Page 291 - Medicine and Surgery
P. 291

P1: FAW
         BLUK007-07  BLUK007-Kendall  May 25, 2005  18:18  Char Count= 0









                    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
   286   287   288   289   290   291   292   293   294   295   296