⚕️ FREE MSRA PODCAST – Tension Headache

🎧 A clear, high-yield breakdown of this common,pressure-like primary headache – perfect for exam prep and real-life clinicalscenarios.

🧠 Key Learning Points

📌 Definition

• The most commonprimary headache, characterised by a dull, bilateral, pressure-like sensationaround the head or neck.

• Typically notassociated with nausea, vomiting, or focal neurological symptoms.

📌 Causes & Risk Factors

•Stress and anxiety 😰

• Poorposture 🪑

•Fatigue and sleep disturbances 😴

•Bruxism (teeth grinding) 😬

•Female gender 🚺

• Family history

•Excessive screen time or neck strain 💻

🧠 Mnemonic: “SLEEP” – Stress, Lifestyle, Emotion,Ergonomics, Posture

📌 Pathophysiology

• Multifactorial –involves increased pericranial muscle tension.

•Central sensitisation may play a role 🧠

• Potentialserotonin imbalance

📌 Symptoms

•Bilateral dull ache or pressure 🔁

• Feels like a tightband around the head

• No photophobia,phonophobia or nausea (or only mild)

• May have scalp orneck tenderness

🧠 Mnemonic: “BAND” – Bilateral, Aching,Non-throbbing, Dull

📌 Differential Diagnosis

• Migraine

• Cluster headache

• Cervicogenicheadache

• Sinus headache

•Raised ICP or red-flag secondary causes ⚠️

📌 Diagnosis

• Clinical diagnosisbased on history

• No imaging orbloods unless red flags present

• Red flags:thunderclap onset, focal neurology, altered consciousness, trauma, fever, orimmunosuppression

📌 Management

• 🧘 Lifestyle: stress reduction, posture correction, hydration, regularsleep

• 💊 Medication: Paracetamol or NSAIDs for acute episodes

• 🧠 Chronic: low-dose amitriptyline may be considered

• 🧠 CBT, mindfulness, headache diary

• ❌Avoid codeine or routine opioid use – risk of medication-overuse headaches

📌 Complications

• Medication overuseheadaches (rebound)

•Chronic tension-type headache 😖

• Reduced quality oflife if unmanaged

📌 Prognosis

•Episodic types resolve easily with self-care 🟢

•Chronic types may impair functioning and require longer-term management 🟠

• Avoid analgesicoveruse to prevent rebound headaches

📎 More MSRA Resources for Tension Headache

📝 Revision Notes: https://www.passthemsra.com/topic/tension-headache-revision-notes/

🧠 Flashcards: https://www.passthemsra.com/topic/tension-headache-flashcards/

💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/tension-headache-accordion-qa-notes/

🚀 Rapid Quiz: https://www.passthemsra.com/topic/tension-headache-rapid-quiz/

🎓 Full Course: https://www.passthemsra.com/courses/neurology-for-the-msra/

Hashtags

#MSRA #MSRARevision#MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQANotes#MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision#MSRARevisionWebsite #TensionHeadache #Neurology

🧬FREE MSRA PODCAST –Friedreich’s Ataxia: From Genes to Gait and Beyond

🎧 In this episode, we untangle Friedreich’s Ataxia (FA)—the most common early-onset inherited ataxia.We’ll break down the genetics, the mitochondrial link, clinical features,complications, and management—everything you need for the MSRA and clinical practice. Quick, focused, and high-yield!

🧠Key Learning Points

📌 Definition

• Friedreich’s Ataxia is a progressive,hereditary neurodegenerative disorder—caused by autosomalrecessive mutations in the FXN gene(chromosome 9) resulting in deficient frataxinprotein.

• Hallmarks:Progressive ataxia (loss of coordination), muscle weakness, and reduced/absentreflexes.

📌 Genetics & Pathophysiology

• Trinucleotide GAA repeat expansion in the FXNgene → reduced frataxin → mitochondrial dysfunction, iron accumulation,oxidative stress, and cell damage (especially nerves & heart).

• No “anticipation”(unlike some other repeat disorders).

• Most common inindividuals of European descent.

• Onset: Usuallyages 10–15.

📌 Symptoms & Clinical Features

• Progressive limb/gait ataxia (balance/walkingdifficulties)

• Dysarthria (slurred speech)

• Reduced proprioception & vibration sense

• Muscle weakness (limbs)

• Areflexia (absent ankle/knee jerks)

• Babinski sign (upgoing plantars)

• Cerebellar ataxia, optic atrophy

• Scoliosis, pes cavus (high-arched feet), high-archedpalate (may appear early)

• Cardiomyopathy (90%: hypertrophic, often amajor cause of death)

• Diabetes mellitus (10–20%)

• Other: Bladder dysfunction, cold peripheries(cyanosis), respiratory issues in late disease

📌 Diagnosis

• Genetic testing (GAA repeat in FXN gene = goldstandard)

• Clinical exam: Progressive ataxia, areflexia,cerebellar/cord signs

• Nerve conduction studies: Absent/reducedsensory potentials

• ECG/echo: Cardiac hypertrophy, arrhythmias

• MRI: Spinal cord atrophy

• Bloods: Glucose (diabetes), vitamin E (excludedeficiency)

📌 Differentials

• Other inheritedataxias (spinocerebellar ataxias)

• Vitamin Edeficiency (treatable mimic!)

• Multiplesclerosis, toxins, metabolic, immune, or structural causes

• Early cognitiveimpairment or marked cerebellar atrophy suggest alternatives

📌 Management

• No cure—focus is on symptom & complicationmanagement

• Multidisciplinary care: Neuro, cardio, physio,OT, speech & language, social support

• Physiotherapy: Mobility, manage spasticity

• Speech therapy: Speech & swallow support

• Cardiac management: Standard treatment forcardiomyopathy/arrhythmias

• Diabetes: Standard diabetic management

• Orthopaedics: Surgery for scoliosis/footdeformity if needed

• Genetic counselling is essential forpatients/families

• Research ongoing: Antioxidants, ironchelation, gene therapy (none proven effective yet)

📌 Complications & Prognosis

• Progressive disability: Wheelchair use ~15years post-diagnosis

• Cardiac complications: Main cause of mortality(mean life expectancy 40–50 years, some live longer)

• Diabetes & respiratory complications alsoreduce quality & length of life

📎More MSRA Resourcesfor Friedreich’s Ataxia:

📝 Revision Notes: https://www.passthemsra.com/topic/friedreichs-ataxia-revision-notes/

🧠 Flashcards: https://www.passthemsra.com/topic/friedreichs-ataxia-flashcards/

💬 Accordion Q&A: https://www.passthemsra.com/topic/friedreichs-ataxia-accordion-qa-notes/

🚀 Rapid Quiz: https://www.passthemsra.com/topic/friedreichs-ataxia-rapid-quiz/

🎓 Neurology Course: https://www.passthemsra.com/courses/neurology-for-the-msra/

#MSRA #MSRARevision#MSRATextbook #FriedreichsAtaxia #Ataxia #Neurology #MitochondrialDisease#MSRAFlashcards #MSRAQuiz #MSRAAccordions #ExamPrep #PassTheMSRA #Revision

⚕️ FREE MSRA PODCAST – Syncope
🎧 A high-yield breakdown of this brief loss of consciousness condition – perfect for exams and real-life clinical practice.

🧠 Key Learning Points

📌 Definition
• Syncope is a sudden, short-lived loss of consciousness due to transient cerebral hypoperfusion, with rapid, full recovery.

📌 Causes & Risk Factors
• 🧠 Neurally mediated syncope (vasovagal, situational, orthostatic)
• ❤️ Cardiac causes (arrhythmias, structural heart disease)
• 🩺 Mixed/other: pulmonary embolism, stroke, hypoglycaemia, drugs
• 👵 More common in teenagers and older adults
• 💊 Risk ↑ with diuretics, antihypertensives
• 💡 Mnemonic: "PUMP, PIPES, or CONTROL" = Cardiac, Vasodilation, Autonomic

📌 Pathophysiology
• 🔻 Drop in BP or HR → cerebral hypoperfusion
• 🔁 Disruption in autonomic regulation or cardiac output
• 💥 Rapid but reversible ‘power cut’ to the brain

📌 Symptoms
• 😵 Dizziness, nausea, sweating, visual blurring
• 🥴 “Blackout” followed by rapid recovery
• 🔍 Warning signs (prodrome) help differentiate from seizures
• 🧠 Duration usually seconds (longer = consider pseudoseizure)

📌 Differential Diagnosis
• ⚡ Seizure (postictal confusion, tongue bite)
• 🧪 Hypoglycaemia
• 🌪️ Vertigo
• 🤯 Pseudosyncope
• 👨‍⚕️ Drop attacks, TIAs, substance misuse

📌 Diagnosis
• 📖 History + witness account = 🥇most important
• 🩺 Orthostatic BP
• 📉 ECG (arrhythmias, QT changes)
• 🩸 FBC, glucose
• 🪑 Tilt table test for suspected NMS
• 🫀 Echocardiogram, Holter/event monitoring if cardiac cause suspected

📌 Management
• 🔁 Depends on the underlying cause
• 🧘‍♀️ NMS: reassurance, trigger avoidance, hydration, isometric manoeuvres
• 🧦 Compression stockings, raise bed head, salt intake
• 💊 Fludrocortisone/midodrine (caution: limited evidence)
• ❤️ Cardiac: pacemaker, ICD, ablation, surgery as required
• 🚗 DVLA: 3P rule (Provoked, Prodrome, Posture) determines driving eligibility

📌 Complications
• 🤕 Injuries from falls
• 🧠 Anxiety and impaired QoL from recurrent episodes
• ⚠️ Red flags: Abnormal ECG, Age >45, Ventricular arrhythmia Hx → ↑ mortality risk

📌 Prognosis
• 🟢 NMS often benign
• 🔴 Cardiac syncope → high risk → prompt treatment essential
• 📈 Risk stratification vital to guide workup and management

📎 More MSRA Resources for Syncope
📝 Revision Notes: https://www.passthemsra.com/topic/syncope-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/syncope-flashcards/
💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/syncope-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/syncope-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/neurology-for-the-msra/

Hashtags
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #Syncope #NeurologyMSRA

⚕️ FREE MSRA PODCAST – Trigeminal Neuralgia
🎧 A clear, high-yield breakdown of this chronic facial nerve pain disorder – perfect for exam prep and real-life clinical scenarios.

🧠 Key Learning Points

📌 Definition
• A chronic pain condition affecting the trigeminal nerve (CN V), causing severe, electric shock-like facial pain.

📌 Causes & Risk Factors
• Vascular compression (most common – e.g., superior cerebellar artery)
• Multiple sclerosis (especially in younger patients)
• Tumours or cysts compressing the nerve
• Risk ↑ with age >50, female sex, MS, family history
💡 Mnemonic: “COMPress” – Compression, Old age, MS, Pseudotumour (mass)

📌 Pathophysiology
• Demyelination or irritation of trigeminal nerve → ectopic firing → paroxysmal neuropathic pain
• Often linked to abnormal sodium channel activity

📌 Symptoms
• Unilateral, sudden, sharp/stabbing or electric-shock pain
• Lasts seconds to minutes
• Triggered by touch, chewing, talking, brushing teeth
💡 Mnemonic: “UP STAIRs” – Unilateral, Paroxysmal, Shock-like, Triggered, Activities, Intense, Recurrent

📌 Differential Diagnosis
• Cluster headache
• Migraine
• Dental pain
• Glossopharyngeal neuralgia
• Temporal arteritis
• Tumours or demyelination (e.g., MS)

📌 Diagnosis
• Clinical diagnosis based on classic presentation
• MRI if red flags: age <40, bilateral pain, forehead-only pain, sensory loss, optic neuritis
💡 MRI rules out secondary causes like tumours, MS plaques, or vascular loops

📌 Management
• 🥇 First-line: Carbamazepine
• Alternatives: gabapentin, lamotrigine, phenytoin, baclofen
• Refractory: Microvascular decompression (MVD), radiofrequency ablation, gamma knife
• Support: Multidisciplinary input, psychosocial care
❌ Paracetamol, NSAIDs, opioids are not effective

📌 Complications
• Side effects from antiepileptics (e.g., dizziness, hyponatraemia)
• Surgical risks (e.g., facial numbness, deafness)
• Severe impact on quality of life and mental health

📌 Prognosis
• Often chronic and recurrent
• Good symptom control with early and appropriate treatment
• Some achieve long-term relief, especially post-surgery

📎 More MSRA Resources for Trigeminal Neuralgia

📝 Revision Notes: https://www.passthemsra.com/topic/trigeminal-neuralgia-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/trigeminal-neuralgia-flashcards/
💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/trigeminal-neuralgia-accordion-qa-notes-2/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/trigeminal-neuralgia-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/neurology-for-the-msra/

🔖 Hashtags
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #TrigeminalNeuralgia #Neurology