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Common problems in neurology


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Common problems in neurology

  1. 1. Common problems • Vertigo and dizziness • Stroke • Headache • Meningitis • Dementia and Parkinson disease I would like to stress on how to simplify this problems and to discuss certain points which would help for prompt and early referrals:
  2. 2. • Approximately 30% people - experience moderate to severe dizziness at some point in their life (Neuhauser et al. 2005). • “Dizziness” refers to various abnormal sensations relating to perception of the body’s relationship to space. • Dizziness - may represent variety of symptoms including : 1. Spinning or movement of the environment (True vertigo) 2. Light-headedness or Presyncope, or 3. Imbalance while walking
  3. 3. PHYSICAL EXAMINATION • A brief general medical examination is important. • Postural Hypotension measurement. • Orthostatic hypotension - probably the most common general medical cause of dizziness among patients referred to neurologists. • Identifying an irregular cardiac rhythm may help. • Other general examination measures to consider in individual patients include a Visual assessment (adequate vision is important for balance) and a musculoskeletal inspection (significant arthritis can impair gait). • In CNS examination look for nystagmus.
  4. 4. Common causes of vertigo VESTIBULAR NEURITIS: • Rapid onset of severe vertigo, nausea, vomiting, and imbalance. • Symptoms gradually resolve over several days • Etiology - probably viral. • Benign and self-limited • Head thrust test BPPV • Patients typically experience brief episodes of vertigo when getting in and out of bed, turning in bed, bending down and straightening up, or extending the head back to look up. • taught to perform a repositioning maneuver • Dix–Hallpike test. MENIERE DISEASE: Vertigo+ Hearing Loss+ Tinnitus+ Aural fullness
  5. 5. CLASSIFICATION • Symptom based •No organic causes •Etiology based Primary headache Secondary Headache
  6. 6. PRIMARY HEADACHES 1. Migraine 2. Tension-type headache 3. Trigeminal autonomic cephalalgias (including cluster headaches) 4. Other primary headache disorders – Cough – Exertional – Headache associated with sexual activity – Hypnic – Primary thunderclap – Hemicranial continua – New daily-persistent headache -ISH Cefalalgia 2013
  7. 7. MIGRAINE • It is the second most common cause of headaches (m/c is tension type headache)1 • Often can be recognized by its activators= TRIGGERS -light, sound, stress, hunger, menstruation, stormy weather, lack or excess of sleep, barometric pressure change, alcohol basis of life style adjustments • A headache diary is often useful in making diagnosis, assessing disability and frequency of treatment for acute attacks 1 Harrison’s Principles of Internal Medicine 18thed
  8. 8. Classic Migraine Potential phases of migraine attack 1. Prodrome – occurs hours to days before headache, change in mood, behaviour, appetite, cognition 2. Aura- occurs within 1 hour of headache, most commonly visual or sensory • Visual aura – Most common – Consists of photopsias, bright flashing lights, scintilating scotomas, field cuts and fortification spectra(zig zag lines/ Teichopsia)
  9. 9. Negative scotoma. Loss of local awareness of local structure Positive Scotoma. Additional structures One side loss of perception. Zigzag structure
  10. 10. • Sensory aura – Numbness and paresthesiae in a limb Motor weakness and aphasia are less common 3. Headache 4. Recovery
  11. 11. Common Migraine Symptoms similar to classical migraine but without aura Precipitating factors: • Foods rich in tyramine ( cheese, redwine) • Foods containing monosodium glutamate (Chinese and Mexican food) • Foods containing nitrates ( salami, smoked meat) • Caffeinated beverages (soft drinks, tea and coffee)
  12. 12. Simplified Diagnostic Criteria for Migraine Repeated attacks of headache lasting 4–72 h in patients with a normal physical examination, no other reasonable cause for the headache, and: At Least 2 of the Following Features: Plus at Least 1 of the Following Features: Unilateral pain Nausea/vomiting Throbbing pain Photophobia and phonophobia Aggravation by movement Moderate or severe intensity
  13. 13. Treatment: Tension-Type Headache • The pain of TTH can generally be managed with simple analgesics such as acetaminophen, aspirin, or NSAIDs. • Behavioral approaches including relaxation can also be effective. • TRIPTANS in pure TTH are NOT HELPFUL, although triptans are effective in TTH when the patient also has migraine. • For chronic TTH , AMITRIPTYLINE is the only proven treatment Other TCA, SSRI and the benzodiazepines have not been shown to be effective.
  14. 14. Medications that can cause headache • CVS- CCBs 1. Antiarrhythmics 2. α1 adrenergic antagonists 3. α2 adrenergic agonists 4. β adrenergic antagonists 5. ACE inhibitors 6. Angiotensin II inhibitors 7. Nitrates 8. Diuretics 9. Phosphodiesterase inhibitors • Antimicrobials • Immunologic/antiinflammatory
  15. 15. RED FLAGS
  16. 16. • Wakes patient from sleep at night • Sleep related disorders(e.g. Obstructive sleep apnea) • Rebound withdrawal headaches • Poorly controlled hypertension YELLOW FLAGS
  18. 18. Peripheral neuropathy
  19. 19. STROKE Departments of Neurology, 1KLE University's Jawaharlal Nehru Medical College & 2KLES Dr Prabhakar Kore Hospital and MRC, Belgaum, INDIA 1/30/2018 Dr.Nikhil Panpalia
  20. 20. DEMENTIA 1/30/2018 Dr.Nikhil Panpalia
  21. 21. 1/30/2018 Dr.Nikhil Panpalia