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HA and Brain Tumors

Clinical Medicine II-Spring 2012

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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