GMS

• Reaches maximum intensity within 5 minutes.
• Lone acute severe headache.
• Lasts several days usually.

Think: sub-arachnoid haemorrhage, cerebral venous sinus thrombosis, or cerebral artery dissection.

• Unilaterally behind the eye.
• Severe pain due to nerve pain.
• streaming eye and runny nose unilaterally.
• 30-90mins each.
• 6-8 episodes over days/weeks.

• Feels like lightening bolts through the face.
• Lasts only seconds but very severe pain.
• Cold air can trigger it.
• Unknown cause.

• Decreased level of consciousness.
• Papilledema.

Raised ICP is a contraindication for lumbar puncture.

• DVT in brain, where the veins drain from the skull base.
• Causes a gaze palsy due to 3-6th nerves.
• Hilary Clinton had it.
• Cause is usually spreading infection from noses, sinus, ears & teeth.

Signs: proptosis, chemosis, periorbital oedema, photosensivity, cranial nerve palsy and headache.

Also known as temporal arteritis.

• Inflammation of the blood vessels of the head.
• Mainly the external carotid artery.
• The most serious complication is occlusion of the ophthalmic artery causing blindness.
• Associated with scalp and jaw pain.
• Diagnosed via biopsy.
• Causes elevated ESR and CRP.
• Treated with steroids (glucocorticoids).

• 1. CT brain (best for fresh blood and bone).
• 2. Lumbar puncture (red cells present in fluid).
• 3. CT brain angio.

Then send to Beaumont for clip & coil.

Blood in CSF due to piercing of a blood vessel.

• This is shown by fewer RBCs in successive bottles. 
• 3 bottle should be taken during every lumbar puncture.
• Xanthchromia is yellowing of CSF due to RBCs.
• 100 RBCs for every 1 WCC is normal.
• RBCs in CSF will excite an inflammatory response within 48hr (↑ CRP & ESR).

• Raised protein:
•                    MS.
•                    Meningitis.
•                    Guillain-Barré syndrome.

• Very raised protein:
•                    Severe bacterial meningitis.
•                    TB.
•                    Spinal block.

• Headache made worse by
•                 -Lying down (Gravity increases ICP).
•                 -Coughing (raises intraabdominal pressure).
•                 -bending over (also seen in sinusitis).
•                 -Valsalva manoeuvre.

• 7 - 15 mmHG normal ICP at rest.
• 20-25 mm Hg higher end of normal range.
• 40-50 mm Hg causes loss of consciousness and infarction.

• New headache >50yo.
• Thunderclap headache.
• Meningism (stiff neck).
• Immunosuppressed patient.
• Symptoms of temporal arteritis (sore scalp & jaw, vision disturbance, >50yo).
• Neurological symptoms & signs (cranial nerve palsy).
• Papilledema. 
• Red eyes and halos seen around lights (acute angle closure glaucoma).