Pemicu 7

Charlie 405100005
 LO 1 Sakit Kepala
Caused by a disturbance or irritation of the pain sensitive structure in the
head
Blood vessels
Meninges
Cranial nerves V, IX, X

Site
Unilateral migraine and cluster
Bilateral tension

Prodromal symptoms
Scintillating scotoma classic migraine headaches or postictal headache in seizure
disorder

Precipitating factors
Alcohol cluster
Nitrate and tyramine containing food migraine headaches
 Description of pain
Lancinating or shooting in V2 or V3 distribution trigeminal neuralgia
Unilateral throbbing migraine
Dull, bandlike, tightening pain tension
Sharp, stabbing pain behind one eye cluster
Associated symptoms and neurologic signs
Nausea and vomiting migraine or raised ICP
Photophobia, phonophobia, increased frequency of headache during
menstruation migraine
Fever mengitis or dental abscess
Unilateral lacrimation or rhinorhea cluster
 Classification
Primary headaches
Migraine
Tension-type
Cluster
Secondary headaches
Temporal arteritis occur in elderly can cause blindness
Subarrachnoid hemorrhage caused by rupture of aneurysm or bleeding
from an arteriovenosus malformation sudden LOC, vomit, neck stiffness
Trigeminal neuralgia
Low pressure headaches
Pseudotumor Cerebri
 Temporal Arteritis
Is a subacute granulomatous inflammatory condition involving the branches of the external carotid
artery, especially the temporal arteries
Occur in elderly >50yo
Characteristic
Headache unilateral or bilateral over the temporal artery
Scalp tenderness
Jaw pain during chewing
Complication
Involvement of the opthalmic artery blindness
Lab exam
Elevated ESR
Diagnosis
Biopsy of temporal artery histologic vasculitis
Treatment
Prednisone on decreasing doses for several months continued for the next 1 to 2 years
 Low Pressure Headache
Characteristic
Headache in an upright position following lumbar
puncture
Relieved when lying down
 Pseudotumor Cerebri
2nd to 4th decade, women >, associated w/
obesity
Headache + visual symptoms
Fleeting loss of visual acuity, scotoma, or double
vision
Treatment
Acetazolamide (inhibit CSF formation)
 Classic Migraine
Type Site Age Clinical Diurnal Life Provoking Associat Treatment
and Characte Pattern Profile Factors ed
Sex ristic Feature
s

Migrain Fronto Wome Throbbin Upon Irregula Bright light, Nausea Ergotamin
e tempo n, g awaken r noise, and e,
Withou ral young (pulsatile ing interval withdrawal vomitin sumatripta
t Aura Uni- or to ) behind Duratio Decrea of caffeine, g n, NSAID
(classic) bilater adults one eye n 4- se in excess Amitryptyli
al or ear 24hr middle cafeine n for
Becomes age intaketensi prevention
dull ache and on,
and pregna alchohol,
generaliz ncy tyramine
ed Relieved by
darkness or
sleep
 Neurologic Migraine
Type Site Age Clinical Diurna Life Provo Associated Treatm
and Characte l Profile king Features ent
Sex ristic Patter Factor
n s
Migrain Sam Same Same as Same Same Same Scintillating Same
e with e as as above as as as lights, as
aura abov above Family above above above visual loss, above
(neurol e history and
ogic frequent scotomas
migrain Unilateral
e) paresthesia
s,
weakness,
dysphasia,
vertigo,
rarely
confusion
 Other forms of aura
unformed flashes of white or silver or, rarely, of multicolored lights
(photopsia)
followed by an enlarging blind spot with a shimmering edge (scintillating
scotoma),
formations of dazzling zigzag lines (arranged like the battlements of a
castle, hence the term fortification spectra or teichopsia)
blurred or shimmering or cloudy vision
Focal neurologic symptoms
numbness and tingling of the lips, face, and hand,
slight confusion of thinking; weakness of an arm or leg
mild aphasia or dysarthria, dizziness, and uncertainty of gait, drowsiness
Paresthetic numbness
 Cluster headaches
Type Site Age Clinical Diurnal Life Provoki Associa Treatm
and Charact Pattern Profile ng ted ent
Sex eristic Factors Feature
s
Cluster Orbitot Adolesc Intense Usually Nightly Alcohol Lacrima Ergota
(histam empora ent and , noctur or daily in tion mine
ine l adult nonthr nal, for some Stuffed before
headac Unilate males obbing 12 h several nostril anticip
he, ral (90%) after weeks Rhinorr ated
migrain falling to hea attack,
ous asleep months Injecte inhale
neuralg Occasio Recurre d 100%
ia) nally nce conjunc o2 10-
diurnal after tivum 15min
many Ptosis to
months abort
or attack
years
 Tension headaches
Type Site Age Clinical Diurnal Life Provoki Associa Treatm
and Charact Pattern Profile ng ted ent
Sex eristic Factors Feature
s
Tension Genera Mainly Pressur Contin One or Fatigue Depres Antianx
headac lized adults, e uous, more and sion, iety
hes both (nonthr variabl periods nervou worry, and
sexes, obbing) e of s strain anxiety antidep
more in , intensit months ressant
women tightne y, for to Drugs,
ss, days, years simple
aching weeks, analges
or ics
months
 Secondary headaches
Type Site Age Clinical Diurnal Life Provoki Associa Treatm
and Charact Pattern Profile ng ted ent
Sex eristic Factors Feature
s
Mening Genera Any Intense Rapid Single None Neck For
eal lized, age, , steady evoluti episod stiff on mening
irritatio or both deep on e forwar itis or
n bioccipi sexes pain, minute d bleedin
(menin tal or may s to bendin g
gitis, bifront be hours g
subarac al worse Kernig
hnoid in and
hemorr neck Brudzin
hage) ski
signs
 Trigeminal Neuralgia (Tic Douloureux)
Characteristic
paroxysms of intense, stabbing pain
initiation of a jab or a series of jabs of pain by stimulation
of certain areas of the face, lips, or gums trigger zones
Site
2nd and 3rd divisions (rarely the ophthalmic division) of the
fifth cranial nerve, unilateral
Duration
seldom lasts more than a few seconds or a minute or two
Onset
frequently, both day and night, for several weeks at a time
 Clasification
Idiopathic TN
Symptomatic TN (involvement of the fifth nerve by some
other disease)
Aggravating factor
Touching trigger points, chewing, smiling, talking, blowing
nose, yawning
Treatment
Carbamazepine,phenytoin, gabapentin, alcohol injection,
coagulation, or surgical (vascular) decompression of root
 LO 2 Menie`re disease
Recurrent attacks of vertigo associated with fluctuating
tinnitus and deafness
Sex and Age
1:1 about fifth decade
Pathologic
increase in the volume of endolymph and distention of the
endolymphatic system
Onset and duration
abrupt and last for several minutes to an hour or longer
recur several times weekly for many weeks on end, or
there may be remissions of several years duration
 Characteristic
whirling or rotational in type (severe that patient cant
stand or walk)
nausea and vomiting, low-pitched tinnitus, a feeling of
fullness in the ear, and a diminution in hearing
Nystagmus (horizontal) during the acute attack
patient prefers to lie with the faulty ear uppermost
and is disinclined to look toward the normal side,
which exaggerates the nystagmus and dizziness
May have otolithic catastrophe of Tumarkin
 Examination
Audiometry sensorineural type of deafness, with air and bone conduction equally depre
Complication
with further attacks progressive increase of deafness (low tones below 500Hz)
Treatment
Acute attack rest in bed find a position in which vertigo is minimal
Promethazine vestibular suppressant
Antihistaminic agents cyclizine, meclizine
Surgical
Destruction of the labyrinth
sectioning vestibular portion of the eight nerve
Endolymphaticsubarachnoid shunt
 Benign Positional Vertigo
Characteristic
paroxysmal vertigo and nystagmus occur on certain positions of the
head (lying down or rolling over in bed, bending over and
straightening up, and tilting the head backward)
Onset and duration
last for less than a minute, but these may recur periodically for several
days or for many months
Diagnosis
Dix-Hallpike manuever
Changing from a recumbent to a sitting position reverses the direction
of vertigo and nystagmus disorder originates in the labyrinth
 Pathologic
Cupulolithiasis otolithic crystals become detached
and attach themselves to the cupula of the posterior
semicircular canal debris detached from the
otolith, forms a free-floating clot in the endolymph of
the canal (canalolithiasis) and gravitates to the most
dependent part of the canal during changes in the
position of the head
Treatment
Epleys maneuver canalith repositioning
Dix-Hallpike
 The maneuver begins with the patient seated and the head turned to one
side at 45 degrees (A), which aligns the right posterior semicircular canal
with the sagittal plane ofthe head.
The patient is then helped to recline rapidly so that the head hangs over
the edge ofthe table (B), still turned 45 degrees from the midline.
Within several seconds, this elicits vertigo and nystagmus that is right
beating with a rotary (counterclockwise) component.
An important feature of this type ofperipheral vertigo is a change in the
direction of nystagmus when the patient sits up again with his head still
rotated.
If no nystagmus is elicited, the maneuver is repeated after a pause of 30 s,
with the head turned to the left
Epley Maneuver
 The maneuver is a fourstep procedure
First, a DixHallpike test is performed with the patients head rotated 45
degrees toward the (affected) right ear and the neck slightly extended with
the chin pointed slightly upward patients head hanging to the right (A)
Once the vertigo and nystagmus provoked by this maneuver cease, the
patients head is rotated about the rostral rostralcaudal body axis until the
left ear is down (B)
Then the head and body are further rotated until the head is almost face
down (C). The vertex of the head is kept tilted downward throughout the
rotation. The patient should be kept in the final, facedown position for about
10 to 15 seconds
With the head kept turned toward the left shoulder, the patient is brought
into the seated position (D). Once the patient is upright, the head is tilted so
that the chin is pointed slightly downward.
 Daftar Pustaka
Adams
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