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Neurology Alim

Neurology Alim

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Published by idno1008

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Published by: idno1008 on Apr 11, 2012
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01/23/2013

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NEUROLOGY
1
 
HEADACHE
Headache is the most common neurological symptom.
AETIOLOGY
1.Tension headache2.Migraine headache3.Cluster headache4.Uncontrolled hypertension5.Meningitis6.Intracranial haemorrhageSubarachnoid haemorrhageIntracerebral haemorrhageAcute and chronic subdural haematoma7.Raised intracranial pressure8.Post traumatic9.Temporal arteritis10.Referred pain from Neck such as cervical spondylosisEyeSinusTeethTemporo mandibular joint
SEVERE HEADACHE
Migraine and cluster headache
Meningitis
Subarachnoid haemorrhage
TENSION HEADACHE
Features
Most common type of headache and experienced some time by most of the population
Usually constant and generalised but often radiates forward from the occipital region,described by the patient as dullness, tightness or pressure which may persist for days or weeks
Usually less severe during the early part of the day, worse as the day goes on and oftendoes not respond well to analgesics and other drugs
Photophobia, phonophobia and nausea may be present
Other features of neurological disease are absent
Pathogenesis is unknown but emotional strain or anxiety is a common precipitant
There may be underlying depressive illness or other psychiatric disorders
Management
Patient assurance that there is no serious illness
Analgesics to control pain
Patients may benefit with anti anxiety drugs and low dose amitriptyline
MIGRAINE
Three times more common in women
Pathogenesis
Initial vasoconstriction followed by vasodilation
Headache usually occurs due to vasodilatation of extracranial vessels
Types
Classic: with aura
Common: without aura
Migraine variants: retinal, ophthalmoplegic, hemiplegic, basilar 
Features
Headache attack lasts 4 to 72 hours
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Headache has at least two of the following characteristicsUnilateral locationPulsating qualityModerate or severe intensityAggravation by routine physical exercise
During headache at least one of the following occurs Nausea and/or vomitingPhotophobiaPhonophobia
At least 5 attacks occur fulfilling the above criteria
History, physical examination and neurologic examination do not suggest any underlyingorganic diseaseMigraine may be precipitated by stress, food such as chocolate and alcohol, menstruation and drugslike oral contraceptives.
TreatmentAbortive
Rest in a quiet and dark room
Analgesics + antiemetics (paracetamol/naproxen + metoclopramide/ Domperidone)
Triptans (sumatriptan, zolmitriptan, rizatriptan) are potent vasoconstrictors of extracranialvessels and may be started at the time of attack and repeated at 2 hours; maximum dose 5 to 6times/week 
Preventive
Propronolol/ amitriptyline, used in alone or in combination
Pizotifen
Sodium valproate
Verapamil
Flunarezine
RAISED INTRACRANIAL PRESSURE
Aetiology
Intracranial space occupying lesionsTumor, abscess, tuberculoma, toxoplasmosis, lymphoma
Intracranial haemorrhageSubdural haematomaIntracerebral haemorrhageSubarachnoid haemorrhage
Meningitis/meningo encephalitis
Hypertensive encephalopathy
Benign intracranial hypertension
FeaturesCardinal features
Headache
Vomiting
PapilloedemaOther features: bradycardia, decreased respiratory rate, 6
th
cranial nerve palsy
Headache is
Worse in the morning but gradually improves throughout the day
May be associated with vomiting in the morning
Dull ache in character 
Aggravated on bending forward
Aggravated with coughing and straining
May be relieved by analgesics
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