3 dau dau dau lung

 Introduction Tiếp Tiếp cận cận chẩn chẩn đoán đoán và và xử xử trí trí đau đau đầu đầu  Tiếp Tiếp cận cận chẩn chẩn đoán đoán và và xử xử trí trí đau đau lưng lưng  Tiếp Tiếp cận cậ

 Introduction

 Tiếp Tiếp cận cận chẩn chẩn đoán đoán và và xử xử trí trí đau đau đầu đầu

 Tiếp Tiếp cận cận chẩn chẩn đoán đoán và và xử xử trí trí đau đau lưng lưng

 Tiếp Tiếp cận cận chẩn chẩn đoán đoán và và xử xử trí trí đau đau lưng lưng

 Headache Headache is is among among the the most most common common reasons reasons

patients patients seek seek medical medical attention attention

 Relatively few cranial structures are pain

pain producing producing:: scalp, scalp, middle middle meningeal meningeal artery, artery, dural dural sinuses,

sinuses, proximal proximal segments segments of of the the large large pial pial arteries

arteries

 Not Not pain pain producing producing :: much much of of brain brain parenchyma, parenchyma,

ventricular ventricular ependymal ependymal… …

8/5/2018 Harrison’s principles of internal medicine - 19 th 2015 3

 PainPain:: anan unpleasantunpleasant sensationsensation localizedlocalized toto aa

partpart ofof thethe bodybody

 Described as a penetrating or tissue

tissue  Described as a penetrating or tissue

tissue destructive process (stabbing, burning,squeezing

squeezing……)) or emotional reaction(terrifying,

(terrifying, sickening)sickening)

 TheThe dualityduality ofof painpain:: sensationsensation andand emotionemotion

8/5/2018 5

8/5/2018 Harrison’s principles of internal medicine - 19 th 2015 7

Triệu chứng Cảm giác Triệu chứng vận động

 PeripheralPeripheral mechanismmechanism:: thethe primaryprimary sensorysensory

afferentsafferents

 CentralCentral mechanismmechanism:: thethe spinalspinal cordcord andand

ascendingascending pathwayspathways

 NeuropathicNeuropathic painpain:: increasedincreased sensitivitysensitivity andand

spontaneousspontaneous activityactivity inin thethe damageddamaged nervenervefibers

fibers oror CNSCNS

Harrison’s principles of internal medicine - 19 th 2015

 Primary Primary headache headache::

 Migraine

 Tension Tension type type headache headache

 Cluster Cluster headache headache

Secondary Secondary headache headache::

The international classification of headache disorders – Cephalalgia 2013

 Secondary Secondary headache headache::

 Meningitis

 Intracranial Intracranial hemorrhage hemorrhage

 Brain Brain tumor tumor

 Headache Headache attributed attributed to to trauma trauma or or injury injury to to the the head head and/or and/or neck neck

 Headache Headache attributed attributed to to infection infection

8/5/2018 11

Harrison’s principles of internal medicine - 19 th 2015

Harrison’s principles of internal medicine - 19 th 2015

8/5/2018 13

The international classification of headache disorders – Cephalalgia 2013

8/5/2018 15

Harrison’s principles of internal medicine - 19 th 2015

8/5/2018 Harrison’s principles of internal medicine - 19 th 2015 17

8/5/2018 19

Harrison’s principles of internal medicine - 19 th 2015

8/5/2018 21

8/5/2018 23

8/5/2018 25