Neuro Lectures Flashcards
what is amaurosis fugax?
the painless, TEMPORARY
loss of vision
to one or both eyes
what are the common causes of amaurosis fugax?
athesclerosis of the internal carotid/opthalmic artery
embolic
giant cell arteritis
optic neuropathies
raised ICP
what are the three causes of primary headaches?
migraine
tension
cluster
name some causes of secondary headaches?
acute: meningism subarachnoid hemorrhage - other vascular event low pressure headache sinusitis acute glaucoma
chronic:
medication overuse headache
raised ICP
when do think a headache might be of secondary cause?
sudden onset- seconds to minutes (subarachnoid) focal neurological symptoms past history of HIV, cancer changing cognitive function/personality worse on coughing, bending forward, waking, lying down (raised ICP) vomiting without other cause jaw claudication(GCA) severe eye pain (glaucoma)
red flags for headache (suspected tumour?) which parent urgent investigation
history of cancer elsewhere
new onset cluster headaches
new onset seizure
significantly altered consciousness/memory/coordination
papiloedema (swollen disc when looking through ophthalmoscope)
other abnormal neuro exam
orange flags for headache? (tumour) which should be monitored carefully and have a low threshold for investigation
new headache where diagnostic pattern cannot be found after 8 weeks
headache aggravated by exertion
headache associated with vomiting
new headache in patient over 50
headache which wakes from sleep
if the headache was suggestive of GCA, what other symptoms would you expect?
and what would you do?
tender, thickened, pulseless temporal arteries
jaw claudication
steroids and admission immediately.
if the headache was suggestive of meningitis what other symptoms would you expect?
photophobia
stiff neck
fever
(maybe rash)
if the headache was suggestive of encephalitis what other symptoms would you expect?
fever
odd behaviour
reduce consciousness
fits
if the headache was suggestive of subarachnoid haemorrhage what other symptoms would you expect?
SUDDEN very sudden onset, within seconds to a minute.
‘worse- ever’
‘thunderclap’
describe a tension headache
most common cause, stress relief best treatment
bilateral, non-pulsatile
no nausea, vomitting, photo or phonophobia,
can carry on with normal activities
not normal brought to the doctor so be careful to diagnose
if the headache was attributable to raised ICP, how would it be described/what would be seen? and what would you do?
worse on lying down/waking/bending forwards/coughing/straining
papilloedema likely seen
vomiting
seizures
imaging- ie CT head
LP is contraindicated until after this
what is medication overuse headache? and how is it treated?
most common cause for a episodic headache to become chronic and daily headache.
normally caused by triptans, ergotamine or paracetamol+codeine mixed analgesics
withdraw from the medication. aspirin may help with the rebound headache. preventative drugs like valproate may be used after they are off the drug.
describe a cluster headache
uncommon but most disabling of the primary headaches.
UNILATERAL- often orbital (in one eye)
affected eye may become red, watery, swollen with ptosis
also autonomic features- such as lacrimation, sweating
last 15 mins to 3 hours
may occur multiple times in a day, esp at night
clusters last for 1-3 months, then may be pain free for months before the next cluster.
