Presentations Flashcards
What are the sinister causes of headaches
V: vascular
I: Infection
V: Vision threatening
I: Intracranial Pressure
D: Dissection
What basic observations do we do for headaches to exclude sinister causes?
Glasgow coma scale, blood pressure and pulse and temperature
What focal neurological signs might appear with a headache?
Focal limb deficit
Third nerve palsy: droopy eyelid, mydriasis, eye deviated down and out
Sixth nerve palsy: convergent squint, failure to abduct eye laterally
Twelfth nerve palsy: tongue deviation (can arise from carotid dissection)
Horner’s Syndrome: partial ptosis, miosis (constricted pupil) and anhydrosis (dry skin around the orbit)
What does one look for in an eye inspection for a headache?
Exophthalmos, cloudy cornea, fixed or dilated oval pupil, optic disc appearance on fundoscopy
What other things might one look for in a headache inspection?
reduced visual acuity (acute glaucoma, temporal arteritis), scalp tenderness (temporal arteritis), meningism ( infection)
Name some causes of non-sinister headaches
Tension type headache (bifrontal pain), migraine (with/without aura), sinusitis (Facial pain + coryza symptoms), medication overuse headache, TMJ syndrome (dull ache in the muscles of mastication), trigeminal neuralgia, cluster headache
Investigations for a subarachnoid haemorrhage
CT scan and LP looking for xanthochromia (yellow CSF) only 12 hrs after onset
What should one organise if frontal sinusitis is suspected?
CT head scan
What sign of fundoscopy is indicative of raised intracranial pressure?
appearance of a poorly defined optic disc - papilloedema due to raised intracranial pressure -> brain tumour?
Raised intracranial pressure also leads to worse headaches in the morning due to gravity
Main symptoms of raised intracranial pressure
Headache - worse when lying down
Nausea - first thing in morning
Papilloedema
Visual blurring
Cushing’s reflex
Cushing’s peptic ulcer
What mechanisms cause raised intracranial pressure?
SOL, cerebral oedema, increased bp in the CNS (malignant hypertension, vasodilator drugs, superior vena cava obstruction), hydrocephalus
