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Conditions > Neurology > Flashcards

Neurology Flashcards

1
Q

Name 4 types of headaches.

A
  • Tension headaches
  • Migraines
  • Cluster headaches
  • Medication overuse headaches
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2
Q

How can headaches be classified?

A
  • Primary
  • Secondary
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3
Q

What is a primary headache?

A

Headache itself is the focus, it is not a symptom of an underlying disease or condition

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4
Q

Give examples of primary headaches (3).

A
  • Tension headaches
  • Migraines
  • Cluster headaches
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5
Q

What is a secondary headache?

A

Headache is a symptom of an underlying disease or condition

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6
Q

Give examples of secondary headaches (5).

A
  • Meningitis
  • Encephalitis
  • Giant cell arteritis
  • Brain haemorrhage
  • Brain tumour
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7
Q

What is the most common and second most common type of primary headache?

A
  • Most common - tension headache
  • Second most common - migraine
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8
Q

What is a tension headache?

A

A headache that causes a mild ache across the forehead, in a band-like pattern around the head

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9
Q

Name 3 muscles which can be affected in a tension headache.

A
  • Frontalis
  • Temporalis
  • Occipitalis
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10
Q

What are tension headaches associated with (5)?

A
  • Stress
  • Alcohol
  • Depression
  • Dehydration
  • Skipping meals
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11
Q

Describe the presentation of a tension headache (3).

A
  • Tight band around the head
  • Non-throbbing
  • Non-pulsatile
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12
Q

How are tension headaches diagnosed?

A

Clinical diagnosis

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13
Q

How can tension headaches be treated (3)?

A
  • Reassurance
  • Basic analgesia e.g paracetamol, ibuprofen
  • Relaxation techniques
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14
Q

What can be given for tension headache prophylaxis?

A

Amitriptyline

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15
Q

How can medication overuse headaches be avoided in the treatment for tension headaches (2)?

A
  • Limit use of analgesia to no more than 6 days per month
  • Avoid opioids
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16
Q

How can tension headaches be differentiated from migraines (4)?

A

Tension headaches:
- Bilateral
- Non-throbbing and non-pulsatile
- No nausea and vomiting
- Not aggrevated by physical activity

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17
Q

What is a migraine?

A

A severe headache that causes a throbbing or pulsing sensation

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18
Q

Are migraines more common in males or females? Why?

A

Females:
- Due to hormonal changes during the menstrual cycle
- Become less frequent in pregnancy and after menopause

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19
Q

What are the 4 different types of migraines?

A
  • Migraines without aura
  • Migraines with aura
  • Silent migraine - with aura but without headache
  • Hemiplegic migraine - mimics a stroke
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20
Q

Describe the presentation of a migraine.

A

POUNDW:
- Pulsating
- Onset of 4-72 hours
- Unilateral
- Nausea and vomiting
- Disabling
- Worse with activity

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21
Q

What sensory changes may be associated with migraines (3)?

A
  • Aura - flashing lights, sparks, blurring/lines across vision
  • Photophobia
  • Phonophobia
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22
Q

What can trigger a migraine?

A

CHOCOLATE:
- CHeese
- Oral contraceptive pill and menustration
- Caffeine
- AlcohOL
- Anxiety/stress
- Travel and too much/little sleep
- Exercise

23
Q

What are the 4 main stages of a migraine? How long does each stage last?

A
  • Prodrome - few hours to days
  • Aura - 5 - 60 mins
  • Headache - 4- 72 hours
  • Postdrome - 24 - 48 hours
24
Q

How is a migraine diagnosed?

A

Clinical diagnosis

25
Q

What can be given for nausea and vomiting associated with migraines?

A

Anti-emetics e.g metoclopramide

26
Q

How can a sudden onset of migraines be treated (3)?

A
  • Paracetamol
  • NSAIDs e.g ibuprofen, naproxen
  • Triptans e.g sumitriptan
27
Q

What can be given for migraine prophylaxis?

A
  • Beta-blockers e.g propanolol
  • Anti-convulsants e.g sodium valproate, topiramate
  • TCAs e.g amitriptyline
28
Q

What should you consider before giving propanolol to someone with migraines?

A

Should not be given to those with asthma

29
Q

What should you consider before giving sodium valproate or topiramate to someone with migraines?

A

It is teratogenic - avoided in women of child-bearing age

30
Q

Why should the oral contraceptive pill be avoided in someone with migraine with aura?

A

Small increased risk of a stroke

31
Q

What is a cluster headache?

A

A very severe type of headache which is often felt around the eye

32
Q

Describe the presentation of a cluster headache (6).

A
  • Excruciating pain around the eye - sharp, piercing, burning
  • Red, swollen and watery eye
  • Miosis
  • Ptosis
  • Nasal discharge
  • Facial sweating
33
Q

How are cluster headaches diagnosed?

A

Clinical diagnosis

34
Q

What investigations can be done for cluster headaches (2)?

A
  • MRI brain - exclude tumour
  • ESR - exclude giant cell arteritis
35
Q

How are cluster headaches treated (2)?

A
  • High flow 100% oxygen
  • Triptans e.g sumitriptan
36
Q

What can be given for cluster headache prophylaxis (3)?

A
  • Verapamil
  • Lithium
  • Prednisolone
37
Q

What are red flag headache symptoms (5)?

A
  • New headache with a history of cancer
  • Cluster headaches
  • Seizures
  • Altered consciousness and memory
  • Papilloedema
38
Q

What is meningitis?

A

Inflammation of the leptominiges (arachnoid and pia mater)

39
Q

What is the most common cause of meningitis? Describe.

A

Streptococcus pneumoniae - gram + diplococci

40
Q

Which organism causes meningitis with the worse prognosis? Describe.

A

Neisseria meningitidis - gram - diplococci

41
Q

What is the most common cause of meningitis in neonates?

A

Streptococcus agalactiae

42
Q

What is the most common cause of meningitis in pregnant women?

A

Listeria monocytogenes

43
Q

What is the most common cause of fungal meningitis? Who does it usually affect?

A

Cryptococcus neoformans - affecting immunocompromised patients

44
Q

What triad of symptoms is associated with meningitis?

A
  • Fever
  • Headache
  • Neck stiffness
45
Q

Describe the presentation of meningitis (6).

A
  • Fever
  • Headache
  • Neck stiffness
  • Non-blanching purpuric/petechial rash
  • Altered mental state
  • Photophobia
46
Q

What investigations can be done for meningitis (4)?

A
  • Blood cultures - identify cause
  • Pneumococcal and meningococcal serum PCR
  • Lumbar puncture
  • CT head - exclude lesions
47
Q

When may a lumbar puncture be contraindicated?

A

If there is suspected raised ICP

48
Q

Describe CSF findings for bacterial meningitis.

A
  • CSF - turbid
  • Cells - neutrophils polymorphs
  • Proteins - raised
  • Glucose - low
49
Q

Describe CSF findings for viral meningitis.

A
  • CSF - clear
  • Cells - lymphocytes
  • Proteins - raised
  • Glucose - normal
50
Q

Describe CSF findings for TB/fungal meningitis.

A
  • CSF - clear
  • Cells - lymphocytes
  • Proteins - raised
  • Glucose - low
51
Q

How is meningitis treated in hospital?

A

Cephalosporins e.g IV cefotaxime, IV ceftriaxone
- Over 50s/immunocompromised - IV amoxicillin

52
Q

How is meningitis treated in the community?

A

Injection of benzylpenicillin and transfer to hospital

53
Q

How is viral meningitis treated (4)?

A

Usually self-resolving:
- Analgesia
- Hydration
- Anti-pyrectics
- Aciclovir in severe cases

54
Q

What is Parkinson’s disease?

A

A neurodegenerat

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