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Psychiatry and Neurology > Neuro- Headaches and Stroke > Flashcards

Neuro- Headaches and Stroke Flashcards

1
Q

What are the 3 main types of primary headache syndromes?

A
  1. Tension type headache
  2. Migraine
  3. Trigeminal autonomic cephalgias
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2
Q

How long do migraines normally last for?

A

4- 72 hours

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3
Q

How long do cluster headaches normally last for?

A

15 mins- 3 hours

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4
Q

Which headache types respond positively to Indometacin?

A

Hemicrania continua

Paroxysmal hemicrania

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5
Q

What is the most common type of headache?

Migraine
Tension type
Hemicrania continua

A

Tension type

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6
Q

What is the most common drug treatment for tension type headaches?

NSAIDs
B blockers
Amityptyline

A

Amitriptyline (TCAs)

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7
Q

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?

A

Tension type

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8
Q

How does a migraine usually change with movement?

A

It becomes worse

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9
Q

Migraine aura symptoms can be divided into sensory, motor, visual and speech. Give examples of these symptoms.

A

Motor- Unilateral weakness/ heaviness
Sensory- Paraesthesia spreading from hand to face
Visual- Flashing lights/ zigzag lines
Speech- Dysphasia

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10
Q

What symptoms may patients experience associated with a migraine?

A 
Nausea and vomiting
Photophobia
Phonophobia
Sounds and smells
Visual disturbance
Lethargy
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11
Q

What are the acute drug treatments for migraine?

A
  1. Triptans eg. Sumitriptan tablets, nasal spray or subcut injections
  2. Antiemetics
  3. NSAIDs/ Paracetamol
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12
Q

What are the preventative drug treatments for migraines?

A
  1. Beta blockers
  2. Topiramate
  3. Botox injections
  4. Amitriptyline
  5. Pizotifen
  6. Riboflavin
  7. Candesartan
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13
Q

Which type of medication is most commonly associated with medication overuse headaches?

NSAIDs
Co-codamol
Amityptyline

A

Co-codamol

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14
Q

Which medication can be used to prevent medication over use headache?

A

Amitriptyline

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15
Q

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?

A

Cluster headache

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16
Q

What are the facial features of cluster headaches?

A 
Periorbital pain
Eye redness
Blocked nose
Tooth pain
Horner's syndrome
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17
Q

What are the acute treatments for cluster headache?

A
  1. Triptan injections

2. High flow oxygen

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18
Q

What are the preventative treatments for cluster headache?

A
  1. Verapamil (NICE 1st line)
  2. Topiramate
  3. Lithium
  4. Pizotifen
  5. Steroids
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19
Q

Gamma core vagus nerve stimulation can be used in acute treatment of which headache type?

A

Cluster headaches

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20
Q

Cluster headaches more commonly affect which gender?

A

Men

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21
Q

Migraines more commonly affect which gender?

A

Women

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22
Q

Which areas of the head is pain most commonly experienced in tension headaches?

A

Frontal

Occipital

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23
Q

In patients aged 40 years plus, what usually causes trigeminal neuralgia?

A

Blood vessel irritating CNV

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24
Q

Which branches of the trigeminal nerve are most commonly affected in trigeminal neuralgia?

A

V2 and V3

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25
Q

In patients aged under 40 years, what is trigeminal neuralgia most commonly associated with?

A

MS

26
Q

What are the most common category of drugs used for trigeminal neuralgia and which is 1st line?

A

AEDs eg. Carbamazepine, Lamotrigine, Phenytoin

Carbamazepine 1st line

27
Q

Post traumatic headache usually occurs less than 2 weeks after an injury and can be treated with which drug?

A

Amitriptyline

28
Q

What are the main symptoms of idopathic intracranial hypertension?

A

Headache

Blurred vision

29
Q

What are the findings on eye examination, lumbar puncture and CT in patients with IIH?

A

Examination: Bilateral papilodema
LP: Opening pressure >30, normal constituents
CT: Normal

30
Q

What are the treatments for IIH?

A
  1. Weight loss
  2. Monitor visual field
  3. Diuretics- Acetazolamide
31
Q

What are the main symptoms of temporal arteritis (aka Giant cell arteritis)?

A

Pain/ tenderness on temple
Jaw and tongue claudications
Difficulty combing hair
Feel generally unwell

32
Q

What happens to blood ESR in temporal arteritis?

A

Raised above 60

33
Q

What are the treatments for temporal arteritis?

A

Steroids for >2 years

34
Q

Stroke is a syndrome of rapidly developing clinical signs, usually of _____ disturbance of cerebral function, lasting over 24 hours or leading to death.

A

Focal

35
Q

What is a non-disabling stroke?

A

Stroke with symptoms which last >24 hours but later resolve, leaving no permanent disability

36
Q

What are the 3 main causes of cerebral ischemia?

A
  1. Large vessel disease- plaque rupture at turbulent site
  2. Cardioembolism- eg from AF
  3. Lacunar infarct
37
Q

What are the triad of symptoms in a carotid artery dissection?

A
  1. Unilateral face and neck pain
  2. Horner’s syndrome
  3. Anterior stroke/ TIA
38
Q

Which conditions increase the risk of lacunar infarct?

A

Diabetes
Hypertension
Hyperlipidaemia

39
Q

The ACA supplies which parts of the brain?

A 
Anterior and medial cerebrum:
Frontal lobe
Parietal lobe
Temporal lobe
Eyes
40
Q

The MCA supplies which parts of the brain?

A

Lateral cerebrum

41
Q

The PCA supplies which parts of the brain?

A 
Posterior brain:
Occipital lobe
Cerebellum
Thalamus
Brainstem
42
Q

What are the 3 main clinical features of an ACA stroke?

A
  1. Homonymous hemianopia
  2. Contralateral UMN hemiparesis/ hemisensory loss
  3. Higher cortical function issues eg. dysphasia, dyphagia, dysarthria
43
Q

What are the main clinical features of a PCA stroke?

A
  1. Vertigo
  2. Ataxia
  3. Diplopia
  4. Dysphagia
  5. Hemiparesis/ tetraparesis (if brainstem)
  6. Blindness
  7. Cranial nerve palsies
44
Q

Which features are common to both ACA and PCA strokes?

A

Hemiparesis
Dysphagia
Dysarthria
Homonymous hemianopia

45
Q

50% of strokes affect which part of the cerebral circulation?

A

Anterior circulation (ACA, MCA)

46
Q

Posterior circulation strokes make up what % of ischemic strokes?

A

25%

47
Q

Lacunar circulation strokes make up what % of ischemic strokes?

A

25%

48
Q

95% of lacunar circulation strokes occur in which parts of the brain?

A

Pons

Basal ganglia

49
Q

What are the 3/4 main clinical features of a lacunar circulation stroke?

A
  1. Contralateral UMN hemiparesis
  2. Contralateral hemisensory loss
  3. Contralateral babinski sign
  4. NO cortical/ higher function issues
50
Q

There are 4 main types of _______ stroke syndrome, which are:

  1. Pure motor hemiparesis
  2. Pure sensory hemiparesis
  3. Hemisensory and motor pattern
  4. Ataxic hemiparesis
A

Lacunar

51
Q

An intracerebral haemorrhage is usually caused by ruptured small penetrating arteries in which part of the brain?

A

Basal ganglia

52
Q

Which type of haemorrhagic stroke’s main features are sudden onset neurological deficit with headache?

A

Intracerebral haemorrhage

53
Q

Which type of haemorrhagic stroke’s main features are sudden onset sever headache, which neck stiffness, nausea and neurological deficit?

A

Subarachnoid haemorrhage

54
Q

What is the main cause of a sub arachnoid haemorrhage?

A

Ruptured berry aneurysm in the circle of willis

Bleeds into the ventricles

55
Q

How should an ischemic stroke be treated if within 4 hours of onset?

A

Thrombolyse with Alteplase

56
Q

How should an ischemic stroke be treated if after 4 hours of onset?

A

Aspirin 300mg

57
Q

Which drug can be given after SAH to prevent risk of secondary ischemia due to vasospasm?

A

Nimodipine

58
Q

Which antiplatelet drugs are given for secondary stroke prevention?

A

Clopidogrel
Aspirin
Dipyridamole

59
Q

What tests should be done in a patient with stroke symptoms?

A
  1. CT scan within 4 hours
  2. Blood tests- FBC, glucose, biochem
  3. ECG and CXR- look for AF/ signs of cardiac emboli
  4. Carotid doppler if suspected anterior ciruclation stroke
60
Q

What are the potential symptoms of venous sinus thrombosis?

A

Headache
Papillodema
Seizures
Focal neurological deficit

61
Q

When should a patient with a proven ischaemic stroke NOT be thrombolysed?

A
  1. Uncontrolled HTN >200/120
  2. Pregnancy
  3. Previous ICH
  4. LP in past 7 days
  5. Oesophageal varices
  6. Seizure at onset of stroke
  7. GI bleed in the past 3 weeks
  8. Active bleeding
  9. Recent surgery

Psychiatry and Neurology (9 decks)

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