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A case study of a 26-year-old female patient experiencing frequent severe headaches. It explores various aspects of headache diagnosis, including differential diagnoses, investigations, and management strategies. Questions and exercises related to the case study, making it suitable for medical students or professionals seeking to enhance their understanding of headache management.
Typology: Exams
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1 | Pa ge
2 | P a g e
3 | P a g e
4 | P a g e
neck stiffness mechanism
inflamed meninges press on dura matter pain fibers from trigeminal nerve
how is cerebral aneurysm screened
MR angiogram
CT w/ contrast angiogram
who need cerebral aneurysm screening
who have 2 1st degree relatives got aneurysm rupture
aneurysm rupture can be warning by
prior less severe headache
2 main reasons of sudden death
cardiac arrythmia
brain hemorrhage
headache differentials
migraine
tension type
cluster
tension type headache mechanism
muscle contraction
trigger by stress
headaches not to miss
subarachnoid hemorrhage
meningitis/encephalitis
subdural hematoma
tumor
giant cell arteritis
glaucoma
subarachnoid hemorrhage features
warning headache
sudden severe
reduced conscious
meningism
family history
causes of subarachnoid hemorrhage
70 % aneurysm rupture
AV malformation and others
meningism
Triad of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light)
and headache
meningitis/encephalitis features
fever
neck stiffness
subdural hematoma features
elderly
alcoholics
anticoagulants
tumor in head features
morning headache
seizures
neurological defects
giant cell arteritis features
unilateral
visual change
jaw claudication
over 50yo
glaucoma features
unilateral
visual change
giant cell arteritis complication
blindness
different pupil size with headache suggest
Inc. cranial pressure
aneurysm at internal carotid/posterior commuting artery junction
how to investigate headache
FBE/UEC/LFT/Coag
CTbrain
lumbar puncture
how ling after intracranial hemorrhage will you see change in CT?
in secs/mins
Xanthochromia (CSF)
Yellow CSF = RBC's breakdown - implies blood is in CSF for several hours and
not due to trauma.
Usu 6- 24 hrs only
GOLD STANDARD for diagnosis!!
how to manage subarachnoid hemorrhage
prevent rebleeding
treat pain, N&V, inc.ICP
how to prevent rebleeding of subarachnoid hemorrhage?
analgesia
BP control
coiling/cliping/surgery
analygesia subarachnoid hemorrhage using principles
don't make patient drowsy
IV: morphin/phentynol/
oral:codien/oxycodone
BP target to prevent subarachnoid hemorrhage
sys 110- 140
how common is subarachnoid hemorrhage rebleeding
50 % in first 6 weeks
symptoms of inc.ICP
Cushing's triad +
headache
papilloedema
drowsiness
cushing's triad
increasing systolic, decreasing diastolic
bradycardia
irregular respirations
causes of inc.ICP
space occupying lession
inc. fluid volume
blood/CSF/edema
how hypoventilation causes inc.ICP
hypercapnia causes vasodilaiton in head
signs of transtentorial herniation
unilaterial pupil dilation
contralateral hemiparesis
Cushing reflex
resp failure
Transtentorial herniation
how to treat inc. ICP
situp 30deg
mannitol
hyperventilation
sedation
remove mass
drain CSF