Red flags 1: Headaches and Vascular Conditions
32 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is NOT a red flag feature for headaches?

  • Progression to constant symptoms
  • New onset in someone over 50
  • Abrupt onset
  • Worse in the afternoon (correct)

    • Temporal arteritis is a type of cervical arterial disease.

    False

    Name one risk factor for vascular headaches.

    High cholesterol

    A sudden and severe headache that is described as the 'WORST headache' ever experienced can indicate a potential _____.

    <p>sub-arachnoid hemorrhage</p> Signup and view all the answers

    Match the following headache presentations with their characteristics:

    <p>Stroke = Can present with weakness or sensory loss TIA = Transient stroke-like symptoms that resolve Atheroma = Plaque build-up in arteries leading to headaches Dissection = Tearing of an artery wall causing headache</p> Signup and view all the answers

    What is a common symptom of arterial dissection?

    <p>Acute tearing pain</p> Signup and view all the answers

    Occlusion refers to the partial or total blockage of a blood vessel.

    <p>True</p> Signup and view all the answers

    What are the two possible outcomes of arterial dissection?

    <p>Blood may become trapped in the second lumen, or the arterial wall may weaken and rupture.</p> Signup and view all the answers

    In arterial dissection, the symptoms may progress to _____ and low-level nausea.

    <p>dizziness</p> Signup and view all the answers

    Which type of dissection is most common?

    <p>Internal carotid dissection</p> Signup and view all the answers

    Match the symptoms to their corresponding classifications:

    <p>Dizziness = Neurological symptom Numbness = Neurological symptom Acute tearing pain = Dissection symptom Pulsatile headache = Dissection symptom</p> Signup and view all the answers

    Pain referral is uncommon to the vertebral artery.

    <p>False</p> Signup and view all the answers

    What is a common characteristic of the headache associated with arterial dissection?

    <p>Pulsatile in quality and progressive in severity.</p> Signup and view all the answers

    Which of the following are considered risk factors for spontaneous arterial dissection? (Select all that apply)

    <p>Hypertension</p> Signup and view all the answers

    Manual therapy is a confirmed risk factor for spontaneous arterial dissection.

    <p>False</p> Signup and view all the answers

    What should be done if a patient's reported symptoms during CAD testing are positive?

    <p>Send them to A&amp;E for immediate checks.</p> Signup and view all the answers

    A common symptom of carotid artery dissection is ________ which may indicate neurological complications.

    <p>dizziness</p> Signup and view all the answers

    Match the symptoms to the condition they are associated with:

    <p>Nystagmus = CAD Dysphagia = CAD Persistent neurologic deficits = Chiropractic manipulation complications Myelopathy = Chiropractic manipulation complications</p> Signup and view all the answers

    What are common complications reported by neurologists following cervical manipulation?

    <p>Strokes and myelopathies</p> Signup and view all the answers

    The sensitivity and specificity of general RoM tests for identifying issues is ________% and -% respectively.

    <p>0-57%, 87-100%</p> Signup and view all the answers

    What is the primary conclusion from Lee KP et al.’s study regarding risks of chiropractic manipulation?

    <p>Risks must be discussed with the patient for informed consent.</p> Signup and view all the answers

    Which of the following is considered a modifiable risk factor for cardiovascular disease?

    <p>Hypertension</p> Signup and view all the answers

    A transient ischemic attack (TIA) can lead to permanent neurological damage.

    <p>False</p> Signup and view all the answers

    What is the term for a clot that forms at the site of an injury?

    <p>Thrombus</p> Signup and view all the answers

    Heavy alcohol use is classified as a __________ risk factor for cardiovascular disease.

    <p>modifiable</p> Signup and view all the answers

    Which complication is characterized by the rupture of a blood vessel leading to blood loss?

    <p>Haemorrhage</p> Signup and view all the answers

    Match the type of blood vessel problem with its definition.

    <p>Occlusion = Blockage of a blood vessel Haemorrhage = Rupture of a blood vessel Thrombus = Clot forming at injury site Embolus = Clot formed elsewhere traveling to another site</p> Signup and view all the answers

    What is the main division of cerebrovascular disease in terms of blockage type?

    <p>Occlusive and haemorrhagic</p> Signup and view all the answers

    People with a family history of cardiovascular diseases are considered to have a modifiable risk factor.

    <p>False</p> Signup and view all the answers

    The brain has a high requirement for __________ and oxygen, with no ability to store them.

    <p>energy</p> Signup and view all the answers

    What effect does calcium influx into neurons have following a blockage?

    <p>It activates proteases and lipases, causing further damage.</p> Signup and view all the answers

    Signup and view all the answers

    Study Notes

    Headache - Red Flag, Part 1

    • Red flag headaches are conditions with specific presenting features, risk factors, and associated vascular or other neurological conditions.
    • Employability skills, such as problem-solving, communication, and teamwork, are enhanced through clinical neurology modules.
    • Lecture outcomes include learning presenting features of red flag headache conditions, recognizing risk factors for vascular headaches, understanding differences between cerebrovascular and cervical artery presentations, and understanding common vascular headaches and the evidence about chiropractic and arterial dissection.

    Vascular Headache Conditions

    • Cerebrovascular conditions: Stroke, transient ischemic attack (TIA)
    • Cervical arterial disease: Atheroma, dissection
    • Aneurysm, subarachnoid hemorrhage, temporal arteritis

    Red Flag Features in Headache

    • New headache, abrupt onset, new in individuals over 50 or in children
    • Worst headache, progression, constant duration, frequent occurrence
    • Duration of headache, new symptoms, location of pain

    Risk Factors for Occlusion/Dissection

    • Modifiable factors: High cholesterol, abdominal obesity, physical inactivity, smoking, hypertension, heavy alcohol use
    • Non-modifiable factors: Age, heart disease, high red blood cell count, history of transient ischemic attacks (TIAs), family history (genetics), connective tissue disorders

    Definitions

    • Occlusion/Infarction: blockage of a blood vessel (in the brain, blood vessel)
    • Thrombus: clot formed at the site of injury
    • Embolus: clot formed elsewhere and travels to the site of injury
    • Hematoma: blood accumulating outside a blood vessel
    • Dissection: tear in the blood vessel wall, can lead to aneurysm
    • Hemorrhage: rupture of a blood vessel leading to blood loss

    Cerebrovascular Disease

    • Any problem disrupting blood supply to the brain
    • Two main divisions: occlusive (blockage), hemorrhagic (rupture)
    • Causes include blood clots, atheromas, vascular malformations, degenerative or inflammatory arterial disease, blood diseases

    What Happens During Occlusion?

    • Some neurons die immediately.
    • Brain's high energy and oxygen (O2) demand, but no storage.
    • Cell membranes depolarize, releasing neurotransmitters.
    • Calcium floods neurons, activating proteases and lipases, damaging nearby neurons.
    • Chemical cascade of damage can continue for weeks.

    Occlusive Cerebrovascular Disease

    • Transient blockage to an already narrowed blood vessel leads to short-term neurological symptoms.
    • Obstruction resolving, no permanent damage.
    • Red flag for stroke development, highest risk within 48 hours.
    • Transient ischemic attack (TIA) within three months.
    • Stroke leads to permanent damage of varying severity.

    Symptoms - Occlusive Disease

    • Sudden onset without warning, affecting different areas (e.g., MCA, ACA, PICA).
    • Specific symptoms, like paraesthesia, weakness, dysphasia, and visual changes.
    • Pulsatile headache.
    • Neurological symptoms resolve within 24 hours (commonly 30 minutes).

    TIA versus Migraine

    • Similarities in symptoms like pulsatile and severe pain.
    • New or first onset headaches require excluding the worst outcome (TIA) first.
    • Treat as potential TIA until proven otherwise.
    • Carry on treatment for migraine once all clear.

    Cervical Arterial Disease

    • Disease affecting carotid or vertebral arteries, with occlusion (blockage) or dissection (tear).
    • Infarction (blockage), atheroma (plaque buildup), leading to partial blockage, potentially complete blockage of an artery.
    • Dissection creates a second lumen in artery.

    Dissection Symptoms

    • General symptoms: acute tearing pain in an artery, minor inciting event or no event, neck stiffness (inflammation).
    • New headache type, pulsatile and progressive, neuro symptoms can progress.
    • Atheroma (plaque buildup) is painless and generally non-emergent, unless accompanied by other symptoms.

    Pain Referral

    • Pain referral patterns differ between vertebral arteries (affecting the back of the head and neck) and internal carotid arteries (affecting the front of the head).

    Cervical Arterial Disease - Neurological Symptoms

    • Neurological symptoms similar, depending on the specific artery or blood vessel affected, especially with early-stage unilateral head rotation as a trigger.
    • Symptoms can include dizziness, visual disturbances, numbness, or nausea.
    • Symptoms may persist until the head returns to a neutral position.

    CAD - Late-Stage Neuro Symptoms

    • Focal spastic weakness or numbness in extremities or the half of the body
    • Contralateral pain and temperature loss along the affected body's side.
    • Ipsilateral pain and temperature loss in the body's same side as the affliction.
    • Dysphagia (difficulty swallowing), dysarthria (difficulty speaking), language problems, tongue deviation, ataxia (loss of coordination), and vertigo.

    Cervical Arterial Dissection

    • Dissection may result from trauma, whiplash, seat belt injuries.
    • Spontaneous arterial dissection can be a risk factor with underlying collagen disorders (e.g., Marfan's, Ehlers-Danlos syndrome), hypertension (high blood pressure), smoking, or a history of cardiovascular disease or stroke.
    • History of headaches, migraine, manual therapy, or other neck activities may also contribute.

    Cervical Arterial Disease - Testing

    • Non-invasive testing is first, including blood pressure, carotid auscultation, carotid palpation, and general ROM (range of motion) tests.
    • If symptoms worsen, stop the tests.
    • CAD testing (identifying artery impact) is inconclusive for isolated symptoms.
    • When in doubt, refer to higher care.

    Cervical Arterial Dysfunction Test

    • CAD-positive is any position provoking symptoms like nystagmus, dizziness, diplopia, loss of consciousness, sweating, dysphagia, dysarthria, nausea, numbness around lips.
    • If positive, immediately refer to an Emergency Room or similar urgent care.

    VBA Dissection and Chiropractic

    • Literature suggests no strong link between chiropractic manipulation and vertebral artery dissection (VBA), but possible risks exist.

    VBA Dissection and Chiropractic (Studies)

    • Lee KP et al. (1995) found no significant cases suggesting possible issues post-neck manipulation.
    • Symons BP et al. (2002), found only minimal strain with cervical neck movements.
    • Cassidy et al (2008) found increased association for stroke cases in younger individuals (<45), before chiropractic visits.

    Cerebral Aneurysm

    • Weakening of arterial wall leading to dilation (ballooning out) in subarachnoid space, range from 3-25mm, rupture rare <7mm.
    • Likely an underlying inflammatory process.
    • Different types: saccular (berry, most common), fusiform, dissecting.

    Cerebral Aneurysms (Complications)

    • Small holes can develop, leading to leakage and full rupture (subarachnoid hemorrhage (SAH)).

    Cerebral Aneurysm (Etiology)

    • Actual etiology unknown; contributing factors: hypertension, cigarette smoking, congenital (genetic) predisposition, vascular/connective tissue defects, injury/trauma to blood vessels, and infections.

    Cerebral Aneurysm (Headaches)

    • Can lead to two headache types: mild, non-specific, and continuous, progressing to sudden, severe and continuous pain which precedes rupture.
    • Symptoms can be preceded by 1-3 weeks of milder symptoms alongside nausea, dizziness, visual changes, or neurological signs.

    What Happens During Hemorrhage?

    • Slower leak of blood, toxic to cells due to free radicals.
    • Damage proteins and lipids, instability.
    • Chemical cascade, neuron death, can take weeks/months/years.

    Subarachnoid Hemorrhage

    • Rare stroke leading to fast brain bleeding.
    • Trauma, ruptured aneurysms, arteriovenous malformations - most common causes.
    • High mortality rate. Symptoms can develop 10-20 days prior to rupture.
    • Common symptoms include headache (sudden or sentinel in nature), dizziness, orbital pain, and/or diplopia.

    Subarachnoid Hemorrhage (Symptoms)

    • Sudden onset severe headaches, similar to a thunderclap, reaches peak intensity quickly (seconds).
    • Nausea/vomiting, meningism (nuchal rigidity, back pain, bilateral leg pain), photophobia, visual changes, neck stiffness, and focal neurological signs.

    Subarachnoid Hemorrhage (CT Scan)

    • CT scans can be diagnostic for detecting subarachnoid hemorrhage.

    Temporal Arteritis

    • Systemic inflammatory vasculitis (blood vessel inflammation) of unknown etiology.
    • Mostly in older adults (typically >65).
    • Primarily affecting superficial temporal arteries.

    Temporal Arteritis (Symptoms)

    • Headache, located in temples, gradual onset that progresses to severity; pulsating pain.
    • Discomfort in jaw muscles; often associated with polymyalgia rheumatica (PMR) which is a bilateral inflammatory condition affecting shoulder and hip muscles..

    Temporal Arteritis (Physical Exam)

    • Palpate temporal arteries for tenderness.
    • Check temperature (low-grade fever is sometimes present).
    • Look for signs of stiffness in shoulder and hip muscles.

    Temporal Arteritis (Management)

    • Urgent referral for investigation.
    • No cervical adjustments.
    • Corticosteroids for a long time and need to watch for osteoporosis consequences.

    Directed Work

    • Essential reading includes the ICHD-II (International Classification of Headache Disorders) and NICE Guideline on headaches.
    • Create a table of case histories comparing likely responses associated with each primary headache type.

    Mechanisms Behind Vascular Headaches

    • Identifying mechanisms of blood vessel issues leading to headaches.
    • Related affected blood vessels with their potential for inducing headache symptoms.

    Headache Assessment

    • Assessment for determining the expected patterns of headaches, onset (acute or gradual), area, pain quality, and other symptoms.
    • Possible clinical tests for evaluating headache causes.
    • Assess red flag symptoms that should lead to referrals versus those that can be treated conservatively.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Headache - Red Flag, Part 1 PDF

    Description

    Test your knowledge on headache characteristics and vascular conditions with this quiz. Explore red flags, risk factors, and symptoms related to various headache types. Challenge yourself to match presentation features with their underlying causes.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser