NEURO - Headache, neuro-oncology and CNS infections Flashcards
What are the 3 types of primary headache
Tension
Cluster
Migraine
Features of tension headache
COntinuous severe P
Bilateral - band like
Every day and can persist for months
Who gets tension headaches
Classically middle aged F
Mx episodic tension headaches (<15d/month)
Paracetamol
Aspirin
Mx tension headache if meds being used >2xW
75mg amitriptylline
Time - cluster headache
30mins -2hrs
Features cluster headache
Multiple times/day Severe unilat pain Centered on 1 eye Comes on suddenly assoc w: red eye, watering eye, vom
What is a common precipitant of cluster headaches
Alcohol
Mx cluster headaches (2)
SC/nasal triptan @ start of attack
Home O2
What % of the population suffer from migraines
10%
What are migraines associated with (4)
Menstruation/OCP
Exercise
Alcohol/food
Sx of migraine w/ aura
Sense of ill health Visual aura Throbbing headache anorexia N +V Photophobia Begins locally, spreads bilaterally
Neuro examination findings migraine
Normal
Conservative Mx of migraine (2)
Headache diary
Avoid triggers
Mx acute migraine attack (3)
NSAIDS/Paracetamol + anti-emetic
PO triptan if severe
Preventative Mx migraine - 1st line
1st line = Topiramate or propranolol
Preventative Mx migraine - 2nd line
Amitriptylline/Anticonvulsants
Sinister causes of headache (6)
Incr ICP Idiopathic IC HTN HTN SAH/Meningitis Temporal arteritis Cancer
Red flags - headache (9)
< 20y/o Vom w/ no cause Worsening headache + fever Thunder clap Neuro deficit Cognitive dysfunction Personality change LOC Triggered - cough/valsava
who is idiopathic intracranial HTN common in?
Obese young women
S+S Idiopathic IC HTN (3)
No mass on imaging
Visual disturbance
Bilateral papilloedema
Ix idiopathic IC HTN (2)
CT/MRI norm
LP - incr CSF P
Mx idiopathic IC HTN (3)
Decr W
CCS
Surgical shunt
PS trigeminal neuralgia
Agonizing sharp pain over CN V
One sided
O/E = normal
Mx trigeminal neuralgia
Carbamazepine
What is atypical facial pain?
Episodic aching in non-anatomical distrib H+N
What is atypical facial pain associated with?
Anxiety/depression
Mx atypical facial pain
Anti-depressants
What does the presentation of a SOL (Intracerebral) depend on? (2)
Rate of growth
Anatomical location
PS Intracerebral SOL (5)
Headache N+V Papilloedema Epileptic seizures Progressive neurological deterioration e.g. weakness, sensory loss, CN palsies, dysphagia
Ix suspected SOL
Early CT
+ MRI if no mass on CT
Mx suspected SOL
Dexamethasone 4-6mg
Anticonvulsants
Rx neuro-oncology
What is paraneoplastic syndrome?
Cluster of Sx
Not explained by tumour, mets or hormones norm secreted by tissue
E.g.s of paraneoplastic syndromes in neurology (4)
Myasthestenia gravis
Eaton-Lambert syndrome
Paraneoplastic sensory neuropathy
Paraneoplastic cerebellar degeneration
What is the most common adult brain malignancy
Malignant glioma
Origin cells malignant glioma
Astrocytes
Prognosis malignant glioma
Dead <6months
What is the most common cerebral neoplasm
Meningioma
Is meningioma benign or malignant
Benign
Mx meningioma
Surgical excision + debulking
Who gets astrocytomas
Young people
Benign + slow growing
When brain cancer = 2’ mets, where do 1’ come from? (6)
Bronchus Breast Kidney Colon Thyroid Malignant melanoma
What is the meningitic triad
Headache
Neck stiffness
Fever
O/E meningitis (4)
Kernig’ +ve
Brudzinksi +ve
Incr ICP
CN palsies
What is Kernig’s +ve
Knee flexion causes pain
Meningitis
What is Brudzinkski +ve
Passive flexion neck –> flexion knees to prevent pain
What 2 organisms are 70% meningitis caused by
N meningitis
Strep pnuemonia
What 4 organisms make up the other 30% causes meningitis
Listeria monocytogenes (elderly IC)
H influe
Staph aureus
TB
Viral causes meningitis (3)
Enterovirus
HSV
VZV
How long does viral meningitis last for
4-10 days
Self limiting
What does TB meningitis follow?
1’/miliary TB infection
RF TB meningitis (2)
IC
Malnourished
PS TB meningitis
Insidious onset
Wt loss
Progressive confusion
Ix TB meningitis
Zeihl Neelson stain
PCR
Mx TB meningitis
RIPE 12 months
Ix meningitis (11)
Bloods: FBC, U+E, LFT, clotting, glucose, lactate Serum PCR Blood cultures LP CT Throat swab
CSF results: (meningitis) Gram +ve intracellular cocci
Pneumococcus
CSF results: (meningitis) Gram -ve cocci
Meningococcus
Normal CSF values
Clear,
<5 cells
Low protein 0.2-0.4
Glucose- ½- 2/3rds
CSF: Appearance - Bacterial
Cloudy
CSF - Appearance - Viral
Clear/cloudy
CSF - Appearance - TB
Slightly cloudy + fibrin web
CSF - Glucose levels - Bacterial
Decreased
CSF - Glucose levels - Viral
normal
CSF - glucose levels - TB
Very low
CSF - protein levels - bacterial
High
CSF - protein levels - viral
Norm-high
CSF - protein levels - TB
High
CSF - WCC - Bacterial
Polymorphs incr
CSF - WCC - Viral
Lymphocytes incr
CSF - WCC - TB
Lymphocytes + polymorphs
If you suspect meningitis - within what time frame must an LP be done
<1hr
Mx meningitis w/ non-blanching rash
BEN PEN 1.2g IM
2.4mg 4hrly
Mx meningitis w/ non blanching rash - PEN ALLERGY
Cefotaxime
Mx meningitis <60 y/o
IV ceftriaxone 2g bd
IV dexamethasone
Mx meningitis <60 y/o PEN ALLERGY
IV chloramphenicol
Mx meningitis >60 or ICC
IV ceftriaxone
IV amoxicillin
IV dexamethasone
Acute complications meningitis (3)
Sepsis/DIC
Hydrocephalus
Adrenal haemorrhage (Waterhouse Friedericschen syndrome)
Long term complications meningitis (4)
Brain abscess
Seizure disorder
CN palsy
Ataxia
Def encephalitis
Inflammation of brain parenchyma
Causes encephalitis (3)
Usually viral
Enterovirus
HSV
VZV
PS Encephalitis (5)
Mild Headache Drowsiness Fever/malaise Confusion
Mortality rate - herpes simplex encephalitis
20%
PS herpes simplex encephalitis
High fever
Mood changes
Progressive drowsiness
Seizure/coma
Ix encephalitis
CT/MRI headh
LP
Viral serology
LP findings herpes simplex encephalitis (5)
Incr P Incr lymphocytes Incr protein Normal glucose \+ve on PCR
Mx herpes simplex encephalitis
IV acyclovir 10 days at least
Cause - epidural spinal abscess
S aureus
DDx epidural spinal abscess
Osteomyelitis
PS epidural spinal abscess (3)
Fever
Back pain
Lateral spinal root lesion
Mx epidural spinal abscess (3)
Emergency imaging
ABx
Surgical decompression
