secondary headache

Question 1

signs of increased ICP

Answer 1

headache present on waking, made worse by coughing, straining, sneezing. vomiting, visual disturbances.

Question 2

what should you do investigations in ICP

Answer 2

CT. LP is contraindicated!!!!!

Question 3

what is IIH (BIH)

Answer 3

reduced CSF resorption in young, obese females assoc with PCOS. brain imaging normal

Question 4

treatment IIH/BIH

Answer 4

repeat LPs, acetazolamide and thiazide diuretics, VP shunt

Question 5

symptoms SAH

Answer 5

sudden typically occipital headache, vomiting, seizures, collapse, coma, neck stiffness, Kernigs sign, bleeds

Question 6

differential for SAH

Answer 6

meningitis, migraine, intracranial bleeds

Question 7

investigations in SAH

Answer 7

CT. LP if CT -ve

Question 8

what does the LP show in SAH

Answer 8

bloody CSF, after a while turns xanthochromic (yellow) due to the breakdown of Hb (bilirubin). xanthrochomic LP confirms diagnosis and not just bloody tap

Question 9

management SAH

Answer 9

refer to neurosurgery immed. reexamine CNS often. nimodipine to reduce vasospasm so reducing mortality from cerebral ischaemia. endovascular coiling in surgery

Question 10

complications SAH

Answer 10

rebleeding main cause of death happens a few days after surgery. cerebral ischaemia due to vasospasm

Question 11

features of GCA

Answer 11

seen in patients >50. headache- pain over the superficial temporal artery, which is painful to touch; facial pain- face, jaw, mouth and jaw claudication; visual problems- visual loss, amaurosis fugax may precede complete loss

Question 12

management GCA

Answer 12

check ESR which is very high >50. superficial temporal artery biopsy. high dose steroids- prednisolone 1mg/kg. long term treatment for a year