Neuro- Headaches and Stroke Flashcards
What are the 3 main types of primary headache syndromes?
- Tension type headache
- Migraine
- Trigeminal autonomic cephalgias
How long do migraines normally last for?
4- 72 hours
How long do cluster headaches normally last for?
15 mins- 3 hours
Which headache types respond positively to Indometacin?
Hemicrania continua
Paroxysmal hemicrania
What is the most common type of headache?
Migraine
Tension type
Hemicrania continua
Tension type
What is the most common drug treatment for tension type headaches?
NSAIDs
B blockers
Amityptyline
Amitriptyline (TCAs)
If a patient has a daily generalised headache, with a tight band feeling, with associated neck and jaw pain, but no associated visual symptoms, which type of headache is this most likely to be?
Tension type
How does a migraine usually change with movement?
It becomes worse
Migraine aura symptoms can be divided into sensory, motor, visual and speech. Give examples of these symptoms.
Motor- Unilateral weakness/ heaviness
Sensory- Paraesthesia spreading from hand to face
Visual- Flashing lights/ zigzag lines
Speech- Dysphasia
What symptoms may patients experience associated with a migraine?
Nausea and vomiting Photophobia Phonophobia Sounds and smells Visual disturbance Lethargy
What are the acute drug treatments for migraine?
- Triptans eg. Sumitriptan tablets, nasal spray or subcut injections
- Antiemetics
- NSAIDs/ Paracetamol
What are the preventative drug treatments for migraines?
- Beta blockers
- Topiramate
- Botox injections
- Amitriptyline
- Pizotifen
- Riboflavin
- Candesartan
Which type of medication is most commonly associated with medication overuse headaches?
NSAIDs
Co-codamol
Amityptyline
Co-codamol
Which medication can be used to prevent medication over use headache?
Amitriptyline
If a patient has a headache lasting for 2 hours mainly at nighttime/ early morning, which is extremely painful and associated with periorbital pain, eye redness and a blocked nose, which type of headache is this most likely to be?
Cluster headache
What are the facial features of cluster headaches?
Periorbital pain Eye redness Blocked nose Tooth pain Horner's syndrome
What are the acute treatments for cluster headache?
- Triptan injections
2. High flow oxygen
What are the preventative treatments for cluster headache?
- Verapamil (NICE 1st line)
- Topiramate
- Lithium
- Pizotifen
- Steroids
Gamma core vagus nerve stimulation can be used in acute treatment of which headache type?
Cluster headaches
Cluster headaches more commonly affect which gender?
Men
Migraines more commonly affect which gender?
Women
Which areas of the head is pain most commonly experienced in tension headaches?
Frontal
Occipital
In patients aged 40 years plus, what usually causes trigeminal neuralgia?
Blood vessel irritating CNV
Which branches of the trigeminal nerve are most commonly affected in trigeminal neuralgia?
V2 and V3
In patients aged under 40 years, what is trigeminal neuralgia most commonly associated with?
MS
What are the most common category of drugs used for trigeminal neuralgia and which is 1st line?
AEDs eg. Carbamazepine, Lamotrigine, Phenytoin
Carbamazepine 1st line
Post traumatic headache usually occurs less than 2 weeks after an injury and can be treated with which drug?
Amitriptyline
What are the main symptoms of idopathic intracranial hypertension?
Headache
Blurred vision
What are the findings on eye examination, lumbar puncture and CT in patients with IIH?
Examination: Bilateral papilodema
LP: Opening pressure >30, normal constituents
CT: Normal
What are the treatments for IIH?
- Weight loss
- Monitor visual field
- Diuretics- Acetazolamide
What are the main symptoms of temporal arteritis (aka Giant cell arteritis)?
Pain/ tenderness on temple
Jaw and tongue claudications
Difficulty combing hair
Feel generally unwell
What happens to blood ESR in temporal arteritis?
Raised above 60
What are the treatments for temporal arteritis?
Steroids for >2 years
Stroke is a syndrome of rapidly developing clinical signs, usually of _____ disturbance of cerebral function, lasting over 24 hours or leading to death.
Focal
What is a non-disabling stroke?
Stroke with symptoms which last >24 hours but later resolve, leaving no permanent disability
What are the 3 main causes of cerebral ischemia?
- Large vessel disease- plaque rupture at turbulent site
- Cardioembolism- eg from AF
- Lacunar infarct
What are the triad of symptoms in a carotid artery dissection?
- Unilateral face and neck pain
- Horner’s syndrome
- Anterior stroke/ TIA
Which conditions increase the risk of lacunar infarct?
Diabetes
Hypertension
Hyperlipidaemia
The ACA supplies which parts of the brain?
Anterior and medial cerebrum: Frontal lobe Parietal lobe Temporal lobe Eyes
The MCA supplies which parts of the brain?
Lateral cerebrum
The PCA supplies which parts of the brain?
Posterior brain: Occipital lobe Cerebellum Thalamus Brainstem
What are the 3 main clinical features of an ACA stroke?
- Homonymous hemianopia
- Contralateral UMN hemiparesis/ hemisensory loss
- Higher cortical function issues eg. dysphasia, dyphagia, dysarthria
What are the main clinical features of a PCA stroke?
- Vertigo
- Ataxia
- Diplopia
- Dysphagia
- Hemiparesis/ tetraparesis (if brainstem)
- Blindness
- Cranial nerve palsies
Which features are common to both ACA and PCA strokes?
Hemiparesis
Dysphagia
Dysarthria
Homonymous hemianopia
50% of strokes affect which part of the cerebral circulation?
Anterior circulation (ACA, MCA)
Posterior circulation strokes make up what % of ischemic strokes?
25%
Lacunar circulation strokes make up what % of ischemic strokes?
25%
95% of lacunar circulation strokes occur in which parts of the brain?
Pons
Basal ganglia
What are the 3/4 main clinical features of a lacunar circulation stroke?
- Contralateral UMN hemiparesis
- Contralateral hemisensory loss
- Contralateral babinski sign
- NO cortical/ higher function issues
There are 4 main types of _______ stroke syndrome, which are:
- Pure motor hemiparesis
- Pure sensory hemiparesis
- Hemisensory and motor pattern
- Ataxic hemiparesis
Lacunar
An intracerebral haemorrhage is usually caused by ruptured small penetrating arteries in which part of the brain?
Basal ganglia
Which type of haemorrhagic stroke’s main features are sudden onset neurological deficit with headache?
Intracerebral haemorrhage
Which type of haemorrhagic stroke’s main features are sudden onset sever headache, which neck stiffness, nausea and neurological deficit?
Subarachnoid haemorrhage
What is the main cause of a sub arachnoid haemorrhage?
Ruptured berry aneurysm in the circle of willis
Bleeds into the ventricles
How should an ischemic stroke be treated if within 4 hours of onset?
Thrombolyse with Alteplase
How should an ischemic stroke be treated if after 4 hours of onset?
Aspirin 300mg
Which drug can be given after SAH to prevent risk of secondary ischemia due to vasospasm?
Nimodipine
Which antiplatelet drugs are given for secondary stroke prevention?
Clopidogrel
Aspirin
Dipyridamole
What tests should be done in a patient with stroke symptoms?
- CT scan within 4 hours
- Blood tests- FBC, glucose, biochem
- ECG and CXR- look for AF/ signs of cardiac emboli
- Carotid doppler if suspected anterior ciruclation stroke
What are the potential symptoms of venous sinus thrombosis?
Headache
Papillodema
Seizures
Focal neurological deficit
When should a patient with a proven ischaemic stroke NOT be thrombolysed?
- Uncontrolled HTN >200/120
- Pregnancy
- Previous ICH
- LP in past 7 days
- Oesophageal varices
- Seizure at onset of stroke
- GI bleed in the past 3 weeks
- Active bleeding
- Recent surgery
