This state has been existing already for 4 years for

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fatigue and polyuria. This state has been existing already for 4 years, for the first time developed after pregnancy and is provoked by mental stress. Neurological status is unremarkable except slightly increased bilateral tendon reflexes and mild upper eyelid tremor. What is your diagnosis? How to treat the patient? Diagnosis: panic attack, sympathetic adrenal type Treatment: Preventive: 1.mild tranquilizer TEMAZEPAM or GIDAZEPAM 2. Inhibiting Atidepressant from tricyclics – AMITRIPTYLINE; SSRIs –PAROXETINE 3.Combination of tranquilizers + antidepressants Abortive: short-acting tranquilizer DIAZEPAM; alpha-blockers – PEROXAN(?); beta-blockers METOPROLOL 2 Patient, 27 years old, female, complains of paroxysms of throbbing headache, mostly right- sided that is accompanied with vomiting and photophobia, last at most 3-12 hours, 33
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preceded with transient visual loss, relieved after coffee intake and sometimes occurs after the menses. During pain patient applies cold compresses to the head and tries to isolate herself in dark room. Vital parameters: BP – 120/76 mm Hg, pulse – 76 beats/sec., breath rate – 13/sec. Neurological status is unremarkable. Mother of the patient also suffers from the similar disorder. What is your diagnosis? How to treat this patient? Diagnosis: classical migraine Treatment: Preventive: non-seletive beta-blockers PROPRANOLOL, METOPROLOL Tricyclic antidepressants – AMITRIPTYLINE Ca2+ channel blockers – VERAPAMIL Antiepileptic drugs – CARBAMAZEPINE, VALPROIC A., TOPIRAMATE or GABAPENTIN Abortive: ergot derivatives; triptanes – SUMATRIPTAN <- they are used only at the beginning of the pain 3 Patient, 33 years old, male, complains of paroxysms of severe squeezing pain around left eye and in the forehead, that are accompanied with mild nausea, last no more than 3 hours, may recur 3-5 times a day and usually start in the morning in the same hour. This headache already persists every day for 3 weeks. 9 years ago woman had the same condition that resolved spontaneously. During pain paroxysm patient also undergoes anxiety, is unable to sit motionlessly and moves from place to place, weeping and moaning. Vital parameters: BP – 115/70 mm Hg, pulse – 80 beats/sec., breath rate – 14/sec. Neurological status is unremarkable. What is your diagnosis? How to treat this patient? Diagnosis: Cluster headache Treatment: emergency treatment include antimigraine drugs : ergot derivatives; triptanes – SUMATRIPTAN, we need to apply lidocaine into nostrils and provide oxygen therapy Preventive :calcium channel blockers – verapamil; lithium carbonate; agonists of serotonin receptors – isothiophan(?); corticosteroids – prednisone, prednisolone; NSAIDs 4 Patient, 40 years old, male, complains of moderate bilateral pressing headache distributed in band-like fashion and accompanied with sense of “muscular spasms and something heavy put at the head crown”. Duration of pain period – from 2-3 hours up to even several days.
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  • Winter '18
  • Jane doe
  • Neurology, Seizure, Seizure types

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