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Stage 3 > Neurology: Headaches, Intracranial Haemorrhage > Flashcards

Neurology: Headaches, Intracranial Haemorrhage Flashcards

1
Q

How do migraines typically present?

A

1) Unilateral, throbbing/pulsating headache lasting 4-72 hours
2) Preceded by aura e.g. visual (lines, zigzags) or sensory (paresthesia spreading from fingers to face) - can last for about an hour before the headaches start
3) Photophobia and phonophobia
4) May be identifiable triggers e.g. oral contraceptives or chocolate
5) Multiple episodic headaches affecting her normal activities
6) Associated with nausea/vomiting
7) Bright visual blind spots (aura)

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2
Q

What are examples of migraine triggers?

A

1) Oral contraceptives
2) Chocolate
3) Tyramine (an amino acid) containing products e.g. red wine contains large quantities and also causes dehydration by alcohol-induced diuresis

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3
Q

Which feature of headache helps to confirm the diagnosis of migraine?

A

Presence of aura

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4
Q

Which criteria are required to diagnose migraine in headaches with no aura?

A

At least 5 headaches lasting 4-72 hours with N/V or photo/phonophobia AND 2 of:
1) Unilateral headache
2) Pulsating character
3) Impaired or worsened by daily activities

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5
Q

How are migraines diagnosed?

A

Clinical - history (recurrent bouts of headache and nausea/vomiting with a symptom-free interval in between the typical episodes in an otherwise healthy child can be considered migraine)

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6
Q

How do you manage migraines?

A

1) Identify and avoid triggers
2) Prophylaxis
3) Manage acute attack (symptomatic treatment - analgesics, antiemetics and triptans)
4) Ensure female patients are not taking COOP as it increases their risk of ischaemic stroke

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7
Q

What medications are used for prophylaxis of migraines in order?

A

1) Propanolol - contraindicated in asthma
2) Topiramate - female patient should be on reliable contraception e.g. implant
3) Amitriptyline - use in caution in diabetes, cardiac risk

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8
Q

How do you manage an acute migraine attack?

A

1) Oral triptan e.g. sumatriptan (contraindicated in ischaemic heart disease)
2) Paracetamol or NSAID

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9
Q

Which is a contraindication to oral triptans e.g. sumatriptan?

A

Ischaemic heart disease

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10
Q

What medication can female patients with migraines not be on and why?

A

COOP - increases risk of ischaemic stroke

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11
Q

Which medication is used for prophylaxis of cluster headaches?

A

Verapamil

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12
Q

How does a cluster headache present?

A

1) Episodic, recurrent, severe unilateral periorbital pain/headache localised in or around the eye associated with ipsilateral autonomic features:
2) Excessive lacrimation - eye watering
3) Rhinorrhoea - nasal congestion
4) Features of Horner’s syndrome e.g. miosis, ptosis
5) Swelling around the eye

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13
Q

What is first-line treatment of trigeminal neuralgia?

A

Carbamazepine

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14
Q

How does trigeminal neuralgia present?

A

Brief episodes of stabbing, shock-like pain across the trigeminal nerve distribution - severe pain in the face, commonly around one eye

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15
Q

What is trigeminal neuralgia?

A

Chronic pain disorder affecting the trigeminal nerve

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16
Q

What are the three main types of intracranial haemorrhage excluding stroke?

A

1) Extradural haemorrhage
2) Subdural haemorrhage
3) Subarachnoid haemorrhage
- Each has distinct presentations and clinical findings on CT

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17
Q

What do intracranial haemorrhages often require?

A

Neurosurgical intervention

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18
Q

What is an extradural haemorrhage?

A

Haemorrhage between the skull and dura mater of the meninges

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19
Q

What is extradural haemorrhage commonly caused by?

A

Trauma to the pterion (thinnest part of the skull in the temporal area), with subsequent tearing of the middle meningeal artery as a result of the fracture - but not diagnostic of extradural haemorrhage

20
Q

How do patients with extradural haemorrhage present?

A

1) Acute severe headache
2) Contralateral hemiplegia
3) Rapid deterioration in GCS following a lucid period
History of trauma

21
Q

What is a biconvex haematoma on CT diagnostic of?

A

Extradural haematoma - occurs as the haemorrhage stops expanding at the suture of the skull, where the dura meets the skull, causing the haemorrhage to expand towards the brain

22
Q

How is extradural haemorrhage usually managed?

A

Neurosurgical intervention

23
Q

What is a subarachnoid haemorrhage?

A

Haemorrhage between the dura mater and arachnoid mater - life-threatening condition, bleeding into the subarachnoid space of the brain

24
Q

What are the different types of subdural haemorrhage?

A

Acute, subacute and chronic

25
Q

How do subdural haemorrhages tend to present?

A

Gradually increasing headache and confusion/decreasing cognition - present more gradually than extradural haemorrhages

26
Q

What are risk factors for subdural haemorrhage?

A

1) Age
2) Historic head trauma
3) Alcoholism
4) Anticoagulation

27
Q

What is a crescent-shaped haematoma on CT diagnostic of?

A

Subdural haemorrhage - this occurs as expansion of the haemorrhage is not limited by skull sutures, so follows the contour of the skull

28
Q

How is a subdural haemorrhage managed?

A

If haemorrhage is symptomatic and severe enough - neurosurgical intervention

29
Q

What is a subarachnoid haemorrhage?

A

Haemorrhage underneath the arachnoid mater

30
Q

How do subarachnoid haemorrhages present?

A

1) Acute sudden onset (within seconds) severe headache - often described as a blow to the back of the head or thunderclap headache (burst berry aneurysm)
2) Seizures, neurological deficits, decreased consciousness and death may rapidly follow
3) Photophobia

31
Q

What are causes of subarachnoid haemorrhage?

A

1) Traumatic
2) Spontaneous
- Most commonly burst aneurysm of a vessel in the circle of Willis e.g. berry anurysm
- Arteriovenous malformation

32
Q

Burst aneurysm of a vessel in what location is likely to cause a subarachnoid haemorrhage?

A

Circle of Willis

33
Q

What does a subarachnoid haemorrhage look like on CT?

A

A white area in the centre of the brain, expanding bilaterally

34
Q

How can diagnosis of subarachnoid haemorrhage be confirmed in the event of a negative CT scan?

A

Lumbar puncture - presence of blood in CSF or xanthochromia (yellowing of the CSF due to haemolysis in older bleeds)

35
Q

How is subarachnoid haemorrhage managed?

A

Prompt ABCDE + neurosurgical intervention is usually needed

36
Q

What would xanthochromia (yellowing of CSF due to haemolysis) on lumbar puncture suggest?

A

Older subarachnoid haemorrhage

37
Q

What is the initial investigation for an intracranial haemorrhage?

A

CT head

38
Q

What would acute intracerebral haemorrhage present with?

A

1) Acute/sudden onset features of raised ICP (not subacute)
2) Sudden onset contralateral hemiplegia which can lead to a fall
3) Feel strange sensation in head before onset of hemiplegia

39
Q

How would giant cell arteritis present?

A

1) New onset headache and visual disturbance
2) Night sweats - consistent with recent onset acute large vessel vasculitis
3) Unilateral optic nerve changes
Abducens nerve palsy uncommon
Elderly man

40
Q

What is the most common cause of intracerebral haemorrhage?

A

Hypertension

41
Q

What can exacerbate uncontrolled hypertension and lead to an acute intracerebral haemorrhage?

A

Valsalva e.g. while straining on the toielt

42
Q

Where can acute intracerebral haemorrhage leading to contralateral hemiplegia be located?

A

Right basal ganglia

43
Q

What does cerebral amyloid angiopathy cause?

A

Microhaemorrhages and clinically evident lobar haemorrhages

44
Q

What can exacerbate uncontrolled hypertension and lead to an acute intracerebral haemorrhage?

A

Valsalva e.g. while straining on the toilet

45
Q

What is the timing of cluster headaches like?

A

1) Typically occurs at the same time of the night or day and lasts 15 mins-3 hours
2) Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year

46
Q

Which sign is usually positive in SAH and why?

A

Kernig’s sign - due to the passage of irritated motor-nerve roots through inflamed meninges

47
Q

What are risk factors for SAH?

A

Hypertension, smoking and elderly age

Stage 3 (61 decks)

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