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Neurology
FA review Round 1 2020
Question | Answer |
---|---|
What is the associated adverse effects of Enflurane? | Seizures and CNS toxicity |
Common inhaled anesthetic that is associated with development of seizures. | Enflurane |
Which inhaled anesthetic is more potent, Halothane or Enflurane? | Halothane |
What is the most severe adverse effect of Halothane? | Malignant hyperthermia |
Methoxyflurane adverse effect: | Nephrotoxic |
What is the adverse effect of N2O as an inhaled anesthetic? | Expansion of trapped gas in the body cavity |
Which receptors are involved in Miosis and Mydriasis? | Alpha-1 and M-3 |
Miosis is caused by which type of drugs: | - alpha-1 antagonists - M3 agonists |
Which receptor in the pupil of the eye, when stimulated by an agonist or antagonist, causes blurred vision? | M3 |
Miosis with blurry far vision is due to: | Ciliary muscle contraction ("accommodation") |
Which receptor in the pupil of the eye causes NO effect on Ciliary muscle, regardless of been agonist or antagonist effect? | Alpha-1 |
The blurred vision caused in Mydriasis by stimulation with M3-antagonist is due to: | Relaxation of ciliary muscle |
Near blurred vision is seen with Mydriasis or Miosis as it is stimulated in M3-antagonist or -agonist? | Mydriasis with a M3-antagonist |
What are sympathomimetics? | Substances (drugs) that mimic the effects of sympathetic activation on the heart and circulation |
What are the stimulated (main) receptors in the use of Sympathomimetics? | Alpha (1 & 2), Beta (1, 2, 3), and Dopamine (1, 2) |
List of Direct Sympathomimetics: | 1. Albuterol, Salmeterol, and Terbutaline 2. Dobutamine 3. Dopamine 4. Epinephrine 5. Fenoldopam 6. Isoproterenol 7. MIdodrine 8. Mirabegron 9. Norepinephrine 10. Phenylephrine |
What receptors are stimulated by Epinephrine? | Beta > alpha |
On high or low doses, is Epinephrine alpha effect more dominant? | High doses |
What are the receptors targeted by Albuterol? | B2> B1 |
Which Direct sympathomimetic has a receptor affinity of: alpha-1 > alpha-2 > Beta-1 | Norepinephrine |
Does epinephrine or norepinephrine has higher affinity to Beta receptors? | Epinephrine |
If the purpose of the treatment is to stimulate alpha-1 receptors more, which is better to use, NE or Epi? | Norepinephrine |
What is the receptor used and its affinity to each in relation to each other of Isoproterenol? | B1 = B2 |
Which is a B-3 direct sympathomimetic? | Mirabegron |
What are the receptors targeted by Dobutamine (and affinity order)? | B1 > B2, alpha |
Fenoldopam is: | D1 direct sympathomimetic |
Which receptors are targeted by Phenylephrine? | alpha-1 > alpha -2 |
What is a common solely alpha-1 direct sympathomimetic? | Midodrine |
What infectious organism is the MCC of meningitis in infants of < 6 months of age? | GBS |
What is the bacterial structure of GBS? | Gram-positive, B-hemolytic, Bacitracin-resistant |
List of MCC of Meningitis in neonates (0-6 months age): | 1. GBS - #1 cause 2. E. coli 3. Listeria |
What is the acute treatment for opioid toxicity? | Naloxone |
What is the MOA of Naloxone? | Pure opioid antagonist |
Naloxone is used to treat: | Opioid toxicity |
What are the classic findings in Opioid toxicity? | Pinpoint pupils (miosis), respiratory depression, and coma |
What condition is treated with Fomepizole? | Alcohol toxicity |
What medication is used to treat Benzodiazepine overdose? | Flumazenil |
What is another name for Lateral Medullary syndrome? | Wallenberg syndrome |
What arterial bodies are dissected, occluded or affected by thrombosis that cause Wallenberg syndrome? | Vertebral or Posterior Inferior Cerebellar Artery (PICA) |
Thrombosis in PICA leads to: | Lateral Medullary syndrome |
Lateral or Medial medullary syndrome is caused by dissection or thrombosis of PICA? | Lateral Medullary syndrome |
What manifestations of Wallenberg syndrome are not classified as Ipsilateral or Contralateral? | Hoarseness of voice, dysphagia, decreased gag reflex, as well as, vomit, vertigo, and ataxia |
What are the IPSILATERAL signs or deficits in Lateral Medullary syndrome? | - Ipsilateral Horner syndrome - Ipsilateral absence of pain and temperature in the face |
What is the the CONTRALATERAL deficit seen with Lateral Medullary syndrome? | Absence of pain and temperature of the body |
Patient present with hoarseness of voice, decrease appetite due to pain. Also indicate no pain or temperature in right side of face, and left side of body. Suspected Dx? | Right Lateral Medullary syndrome |
If a patient present with Ipsilateral Horner syndrome and a decreased sensation of pain/temperature in left arm after thrombosis of right PICA. Dx? | Right Lateral Medullary syndrome |
Which vessels are affected in Subdural hematomas? | Bridging veins |
If the patient presents with rupture of Bridging veins in the brain, what is the most likely diagnosis? | Subdural hematoma |
What is the associated shape of the hematoma in Subdural hematoma CT? | Crescent |
Easy way to remember that Subdural Hematomas have Crescent -shaped hemorrhage in CT: | The "S" of Subdural hematoma is formed by 2-crescnts |
Lentiform-shaped hematoma. Dx? | Epidural hematoma |
Rupture of the MMA at the pterion. Dx? | Epidural hematoma |
Crescent-shaped hematoma of brain CT. Dx? | Subdural hematoma |
What is the main function of Oligodendrocytes? | Myelinate CNS axons |
Which is the most common location for Oligodendrogliomas? | Frontal lobes |
What is the histological view of Oligodendrocytes? | "Fried egg" appearance |
Class of drugs of Triptans | Serotonin (5-HT) receptor agonists |
What is the most common use for Triptans? | As abortive treatment for migraine headaches |
What drug class is most often used for acute treatment of migraine headaches? | Triptans |
How do Triptan mechanism of action act on treating a migraine headache? | Inducing cerebral vasoconstriction, inhibiting trigeminal activation and preventing vasoactive peptide release |
Serotonin receptor agonists used for migraines | Triptans |
What information is known to be carried by the Dorsal column/ Medial Lemniscus tract? | Proprioception, vibration, and light touch |
What does a (+) Romberg test indicates? | Impaired proprioception, suggesting damage to the Dorsal column/Medial Lemniscus tract |
Impaired proprioception is indicated by what clinical annotation or result? | (+) Romberg test |
What medication is used to treat Parkinsonian dyskinesias, commonly? | Amantadine |
What is the common use for Amantadine? | Anti-parkinsonism; Decrease Parkinsonian dyskinesias, in young patients with mild symptoms |
What are the two main adverse effects associated with Amantadine? | 1. Ataxia 2. Livedo reticularis |
What medication is often associated with Livedo reticularis? | Amantadine |
What causes Livedo Reticularis? | Swelling of the venules due to small blood clots forming in the capillaries |
What are the effects of Chronic Livedo reticularis? | Permanently dilated and telangiectatic vessels |
Which foramina is used by CN V3 to exit the skull? | Foramen ovale |
Which branch of the Trigeminal nerve exits the skull through the foramen Ovale? | V3 |
What is the MCC of VIRAL encephalitis in HIV patients? | HSV-1 infection |
What lobe is most commonly affected by HSV-1 encephalitis? | Temporal lobe |
What medication is used to treat HSV-1 encephalitis? | Acyclovir |
What cells are seen in CSF of HSV-1 (viral) encephalitis sample? | Lymphocytes, and RBCs |
How are protein and glucose levels in CSF sample of a viral encephalitis? | Normal, to mildly elevated glucose |
What is the normal INR for a patient on Warfarin? | 2.5 - 3.5 |
Common antibiotic used topically for rashes, that is known to be a CYP450 inducer. | Griseofulvin |
Inducers or Inhibitors of CYP450 increase the metabolism of Warfarin? | Inducers |
An inducer of CYP450 is known to cause what when co-administered with Warfarin? | Increase metabolism of Warfarin, leading to inadequate coagulation and natural decrease in INR |
What pathogen is the MCC of meningitis in college students living in the dorms? | N. meningitidis |
What is the most common choice for treating N. meningitis? | Ceftriaxone |
What generation of Cephalosporin is Ceftriaxone? | 3rd generation |
Why is Ceftriaxone a proper choice for treatment of Neisseria meningitidis meningitis? | Can cross the BBB |
What are the clinical symptoms of Progressive Multifocal Leukoencephalopathy? | Subacute mental status decline, neurological deficits, visual and motor changes, and ataxia |
What causes in HIV patients PML? | Reactivation of JC virus |
What conditions i associated by the reactivation of JC virus? | Progressive Multifocal Leukoencephalopathy |
At what CD4+ count is PML often presented in HIV patient? | < 200 cells |
What are the featured clinical results of PML? | Neuroimaging reveal multiple, non-enhancing white matter lesions with a normal CSF profile |
What is Delayed Sleep-Wake Phase disorder? | Disturbance in the natural Circadian rhythm, leading to a delayed sleep onset, delated sleep offset and sleep insufficiency |
List of main functions of Astrocytes: | 1. Physical support and repair cells of the CNS 2. Help maintain the BBB 3. Metabolize potassium |
Which CNS cells are known to serve as physical support, repair cells in CNS, and maintain the BBB? | Astrocytes |
What muscles are derived by the Second pharyngeal arch? | 1. Muscle of facial expression 2. Stapedius 3. Stylohyoid 4. Platysma 5. Posterior belly of digastric |
What branchial arch givers rise to the anterior belly of the digastric? | First branchial arch |
Muscles of facial expression , are derived from the ____________ branchial arch. | Second |
What roots convey the Musculocutaneous nerve? | C5 - C7 |
Which reflex is lost in musculocutaneous nerve injury? | Bíceps reflex |
Absent biceps reflex is a common feature of: | Musculocutaneous nerve injury |
What motor actions are lost by injury to the Musculocutaneous nerve? | Loss of flexion of forearm and loss of supination |
What part of the upper extremity loses sensation by injury to the Musculocutaneous nerve? | Lateral forearm |
Loss sensation of the lateral forearm is commonly due to injury to which brachial plexus nerve? | Musculocutaneous nerve |
Which nerve is commonly affected by Upper trunk compression of the Brachial plexus? | Musculocutaneous nerve |
What is the motor innervation of the Vagus nerve? | Palatal arches and uvula |
Does a UMN or LMN injury to the CN X, causes a contralateral uvula deviation? | LMN injury |
Does the uvula deviate to the contralateral or ipsilateral side in LMN CNX injury? | Contralateral |
Broca, Wernicke, or both, have poor repetition? | Both |
What is the most common location affected by Wernicke aphasia? | Superior Temporal gyrus of the left temporal lobe |
What is affected or limited in Wernicke aphasia? | Comprehension and repetition |
If a person is able to complete words and sentences, but fails to respond to verbal commands, and the sentences are fluent but non-coherent. Dx? | Wernicke's aphasia |
What is the reversal treatment for Benzodiazepine overdose? | Flumazenil |
What is the mode of action of Flumazenil? | Competitive antagonist of GABA receptor |
What is a very common Competitive antagonist of the GABA receptor? | Flumazenil |
What are the clinical signs indicating probable benzodiazepine overdose? | Somnolence, respirator depression, amnesia, and ataxia |
Flumazenil is often used in : | Acute reversal of Benzodiazepine overdose |
Potent CNS stimulant that acts by inhibiting the reuptake of Dopamine, Norepinephrine,and Serotonin. | Cocaine |
Which hormones are prevented to be retaken by Cocaine? | Dopamine, Norepinephrine, and Serotonin |
How does Cocaine work? | Inhibit reuptake of Dopamine, NE, and Serotonin |
What are featured signs of Cocaine overdose? | Psychomotor agitation, HTN, mydriasis, and at times convulsions |
What is Muscarine? | Toxin found in some mushrooms that agonized ACh muscarinic receptors |
What type of receptors are affected by Muscarine? | ACh muscarinic receptors |
What is the result of agonist effect on ACh receptors by mushroom toxin, muscarine? | Increased activity of PNS which leads to series of symptoms including vasodilation, sweating, salivation, GI motility, miosis, etc |
Would the consumption of some toxic mushrooms will cause vasodilation or vasoconstriction, if such contains muscarine? | Vasodilation |
What is a more common name for Rubeola? | Measles |
What virus is associated with development of Subacute Sclerosing Panencephalitis? | Measles |
Does Rubella or Rubeola causes SSPE? | Rubeola |
What is the clinical profile of Subacute Sclerosing Panencephalitis? | Dementia, myoclonus, and personality changes, after 2-10 years after initial Rubeola (Measles) virus infection |
What is that possible and severe consequence of badly treated childhood Measles infection? | Subacute Sclerosing Panencephalitis |
What are the clinical deficits seen with MCA infarction? | 1. Contralateral face and arm weakness of UMNs 2. Gaze preference toward the side of lesion and variable unilateral neglect |
An MCA lesion produces a gaze preference toward or away the side of the lesion? | Toward |
MCA infarction causes deficits in face/arms or in legs? | Face and arms |
MCA infarction deficits are produced ipsilateral or contralateral? | Contralateral arms and face |
MCA infarction ins the dominant hemisphere produces: | Aphasia |
Which hemisphere is affected if the MCA occlusion produces hemineglect? | Non-dominant |
Which is more common to be the dominant brain hemisphere, right or left? | Left |
Which is most commonly the non-dominant hemisphere, right or Left? | Right |
Which Dopamine pathway is interrupted by Antipsychotics? | Nigrostriatal pathway |
What type of symptoms or effects are produced by interfering the Nigrostriatal dopaminergic pathways? | EPS |
What are some common EPS due to antipsychotic effects? | Dystonia, akathisia, tardive dyskinesia, and Parkinsonism |
A interruption or deficit to the Tuberoinfundibular dopamine pathway results in: | Increased prolactin, sexual dysfunction, and galactorrhea |
If the patient present with dystonia and movement disorders, is fair to assume which dompanie pathway was altered? | Nigrostriatal pathway |
ACA defects due to blockage or infarction will result in: | Contralateral leg paresis |
Does ACA infarct deficits produce contralateral or ipsilateral leg deficits? | Contralateral leg paresis |
What causes the Leg cortical-type sensory loss in ACA infarction? | Damage to the sensory cortex |
What is the most common symptom or sign of a pineal mass? | Symptoms of ICP |
What causes the ICP seen with penal masses? | Obstruction of CSF flow by a space-occupying lesion |
What is a severe complication of Pineal masses compressive effects? | Parinaud syndrome |
What region is compressed by a Pineal mass in order to produce Parinaud syndrome? | Pretectal region of the midbrain |
The compression of the Pretectal region of the midbrain may cause: | Parinaud syndrome |
What are the main features of Parinaud síndrome? | Vertical gaze and Pupil abnormalities |
What is the most common opportunistic infection in HIV/AIDS patients? | Toxoplasmosis |
What is Toxoplasmosis? | CNS infection in HIV patients with CD4 count < 100, that leads to focal neurologic deficits and chorioretinitis |
What is the MCC of focal brain lesions, comma, and death in HIV patients? | Toxoplasmosis |
Common cause of encephalitis in HIV-infected patients | Toxoplasmosis |
Disorder caharcted by degeneration of Dopaminergic neurons in the Substantia nigra par compacta. | Parkinson disease |
Neurons from the Substantia nigra project into the: | Striatum |
What are the components of the Striatum? | Putamen and Caudate |
Putamen + Caudate = | Striatum |
What part of the Basal ganglia functions by modulating activity in both direct and indirect pathways of the Dopamine effects? | Striatum |
Which hemisphere, left or right, has the language centers in most people? | Left |
Which arterial body is known to most commonly supply the Language centers in the brain? | Left MCA |
MCA infarction results in what type of aphasia? | Broca aphasia |
In which aphasia, Broca or Wernicke, does the patient get frustrated by not been able to produce words or sentences, but have good comprehension? | Broca aphasia |
What is the most common childhood supratentorial tumor? | Craniopharyngioma |
What are the associated clinical deficits seen in Craniopharyngioma in a child? | Headaches and bitemporal hemianopia |
From what tissue are Craniopharyngiomas derived? | Remnants of the Rathke's pouch |
Which childhood brain tumor is derived from remnants of the Rathke's pouch? | Craniopharyngioma |
A craniopharyngioma will present with increase or decrease secretion of anterior pituitary hormones? | Decrease |
Does a prolactinoma or craniopharyngioma, is more likely to present with low levels of GH? | Craniopharyngioma |
What are the motor and sensory deficits seen in S1 radiculopathy? | 1. Decreased sensation of Posterior Leg and Lateral foot 2. Diminished ankle-jerk reflex 3. Weak plantarflexion of the foot 4. Back pain radiating to the lower extremity 5. Positive Straight leg raise est |
What is commonly herniated tint order to develop S1 radiculopathy? | L5-S1 disc |
Which part of the led loses sensation in S1 radiculopathy? | Posterior loeg and lateral foot |
Diminished ankle-jerk reflex, is commonly seen in? | S1 radiculopathy |
Which reflex is affected by S1 radiculopathy? | Ankle-jerk reflex |
Is Plantarflexion or dorsiflexion of foot affected by S1 radiculopathy? | Plantarflexion of foot |
A positive Straight Leg Raise test is seen with which condition? | S1 radiculopathy |
When does an Uncal Herniation occur? | It occurs when a Supratentorial mass pushes that medial temporal lobe medially and inferiorly, compressing the Ipsilateral oculomotor nerve and contralateral crus cerebri, against the Kernohan's notch |
What structures are compressed in Uncal herniations? | 1. Ipsilateral Oculomotor nerve 2. Contralateral Crus cerebri against Kernohan's notch |
Which nerve is commonly affected in a Left sided Uncal herniation? | Left CN3 |
Uncal herniations will present with ipsilateral or contralateral hemiparesis? | Contralateral hemiparesis |
Which part of the Basal Ganglia is targeted in ablation treatment for Parkinson disease? | Internal segment of the Globus Pallidus |
Which is the possible condition been diagnosed in a patent schedule to have the internal segment of the Globus pallidus ablated? | Parkinson disease |
What is the intended result of ablation of internal segment of Globus pallidus in Parkinson disease? | Decrease inhibitions of the Thalamus, leading to improvement of bradykinesia |
Which date value is most affected by an outlier in a small set of data? | Mean |
What is the triad seen in NPH? | 1. Urinary incontinence 2. Ataxia 3. Dementia |
What is the cause for NPH? | Decreased CSF absorption into the venous system |
Which sinus is most commonly affected in NPH? | Superior Sagittal sinus |
What conditions is often seen with a deficit or affection to the Superior Sagittal sinus ? | NPH |
What is the main clinical symptom of Cerebellar hemispheres? | Limb ataxia |
Limb ataxia due to cerebellar hemisphere lesions causes Contralateral or Ipsilateral? | Ipsilateral |
What is a common type of limb ataxia? | Dysmetria |
What is Dysmetria? | Lack of coordination |
What is a clinical sign of Dysmetria? | Overshoot of intended limb movement |
What is Conversion disorder? | Dysfunction of water or sensory symptoms without a physiological cause, often following an acute stressor |
What is the associated motor effects of Conversion disorder? | Normal deep tendon reflexes and normal sensation |
What is a featured characteristic of Conversion disorder? | La belle indifference |
Which nerve is injured in Thyroid surgery that leads to hoarseness of voice? | Recurrent Laryngeal branch of the Vagus nerve |
What surgery may cause injury to the Recurrent Laryngeal branch of CN X? | Thyroid surgery |
What is the main result of damaged recurrent laryngeal branch of Vagus nerve? | Hoarseness of the voice |
The Recurrent Laryngeal branch of the Vagus nerve is derived from which branchial arch? | 6th Branchial arch |
What muscles are innervated by CN X recurrent laryngeal branch? | All intrinsic muscles except for the Cricothyroid |
Which muscle is not innervated by CN recurrent laryngeal nerve? | Cricothyroid |
Common drug that is known to stimulate muscarinic receptors M1, M2, and M3? | Pilocarpine |
How does Pilocarpine help in treating dryness of an eye? | M3 receptor stimulation leads to increase secretion of lacrimal and salivary glands |
Which G-protein-linked second messenger pathway does M3 stimulate? | Gq |
What is the overall effect of stimulating M3 receptor? | Increase in intracellular calcium levels |
What is another name for the Plantar reflex? | Babinski sign |
By what age is the Babinski reflex commonly lost? | After 18-24 months of age |
What is the Babinski sign? | Primitive reflex in which an infant responds to stroking the bottom of foot with dorsiflexion of big toe and fanning out of the rest of the toes |
Which lobe of the brain develops enough for the Babinski sign to disappear? | Frontal lobe |
What type of lesion is to be suspected with an adult with (+) Babinski sign? | UMN lesion |
An UMN lesion will present with what type of abnormal reflex? | (+) Babinski sign |
What is the most common transmission mode for a mother to contract Toxoplasmosis? | Via cat feces |
What are the neonatal manifestations of Congenital Toxoplasmosis? | Chorioretinitis, Hydrocephalus, and intracranial calcifications |
Neonate with intracranial calcifications, and hydrocephalus. Which is the most likely ToRCHES infection? | Congenital Toxoplasmosis |
HSV latency establishment in sensory ganglia uses what protein transport? | DYENIN-dependent retrograde transport |
The reactivation or recurrence of HSV infection, is due to what protein transport? | Kinesin-dependent anterograde transport |
Reactivation of HSV infection in lips, is due to Dynein or Kinesin transport? | Kinesin-dependent anterograde transport |
In which ganglia is HSV latency established? | Sensory ganglia |
What is the earliest symptom of Alcoholic Cerebellar degeneration? | Gait impairment |
What are the late manifestations of Alcoholic Cerebellar degeneration? | Dysarthria, intermittent diplopia or blurred vision |
What is dysarthria? | Weakness in the muscles used for speech, which often causes slowed or slurred speech. |
What are the clinical features of Bell palsy? | Ipsilateral dry eye, dry mouth, decreased taste sensation, retroauricular pain, sensitivity to noise and facial paralysis |
Which cranial nerve is involved in Bell palsy? | Facial nerve |
Do Bell palsy causes Ipsilateral or Contralateral deficits? | Ipsilateral |
What is a common result or complication of Pinealomas? | Parinaud syndrome |
What are the features of Parinaud syndrome? | Paralysis of upward gaze |
What are the common complications of Pinealomas? | 1. Parinaud syndrome 2. Obstructive hydrocephalus 3. Precocious puberty in males |
What are the sings and symptoms of Cerebellar dysfunction? | Ataxia, dysmetria, dysarthria, and nystagmus |
What are the functions of Cerebellum? | 1. Modulates movement 2. Aids in coordination and balance |
What are the complications of LATERAL cerebellum lesions? | 1. Affect voluntary movement of extremities 2. Propensity to fall to injured side |
What are signs of medial cerebellar injury? | Truncal ataxia, nystagmus, and head-tilting |
What are the main characteristics of NF-type 1? | 1. Neurofibromas 2. Cafe-au-lait spots 3. Lisch nodules |
What are Lisch nodules in NF type 1? | Pigmented nodules on the iris |
How are neurofibromas appear in NF1? | Bumpy prominences in upper back and shoulders |
What causes VHL syndrome? | Deletion of VHL gene on chromosome 3 |
What are the tumors associated in VHL syndrome? | Hemangioblastomas in cerebellum and spine, RCC, and Retinal angiomas (retinal capillary hemangioblastoma) |
Which parts of nervous system have the cell bodies of UMNs? | Cortex and Brainstem |
Where do UMN synapse? | At ganglia of LMN of the anterior horn and modulate voluntary motor and reflexes of skeletal muscle |
UMN are proximal or distal to anterior horn? | Proximal |
LMN are proximal or distal to anterior horn? | Distal |
Which are Proximal to anterior horn, UNM or LMN? | UMN |
Which are distal to anterior horn, UMN or LMN? | LMN |
What is the genetic make up of HSV? | Enveloped, double-stranded, linear virus |
What is the MCC of Temporal encephalitis in HIV patients? | HSV-2 infection |
What are the actions done by alpha-1 receptor? | Increase vascular smooth muscle contraction, miosis |
What are some actions of Beta-2 receptor? | Vasodilation and bronchodilation |
Description of a Cluster headache: | Severe, recurrent, and unilateral headache with conjunctival injection, lacrimation, rhinorrhea, and transient Horner syndrome |
Which headache type is associated with lacrimation and unilateral location? | Cluster headache |
What is the MC prophylaxis medication for a Cluster headache? | Verapamil |
What are the treatments for acute cluster headache? | Sumatriptan and 100% oxygen |
Common use for Verapamil: | Prophylaxis of Cluster headache |