Trigger HAs - All (billie)

Question 1

suspicion of what condition would lead to ordering ESR and CRP

Answer 1

temporal arteritis

should also get a temporal artery biopsy

Question 2

patients who are elderly, alcoholics, substance abusers, or on antiplatelt/anticoags are all at increased suspicion for what etiology of headache

Answer 2

subdural hematomas and intracerebral hemorrhages

Question 3

a patient w HA who also has vestibular symptoms is suspected to have what etiology

Answer 3

cerebellar hemorrhage

Question 4

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?

Answer 4

space occupying brain tumors

other sx: nausea/vomiting

Question 5

patients with AMS, seizures and a hx of cancer are at increased risk of what HA etiology

Answer 5

metastatic brain lesions

Question 6

a patient with polycythemia or clotting factor deficiencies is at risk for what HA etiology?

Answer 6

cerebral venous thrombosis

risk factors:
hypercoagulable states d/t OCP
postpartum
perioperative status
clotting factor deficiencies
polycythemia

Question 7

a patient who is postpartum, perioperative status, or on OCPs is at risk for what HA etiology?

Answer 7

cerebral venous thrombosis

risk factors:
hypercoagulable states d/t OCP
postpartum
perioperative status
clotting factor deficiencies
polycythemia

Question 8

PE shows papilledema with neuro symptoms that wax and wane

Answer 8

cerebral venous thrombosis

risk factors:
hypercoagulable states d/t OCP
postpartum
perioperative status
clotting factor deficiencies
polycythemia

(idiopathic intracranial HTN also presents w papilledema)

Question 9

lumbar pressure will show increased opening pressure in which HA etiologies

Answer 9

• cerebral venous thrombosis
• idiopathic intracranial HTN

Question 10

best test for this HA etiology is MR venography

Answer 10

cerebral venous thrombosis

Question 11

presents with fatigue, fever, jaw claudication, and visual disturbances.

Answer 11

temporal arteritis

also see tender/pulsless, or normal temproal arteries

Question 12

MC in patients over 50 and risk increases w age

Answer 12

temporal arteritis

Question 13

gradual onset HA with pulsating unilateral pain and associated phonophobia and photophobia that is worse with activity

Answer 13

migraine headache

Question 14

MC in obese women 20-44

Answer 14

idiopathic intracranial HTN

Question 15

HA presenting with back pain, visual disturbances and tinnitus is likely what etiology?

Answer 15

idiopathic intracranial HTN

PE would show papilledema

Question 16

presents with papilledema

Answer 16

• idiopathic intracranial HTN
• cerebral venous thrombosis

Question 17

can lead to permanent visual loss

Answer 17

• idiopathic intracranial HTN
• temporal arteritis

Question 18

Pt w a headache who has a hx of epidural injection yesterday is likely what etiology

Answer 18

intracranial hypotension

Question 19

pt presents with HA that is worse when sitting up and alleviated by lying down. she is vomiting and has altered hearing and vision

Answer 19

intracranial hypotension

Question 20

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

Answer 20

cluster HA

Question 21

tx w oral prednisone 60mg QD

Answer 21

temporal arteritis WITHOUT vision loss

Question 22

tx with acetazolamide 250-500mg BID

Answer 22

idiopathic intracranial hypertension.

aslo:
- reccomend weight loss to obese patients.
- remove excess CSF during diagnostic LP to 15-20cm H2O
-consult neuro/opthalmology

Question 23

tx is epidural blood patch

Answer 23

intracranial hypotension

Question 24

tx is high flow oxygen 12L/min for 15 min. also give SQ sumatriptan if needed

Answer 24

cluster headaches

Question 25

a HA patient with polycystic kidney disease, marfans syndrome or ehlers-danlos syndrome suggests what possible etiology

Answer 25

SAH

Question 26

if a LP shows RBC’s or xanthochromia what is the suspected HA etiology

Answer 26

SAH

Question 27

enterovirus and echovirus are the MCC of what headache etiology

Answer 27

Aseptic meningitis

Question 28

HSV is the MC and most treatable cause of what

Answer 28

encephalitis

Question 29

cog deficits, psych symptoms, and seizures in the presence of headache and fever may suggest what etiology?

Answer 29

encephalitis

can also see:
AMS
neck stiffness

Question 30

pts with meningitis that are also one of the following are at risk for what bacterial etiology:
- 50+ years
- pregnant
- alcoholic
- immunocomp

Answer 30

listeria monocytogenes meningitis
(tx w 3rd gen ceph (ceftriaxone(rocephin)) + vanc + ampicillin)

Question 31

pt with symptoms for 1-8 weeks prior to diagnosis and radiation of symptoms to ears/eyes/sinuses

Answer 31

brain abscess

Question 32

over half of these infections spread from hematogenous spread of bacteria from soft tissue, urine or respiratory sources.

Answer 32

epidural abscesses

Question 33

characterized by back pain, fever, neuro symptoms

Answer 33

spinal epidural abscess (fever also common)

Question 34

IVDU, spinal surgery, and LP or epidural are all risks for what HA etiology

Answer 34

spinal epidural abscess

Question 35

decreased rectal tone and decerased perineal sensations

Answer 35

cauda equina syndrome

Question 36

1st line- gadolinium MRI
2nd - CT w myelography if MRi not possible

Answer 36

epidural abscess

Question 37

treat with Vanc + ceftazidime/cefipime +/- gentamycin

Answer 37

epidural abscess suspicion

Question 38

1/3 of these events are associated w neurologic events such as TIA and stroke

Answer 38

temporal arteritis

Question 39

PE shows auditory processing disorder and flame hemorrhages on fundoscopy

Answer 39

Temporal arteritis

Question 40

Presents with a normal PE

Answer 40

trigeminal neuralgia

Question 41

tx by carbamazepine 100mg PO BID then increasing dose slowly as needed.

Answer 41

trigeminal neuralgia