pressure on the optic nerves may be considered.
-
Prognosis:
- With proper treatment, symptoms can often be managed, and vision loss can be prevented or reduced. However, ongoing monitoring is important, as the condition can recur.
Pseudotumor cerebri is a condition where increased pressure inside the skull causes symptoms similar to a brain tumor, but without any actual tumor present. It mainly affects young, overweight women and can lead to headaches and vision problems. Treatment focuses on reducing the pressure and addressing any underlying risk factors.
