headache eventually becomes continuous (Figure 1.16(77)).
The "grasp reflex" may be observed: if an object is put on the palm of the hand between thumb
and index finger, the patient will automatically grasp it. This reflex action is only present on the
side opposite to the location of the tumour.
Hypertensive
Essential Hypertension
This indicates a persistent high blood pressure without an apparent cause. It occurs in persons
between 40 and 70.
The main manifestations are a vertical (on top of the head) or occipital headache, occipital
stiffness, giddiness, tinnitus, irritability and, in a few cases, epistaxis. The main sign is, of
course, a raised diastolic and/or systolic blood pressure. However, it is not at all uncommon to
see patients with raised blood pressure without any of the above symptoms. The headache from
hypertension can occur either on the top of the head or on the occiput and is accompanied by a
pronounced stiffness of the neck muscles (Figure 1.17(78)).
Secondary Hypertension
This a raised blood pressure secondary to other factors, the most frequent of them being chronic
glomerulo-nephritis (see Chapter 22, "Oedema").
The main manifestations, apart from a raised blood pressure and a headache, are an ache in the
loins, tiredness, oedema and albuminuria.
Cranial
Sinusitis
This is a common complaint in industrialized countries. It is characterized by inflammation of
the sinuses.
The headache from sinusitis is easily distinguished from that from other causes as it is clearly
located on the face in correspondence with the frontal, ethmoidal or maxillary sinuses (Figure
1.18(79)).
Other manifestations include a runny nose, a post-nasal discharge and a characteristic feeling of
muzziness of the face.
Otitis