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BRS YEAR 2 > Neuro - Headaches > Flashcards

Neuro - Headaches Flashcards

1
Q

How common are headaches

A

half to two thirds of the population between 18-65 have experienced a headache in the past year, 30% of these have reported a migraine

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2
Q

What are the 3 main causes of headaches

A

Structural
Pharmacological
Psychological

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3
Q

What is a pharmacological cause of headache

A

GTN spray

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4
Q

What is a psychological cause of headache

A

Stress

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5
Q

What are the main headache patterns

A

Single acute headache

Dull headache

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6
Q

What type of dull headaches can we have

A

Increasing in severity

Unchanged in the past few months

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7
Q

What other types of headaches can we see

A

Triggered headache

Recurrent headache

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8
Q

What are the red flags for a headache

A 
Systemic symptoms 
Onset
Meninigism 
Neurological deficit/ focal signs 
Orthostatic 
Strictly unilateral
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9
Q

What is third nerve palsy

A

Third nerve dysfunction leading to ptosis and eye dropping and looking outwards

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10
Q

What can be a cause of third nerve palsy

A

PCA aneurysm rupture

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11
Q

What is Horner’s syndrome

A

Problem with sympathetic innervation of the eye leading to ptosis, miosis and anhydrosis unilaterally

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12
Q

What is the presentation of a Sub arachnoid haemorrhage

A

Acute thunderclap

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13
Q

Where do SAH often occur in the head

A

Often occipital

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14
Q

What causes SAH

A

Commonly due to ruptured aneurysms, but also due to arteriovenous malformations and sometimes unknown

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15
Q

What is the mortality of SAH

A

50% fatal

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16
Q

What may help with SAH

A

Vasospasm to try and stop the bleeding

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17
Q

How can we investigate SAH

A

We can do an MRA Angiogram, CT brain and lumbar puncture

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18
Q

How do we treat an aneurysm

A

Coiling

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19
Q

What is an acute intracerebral bleed

A

Extensive bleeding that fills up the ventricles

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20
Q

How does an intracerebral bleed cause death

A

Coning - increase in intracranial pressure therefore brain will crush brainstem to cut off blood supply and thus kill us

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21
Q

What are the weakpoints for coning

A

Falx cerebri
Tentorium cerebelli
Foramen magnum

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22
Q

What is seeping of the falx called

A

Falcine herniation

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23
Q

What is seeping of the tentorium called

A

Tectorial herniation

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24
Q

What is seeping of the foramen magnum called

A

Herniation of the foramen magnum

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25
What may be observed with acute intracerebral bleed
Papilloedema - swelling of the optic disc due to increased pressure
26
How does dissection cause headache
Dissection in vertebral or carotid arteries means we get turbulent blood flow in the true lumen, therefore possible ischaemia and pain
27
What pain does vertebral dissection cause
Occipital or neck
28
What pain does carotid dissection called
Phantom of the opera mask pain
29
What age is ischaemic stroke common
20% occur in those younger than 45 - mean age is 40
30
What ischaemic stroke is most common
Carotid
31
What can cause iscahemic stroke
Spontaneous Trauma Ehler Danlos (collagen defect)
32
How do we investigate ischaemic stroke
MRI/ MRA, Dopple, Angiography
33
How do we treat iscahemic stroke
Aspirin or anticoagulants as blood gets more sticky with turbulent flow therefore we want to prevent clotting
34
What happens in an SDH
Slow onset due to venous sinus or cerebral vein bleeding
35
Who is commonly affected by SDH
Old people on anticoagulants
36
What is temporal arteritis
Inflammation of the blood vessels
37
Who is affected by temporal arteritis most
Women over the age of 55
38
How does temporal arteritis present
``` Constant unilateral headache Sensitive scalp Jaw pain when eating 25% have polaymglia rheumatic Blindness due got blockage of he ciliary arteries ```
39
How do we investigate temporal arteritis
Inflammatory markers increase Visual inspection of the temporal arteritis Ultrasound shows halos surrounding the temporal artery Biopsy reveals inflammation and giant cells
40
What is cerebral vein thrombosis
Occurs in the dural venous sinus or cerebral vein
41
What may we see in cerebral vein thrombosis
ICP increases and papilloedema | Veins may infarct due to ICP and fragility
42
What may cause cerebral vein thrombosis
Thrombophilia Pregnancy Dehydration Bechets
43
What is meningitis
Inflammation and irritation of the meninges
44
What are the viral causes of meningitis
Coxsachie ECHO Mumps EBV
45
What are the fungal causes of meningitis
Cryptococci
46
What are the bacterial causes of meningitis
``` Meningococci Pneumococci Haemophilus influenza type B TB Staphylococci (neonates) ```
47
What are the granulomatous causes of meningitis
Lyme disease Brucella Syphilis Sarcoid
48
What are the symptoms of meningitis
``` Malaise Photophobia Phonophobia Headache Neck stiffness Confusion Alteration of consciousness Fever - sepsis if left untreated ```
49
What do we see in post herpetic encephalitis
Classic haemorrhage changes n the temporal lobes
50
How do we treat meningitis
Antibiotics Blood and urine culture Lumbar puncture CT/MIR scan
51
What do we see in sinusitis x ray
Opacification of the sinuses
52
What are the symptoms of sinusitis
``` Malaise Headache Blocked nose Anosmia Nasal/post nasal catarrh Local pain/tenderness Worse in morning - gets better throughout day ```
53
What is IIH
Idiopathic intracrhail hypertnesion
54
What are the signs of IIH
``` Headaches Visual disturbance Tinnitus Diplopia Papilloedema ```
55
What are the causes of IIH
Antibiotics Hormones such as birth control drugs Steroids Vitamin E
56
What is the treatment for IIH
``` Optic nerve sheath decompression Lumbo-peritoneal shunt Stening of stenosed venous sinuses Weight loss Diuretics ```
57
What happens in a low pressure headache
Loss of CSF therefore when we lie down, everything is fine but when we stand up, there is less CSF in the head therefore the brain is tugged down causing pain
58
What causes low pressure headaches
Trauma post lumbar puncture | Spontaneous
59
What do we see on MRI in low pressure headache
Meningeal enhancement with contrast injection
60
What is the treatment for low pressure headache
Rehydration Caffeine Blood patch
61
What is a Chiari malformation
Normal brain sits very low within the skull Cerebellar tonsils descending through foramen magnum therefore when the patient coughs, ICP rises and the meninges are tugged on
62
What triggers pain in chiari malformation
Straining to increase ICP
63
How do we treat chiari malformation
Treat underlying cause of the straining, or remodel the skull base
64
What is OSA
Patient retains Co2 due to breathing obstruction when sleeping. Co2 acts as a vasodilator therefore acts on the head to cause headaches
65
What are the symptoms of OSA
Depression Impotence Poor performance at work Fatigue
66
How do we treat OSA
Sleep study, then we can move to NIV or surgery
67
What is trigeminal neuralgia
When there is neurovascular conflict that affects any branch of the trigeminal nerve therefore causing electric shock pain
68
What triggers trigeminal neuralgia
Innocuous stimulus e.g. shaving
69
What is linked with trigeminal neuralgia
MS
70
What is the treatment for trigeminal neuralgia
Lamotrigine Gabapentin Carbamazepine Posterior fossa decompression when severe pain
71
What is atypical face pain
Usually affects depressed/anxious middle aged ladies - aching pain that extends in the jaw bones, neck and throat
72
What is not present in atypical face pain
Not lacinating No sensory loss Hard to find cause
73
How do we treat atypical face pain
Painkillers, opiates and nerve blocks do not work therefore we move to tricyclic antidepressants
74
What is a post traumatic headache
Headache present after head trauma
75
How common are post traumatic headache
Affects 36% at discharge, and 16% still have it after 12 months since trauma
76
How is post traumatic headache managed
Explanation that recovery may take a long time Stop analgesic abuse e.g, opiates - use modulatory drugs such as amitriptyline or NSAIDs Be patient - recovery can last 3-4 years
77
What is cervical spondylosis
Narrowing of the joint space due to wearing of the disc
78
Who is commonly affected by cervical spondylosis
Elderly patients - constant pain in the bakc of the head worse in the morning and with neck movement No nausea and vomiting, but pain sometimes radiates froward
79
How do we manage cervical spondylosis
Rest, deep heat massage | Anti-inflammatory analgesics

BRS YEAR 2 (37 decks)

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