Trigger - All Flashcards
suspicion of what condition would lead to ordering ESR and CRP
temporal arteritis
should also get a temporal artery biopsy
patients who are elderly, alcoholics, substance abusers, or on antiplatelt/anticoags are all at increased suspicion for what etiology of headache
subdural hematomas and intracerebral hemorrhages
a patient w HA who also has vestibular symptoms is suspected to have what etiology
cerebellar hemorrhage
HA that is worse in the morning, better/worse with position changes and worse with valsalva is likely what etiology? what other symptoms may you see?
space occupying brain tumors
other sx: nausea/vomiting
patients with AMS, seizures and a hx of cancer are at increased risk of what HA etiology
metastatic brain lesions
a patient with polycythemia or clotting factor deficiencies is at risk for what HA etiology?
cerebral venous thrombosis
risk factors:
hypercoagulable states d/t OCP
postpartum
perioperative status
clotting factor deficiencies
polycythemia
a patient who is postpartum, perioperative status, or on OCPs is at risk for what HA etiology?
cerebral venous thrombosis
risk factors:
hypercoagulable states d/t OCP
postpartum
perioperative status
clotting factor deficiencies
polycythemia
PE shows papilledema with neuro symptoms that wax and wane
cerebral venous thrombosis
risk factors:
hypercoagulable states d/t OCP
postpartum
perioperative status
clotting factor deficiencies
polycythemia
(idiopathic intracranial HTN also presents w papilledema)
lumbar pressure will show increased opening pressure in which HA etiologies
- cerebral venous thrombosis
- idiopathic intracranial HTN
best test for this HA etiology is MR venography
cerebral venous thrombosis
presents with fatigue, fever, jaw claudication, and visual disturbances.
temporal arteritis
also see tender/pulsless, or normal temproal arteries
MC in patients over 50 and risk increases w age
temporal arteritis
gradual onset HA with pulsating unilateral pain and assocaited phonophobia and photophobia that is worse with activity
migraine headache
MC in obese women 20-44
idiopathic intracranial HTN
HA presenting with back pain, visual disturbances and tinnitus is likely what etiology?
idiopathic intracranial HTN
PE would show papilledema
presents with papilledema
- idiopathic intracranial HTN
- cerebral venous thrombosis
can lead to permanent visual loss
- idiopathic intracranial HTN
- temporal arteritis
Pt w a headache who has a hx of epidural injection yesterday is likely what etiology
intracranial hypotension
pt presents with HA that is worse when sitting up and alleviated by lying down. she is vomiting and has altered hearing and vision
intracranial hypotension
unilateral HA with associated symptoms of nasal congestion and constant pacing across the room. pt reports this has been happening daily for the past 2 weeks
cluster HA
tx w oral prednisone 60mg QD
temporal arteritis WITHOUT vision loss
tx with acetazolamide 250-500mg BID
idiopathic intracranial hypertension.
aslo:
- reccomend weight loss to obese patients.
- remove excess CSF during diagnostic LP to 15-20cm H2O
-consult neuro/opthalmology
tx is epidural blood patch
intracranial hypotension
tx is high flow oxygen 12L/min for 15 min. also give SQ sumatriptan if needed
cluster headaches
a HA patient with polycystic kidney disease, marfans syndrome or ehlers-danlos syndrome suggests what possible etiology
SAH
if a LP shows RBC’s or xanthochromia what is the suspected HA etiology
SAH
enterovirus and echovirus are the MCC of what headache etiology
Aseptic meningitis
HSV is the MC and most treatable cause of what
encephalitis
cog deficits, psych symptoms, and seizures in the presence of headache and fever may suggest what etiology?
encephalitis
can also see:
AMS
neck stiffness
pts with meningitis that are also one of the following are at risk for what bacterial etiology:
- 50+ years
- pregnant
- alcoholic
- immunocomp
listeria monocytogenes meningitis
(tx w 3rd gen ceph (ceftriaxone(rocephin)) + vanc + ampicillin)
pt with symptoms for 1-8 weeks prior to diagnosis and radiation of symptoms to ears/eyes/sinuses
brain abscess
over half of these infections spread from hematogenous spread of bacteria from soft tissue, urine or respiratory sources.
epidural abscesses
characterized by back pain, fever, neuro symptoms
spinal epidural abscess (fever also common)
IVDU, spinal surgery, and LP or epidural are all risks for what HA etiology
spinal epidural abscess
decreased rectal tone and decerased perineal sensations
cauda equina syndrome
1st line- gadolinium MRI
2nd - CT w myelography if MRi not possible
epidural abscess
treat with Vanc + ceftazidime/cefipime +/- gentamycin
epidural abscess suspicion
1/3 of these events are associated w neurologic events such as TIA and stroke
temporal arteritis
PE shows auditory processing disorder and flame hemorrhages on fundoscopy
Temporal arteritis
Presents with a normal PE
trigeminal neuralgia
tx by carbamazepine 100mg PO BID then increasing dose slowly as needed.
trigeminal neuralgia
