TBL - headaches Flashcards
investugation for giant cell arteritis
Immune mediated vascululitis – ESR less invasive – indicator of inflammation so do for giant cell arteritis
can do temporal artery biopsy - ESR 1st
can you see cavernous sinus thrombosis on CT
MRI with contrast better at looking for cavernous sinus thrombosis than CT – CT don’t pick it up regularly
why is there pain on chewing in giant cell arteritis
ischemic symptom – because more blood needs to flow for muscle use = more pain
raised ICP associated symptoms
N and V
vision change causes
glaucoma
stroke
giant cell arteritis
lacrimation cause
cluster headache
if headache and preceding viral illness got to think….
meningitis
neck pain and stiffness..
meningism
headache red flags
new severe/unextected headache - max severity within 5mins
progressive persistent headache, or headache that has changed dramatically
contacts with similar symptoms
current/recurrent pregnancy - increased ischemic risk, and eclampsia
comorbidities - comprimised immunity (HIV/med) or past malignancy
precipitating factors - head trauma, triggered by valsalva maneuver, positional - worse on standing or lying down
associated features - meningitis symptoms, papilloedeam, new onset neurological deficit, atypical aura, dizziness, visual disturbance or vomiting
effects of paracetamol
reduce fever and pain
could be hiding fever which is an associated symptom
what looking for on CFS analysis
culture for meningitis, pathogens, analyse for blood (xanthochromia) – SAH, markers of inflammation – SOL, cancer. CSF in infection – WCC and glucose change – get back quicker than culture
Glucose low in bacterial meningitis, WCC high - not in viral
CI for LP
check for raised ICP – CI for LP- pressure = brain herniation – LP remove CSF from spinal cord = downward pressure on brain. So do CT first and fundoscopy for papilloedmea
CT angiogram
look at cerebral arteries and carotid arteries for ischemic events
does low pressure headache relate to BP
• Low pressure headache in CSF and spinal system – intracranial pressure – doesn’t affect the BP
