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Neurology and Special Senses > Secondary Headaches: Life-threatening > Flashcards

Secondary Headaches: Life-threatening Flashcards

1
Q

What is a SAH? What is it usually caused by?

A

Bleeding in the subarachnoid space usually caused by a rupture of a berry aneurysm in the Circle of Willis

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2
Q
  1. Medical conditions that can increase the risk of a SAH? (4) 2. What recreational drugs increases the risk?
A
  1. Ehlers-Danlos Syndrome
    - Marfans Syndrome
    - Polycystic Kidney Disease
    - Sickle Cell anaemia
  2. Cocaine
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3
Q

What type of headache presents in a SAH?

A

Thunderclap headache, reaching intensity within seconds

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4
Q

Where is the location of the headache pain in SAH?

A

Occipital

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5
Q

Clinical presentation of SAH?

A
  1. Thunderclap headache (+ sentinel headache)
  2. Nausea/Vomiting
  3. Seizures
  4. Collapse, LOC, coma
  5. Local neurological signs
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6
Q

What is a sentinel headache seen in SAH?

A

Prior mild headache that appears a few days/ weeks before a SAH reflecting an aneurysm leak.

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7
Q

Investigation of SAH?

A
  1. bloods: FBC, clotting, U&E, glucose,
  2. ECG (long QT, ST elevation)
  3. CT head (without contrast)
  4. LP (if CT head is negative)
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8
Q

How long should you wait to do an LP be done after the onset of a SAH?

A

12 hours to show the presence of Xanthochromia

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9
Q

What are you looking for in a LP?

A

The presence of Xanthochromia

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10
Q

Is a CT head done with or without contrast for a SAH?

A

Without

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11
Q

What are the main aims of SAH management? (2)

A
  1. prevent a re-bleed

2. prevent vasospasm (therefore preventing ischaemia)

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12
Q

What are the 2 surgical techniques that can be used to prevent a re-bleed in SAH?

A
  1. Endovascular coiling

2. Clipping

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13
Q

What drug is given to prevent vasospasm in SAH treatment?

A

CCB - Nimodipine

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14
Q

Who should you make a referral to when a patient presents with a SAH?

A

Neurosurgeons

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15
Q

What should be monitored when patients present with a SAH? (4)

A
  1. GCS
  2. Pupils
  3. Neuro signs
  4. Bp (keep systolic <180mmHg)
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16
Q

Complications of SAH? (4)

A
  1. Re-bleed
  2. Vasospasm –> cerebral ischaemia
  3. Obstructive hydrocephalus
  4. Arrhythmia
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17
Q

What is GCA/Temporal arteritis?

A

Inflammation of middle or large cerebral arteries, commonly affecting the temporal artery

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18
Q

Type of headache/pain seen in GCA?

A

Unilateral throbbing temporal pain

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19
Q

Clinical presentation of GCA? (6)

A
  1. Temporal pain
  2. Jaw Claudication
  3. Scalp tenderness
  4. Fever, malaise
  5. Initially painless, transient vision loss (amaurosis fugax)
  6. Morning stiffness (polymyagia rheumatica)
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20
Q

What condition is typically seen with GCA?

A

Polymyalgia Rheumatica (50%)

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21
Q

What will temporal artery palpation present with in GCA?

A

Tender, pulseless temporal artery

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22
Q

Investigations for GCA?

A
  1. Bloods - FBC CRP, ESR, AST

2. Imaging - USS and temporal artery biopsy

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23
Q

What do these markers show in GCA?

  1. FBC
  2. CRP and ESR
  3. LFTs
A
  1. FBC = low Hb (anaemia), raised platelets (thrombocytosis)
  2. CRP and ESR = raised
  3. LFTs = raised ALP
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24
Q

What is Amaurosis Fugax?

A

Transient sudden painless loss of vision that usually occurs due to an occlusion to a retinal artery by a clot from a diseases artery. Can also occur due to a vasculitis (e.g. in GCA)

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25
Q

Gold standard for the diagnosis of GCA? What will the results show?

A
  1. Temporal Artery biopsy.

2. Multi-nucleated Giant Cells

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26
Q

Why might a patient develop chest pain if they have GCA?

A

They may have Aortitis

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27
Q

Key treatment for GCA? Other treatments provided?

A
  1. High dose steroids (Prednisolone)
  2. Aspirin (prevent stroke and vision loss)
  3. PPI (gastroprotection whilst on steroids and aspirin)
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28
Q

Complications for GCA? (2)

A
  1. Aortitis - AAA, aortic dissection
  2. Stroke
  3. Vision loss
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29
Q

What is a subdural haematoma? Pathophysiology?

A
  1. Bleed in the brain between the dura and subarachnoid mater (subdural space)
  2. Rupture of bridging veins
30
Q

Common cause of a subdural haematoma?

A

Traumatic head injury

31
Q

Risk factors that predisposes patients to a subdural haematoma? (3)

A
  1. Alcohol
  2. Age (older)
  3. Anticoagulants
32
Q

Investigations for Subdural Haematoma?

A 
ABCDE on admission 
Bloods - clotting, G&S., glucose 
Neuro obs - GCS, fundoscopy 
ECG
CT scan
33
Q

What will a CT scan show in a Subdural Haematoma?

A 
Crescent mood shape along 1 side
midline shift (severe) 
shrunken ventricles
34
Q

How may the ventricles appear in a subdural haematoma?

A

Shrunken

35
Q

How does alcoholism increase the risk of a subdural haematoma? (2)

A

Alcoholism causes:

  1. thrombocytopenia causes prolonged bleeding time
  2. cerebral atrophy - puts pressure on the bridging veins
36
Q

Clinical presentation of a Subdural haematoma? (5)

A
  1. Nausea and vomiting
  2. Confusion, reduced consciousness, seizures
  3. Severe sudden headache
  4. focal neurological signs
  5. signs of raised ICP (e.g. papilloedema)
37
Q

How does old age increase the risk of a subdural haematoma?

A

Cerebral atrophy with age puts tension on the bridging veins.

38
Q

Management of a subdural haematoma if it is small?

A

Continuous neuro obs (GCS, pupils, focal signs) a

39
Q

Management of subdural haematoma if it is large causing a midline shift, signs of raised ICP and focal neuro signs?

A

Referral to neurosurgeons for clot decompression and craniotomy.

40
Q

Management of seizures

A

Levetiracetam (Keppra)

41
Q

What can these tests show in a subdural haematoma?

  1. FBC
  2. U&E
  3. LFTs
  4. Bone profile
  5. Coagulation
  6. G&S
  7. Crossmatch
A
  1. FBC - anaemia, thrombocytopenia
  2. U&E - sodium
  3. LFTs - history of alcohol abuse
  4. Bone profile - calcium
  5. Coagulation - clotting disorder
  6. G&S - work up for surgery
  7. Crossmatch - for products such as platelets, packed RBCs, FFP
42
Q

Management options for raised ICP in subdural haematoma?

A

Hypertonic saline 2.7% or Mannitol

43
Q

What GCS score requires airway management?

A

GCS <8

44
Q

Complications of subdural haematoma

A
  1. coma/ death

2. permanent neuro damage (weakness, paralysis, speech deficits)

45
Q

What is meningitis?

A

Inflammation of the meninges

46
Q

Which is more serious- bacterial or viral meningitis?

A

Bacterial meningitis

47
Q

Common bacterial causes of meningitis in infants (<3 months)? (3) Which out of these are most common?

A
  1. Group B Strep (most common)
  2. E coli (gram -ve)
  3. Listeria
48
Q

Common bacterial causes of meningitis in >3 months and adults? (3)

A
  1. Neisseria Meningitidies (Meningococcus)
  2. Streptococcus Pneumoniae
  3. Haemophilus Influenza type B (HiB)
49
Q

Name of the condition where the meningococcus infection enters the bloodstream?

A

Meningococcal Septicaemia

50
Q

Common bacterial causes of meningitis in elderly? (4)

A
  1. Listeria
  2. Steptococcus Pneumoniae
  3. TB
  4. E-coli (gram -ve)
51
Q

Classical presentation of meningitis due to irritation of the meninges (3)

A

Meningism:

  1. Neck stiffness
  2. Photophobia
  3. Headache
52
Q

Name of the 2 signs you can look for during the examination of meningitis?

A
  1. Kernig’s sign

2. Brudzinski’s sign

53
Q

What is Kernig’s sign?

A

Pain elicited during knee extension when the hip and knee are initially flexed

54
Q

What is Brudzinski’s sign?

A

Knees and hips flexed when neck flexed

55
Q

Other clinical presentation of meningitis excluding meningism? (4)

A
  1. Fever
  2. Confusion, reduced consciousness
  3. Focal neuro signs
  4. Non-blanching rash (meningococcus septicaemia)
56
Q

Name of the condition where the meningococcus bacteria affects the meningitis and CSF around the brain and spinal cord

A

Meningococcus Meningitis

57
Q

Investigation of meningitis? (4)

A
  1. Bloods
  2. Meningococcal PCR
  3. CT scan (prior to LP to rule out raised ICP)
  4. LP (show bacterial or viral meningitis)
58
Q

Viral causes of meningitis?

A
  1. Enterococcus (Coxsackie)
  2. Herpes Simplex (commonly type 2)
  3. Mumps
  4. Measles
  5. HIV
59
Q

Why is diagnosis of meningitis challenging?

A

Definitive diagnosis is done through isolation of the pathogen in the CSF. However, it can be difficult to isolate especially if antibiotics has already been initiated. So diagnosis can be made with CSF suggestive of infection (+ positive blood culture)

60
Q

Treatment of bacterial meningitis in the community?

A

Benzylpenicillin

61
Q

Treatment of bacterial meningitis in hospital for infants <3 months

A

Ceftriaxone or Cefotaxime with Amoxicillin

62
Q

Why is Amoxicillin added to the treatment in infants <3 months and elderly with bacterial meningitis?

A

To cover Listeria

63
Q

Treatment of bacterial meningitis in infants >3 months and adults?

A

Ceftriaxone or Cetotaxime

64
Q

Why is dexamethasone given to children >3 months with bacterial meningitis?

A

Reduces the risk of hearing loss and neurological complications.

65
Q

What drug is given to reduce the risk of hearing loss and neurological damage after bacterial meningitis?

A

Dexamethasone QDS for 4 days

66
Q

Treatment of viral meningitis?

A

Supportive management - fluids, analgesia, antimetics

67
Q

Drug given for the prophylaxis of bacterial meningitis for prolonged contacts? (2)

A

Single dose Ciprofloxacin or 2 days Rifampicin

68
Q

Complications of meningitis?

A
  1. Severe sepsis
  2. Death
  3. neurological deficits
  4. Seizures/ epilepsy
69
Q

Treatment of viral meningitis if caused by HSV?

A

Aciclovir

70
Q

Drug given in bacterial meningitis when there is a risk of penicillin/cephalosporin resistance (recent foreign travel)

A

Vancomycin

Neurology and Special Senses (9 decks)

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