Week 22 - Brain metastasis, epilepsy, meningitis, migraine Flashcards
what are the four main types of migraines
migraine without aura
migraine with aura
silent migraine
hemiplegic migraine
what are the five stages of a migraine
premonitory or prodromal
aura (lasts for up to 60mins)
headache (lasts 4-72hrs)
resolution
postdromal or recovery phase
what may the prodromal phase involve
subtle symptoms such as yawning, fatigue or mood change
what are the typical features of a migraine headache
usually unilateral
moderate-severe intensity
pounding or throbbing
photophobia
phonophobia
osmophobia
aura (visial changes)
nausea or vomiting
what can migraine aura affect
vision, sensation or language
what are the visual symptoms associated with aura
sparks in the vision
blurred vision
lines across the vision
loss of visual fields (scotoma)
what do sensation aura changes include
tingling or numbnessw
what language aura symptoms may be found in migraine
dysphasia - difficulty speaking
what is the main features of hemiplegic migraines
hemiplegia - unilateral limb weakness
what other symptoms may be seen in hemiplegic migraines
ataxia - loss of coordination
impaired consciousness
what is familial hemiplegic migraine
an autosomal genetic condition characterised by hemiplegic migraines that run in families. however, they may occur without any genetic link or family history
what can hemiplegic migraines mimic
can mimic a stroke or a TIA - it is essential to exclude a stroke with sudden-onset hemiplegia
what are the common triggers for the onset of migraines
Stress
Bright lights
Strong smells
Certain foods (e.g., chocolate, cheese and caffeine)
Dehydration
Menstruation
Disrupted sleep
Trauma
what is the acute medical management of migraines
NSAIDs (naproxen or ibuprofen)
paracetamol
triptans - sumatriptan
antiemetics if vomiting occurs
what is NOT used in the treatment of migraines and why
opiates are NOT used to treat migraines and may make the condition worse
when are triptans used
used to abort migraines when they start to develop.
what is the mechanism of action of triptans
They are 5-HT receptor agonists (they bind to and stimulate serotonin receptors), specifically 5-HT1B and 5-HT1D. They have various mechanisms of action, including:
- Cranial vasoconstriction
- Inhibiting the transmission
of pain signals
- Inhibiting the release of inflammatory neuropeptides
what are the main contraindications related to triptans
vasoconstriction for example, hypertension, coronary artery disease, or previous stroke, TIA, or MI
what are the usual prophylactic medications used to reduce the frequency and severity of migraine attacks
Propranolol (a non-selective beta blocker)
Amitriptyline (a tricyclic antidepressant)
Topiramate (teratogenic and very effective contraception is needed)
give two names of prophylactic triptans
frovatriptan or zolmitriptan
when are prophylactic triptans used
for menstrual migraines
symptoms tend to occur two days before until three days after the start of menstruation
regular triprans may be used at this time
what are the risks associated with migraines
migraines are assoiated with a slightly increased risk of stroke, particularly when associated with aura.
the risk of stroke is further increased with the combined pill, making them a contraindication to the combined pill
what is epilepsy characterised by
seizures
what are seizures
transient episodes of abnormal electrical activity in the brain
what are the common 5 types of seizures seen in adults
Generalised tonic-clonic seizures
Partial seizures (or focal seizures)
Myoclonic seizures
Tonic seizures
Atonic seizures
what are the types of seizures more commonly seen in children
absence seizures
infantile spasms
febrile convulsions
what do generalised tonic-clonic seizures involve
tonic (muscle tensing) and clonic (muscle jerking) movements associated with a complete loss of consciousness
what are generalised tonic-clonic seizures also called
grand mal seizures
what may patients experience before a generalised tonic-clonic seizure
aura, an abnormal sensation that gives a warning that a seizure will occur.
there may be tongue biting, incontinence, groaning or irregular breathing
what happens after the seizure
there is a prolonged post-ictal period, where the person is confused, tired and irritable or low
where do partial seizures/focal seizures occur
in an isolated brain area, often in the temporal lobes
what do partial seizures affect
hearing, speech, memory and emotions
what is the common state of the patient during a partial seizure
patients remain awake during partial seizures
they remain aware during simple partial seizures but lose awareness during complex partial seixures
what are the various symptoms associated with partial seizures, depending on the location of the abnormal electrical activity
Déjà vu
Strange smells, tastes, sight or sound sensations
Unusual emotions
Abnormal behaviours
how do myoclonic seizures present
with sudden, brief muscle contractions like an abrupt jump or jolt. they remain awake.
what do tonic seizures involve
a sudden onset of increased muscle tone, where the entire body stiffens.
what do tonic seizures usually result in and how long do they last
usually result in a fall if the patient is standing, usually backwards
they last only a few seconds, or at most a few minutes
what do atonic seizures involve
sudden loss of muscle tone, often resulting in a fallh
how long do atonic seizures last and are patients awake during them?
They last only briefly, and patients are usually aware during the episodes. They often begin in childhood.