Neurology

can be infrequent, episodic or chronic

last days)
Onset: after rising, gets worse during day
Physical examination: muscle tension (e.g. frowning), scalp often tender to touch, ‘invisible pillow’ sign may be positive
Treatment: NSAIDs or acetaminophen

Risk factors
Stress
Hunger
History of teeth grinding or jaw clenching
Anxiety
Depression
Sleep apnea or sleep disruption
Eyestrain
Poor posture
Injuries or arthritis of the neck area
Temporomandibular joint disease (TMJ)
Medications
Low physical activity
Obesity
Smoking

verapamil

Site: over or about one eye
Horner’s syndrome
Radiation: frontal and temporal regions
Frequency: one every other day and 8 per day for more than half the time
Duration: 15–180 minutes (average 30 minutes); the clusters last 4–6 weeks (can last months)
Onset: suddenly during night (usually), same time about 2–3 hours after falling asleep; the ‘alarm clock’ headache
Offset: spontaneous

dropping of the upper eyelid. Denervation of smooth mm. serving palpebra
Pseudo-enophtalmos
sunken globe. Appearance based on ptosis.
Hyperemia
flushed skin. Denervation of vasomotor fibers
Anhydrosis
lack of sweating. Denervation of sudomotor fibers

(classic)
Treatment
Mild: NSAIDs
Severe or refractory: Triptans, ergots
Prophylaxis:
Beta blocker – propranolol
Valproic acid or topiramate

Site: temporofrontal region (unilateral) can be bilateral
Radiation: retro-orbital and occipital
Quality: intense and throbbing
Frequency: 1 or 2 per month
Duration: 4–72 hours (average 6–8 hours)
Onset: paroxysmal, often wakes with it
Offset: spontaneous (often after sleep)
Aggravating factors: tension, activity
Relieving factors: sleep, vomiting
Associated factors: nausea, vomiting (90%) irritability aura

pressure
Bradycardia
Fever
Focal neurologic deficit
Nausea
Vomiting
Usually woman

Diagnosis
Lumbar puncture
OP>25 cm H2O
Treatment
Acetazolelamide
Serial lumber
VP shunt

root entry zone by vessels (probably up to 75%)
Multiple sclerosis
Neurosyphilis
Tumours of the posterior fossa

unilateral
excruciating, searing jabs of pain like a burning knife or electric shock
Duration of pain is variable
Seconds to 1–2 minutes (up to 15 minutes)
Onset: spontaneous or trigger point stimulus
Offset: spontaneous
Madibular affected most often
Precipitating factors: talking, chewing, touching trigger areas on face

tumor
stroke
Associations:
herpes simplex virus (postulated)
diabetes mellitus
hypertension
thyroid disorder

Abrupt onset (can worsen over 2–5 days)
Weakness in the face (complete or incomplete)
Preceding pain in or behind the ear
Impaired blinking
Bell phenomenon—when closing the eye it turns up under the half-closed lid

and facial exercises during recovery
Prednisone taper
Virus infection: acyclovir, valacyclovir

Diagnosis
Clx

doctor if you’re allergic to povidone-iodine (an antiseptic) or procaine (an anesthetic).

Bleeding in the brain (intracranial hemorrhage).
Dementia.
Leukemia or other cancers.
Meningitis and encephalitis (brain and spinal cord infections).
Multiple sclerosis or other autoimmune disorders.
Myelitis (spinal cord inflammation).
Excess cerebrospinal fluid.
Administer regional anesthesia, such as an epidural to block pain in the lower part of the body.
Inject dye for an X-ray diagnostic test (myelogram).
Inject cancer medications or muscle relaxers.
Relieve intracranial (head) pressure.

your lower back to numb the area. You might feel a slight burning sensation.
Inserts a thin, hollow needle between two vertebrae (spinal bones) in the lower part of the spine. You may feel some pressure.
Draws fluid into the needle or injects medication or dye.
Gently withdraws the needle.
Cleans the skin again with an antiseptic and covers the puncture site with a bandage.

tilt table
Tx: betablockers

nervous system: old and Parkinson
Dx: orthostatic vital signs
Tx: IVF

- weakness

Mechanical cardiac – a structural heart disease
Exertional syncope, a murmur
Dx: Echo
Tx: surgery the valves
Arrhythmia
Sudden onset
Dx: Holter monitor
Neurogenic (rare)
Sudden onset and focal neurologic deficit
Dx: U/S