Page 291 - Medicine and Surgery

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Nervous system 7

Clinical, 287 Parkinson’s disease and other Disorders of muscle and
Cerebrovascular disease, 295 movement disorders, 318 neuromuscular junction, 332
Infections of the nervous system, Multiple sclerosis, 322 Disorders of cranial and peripheral
301 CNS causes of headache, 324 nerves, 334
Disorders of conciousness and Motor neurone disease, 327 Hereditary and congenital
memory, 308 Disorders of the spinal cord, 328 disorders, 345
Tumours of the nervous system, 348

Clinical can be classified into cardiovascular, neurological or
metabolic. Cardiovascular causes are described under
Syncope (see page 24).
Symptoms Seizures: Features that suggest a seizure include wit-
nessed convulsions (one or both sides of the body), post-
Headache ictal (post-seizure) confusion, drowsiness and headache.
Loss of consciousness is not invariable. Biting the side
Headache is a very common symptom. Most headaches
of the tongue and urinary incontinence (due to re-
do not have a serious cause. The history is the most
laxation of the bladder sphincters) and other injuries
important diagnostic tool.
such as shoulder dislocation are very suggestive. If there
As with most types of pain, specific features that must
are warning signs prior to the seizure, e.g. a certain
be enquired about include: Site, Onset, Character, Radi-
smell, a feeling, visual phenomena, these are described
ation, Associated symptoms, Timing, Exacerbating and
as an ‘aura’ and are in fact a type of seizure, which
relieving factors, and Severity (SOCRATES). The site of
may then be followed by convulsions. Auras are un-
pain is sometimes generalised, but if focal may be de-
usual in other types of fits and faints except for in mi-
scribed as frontal, occipital, temporal and either unilat-
graine which does not result in loss of consciousness or
eral or bilateral. See Table 7.1.
seizure.
Drugs, including recreational drugs and substances
Absence seizures (previously called petit mal) are
such as alcohol, nicotine and caffeine, can lead to
found only in children – the individual appears briefly
headaches, either directly or during withdrawal.
unresponsive to onlookers but without seizures and
Features that suggest a serious underlying disease:
without loss of muscle tone.
Sudden onset

Notall seizures are due to epilepsy – intracranial le-
Severe pain

sions such as tumours, stroke and haemorrhage, or ex-
Associated neurological abnormalities

tracranial causes such as drugs and alcohol withdrawal
Impaired consciousness

are important underlying causes.
Seizures

Metabolic causes that must be excluded in any sus-
Previous head injury or history of fall or trauma

pected fit or faint include hypoglycaemia and hypocal-
Signsofsystemic illness

caemia.
Hypoglycaemia is most common in previously diag-
Fits and faints
nosed diabetic patients and is often associated with
Transient loss of consciousness may occur in the context hunger, sweating and shaking, but may be asymp-
of fits (seizures) or faints and falls. The major causes tomatic until loss of consciousness occurs.
287