Neurology 2.pptx

Migraine Definition A periodic disorder of function of the cranial blood vessels, resulting in headache of varying intensity, often preceded by visual or sensory symptoms and accompanied by nausea and vomiting. Incidence: 5-10% of the population Classification: Classical migraine: (migraine with...

Migraine Definition A periodic disorder of function of the cranial blood vessels, resulting in headache of varying intensity, often preceded by visual or sensory symptoms and accompanied by nausea and vomiting. Incidence: 5-10% of the population Classification: Classical migraine: (migraine with an aura) Headache preceded or accompanied by transient focal neurological symptomsvisual, sensory or affecting speech. Common migraine (migraine without an aura) similar headache lacking. The clear-cut prodromata, and more frequently encountered in practice. • Hemiplegic migraine • Ophthalmoplegic migraine • Periodic migrainous neuralgia: Cluster headache Etiology • Different theories the most important is genetics theory of migraine. • Autosomal dominant mode of inheritance . The migrainous attack: It may be divided into 1. Prodormal symptoms-in classical, not in common migraine. 2. The headache Prodromal symptoms: It is related to partial ischemia in certain intracranial arteries it may be in the form of • Retinal vessels---------- patchy scotomata • Ophthalmic artery ---------unilateral blindness • Vessels to optic chiasma--------- bitemporal hemianopia • Basilar artery migraine ------ blurring or loss of vision in both eyes, ataxia, dysarthria, These symptoms last from few minutes to three quarters of an hour, and as they subside they merge into the second attack. The headache: • Although by original definition it should be hemicranial, it is quite frequently more generalized or may rapidly become so. • It starts as vague pain and building up to throbbing intensity associated with pallor, anorexia, nausea, vomiting and photophobia. • It may last for several hours and after vomiting has occurred, may decrease in intensity followed by sleep. • In some patients the headache persists for 48 hours or more. • Towards the end of an attack there may be a marked diuresis due to sodium and water retention due to increase aldosterone during attack then decreases after it ends. Variants of migraine: Basiler artery migraine: • The prodromal symptoms as mentioned before. • The headache is usually occipital and of great severity. • There may be transient impairment of consciousness. Hemiplegic migraine: • The attack starts with unilateral severe headache which lasts 24-48 hours and is • followed by contralateral hemiparesis or hemiplegia which lasts up to 10 days after the headache has stopped. • The middle cerebral artery appears narrowed on arteriography Ophthalmoplegic migraine: • It starts with headache in and around one eye and one side of the forehead and lasts for two to three days. • As headache subsides the patients may develop either a third nerve palsy or a total ophthalmoplegia on the affected side Facioplegic migraine: • Headache is followed by facial paralysis Migraine without headache: • It may occur in the early stages of migraine for one to two years prodramata without headache before the headache develops. Cluster headache: Synonyms: periodic migrainous neuralgia, histamine cephalalgia. • It affects men six times more often than women. • It usually starts in the third or fourth decade. • The attack tends to occur exactly the same time each day particularly between midnight and 3 a.m. • The patient is awakened by severe boring pain in one eye, always on the same side, • which spreads to forehead, and sometimes side of the neck. The pain is so severe he can not lie down . • The affected eye become red and lacrymates. • Visual disturbances, photophobia and vomiting are rare. • Horner's syndrome may develop during an attack and clear up as it subsides. • Plasma histamine is increased in up to 80%. The mechanism of migranous attack • The prodromal symptoms arise from ischemia caused by spasm of intracranial arteries and • the headache from dilatation of extra cranial vessels that follows. The treatment of migraine: General measures • Avoidance of precipitating factors • Relaxation exercises • Concomitant factors requiring attention and treatment such as sinusitis, dental care, hypertension, depression. Arrest of an attack • Rest, darkened room • Antiemetics, metoclopramide • Analgesics (acetylsalicylic acid, paracetamol) • Ergotamine 1-2mg/attack • Dihydroergotamine (1mg IV/attack) Prophylactic measures (when more than two attacks per month) • Metoprolol 100-200 mg/day • Propranolol 60-240 mg/day • Dihydroergotamine 3-4.5 mg/day • Clonidine 0.05mg b.d • Verapamil 3 x 80 mg • Amitryptyline 10-150mg A four weeks drug holiday should be introduced after 4-6 months of treatment orofacial manifestations of some neurological disorders Tuberous sclerosis • Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome • It is a disorder of cellular differentiation and proliferation leading to the development of benign tumors such as neurofibromas and angiofibromas and hamartomatous lesions in virtually all organs • The cardinal features of TSC are skin lesions, convulsive seizures, and mental retardation Tuberous sclerosis Orofacial manifestations include • fibrous hyperplasia, • hemangiomas, facial angiofibromas, hypomelanotic spots known as (ash-leaf spots), • facial asymmetry, • bifid uvula, • cleft lip and palate, • macroglossia, • high arched palate, • delayed eruption, • diastemas, and enamel defects. Parkinson’s disease • Parkinson’s, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. • As the disease worsens, non-motor symptoms become more common. • The symptoms usually emerge slowly. Parkinson’s disease • Early in the disease, the most obvious symptoms are shaking, rigidity, slowness of movement, and walking. • Dementia becomes common in the advanced stages of the disease. • Other symptoms include sensory, sleep and emotional problems. Parkinson’s disease Oral disorders occur due to • general motor impairment and hypokinesia (dental and periodontal diseases due to difficulties in maintaining oral hygiene); • manifestation of involuntary movements (facial dyskinesias/dystonia), • medication (xerostomia), • part of sensory dysfunction (taste impairment), • depressive symptoms (burning mouth syndrome, orofacial pain). Thanks Case scenario • 18-year-old female reported to the Department of Oral and Maxillofacial Surgery • with the chief complaint of painless swelling on the left side of face since 8 years and • reddish discoloration of skin on the same side of face and neck since birth with no positive family history • History of repeated excisions of gingival growth was present since patient was 4 years old. • On physical examination, the patient was well-oriented to time, place, and person; moderately built with normal gait and IQ Orthopantomography showed • a multilocular mixed radiolucent-radiopaque lesion with incomplete septae involving the left mandibular region eroding the posterior ramus of mandible causing an altered shape of the left mandibular ramus, condyle, and coronoid process • Magnetic resonance imaging (MRI) brain and carotid angiograph were suggestive of cortical and sub-cortical hyperintensities with gyral calcification; What is most probable diagnosis ? Why ? • common with tuberous sclerosis What do you think about the prognosis of this case ? • In this case, the prognosis seems good, as the patient presented with only oral and cutaneous manifestations without any mental retardation or convulsive seizures. Give your comments on the following figures related to this disease