This document discusses common neurological problems such as vertigo, dizziness, stroke, headache, and dementia. It provides details on the evaluation and causes of these conditions. Approximately 30% of people experience dizziness at some point, which can involve sensations of spinning, lightheadedness, or imbalance. A physical exam is important and may reveal signs such as nystagmus or postural hypotension. Common causes of vertigo include vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and Meniere's disease. Primary headaches include migraine, tension-type headache, and cluster headaches. Red flags are identified to help determine secondary causes versus primary headaches.
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Common problems in neurology
1.
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:
3.
4.
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
6.
7.
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
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
26.
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.
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
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.
