Neuro: Headaches, Haemorrhages & Oncology Flashcards
(90 cards)
1
Q
Severe orbital-temporal pain around eye
Short (30 mins)
10 - 30 X per day
A
Paroxysmal hemicrania
2
Q
Management for Paroxysmal hemicrania
A
Idomethacin
3
Q
Unilateral Red, swollen + watery eye Miosis (pinpoint pupil) Ptosis (Drooping of the eyelid) Nasal discharge/stuffiness Facial sweating Severe pain around eye
Once or twice per day
Last 15 mins - 2 hours per episode
Continue for 4 - 12 weeks
A
Cluster headaches
- triggered by strong smells / exercise
4
Q
Acute management for cluster headaches
A
Triptans
- Sumatriptan
High flow O2
5
Q
Prophylactic management for cluster headaches
A
Verapamil
Lithium
Prednisolone
6
Q
Headache worse when upright
Associated with Marfan’s
A
Spontaneous Intracranial Hypotension
- due to CSF leak
- pachymeningeal (dural) enhancement on MRI
- conservative tx
7
Q
Unilateral headache in trigeminal area
10 - 20 per day
30s each episode
A
Trigeminal neuralgia
“suicide disease” - as so painful
- 10% bilateral
8
Q
Management of trigeminal neuralgia
A
Carbamazepine
9
Q
Bilateral headache
“band around head”
Recurrent
A
Tension headache
10
Q
Headache behind eyes and nose
A
Sinusitis
11
Q
Scalp tenderness
> 60 years old
Associated with polymyalgia rheumatica
A
Giant Cell Arteritis “Temporal arteritis”
12
Q
Pain at back of neck
A
Cervical spondylosis
13
Q
Unilateral throbbing pain Preceded by prodrome + aura Lasts all day Resolves with sleep Nausea + vomiting Limb weakness
A
Migraine
14
Q
Features of migraine aura
A
Transient hemianopia disturbance “jagged crescent”
Sparks in vision
Photophobia
- Develops hours before onset of pain
15
Q
Triggers of migraine
A
CHOCOLATE
Chocolate Hangovers Orgasms Cheese + Caffeine Oral contraception Lie ins Alcohol (red wine) Travel Exercise
16
Q
Acute management of migraines
A
Triptans (Sumatriptan) + NSAIDs
Metoclopramide
Prochlorperazine
17
Q
Prophylactic management of Migraines
A
- Topiramate (avoid in pregnancy, risk of cleft palate)
- Propranolol (avoid in asthmatics)
- Riboflavin
Give when > 2 attacks per month
18
Q
Management for menstrual migraine
A
Fovatriptan
Zolmitriptan
19
Q
Excessive volume of CSF caused by an imbalance between CSF + absorption
A
Hydrocephalus
20
Q
Child:
- Increased head circumference
- Bulging fontanelle
- Sunsetting or eyes (impaired upward gaze)
- Dilated scalp veins
Adult:
- Morning headache (or upon lying down)
- Nausea + vomiting
- Papilloedema
- Coma
A
Hydrocelphalus
21
Q
Causes of hydrocephalus
A
Obstructive (non-communicating)
- tumours
- SAH
- aqueduct stenosis
Non-obstructive (communicating)
- Increased production of CSF (choroid plexus tumour)
- Failure of reabsorption at arachnoid granulations)
- meningitis
- post-haemorrhage - Normal pressure hydrocephalus
22
Q
Enlarged ventricles in brain (4th) Normal ICP Dementia (reversible) Incontinence Disturbed gait
A
Normal pressure hydrocephalus
23
Q
Investigations of hydrocephalus
A
CT
MRI
LP (not in obstructive as can cause herniation)
24
Q
Acute management of hydrocephalus
A
External ventricular drain (EVD)
- drains to external bag
25
Long-term management of hydrocephalus
Ventriculoperitoneal shunt
| - drains to peritoneum
26
```
Headache
Blurred vision
Papilloedema
Enlarged blind spot
Horizontal diplopia (CN VI palsy)
Young overweight female
```
Idiopathic intracranial HTN
27
Risk factors for idiopathic intracranial HTN
```
Obesity
Female
Pregnancy
COCP
Steroids
Tetracyclines
Lithium
Vit A
```
28
Management for idiopathic intracranial HTN
```
Weight loss
Acetazolamide
Topiramate
Repeat LP
Surgery
- optic nerve sheath decompression
- lumboperitoneal shunt
- ventriculoperitoneal shunt
```
29
Irregular/ decreased RR
Bradycardia
HTN
Wide pulse pressure
Cushing's triad
- seen in increased ICP
- pre-terminal event
30
Headache post LP
Low pressure headache
31
Management of low pressure headache
Caffeine + hydration
32
Investigation for increased ICP
Fundoscopy
| - looking for papilloedema
33
Headache
Postural hypotension
Papilloedema
Increased ICP
34
Management of increased ICP
Controlled hyperventilation
| Raise head to 30 degrees
35
Management of severe increased ICP
Prior to surgery
- IV Mannitol / furosemide
Surgery
36
Diagnostic criteria for migraines
5 + attacks
- need
Lasting 4 - 72 hours
- need
```
Unilateral
Pulsating
Painful
Aggravated by activity
-need 2/4
```
Nausea + vomiting
Photophobia + photophobia
- need 1/2
Not caused by another illness
37
Neuro red flags / when to review immediately
```
GCS < 13 on assessment
GCS < 15 after 2 hours
Seizure post trauma
Focal neuro deficit
> 1 episode of vomiting
Suspected skull fracture
- haemotympanum
- panda eyes
- CSF leak
- Mastoid bruising "battle sign"
```
38
Neuro amber flags / when to review within 8 hours
```
LOC/ amnesia + > 65 years old
Hx of bleeding/clotting disorder
Dangerous mechanism of injury
> 30 mins retrograde amnesia
On warfarin
```
39
First line investigation in suspected brain haemorrhage
CT
40
Intraparanchymal bleeding
| CT: bright hyper-dense lesion
Intracerebral haematoma
| "Haemorrhagic stroke"
41
Risk factors for a intracerebral haematoma
```
HTN
Aneurysms
Atriovenous malformation
Cerebral amyloid angiopathy
Trauma
Brain tumour
Infarct
```
42
Intra-ventricular haemorrhages are seen in
Premature babies
| Non-accidental injury in kids
43
```
Trauma to the side of the head
- acceleration/ deceleration injury
Lucid interval
Increased ICP
CT: Lens shaped
```
Extradural Haematoma "Epidural"
44
Haematoma associated with temporal bone fracture
Extradural Haematoma
45
Type of bleed from extradural haematoma
Arterial bleed
- middle meningeal artery
- between dura mater + skull
46
Complications of extradural haematoma
Can lead to tentorial herniation
47
Management of tentorial herniation
Parietotemporal Craniotomy
48
```
Haematoma of slow onset
Fluctuating confusion/ consciousness
Old age
Alcoholism
Anticoagulated
Crosses suture lines
CT: Cresent shape
```
Subdural haematoma
49
Hypodense present shape on CT
Chronic subdural haematoma
50
Type of bleed from subdural haematoma
Venous bleed
- bridging veins
- bleeds into the outermost meningeal layer
- around frontal and parietal lobes
51
```
Sudden onset
Severe occipital "thunder clap" headache
"Like getting hit on back of head by a baseball bat"
Meningism
- photophobia
- neck stiffness
Nausea + vomiting
Coma/ sudden death
Seizures
Increased ST
```
Subarachnoid haemorrhage (SAH)
52
Causes of SAH
```
Intracranial aneurysm (berry aneurysm) = 85%
- Ehler danlos syndrome
- PCKD
- Coarctatino of aorta
Atriovenous malformation
Pituitary apoplexy
Arterial dissection
Cocaine use
Sickle cell anaemia
```
53
Investigation findings of SAH
CT: - bright hyperdense (acute bleed)
- basal cisterns, sulk, ventricular system
- not picked up in 7%
LP: - increased RBC
- Xanthochromia (yellow CSF- bilirubin)
- performed 12 hours after (RBC breakdown)
- normal/raised opening pressure
Bloods: Hyponatraemia (SIADH)
54
Management of SAH
1. Coiling of intracranial aneurysms
2. Nimodipine (21 days)
- CCB
- Prophylaxis for vasospasm
Watch for - re-bleeding (10% first 12 hours)
- hydrocephalus
- hyponatraemia
55
Cerebral perfusion pressure
Adults: > 70mmHg
Children: 40-70mmHg
56
Most common cancers that cause brain metastasis
Lucky brains become so kind
```
Lung
Breast
Bowel
Skin
Kidney
```
57
```
Increased ICP
- Papilloedema
Change in personality
Vomiting
Headache (worse on bending over)
```
Think brain tumour
- mass effect
58
```
Unilateral hearing loss
Tinnitus
Vertigo
Absent corneal reflex
Facial palsy
```
Vestibular schwannoma "Acoustic neuroma"
- 5% of Intra Cranial Tumours
- 90% of cerebellopontine angle tumours
- slow growing & benign
59
Vestibular schwannomas arise from what nerve
CN VIII
60
Bilateral vestibular schwannomas are seen in
Neurofibromatosis Type 2
61
Investigations for vestibular schwannomas
MRI: Cerebellopontine angle tumour
Audiometry
```
Histology: Antoni A/B patterns
Verocay bodies (acellular areas surrounded by nuclear palisades)
```
62
Management of vestibular schwannomas
Surgery
Radiotherapy
Observation
63
```
Solid/cystic tumour of sellar region
Derived from remnants of Rathke's pouch
- Hormonal disturbance
- Hydrocephalus
- Bitemporal hemianopia
```
Craniopharyngioma
64
Most common paediatric supratentorial tumour
Craniopharyngioma
- also occurs in adults
65
Investigations for Craniopharyngioma
Pituitary blood profile
| MRI
66
Management of Craniopharyngioma
Surgical
67
Tumour found in the 4th ventricle
| Hydrocephalus
Ependymoma
68
Histology shows: Perivascular psuedorosettes
Ependymoma
69
Vascular tumour of cerebellum
| Associated with von-hipper-lindau syndrome
Haemangioblastoma
70
Histology: Foam cells + high vascularity
Haemangioblastoma
71
Benign slow growing tumour
| Common in frontal lobes
Oligodendroma
72
Histology: Calcifications with "fried egg" appearance
Oligodendroma
73
Tumour of the brain membrane
| Arises from the dura matter + compresses
Meningioma
74
Tumour located at:
- falx cerebri
- superior sagittal sinus
- convexity
Meningioma
75
2nd most common primary brain tumour in adults
Meningioma
76
Histology: Spindle cells in concentric whorls + calcified psammoma bodies
Meningioma
77
Management of meningiomas
Observe
Radiotherapy
Surgical resection
78
Most common primary brain tumour in adults
Glioblastoma multiforme
- malignant
- Poor prognosis (1y)
79
MRI: Solid tumour with central necrosis + enhanced rim
Glioblastoma multiforme
80
Histology: Pleomorphic tumour cells border necrotic areas
Glioblastoma multiforme
81
Management of Glioblastoma multiforme
Dexamamethasone (for oedema due to disruption of blood brain barrier)
Post op chemo and radiotherapy
82
Most common primary brain tumour in children
Pilocystic astrocytoma
83
Histology: Rosenthal fibres (corkscrew eosinophilic bundle)
Pilocystic astrocytoma
84
Aggressive paediatric brain tumour
Arises in infratentorial compartment
Spreads through CSF
Medulloblastoma
85
Histology: Small blue cells, Rosette pattern, many mitotic figures
Surgical resection
| Chemotherapy
86
Types of pituitary adenoma
Secretory
Non-secretory
Microadenomas (<1cm)
Macroadenomas (> 1cm)
87
Cushing's features (Increased ACTH)
Acromegaly (Increased GH)
Bitemporal hemianopia
Pituitary adenoma
88
Cause of bitemporal hemianopia in pituitary adenoma
Compression of the optic chasm
| (due to crossing nasal fibres)
89
Management of pituitary adenoma
Manage hormonal side of things
| Surgical (transphenoidal resection)
90
Decreased GCS
Quadraplegia
Miosis
Absent horizontal eye movements
Pontine haemorrhage
- caused by chronic HTN
