Showing posts with label #neurosurgeon. Show all posts
Showing posts with label #neurosurgeon. Show all posts

 Nuances of Awake Craniotomy Brain Surgery | Neurosurgery Lecture by Dr Sandeep Moolchandani


0:00 Introduction to Awake Craniotomy 4:15 History and Evolution of Awake Craniotomy 9:25 Importance of Awake Craniotomy 16:22 Advantages of Awake Craniotomy 20:54 Areas Indicated for Awake Surgery 22:14 Diseases Indicated for Awake Surgery 24:45 Patient Selection for Awake Brain Surgery 26:19 Age Limit for Awake Craniotomy 27:20 Contraindications for Awake Craniotomy 30:20 Complications in Awake Craniotomy 31:15 Prevention and Treatment of Intraoperative Seizures in Awake Brain Surgery 33:30 Preoperative Planning for Awake Brain Surgery 49:12 Intraoperative Monitoring in Awake Brain Surgery 1:08:16 Anesthesia Considerations for Awake Brain Surgery #Neurosurgery #Awake #Craniotomy A lot of you joined yesterday's demo Neurosurgery class by Dr Sandeep.

Those who wish to attend the NEET SS Neurosurgery Preparation course, can contact now:

Whatsapp chat helpline - +91 7395939989 Email - info@surgtest.com

📣Attention 𝗮𝗹𝗹 𝗡𝗘𝗘𝗧 𝗦𝗦 𝗡𝗲𝘂𝗿𝗼𝘀𝘂𝗿𝗴𝗲𝗿𝘆, 𝗔𝗜𝗜𝗠𝗦 𝗠𝗖𝗵 𝗡𝗲𝘂𝗿𝗼𝘀𝘂𝗿𝗴𝗲𝗿𝘆 𝗮𝗻𝗱 𝗡𝗜𝗠𝗛𝗔𝗡𝗦 𝗮𝘀𝗽𝗶𝗿𝗮𝗻𝘁𝘀!

Enroll in 1 course and get 4 benefits! ✅ Live and online classes taught by expert faculty ✅ Video Recordings of all sessions ✅ Notes/slides prepared personally by the faculty ✅ Topic-based conceptual classes: Answer any variation of questions asked on a topic!


Download the 𝗰𝗼𝘂𝗿𝘀𝗲 𝗯𝗿𝗼𝗰𝗵𝘂𝗿𝗲 here:

https://drive.google.com/drive/folders/1bbIIqcqyRukyhRMNDVrJ72fkQVnrp_mQ?usp=sharing&fbclid=IwAR0IQeEbbGGW2l9SpDbZO-H3kWzfDf2SnWYyaf1e-99iBEP7oevKSWOLSnw https://www.worldsurgeryforum.net

5/15/2021 01:27:00 AM
How to crack MCh/ DrNB Neurosurgery Entrance (NEET Neurosurgery)?


Here is another blog for those who want to crack Neurosurgery entrance exams for MCh and DrNB. Here I will tell you in a step-by-step manner how you can go about your neurosurgery entrance exam preparation. "How to crack Neurosurgery entrance" will be discussed under the following headings:

What are the various examinations conducted for Neurosurgery Entrance?


The examinations for Neurosurgery which you can appear after your MS General Surgery are:
  • NEET SS Neurosurgery (MCh/ DrNB)
  • NIMHANS Neurosurgery (MCh)
  • AIIMS Neurosurgery (MCh)
  • PGI Chandigarh Neurosurgery (MCh)
  • JIPMER Neurosurgery (MCh)

What Online Course to join for MCh/ DrNB Neurosurgery Entrance?

Usually people find it difficult to read Neurosurgery from books by themselves, because most of them have not had a practical exposure, thus grasping and remembering Neuroanatomical and Neurosurgical facts can be a daunting task. Check out this Conceptual Neurosurgery course for Neurosurgery Entrance Preparation which I will be teaching for Surgtest (App Link). Below are the salient features and contact details:

✅ Live and online classes  
✅ Video Recordings of all sessions
✅ Notes/slides prepared personally by the faculty 
✅ Topic-based conceptual classes: Answer any variation of questions asked on a topic! 

Download the 𝗰𝗼𝘂𝗿𝘀𝗲 𝗯𝗿𝗼𝗰𝗵𝘂𝗿𝗲 here to know the details and topic wise schedule: 

Whatsapp chat helpline - +91 7395939989 
Email - info@surgtest.com


What are the theory books to prepare for MCh/ DrNB Neurosurgery Entrance?

Following are the theory books from which majority of the questions are framed:

Greenberg is prefered more because it is high yield even for Neurosurgery residents but it is difficult to grasp and remember. It is so exhaustive that you can be almost sure that you won't miss anything.

Ramamurthy and Tandon Manual ("Manual", Not the Ramamurthy Textbook) is better in terms that it clears your concepts of Neurosurgery, it is written in simple language, written by authors who are Senior faculties in AIIMS and in other institutes of national importance and you can finish reading it in 2-3 months time.

What are the MCQ books to prepare for MCh/ DrNB Neurosurgery Entrance?


Amongst most of the MCQ books available in the market, no single book is satisfactory yet, you can check out these books for MCQs.


How much time is required to prepare for MCh/ DrNB Neurosurgery Entrance?

In ideal conditions 1-1.5 years is necessary to grasp all neurosurgery concepts, finish a textbook and practice MCQs if you are reading along with your General Surgery Residency. 

If after finishing your general surgery residency, you are able to give your dedicated attention, the time required can be shorter. 

How many daily hours of study are required to prepare for MCh/ DrNB Neurosurgery Entrance?


As any other competitive entrance in country like India, atleast 5-6 hours of dedicated study time on daily basis is required to crack the entrance exam.

What books to read for Neuroanatomy for MCh/ DrNB Neurosurgery Entrance?

Best book for reading Neuroanatomy is undoubtedly Snell's Neuroanatomy. All diagrams and MCQs given in the book are important.

What are the important topics for the preparation of  MCh/ DrNB Neurosurgery Entrance?

Following topics or areas are very important in terms of bulk of questions asked:
  • Neuroanatomy
  • Neurotrauma
  • Neuroncology 
  • Infections of brain
  • Neuropthalmology 

How is Neurosurgery as a branch?

I have listed down the pros and cons of joining Neurosurgery below so that you can make up your mind for starting your Neurosurgery preparation. Always remember at the end- Most important factor to decide is asking yourself - "What kind of work I will love to do for the rest of my life?"

  • Easy to get jobs both in metro cities and tier B cities
  • Good remuneration (One of the top most)
  • Challenging in terms of hours and techniques involved
  • Has a variety of procedures including Neuroncology, Brain Trauma Surgery, Endoscopic Surgery, Neurovascular Surgery, Spine surgery, Peripheral Nerve Surgery
  • Evolving fast with many new breakthroughs
  • Can also do individual practice and do basic procedures
  • High in demand
  • High stress
  • High patient load
  • High complications and mortality rates

When to start preparation for MCh/ DrNB Neurosurgery Entrance?


Make up your mind in 1st year of General Surgery residency itself on what branch you want to join and start preparing or atleast orienting yourselves to that specific branch in terms of both theoretical and practical knowledge. 

Start reading formally when you start to get more time for reading books from 2nd year of your residency.


Is there any Facebook or Whatsapp group for  guidance and preparation of MCh/ DrNB Neurosurgery Entrance?


For further guidance, I will be available at following groups on Facebook and Whatsapp.

Facebook NEET SS Neurosurgery Preparation

Whatsapp Surgtest Neurosurgery Group



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5/07/2021 07:54:00 PM
Subaxial Cervical Spine Injuries

Subaxial Cervical Spine Injuries: Introduction

  • Common cause of disability 
  • Most common causes:–  RTA, Fall, Penetrating trauma, Sports 
  • Highly prone to traumatic injury:
  • Mobile, relatively unprotected, and its high position 
  • 60% of all spinal injuries occur in the cervical spine 
  • Subaxial cervical spine injuries include:
    • 2/3rd of all cervical fractures
    • 75% of all cervical dislocations 
  • One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

Subaxial Cervical Spine Injuries: Epidemiology

  • Bimodal Peak
  • Adolescents and Young Adults
  • Middle Aged Individuals (55 years)
  • Males accounts for 80% of injuries 
3/11/2021 08:32:00 AM

 

BEST Neuroanatomy books for MBBS, NEET SS & Residents



Best book for Neuroanatomy for 1st Year MBBS

Though ‘Snell’s Clinical Neuroanatomy’ is one of the world's most popular neuroanatomy books for Medical students, but it is quite detailed for a student of 1st-year MBBS. So if you want to go easy with your Neuroanatomy in your 1st-year MBBS or time is a constraint, you can go for Vishram Singh or Inderbir Singh Neuroanatomy. They take care of basics in an easily digestible manner and cover the subject enough for 1st year MBBS. Also, you can supplement your study with video lectures of Dr. Najeeb.


Vishram Singh Neuroanatomy: 

  • Good set of diagrams
  • Very simple and easy to grasp


Inderbir Singh

  • Well illustrated and easy to retain

Best Book for Neuroanatomy for NEET SS Neurosurgery Preparation

Best Book for Neuroanatomy from MCQ perspective for NEET SS Neurosurgery: Snell's Neuroanatomy

Why?

  • Includes Clinical notes with neuroanatomy, covers many important mcq points
  • MCQs and clinical problems with detailed explanations of the answers, many MCQs can be directly asked in the exams
  • Additional online resources in the form of an interactive atlas and 450 USMLE-style review questions - again many of these MCQs are based on important high yield topics




Best Book for Neuroanatomy for MCh/ DNB Neurosurgery Residents/ FRCS Neurosurgery

Book for Basic Neuroanatomy for Neurosurgery Residents


There are limited number of real human brains and sections. Most of the diagrams are schematics and not completely applicable to surgical practice.



This interesting, far reaching book gives rich visual direction on all parts of neuroanatomy, along with fine art by ace clinical artist Frank H. Netter, MD. Brief tables feature significant parts of each structure, outfitting you with the basic information you have to ace this intricate control. Most of the diagrams are schematics, good for developing concepts.






  • Coverage of both regional and systemic neurosciences 
  • Netter and Netter-style illustrations to highlight key neuroanatomical concepts and clinical correlations.
  • Reflects the current understanding of the neural components and supportive tissue, regions, and systems of the brain, spinal cord, and periphery.
  • Easy to memorize overview of anatomy, function, and clinical relevance.
  • The succinct and useful format utilizes tables and short text to offer easily accessible "at-a-glance" information.
More Info: 

Highlights cross-sectional brain stem anatomy and side-by-side comparisons of horizontal sections, CTs and MRIs.


Student Consult eBook version included with purchase. This enhanced eBook experience includes access -- on a variety of devices -- to the complete text, 14 videos, and images from the book.
Expanded coverage of cellular and molecular neuroscience provides essential guidance on signaling, transcription factors, stem cells, evoked potentials, neuronal and glial function, and a number of molecular breakthroughs for a better understanding of normal and pathological conditions of the nervous system.

Micrographs, radiologic imaging, and stained cross sections supplement illustrations for a comprehensive visual understanding.


Book for Surgical Neuroanatomy for Neurosurgery Resident

Rhoton's Cranial Anatomy and Surgical Approaches



  • 2000 full-color illustrations
  • the best book to understand microsurgical anatomy of the brain for neurosurgeons at any career stage


  • This book presents neurosurgical cadaveric anatomy by detailing approaches in the same operative position patients would be placed in during a real operative procedure. 
  • It includes:
    • all commonly used cranial and cranial base approaches
    • anterior, posterior, anterolateral, and posterolateral approaches to all segments of the spine
    • all commonly performed procedures on peripheral nerves
    • endoscopic approaches to cranial and spinal neurosurgery



Book for Radiological Neuroanatomy for Neurosurgery Residents:

Netter’s Correlative Imaging: Neuroanatomy


Interpret the complexities of neuroanatomy like never before with the unparalleled coverage and expert guidance from Drs. Srinivasan Mukundan and Thomas C. Lee in this outstanding volume of the Netter’s Correlative Imaging series. Beautiful and instructive Netter paintings and illustrated cross-sections created in the Netter style are presented side by side with high-quality patient images and key anatomic descriptions to help you envision and review intricate neuroanatomy.

Cranial Neuroimaging and Clinical Neuroanatomy: Atlas of MR Imaging and Computed Tomography


Detailed brain anatomy shown in the three orthogonal planes; two-page spreads showing imaging studies keyed to the graphics using numbers that are consistent throughout. Graphic representation of the major arterial and venous territories and CNS spaces, supra- and infratentorial It revealed in multiplanar parallel sections, including detail on the potential sites of lesions and corresponding neurologic deficits

New to the fourth edition:

All X-ray and CT-/MR images replaced with new high-resolution CT and MR images

High resolution 3-Tesla MR images of the brainstem, 7-Tesla-images, fractional anisotropy (FA) maps as well as quantitative susceptibility maps (QSM)

New material on temporal bone, brain maturation, neurofunctional systems

Clinical context updated and expanded

Neuroradiology: The Requisites (Requisites in Radiology) 

Highlights 1,200 great neuroimaging pictures. Makes it simple to find any topic of interest because of an intelligent association by ailments and areas.  Summarizes differential diagnoses in quick-reference tables to reinforce important facts. Focuses on essentials to pass the exams.





10/21/2020 07:30:00 AM
Eligibility Requirements for FRCS Neurosurgery

Following are eligibility requirements for appearing for FRCS Neurosurgery:

Now it is not compulsory to crack MRCS for JSCFE FRCS (International). You can appear in FRCS Neurosurgery even if you don't have cleared MRCS. 

There are two versions of FRCS, one for domestic and other for International candidates.

  • JCIE  FRCS (Joint Committee on Intercollegiate Examinations) (domestic - UK & Ireland) 
  • JSCFE FRCS (Joint Surgical Colleges’ Fellowship Examinations) (international)

Being an Indian medical graduate currently working as a Neurosurgeon, you will have to appear for JSCFE FRCS Neurosurgery. 

To appear for this exam you need to have a minimum of 6 years of experience to be just eligible to write the exam. 3 Year of your General Surgery experience + 3 years of Neurosurgery residency experience. 

For this you need to provide evidence in form of following:

What you'll need at the time of application for FRCS Neurosurgery?

  • Medical Qualification – year/country obtained (Candidate should have completed a locally recognized neurosurgical residency program)
  • MRCS – month/year obtained [if applicable, not mandatory]
  • Your three signed Structured References (pdf format)
  • Curriculum Vitae (pdf format)
  • Summary of Operative Experience -Logbook in prescribed format (pdf format)
  • Photocopy of your passport (identification page)

Structured References required for eligibility of your training for FRCS Neurosurgery

  • The principal referee must be the applicant’s current of Head of Department or Head of the Recognised Training Committee/Programme in which the applicant has participated 

  • The  second  referee must  be a  senior  clinician who  has worked  with  the applicant and  has knowledge of the applicant’s work in his/her specialty within the last two years 

  • The  third  referee  must  be  a  senior  clinician  who  has  worked  with  the  applicant  and  has knowledge of the applicant’s work in his/her specialty within the last two years

What is the Exam Format for FRCS Neurosurgery?

Section 1 examinations from 1 January 2021 the format will be as follows: 
  • Paper 1 120 Single Best Answer [SBA] (2 hours 15 mins) 
  • Paper 2 120 Single Best Answer [SBA] (2 hours 15 mins) 
Once you pass the Section 1 exam, you will receive a ‘Eligibility to Proceed’ certificate by email, after which you will be allowed to appear for the Section 2 exam.

Section 2 examinations: Clinical component consisting of a series of carefully designed and structured interviews on clinical topics, some being scenario based (structured orals) and some being patient based.

Allowed Number of Examination Attempts for FRCS Neurosurgery

Candidates are given up to a maximum of 7 years to complete the examination process as follows: 
  • Section 1(MCQ):  Candidates will have a maximum of 4 attempts with no re‐entry  
  • Section 2 (OSCE):  Candidates will have a maximum of 4 attempts with no re‐entry 

References:


Read other related Posts regarding FRCS Preparation


8/23/2020 03:31:00 PM
7/22/2020 11:18:00 PM
Neuro Urology and The Neurogenic Bladder

1. Neurogenic bladder refers to dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition . 
2. Non Neurogenic bladder refers to dysfunction of the urinary bladder due to dynamic disturbance of genitourinary system. 
 
Micturition Pathway
3. detrusor muscle of the bladder is innervated by parasympathetic neurons located in the S2-S4  column
 
5/19/2020 01:08:00 AM

The CT comma sign is a characteristic sign seen in head trauma. It is the presence of concurrent epidural and subdural hematomas, which gives the characteristic appearance of this sign as a "comma" shape.

The CT comma sign is a characteristic sign seen in head trauma. It is the presence of concurrent epidural and subdural hematomas, which gives the characteristic appearance of this sign as a "comma" shape.

The CT comma sign is a characteristic sign seen in head trauma. It is the presence of concurrent epidural and subdural hematomas, which gives the characteristic appearance of this sign as a "comma" shape.
The CT comma sign is a characteristic sign seen in head trauma. 
It is the presence of concurrent epidural and subdural hematomas, 
which gives the characteristic appearance of this sign as a "comma" shape.           

70/M 

Chief Complaints: Numbness Lt Arm, 1 Episode of Partial seizure,Lt grip weakness since today morning. 

H/o Fall 3 days back. 

K/C/O HTN/DM/Post CABG 1994 with implanted defibrillator device (CRTD)/ Post Mechanical Thrombectomy for Rt MCA territory Infarct (March2020) on Ecospirin and T. APIXABAN(last dose today). 

Kn chronic  smoker and alcoholic. 

O/E 

E4V5M6
Pupils B/L 2mm RTL . 
Power Lt side 4/5. 
Left Hand grip 70%.

Since the patient was having multiple comorbidities with deranged coagulation and the GCS was 15, it was decided to manage the patient conservatively. Ecospirin and APIXABAN were stopped after consulting with a cardiologist and neurologist. 

#neuroradiology#neuroscience
#neurosurgeon #brainmri #braincat 

Reference


5/08/2020 10:28:00 AM

     

    MRI Spectroscopy : Neurosurgery Notes

    1. MR spectroscopy provides a measure of brain chemistry.
    2. The most common nuclei that are used are 
      • 1H (proton)
      • 23Na (sodium)
      • 31P (phosphorus). 
      • Proton spectroscopy is easier to perform and provides much higher signal-to-noise than either sodium or phosphorus.
    3. MRS can be performed within 10-15 minutes and can be added on to conventional MR imaging protocols. 
    4. It can be used to serially monitor biochemical changes in tumors, stroke, epilepsy, metabolic disorders, infections, and neurodegenerative diseases. 
    5. They require interpretation and should always be correlated with the MR images before making a final diagnosis.
5/05/2020 01:23:00 AM
    Hypothalamus Neuroanatomy/ Neurosurgery Notes




     Video Link:Neurosurgery written board crash course - hypothalamus 


     

    1. hypothalamus as the name suggests is directly underneath the thalamus and it's directly above the pituitary 
    2. borders of the hypothalamus can be drawn by a triangle 
      • line between the anterior commissure and a posterior commissure and it's called the ACPC line
      • line between the anterior commissure and the optic chiasm roughly boarded by the lamina terminalis 
      • line between the chiasm and the posterior commissure 
5/02/2020 09:39:00 PM


Q1. The “Nissl substance” represents which organelle of neuron?
A. Golgi complex
B. Nucleolus
C. Rough endoplasmic reticulum
D. Mitochondria

Ans: The cytoplasm of a neuron shows the presence of a granular material that stains intensely with basic dyes called Nissl substance (also called Nissl bodies or granules) . These bodies are rough endoplasmic reticulum

Q2. Which of the following provides myelin sheath to the axons of the CNS?
A. Astrocytes
B. Oligodendrocytes
C. Microglia
D. Ependymocytes

Ans: Oligodendrocytes form myelin sheath in CNS. Schwann cells form myelin sheath in PNS

Q3. The perivascular foot of the “blood–brain barrier” is an extension from the:
A. Oligodendrocyte
B. Ependymocyte
C. Astrocyte
D. Microglia

Ans: Astrocytes form the perivascular feet around a capillary. Astrocytes act as insulators, nourish the neurons, help form blood-brain barrier.

Q4. Sensation of pain is detected by:A. Mechanoreceptor
B. Chemoreceptor
C. Nociceptor
D. Thermoreceptor
Ans: Nociceptor

Q5. The cerebral aqueduct is developed from the cavity of:A. Rhombencephalon
B. Mesencephalon
C. Telencephalon
D. Diencephalon
Ans: The cavity of each telencephalic vesicle becomes the lateral ventricle. The cavity of  iencephalon (along with the central part of the telencephalon) becomes the third ventricle. The cavity of the mesencephalon remains narrow, and forms the cerebral aqueduct (aqueduct of Sylvius). The cavity of the rhombencephalon forms the fourth ventricle. Its continuation in the spinal cord is the
central canal


Q6. The failure of closure of the cranial end of neural tube gives rise to:A. Anencephaly
B. Hydrocephalus
C. Microcephaly
D. Meningomyelocoele

Ans: The neural tube remains open in the region of the brain because of nonclosure of the anterior neuropore. This results in anencephaly. Brain tissue, which is exposed, degenerates

Q7. By which week of intrauterine life does the neural tube close?
A. Fourth
B. Fifth
C. Sixth
D. Seventh

Ans: At 4 weeks the neural tube is normally completely closed (Ref: https://embryology.med.unsw.edu.au/embryology/index.php/Timeline_human_development#Neural)

Q8. The cervical flexure of the neural tube occurs:A. Between the forebrain and midbrain
B. In the midbrain
C. Between hindbrain and spinal cord
D. In the hindbrain 

Ans: The cervical flexure lies at the junction of the rhombencephalon and the spinal cord  


Q9:Rabies virus, from the site of bite, travels along nerves by 
A. Forward Axoplasmic Flow
B: Reverse Axoplasmic flow
C: Dendritic Flow
D: Along the Endoneurium of nerve fibres


Ans: Rabies virus, from the site of bite, travels along nerves by reverse axoplasmic flow.

Q10:Polio virus is also transported from the gastrointestinal tract through :

A. Forward Axoplasmic Flow
B: Reverse Axoplasmic flow
C: Dendritic Flow
D: Along the Endoneurium of nerve fibres

Ans: Polio virus is also transported from the gastrointestinal tract through reverse axoplasmic flow.


Q11:Tetanus bacteria, in contrast, travels from the site of infection to the brain by:
A. Forward Axoplasmic Flow
B: Reverse Axoplasmic flow
C: Dendritic Flow
D: Along the Endoneurium of nerve fibres

Ans: Tetanus bacteria travels from the site of infection to the brain along the endoneurium of nerve fibres
  
Reference:

4/11/2020 07:30:00 AM
History Taking in Neurosurgery : Headache

What are the pain sensitive intracranial structures?

Brain itself is pain insensitive. 

The following intracranial structures are pain-sensitive:
  1. Meningeal arteries
  2. Proximal portions of the cerebral arteries
  3. Dura at the base of the brain
  4. Venous sinuses
  5. Cranial nerves 5, 7, 9, and 10, and cervical nerves 1, 2, and 3

What are the mechanisms causing headaches?

  • Distortion or traction of Dura, Venous Sinuses or Blood vessels: 

    • Drainage of CSF in erect posture causes headache, secondary to traction on the venous sinuses when the brain sinks toward the tentorium as it loses CSF flotation
    • Intracranial mass distorts the dura or the arteries at the base of the brain 
    • Distortion due to raised ICP 

  • Distension of a vessel

    • Distension of extracranial and occasionally intracranial arteries is thought to be the cause of pain in migraine (activate the trigeminal nerve terminals in the vessel wall)

  • Inflammation

    • Inflammation in the subarachnoid space can result in headache. Inflammation can be caused by infection, hemorrhage, or chemical irritation
    • Inflammation of vessel wall by autoimmune process. eg Giant cell arteritis

  • Referral of Pain

    • Lesions above the tentorium - referred pain in trigeminal nerve distribution (the forehead or behind the eye) - because the dura in this region is supplied by the trigeminal nerve
    • Lesions in the posterior fossa - 
      • referred pain in the ear and the back of the head - because this part of the dura is supplied by cranial nerves 9 and 10 and the upper three cervical roots
      • refer pain to orbit -  termination of orbital (ophthalmic division) pain nerve fibers in the lowest part of the spinal nucleus of the trigeminal nerve, which also receive termination of the upper cervical pain afferent nerve fibers 
      • referred pain to ear - Irritation of cranial nerves 7, 9, and 10 - because the ear has cutaneous supply from each of these nerves as well as cranial nerve 5.

What are the types of Headaches?

For the purpose of history taking, headaches can be divided into two types:
  • Primary- no identifiable cause on examination or investigation and diagnosis is based on  recognizing a pattern, e.g.
    • Migraine
    • Cluster headache
    • Tension-type headache
  • Secondary - definite identifiable cause on examination or investigation, e.g. 
    • Brain tumors
    • Meningitis
    • Sub-arachnoid hemorrhage 
  • 90% - primary headaches, less than 10% are secondary headaches (Rasmussen 1991)

What are the headache "Red Flags"?

  • Worst Headache ever
  • New onset Headache
  • Onset after age of 50 yrs
  • Change in pattern of headache
  • Worsening headache
  • Sudden onset during exertion, sneezing, coughing
  • Headache with postural variation
  • Headache in setting of malignancy or HIV
  • Headache associated with Neurological symptoms or signs
  • Associated with systemic symptoms - fever, weight loss and chronic cough

What history to take in a patient presenting with Headache?
Duration
Exact duration as reported by patient
NEW onset headache or something that has been there since before and has worsened now

Onset ( sudden/ gradual )
Acute onset, severe, first and worst headache, the common possibilities are sub-arachnoid hemorrhage, vascular dissection, pituitary apoplexy
Gradual onset – migraine(mins to days), SDH, GCA(days to months)

Severity
verbal rating scale from 0 to 10

Character
Pulsatile or throbbing or hammering (Raised ICP Headaches/ Migraine)
Dull featureless pain (Tension type headache)
Boring sharp- cluster HA

Time of occurrence
Raised ICP headaches - More in morning, May waken the patient at an early hour

Frequency
Increase in frequency - red flag

Distribution
Frontal or Holocranial - Raised ICP
Band like - tension headaache


Aggravating factors
Exertion, coughing, sneezing, stooping, and straining at stool
Changes in posture (increases in supine - ↑ICP , increases in upright – low CSF pressure headache)

Relieving factors
Improvement on lying flat - low pressure headache

Associated features
Blurring of Vision - Papilloedema
Diplopia, the commonest cause of which is abducens nerve paresis
Nausea & vomiting – migraine, ↑ICP
Neck stiffness – meningeal process
Changes in consciousness
Focal neurological symptoms


References


12/24/2019 10:06:00 PM

Topics

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