Describe a thunder-clap headache?
- Reaches maximum intensity within 5 minutes.
- Lone acute severe headache.
- Lasts several days usually.
sub-arachnoid haemorrhage, cerebral venous sinus thrombosis, or cerebral artery dissection.
Describe cluster headaches?
- 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.
Describe trigeminal neuralgia.
Describe trigeminal neuralgia?
- Feels like lightening bolts through the face.
- Lasts only seconds but very severe pain.
- Cold air can trigger it.
- Unknown cause.
Name 2 signs of raised ICP?
- Decreased level of consciousness.
Raised ICP is a contraindication for lumbar puncture.
Describe cavernous sinus thrombosis?
- 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.
Describe Giant cell arteritis?
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).
How is a subarachoidnoid haemorrhage diagnosed?
- 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.
What is a 'Bloody Tap'?
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).
What would cause raised protein in CSF?
- Raised protein:
- Guillain-Barré syndrome.
- Very raised protein:
- Severe bacterial meningitis.
- Spinal block.
Describe a space occupying lesion headache?
- 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.
What are red flags in a patient suffering from a headache?
- 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).
- Red eyes and halos seen around lights (acute angle closure glaucoma).