Vision problems are common in the general population, which are due to neurological disorders we include within the term the neuro-ophthalmological pathology.
We divide them into a series of changes by symptoms that the patient note:
Diplopia or double vision
Loss of vision in one or both eyes
Changes in pupils (anisocoria)
Eyelid drooping or ptosis
In double vision (diplopia) is essential to know if the patient has to look with both eyes but to cover her either disappears, usually caused by neurological disorders, which remains to cover her one eye that usually ophthalmological be.
The causes of double vision of neurological origin are varied, from paretic problems (loss of strength or lack of activation of the muscles that move the eyes) or restrictive (fibrosis or injuries that prevent the eye from moving. The diplopia, though it may be due to slight alterations, sometimes it is the expression of serious illness and is recomentable evaluation by a neurologist as soon as possible. diseases such as multiple laesclerosis, myasthenia, intracranial hypertension may present with double vision.
One of the most important and urgent neurological conditions is the loss of vision of one or both eyes. It may be due to multiple causes and is crucial to perform an early diagnosis can sometimes prevent loss of vision or worse or the patient associate other deficits.
Among the paintings that produce vision loss in young people is multiple sclerosis, which may be of debut or Devic’s disease. In both early diagnosis it is important. In patients with risk factors can cause a stroke in the anterior optic nerve is known as anterior ischemic optic neuropathy (AION). Sometimes the NOIA are an expression of temporal arteritis and proper and early treatment changes the prognosis of patients.
Although it may seem banal alteration in the pupils (anisocoria) may be the expression of serious diseases. In these cases the patient should be evaluated, even to test or tests to rule out serious pathology such as lesions in the arteries that carry blood to the brain.
Eyelid drooping or ptosis is another symptom that may alarm or debut of serious diseases such as myasthenia
Dizziness and vertigo
Dizziness and vertigo are two symptoms that can be really serious expression of benign processes or pictures. Both are incapacitating and a common cause of going to the neurologist. We included them in the neuro-otologic pathology.
One of the most common causes of dizziness is vertigo. The term vertigo involves illusion of motion and almost always refers to a disruption of the central or peripheral vestibular pathways. Usually this feeling will be rotational in the horizontal plane (like a merry-go), however in some patients may be displaced or
rotation in the vertical plane.
There are many causes of vertigo and neurologist distinguish which are due to diseases of the brain, which we call plants, those that are ear problems and pathways that carry information to the brain, which we call peripheral. Among the plants there are serious conditions, such as stroke or multiple sclerosis. Other neurological diseases may also have vertigo as migraines, without being serious are very important because they undermine much the quality of life of patients and also have very effective treatments.
In the case of a suspected stroke urgent assessment by a neurologist it is essential. If detected early we can put substances that dissolve the thrombus and improve the patient. Within sometimes called peripheral they are due to viruses affecting other ear otoliths shift, some stones we have in the ear by moving the head indicate that we’re falling. The latter known as vertigo BPPV maneuvers improvement that can be made in consultation. Contrary to popular belief most people cervical problems rarely cause lightheadedness. Nor should it be «pinched» the vessels that carry blood to the brain by the cervical osteoarthritis.
In summary, patients with vertigo need a detailed evaluation and maneuvers and now have effective treatments for most patients.
Headaches are one of the most frequent and disabling neurological disorders. It is fundamenal reach a proper diagnosis to design a tailored treatment and to improve the patient.
The following linl can access specific questions answered through the newspaper patients 20 minutes
Most headaches are primary, that is not due to any injuries, so we can rest easy. However in case of headaches that wake up at night to the patient, appearing with (cough, do belly, …) efforts that are like an explosion inside the head, appear with fever, in older patients than ever them has hurt the head, gradually increase intensity or showing neurological symptoms (unable to speak, loss of strength, etc.) should consult our primary care physician or neurologist.
We should also worry if our primary headache (migraine for example) is becoming more common and need many painkillers that can be becoming chronic and it is important to specific treatment.
We have compiled the following guide to counsel patients about this important disease.
When a patient has a headache first thing we do it is try to distinguish whether it is a primary headache, ie, headache is the disease and not due to tumors or other abnormalities. Or if it’s high, the patient has a disease that causes the headache. For them are important warning signs that we summarize in the image.
Migraine is one of the most common and disabling headaches. Migraine is a recurrent and episodic headache characterized by a combination of neurological symptoms, gastrointestinal and autonomic
you. It is a picture that is not the same in every patient, varying attacks intensity, duration and frequency among people and each person over time.
The typical headache of migraine is on one side and changing deuna pain crisis to another, (although it may be bilateral or unilateral start later generalized), throbbing like a heart in most patients. Episodes with moderate or severe intensity, and increases with physical activity or simply nod. It can occur at any time of day, but more often occurs at dawn. The onset is usually gradual, reaches its peak and then decreases in intensity and usually disappears between 4-72 hours. The pain of migraine is invariably accompanied by vegetative manifestations.
Anorexia is common but can be seen craving for food. Nausea occurs in almost all patients while vomiting occur in one third of them and diarrhea can 5%. More than 75% of patients report during crises hypersensitivity to sensory stimuli expressed as sensibilida to noise, lights and intolerance to olfactory stimuli. Often the skin paleness and alterations in body temperature.
The treatment is complex and must make a suit to avoid side effects in our patients.
Type strain or tension headache is the most common. The pain is described as a tightness or «weight» cephalic without pulsatile character in most patients. The location of the pain is all over the head in most patients but could fluctuate over the coming days to present unilaterally in some patients. Striking is the absence of worsening physical activities characteristic finding of migraine headaches. The intensity of pain is mild to moderate although there is a greater severity in patients with chronic daily.
Accompanying symptoms of migraine are absent in most subjects except for occasional gagging sensation. Symptoms are often associated with fatigue, sleep disturbances or feeling unsteady gait
For patients with inflammatory get occasional headaches, if they are frequent preventive we prescribed.
Autonomic trigeminal headaches are a set of entities that are characterized by pain always located on one side of the head or face, usually the same and corresponds to the territory innervated by the trigeminal nerve and occur in association with cranial autonomic symptoms
Cluster headache is the most common type of headache trigeminal autonomic. Other names with which it is also known to this Horton headache or cluster are even been given the nickname «suicide headache» due to the high intensity of pain of suicidal ideation in those who suffer. The location in most patients is around the eye. It affects young adults being the debut for approximately 30 years. It is often accompanied by nervousness, closed eye, red and crises last about 1-2 hours and usually coincides at the same time and wake the patient. It is essential to start treatment early and there are treatments that can shorten the outbreak. Interesting website of the association.
Paroxysmal hemicrania is a rare trigeminal autonomic headache. Patients present unilateral short attacks of severe pain, accompanied by eyelid droop or change the pupils. There are very effective and specific treatments such as indomethacin.
The SUNCT headache is an uncommon but increasingly diagnosed more. Is characterized by a cluster headache location is around the eye, moderate intensity, being sharp or throbbing and characteristics as indicated by its acronym is accompanied by conjunctival injection and tearing the same eye.
Hemicrania continua is a unilateral headache not only changing sides. Although fluctuating, it is continuing with great intensity exacerbations during which autonomic symptoms may occur. It should be studied to rule out intracranial lesions. The response to indomethacin is complete and maintained.
Headache associated with myofascial pain is a muscle located in the area of pain can be intense and referred to other areas of the head or neck box. It is diagnosed with proper palpation cranial
Primary cough headache is a headache triggered by a cough or Valsalva maneuvers. Sudden onset and short duration, usually from seconds to half an hour. Looking ahead to a proper diagnosis is essential to urgently go to the neurologist to rule out serious conditions.
The sharp primary headache is characterized by pain of short duration, usually less than a second puncture type. It consists of twinges or fleeting, isolated or in salvos, a fingertip punctures.
Effort headache is a headache of variable duration, from 5 minutes to two days, which occurs only during exercise. It can be hemicranial, bilateral or diffuse, of variable location. In these cases we consult a neurologist or an emergency to rule out serious illnesses.
Orgasmic headache is a headache explosive characteristics that coincides with the arrival of orgasm. It is of great intensity, as in other explosive headaches in the first crises must exclude extremely serious pictures.
Hypnic headache is a headache exclusively nocturnal, waking the patient, who usually appears above the 5th decade of life. In most cases it is bilateral, mild or moderate intensity (may be severe in up to 20% of cases), deaf in his quality and usually lasts more than 15 minutes and less than 180 minutes. You always have to go to a neurologist to rule out intracranial injury. Some patients improve with a coffee before bedtime, others need medical treatment.
Continuous headache from the start is a continuous headache since its inception, in which there are no periods without headache. It is bilateral, oppressive and not aggravated with activity.
There are mutiple causes of secondary headache, which headache is produced by another process, such as problems in the temporomandibular joint, drugs, idiopathic intracranial hypertension, in these situations we must act early to eliminate the causative element.
Trigeminal neuralgia is characterized by paroxysmal attacks of facial pain, like a cramp or whiplash, brief seconds, but repetitive, affecting one or more branches of the trigeminal nerve, usually at the bottom of the face. He never cross to the other side and generally respect the language. It may be triggered by different stimuli (eating, talking, shaving …) or a simple touch on areas «trigger» (a peri level or intraoral). There are multiple treatments and reveldes cases resort to surgery.
Possibly the most common cause of neuropathic pain is a herniated disc. The hernia occurs when compressing a root radiculopathy (commonly known as sciatica), with severe pain in the region bearing the sensitivity of that root.
Some patients have pain and tingling in the lower limbs when roam or make efforts. The most common cause of this «claudication» is usually vascular, narrowed arteries that do not provide enough blood, but sometimes are due to a neurological problem and known as neurogenic claudication. Lumbar canal stenosis is one of the causes of such claudication.
Sometimes the chicken pox virus can manifest itself in adults sprouting in the region of a root constituting what is known as zoster or «shingles». This painful condition can persist over time. Neuropathic pain it produces is highly incapacitating. Treatments in the initial phase with antivirals and treatment of neuropathic pain are fundamental to improving the patient.
A complex picture is fibromyalgia, patients with marked muscle pain that may be associated other symptoms such as dizziness, headache, memory impairment. Recent studies relate it with a fine fobra neuropathy. Treatment should be individualized.
A proper diagnosis of facial pain syndromes involves neuroanatomical knowledge that allows us to define syndromes. In these cases the detailed neurological examination is essential in the differential diagnosis and to exclude serious diseases.
Hypoesthesia or painful, persistent, in the territory of distribution of the trigeminal nerve or one of its branches or the occipital nerves anesthesia. The anesthesia dolorosa is often related to surgical trauma of nerves or trigeminal ganglion, often caused after rhizotomy or thermocoagulation therapeutic classical trigeminal neuralgia.
Persistent facial pain can be initiated by surgery or facial trauma, teeth or gums but persists without any demonstrable local cause. Facial pain around the pinna or temple may precede the detection of ipsilateral lung cancer.
The atypical toothache term has been applied to a continuous pain in the teeth, or in the bed left by a tooth after extraction, in the absence of an identifiable cause tooth
We can also talk about rinalgias and oftalmodinias if the pain is located in the root nasal or eye.
Rinalgia idiopathic syndrome is a stereotypical nasal root pain not due to external compression (goggles, ..) The oftalmodinia is a picture of perorbitario pain not due to other causes
Syndrome burning or burning mouth suede limited to the language (glossodynia). It may be associated with dry mouth, paresthesia and taste disorders. They should initially rule out metabolic and deficiency causes.
Syndrome red ear is a well known entity. He related migraine is an entity that can sometimes present a long-term and generate discomfort with touch. The anesthetic block is a therapeutic option.
Neuromuscular diseases are a large group of diseases that affect the nerve, neuromuscular junction or muscle. They are varied, although most of them usually cause loss of strength and some with sensory disorders.
Amyotrophic lateral sclerosis, known as ALS is a disease that affects the motor system and progressively patients lose strength and muscle mass. Typically they have twitches (as jumps in muscles). No sensory involvement or the esfunteres or eye movement.
Myasthenia gravis is the most common disease that affects the neuromuscular junction. It is clinically characterized by fatigability with a significant prevalence of ocular symptoms. The patient is often wearied with repeated movements, double vision have ptosis (droopy eyelid), slurred speech, swallow, …
Polyneuropathies are a group of diseases characterized by nerve involvement, usually symmetrically with tingling (and subsequently sock and glove) and loss of strength. In this group of diseases it is essential to make an early diagnosis of the cause and treat them appropriately.
A special form of polyneuropathy, for its rapid onset, is Guillain-Barre syndrome. It is a serious condition that usually usually associated with loss of strength and tingling sensation of instability and rising from the feet to the knees. This picture progresses in hours or days puediedo affect the respiratory muscles. Early diagnosis and treatment with immunoglobulins and if the patient progresses in the ICU is essential to stop the disease from progressing.
It is a common neurological disease characterized by crises that can range from simply noticing tingling on one side of the body to lose consciousness and sudden movements.
There are many types of epilpesia and most patients can lead a normal life and controlled with treatment. Early diagnosis is important, as is knowing the characteristics of the episodes.
Sometimes we use diagnostic techniques such as electroencephalogram brain activity sees (EEG) or even ask our patient is in the hospital a few days with video-EEG.
We have many useful drugs so that in principle, we will have a treatment «as» avoiding side effects.
In this guide the disease and the attitude we should follow described, there are also tips published by JAMA about epilepsy.
Alzheimer’s and other dementias
Cognitive impairment is a common neurological condition in which the proper diagnosis is essential for
personal, family and social implications involved. There are many types of dementia and with a proper study can make a clinical diagnosis of most of them.
Besides medical treatment periodically performing moderate exercise is recommended, control vascular risk factors and follow a healthy and varied diet. the association is patients are useful and help answer questions that arise.
You can find information accompanying JAMA on mild cognitive impairment or dementia
To resolve the doubts sessions laws and dementias are made where these problems are analyzed
Multiple sclerosis is a neurological disease that affects the brain, brain stem and spinal cord. Myelin, the substance that covers nerve fibers, is damaged by our own defense cells and then the ability of the nerves to conduct the orders of the brain is interrupted. This causes the patient has neurologic symptoms that affect different systems.
In this way the patient may experience loss of vision in one eye by unaneuritis optics, impaired balance, double vision, tingling or parts of the body asleep or loss of strength. The patient may improve spontaneously and after a while introducing a new outbreak.
Depending on the timing and extent of recovery we divide it into:
Relapsing-remitting (RRMS) is characterized by recurring outbreaks from time to time and are repeated as they occur varying degrees of residual symptoms. It is the most common way to start, although many patients subsequently evolve to a secondary progressive form.
Primary progressive (PPMS): in these patients symptoms progress from the onset of the disease, with occasional period of stability and less disability. Present progressive functional impairment from the beginning, not presenting exacerbations. This form usually have a later age of presentation and greater disability. Represents 10% of cases the onset of the disease
Secondary progressive (SPMS): The disease begins in outbreaks, as a relapsing-remitting, then take a progressive course. It is responsible for the greatest degree of disability.
Progressive-relapsing (PRMS): these patients have a progressive course with occasional exacerbations.
Currently there are many treatments and try to control and patient to prevent this deficit.
NMO, also known as Devic syndrome, is a demyelinating disease that affects in its typical form exclusively to the optic nerve and spinal cord, and is a combination of bilateral optic neuropathy and myelopathy. There is no other demyelinating territories, at least in the typical form of this entity.
Parkinson’s and other movement disorders
Movement disorders include a group of diseases in which the shape and speed of body movements is altered. The motor disorder may be the only clinical manifestation of the disease or be part of a group of complex neurological symptoms.
Usually we divide them into two groups:
Hypokinetic movement disorders: characterized by poverty or slowness of movement we call technically hypo- or akinesia.
Hyperkinetic movement disorders: characterized by excessive involuntary movement or abnormal movements.
Parkinson’s disease is a neurodegenerative disease that is included within the hypokinetic. Attends mainly to slowing, stiffness of limbs and trembling when members are at rest. Currently we have mutiple drugs for treatment and can be achieved for many years that patients make a normal life. Sometimes parkinsonism is drug induced, and should be assessed, this is common with flatoril, neuroleptics and some treatments vertigo
The following guide has useful advice for patients with Parkinson’s disease. For more information we can lower these tips on Parkinson’s disease.
Other disorders with parkinsonism include progressive supranuclear palsy, multisystem atrophy, dementia with Lewy bodies or corticobasal degeneration.
Within we include many varieties of hyperkinetic movement disorders such as:
Tremor: a rhythmic oscillatory movement of a body part due to rhythmic contractions of agonist and antagonist muscles. It may be due to stress or diseases such as Parkinson’s disease, essential tremor or cerebellum.
Dystonia: It is an involuntary muscle contraction that makes us adopt abnormal postures or close your eyes, with bolulínica toxin patients improve much.
Chorea: is like an unpredictable, abrupt and short irregular dance conmovimientos changing a body area to another at random. It may be for Parkinson’s disease and its treatment or serious illness.
Tribalism is an involuntary movement as throwing objects or kicking. His abrupt onset or side is a reason to go to the emergency room as soon as possible.
Tics are frequent and usually consist of brief repetitive movement that can help but generate anxiety.
Myoclonus: are sudden, quick, very short and variable amplitude movements caused by muscle contractions. They may be normal, due to severe neurological disease or liver problems, kidney or lung.
The legs are a desagadable inquiertas sagging feeling when you move your legs or walk. It is common and treatable.
The gait disorders are complex and require detailed neurological evaluation. Many neurological and other diseases due to bone involvement or joint can modify our way of walking.
Since Parkinson’s disease some vitamin deficiencies such as B12 may be accompanied by problems vagrancy. The evaluation must be extensive because many of them have a specific treatment. Neurologists try to frame their alteration within this group:
Bruns frontal ataxia or gait apraxia
Ataxia or vestibular imbalance
Sensory ataxia, cordonal Tabetic up or ataxia
Small steps up Déjerine and Pierre-Marie
Anserina up or Myopathic
Gait paretoatetósica Little or cerebral palsy type
Stroke and intracranial hemorrhage
Strokes are a common and severe neurological disease. Immediate attention in a center with adequate equipment available fibrinolysis neurology, stroke unit and possibility of rescue intraarterial clearly improves prognosis. In Spain have been constituted stroke units in most regions and by early stroke code move patients to these centers.
The recommendations of the NIH are very useful and are in Castilian.
In the United States their knowledge is disseminated by the phrase:
GIVE ME FIVE or ACT FAST
Summarizes the following points are essential for early detection of this disease
We make the patient smile and see if the mouth deviates
We tell you to raise your arms and see if transgress
We will talk and see if mispronounced, words can not issue or change for each other
We act fast by calling 112 and commented that we are facing a possible stroke.