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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
Q

What may be observed with acute intracerebral bleed

A

Papilloedema - swelling of the optic disc due to increased pressure

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26
Q

How does dissection cause headache

A

Dissection in vertebral or carotid arteries means we get turbulent blood flow in the true lumen, therefore possible ischaemia and pain

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27
Q

What pain does vertebral dissection cause

A

Occipital or neck

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28
Q

What pain does carotid dissection called

A

Phantom of the opera mask pain

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29
Q

What age is ischaemic stroke common

A

20% occur in those younger than 45 - mean age is 40

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30
Q

What ischaemic stroke is most common

A

Carotid

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31
Q

What can cause iscahemic stroke

A

Spontaneous
Trauma
Ehler Danlos (collagen defect)

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32
Q

How do we investigate ischaemic stroke

A

MRI/ MRA, Dopple, Angiography

33
Q

How do we treat iscahemic stroke

A

Aspirin or anticoagulants as blood gets more sticky with turbulent flow therefore we want to prevent clotting

34
Q

What happens in an SDH

A

Slow onset due to venous sinus or cerebral vein bleeding

35
Q

Who is commonly affected by SDH

A

Old people on anticoagulants

36
Q

What is temporal arteritis

A

Inflammation of the blood vessels

37
Q

Who is affected by temporal arteritis most

A

Women over the age of 55

38
Q

How does temporal arteritis present

A 
Constant unilateral headache 
Sensitive scalp
Jaw pain when eating
25% have polaymglia rheumatic 
Blindness due got blockage of he ciliary arteries
39
Q

How do we investigate temporal arteritis

A

Inflammatory markers increase
Visual inspection of the temporal arteritis
Ultrasound shows halos surrounding the temporal artery
Biopsy reveals inflammation and giant cells

40
Q

What is cerebral vein thrombosis

A

Occurs in the dural venous sinus or cerebral vein

41
Q

What may we see in cerebral vein thrombosis

A

ICP increases and papilloedema

Veins may infarct due to ICP and fragility

42
Q

What may cause cerebral vein thrombosis

A

Thrombophilia
Pregnancy
Dehydration
Bechets

43
Q

What is meningitis

A

Inflammation and irritation of the meninges

44
Q

What are the viral causes of meningitis

A

Coxsachie
ECHO
Mumps
EBV

45
Q

What are the fungal causes of meningitis

A

Cryptococci

46
Q

What are the bacterial causes of meningitis

A 
Meningococci
Pneumococci 
Haemophilus influenza type B
TB
Staphylococci (neonates)
47
Q

What are the granulomatous causes of meningitis

A

Lyme disease
Brucella
Syphilis
Sarcoid

48
Q

What are the symptoms of meningitis

A 
Malaise
Photophobia
Phonophobia
Headache
Neck stiffness
Confusion
Alteration of consciousness
Fever - sepsis if left untreated
49
Q

What do we see in post herpetic encephalitis

A

Classic haemorrhage changes n the temporal lobes

50
Q

How do we treat meningitis

A

Antibiotics
Blood and urine culture
Lumbar puncture
CT/MIR scan

51
Q

What do we see in sinusitis x ray

A

Opacification of the sinuses

52
Q

What are the symptoms of sinusitis

A 
Malaise
Headache
Blocked nose
Anosmia
Nasal/post nasal catarrh
Local pain/tenderness
Worse in morning - gets better throughout day
53
Q

What is IIH

A

Idiopathic intracrhail hypertnesion

54
Q

What are the signs of IIH

A 
Headaches
Visual disturbance
Tinnitus 
Diplopia 
Papilloedema
55
Q

What are the causes of IIH

A

Antibiotics
Hormones such as birth control drugs
Steroids
Vitamin E

56
Q

What is the treatment for IIH

A 
Optic nerve sheath decompression
Lumbo-peritoneal shunt
Stening of stenosed venous sinuses
Weight loss
Diuretics
57
Q

What happens in a low pressure headache

A

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
Q

What causes low pressure headaches

A

Trauma post lumbar puncture

Spontaneous

59
Q

What do we see on MRI in low pressure headache

A

Meningeal enhancement with contrast injection

60
Q

What is the treatment for low pressure headache

A

Rehydration
Caffeine
Blood patch

61
Q

What is a Chiari malformation

A

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
Q

What triggers pain in chiari malformation

A

Straining to increase ICP

63
Q

How do we treat chiari malformation

A

Treat underlying cause of the straining, or remodel the skull base

64
Q

What is OSA

A

Patient retains Co2 due to breathing obstruction when sleeping. Co2 acts as a vasodilator therefore acts on the head to cause headaches

65
Q

What are the symptoms of OSA

A

Depression
Impotence
Poor performance at work
Fatigue

66
Q

How do we treat OSA

A

Sleep study, then we can move to NIV or surgery

67
Q

What is trigeminal neuralgia

A

When there is neurovascular conflict that affects any branch of the trigeminal nerve therefore causing electric shock pain

68
Q

What triggers trigeminal neuralgia

A

Innocuous stimulus e.g. shaving

69
Q

What is linked with trigeminal neuralgia

A

MS

70
Q

What is the treatment for trigeminal neuralgia

A

Lamotrigine
Gabapentin
Carbamazepine
Posterior fossa decompression when severe pain

71
Q

What is atypical face pain

A

Usually affects depressed/anxious middle aged ladies - aching pain that extends in the jaw bones, neck and throat

72
Q

What is not present in atypical face pain

A

Not lacinating
No sensory loss
Hard to find cause

73
Q

How do we treat atypical face pain

A

Painkillers, opiates and nerve blocks do not work therefore we move to tricyclic antidepressants

74
Q

What is a post traumatic headache

A

Headache present after head trauma

75
Q

How common are post traumatic headache

A

Affects 36% at discharge, and 16% still have it after 12 months since trauma

76
Q

How is post traumatic headache managed

A

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
Q

What is cervical spondylosis

A

Narrowing of the joint space due to wearing of the disc

78
Q

Who is commonly affected by cervical spondylosis

A

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
Q

How do we manage cervical spondylosis

A

Rest, deep heat massage

Anti-inflammatory analgesics

BRS YEAR 2 (37 decks)

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