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12.10.29 Clinic notes

Headaches
  • Classification
    • Tension
    • Migraine
    • Trigeminal autonomic cephalgias
      • => Always scan
  • Chronic paroxysmal hemicrania
    • => Indomethacin


Refractory epilepsy - questions

  1. Is it epilepsy?
  2. Are they compliant with medication?
  3. 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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