Headaches- Classification
- Tension
- Migraine
- Trigeminal autonomic cephalgias
- Chronic paroxysmal hemicrania
Refractory epilepsy - questions
- Is it epilepsy?
- Are they compliant with medication?
- Are you missing something (e.g. secondary cause)
Headache - 8 red flags- New onset or change in headache in patients who are aged over 50
- Thunderclap headache
- Rapid time to peak headache intensity (seconds to 5 mins)
- Focal neurological symptoms
- e.g. limb weakness, aura <5 min or >1 hr
- Signs of raised ICP
- Headache that changes with posture
- Headache wakening the patient up or worse in morning
- Papilloedema
- Accompanied by nausea or vomiting
- Visual disturbance
- History of trauma
- New onset headache in an immunosuppressed patient
Migraine
- Try amitriptyline or propanolol first
- Then topiramate (topomax)
Epilepsy - Classification
- Localized (partial or focal onset seizures) or distributed (generalized
seizures)
- Partial seizures are further divided on the extent to which
awareness is affected
- If it is unaffected, then it is a simple partial seizure
- Otherwise it is a complex partial (psychomotor) seizure
- A partial seizure may spread within the brain - secondary generalization
Notes
- Fingolimod
- Immunomodulating drug, approved for treating multiple sclerosis
- Reduces the rate of relapses in relapsing-remitting multiple
sclerosis by over half, but has serious adverse effects
- Sphingosine 1-phosphate receptor modulator
- Sequesters
lymphocytes in lymph nodes, preventing them from contributing to an
autoimmune reaction
- Acuity
- FIRST NUMBER IS ALWAYS 6!
- e.g. 6/12 means they can see at 6 metres what a normal person can see at 12
- Tegretol = Carbamazepine
- Topomax = Topiramate
- Cholesteatoma
- Atonic seizure
- IIH / (BIH)
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