Neurology Headaches

Question 1

Recognise the clinical presentation of subarachnoid haemorrhage
- pathway for thunderclap headache

Answer 1

• Sudden pain
• Severe headache, which would progress within minutes from the onset
• Lasts for five or more minutes or a few hours.
• Nausea or vomiting.

1) CT scan
2) Subarachnoid blood –> CT and lumbar puncture
3) Surgery

Question 2

what surgery can you do for an aneurysm ?

Answer 2

1) clipping

2) coiling

Question 3

Treatment for a subarachnoid haemorrhage ?

complication of SAH

Answer 3

Prevention of MI: Non-contrast CT head to diagnose 
1) Nimodipine (Ca2+ blocker , prevents vasospasm)
Hypervolemia 
2) Normal saline 
Rescue :
- Bolus of IV
- HT therapy
- Angioplasty 

Other complications :
1- Hydrocephalus 
2- Seizures
3- Electrolyte Problems 
4- Cardiac rhthym changes 
5-Pulmonary oedema

Question 4

Test for intercranial haemorrhage
what can cause haemorrhage ?
name some causes (4)

Answer 4

• CT, MRI, Spinal tap

CAUSES
1- Head trauma,
2-High blood pressure (hypertension), which can damage the blood vessel walls and cause the blood vessel to leak or burst.
3- atherosclerosis
4- Blood clot.
5- Ruptured cerebral aneurysm
6-Buildup of amyloid protein within the artery walls of the brain (cerebral amyloid angiopathy).
7- A leak from abnormally formed connections between arteries and veins (arteriovenous malformation).
8- Bleeding disorders or treatment with anticoagulant therapy (blood thinners).
9- Brain tumor that presses on brain tissue causing bleeding.
10- Smoking, heavy alcohol use,cocaine
11- Conditions related to pregnancy or childbirth, including eclampsia, postpartum vasculopathy, or neonatal intraventricular hemorrhage.
12- Conditions related to abnormal collagen formation in the blood vessel walls that can cause to walls to be weak, resulting in a rupture of the vessel wall.

Question 5

Migraine

4

Answer 5

1) Pain usually on one side of your head, but often on both sides.
2) Pain that throbs or pulses.
3) Sensitivity to light, sound, and sometimes smell and touch.
4) Nausea and vomiting.

Question 6

outline the features of Intracerebral haematoma
causes
presentation is similar to ……….
what scan is needed ?

Answer 6

An intracerebral (or intraparenchymal) haemorrhage is a collection of blood within the substance of the brain.

Causes / risk factors include: hypertension, vascular lesion (e.g. aneurysm or arteriovenous malformation), cerebral amyloid angiopathy, trauma, brain tumour or infarct (particularly in stroke patients undergoing thrombolysis).

Patients will present similarly to an ischaemic stroke (which is why it is crucial to obtain a CT in head in all stroke patients prior to thrombolysis) or with a decrease in consciousness.

Question 7

what is a Subdural haematoma

scenario ?

Answer 7

Bleeding into the outermost meningeal layer. Most commonly occur around the frontal and parietal lobes.

An elderly alcoholic man presents with a persistent headache after falling over the previous day. On examination he has a fluctuating level of consciousness

suB= banana convex bleed

Question 8

outline Extradural (epidural) haematoma
what Is it ?
How can it occur ?
Where do they occur? 
(6)

Answer 8

• Bleeding into the space between the dura mater and the skull.
• Often results from acceleration-deceleration trauma or a blow to the side of the head.
• The majority of epidural haematomas occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery.

EPI= PIE = LEMON shaped bleed on CT

Question 9

Symptoms to look out for in thunderclap headache?

Answer 9

Symptoms to look out for in thunderclap headache?
Have they ruptured an aneurysm ?
	- Under 40 
	- Neck pain or stiffness
	- During Exertion 
	- Thunderclap onset

Question 10

how to treat Headaches ?
migraine?
remember headaches such as migraine causes vasodilation of vessels

Answer 10

1) ibuprofen and paracetamol
2) then Triptans ( vasoconstriction , pain relief , and anti-inflammatory )

Triptans are selective 5-HT1 receptor agonists, indicated in severe migraine attacks. These drugs act by causing vasoconstriction primarily in the cranial blood vessels.

Question 11

what head haemorrhage has a lucid interval ?

Answer 11

Extradural/ Epidural haemorrhage

Question 12

This is the prophylactic management of migraine. Management includes the following:

Answer 12

1st line = Beta-blocker or Amitriptyline

2nd line = Topiromate/valproate

3rd line = Pizotifen