38 Questions
What is the most likely consequence of cerebral edema?
Flattening of gyri and narrowing of sulci
In non-communicating hydrocephalus, which part of the ventricular system is likely to be enlarged?
Portion of ventricular system
What is the most common cause of hydrocephalus?
Impaired flow and resorption of CSF
What are the symptoms of raised intracranial pressure/hydrocephalus?
Slowing of mental capacity and headaches, especially more severe in the morning
What is the key pathway for pain in migraine?
Trigeminovascular input from the meningeal vessels to the trigeminal ganglion
What is the role of CGRP (calcitonin-gene-related peptide) in migraine?
It is a vasodilator and increases pain
What is the best accepted theory for the pathophysiology of 'other' neurologic findings in migraine?
Neurovascular theory involving primary neural dysfunction and spreading depression wave
What are the early signs/symptoms of prodrome in migraine?
Sensitivity to light, sound, and odors; lethargy
What are the diagnostic criteria for migraine according to the text?
Repeated attacks of headache lasting 4 - 72 hours
How does increased intracellular calcium lead to increased nitric oxide production?
Activation of nitric oxide synthase by calcium-calmodulin complex
In the subacute phase of ischemic insult, what is the characteristic cellular response?
Reactive astrocytes and influx of leukocytes across BBB
What is the main feature of liquefactive necrosis?
Digestion of dead cells and transformation of tissue into a liquid viscous mass
What is the consequence of hypoxic death of cells within the central nervous system?
Manifestation as liquefactive necrosis
What occurs during the resolution phase of ischemic insult in the central nervous system?
Development of astrocytic 'scar' and removal of liquefied mass
What are the typical signs and symptoms of idiopathic intracranial hypertension?
Headache, diplopia, tinnitus, and visual field defects
What is the predominant demographic affected by idiopathic intracranial hypertension?
Obese women of childbearing age
What is the suggested treatment for idiopathic intracranial hypertension?
Weight loss
What is the characteristic presentation of acute neuronal injury?
Red neurons with increased eosinophilia, pyknosis, and cell shrinkage
Which cells exhibit minimal changes when tissue is damaged in the central nervous system?
Oligodendrocytes and ependymal cells
Which type of headache is characterized by excruciating pain and autonomic features like conjunctival injection and tearing?
Cluster headache
What is the typical duration of tension-type headaches?
30 minutes to 7 days
What is the potential link of Secondary headaches to pathogenesis?
Subarachnoid hemorrhage
What are the characteristics of secondary headaches?
Pathogenesis related to rises in inter-cranial pressure
Which type of cerebral edema is associated with ischemia?
Cytotoxic cerebral edema
Which type of headache is characterized by unilateral, severe, and stabbing pain in the orbital, supraorbital, and/or temporal region?
Cluster headache
Which of the following structures can sense pain and cause a headache if irritated?
Intercranial vessels
Which type of headache is the disorder itself, rather than being caused by an exogenous disorder?
Migraine headache
What are the common features of tension-type headaches?
Bilateral, pressing or tightening pain
What are the typical characteristics of migraine headaches?
Unilateral, severe pain with autonomic features
What are some common causes of secondary headaches according to the text?
Caused by an exogenous disorder
Overproduction CSF is a common cause of cerebral edema
False
Transtentorial herniation is associated with....
3rd cranial nerve palsy
Subfalcine herniation can lead to the compression of....
Anterior cerebral aretry
Hemorrhagic lesions of midbrain and pons are characteristic of....
Transtentorial herniation
What type of herniation could be the most lethal?
Tonsillar
Which of the following excitatory molecules are released during ischemia?
Glutamate
Which phase of ischemia do red neurons start to develop?
Later insult (hours - a day)
Following resolution, necrotic area could be filled with neurons and new blood vessels
False
Study Notes
Headache Disorders: Types, Symptoms, and Pathophysiology
- Tension-type headaches exhibit pressing or tightening quality, are bilateral, and have mild to moderate intensity, lasting 30 minutes to 7 days.
- Cluster headaches, a type of trigeminal autonomic cephalalgias (TACs), are excruciating, with autonomic features such as conjunctival injection and tearing.
- Pathogenesis of TACs is not fully understood, but it may be linked to hypothalamic/circadian circuits and vasodilation.
- Cluster headaches and TACs, including paroxysmal hemicrania and SUNCT, have distinct characteristics in terms of gender prevalence, type, severity, site, frequency, and duration of attack.
- Cluster headaches tend to occur frequently for a period, followed by a headache-free interval, and patients may exhibit restlessness or agitation during attacks.
- Secondary headaches are associated with more clearly defined underlying causes, such as elevations in intracranial pressure or irritation of the meninges.
- Secondary headaches are linked to pathologies like meningitis, encephalitis, subarachnoid hemorrhage, and intracranial mass, which can cause pain due to edema and hydrocephalus.
- Criteria for low-risk headaches include age younger than 30, typical features of primary headache, no abnormal neurological findings, and no concerning change in the usual headache pattern.
- Meningitis, encephalitis, subarachnoid hemorrhage, intraparenchymal hemorrhage, intracranial mass, and general neuropathology can cause secondary headaches.
- Cerebral edema, a type of elevated intracranial pressure, can be vasogenic or cytotoxic, leading to fluid shifts and increased intracellular fluid.
- Secondary headaches may have a poor prognosis, and these pathologies need to be fully evaluated.
- No clear pathophysiology has been established for tension-type headaches, and much work is needed to understand the dysregulation of pain sensation in the central nervous system.
Test your knowledge of headache disorders with this quiz covering types, symptoms, and pathophysiology. From tension-type headaches to cluster headaches and secondary headaches, this quiz will challenge your understanding of the characteristics, causes, and risk factors associated with different headache disorders.
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