Headache : An Overview of Secondary Headaches

Headache

Headaches are possibly the most common symptoms patients might present with to Neurologists , and even to a General Practitioner!

Here's a more practical and clinical approach to identifying the cause of a headache.

Headache disorders can be secondary to a systemic or neurological condition such as Meningitis or Dengue ; or can be due to a primary headache disorder such as Migraine or Tension headache.

In this post I'd like to summarize causes of secondary headaches.

Important  Causes of Secondary Headache

- Refractive Errors : if an Adolescent or person in his 20's comes with headache , it's important to look into the possibility of a Myopia causing headache.

- Hypertension : especially occipital headache in a 40-50 year old obese male.

- Sinusitis : Maxillary and Frontal sinusitis can commonly cause headache and may confuse for a primary headache disorder.
Associated with Post nasal drip , upper respiratory tract infection , sinus pain on bending over and tender sinuses.

- Systemic Infections :
Dengue - Especially a bifrontal headache
Malaria
Typhoid fever

- Meningitis , Encephalitis, Brain Abscess
Meningitis is typically fever , headache and altered sensorium with neck stiffness.
If these features are present with Diffuse Neurological depression it can be Encephalitis and if Focal features it could be an Abscess.
Tuberculous Meningitis is an important entity to be considered for Chronic headache in India.

- Venous Sinus thrombosis : Suspect in Females on OC Pills / Hormone Replacement or Men on chemotherapy.
Presents with chronic headache and may be accompanied by focal features occassionally.

- Trauma

- Sub Arachnoid Hemorrhage : the typical Thunder clap headache followed by complete collapse of the person is typically for SAH.
Typically in 30-40 year old men , with history of senitnel headaches and generally hypertensive.

- Brain Tumors

- Temporal Arteritis : 60 years and above - Large vessel Vasculitis causing sharp superficial headache especially in temporal region , raised ESR and responsive to steroids to a good extent.

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The next post will be a summary of clinical profiles of primary headache disorders.

Hope this helped !
Happy Studying!
Stay awesome !
~ A.P. Burkholderia.

Crepts : An Overview

Hi everyone ! Just a short summary post on Crepts. Would like to thank Upasana for suggesting this topic ! 

Crepts

1 . Synonyms = Rales , Crepitations , Crackles

2 . Character = Rustling/  Bubbling type of sounds
Short , sharp, interrupted sounds.
(Wet Sounds)

3 . Types =

Fine and Coarse crepts -
Differentiation is clinical - fine crepts have a shorter amplitude while Coarse crepts have a higher amplitude and are usually louder with a lower frequency.

So ,  if you hear crepts of mellow tone (lighter quality) , with a very small gap between two crepts they are fine.
If they are very harsh and widely spaced they're likely to be Coarse crepts. 

As a thumb rule , fine crepts are generally Cardiac and Coarse are of Respiratory origin (with exceptions).

4 . Special types of Crepts :

Velcro crepts = Fine crepts of Interstitial Lung Disease

Coarse leathery crepts = Harsh Coarse crepts of Bronchiectasis

5 . Mechanism of Crepts :
- unclear but certain reasons are hypothesized.
- When an Alveolus is in a  collapsed state and then bursts open it produces a crept.
So for example -  in a pneumonia due to the exudates accumulated in the alveolus there is very little air in it and the alveolus is in a collapsed state at the end of expiration. Due to this, when a person inspires the collapsed alveolus and airway suddenly open with a snap and produce a sharp sound due to sudden pressure equalisation.
When many such alveoli open in a serial fashion from top to bottom we hear the typical bubbling sound of 'Crepts'.

- Older reasons - Air bubbling through exudative alveolus. But rejected as other forms of airway Obstruction like Bronchiectasis and Fibrosis causing collapsed airways also causes crepts.

6 . Causes of Crepts :

- Pneumonia / Consolidation
- Interstitial Lung Disease and Pulmonary Fibrosis
- Bronchiectasis
- Bronchitis
- Lung Abscess
- At times in COPD patients - Expiratory crepts may be heard.

Cardiac causes :
- Pulmonary edema due to Left Ventricular Failure.

7 . Cardiac vs Respiratory crepts :

Cardiac crepts are typically Basal and Bilateral , are fine crepts , associated with features of Heart Failure and may disappear on adminstering diuretics.
The opposite is true for Respiratory crepts.

Hope this was concise enough and helped !
Happy Studying!
Stay Awesome!

~ A.P.Burkholderia

Transamination

Have you ever wondered about the difference between non-essential and essential amino acids? 

I’m pretty sure you know the difference :))

If non-essential amino acids are not delivered to the body through diet then how are they made in the body? 

Answer is simple it is by the process of transamination

I hope my notes will help you! If you have any doubts, don’t hesitate to comment or send a message on WhatsApp group :)

Maxillary Artery notes

Hello Friends! This is Anisha :))

Maxillary artery is divided into three branches. Again, each branch is subdivided. 

We also have to learn their course which is very confusing and we forget it during our exam :( 

So, I came up with an easy way to learn it. I decided that I will show the course of the artery in form of a diagram ( you will get more marks! ) and write down what it supplies. 

I hope my notes will help you :)) All the best

Autonomic neuropathy in diabetes mnemonic

Autonomic neuropathy in diabetes mnemonic

Hi everyone! This is one of the longest mnemonic in my sleeve.

I made this one up because it comprises a group of bizzare symptoms which we seldom relate to diabetes and take less notice of. These symptoms are indications of poor glycemic control.

The mnemonic is, 'AUTONOMIC NEUROPATHY' itself:

A - Abdominal fullness
U - Urinary incontinence
T - Tachycardia (Resting)
O - Oesophageal atony (Dysphagia)
N - Nocturnal sweats
O - Oedema (dependent)
M - Micturition delayed
I - Infection
C - Constipation

N - Nocturnal diarrhoea
E - Erectile dysfunction
U - Uncontrolled glycaemia
R - Retrograde ejaculation
O -
P - Pupillary signs (pupil size decreases, delayed or absent reflexes)
A - anhidrosis
T - Temperature (cold feet)
HY - Hypotension (postural)

This mnemonic was written by our Medical Student Guest Author, Nikhil

Mnemonic for the Ascending tracts & Descending tracts in Spinal Cord

Hiiiii everyone, it’s mnemonic time again! From the title, I guess you all know what it is about… I had a hard time memorizing these tracts so I created this mnemonic to help you guys out!

he drove a honda CRV TO disneyland.

Corticospinal tract (Lateral & Anterior)

Rubrospinal tract
Vestibulospinal tract
Tectospinal tract
Olivospinal tract

**Disneyland = Descending. Hence, this mnemonic is for the descending tract
**Since it’s a descending pathway, so all the fibers will travel to spinal cord from their origins. Therefore, just add “spinal” after each word (e.g. …spinal tract)
**Don’t forget that there’s lateral and anterior for Corticospinal tract. Honda CRV from Los Angeles maybe? Hahahah :3

That Los Angeles STudent went up to stage and SCream using the PA system because he got a Freaking Cool First Grade result.

ST – SpinoThalamic tract (Lateral & Anterior)
SC – SpinoCerebellar tract (Posterior & Anterior)
FC – Fasciculus Cuneatus
FG – Fasciculus Gracilus

**Went up = Ascending. Hence, this mnemonic is for the ascending tract
**Los Angeles for STudent ; PA for SCream
**In addition, if you follow the order of FC and FG, it actually matches with the position of them from left to right in the spinal cord and mirror reflect them. (FC àFG à FG à FC)

Please comment if you have a better mnemonic! Let’s share our mnemonics ^.^

-Calvin Ong K. Y.

Complications of Myocardial Infarction Mnemonic

 Hello everyone!

Here's another whiteboard mnemonic of a commonly tested topic. The scary MI and the scary DARTH VADER from Star Wars.
































Let me know if anything requires clarification.

Hope it helps. Happy studying!
-- Ashish Singh

The basics: Osteomyelitis

Osteomyelitis is an infectious disease that attacks the bones, specifically the bone marrow. It can have several etiologies: infection from an open fracture, postoperative infection, spread of a blood-borne infection such as pharyngitis, otitis etc. The causative organisms are most often staphylococcus aureus and group A streptococcus.

It is manifested by episodes of fever, often excruciating pain and functional impotence in the affected limb.

It is prevalent among the poor, especially children. In Haiti, it represents a real cause of morbidity and mortality.

It can eventually cause various complications such as: chronic osteomyelitis, pathological fracture by weakening of the bone, length difference in limbs etc.

This mnemonic was written by our Medical Student Guest Author, Rebecca St Louis

She originally wrote this for us in French:

*Ostéomyélite aigüe*

L'ostéomyélite est une maladie infectieuse attaquant les os plus précisément la moëlle osseuse. Elle peut avoir plusieurs étiologies: infection à partir d'une fracture ouverte, infection post-opératoire, propagation d'une infection hématogène comme une pahryngite, une otite etc. Les germes en cause sont le plus souvent le staphylocoque auréus et le streptocoque du groupe A.

Elle se manifeste par des poussées de fièvre, par une douleur souvent atroce et une impotence fonctionnelle au niveau du  membre atteint.

Elle est prévalente chez les pauvres surtout les enfants. En Haïti, elle représente une véritable cause de morbidité et de mortalité.

Elle peut occasionner àla longue diverses complications telles que: ostéomyélite chronique, fracture pathologique par fragilisation de l'os, différence de longueur au niveau des membres etc.

De ce fait, contribuer à l'abaissement de l'incidence de cette pathologie est d'une importance capitale. Voilà pourquoi nous encourageons les parents:
- à promouvoir l'application des règles d'hygiène par les enfants dès les premières années.
-à penser rapidement à faire sougner leurs enfants en cas d'infections hématogènes.

MIL: Cystic degeneration of pterygium

A case of cystic degeneration of pterygium

Causes of a Non Healing Ulcer : Summary

Hi everyone !

This is a short summary on what causes an ulcer to have delayed healing.
Most cases in the wards and the boards are Traumatic ulcers that have now failed to heal due to some or the other reason. Most commonly the reason is Diabetes , other common ones including Poor general health and Varicose veins.
This post summarises the causes.

Causes of Non healing ulcer

Local :
- Site of high pressure / mobility
- Repeated trauma to site
- Foreign body at the ulcer base
- Local infection at ulcer site

Focal :
- Varicose ulcer (Generally at the Medial malleolus)
Reason : Venous congestion eventually causes the trapped macrophages etc to release their mediators producing Inflammatory changes + Pigmentary changes occur due to microruptures of congested venules causing Hemosiderin formation and irritation of skin by the Pigment.
- Deep Vein Thrombosis (Same as above).
- Peripheral Arterial Disease ( Arterial blockade -- causes tissue Hypoxia and thus impaired healing ) 
- Neuropathy ( Impaired sensations cause repeated trauma at the site of the ulcer delaying its healing ).
- Lymphatic D's ( Lymphedema -- can cause skin hypertrophy and other odd changes due to mediators from the Lymph causing ulceration)

Systemic :
- Malnutrition
- Anemia
- Low proteins
- Vitamin deficiencies - esp Vit C , K
- Diabetes Mellitus
- Hypertension (Martorell Ulcer)

_________________________________

Why Diabetes causes non healing of any ulcer ?
3 important reasons :
- Microangiopathy : Due to deposition of various Glycated end products into the microcirculation causing Hypoxia and thus impaired healing
- Neuropathy : due to diabetic Neuropathy , the sensations to the area may be diminished and this will cause repeated trauma to the ulcer.
- Infections : High glucose levels serve as a pabulum or conducive manure for growth of various microbes.  Infection causes impaired healing of the ulcer.

Hope this was helpful!
Happy Studying!
Stay awesome !
~ A.P. Burkhodleria

Alport syndrome mnemonic

Hello,

This mnemonic is on Alport syndrome!

Well, the 'Port' in alPORT reminds me of 'Pirate ship' (port - a port in the sea - pirate ship).

1. The pirate flag has cross bones which kinda reminds me of X for X - linked disease. 

2. ‎Number 4 in the port side for type 4 collagen defect.

3. ‎'Bloody' pirates reminds me of haematuria and glomerular basement membrane damage. 

4. ‎Captain shouting, "AAARGH" for crew members who can't hear (Sensory neural hearing loss)
S for sensory, S for sailor, the deaf sailor kinda reminds me of it.

6. ‎Eye patch - for cataract.

That's all!
Stay awesome!

This mnemonic was written by our Medical Student Guest Author, Nikhil.

The image was illustrated by our Medicowesome author, Chaitanya Inge.

Lymphoma and Leukemia Translocations Mnemonic

Hello everyone!

Here's an intuitive way to remember the chromosomal translocations involved in various lymphomas and leukemias.
































Hope this helps. Happy studying!

-- Ashish Singh

Arterial Supply of the Head & Neck in a Nutshell!

Helloooo everyone!!

Here’s some mnemonic I created myself for the branches of external carotid artery and the branches of facial artery. To memorize the name of the branches of external carotid artery, you just need to....