Comprehensive Case: Frequent Severe Headaches in a 26-Year-Old, Exams of Nursing

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2 main reasons of sudden

death -

✔✔ANSW✔✔..cardiac

arrythmiabrain hemorrhage

analygesia subarachnoid hemorrhage

using

principles - ✔✔ANSW✔✔..don't

makepatient

drowsy

IV:

morphin/phentynol/oral:codien/

oxycodone

aneurysm rupture can be warning by

-

✔✔ANSW✔✔..prior less severe

headache

BP target to prevent subarachnoid

hemorrhage - ✔✔ANSW✔✔..sys 110-

causes of inc.ICP -

✔✔ANSW✔✔..space

occupying

lessioninc. fluid

volume blood/CSF/

edema

causes of subarachnoid

hemorrhage -

✔✔ANSW✔✔..70% aneurysm

rupture AV malformation and

others

cushing's triad -

✔✔ANSW✔✔..increasing

systolic, decreasing

diastolic bradycard

iairregular respirations

different pupil size with headache

suggest - ✔✔ANSW✔✔..Inc. cranial

pressureaneurysm at internal

carotid/posterior commuting artery junction

giant cell arteritis

complication -

✔✔ANSW✔✔..blindness

giant cell arteritis features -

✔✔ANSW✔✔..unilate

ral

visual

changejaw

claudication over 50yo

glaucoma features -

✔✔ANSW✔✔..unilate

ral

visual

change

headache

differentials -

✔✔ANSW✔✔..migrai

netension

typecluster

headaches not to

miss -

✔✔ANSW✔✔..subarachnoid

hemorrhagemeningitis/

encephalitis subdural

hematomatumo

rgiant cell

arteritis glaucom

a

how common is subarachnoid

hemorrhage

rebleeding - ✔✔ANSW✔✔..50% in

first 6

week

s

how hypoventilation causes

inc.ICP -

✔✔ANSW✔✔..hypercapnia

causesvasodilaiton in

head

how is cerebral aneurysm

screened -

✔✔ANSW✔✔..MR

angiogramCT w/ contrast

angiogram

how ling after intracranial

hemorrhage will

you see change in CT? -

✔✔secs/minsANSW✔✔..in

how to investigate

headache -

✔✔ANSW✔✔..FBE/UEC/LFT/

CoagCXR

CTbrai

nlumbar

puncture

how to manage subarachnoid

hemorrhage -

✔✔ANSW✔✔..prevent

rebleedingtreat pain, N&V,

inc.ICP

how to prevent rebleeding of

subarachnoid hemorrhage? -

✔✔ANSW✔✔..analgesia

BP

controlcoiling/cliping/

surgery

how to treat inc. ICP -

✔✔30deANSW✔✔..situp

g mannit

olhyperventilati

onsedatio

n remove

massdrain

CSF

meningism - ✔✔ANSW✔✔..Triad of

nuchal

rigidity (neck stiffness),

photophobia(intolerance of bright light) and

headache

meningitis/encephalitis

features -

✔✔ANSW✔✔..fev

erneck

stiffness

neck stiffness

mechanism - ✔✔ANSW✔✔..inflamed meninges

press on

dura matter pain fibers from

trigeminalnerv

e

signs of transtentorial

herniation - ✔✔ANSW✔✔..unilaterial pupil

dilationcontralateral

hemiparesis Cushing

reflexresp failure

subarachnoid hemorrhage

features -

✔✔ANSW✔✔..warning

headachesudden

severe reduced

consciousmeningis

mfamily history

subdural hematoma

features - ✔✔ANSW✔✔..elder

lyalcoholic

santicoagulants

symptoms of

inc.ICP - ✔✔ANSW✔✔..Cushing's

triadheadach +

e N&

V

papilloede

ma

drowsiness

tension type headache

mechanism -

✔✔ANSW✔✔..muscle

contractiontrigger by

stress

Transtentorial herniation -

✔✔ANSW✔✔.. 小

脑幕切迹疝

tumor in head features - ✔✔ANSW✔✔..morning

headache

seizure

sneurological

defects

who need cerebral aneurysm

screening -

✔✔ANSW✔✔..who have 2 1st

degreerelatives got aneurysm

rupture

Xanthochromia (CSF) -

✔✔ANSW✔✔..Yellow CSF =

RBC's

breakdown - implies blood is in

CSFseveral for hours and not due to

trauma. Usu 6- 24 hrs

only

GOLD STANDARD for

diagnosis!!