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MRCS A > NEURO - Headache, neuro-oncology and CNS infections > Flashcards

NEURO - Headache, neuro-oncology and CNS infections Flashcards

1
Q

What are the 3 types of primary headache

A

Tension
Cluster
Migraine

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2
Q

Features of tension headache

A

COntinuous severe P
Bilateral - band like
Every day and can persist for months

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3
Q

Who gets tension headaches

A

Classically middle aged F

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4
Q

Mx episodic tension headaches (<15d/month)

A

Paracetamol
Aspirin

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5
Q

Mx tension headache if meds being used >2xW

A

75mg amitriptylline

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6
Q

Time - cluster headache

A

30mins -2hrs

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7
Q

Features cluster headache

A

Multiple times/day
Severe unilat pain
Centered on 1 eye
Comes on suddenly
assoc w: red eye, watering eye, vom

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8
Q

What is a common precipitant of cluster headaches

A

Alcohol

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9
Q

Mx cluster headaches (2)

A

SC/nasal triptan @ start of attack
Home O2

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10
Q

What % of the population suffer from migraines

A

10%

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11
Q

What are migraines associated with (4)

A

Menstruation/OCP
Exercise
Alcohol/food

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12
Q

Sx of migraine w/ aura

A

Sense of ill health
Visual aura
Throbbing headache
anorexia
N +V
Photophobia
Begins locally, spreads bilaterally

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13
Q

Neuro examination findings migraine

A

Normal

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14
Q

Conservative Mx of migraine (2)

A

Headache diary
Avoid triggers

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15
Q

Mx acute migraine attack (3)

A

NSAIDS/Paracetamol + anti-emetic
PO triptan if severe

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16
Q

Preventative Mx migraine - 1st line

A

1st line = Topiramate or propranolol

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17
Q

Preventative Mx migraine - 2nd line

A

Amitriptylline/Anticonvulsants

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18
Q

Sinister causes of headache (6)

A

Incr ICP
Idiopathic IC HTN
HTN
SAH/Meningitis
Temporal arteritis
Cancer

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19
Q

Red flags - headache (9)

A

< 20y/o
Vom w/ no cause
Worsening headache + fever
Thunder clap
Neuro deficit
Cognitive dysfunction
Personality change
LOC
Triggered - cough/valsava

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20
Q

who is idiopathic intracranial HTN common in?

A

Obese young women

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21
Q

S+S Idiopathic IC HTN (3)

A

No mass on imaging
Visual disturbance
Bilateral papilloedema

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22
Q

Ix idiopathic IC HTN (2)

A

CT/MRI norm
LP - incr CSF P

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23
Q

Mx idiopathic IC HTN (3)

A

Decr W
CCS
Surgical shunt

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24
Q

PS trigeminal neuralgia

A

Agonizing sharp pain over CN V
One sided
O/E = normal

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25
Mx trigeminal neuralgia
Carbamazepine
26
What is atypical facial pain?
Episodic aching in non-anatomical distrib H+N
27
What is atypical facial pain associated with?
Anxiety/depression
28
Mx atypical facial pain
Anti-depressants
29
What does the presentation of a SOL (Intracerebral) depend on? (2)
Rate of growth Anatomical location
30
PS Intracerebral SOL (5)
Headache N+V Papilloedema Epileptic seizures Progressive neurological deterioration e.g. weakness, sensory loss, CN palsies, dysphagia
31
Ix suspected SOL
Early CT + MRI if no mass on CT
32
Mx suspected SOL
Dexamethasone 4-6mg Anticonvulsants Rx neuro-oncology
33
What is paraneoplastic syndrome?
Cluster of Sx Not explained by tumour, mets or hormones norm secreted by tissue
34
E.g.s of paraneoplastic syndromes in neurology (4)
Myasthestenia gravis Eaton-Lambert syndrome Paraneoplastic sensory neuropathy Paraneoplastic cerebellar degeneration
35
What is the most common adult brain malignancy
Malignant glioma
36
Origin cells malignant glioma
Astrocytes
37
Prognosis malignant glioma
Dead <6months
38
What is the most common cerebral neoplasm
Meningioma
39
Is meningioma benign or malignant
Benign
40
Mx meningioma
Surgical excision + debulking
41
Who gets astrocytomas
Young people Benign + slow growing
42
When brain cancer = 2' mets, where do 1' come from? (6)
Bronchus Breast Kidney Colon Thyroid Malignant melanoma
43
What is the meningitic triad
Headache Neck stiffness Fever
44
O/E meningitis (4)
Kernig' +ve Brudzinksi +ve Incr ICP CN palsies
45
What is Kernig's +ve
Knee flexion causes pain (Meningitis)
46
What is Brudzinkski +ve
Passive flexion neck --> flexion knees to prevent pain
47
What 2 organisms are 70% meningitis caused by
N meningitis Strep pnuemonia
48
What 4 organisms make up the other 30% causes meningitis
Listeria monocytogenes (elderly IC) H influe Staph aureus TB
49
Viral causes meningitis (3)
Enterovirus HSV VZV
50
How long does viral meningitis last for
4-10 days Self limiting
51
What does TB meningitis follow?
1'/miliary TB infection
52
RF TB meningitis (2)
IC Malnourished
53
PS TB meningitis
Insidious onset Wt loss Progressive confusion
54
Ix TB meningitis
Zeihl Neelson stain PCR
55
Mx TB meningitis
RIPE 12 months
56
Ix meningitis (11)
Bloods: FBC, U+E, LFT, clotting, glucose, lactate Serum PCR Blood cultures LP CT Throat swab
57
CSF results: (meningitis) Gram +ve intracellular cocci
Pneumococcus
58
CSF results: (meningitis) Gram -ve cocci
Meningococcus
59
Normal CSF values
Clear, <5 cells Low protein 0.2-0.4 Glucose- ½- 2/3rds
60
CSF: Appearance - Bacterial
Cloudy
61
CSF - Appearance - Viral
Clear/cloudy
62
CSF - Appearance - TB
Slightly cloudy + fibrin web
63
CSF - Glucose levels - Bacterial
Decreased
64
CSF - Glucose levels - Viral
normal
65
CSF - glucose levels - TB
Very low
66
CSF - protein levels - bacterial
High
67
CSF - protein levels - viral
Norm-high
68
CSF - protein levels - TB
High
69
CSF - WCC - Bacterial
Polymorphs incr
70
CSF - WCC - Viral
Lymphocytes incr
71
CSF - WCC - TB
Lymphocytes + polymorphs
72
If you suspect meningitis - within what time frame must an LP be done
<1hr
73
Mx meningitis w/ non-blanching rash
BEN PEN 1.2g IM 2.4mg 4hrly
74
Mx meningitis w/ non blanching rash - PEN ALLERGY
Cefotaxime
75
Mx meningitis <60 y/o
IV ceftriaxone 2g bd IV dexamethasone
76
Mx meningitis <60 y/o PEN ALLERGY
IV chloramphenicol
77
Mx meningitis >60 or ICC
IV ceftriaxone IV amoxicillin IV dexamethasone
78
Acute complications meningitis (3)
Sepsis/DIC Hydrocephalus Adrenal haemorrhage (Waterhouse Friedericschen syndrome)
79
Long term complications meningitis (4)
Brain abscess Seizure disorder CN palsy Ataxia
80
Def encephalitis
Inflammation of brain parenchyma
81
Causes encephalitis (3)
Usually viral Enterovirus HSV VZV
82
PS Encephalitis (5)
Mild Headache Drowsiness Fever/malaise Confusion
83
Mortality rate - herpes simplex encephalitis
20%
84
PS herpes simplex encephalitis
High fever Mood changes Progressive drowsiness Seizure/coma
85
Ix encephalitis
CT/MRI headh LP Viral serology
86
LP findings herpes simplex encephalitis (5)
Incr P Incr lymphocytes Incr protein Normal glucose +ve on PCR
87
Mx herpes simplex encephalitis
IV acyclovir 10 days at least
88
Cause - epidural spinal abscess
S aureus
89
DDx epidural spinal abscess
Osteomyelitis
90
PS epidural spinal abscess (3)
Fever Back pain Lateral spinal root lesion
91
Mx epidural spinal abscess (3)
Emergency imaging ABx Surgical decompression

MRCS A (36 decks)

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