Remember:  Common problems occur most commonly!


Headache is not usually due to a brain tumour, although the patient may be worried 
that it is. The commonest causes of headache are probably "tension" and migraine,
eye-strain and sinusitis.  How do you achieve a reliable diagnosis (through history,
examination, investigation or referral) in patients presenting with the following 
problems:


1) Severe headache for three hours

2) Intermittent headache for six months (including "clusters")

3) Collapse with dysarthria

4) Transient loss of vision in one eye

5) A 12 year old child who falls off a bicycle and then twitches

6) A 2 year old child who seems to be having a fit

7) A 75 year old woman with progressive memory loss

8) Photophobia and neck stiffness

9) Paraesthesia of the lateral aspect of the thigh

10) Nocturnal pain and tingling in the fingers

11) Weakness and wasting of muscles of one hand with pain in the fore-arm or slurred

    speech and fasciculation of the tongue

12) "My Uncle has Huntingdon's Disease"

13) Unilateral facial pain and weakness.

14) Deja-vu, swallowing, yawning and unilateral hemianopia

15) A minor head injury with nausea and amnesia

16) Sudden onset of sciatica

17) A first epileptic fit aged sixteen

18) A first epileptic fit aged  45



What would make you suspect a diagnosis of:


1) Multiple Sclerosis

2) Normal pressure hydrocephalus

3) Guillain-Barré Syndrome

4) Alcoholic Neuropathy

5) Sub-arachnoid haemorrhage

6) Sub-dural haemorrhage

7) Extra-dural haemorrhage

8) Intracranial haemorrhage

9) Ramsay-Hunt syndrome

10) Herpes Zoster Ophthalmicus

11) Trigeminal neuralgia

12) Tension headache

13) Cluster headache

14) Parkinson's disease

15) Multi-infarct dementia

16) Alzheimer's disease


Please add any other neurological problems you would like to discuss . . . . . . .


                                                     Tutorial submitted by Andrew Crawshaw - Mevagissey (1999)