Intracranial Hypotension
Intracranial hypotension, or low cerebrospinal fluid (CSF) pressure, should be suspected in a patient with a positional headache that worsens within 15 minutes of standing and improves with recumbency. The…
Trigeminal Neuralgia
Trigeminal neuralgia, also known as tic douloreux, manifests as recurrent attacks of abrupt, unilateral, severe stabbing (or electric-like) pain in the distribution of the trigeminal nerve. Typically, the mandibular or…
Trigeminal Autonomic Cephalalgias: Treatment
Trigeminal autonomic cephalalgias (TACs) encompass a group of primary headache disorders characterized by unilateral headache with ipsilateral cranial autonomic symptoms such as conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial sweating,…
Migraine Headache: Prophylactic Treatment
Prophylactic therapy for migraine is aimed at reducing the frequency, and possibly severity, of recurrent migraine headaches. To maximize tolerability, it is important to start with low doses and titrate…
Migraine Headache: Acute Treatment
Acute treatment of migraine should target both head pain and, if present, associated symptoms such as nausea and vomiting. The latter may limit absorption of oral medications; in these cases,…
Postconcussive Syndrome
While the initial neurologic symptoms following concussion typically resolve quickly, many will have symptoms that evolve over the ensuing 1–3 days. The majority of patients experience a complete recovery in…
Traumatic Brain Injury
Initial primary brain injury following trauma occurs immediately at the time of head impact and is largely irreversible. Public health measures such as airbags, seat belts, bike helmets, and fall…
Concussion
A. Concussion, more appropriately called mild traumatic brain injury, refers to any trauma-induced alteration in brain function. An obvious corollary of this is that patients must have head trauma causing…
Paroxysmal Sympathetic Hyperactivity
A. Paroxysmal sympathetic hyperactivity (PSH) is a syndrome encountered in patients with severe acute neurologic injury. Patients with PSH may have episodic tachycardia, hypertension, tachypnea, fever, diaphoresis, and posturing. Episodes…
Management of Neuromuscular Respiratory Failure
Patients with neuromuscular disease presenting with severe weakness require close monitoring of their respiratory status, as progression to respiratory failure can occur relatively suddenly. As the fundamental problem is one…
