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HA and Brain Tumors
Clinical Medicine II-Spring 2012
| Question | Answer |
|---|---|
| What are extracranially causes of HA’s | skin, muscle, BV’s, periosteum |
| Intracranially causes of HA’s | Venous sinuses/arteries, Dura, Falk cerebri |
| Does the actual brain tissue (parenchyma) itself cause pain | no |
| When do migraines usually start | adolescence or young adulthood, possible childhood. Rare to start in adulthood, suspect other causes. |
| Epidemiology of migraine HA’s | runs in families, starts in childhood, MC in women (menstruation) |
| Two types of migraine HA’s | Common (MC) and Classic |
| Characteristics of a common migraine | 4-72hrs, unilateral, pulsating, mod-sev pain, aggravated by PA, N/V, Photophobia/phonophobia |
| How many attacks until can probably make the dx | at least 5 attacks to dx w/ migraine HA’s |
| What is a classic migraine | same as common but have an aura gradually prior to HA lasting <60min |
| What are the three types of aura | visual (MC), sensory (unilateral paresthisias/numbness), Motor (unilateral weakness, speech difficulty) |
| Does the aura resolve prior to HA | yes, will resolve than “Boom” hit by HA |
| What can cause a Migraine HA | Must be susceptible but common onset by menstration, sleep, fasting, PA, stress, Tyramine foods (red wine, hard cheeses, herring), phenylethlamine (chocolate), Nitrates (processed meats), Caffeine withdrawal/excess, MEDS: OCP’s antiHTN’s |
| What is the primary pathophysiology behind migraines | start by vasoconstriction followed by abnl vasodilation |
| Common prophylaxis for migraines | BB’s CCB’s, SSRIs, TCA’s, Anti-sz meds |
| Common abortive tx of migraines | OTC analgesics, Vasoconstrictors/Ergots, Anti-emetics, serotonin agonists, IV/IM NSAIDS: ketorolac, narcs, steroids |
| Cluster HA’s | serious of HA’s over a period of 2-3m every 1-2 years M>F, onset late 20’s |
| What can trigger cluster HA’s | alcohol, nitroglycerine, histamine |
| Clinical features of cluster HA’s | pain always unilateral, excruciating, penetrating, not throbbing, around the trigeminal n. distribution, behind eye, autonomic sxs |
| What are the autonomic features w/ cluster HA’s | lacrimation, conjunctival injection (unilateral), nasal congestion/rhinorrhea, ptosis: eyelid dropping/miosis:pupil constriction |
| Tx cluster HA | high flow O2 inhalation 5-8L/m for 10 mins, effective ~70%, same as migraines |
| Proposed mechanism of cluster HA’s | dilation of retroorbital blood vessels and inflammation of trigeminal n. branches |
| Most common type of HA | tension headache, band like constriction around head, 30m-7days, PA unaffected, some photo/phonphobia, no N/V usually |
| Tx tension HA’s | Mild analgesics, stress reduction, relaxation techniques |
| 5 Extra-cranial sources of HA | sinusitis, acute glaucoma, temporal arteritis, TMJ, trigeminal neuralgia |
| HA: worse w/ bending forward, coughing, better w/ supine, usually stabbing/aching | Sinusitis: pain over sinuses, URI sx |
| Orbital pain w/ N/V, unilateral, visual disturbances in that eye | acute glaucoma, cornea is often edematous, cunjunctiva is injected, |
| Dx of acute glaucoma | tonometry (measuring the intra-ocular pressure) |
| Jabbing excrutiating pain over the temple, unilateral or can be bilateral, visual loss may be present, often w/ other systemic sxs | Temporal arteritis |
| Why is temporal arteritis so important to dx | inflammation can also be happening at ophthalmic a. →blindness |
| Epidemiology of temporal arteritis | >50yo, 4xF>M |
| Dx of temporal arteritis | labs: elevated ESR, biopsy, |
| What is tic doloureux | trigeminal neuralgia: brief, severe attacks in distribution of branch of trigeminal n. pain is lancinating “electric shop” |
| Cause and triggers of tic doloureux | D/t partial demylinization of trigeminal n. possible d/t n. compression, triggered by eating, talking, washing face |
| Tx of tic doloureux | analgesics, narcs, anti-sz |
| Name 5 life threatening HA’s | SAH, meningitis, brain tumor, subdural/epidural hematoma, HTN HA |
| What is a diagnostic feature of a SAH | pt states “Worst HA of my life” very acute |
| Signs of a SAH, dx | LOC, focal neuro signs, sz, nuchal rigidity, CT, -? Then do LP! |
| Where do most of the cerebral aneurysms occur | around the Circle of Willis |
| What does acute blood look like on a CT? | white |
| Tx once dx has been made of SAH | Nimodipine (CCB); vasodilator, phenytoin, and urgen neurosurgical consultation |
| Sxs Dx and tx of Meningitis | HA, fever, nuchal rigidity, toxicity, D:LP, Tx: bacterial: IV, abx, steroids, viral: supportive |
| Difference b/w CT of subdural and epidural hematoma | S: sickle, H: lenticular shaped, like a lense |
| Story of a subdural hematoma | HA w/ confusion, obtundation, in elderly often w/ minor head injury, DX: CT |
| Difference b/w epidural and subdural hematoma | E: artery bleed: more serious, S: venous bleed |
| Story of an epidural hematoma | trauma, brief LOC, HA when awake, deteriorating mental status, URGENT neurosurg |
| What classifies a HTN HA | Diastolic BP >130, will be alleviated by BP control |
| Progressively worsening HA over days to weeks, often worse in the morning w/ a.m. vomiting | brain tumor HA |
| Complaints of a brain tumor | HA, weakness, paralysis, sensory deficits, cranial n. palsie, visual distrb, ataxia, AMS, sz’s |
| Study of choice to dx a brain tumor | MRI, or CT w/ contrast (acute setting), EEG w/ sz’s |
| 4 types of brain tumors | astrocytoma (gliomas), meningioma, acoustic neuroma, metastasis (2nd brain tumor) |
| MC brain tumor and location | astrocytoma, in cerebral hemispheres |
| Histopathological grading of a astrocytoma | low-grad astrocytoma (6-8yr), anaplastic astroycytoma (5ys), glioblastoma multiforme (<1yr)(biopsy to grade) |
| RF’s of astrocytoma | radiation, some genetics, |
| Tx astrocytoma | surgery (debulking), radiation, chemotherapy, stroids if edema present, anticonvulsants |
| Second MC type of brain tumor | meningioma, on surface of brain in concavity of skull, mostly benign |
| Tx meningioma | managing sxs, observation, surgical if easily accessible, radiation |
| Acoustic neuroma, RF’s | tumor that rises from schwann cell sheath around vestibule-chochlear n. RF’s: radiation, neurofibromatosis type II |
| Unilateral HL MC complaint | Acoustic neuroma, have tinnitus, vertigo, disequilibrium, HA, or facial n. compression: weakness or numbness |
| TX acoustic neuroma | surgical excision to preserve hearing, If not surgical candidate: gamma knife to reduce size, maybe just observe in elderly or if sm |
| Complication of surgical excision | facial n. paralysis |
| MC sources of 2nd cerebral metastases | Lung, Breast, Genitourinary, Osteosarcoma, Melanoma, GI |
| When do we consider the brain tumor is a metastases | when there are more than one tumor in the brain, check other sources |
| Tx cerebral metastases | avoid surgery, whole-brain radiation therapy, gamma knife: but subclinical lesions are most likely present, chemo |
| What are surgical indications for brain mets | solitary lesion >3cm, in an accessible area of brain, or if only ONE lesion is symptomatic |
Created by:
streetsmarts
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