PBL your kiss gives me headachePresentation Transcript
Definition : A headache involves pain in the head which can arise from many disorders or may be a disorder in and of itself.
There are three types of primary headaches: tension-type (muscular contraction headache), migraine (vascular headaches), and cluster
Headaches may result from contraction of the muscles of the scalp, face or neck; dilation of the blood vessels in the head; or brain swelling that stretches the brain's coverings
Definition : a decreased level of consciousness characterized by sleepiness and difficulty in remaining alert but easy arousal by stimuli.
It may be caused by a lack of sleep, medications, substance abuse, or a cerebral disorder.
Major function :
Shock-absorbing fluid to prevent brain from bumping against the interior of the hard skull when head is subjected to sudden, jarring movement
Exchange of materials between neural cells and interstitial fluid surrounding the brain
Materials exchange freely between CSF and interstitial fluid rather than between blood and brain interstitial fluid.
By choroid plexuses :
Found in particular region of ventricles
Richly vascularized, cauliflower-like masses of pia mater tissue that dip into pockets formed by ependymal cells
Formed as result of selective transport mechanisms across the membrane
Compared to blood : Low K + and higher Na + (ideal concentration gradient) for conduction of nerve impulse and almost no protein
Flows through 4 interconnected ventricles and through spinal cord narrow central canal (continuous with last ventricles)
Escapes through small opening from 4 th ventricles at the base of brain to enter subarachnoid space and flows between meningeal layers
At upper regions of brain, reabsorbed from subarachnoid space into venous blood through arachnoid villi
Facilitated by ciliary beating along with circulatory and postural factors result in CSF pressure of 10mmHg
Reduction of pressure by removal of few ml of CSF will cause headache
CSF volume : 125-150ml replaced 3x a day
Landmarks : plane of iliac crest through L4. in adults, spinal cord ends at L1,2 disc.
CSF findings :
Bloody tap – artefact due to piercing of blood vessel, if RBC reuced in subsequent bottle and no xanthochromia
Subarachnoid haemorrhage – yellow CSF (xanthochromia), same RBC amount in all tap
Very raised CSF protein – spinal block; TB; severe bacterial meningitis
Raised protein – meningitis; MS; uremia; hypothyroidism; DM; Guillain-Barre
Seizure first aid
Prevent injury During the seizure, you can exercise your common sense by insuring there is nothing within reach that could harm the person if she struck it.
Pay attention to the length of the seizure
Make the person as comfortable as possible
Keep onlookers away
Do not hold the person down If the person having a seizure thrashes around there is no need for you to restrain them. Remember to consider your safety as well
Do not put anything in the person's mouth Contrary to popular belief, a person having a seizure is incapable of swallowing their tongue so you can breathe easy in the knowledge that you do not have to stick your fingers into the mouth of someone in this condition.
Do not give the person water, pills, or food until fully alert
If the seizure continues for longer than five minutes, call 911
Be sensitive and supportive, and ask others to do the same
After the seizure, the person should be placed on her left side. Keep in mind there is a small risk of post-seizure vomiting, before the person is fully alert. Therefore, the person’s head should be turned so that any vomit will drain out of the mouth without being inhaled. Stay with the person until she recovers (5 to 20 minutes).
Causes of optic disc swelling
Raised intracranial pressure: papilledema
This may be due to :
obstruction of the ventricular system, space-occupying lesions , impairment of CSF absorption, diffuse cerebral oedema or idiopathic (benign/essential) intracranial hypertension . Some medications have been associated with this, e.g. tetracycline , minocycline , lithium, isotretinoin, nalidixic acid and corticosteroids (both use and withdrawal).
Presentation : headache (worse on waking and when coughing), may have nausea/vomiting and may have other neurological symptoms.
Glasgow Coma Scale The scale comprises three tests: eye , verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death ), while the highest is 15 (fully awake person). 1 2 3 4 5 6 Eyes Does not open eyes Opens eyes in response to painful stimuli Opens eyes in response to voice Opens eyes spontaneously N/A N/A Verbal Makes no sounds Incomprehensible sounds Utters inappropriate words Confused, disoriented Oriented, converses normally N/A Motor Makes no movements Extension to painful stimuli ( decerebrate response ) Abnormal flexion to painful stimuli ( decorticate response ) Flexion / Withdrawal to painful stimuli Localizes painful stimuli Obeys commands
Incidence & Aetiology
Neonates (HS 2)
Infected during delivery to a woman with active genital herpes
2. Adults (HS 1)
Infected through bloodstream from minor focus of viral replication, usually in mouth.
3. Immunocompromised person
Undergoing chemotherapy for Rx of cancer
Virus reaches brain via blood stream
Infects brain cells, causing neuronal necrosis and marked cerebral edema, lead to acute cerebral dysfunction and increased ICP