Type of Headache Symptoms and Signs Syndromes

Atypical facial pain Secondary headache Mild to severe, often unilateral pain (transformed migraine). Additional migraine attacks (p. 184) Unilateral or bilateral pain, often predominantly felt in the nasolabial or palatal region, often very severe. Unresponsive to a wide variety of medical and surgical therapies. Normal findings on a wide variety of diagnostic tests (diagnosis of exclusion) Posttraumatic, drug-induced, vascular (p. 182), intracranial mass, hydrocephalus, sinusitis,...

Underlying Condition Trigger

Cardiac Arrhythmia bradyrhythmia, tachyrhythmia, or reflex arrhythmia , heart disease e. g., cardiomyopathy, myxoma, mitral stenosis, congenital malformation, pulmonary embolism Hemodynamic Hypovolemia, hypotension vasovagal as an emotional reaction to pain, anxiety, sudden shock, sight of blood hypotension from prolonged standing, heat, exhaustion, alcohol multiple system atrophy polyneuropathies, e.g., amyloid, hereditary, toxic polyradicu-lar neuropathies Guillain-Barre syndrome...

Potential causes

Acute generalized Myasthenia gravis, botulism, periodic paralysis1, polymyositis dermatomyositis, acute weakness rhabdomyolysis, critical illness myopathy, toxic or drug-induced myopathy2, hypermag- Subacute or Myasthenia gravis, Lambert-Eaton syndrome, muscular dystrophy, congenital myopathy, chronic, mainly pro- polymyositis dermatomyositis, metabolic myopathy, mitochondriopathy, electrolyte im-ximal weakness balance, endocrine disorder3, toxic or drug-induced myopathy Subacute or Inclusion...

C8 L3 L4 L5 S1

Rhomboids, supraspinatus, infraspinatus, deltoid Biceps brachii, brachioradialis Triceps brachii, extensor carpi radialis, pectoralis major, flexor carpi radialis, pronator teres Abductor pollicis brevis, abductor digiti quinti, flexor carpi ulnaris, flexor pollicis brevis Quadriceps femoris, iliopsoas adductor longus, brevis et magnus Quadriceps femoris vastus medialis m. Extensor hallucis longus, tibialis anterior, tibialis posterior, gluteus medius Gastrocnemius, gluteus maximus Normal....

Hor

Multiple Sclerosis

- Prominent temporal artery Ptosis, miosis, reddening of eyes Lacrimation -Rhinorrhea - Prominent temporal artery Ptosis, miosis, reddening of eyes Lacrimation -Rhinorrhea The brain tissue itself is insensitive to pain. The major cranial and proximal intracranial vessels and dura mater of the supratentorial compartment derive nociceptive innervation from the ophthalmic nerve V 1, p. 94 , while those of the posterior fossa are innervated by C2 branches. Because nociceptive impulses from the...

Info

Multiple Sclerosis Info

The basal ganglia consist of the caudate nucleus CN , putamen, globus pallidus pallidum GPe external segment, GPi internal segment putamen pallidum lentiform nucleus , claustrum, substantia nigra SN SNc pars compacta, SNr pars reticularis , and the subthalamic nucleus STN . CN putamen dorsal striatum nucleus accumbens portions of olfactory tubercle anterior portion of putamen CN limbic ventral striatum. Substantia nigra SN The SNr ventral portion of SN contains small amounts of...

Bhl

Parapraxia 128 Paraproteinemic poly- neuropathy 328, 329, 406 Parasomnias 114 Parasympathetic nervous system 90, 140, 147, 148, 154 Paresis crossed 47 ipsilateral 46 Lyme disease and 228, 229 multiple sclerosis 214 peripheral 47 Paresthesia 106, 316 multiple sclerosis 214 spinal artery syndrome 282 Parinaud syndrome 70, 92, 358 Parkinson disease 62, 206-213 agraphia 128 bladder disorders 208, 371 blood pressure changes 208 constipation 208 hyperhidrosis 208 leg edema 208 seborrhea 208 sexual...

Clinical Features

Basal Ganglia Bleed

Spontaneous i.e., nontraumatic intracranial hemorrhage may be epidural, subdural p. 267 , subarachnoid, intraparenchymal, or intraventricular. Its site and extent are readily seen on CT somewhat less well on MRI and determine its clinical manifestations. Subarachnoid Hemorrhage SAH Symptoms and signs. The typical presentation of aneurysmal rupture by far the most common cause of SAH is with a very severe headache of abrupt onset the worst headache of my life , often initially accompanied by...

Drugs That Can Aggravate Myasthenia Gravis

Antibiotics tetracyclines, aminoglycosides, polymy-xins, gyrase inhibitors, penicillins Psychoactive drugs benzodiazepines, barbiturates, tricyclic antidepressants, chlorpromazine, haloperidol, droperidol, lithium Anticonvulsants phenytoin, ethosuximide, barbiturates Cardiovascular agents Quinidine, ajmaline, procainamide, lidocaine, ganglioplegics, nifedipine, -block- Promethazine, thioridazine. Chlordiazepoxide, ma-protiline, mianserin or carbamazepine can be used at low doses and with...

How To Cure Exercise Induced Hypoxemia

Multiple Sclerosis

Normal muscle strength after edrophonium chloride Amplitude reduction decrement from 1st to 5th stimulus Amplitude reduction decrement from 1st to 5th stimulus Repeated low-frequency stimulation 3 Hz, trapezius m., MG Increase in amplitude increment gt 3.5 times higher than baseline Repeated low-frequency stimulation 3 Hz, trapezius m., MG Increase in amplitude increment gt 3.5 times higher than baseline Repeated high-frequency stimulation 20 Hz, abductor digiti quinti m., LEMS ACh...

Muscular Dystrophy

Muscular Dystrophy Calf Muscle

The muscular dystrophies myopathies characterized by progressive degeneration of muscle are mostly hereditary. Pathogenesis Table 65, p. 398 Dystrophinopathies are X-linked recessive disorders due to mutations of the gene encoding dystrophin, a protein found in the cell membrane sarcolemma of muscle fibers. Such mutations cause a deficiency, alteration, or absence of dystrophin. The functional features of dystro-phin are not fully understood it is thought to have a membrane-stabilizing effect....

Are Allodynia And Multiple Sclerosis Related

Neuropathies

Disturbances of the peripheral nervous system may be subdivided into those affecting neuronal cell bodies neuronopathy and those affecting peripheral nerve processes peripheral neuropathy . Neuronopathies include anterior horn cell syndromes motor neuron lesions p. 50 and sensory neuron syndromes sensory neuronopathy, ganglionopathy pp.2, 107, 390 . Motor neuron diseases are described on p. 304. Peripheral neuropathy is characterized by damage to myelin sheaths myelinopathy and or axons...

Nodules On Iris In Multiple Sclerosis

The phakomatoses neurocutaneous diseases are a group of congenital diseases in which pathological changes are found in both the central nervous system and the skin. Neurofibromatosis, tuberous sclerosis, and von Hippel-Lindau disease are transmitted in an autosomal dominant inheritance pattern with high penetrance and variable phenotypic expression. These disorders are generally characterized by the formation of benign nodules hamartoma malignant tumors e.g., hamartoblastomas are rare....

Alcohol Intoxication

Alcoholic Dementia

Encephalopathy due to sepsis, multiple organ failure, or burns may arise within a few hours, manifesting itself as impaired concentration, disorientation, confusion, and psychomotor agitation in addition to the already severe systemic disturbances. In severe cases, there may be delirium, stupor or coma. Focal neurological signs are absent meningismus may be present, and CSF studies do not show signs of meningoencephalitis. There are nonspecific EEG changes generalized delta and theta wave...

Intracranial Hypertension

The normal intracranial pressure ICP is 60-120 mmH2O, which corresponds to 5-15 mmHg. An ICP greater than 30 mmHg impairs cerebral blood flow an ICP greater than 50 mmHg for more than 30 minutes is fatal an ICP greater than 80 mmHg for any length of time can cause brain damage. Intracranial hypertension may be either acute developing in hours to days or chronic lasting for weeks or months . Its manifestations are progressively more severe as the ICP rises, but are not specific thus, the...

Arcuate Fasciculus

Arcuate Fasciculus

Language is a means of transmitting and processing information, organizing sensory perceptions, and expressing thoughts, feelings, and intentions. The content of language encompasses the past, present, and future. The development of language does not necessarily require speech and audition deaf-mutes learn to communicate with sign language. Language is most easily acquired in childhood. Linguistic messages are transmitted and received through speaking and hearing, writing and reading, or in the...

Muscular Sclerosis

Lesions Pyramidal Tract

bladder, bowel, circulatory system genital organs, sweating left, dermatomes right, segment-indicating muscles Paralysis of peripheral origin can be caused by lesions of the anterior horn lower motor neuron, LMN , nerve root, peripheral nerve, or motor end plate and must be distinguished from weakness due to disease of the muscle itself myopathy . Apparent weakness can also be produced by tendon rupture or injury to bones and joints. Paralysis. Paralysis is accompanied by diminution of muscle...

Spinal Cord Lesion

Spinal Cord Lesions

Sensory loss in perianal region and inner thigh Flaccid paralysis of bladder and bowel, loss of erectile function 1 Spinal cord level not the same as vertebral level . 2 See p. 32ff. 3 Disturbance of bladder, bowel, rectal, and erectile function, sweating, and blood pressure regulation p. 140ff. 4 High cervical cord lesion. 5 Low cervical cord lesion. 6 Epiconus. 7 Conus medullaris. Chronic stage late sequelae. Persistence of neurological deficits assorted complications including venous...

Multiple Sclerosis Motor Tics

Tics are rapid, irregular, involuntary movements motor tics or utterances vocal tics that interrupt normal voluntary motor activity. They are triggered by stress, anxiety, and fatigue but may also occur at rest they can be suppressed by a voluntary effort, but tend to re-emerge with greater intensity once the effort is relaxed. Tics are often preceded by a feeling of inner tension. They may be transient or chronic. Simple tics. Simple motor tics involve isolated movements, e. g., blinking,...

Pathophysiology Of Multiple Sclerosis

Territorial Infarction

The risk of stroke increases with age and is higher in men than in women at any age. Major risk factors include arterial hypertension gt 140mmHg systolic, gt 90mmHg diastolic , diabetes mellitus, heart disease, cigarette smoking, hyperlipoproteinemia total cholesterol gt 5.0 mmol l, LDL gt 3mmol l, HDL lt 0.9-1.2 mmol l , elevated plasma fibrinogen, and obesity. Symptomatic or asymptomatic carotid artery stenosis, elevated plasma homocysteine levels, erythrocytosis, anti-phospholipid...

Pics Of Spinal Sclerosis

Posterior Column Lesion

Localized sensory disturbance not in a dermatomal or peripheral nerve distribution 2 Skin lesions, scars, lepromatous leprosy dissociated sensory deficit3 distally in the limbs, tip of nose, external ear Often pain and paresthesia at first, then sensory deficit, in a distribution depending on the site of the lesion Mononeuropathy compression, tumor , mononeuritis multiplex involvement of multiple peripheral nerves by vasculitis, diabetes mellitus, etc. Distal symmetrical sensory disturbances...

Basilar Skull Fracture

As the treatment and prognosis of brain tumors depend on their histological type and degree of malignancy, the first step of management is tissue diagnosis see Table 31, p. 377 . The subsequent clinical course may differ from that predicted by the histological grade because of sampling error i.e., biopsy of an unrepresentative portion of the tumor . Other factors influencing prognosis include age, the completeness of surgical resection, the preoperative and postoperative neurological findings,...

Cerebellopontine Angle Tumor

The clinical manifestations of a brain tumor may range from a virtually asymptomatic state to a constellation of symptoms and signs that is specific for a particular type and location of lesion. The only way to rule out a brain tumor for certain is by neuroimaging CT or MRI . Tumors whose manifestations are mainly nonspecific include astrocytoma, oligodendroglioma, cerebral metastasis, ependymoma, meningioma, neoplastic meningitis, and primary CNS lymphoma. Behavioral changes. Patients may...

Herpes Viral Encephalitis And Multiple Sclerosis

Herpes Simplex Encephalitis

Human Immunodeficiency Virus HIV Infection Pathogenesis. HIV type 1 HIV-1 is found worldwide, HIV-2 mainly in western Africa and only rarely in Europe, America, and India. HIV is transmitted by sexual contact, by exposure to contaminated blood or blood products, or from mother to neonate vertical transmission . It is not transmitted through nonsexual contact during normal daily activities, by contaminated food orwater, orby insect bites. In industrialized countries, the mean incubation period...

Simple Partial Seizures

Hyperventilation

Nonorganic, nonepileptic seizures arising from psychological factors do not involve loss of consciousness. They are involuntary and unintentional, and thus must be differentiated from simulated seizures, which are voluntarily, consciously, and intentionally produced events. Psychogenic seizures may resemble frontal lobe seizures p. 194 and are more common in women than men. About 40 of patients with psychogenic seizures also suffer from true epileptic seizures. The case history often reveals...

Multiple Sclerosis

Veps Multiple Sclerosis

Patients with MS are evaluated by clinical examination, laboratory testing, neuroimaging, and neurophysiological studies. The clinical manifestations of MS and the lesions that cause them vary over the course of the disease dissemination in time and space . Diagnostic classification is problematic p. 216 if only one lesion is found e.g., by MRI , if symptoms and signs are in only one area of the CNS e.g., spinal cord , or if only one attack has occurred Table 27, p 375 . Sensory deficits,...

Secondary Sleep Disorders

Secondary Sleep Disorders

Depression of various types can impair sleep, though paradoxically sleep deprivation can ameliorate depression. Depressed persons typically complain of early morning awakening, nocturnal restlessness, and difficulty in starting the day. Sleep disturbances are also common in patients suffering from psychosis, mania, anxiety disorders, alcoholism, and drug abuse. Neurogenic sleep disorders. Sleep can be impaired by dementia, Parkinson disease, dys-tonia, respiratory...

Cribriform Plate Infection

Subdural Empyema Pathogenesis

CNS infection may involve the leptomeninges and CSF spaces meningitis , the ventricular system ventriculitis , the gray and white matter of the brain encephalitis , or the spinal cord myelitis . A focus of bacterial infection of the brain is called a brain abscess, or cerebritis in the early stage before a frank abscess is formed. Pus located between the dura mater and the arachnoid membrane is called a subdural empy-ema, while pus outside the dura is called an epidural abscess. The clinical...

Trigeminal Nucleus Caudalis

Trigeminovascular

Migraine is a periodic headache often accompanied by nausea and sensitivity to light and noise photophobia and phonophobia . A typical attack consists of a prodromal phase of warning premonitory symptoms, followed by an aura, the actual headache phase, and a resolution phase. Attack characteristics often change over time. Attacks often tend to occur in the morning or evening but may occur at any time. They typically last 4-72 hours. Prodromal phase. The migraine attack may be preceded by a...

Festinating Gait

Gait Instability

The diagnosis of Parkinson disease PD sometimes termed idiopathic Parkinson disease, to distinguish it from symptomatic forms of parkinsonism, and from other primary forms is mainly based on the typical neurological findings, their evolution over the course of the disease, and their responsiveness to levodopa l-dopa . Longitudinal observation may be necessary before a definitive diagnosis of PD can be given. PD is characterized by a number of disturbances of motor function cardinal...

M

Multiple Sclerosis Demyelination

Special tests in MS IEF isoelectric focusing MRI T2-weighted image of cerebellum Activation. Circulating autoreactive CD4 T lymphocytes bear antigen-specific surface receptors and can cross the blood-brain barrier BBB when activated, e.g., by neurotropic viruses, bacterial superantigens, or cytokines. In MS, activated T lymphocytes react with MBP, PLP, MOG, and MAG. Circulating antibodies to various components of myelin can also be detected for abbreviations, see below1 . Passage through the...

Coma Staging

Kussmaul Respiration

The degree of impairment of consciousness is correlated with the extent of the causative lesion. The severity and prognosis of coma are judged from the patient's response to stimuli. There is no universally accepted grading system for coma. Proper documentation involves an exact description of the stimuli given and the responses elicited, rather than isolated items of information such as somnolent or GCS 10. Coma scales e. g., the Glasgow Coma Scale are useful for the standardization of data...

Frontal Lobe Lesions

Progressive Supranuclear Palsy

The frontal lobe includes the motor cortex areas 4, 6, 8, 44 , the prefrontal cortex areas 9-12 and 45-47 , and the cingulate gyrus p. 144 . It is responsible for the planning, monitoring, and performance of motor, cognitive, and emotional functions executive functions . Frontal lobe syndromes may be due to either cortical or subcortical damage and thus cannot be reliably localized without neuroimaging. The typical syndromes listed here are useful for classification but do not imply a specific...

Spinothalamic Tract

Spinothalamic Pathway And Proprioception

From the receptor, information is transmitted to the afferent fibers of the pseudounipolar spinal ganglion cells, whose efferent fibers reach the spinal cord by way of the dorsal root. A synapse onto a second neuron in the sensory pathway is made either immediately, in the posterior horn of the spinal cord protopathic system , or more rostrally, in the brain stem epicritic lemniscal system . The highest level of the somatosensory pathway is the contralateral primary soma-tosensory cortex. The...

Auditory Pathway

Hearing Pathway Blood Vessel

As it ascends from the cochlea to the auditory cortex, the auditory pathway gives off collateral projections to the cerebellum, the oculomotor and facial nuclei, cervical motor neurons, and the reticular activating system, which form the afferent arm of the acoustically mediated reflexes. Axons of the cochlear nerve originating in the cochlear apex and base terminate in the anterior and posterior cochlear nuclei, respectively. These nuclei contain the second neurons of the auditory pathway....

Supranuclear Lesions

Horner Syndrome Subclavian

Lesions above the oculomotor nucleus tend to cause bilateral pupillary dysfunction the most common cause is dorsal compression of the midbrain Parinaud syndrome p. 358 . Neurosyphilis produces Argyll-Robertson pupils unequal, irregularly miotic pupils with a variable degree of iris atrophy, and light-near dissociation. The cause of coma may be structural, metabolic, or toxic. Pupilloconstriction is produced by opiates, alcohol, and barbiturates, pupillary dilatation by atropine poisoning...

Corticospinal Tract

Corticospinal Tract

The brain stem consists of the midbrain mesencephalon , pons, and medulla. It contains the nuclei of the cranial nerves and ascending and descending tracts running to and from the brain, cerebellum, and spinal cord. It also contains au-tonomic centers that regulate cardiovascular function, breathing, and eating behavior as well as acoustic and vestibular relay nuclei. The flow of information along afferent and efferent pathways is regulated by reflex systems. All motor p. 44 and sensory...

The Near Response Convergence Pupilloconstriction Accommodation

Levator Palpebrae

When a subject watches an approaching object, three things happen the eyes converge through the action of the medial rectus muscles the pupils constrict and the curvature of the lens increases through the action of the ciliary muscle accommodation . The near response may be initiated voluntarily by squinting but is most often the result of a reflex, whose afferent arm consists of the visual pathway to the visual cortex. The efferent arm for convergence consists of descending fibers to the...

Lumbar Myotomes

Ulnar Nerve Myotomes

The precise region of impaired sensation to light touch and noxious stimuli is an important clue for the clinical localization of spinal cord and peripheral nerve lesions. Reflex abnormalities and autonomic dysfunction are further ones, as discussed below p. 40, p. 110 . A dermatome is defined as the cutaneous area whose sensory innervation is derived from a single spinal nerve i.e., dorsal root . The division of the skin into dermatomes reflects the segmental organization of the spinal cord...

Gustatory Disturbances Dysgeusia

Anopsia Diagnosis

78 When smell is impaired, the patient loses the capacity for fine differentiation of tastes but is able to distinguish the primary tastes sweet, Ventral posteromedial -nucleus of the thalamus Salivatory nuclei inferior and superior Ventral posteromedial -nucleus of the thalamus facial expression, mastication, and deglutition Inferior ganglion of X Inferior ganglion of IX Jugular foramen Glossopharyngeal n. Superior laryngeal n. X -Lingual n. V 3 Retina. Visible light is electromagnetic...

Substantia Nigra

Fronto Ponto Cerebellar Tract

The motor system controls the timing, direction, amplitude, and force of movement through the coordinated opposing actions of agonist and antagonist muscles. It also keeps the body in a stable position through postural and righting reflexes. Reflex movements are involuntary, stereotyped responses to stimuli. Rhythmic movements have both reflex and voluntary components. Voluntary movements are performed at will. Withdrawing a foot from a noxious stimulus or spreading the arms when falling are...

H

Rest Tremor

Posture and gait in youth left and old age right left, Parkinson disease right, start delay gait apraxia quadriceps paresis, leg dorsally angulated Tremor, the most common movement disturbance, is an involuntary, rhythmic, oscillating movement of nearly constant amplitude. It can occur wherever movement is subserved by antagonistic muscle pairs. Different types of tremor may be classified by the circumstances in which they are activated or inhibited and by their location, frequency, and...

Olfactory Disturbances Dysosmia

Cirrhosis And Cerebral Edema

76 Olfactory disturbances can be classified as either quantitative anosmia, hyposmia, hyper-osmia or qualitative parosmia, cacosmia . Con genital olfactory disturbances manifest themselves as partial anosmia olfactory blindness . The perceived intensity of a persistent odor decreases or disappears with time olfactory adaptation . External factors such as an arid environment, cold, or cigarette smoke impair the ability to smell diseases affecting the na-sopharyngeal cavity impair both smell and...

Rubrospinal Tract

Muscular Dystrophy Gowers Sign

Problems such as muscle weakness, fatigue, stiffness, cramps, tension, atrophy, pain, and involuntary movement do not necessarily signify disease of the muscle itself. Myopathy must be distinguished from neurogenic weakness of UMN or LMN type. Weakness may accompany systemic disease because of a generalized cata-bolic state or through a specific disease-related impairment of muscle function. Myopathy may be either primary or secondary, i.e., the product of another underlying disease. Different...

Branches Of Cavernous

Carotid Siphon

Blood is pumped from the left ventricle of the heart to the aortic arch and thence to the common carotid arteries and anterior circulation of the brain internal carotid, middle cerebral, and anterior cerebral arteries , and to the subclavian arteries and posterior circulation of the brain vertebral, basilar, and posterior cerebral arteries . The anterior circulation supplies the eyes, basal ganglia, part of the hypothalamus, the frontal and parietal lobes, and a large portion of the temporal...

Posterior Cerebral Artery Branches

Posterior Cerebral Artery Branches

The precommunicating segment of the PCA P1 extends from the basilar bifurcation to the origin of the posterior communicating artery PCommA . Its course lies within the inter-peduncular cistern, which is demarcated by the clivus and the two cerebral peduncles. The oculomotor nerve, after its emergence from the brain stem, runs between the PCA and the superior cerebellar artery. The postcommunicating segment P2 curves laterally and backward around the crus cerebri and reaches the posterior...

Bridging Veins Of The Brain

Bridging Veins The Brain

The superficial cerebral veins cortical veins carry blood from the outer 1-2 cm of the brain surface to large drainage channels such as the superior and inferior sagittal sinuses, the great cerebral vein of Galen, the straight sinus, and the tentorial veins. Thus, the cerebellar veins drain blood from the cerebellar surface into the superior vermian vein and thence into the great cerebral vein, straight sinus, and transverse sinuses. The deep cerebral veins central veins drain blood from the...

Sella Turcica Bone

Epidural Dural Arachnoid

The skull cranium determines the shape of the head it is easily palpated through the thin layers of muscle and connective tissue that cover it. It is of variable thickness, being thicker and sturdier in areas of greater mechanical stress. The thinner bone in temporal and orbital portions of the cranium provides the so-called bone windows through which the basal cerebral arteries can be examined by ultrasound. Thinner portions of the skull are more vulnerable to traumatic fracture. The only...