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Dictionary The Nervous System

Headaches

Synonyms :  

Clinical features, Diagnosis, Management, Prognosis,

Secondary Headache

1. Raised intracranial pressure

  • Intracranial pressure may be raised due to swelling of the brain (inflammatory processes such as encephalitis, brain abscess, after brain infarction, brain trauma), expanding mass of tissue (primary or metastatic brain tumour) or accumulating blood (intracerebral, subarachnoid, epidural or subdural haemorrhage).
  • The pain is caused by distortion of or traction on nearby arteries, venous sinuses or meninges which are pain sensitive structures.
  • The pain is felt diffusely over the cranium (not localised); and may be aggravated by activities which further increase the intracranial pressure (e.g., coughing, bending and straining).
  • Associated phenomena include vomiting, drowsiness, confusion, impairment of consciousness level, bradycardia and hypertension, papilloedema (swelling of the optic nerve papilla, seen on ophthalmoscopy), and finally come supervenes.
  • This necessitates prompt investigation depending on suspected cause (e.g., CT, MRI, spinal tap) and treatment, for patient's life can be in danger.

2. Meningitis

  • It may be due to viruses (e.g., echoviruses, coxsackieviruses, mumps virus, herpes simplex virus, influenza viruses) or to various bacteria (e.g., meningococcus, streptococcus, Haemophilus influenzae, Mycobacterium tuberculosis).
  • The pain is diffuse with poor localisation, progressive and throbbing.
  • Neck stiffness ('meningism' = meningeal irritation) can be elicited by passive neck flexion which is resisted as a result of muscle spasm.
  • Fever is variable depending on the cause, sometimes is very high.
  • Patients frequently complain of malaise, myalgia, anorexia, nausea, vomiting, abdominal pain and diarrhoea.
  • Prostration, convulsions and even coma can occur in a severe case of bacterial meningitis, whereas viral infection usually results in a benign and self-limiting illness.
  • Analysis of cerebro-spinal fluid (CSF) sample withdrawn by a lumbar puncture will show whether the disease is bacterial or viral in origin.
  • No specific treatment is necessary for viral meningitis, in contrast to bacterial meningitis which requires aggressive antibiotic treatment depending on isolated bacterium.

 

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Diagnosis:  < BACK TO TOP >

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Management  < BACK TO TOP >

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