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CP3 Medicine > 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
Q

Mx trigeminal neuralgia

A

Carbamazepine

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26
Q

What is atypical facial pain?

A

Episodic aching in non-anatomical distrib H+N

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27
Q

What is atypical facial pain associated with?

A

Anxiety/depression

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28
Q

Mx atypical facial pain

A

Anti-depressants

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29
Q

What does the presentation of a SOL (Intracerebral) depend on? (2)

A

Rate of growth

Anatomical location

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30
Q

PS Intracerebral SOL (5)

A 
Headache 
N+V
Papilloedema 
Epileptic seizures 
Progressive neurological deterioration e.g. weakness, sensory loss, CN palsies, dysphagia
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31
Q

Ix suspected SOL

A

Early CT

+ MRI if no mass on CT

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32
Q

Mx suspected SOL

A

Dexamethasone 4-6mg
Anticonvulsants
Rx neuro-oncology

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33
Q

What is paraneoplastic syndrome?

A

Cluster of Sx

Not explained by tumour, mets or hormones norm secreted by tissue

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34
Q

E.g.s of paraneoplastic syndromes in neurology (4)

A

Myasthestenia gravis
Eaton-Lambert syndrome
Paraneoplastic sensory neuropathy
Paraneoplastic cerebellar degeneration

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35
Q

What is the most common adult brain malignancy

A

Malignant glioma

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36
Q

Origin cells malignant glioma

A

Astrocytes

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37
Q

Prognosis malignant glioma

A

Dead <6months

38
Q

What is the most common cerebral neoplasm

A

Meningioma

39
Q

Is meningioma benign or malignant

A

Benign

40
Q

Mx meningioma

A

Surgical excision + debulking

41
Q

Who gets astrocytomas

A

Young people

Benign + slow growing

42
Q

When brain cancer = 2’ mets, where do 1’ come from? (6)

A 
Bronchus 
Breast 
Kidney
Colon 
Thyroid 
Malignant melanoma
43
Q

What is the meningitic triad

A

Headache
Neck stiffness
Fever

44
Q

O/E meningitis (4)

A

Kernig’ +ve
Brudzinksi +ve
Incr ICP
CN palsies

45
Q

What is Kernig’s +ve

A

Knee flexion causes pain

Meningitis

46
Q

What is Brudzinkski +ve

A

Passive flexion neck –> flexion knees to prevent pain

47
Q

What 2 organisms are 70% meningitis caused by

A

N meningitis

Strep pnuemonia

48
Q

What 4 organisms make up the other 30% causes meningitis

A

Listeria monocytogenes (elderly IC)
H influe
Staph aureus
TB

49
Q

Viral causes meningitis (3)

A

Enterovirus
HSV
VZV

50
Q

How long does viral meningitis last for

A

4-10 days

Self limiting

51
Q

What does TB meningitis follow?

A

1’/miliary TB infection

52
Q

RF TB meningitis (2)

A

IC

Malnourished

53
Q

PS TB meningitis

A

Insidious onset
Wt loss
Progressive confusion

54
Q

Ix TB meningitis

A

Zeihl Neelson stain

PCR

55
Q

Mx TB meningitis

A

RIPE 12 months

56
Q

Ix meningitis (11)

A 
Bloods: FBC, U+E, LFT, clotting, glucose, lactate 
Serum PCR
Blood cultures
LP
CT
Throat swab
57
Q

CSF results: (meningitis) Gram +ve intracellular cocci

A

Pneumococcus

58
Q

CSF results: (meningitis) Gram -ve cocci

A

Meningococcus

59
Q

Normal CSF values

A

Clear,
<5 cells
Low protein 0.2-0.4
Glucose- ½- 2/3rds

60
Q

CSF: Appearance - Bacterial

A

Cloudy

61
Q

CSF - Appearance - Viral

A

Clear/cloudy

62
Q

CSF - Appearance - TB

A

Slightly cloudy + fibrin web

63
Q

CSF - Glucose levels - Bacterial

A

Decreased

64
Q

CSF - Glucose levels - Viral

A

normal

65
Q

CSF - glucose levels - TB

A

Very low

66
Q

CSF - protein levels - bacterial

A

High

67
Q

CSF - protein levels - viral

A

Norm-high

68
Q

CSF - protein levels - TB

A

High

69
Q

CSF - WCC - Bacterial

A

Polymorphs incr

70
Q

CSF - WCC - Viral

A

Lymphocytes incr

71
Q

CSF - WCC - TB

A

Lymphocytes + polymorphs

72
Q

If you suspect meningitis - within what time frame must an LP be done

A

<1hr

73
Q

Mx meningitis w/ non-blanching rash

A

BEN PEN 1.2g IM

2.4mg 4hrly

74
Q

Mx meningitis w/ non blanching rash - PEN ALLERGY

A

Cefotaxime

75
Q

Mx meningitis <60 y/o

A

IV ceftriaxone 2g bd

IV dexamethasone

76
Q

Mx meningitis <60 y/o PEN ALLERGY

A

IV chloramphenicol

77
Q

Mx meningitis >60 or ICC

A

IV ceftriaxone
IV amoxicillin
IV dexamethasone

78
Q

Acute complications meningitis (3)

A

Sepsis/DIC
Hydrocephalus
Adrenal haemorrhage (Waterhouse Friedericschen syndrome)

79
Q

Long term complications meningitis (4)

A

Brain abscess
Seizure disorder
CN palsy
Ataxia

80
Q

Def encephalitis

A

Inflammation of brain parenchyma

81
Q

Causes encephalitis (3)

A

Usually viral
Enterovirus
HSV
VZV

82
Q

PS Encephalitis (5)

A 
Mild 
Headache 
Drowsiness 
Fever/malaise
Confusion
83
Q

Mortality rate - herpes simplex encephalitis

A

20%

84
Q

PS herpes simplex encephalitis

A

High fever
Mood changes
Progressive drowsiness
Seizure/coma

85
Q

Ix encephalitis

A

CT/MRI headh
LP
Viral serology

86
Q

LP findings herpes simplex encephalitis (5)

A 
Incr P 
Incr lymphocytes
Incr protein
Normal glucose 
\+ve on PCR
87
Q

Mx herpes simplex encephalitis

A

IV acyclovir 10 days at least

88
Q

Cause - epidural spinal abscess

A

S aureus

89
Q

DDx epidural spinal abscess

A

Osteomyelitis

90
Q

PS epidural spinal abscess (3)

A

Fever
Back pain
Lateral spinal root lesion

91
Q

Mx epidural spinal abscess (3)

A

Emergency imaging
ABx
Surgical decompression

CP3 Medicine (29 decks)

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