Neurology

Question 1

SUBARACHNOID causes

Answer 1

• Head injury* (most common)
• Intracranial aneurysm (saccular ‘berry’ aneurysms)*2
  o Ass conditions: HTN, adult polycsitic kidney disease, Ehlers-Danlos
• Ateriovenous malformation
• Pituitary apoplexy
• Mycotic (infective) aneurysms

*Traumatic SAH other called spontaneous
*2 ~85% cases

Question 2

SUBARACHNOID IX + referral

Answer 2

**- non-contrast CT
o If done within 6hrs = normal -> no lumbar puncture.
o **If >6hrs = lumbar puncture **

• Lumbar puncture >12hrs following sx onset
  o Looking for xanthochromia
  o Normal or raised opening pressure
• If CT = SAH evidence
  o Refer to neurosurgery (to identify causative path for urgent tx):
  ~ CT intracranial angiogram (vascular lesion e.g. aneurys or AVM)
  ~ +/- digital subtraction angiogram (catheter angiogram)

Xanthochromia helps distinguish between true SAH from ‘traumatic’ tap

Question 3

SUBARACHNOID TX

Answer 3

• Supportive
  o Bed rest
  o Analgesia
  o Venous thromboembolism (VTE) prophylaxis
  o Disco. anithrombotics
• **Vasospasms **(using oral nimodipine)
• Intracranial aneurysms - intervention coil by neuroradiologist or craniotomy and clipping by neurosurgeon

Question 4

Rx overuse headache FX

MOH - Rx use

Common cause of chronic daily headache (1 in 50)

Answer 4

• Px for 15 days or more per month
• Developed or worsened whilst taking regular sx rx
• Patient using opiods and triptans more at risk
• ~ psychiatric co-morb

Question 5

Rx overuse headache MX

MOH, withdrawal sx

Answer 5

• Simple analgesia and triptans should be withdrawn abruptly *
• Opiod analgesia** gradually withdrawn**

Withdrawal sx:
- Vomiting
- HyPOtn
- Tachycardia
- Restlness
- Sleep disturbance
- Anxiety

*may initally worsen headaches