This document discusses headache syndromes and provides details on evaluating and diagnosing different types of headaches. It covers primary headaches like migraines and tension headaches. It also discusses secondary headache disorders and dangerous causes of sudden onset headaches like subarachnoid hemorrhage. Key factors for diagnosis are discussed like headache location, character, duration and associated symptoms. Diagnostic criteria for specific conditions like migraines are also provided.
This document defines various neurological conditions and disorders. It begins by defining common types of headaches like migraines and clusters headaches, as well as tumors, infections, and head injuries. It then discusses vascular conditions like strokes and transient ischemic attacks. Several spinal cord dysfunctions and neuromuscular disorders are also defined. The remainder of the document provides more detailed descriptions and treatments for various neurological conditions like meningitis, encephalitis, brain abscesses, and traumatic brain injuries including hemorrhages.
Headaches can be caused by many factors and require evaluation to determine the cause. Sudden, severe headaches require prompt evaluation to rule out serious underlying issues. Migraines typically involve throbbing pain and associated symptoms like nausea while tension headaches feel like pressure across the entire head. Treatment depends on the identified cause but may include medications, lifestyle changes, and reassurance when risks of serious conditions are low.
Subarachnoid haemorrhage occurs when there is bleeding into the subarachnoid space between the membranes surrounding the brain. The most common cause is rupture of a berry aneurysm. Patients typically experience a sudden and severe headache, vomiting, and may lose consciousness. Complications include rebleeding, hydrocephalus, cerebral vasospasm leading to ischemia, and hyponatremia. Prompt diagnosis and treatment are important to prevent neurological deficits and reduce mortality.
1. The document provides information about stroke, including its definition, risk factors, pathophysiology, early warning signs, and primary impairments. It notes that stroke is caused by either blockage or rupture of blood vessels in the brain.
2. High blood pressure, diabetes, heart disease, smoking, age, race, family history, and prior stroke or TIA are identified as major risk factors. Ischemic and hemorrhagic strokes are described in terms of pathophysiology.
3. Early warning signs include sudden numbness, confusion, vision problems, and difficulty walking or balancing. Primary impairments involve sensation, motor function, coordination, reflexes, and speech/language.
intra-operative acre of patients of aneurysm.pptxAnujaSebastian
An aneurysm is an abnormal dilation of a brain artery that can rupture, causing bleeding in the brain. Ruptured aneurysms have high mortality rates. Symptoms include severe headaches and changes in consciousness. Diagnosis involves CT, MRI, or cerebral angiography. Treatment may involve surgical clipping or endovascular coiling to prevent rebleeding. Postoperative care focuses on monitoring for complications like vasospasm, seizures, hydrocephalus, or rebleeding while restricting activity and managing anxiety.
Intracranial bleeding encompasses all bleeds that may occur within the cranial cavity including Epidural, Subdural, Sub arachnoid, intraparenchymal and Intraventricular haemorrhages. all are discussed in these slides and relevant references are provided for detailed information.
It is important to note that medicine is not learnt online but through series of organised events under specialised supervision in recognised institutions of learning.
This document provides an overview of approaches to evaluating and treating different types of headaches. It discusses evaluating patients for primary headaches like migraines and cluster headaches versus secondary headaches that could indicate an underlying condition. The assessment involves taking a thorough history and performing a neurological exam to identify concerning symptoms. Red flags that warrant further investigation include new severe headaches or headaches in older patients. Imaging and lumbar puncture may be used to rule out conditions like hemorrhage or infection. Treatment differs based on the headache type but may include abortive medications, prophylaxis, oxygen for cluster headaches, and steroids.
UG Aug 2021 ppt neurology Headaache.pptxmanjujanhavi
The document discusses different types of primary headache syndromes including tension-type headache, migraine, medication overuse headache, cluster headache, and trigeminal neuralgia. It provides details on the pathophysiology, clinical features, and management of tension-type headache and migraine. For migraine specifically, it describes the theories of cortical spreading depression and activation of the trigeminovascular system in its pathogenesis.
This document defines various neurological conditions and disorders. It begins by defining common types of headaches like migraines and clusters headaches, as well as tumors, infections, and head injuries. It then discusses vascular conditions like strokes and transient ischemic attacks. Several spinal cord dysfunctions and neuromuscular disorders are also defined. The remainder of the document provides more detailed descriptions and treatments for various neurological conditions like meningitis, encephalitis, brain abscesses, and traumatic brain injuries including hemorrhages.
Headaches can be caused by many factors and require evaluation to determine the cause. Sudden, severe headaches require prompt evaluation to rule out serious underlying issues. Migraines typically involve throbbing pain and associated symptoms like nausea while tension headaches feel like pressure across the entire head. Treatment depends on the identified cause but may include medications, lifestyle changes, and reassurance when risks of serious conditions are low.
Subarachnoid haemorrhage occurs when there is bleeding into the subarachnoid space between the membranes surrounding the brain. The most common cause is rupture of a berry aneurysm. Patients typically experience a sudden and severe headache, vomiting, and may lose consciousness. Complications include rebleeding, hydrocephalus, cerebral vasospasm leading to ischemia, and hyponatremia. Prompt diagnosis and treatment are important to prevent neurological deficits and reduce mortality.
1. The document provides information about stroke, including its definition, risk factors, pathophysiology, early warning signs, and primary impairments. It notes that stroke is caused by either blockage or rupture of blood vessels in the brain.
2. High blood pressure, diabetes, heart disease, smoking, age, race, family history, and prior stroke or TIA are identified as major risk factors. Ischemic and hemorrhagic strokes are described in terms of pathophysiology.
3. Early warning signs include sudden numbness, confusion, vision problems, and difficulty walking or balancing. Primary impairments involve sensation, motor function, coordination, reflexes, and speech/language.
intra-operative acre of patients of aneurysm.pptxAnujaSebastian
An aneurysm is an abnormal dilation of a brain artery that can rupture, causing bleeding in the brain. Ruptured aneurysms have high mortality rates. Symptoms include severe headaches and changes in consciousness. Diagnosis involves CT, MRI, or cerebral angiography. Treatment may involve surgical clipping or endovascular coiling to prevent rebleeding. Postoperative care focuses on monitoring for complications like vasospasm, seizures, hydrocephalus, or rebleeding while restricting activity and managing anxiety.
Intracranial bleeding encompasses all bleeds that may occur within the cranial cavity including Epidural, Subdural, Sub arachnoid, intraparenchymal and Intraventricular haemorrhages. all are discussed in these slides and relevant references are provided for detailed information.
It is important to note that medicine is not learnt online but through series of organised events under specialised supervision in recognised institutions of learning.
This document provides an overview of approaches to evaluating and treating different types of headaches. It discusses evaluating patients for primary headaches like migraines and cluster headaches versus secondary headaches that could indicate an underlying condition. The assessment involves taking a thorough history and performing a neurological exam to identify concerning symptoms. Red flags that warrant further investigation include new severe headaches or headaches in older patients. Imaging and lumbar puncture may be used to rule out conditions like hemorrhage or infection. Treatment differs based on the headache type but may include abortive medications, prophylaxis, oxygen for cluster headaches, and steroids.
UG Aug 2021 ppt neurology Headaache.pptxmanjujanhavi
The document discusses different types of primary headache syndromes including tension-type headache, migraine, medication overuse headache, cluster headache, and trigeminal neuralgia. It provides details on the pathophysiology, clinical features, and management of tension-type headache and migraine. For migraine specifically, it describes the theories of cortical spreading depression and activation of the trigeminovascular system in its pathogenesis.
This document discusses subarachnoid hemorrhage (SAH), which occurs when there is bleeding into the space between the brain and the thin tissues that cover the brain. The most common cause of SAH is the rupture of an intracranial aneurysm, which affects around 25,000-30,000 people in the US each year. The initial mortality rate is around 45% and over half of survivors are left with major neurological deficits. Diagnosis involves CT scans, lumbar puncture, and angiography. Treatment focuses on surgical clipping or coiling of the aneurysm as well as managing complications like vasospasm, hydrocephalus, and rebleeding through medical therapy.
This document provides guidance on evaluating acute headaches. It outlines important risk factors that suggest serious underlying causes, including sudden severe headaches, new headaches accompanied by neurological deficits, and headaches in certain high-risk populations. Evaluation may involve imaging like CT or MRI to rule out conditions such as subarachnoid hemorrhage, tumors, infections, or vascular abnormalities. The document also discusses distinguishing primary headache types and evaluating at-risk features to identify secondary headache causes.
Epilepsy is a common condition, encountered by neurologists, pediatricians, physicians and other doctors. It can be easily treated with anti-epileptic drugs. The current presentation discusses the approach to management of epilepsy, focussing on diagnosis and treatment.
This document discusses various types of headaches including their causes, characteristics, and treatments. Primary headaches have uncertain causes and include migraines, which are characterized by severe unilateral pulsating headaches that may be preceded by visual disturbances. Secondary headaches have defined pathological causes and can be due to conditions that increase intracranial pressure like tumors or idiopathic intracranial hypertension. Other secondary headaches discussed include cluster headaches and trigeminal neuralgia.
A brief presentation about confusional states. Difference between coma. This presentation is focused on Pathophysiology, major causes and approach to diagnosis and diagnosis tools.
The document discusses the approach to transient ischemic attack (TIA) and stroke. It provides definitions of TIA and acute stroke, and classifications of stroke. It also reviews epidemiological data on stroke from Malaysia, clinical features of different types of stroke, etiologies, investigations and management of acute ischemic stroke.
This patient presented with left-sided weakness and slurred speech. CT scan was normal. After tPA infusion, her blood pressure was elevated. The appropriate next step is to administer nicardipine to lower her blood pressure and prevent intracerebral hemorrhage.
This patient is being followed up after an ischemic stroke. Testing shows a left pontine infarct. The appropriate secondary prevention is to substitute clopidogrel for aspirin given his history of peripheral artery disease.
This patient presented with headache and papilledema. MRI was normal. Magnetic resonance venography is the best next test to evaluate for dural sinus venous thrombosis given her risk factors.
Head injuries can range from minor scalp lacerations to major traumatic brain injuries. The document outlines various types of head injuries including concussions, skull fractures, and intracranial lesions like epidural hematomas, subdural hematomas, and intracerebral hematomas. It discusses mechanisms of injury, classifications, signs and symptoms, diagnostic studies, and management approaches including decreasing intracranial pressure and monitoring for complications.
Stroke or Cerebrovascular incident, is defined as an abrupt onset of a neurological deficit that is attributable to a focal vascular cause.
The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain
Cerebrovascular accident, also known as stroke, is caused by a sudden blockage or rupture of an artery in the brain, cutting off blood flow. There are two main types - ischemic (caused by clot) and hemorrhagic (caused by bleeding). Risk factors include hypertension, smoking, diabetes, heart disease, and family history. Symptoms depend on the affected brain region but may include weakness, numbness, trouble speaking, and loss of coordination. Treatment focuses on restoring blood flow, preventing further damage, and rehabilitation. Control of risk factors can help prevent strokes.
syncope in children , vasovagal syncope , fainting in children , causes of syncope in children , how to manage syncope in children , cardiac syncope , differnetial diagnosis of syncope , approach to syncope
This document discusses vertigo, which refers to a hallucinatory sensation of movement caused by a mismatch of sensory information from the vestibular, visual, and proprioceptive systems. Vertigo can be caused by lesions in the peripheral, intermediate, or central nervous system. Common causes of peripheral vertigo include BPPV, Meniere's disease, and labyrinthitis. Intermediate vertigo may be caused by vestibular neuronitis or acoustic neuroma. Central causes include stroke, MS, migraines, and brain tumors. Clinical tests like nystagmus patterns and the head thrust test can help differentiate peripheral from central vertigo. Treatment depends on the underlying cause but may include medications, exercises
Headache with Special Reference to MigraineAbinayaa Arasu
Headache is a common pain problem that can have various causes. The document discusses the main types of headaches including those due to vasodilation, traction, inflammation, muscle spasm, referred pain, and psychogenic factors. It then focuses on migraine headaches, providing details on characteristics, pathogenesis, diagnostic criteria, treatment and variants. Tension-type headaches and cluster headaches are also summarized, with the key points being their recurrent but mild-moderate pain, and the severe unilateral pain of cluster headaches that occurs in bouts. A headache diary and red flag signs are important for properly evaluating the type and cause of a patient's headaches.
Headache is a common reason patients seek medical attention and can be primary or secondary. Primary headaches include tension-type headaches, which cause bilateral tight band-like pain, and migraines, which often cause severe one-sided throbbing pain accompanied by sensitivity to light, sound, and nausea. Migraines are thought to involve neurovascular and serotonergic mechanisms. Cluster headaches are rare but cause excruciating unilateral orbital or temporal pain and may be associated with autonomic symptoms. Treatment involves acute abortive medications as well as preventive medications depending on headache type and frequency. Secondary headaches require evaluation for underlying causes such as infection, trauma, or vascular abnormalities.
TBI definion and their types well explainedHariSadu6
- Traumatic brain injury results from a primary impact injury and secondary injury in subsequent hours and days. Understanding intracranial pressure is key to minimizing secondary injury.
- Moderate and severe TBI require resuscitation per ATLS guidelines. A thorough history including mechanism of injury and neurological progression is important. Examination should check pupils, GCS, and spine.
- Common surgical pathologies include extradural hematoma, subdural hematoma, contusions, and diffuse axonal injury which can be seen on CT and require different management.
Stroke is a leading cause of death and disability globally. The presentation summarizes key aspects of stroke management. It describes the epidemiology, pathophysiology, clinical features, diagnosis and management of both ischemic and hemorrhagic strokes. Prevention of initial and recurrent strokes is emphasized through control of risk factors and use of anticoagulants or antiplatelets depending on the patient's risk profile. Early diagnosis and treatment including thrombolysis are important to minimize brain damage from acute strokes.
A 35-year-old man presented to the emergency department with neck pain, dizziness and confusion after yanking a fishing rod the previous day. Imaging revealed a left internal carotid artery dissection with an ischemic stroke in the left frontal region. He was started on dual antiplatelet therapy and speech therapy. A follow up after 3 months showed modified Rankin score of 0-1, indicating minimal or no symptoms. Cervico-cephalic artery dissections occur when there is a tear in the artery wall, allowing blood to dissect into the wall and cause a hematoma. They typically present with neck pain, headaches, strokes, or Horner's syndrome. Diagnosis is made using CTA, MRA
Final [CH13] NOTES ppt, Neurological Problems.pptTristanBabaylan1
This document provides an overview of rapid neurologic assessment techniques including the Glasgow Coma Scale and assessment of level of consciousness. It also discusses conditions such as migraines, seizures, meningitis, increased intracranial pressure, strokes, Parkinson's disease, and Alzheimer's disease. For each condition, it outlines signs and symptoms, diagnostic testing, treatment options, nursing considerations, and interventions.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
This document discusses subarachnoid hemorrhage (SAH), which occurs when there is bleeding into the space between the brain and the thin tissues that cover the brain. The most common cause of SAH is the rupture of an intracranial aneurysm, which affects around 25,000-30,000 people in the US each year. The initial mortality rate is around 45% and over half of survivors are left with major neurological deficits. Diagnosis involves CT scans, lumbar puncture, and angiography. Treatment focuses on surgical clipping or coiling of the aneurysm as well as managing complications like vasospasm, hydrocephalus, and rebleeding through medical therapy.
This document provides guidance on evaluating acute headaches. It outlines important risk factors that suggest serious underlying causes, including sudden severe headaches, new headaches accompanied by neurological deficits, and headaches in certain high-risk populations. Evaluation may involve imaging like CT or MRI to rule out conditions such as subarachnoid hemorrhage, tumors, infections, or vascular abnormalities. The document also discusses distinguishing primary headache types and evaluating at-risk features to identify secondary headache causes.
Epilepsy is a common condition, encountered by neurologists, pediatricians, physicians and other doctors. It can be easily treated with anti-epileptic drugs. The current presentation discusses the approach to management of epilepsy, focussing on diagnosis and treatment.
This document discusses various types of headaches including their causes, characteristics, and treatments. Primary headaches have uncertain causes and include migraines, which are characterized by severe unilateral pulsating headaches that may be preceded by visual disturbances. Secondary headaches have defined pathological causes and can be due to conditions that increase intracranial pressure like tumors or idiopathic intracranial hypertension. Other secondary headaches discussed include cluster headaches and trigeminal neuralgia.
A brief presentation about confusional states. Difference between coma. This presentation is focused on Pathophysiology, major causes and approach to diagnosis and diagnosis tools.
The document discusses the approach to transient ischemic attack (TIA) and stroke. It provides definitions of TIA and acute stroke, and classifications of stroke. It also reviews epidemiological data on stroke from Malaysia, clinical features of different types of stroke, etiologies, investigations and management of acute ischemic stroke.
This patient presented with left-sided weakness and slurred speech. CT scan was normal. After tPA infusion, her blood pressure was elevated. The appropriate next step is to administer nicardipine to lower her blood pressure and prevent intracerebral hemorrhage.
This patient is being followed up after an ischemic stroke. Testing shows a left pontine infarct. The appropriate secondary prevention is to substitute clopidogrel for aspirin given his history of peripheral artery disease.
This patient presented with headache and papilledema. MRI was normal. Magnetic resonance venography is the best next test to evaluate for dural sinus venous thrombosis given her risk factors.
Head injuries can range from minor scalp lacerations to major traumatic brain injuries. The document outlines various types of head injuries including concussions, skull fractures, and intracranial lesions like epidural hematomas, subdural hematomas, and intracerebral hematomas. It discusses mechanisms of injury, classifications, signs and symptoms, diagnostic studies, and management approaches including decreasing intracranial pressure and monitoring for complications.
Stroke or Cerebrovascular incident, is defined as an abrupt onset of a neurological deficit that is attributable to a focal vascular cause.
The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain
Cerebrovascular accident, also known as stroke, is caused by a sudden blockage or rupture of an artery in the brain, cutting off blood flow. There are two main types - ischemic (caused by clot) and hemorrhagic (caused by bleeding). Risk factors include hypertension, smoking, diabetes, heart disease, and family history. Symptoms depend on the affected brain region but may include weakness, numbness, trouble speaking, and loss of coordination. Treatment focuses on restoring blood flow, preventing further damage, and rehabilitation. Control of risk factors can help prevent strokes.
syncope in children , vasovagal syncope , fainting in children , causes of syncope in children , how to manage syncope in children , cardiac syncope , differnetial diagnosis of syncope , approach to syncope
This document discusses vertigo, which refers to a hallucinatory sensation of movement caused by a mismatch of sensory information from the vestibular, visual, and proprioceptive systems. Vertigo can be caused by lesions in the peripheral, intermediate, or central nervous system. Common causes of peripheral vertigo include BPPV, Meniere's disease, and labyrinthitis. Intermediate vertigo may be caused by vestibular neuronitis or acoustic neuroma. Central causes include stroke, MS, migraines, and brain tumors. Clinical tests like nystagmus patterns and the head thrust test can help differentiate peripheral from central vertigo. Treatment depends on the underlying cause but may include medications, exercises
Headache with Special Reference to MigraineAbinayaa Arasu
Headache is a common pain problem that can have various causes. The document discusses the main types of headaches including those due to vasodilation, traction, inflammation, muscle spasm, referred pain, and psychogenic factors. It then focuses on migraine headaches, providing details on characteristics, pathogenesis, diagnostic criteria, treatment and variants. Tension-type headaches and cluster headaches are also summarized, with the key points being their recurrent but mild-moderate pain, and the severe unilateral pain of cluster headaches that occurs in bouts. A headache diary and red flag signs are important for properly evaluating the type and cause of a patient's headaches.
Headache is a common reason patients seek medical attention and can be primary or secondary. Primary headaches include tension-type headaches, which cause bilateral tight band-like pain, and migraines, which often cause severe one-sided throbbing pain accompanied by sensitivity to light, sound, and nausea. Migraines are thought to involve neurovascular and serotonergic mechanisms. Cluster headaches are rare but cause excruciating unilateral orbital or temporal pain and may be associated with autonomic symptoms. Treatment involves acute abortive medications as well as preventive medications depending on headache type and frequency. Secondary headaches require evaluation for underlying causes such as infection, trauma, or vascular abnormalities.
TBI definion and their types well explainedHariSadu6
- Traumatic brain injury results from a primary impact injury and secondary injury in subsequent hours and days. Understanding intracranial pressure is key to minimizing secondary injury.
- Moderate and severe TBI require resuscitation per ATLS guidelines. A thorough history including mechanism of injury and neurological progression is important. Examination should check pupils, GCS, and spine.
- Common surgical pathologies include extradural hematoma, subdural hematoma, contusions, and diffuse axonal injury which can be seen on CT and require different management.
Stroke is a leading cause of death and disability globally. The presentation summarizes key aspects of stroke management. It describes the epidemiology, pathophysiology, clinical features, diagnosis and management of both ischemic and hemorrhagic strokes. Prevention of initial and recurrent strokes is emphasized through control of risk factors and use of anticoagulants or antiplatelets depending on the patient's risk profile. Early diagnosis and treatment including thrombolysis are important to minimize brain damage from acute strokes.
A 35-year-old man presented to the emergency department with neck pain, dizziness and confusion after yanking a fishing rod the previous day. Imaging revealed a left internal carotid artery dissection with an ischemic stroke in the left frontal region. He was started on dual antiplatelet therapy and speech therapy. A follow up after 3 months showed modified Rankin score of 0-1, indicating minimal or no symptoms. Cervico-cephalic artery dissections occur when there is a tear in the artery wall, allowing blood to dissect into the wall and cause a hematoma. They typically present with neck pain, headaches, strokes, or Horner's syndrome. Diagnosis is made using CTA, MRA
Final [CH13] NOTES ppt, Neurological Problems.pptTristanBabaylan1
This document provides an overview of rapid neurologic assessment techniques including the Glasgow Coma Scale and assessment of level of consciousness. It also discusses conditions such as migraines, seizures, meningitis, increased intracranial pressure, strokes, Parkinson's disease, and Alzheimer's disease. For each condition, it outlines signs and symptoms, diagnostic testing, treatment options, nursing considerations, and interventions.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
2. Introduction
• Approximately one-half of the adult population worldwide is affected by a
headache disorder.
• The International Headache Society classification and diagnostic criteria can help
clinicians differentiate primary headaches (e.g., tension, migraine, cluster) from
secondary headaches (e.g., those caused by infection or vascular disease).
• A thorough history and physical examination, and an understanding of the typical
features of primary headaches, can reduce the need for neuroimaging, lumbar
puncture, or other studies
• The most common types of headaches are tension-type headaches, migraines,
and cluster headaches, which affect approximately 40, 10, and 1 percent of the
adult population, respectively.
• Most headache diagnoses are based entirely on the patient history. Only rarely
does physical examination provide clues to the diagnosis
3. Epidemiological factors
• Patient age, gender, and medical history may suggest specific
headache etiologies in some instances.
1. Patients older than 55 are at risk for temporal arteritis.
2. Young women are the population that is most likely to have
migraines.
3. Middle-aged men are susceptible to cluster headaches.
4. Obese young and middle-aged women are the patients most likely
to have pseudotumor cerebri.
5. Puerperal women and those with hypercoagulable states are at
greatest risk for cerebral venous sinus thrombosis.
4. Location of headache
• Most headaches are frontal or holocranial - location may not be
particularly helpful in establishing headache etiology.
• Occipital or nuchal headaches are most commonly tension headaches
or occipital neuralgia.
• Common causes of unilateral retro-orbital headaches are migraine
and cluster headaches.
5. Character – most helpful factor
• Dullness and squeezing - tension headaches, brain tumors, temporal
arteritis, and pseudotumor cerebri.
• Throbbing and pulsation - migraines and other vascular headaches.
• Sharp, stabbing pain is – cluster headaches and indomethacin-
responsive headaches.
6. Rapidity of onset
• Most headaches develop over minutes to hours,
• Sudden onset, severe headaches - require immediate attention, as
they often represent life-threatening neurological emergencies such
as subarachnoid hemorrhage, carotid artery dissection, and pituitary
apoplexy.
7. Duration
• Cluster headaches and indomethacin-responsive headaches are very
brief, usually lasting from just a few seconds to several minutes at a
time.
• Most headaches can last for half an hour at a time or for days on end.
8. Diurnal variation
• Most headaches, including tension headaches and migraines, develop
in the late morning or early afternoon.
• Cluster headaches and headaches caused by increased intracranial
pressure, which are usually worse at night and may awaken a patient
from sleep.
9. Associated symptoms - Aura
• is a neurological symptom that begins several minutes prior to
migraine onset and most commonly takes the form of visual
hallucinations of flashing lights, lightning strikes, starburst patterns, or
distortions in size such as micropsia and macropsia.
• Auras may have sensorimotor manifestations including tingling,
weakness , and numbness .
• Aura symptoms characteristically spread over 15–20 minutes, which
distinguishes them from stroke (sudden-onset symptoms) and seizure
(symptoms that develop over seconds).
10.
11. Other neurological symptoms
• Sudden unilateral or sequential visual loss - suggests temporal
arteritis.
• Seizures or other rapidly developing, fixed neurological signs point to
serious pathologies including intracranial hemorrhage, mass lesions,
venous sinus thrombosis, encephalitis, or hypertensive
encephalopathy
12. Systemic symptoms
• Nausea, vomiting, photophobia, and phonophobia frequently
accompany migraine.
• Conjunctival injection, lacrimation, and rhinorrhea are features of
both cluster and indomethacin-responsive headaches
• Visual loss, scalp tenderness, jaw claudication (pain with chewing),
low-grade fever, and proximal muscle tenderness - systemic
symptoms of temporal arteritis
13. Exacerbating factors
• High stress levels worsen almost all headaches.
• Actions that strain the neck including excessive head turning, staring
at a computer screen for prolonged periods, and even sleeping in the
wrong position tend to precipitate tension headaches.
• Not eating, poor sleep, excessive caffeine or caffeine withdrawal, the
menstrual period, chocolate, cheese, and red wine all exacerbate
migraine headaches.
• Lying flat and sleeping worsen headaches due to increased
intracranial pressure, while standing precipitates or worsens low-
pressure headaches secondary to spontaneous intracranial
hypotension or lumbar puncture.
14. Alleviating factors
• Rest in a quiet, dark room improves migraines.
• Loosening a tight necktie, massage, or applying heat - helps tension
headaches.
• Lying down improves low-pressure headaches, while standing up
improves headaches due to increased intracranial pressure.
15. Frequency
• cluster headache – multiple episodes of headache occur within a span
of a few weeks or months,
• Patients with frequent migraine attacks may benefit from prophylactic
medication, while those with infrequent attacks need symptomatic
treatment only.
21. Subarachnoid hemorrhage
• SAH due to aneurysmal rupture.
• S/S - Headache is usually severe and builds to a climax in just a few
seconds and is sufficiently jarring to stop patients in their tracks.
• Vomiting and stiff neck, seizure and loss of consciousness occur at
onset.
• Some patients may have a sentinel headache due to leakage of a
small amount of blood from the responsible aneurysm and preceding
the SAH by up to 2 weeks.
• Incidence of sentinel headache – up to 40%
22. SAH investigations
• Noncontrast head CT, the first diagnostic test.
• Likelihood of finding subarachnoid blood after SAH ↓ with time
1. 95% between 0 and 1 days after rupture
2. 90% between 1 and 2 days after rupture
3. 85% at 5 days after rupture
4. 50% at 1 week after rupture
5. 30% at 2 weeks after rupture
6. almost zero at any time after 3 weeks
23. SAH - Tx
• If SAH suspected and CT is negative - lumbar puncture to look for
subarachnoid blood (Xanthochromic CSF, Bilirubin levels in the CSF)
• Once SAH confirmed – Conventional angiography (CTA and MRA may
miss aneurysms < 5mm)
• Treatment – Coiling preferred, if no expertise then clipping.
24. Unruptured aneurysm
• Are almost always asymptomatic and are noted when neuroimaging is
performed to evaluate headache, memory loss, or another vague
neurological complaint.
• Risk for aneurysmal rupture must be weighed against the risk for
surgical or endovascular interventions.
• International Study of Unruptured Intracranial Aneurysms ISUIA DATA
– 1 year risk for death or poor neurological outcome is approximately
13% for open surgical clipping and 9% for endovascular coiling.
• Poor out come risks - older age, larger aneurysm size, and posterior
circulation location
25. 5-year risk for aneurysmal rupture from the International Study of Unruptured
Intracranial Aneurysms (ISUIA)
26. SAH …
• The patients with the most obvious benefit from intervention are
younger patients with aneurysms between 7 and 24 mm in diameter.
• Patients with aneurysms smaller than 7 mm in diameter or
asymptomatic intracavernous aneurysms should not undergo
intervention
27. Carotid artery dissection
• May produce a sudden-onset, severe headache.
• Precipitants - Trauma, especially that caused by vigorous exercise, yoga, or
chiropractic manipulation,
• Headache – typically unilateral, throbbing, and retrobulbar, (maybe
misdiagnosed as migraine)
• Diagnosis - CTA or MRA of the neck.
• Complication – embolic stroke; thrombus at the dissection site is fertile
ground for small clots, which are thrown distally into the anterior
circulation.
• Antiplatelet therapy or anticoagulation required to prevent distal
embolization (risk of stroke with either therapy is 2%)
28. Pituitary apoplexy
• Rapidly growing pituitary adenoma - outstrips its vascular supply →
infarction of the pituitary gland.
• S/S – Sudden onset headache, bitemporal hemianopsia (compression
of the optic chiasm) and ophthalmoplegia (involvement of the CN III
in the adjacent cavernous sinus).
• Biggest risk – Hypotension (from the acute loss of ACTH).
• Treatment – dexamethasone (4 mg IV) to prevent adrenal
insuffciency, and intravenous fluid boluses to maintain adequate BP.
• Definitive management- endocrinologist (hormonal replacement)
and neurosurgeon ( removal of tumor)
30. Temporal arteritis (Giant cell arteritis)
• is a vasculitis of medium- and large-sized arteries characteristically
involving one or more branches of the carotid artery, particularly the
temporal artery.
• Age group - >55yrs
• Headache in GCA/TA has no specific features.
• Clues - monocular visual loss, jaw claudication, scalp tenderness, and fever.
• Polymyalgia rheumatica , characterized by pain in the shoulders and hips,
frequently accompanies temporal arteritis.
• Diagnosis - ↑ESR and CRP, Temporal artery biopsy confirms diagnosis.
• Treatment – Steroids for > 1yr.
31. Cerebral venous sinus thrombosis
• S/S - headache, seizures, encephalopathy, and venous strokes.
• Takes several weeks to develop, earliest stages - nonspecific
headache that resembles migraine or tension headache
• Population at risk - Women in the puerperium, oral contraceptives
use, Sepsis, malignancy, dehydration and hypercoagulable states
• Neurological examination may be normal, may show an
encephalopathy, or may show focal signs that reflect a venous stroke.
• Contralateral leg weakness due to superior sagittal sinus thrombosis
is particularly suggestive of stroke due to CVST.
32. CVST investigations and treatment
• Neuroimaging - positive delta sign on contrast-enhanced CT scan,
which indicates collateral channels surrounding a torcular thrombus.
• A CT scan may also show hemorrhagic infarction or cerebral edema.
• In milder cases, the diagnosis is made only with the aid of magnetic
resonance venography (MRV).
• Complications – seizure, ↑ ICP, stroke.
• Treatment – Heparin and warfarin for 3 – 6 months (INR 2-3)
33. Meningitis
• characterized by fever and sometimes by headache and stiff neck.
• Headache may be the most prominent or a solitary symptom in
immunocompromised patients
34. Headache secondary to mass lesions
• Classically worse while recumbent, may awaken the patient in the
middle of the night, and may be associated with focal neurological
signs or seizures.
• Classical presentation – rare, most patients have headaches that
resemble tension headaches.
35. Pseudotumor cerebri (idiopathic intracranial
hypertension )
• Etiology – uncertain.
• S/S – headache (non specific resembling tension headache) and visual
loss (blurriness or transient orthostatic visual loss progressing to
blindness)
• Pop at risk - young, obese women (hence diagnosis often missed in
other groups).
• Precipitants – obesity, excess vitamin A, lithium, tetracyclines, and
both steroid administration and withdrawal.
36. Pseudotumor cerebri diagnostic tests
1. CT scan or MRI of the brain to exclude the possibility of true tumor
or another cause of ↑ ICP.
2. LP - opening pressure of at least 20 cm H₂O.
3. Dilated funduscopic examination to look for papilledema.
4. Formal perimetry to determine the exact extent of visual field loss.
37. Treatment of pseudotumor cerebri
• Discontinue any potentially responsible medications.
• Weight loss
• acetazolamide , administered at doses ranging from 250 mg bid to
1000 mg bid.
• serial lumbar punctures (impractical for doctor and patient alike)
• If serial lumbar punctures provide consistent relief,
→ventriculoperitoneal shunting as a more permanent method to
remove CSF.
• Patients with rapidly progressive visual loss may need optic nerve
sheath defenestration to prevent complete blindness.
38. Hypertensive encephalopathy
• Occurs in patients with either very high blood pressure or rapid
increases in blood pressure.
• S/S – Headache, seizures, visual loss, confusion, any focal neurological
finding.
• Frequently accompanied by other problems related to malignant
hypertension including angina, pulmonary edema, and renal failure.
• Treatment - lower the blood pressure to prevent irreversible
neurological and systemic damage.
40. Migraine
• Typical migraine - characterized by a throbbing, unilateral headache
associated with nausea, vomiting, photophobia, and phonophobia.
• May be preceded by a variety of aura symptoms - visual loss, scintillating
scotoma, tingling in the extremities, and even weakness resembling stroke.
• M:F =1:3 Age of 1st attack – teens – early 20s, rare for the disorder to first
appear after age 50.
• Diagnosis – made on clinical grounds, with neuroimaging studies being
used to exclude other more serious conditions.
• Treatment – Lifestyle adjustments, abortive medication and prophylaxis.
41. Migraine without Aura ICHD -3 Criteria
A. At least five attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hr (untreated or unsuccessfully treated)2;3
C. Headache has at least two of the following four characteristics:
• unilateral location
• pulsating quality
• moderate or severe pain intensity
• aggravation by or causing avoidance of routine physical activity (eg, walking or
climbing stairs)
D. During headache at least one of the following:
• nausea and/or vomiting
• photophobia and phonophobia
E. Not better accounted for by another ICHD-3 diagnosis.
42. Other migraine variants
• Migraine with aura - aura is accompanied or followed within 60
minutes by headache with or without migraine characteristics.
• Typical aura without headache - Migraine with typical aura in which
aura is neither accompanied nor followed by headache of any sort.
• Hemiplegic migraine - Migraine with aura including motor weakness.
• Basillar migraine ( Migraine with brain stem aura)
43. Migraine with brainstem aura
• Attacks fulfilling criteria for Migraine with aura and criterion below. Aura with
both of the following:
1. at least two of the following fully reversible brainstem symptoms:
2. a) dysarthria
3. b) vertigo
4. c) tinnitus
5. d) hypacusis
6. e) diplopia
7. f) ataxia not attributable to sensory deficit
8. g) decreased level of consciousness (GCS ≤13)
9. no motoror retinal symptoms.
44. • Migraine headache in children and adolescents (aged under 18 years)
is more often bilateral than is the case in adults; unilateral pain
usually emerges in late adolescence or early adult life. Migraine
headache is usually frontotemporal
• Very frequent migraine attacks are now distinguished as Chronic
migraine. When there is associated medication overuse, both
diagnoses, Chronic migraine and Medication-overuse headache,
should be applied.
45.
46. Migraine pathogenesis
• Various theories have been proposed – vascular, neurovascular,
cortical spreading depression etc.
• Currently the underlying process is believed to be sensory sensitivity
due to dysfunction of monoaminergic sensory control systems located
in the brainstem and hypothalamus.
47. Lifestyle modifications
• Ask patient about migraine precipitants such as sleep deprivation,
stress, not eating, menstruation, and foods such as chocolate, cheese,
caffeine, and red wine.
• Headache diary – Helpful to keep track of these exposures and the
consequent migraine frequency.
• Lifestyle modifications may reduce headache frequency considerably
or even cure the headaches in a very small minority.
48. Abortive medication
• 1st line - acetaminophen, ibuprofen, or naproxen,
• 2°line - triptan (serotonin 1B/1D agonist); effective in aborting migraines if
given early enough in the course of an attack: ideally, a patient should take
the triptan within 30 minutes of developing a headache, but they may still
benefit up to 3 hours after headache onset.
• side effects of triptans - chest pain, flushing, nausea, and grogginess.
• Triptans should be avoided in patients with cardiovascular or
cerebrovascular disease and in those who are taking monoamine oxidase
inhibitors
• 3 or more attacks per month or attacks that interfere with the patient’s
ability to work or to attend school – Propylaxis.
49.
50.
51.
52.
53.
54. Tension headache.
• bifrontal, holocranial, nuchal, or occipital squeezing or tightness.
Severe tension headaches may be accompanied by nausea and
vomiting, symptoms that are more typical of migraines
• Precipitants - neck strain, sitting still for a prolonged time, and
sleeping in an awkward position.
• Treatment – Mild analgesics (acetaminophen or ibuprofen),
• Severe attacks not responding to NSAIDS - Heat application and
stretching exercises may help. Muscle relaxants such as diazepam (2–
5 mg tid), metaxalone (400–800 mg bid), baclofen (10–40 mg bid), or
cyclobenzaprine (5–10 mg tid) are also often helpful.
55. Tension headache diagnostic criteria
• Lasting from 30 minutes to 7 days
• At least two of the following four characteristics:
• bilateral location
• pressing or tightening (non-pulsating) quality
• mild or moderate intensity
• not aggravated by routine physical activity such as walking or climbing stairs
• Both of the following:
• no nausea or vomiting
• no more than one of photophobia or phonophobia
• Not better accounted for by another ICHD-3 diagnosis
56. Tension headache variants
• Infrequent episodic tension-type headache - At least 10 episodes of
headache occurring on <1 day/month on average (<12 days/year) and
fulfilling criteria for tension headache. May or may not be
accompanied by pericranial tenderness.
• Frequent episodic tension-type headache - At least 10 episodes of
headache occurring on 1-14 days/month on average for >3 months
(≥12 and <180 days/year) and fulfilling criteria ± Pericranial
tenderness.
• Chronic tension-type headache - Headache occurring on ≥15
days/month on average for >3 months (≥180 days/year), fulfilling
criteria ± pericranial tenderness.
57. Cluster headaches
• Daily bouts of one to more attacks of relatively short-duration unilateral
pain for 8–10 weeks a year;
• Attacks last seconds to minutes.
• Pain is retroorbital, excruciating, nonfluctuating, and explosive in quality
• At least one of the daily attacks of pain recurs at about the same hour each
day for the duration of a cluster bout.
• Ipsilateral Horner’s syndrome is a frequent finding.
• Patients with cluster headache tend to move about during attacks, pacing,
rocking, or rubbing their head for relief; some may even become aggressive
during attacks.
• M;F 3:1 50% of the attack occur at night waking the patient up.
58. Cluster headache diagnostic criteria
A. At least five attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180
minutes (when untreated)1
C. Either or both of the following:
1. at least one of the following symptoms or signs, ipsilateral to the headache:
• conjunctival injection and/or lacrimation
• nasal congestion and/or rhinorrhoea
• eyelid oedema
• forehead and facial sweating
• miosis and/or ptosis
2. a sense of restlessness or agitation
C. Occurring with a frequency between one every other day and 8 per day
D. Not better accounted for by another ICHD-3 diagnosis
59. • Episodic cluster headache - attacks occurring in periods lasting from 7
days to one year, separated by pain-free periods lasting at least 3
months.
• Chronic cluster headache - attacks occurring for one year or longer
without remission, or with remission periods lasting less than 3
months
60. Cluster headache treatment
• Acute treatment - inhaled 100% oxygen, triptans or intranasal
lidocaine (1 ml 4% solution).
• Prophylaxis - verapamil (120–240 mg qd) or lithium (300 mg bid,
titrated to 600 mg bid with a goal plasma level between 0.6 and 1.2
mmol/l).
61. Chronic paroxysmal hemicrania
• Characterized by brief, episodic unilateral headaches, which are
accompanied by conjunctival injection, tearing, and rhinorrhea.
• Most frequent in young women, sometimes confused with migraine
or cluster headaches.
• It is distinguished from other forms of headache by its exquisite
sensitivity to indomethacin at doses of 25–100 mg bid–tid.
62. Visual strain headaches
• Following excessive reading, TV watching, or computer work, patients
note an aching or burning pain behind the eyes accompanied by
ocular fatigue and sometimes by conjunctival injection.
• The pain often radiates into the forehead or temples.
• Correction of refractive errors often helps to reduce the frequency
and severity of these headaches.
63. Medication-related headache
• Headache is listed as a side effect in the product inserts of almost
every medication.
• Common offenders include beta-blockers, cyclosporine, dipyridamole,
isotretinoin, and vasodilators such as nitroglycerin.
• It is often difficult to distinguish between headaches caused by
medication and those that are caused by a primary headache
disorder.
• A brief trial of withdrawing the presumed precipitant may be
warranted.
64. Postlumbar puncture headaches
• Occurs in 20–30% of patients following lumbar puncture,
• Caused by persistent leakage of CSF through the puncture site.
• Headache develops between 1 - 2 days after the LP is performed, Fronto-
occipital bilat, appear within seconds of assuming an upright position,
relieved by lying flat.
• Treatment - patient to lie flat for 24 hours and drink caffeinated,
carbonated beverages. If symptoms do not resolve, try the combination of
caffeine/butalbital/acetaminophen for no more than 72 hours.
• If conservative mx fails - epidural blood patch to promote sealing of dural
tear.
65. Spontaneous intracranial hypotension
• caused, by a traumatic dural tear with resulting spinal fluid leakage.
• Holocranial or occipital headache develops suddenly and occurs when
the patient is upright, and improves or resolves completely when they
lie flat. The patient may report vertigo and diplopia, and some
patients develop sixth nerve palsies.
• Imaging – sagging of the cerebellar tonsils and diffuse
pachymeningeal enhancement
• Treatment - aggressive hydration, caffeine, and epidural blood
patches, surgical closure if no improvement.
66. Headache in pregnancy
• Uncommon but dangerous causes of headache that may develop during
pregnancy include cerebral venous sinus thrombosis, eclampsia, and
pituitary apoplexy.
• Any woman without a prior history of headaches should undergo MRI of
the brain, especially if the headaches are associated with neurological
findings.
• Most common headache types in pregnancy - migraines (tends to improve
in frequency and severity during pregnancy) and tension headache
(worsens during pregnancy).
• Treatment – Avoid medicines if possible, paracetamol, ice packs, codeine or
short courses of NSAIDS (Avoid in late trimester 3),
• Consider propranolol or nortryptiline for women who require migraine
prophylaxis
67. Status migrainosus
• Migraine that lasts continuously or >72 hours.
• Precipitants - noncompliance with prophylactic medications, stress, poor
sleep, and head trauma.
1. Place the patient in a dark, quiet room and obtain intravenous access to
administer medications and replace fluids.
2. DVT prophylaxis
3. Antiemetic agents – Promethazine, Prochlorperazine Ondansetron
4. Acute pain – Ketorolac iv, Narcotics
5. Dihydroergotamine (1 mg IV), vasoconstrictor and serotonin 1B/1D
agonist may help abort migraine symptoms, even after 72 hours of
symptoms
6. Sleep aid – Diazepam iv
Triptan cause vasoconstriction between 10 – 20% hence may trigger CVA and angina.
Some triptans are metabolized by MAO system hence MAOI will result in elevated levels of triptans in the body.