By DR SAMED ALSALMI
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Sample text
Migraine This periodic disorder is characterised by paroxysmal headache, often unilateral, and is characteristically throbbing. It is often accompanied by unpleasant gastrointestinal disturbance such as nausea, vomiting and abdominal pain and by visual disturbance. The visual disturbances include: Negative phenomena such as: hemianopia (loss of half the visual field) scotoma (small areas of visual loss). Positive phenomena such as: fortification spectra (seeing zigzag lines). Rarely, there are unilateral sensory or motor symptoms.
There are usually no other symptoms, but it may be accompanied by abdominal pain and behaviour problems. It may occur daily. Raised intracranial pressure and space-occupying lesions Headaches often raise the fear of brain tumours and may be the reason for parents to consult a doctor. Headaches due to a space-occupying lesion are worse when lying down and morning vomiting is characteristic. The headaches may also cause nighttime waking. There is often a change in mood, personality or educational performance.
Finger-to-nose test, rapid alternating movements, and action tremors) Palpation of shunt track if ventriculoperitoneal shunt present Role of Neuroimaging Studies When to Order a Neuroimaging Study Abnormal neurologic findings Chronic or progressive headaches Unilateral headaches that never alternate sides Headache associated, even briefly, with alteration of sensorium Presence of papilledema Meningeal signs without fever Recent worsening Advantages of Magnetic Resonance Imaging (MRI) Most vascular malformations are detected Accurate detection of tumors in temporal lobes and posterior fossa, and small tumors that obstruct CSF flow (quadrigeminal plate and third ventricular) Paranasal sinuses usually included in the examination without special request More sensitive for detecting transependymal CSF in cases of borderline hydrocephalus Diagnostic for Chiari malformations Magnetic resonance angiography can detect many aneurysms Magnetic resonance venography can detect cortical vein and dural sinus thrombosis Advantages of Computed Tomography Less expensive and easier access than MRI May be used in patients with pacemakers, metal implants (surgical clips), and cosmetic tattoos (MRI may turn off pacemakers and dislodge the clips; tattoos distort the mage Management The mainstay of management is a thorough history and examination with detailed explanation and advice.