Pounding Questions
This primary headache type often presents with unilateral throbbing pain, nausea, and photophobia.
What is a migraine?
Giant cell arteritis is associated with this elevated lab marker.
What is ESR or CRP?
What is the first line treatment for moderate to severe migraines?
What are triptans?
*Antiemetics/ergots are second to third line treatments.
Numbness and loss of corneal reflex suggest a lesion affecting this cranial nerve.
What is cranial nerve V (trigeminal nerve)?
In a headache patient, bilateral papilledema suggests this dangerous finding.
What is increased intracranial pressure?
Headache with the "worst pain of my life" should prompt evaluation for this dangerous condition.
What is subarachnoid hemorrhage?
A 25-year-old man presents complaining of a severe, persistent headache that began suddenly 24 hours earlier while he was exercising. He denies having similar headaches. He has normal vital signs and a normal neurologic examination. Results of a
noncontrast head CT are negative. What is the next best management step?
A. Administer antibiotics
B. Perform LP
C. Repeat head CT in 4 hours
D. Treat symptoms and discharge
B. Perform LP
This medication is used to prevent headache recurrence in patients with cluster headaches.
What is verapamil?
Name the symptoms and treatment for trigeminal neuralgia.
What are brief, sharp, lancinating pain episodes in the distribution of the trigeminal nerve, and carbamazepine?
A patient with an acute CN III palsy and headache requires immediate imaging to rule out this cause.
What is a posterior communicating artery aneurysm?
Name the three primary headache syndromes, and specify which is the most common?
What are migraine, tension (most common), and cluster?
Name the physical exam findings that differentiate Bell palsy from central lesions.
What is inability to raise the eyebrow on the affected side, and inability to wrinkle the forehead?
Damage to this cranial nerve can cause dysphagia, vocal cord weakness, inability to speak, hoarseness and pain.
What is CN X (vagus nerve)?
Patients with this cranial nerve palsy have double vision exacerbated by looking downwards. They may have difficulty going down stairs. The head may tilt away from the affected side.
What is a CN IV (trochlear nerve) palsy?
Name the classic findings in Horner's syndrome and also name the deficiency.
What is Ipsilateral miosis (constricted pupil), ptosis (weak, droppy eyelid), anhidrosis (decreased sweating)? What is the sympathetic trunk?
This headache disorder, often triggered by coughing, sneezing, or exertion, is associated with a structural abnormality at the craniovertebral junction, where cerebellar tonsils extend below the foramen magnum. MRI is the diagnostic modality of choice.
What is a Chiari malformation?
Name and describe the feature found on lumbar puncture that is associated with subarachnoid hemorrhage.
What is xanthochromia? What is a hellowish appearance of CSF due to generation of bilirubin after heme is metabolized?
DAILY DOUBLE!!
Bilateral trigeminal neuralgia is very rare except for trigeminal neuralgia caused by this.
Name the two most frequent causes of cranial nerve impairment in the brain.
What are stroke and demyelinating disease?
Name the cranial nerve that is most frequently damaged in trauma.
What is CN I (olfactory nerve)?
This severe headache is caused by reversible segmental narrowing of the cerebral arteries and is often triggered by physical exertion, emotional stress, or vasoactive substances like triptans or cocaine. It is a diagnosis of exclusion and may mimic subarachnoid hemorrhage.
What is reversible cerebral vasoconstriction syndrome?
Name the most common tumor found at the cerebellopontine angle, and which cranial nerve is implicated.
What is vestibular schwannoma and CN VIII (vestibulocochlear nerve)?
Name the anatomical structure that is frequently the cause of trigeminal neuralgia.
What is the superior cerebellar artery?
Name the cranial nerve(s) involved in Wallenberg syndrome.
What are CN IX (glossophgaryngeal nerve) and CN X (vagus nerve)?
Name the cranial nerve(s) that is(are) considered an extension of the brain?
What are CN I (olfactory nerve) and CN II (optic nerve)? This is why these two cranial nerves do not get schwannomas.