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YR3 Core Conditions > Neurology > Flashcards

Neurology Flashcards

1
Q

Classic explanation of a tension headache

A

Tight band across the head

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2
Q

Causes of tension type headache

A

Most common: psychological stress

Others: sleep disturbance, extended periods of mental tension

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3
Q

Typical age of onset of tension headaches

A

20-30s

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4
Q

Pathophysiology of tension headache

A

release and activation of inflammatory agents leads to sensitisation of peripheral trigeminal afferents and ultimately in central hypersensitivity

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5
Q

RFs for tension headache

A

Stress
Missing meals
Sleep disturbance
Mental tension

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6
Q

Clinical presentation of tension headache

A 
generalised head pain 
frontal or occipital head pain 
non-pulsatile head pain 
constricting pain 
normal neurological examination
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7
Q

Differentials of CHRONIC headache

A

MMM IT ACHES

MIGRAINE
MENINGITIS
MEDICATION
ICP CHANGE
TENSION HEADACHE, TEMP. ART. , TRIGEM. NEURALGIA
ARTERIOVENOUS ABNORMALITIES
CLUSTER
HTN , HAEMORRHAGE 
EYE (GLAUCOMA)
SINUSITIS, SYSTEMIC ILLNESS
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8
Q

Differentials of ACUTE headache

A

VICIOUS

VASCULAR: haemorrhage, infarction
INFECTION / INFLAMM.
COMPRESSION: obstructive hydrocephalus, pit. tum. 
ICP: spont/ intracranial hypoten. 
OPHTHALMIC: acute glaucoma
UNKNOWN: situational factors
SYSTEMIC: HTN, CO poisoning
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9
Q

Mx of tension headaches

A

In the acute patient: simple analgesia
In the chronic patient (>7 episodes per month):
-low dose antidepressant i.e. amitriptyline
-+ non pharmacological relaxation therapies

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10
Q

Key descriptive features of SAH

A

Sudden onset (thunderclap)
Worst pain ever
Occipital localisation

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11
Q

What is a migraine?

A

Chronic, genetically determined, episodic disorder presenting with a severe headache causing disability

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12
Q

Epidemiology of migraine

A

F>M = 2:1
Common condition, more so in the west
Prevalence around 8%

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13
Q

Pathology of migraines

A
  1. neurogenic inflammation of first-division trigeminal sensory neurons that innervate the large vessels and meninges of the brain
  2. trigeminal neurons release substances that cause dilation of meningeal blood vessels, leakage of plasma proteins into surrounding tissue, and platelet activation
  3. Sensitises peripheral nerves so that small things like pulsing is considered as pain
  4. If the headache continues, second- and third-order neurons are sensitised (central sensitisation) and cutaneous stimuli, such as light touch, are interpreted as painful
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14
Q

Migraine RFs

A 
Female
Stress
Overuse of headache medication
\+ FHx
Menstruation
Obesity
Patent Foramen Ovale
Lack of sleep
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15
Q

Presentation of migraine

A 
Headache worse with activity
Nausea
Long term headache
Inability to function normally
Sensitivity to light
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16
Q

What may come on before a full blown migraine

A

Aura (changes to vision but no vision loss)

17
Q

What are some features of prodrome

A

Yawning
Food cravings
Change to sleep pattern, appetite or mood

18
Q

Diagnostic criteria for migraine

A

Aura + headache or

  • > 5episodes of headache + n/v + photophobia + >2:
    • unilateral
    • pulsating
    • inability to function
    • worse on activity
19
Q

Triggers of migraine

A

CHOCOLATE

CHeese
OCP (contraceptive pill)
Caffeine
alcohOL
Anxiety
Travel
Exercise
20
Q

Mx of migraine

A

Acute episode

  1. analgesia + magnesium therapy (sumatriptan)
  2. NSAID (ketoprofen)
  3. Rizatriptan
21
Q

Prophylaxis of migraine

A

Avoid triggers

  1. Propanolol + topiramate / amitriptyline
  2. Valporate, pizotifen, gabapentin
22
Q

Cluster headache presentation

A 
Rapid onset
Pain around one eye
Red, watery eye
Miosis, ptosis
15min-3hrs duration
23
Q

Epidemiology of SAH

A

6-8/100K

Average age of onset 35-65

24
Q

Causes of SAH

A

Most commonly rupture of saccular aneurysm (80%)

Arteriovenous malformations account for the rest

25
Q

Common sites for aneurysms to form

A

Junctions between:

  1. AComm/ACA
  2. ICA/PComm
  3. MCA Bifurcation
26
Q

Which individuals should be screened for aneurysms?

A

Those with auto. dom. polycystic kidney disease

Those with 1st/2nd relatives that have had a SAH

27
Q

RFs for SAH

A 
Smoking
Drinking
HTN
\+FHx
ADPKD
Bleeding disorders
Mycotic aneurysms
28
Q

Clinical presentation of SAH

A 
Sudden onset
Vomiting
LoC
'Worst pain ever'
Photophobia
Neck stiffness
Seizures
29
Q

Signs in SAH

A

+ kernigs

30
Q

Ix in SAH

A

CT head detected >90% within 48hrs

LP if CT -ve + >12hrs post headache. Will look bloody then xanthacromia will develop (Yellow CSF)

31
Q

Mx of SAH

A 
Refer to neurology
Frequent neuro obs
Maintain cerebral perfusion
Nimodipime for 3 weeks to reduce vasospasm
Surgery with clipping or coiling
32
Q

Complications of SAH

A

Rebleed
Cerebral ischaemia
Hydrocephalus
Hyponatremia

YR3 Core Conditions (32 decks)

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