14100929
Description
Flashcards by Averil Tam, updated more than 1 year ago
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Created by Averil Tam
over 6 years ago
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| Question | Answer |
| 1. A 7yo boy is brought with acute severe headache by his parents. Which of following are important causes in the given context? A. Migraine B. Meningitis C. Hypertension D. Subarachnoid hemorrhage E. Sinus venous thrombosis F. Tension headache | A to E. First episode of migraine is still an important cause of acute severe headache especially in the context of normal neurological examination. Meningitis, hypertension, subarachnoid haemorrhage and sinus venous thrombosis are less common but important to recognise in the emergency setting. Tension headache presents more often with daily mild lingering chronic headache. |
| 2. Which of following symptoms are unusual for a diagnosis of migraine? A. Vomiting B. Double vision C. Vertigo D. Lack of family history of migraine E. Reversible focal neurological symptoms F. Persistent headache | B, D and F. Migraine can be associated with vomiting (A), vertigo (C) and (E) reversible focal symptoms especially when recurrent. Presence of diplopia (B) and persistent headache (F) may suggest raised intracranial pressure and one should consider neuroimaging in this context. It is important to take careful family history. One should be cautious in diagnosing migraine in the absence of family history of migraine (D). |
| 3. TRUE/FALSE? A. Normal examination rules out serious causes of headache. | False. Normal examination does not exclude serious causes of headache. In presence of persistent headache/ nocturnal headache/recent change in behaviour, imaging should be considered especially in young children where examination may be difficult. |
| 3. TRUE/FALSE? B. CSF studies are done when meningitis or subarachnoid hemorrhage is suspected. | True. Normal CT may not exclude subarachnoid haemorrhage and may need CSF studies. |
| 3. TRUE/FALSE? C. EEG provides useful information. | False. EEG is not indicated unless seizures are present. |
| 3. TRUE/FALSE? D. Routine CT is indicated to rule out tumour/bleed. | False. CT brain is not indicated, as it may not provide adequate information and is associated with risk of radiation. |
| 3. TRUE/FALSE? E. MRI is the imaging of choice in headache. | True. MRI is the imaging of choice as it provides better definition in terms of edema, infarct, inflammation, posterior fossa structures and venous sinuses. |
| 4. A father brings his 10yo daughter with headache and asks for MRI. When is neuroimaging indicated in the context of headache? A. Unilateral headache with vomiting B. Daily headaches C. Early morning progressive headache D. Presence of seizures E. Focal neurological signs | C, D and E. The American Academy of Neurology practice parameter recommendations: 1. Obtaining a neuroimaging study on a routine basis is not indicated in children who have recurrent headaches and normal results on neurologic examination. 2. Neuroimaging should be considered in children who have abnormal results on neurologic examination, the coexistence of seizures, or in whom there are historical features to suggest the recent onset of severe headache, change in the type of headache, or if there are associated features that suggest neurologic dysfunction. |
| 5. TRUE/FALSE? A. IIH is most likely cause in an overweight adolescent with papilledema on acne treatment. | True |
| 5. TRUE/FALSE? B. Triptans are contraindicated in familial hemiplegic migraine. | True |
| 5. TRUE/FALSE? C. Migraine prophylactic agents needs 4-6 weeks to show efficacy. | True |
| 5. TRUE/FALSE? D. Opioids are useful in the treatment of migraine. | False. Opioid use is not indicated in migraine due to in efficacy, side effects and risk of overuse. |
| 5. TRUE/FALSE? E. Life style modification is important in migraine. | True |
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