Week 4 part 2 Flashcards
What is the commonest extra-axial tumour?
Meningioma
What presents with progressive neurological deficit, motor weakness, headache and seizures?
Brain tumour
What is a headache due to if its worse in the morning, wakes them up, increases with coughing/leaning forward and decreased with vomiting?
ICP
What can be secondary to diplopia (CN VI) and secondary to difficulty focusing?
Tumour headache
A tumour where affects perserveration?
Frontal lobe
A tumour where affects dyspraxia and neglect?
Parietal lobe
How do you investigate bran tumour?
CT, MRI LP
What two cells make up neuroepithelial tissue?
Astrocytes
Oligodendroglial cells
What do glial tumours arise from?
Astrocytes or oligodendrocytes
What grade of astrocytoma is truly benign, slow growing, children young adults, pilocytic astrocytomas and treatment of choice is surgery?
grade 1 astrocytomas
What do low grade astrocytomas present with?
Seizures
Where do low grade astrocytomas want to occur?
IN temporal lobe
Posterior frontal
anterior parietal
What grades are malignant astrocytomas?
Grades III - IV
How common is glioblastoma multiforme (malignant)?
Most common primary tumour - spreads white matter tracking
Tumours are solid, appear grey/whiteish and subarachnoid accumulations are grossly characterised by surgeons as having toothpaste morphology
oligodendroglial tumours
How do you treat oligodendroglial tumours?
Chemosensitive - procarbazinr, lomustine, vincristine
Arachnoid cap cells, extraaxial, 20% of intracranial neoplasms, majority asymptomatic ?
Meningiomas
What condition has vestibular schwannomas?
NF type II
hEARING Loss, tinnitus, dysequilibrium?
Acoustic neuromas
What are the red flag s for headaches?
- New onset over 55 years
- Known/previous malignancy
- Immunosuppressed
- Early morning headache
- Exacerbation by valsalva
In the pathophysiology of a migraine what chemical irritates nerves and blood vessels causing pain?
Substance P
What do the dorsal raphe nucleus and the locus coeruleus make up?
Migraine center
What is more common - migraine with or without aura?
Without (flashibg kights, weakness, balance problems)
What abortive drugs can you give for migraines +/- an anti-emetic?
Aspirin
Naproxen
Ibuprofen
When should you give triptans fot a migraine?
At start of headaceh
What kind of relief does frovatriptan give for migraines>
SUSTAINED
When might you consider prophylactic migraine treatment?
If nmroe thanb three attacks per month or very severe consider prophylaxis
When beta blockers are given for migraines qwhat do you need to be careful for?
Avoid asthma, PVD (heart gfaiure)
A carbonic anhydrase inhibityor topiramate can be used for migraine - give some adverse effects?
- Weight loss
- Paraesthesia
- Imparied concentration
- Enzyme inducer
Amitriptyline can be given for migraines - give some adverse effects?
- Dry mouth
- Postural hypotension
- Sedation
What are the trigeminal autonomic cephalgias (TACs)?
A group of primary heache disorders characterised by unilateral trigeminakl distribution pain that occurs in association with prominent ipsilateral cranial autonomic features
What are ptosis, miosis, nasal stuffiness, nausea, teareing and eye lid oedema?
Ipsilateral cranial autonomic features
What are cluster, paroxysmal hemicrania, hemicrania continua and SUNCT?
TCA types - trigeminal autonomic cephalgias
What kind of age group get cluster headaches?
30s and 40s
When do people get cluster headaches?
Striking circadian (around sleep) nd seasonal variation
Severe unilateral headache, duration 45-90 minutes, 1 to 8 a day and cluster bout may last from a few weeks to months?
Cluster headache
How is cluster headache treated?
- High flow oxygen
- Sub cut sumatriptan
- Steroids
- Verapamil for prohpylaxis
Who gets paroxysmal hemicrania?
Elderly 50s and 60s, women more than men
Severe unilateral headache, unilateral autonomic features, 10-30 minutes, 1 to 40 a day?
Paroxysmal hemicrania (shorter duration and more frequent than cluster)
How is paroxysmal hemicrania treated?
Absolute response to indomethicin
What is short lived, unilateral, neuralgiaform headache, conjunctival injetions and tearing?
SUNCT
How is SUNCT treated?
Lamotrigine
Gabapentin
What is done for patients with new onset unilateral cranial autonomic features?
MRI brain and MR angiogram
Who gets trigeminal neuralgia?
Elderly ikder than 60, women more than men
What headache s triggered by touch, usuall V2/3?
Ttrigeminal neuralgia
Severe stabbing unilateral pain, 1 second to 90 seconds, 10 to 100 a day, bouts of pain may last from few weeks to months before remission?
Trigeminal neuralgia
If a patinet has trigeminal neuralgia and signs of atypical features, poor response to treatment what might yoyu do?
MRI
How is trigeminal neuralgia trated?
Carbamazepine
Gabapentin
Phenytoin
Baclofen
Name a trigger for cluster headache?
Alcohol (more common in males)
Are the majority of adult brain tumours supratentorial or infratentorial?
Supratentorial - children infratentorial
What brain tumour: pleomorphic tumour cells border necrotic areas?
Gliolastoma multiforme - most common primary brain tumour
What brain tumour: spindle cells in concentric whorls and calcified psammoma bodies?
Meningioma
What schwannoma is seen in cerebellopontine angle?
Acoutic neuroma
What is the most common primary brain tumour in children?
Pilocytic astrocytoma
What brain tumour: rosenthal fibres (corkscrew eosinophilic bundle)?
Piloctic astrocytoma
What brain tumour: benign, slow growing common in frontal lobes, calcifications with fried egg appearance?
Oligodendroma
What are these all patterns of: amyotrophic lateral sclerosis, progressive muscular atrophy and bulbar palsy?
MND
wHAT IS associated with low levels of orexin (hypocretin), a protein responsivle for appetite and sleep patterns?
Narcolepsy
Typical onset teenage years, hypersomnolence, cataplexy (sudden loss of muscle tone triggered by emotion), sleep paralysis and vivid hallucinations on going to sleep or waking up?
Narcolepsy
How do you investigate narcolepsy?
Multiple sleep latency EEG
