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Common problems in neurology
- 2. 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:
- 5. • 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
- 8. 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.
- 9. 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
- 17. CLASSIFICATION • Symptom based •No organic causes •Etiology based Primary headache Secondary Headache
- 18. 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
- 20. 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
- 21. 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)
- 22. Negative scotoma. Loss of local awareness of local structure Positive Scotoma. Additional structures One side loss of perception. Zigzag structure
- 23. • Sensory aura – Numbness and paresthesiae in a limb Motor weakness and aphasia are less common 3. Headache 4. Recovery
- 24. 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)
- 25. 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
- 27. 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.
- 28. 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
- 29. RED FLAGS
- 30. • Wakes patient from sleep at night • Sleep related disorders(e.g. Obstructive sleep apnea) • Rebound withdrawal headaches • Poorly controlled hypertension YELLOW FLAGS
- 31. NUMBER OF NERVE INVOLVED MONONEUROPATHY MONONEURITIS MULTIPLEX POLYNEUROPATHY Peripheral neuropathy
- 33. 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
Editor's Notes
- Semantically, the term headache encompasses all aches and pains located in the head, but in practice, its application is restricted to discomfort in the region of the cranial vault. Facial, lingual, and pharyngeal pains are put aside as something different and usually not considered as headaches
- Red flag symptom means that a headache warrants further investigation.
- Mononeuritis multiplex (multiple mononeuropathy and/or multifocal neuropathy) affects several or multiple nerves. Polyneuropathy describes diffuse, symmetrical disease, usually commencing peripherally.