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    5.neuro History

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    noura

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    5.neuro History

    Uploaded by

    noura
    5 views28 pages

    Original Title

    5.Neuro History

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    5 views28 pages

    5.neuro History

    Uploaded by

    noura

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    The Nervous System

    Symptoms

    • Headache

    • Disturbances of consciousness
    1. Syncope
    2. Seizures
    3. Dizziness
    4. Vertigo
    Headache
    • Primary or secondary
    • Causes:
    • SOCRATES to analyse it
    Onset and course of headaches
    Acute single episode

    Subarachnoid haemorrhage Vasodilator drugs


    Acute meningitis Angle-closure glaucoma

    Acute recurrent

    Migraine Angle-closure glaucoma


    Sinusitis Cluster headache
    Neuralgias (e.g. trigeminal and post-herpetic)

    Subacute single episode

    Infections (e.g. tuberculous meningitis, cerebral abscess)


    Raised intracranial pressure (e.g. tumour, hydrocephalus)
    Benign intracranial hypertension
    Temporal arteritis
    Onset and course of headaches

    Chronic

    Chronic daily headache syndrome


    Depression
    Cervical spondylosis
    Drugs (e.g. nitrates, overuse of analgesics)
    Migraine
    • Is a primary headache disorder characterized by
    recurrent headaches that are moderate to
    severe. Typically, the headaches affect one half of the head,
    are pulsating in nature, and last less than 24 hrs with
    weeks to months symptoms free.

    • Classified into classic (with aura) and common (without


    aura).

    • Precipitated by: bright light, loud noise, strong odors,


    missed meals, intake of chocolate, cheese, citrus fruit,
    travel, oral contraceptive pills.
    Tension headache

    • Bilateral

    • 0ften frontal, temporal or occipital or 'like a


    tight band‘ or “pressure over the head”.

    • It is usually worse towards the end of the day.


    Cluster headaches
    • Attacks last 30-120 min
    • 1-4 attacks within 24 hrs
    • Clusters usually last weeks to months
    • Awake the patient after 2-3 hours of falling
    asleep
    • Unilateral in the cheek, temple or around the
    eye.
    • Accompanied by ptosis, eye redness, eye
    swelling and unilateral watering of the eye or
    nose
    Secondary Headache Syndromes

    • Meningitis

    • Subarachnoid haemorrhage

    • Temporal arteritis ( usually more than 55


    yrs with jaw pain , visual symptoms , and
    tender temporal arteries).
    Disturbances of consciousness
    Syncope

    • Alteration (or loss) of consciousness resulting


    from a recoverable loss of adequate cerebral
    blood flow.

    • Mechanism:
    Reduced cardiac output (Cardiac syncope) or
    increased peripheral vasodilatation (Vasovagal
    syncope) or combination of both.
    Cardiac syncope

    • May be provoked by exertion e.g. severe


    aortic stenosis, HOCM.

    • Or suddenly without warning when due to


    cardiac arrhythmias.

    • Recovery is usually rapid.


    Vasovagal syncope

    • Usually occurs whiles standing.


    • Provoked by stimulation of the parasympathetic
    system e.g. pain, emotional upset.
    • More common in warm environments.
    • Often preceded by light-headedness, vision
    darkening, tinnitus, and nausea.
    • It causes skin pallor.
    • If kept flat, recovery is rapid.
    Epileptic Seizures

    • Definition: paroxysmal electrical


    discharges from either the whole brain or
    part of the brain

    • Types:
    1. Generalized
    2. Focal (partial)
    3. Focal with secondary generalization
    Generalized tonic- clonic seizures pattern

    Prodromal phase
    Change of mood or 'odd' feeling (aura)
    Tonic phase
    Loss of consciousness Cyanosis
    Spasm of all muscles Fall
    Clonic phase
    Jerking of limbs and trunk
    Tongue biting
    Incontinence of urine
    Post-ictal phase
    Flaccidity
    Confusion
    Headache
    Amnesia
    • Focal seizure:
    Simple focal
    Complex focal

    Features of complex partial seizures

    •Dream-like states
    •Disturbances of memory (déjà-vu, jamais vu)
    •Hallucinations of smell, taste or auditory
    •Emotional disturbance
    •Abnormal behavior
    Vertigo (the illusion of movement)

    Causes of vertigo

    Central
    •Migraine
    •Brainstem ischemia or infarction
    •Multiple sclerosis
    Peripheral
    •Méniére's disease (hearing loss , tinnitus , nausea and vomiting
    •Benign paroxysmal positional vertigo
    •Vestibular neuritis
    •Trauma
    •Drugs, e.g. gentamicin, anticonvulsants
    Dizziness

    May be due to:

    1. Postural hypotension
    2. Cerebrovascular disease/vertebra
    basilar insuffeceincy
    3. Arrhythmia
    4. Hyperventilation
    Stroke
    Ischemic Stroke

    Hemorrhagic Stroke

    30
    Territory of the cerebral vessels

    Anterior Cerebral Artery


    (light blue)

    Middle Cerebral Artery

    (pink)

    Posterior Cerebral Artery

    (light green)
    Stroke Left Brain Stroke Right Brain
    Middle Cerebral Artery (MCA) Occlusion
    • Contralateral lower face weakness

    • Contralateral hemiplegia

    • Contralateral hemianesthesia

    • Ataxia

    • Speech impairments (usually the left brain)

    • Perceptual deficits (usually the right brain)

    • Visual deficits
    Anterior Cerebral Artery
    (ACA) Occlusion

    • Weakness of foot and leg

    • Sensory loss of foot and leg

    • Ataxia

    • Incontinence
    Posterior Cerebral Artery
    (PCA) Occlusion

    • Midbrain syndrome (Weber’s


    Syndrome) occlusion of
    the paramedian branches of
    the posterior cerebral artery
    • Ipsilateral Third nerve palsy
    • Contralateral hemiplegia

    • Thalamic Syndromes
    • Chorea or hemiballismus
    • Hemisensory disturbances

    • Visual field deficits (macular


    sparing)

    • Visual hallucinations

    • Memory problems
    The history
    • Past history : important risk factors, e.g. other vascular
    disease, hypertension.

    • Family history (Some conditions have a variety of


    inheritance patterns, e.g. Charcot–Marie–Tooth disease,
    mitochondrial DNA abnormalities

    • Drug history

    • Social history :Alcohol is the most common neurological


    toxin and damages both the CNS (ataxia, seizures,
    cognitive symptoms) and the PNS (neuropathy). Poor diet
    with vitamin deficiency

    • Occupational history

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