Migraines Holistic Treatments
Migraine is a debilitating neurological disorder with which many people, including myself, are all too familiar. Indeed, it is one of the most common of chronic disorders with a prevalence of up to 24 in women and 12 in men (Russell et al., 1995) and it costs the United Kingdom half a billion pounds each year in lost productivity. The attacks last from 4 to 72 hr and the symptoms include headache (often confined to one side of the head), nausea, vomiting, and sensitivity to light and noise. Around 20 of patients experience an aura prior to an attack that may manifest as visual disturbances, weakness of the limbs, and difficulty in speaking. For all its debilitating effects, migraine is not entirely without its positive aspects the remarkable colours and distorted visual perception experienced during the classical aura have inspired many artists and poets. FHM is a rare autosomal dominant type of migraine with aura. It is associated with paralysis of one half of the body during an...
Serum PRL measured between migraine attacks is normal in men and women (54). Endocrine challenge studies of migraineurs have shown that I-deprenyl, which increases the availability of endogenous dopamine, produces greater decrease in serum PRL in migraineurs than in normal subjects, implying increased dopamine receptor sensitivity in migraine. Simultaneous administration of TRH, luteinizing hormone releasing hormone, and insulin also produces greater PRL release for migraineurs than for normal controls, suggesting serotonergic hyperactivity in migraine (55). The effects of acute migraine attacks have not been studied.
G43.1 Migraine with aura classical migraine Migraine aura without headache G43.3 Complicated migraine G43.8 Other migraine Ophthalmoplegic migraine Retinal migraine G43.9 Migraine, unspecified Other headache syndromes Excludes atypical facial pain ( G50.1 ) headache NOS ( R51 ) trigeminal neuralgia ( G50.0 ) G44.0 Cluster headache syndrome Chronic paroxysmal hemicrania Cluster headache G44.1 Vascular headache, not elsewhere classified Vascular headache NOS G44.2 Tension-type headache Chronic tension-type headache Episodic tension headache Tension headache NOS G44.3 Chronic post-traumatic headache G44.4 Drug-induced headache, not elsewhere classified Use additional external cause code (Chapter XX), if desired, to identify drug. G44.8 Other specified headache syndromes
(71) and cancer cachexia (72), but so far without encouraging results. Newer, non-sedating antihista-minergic agents such as loratadine and astemizole also produce weight gain, but to a lesser degree than the older compounds (73). The calcium antagonist flunarizine, used in migraine prophylaxis, has in several studies (74,75) been shown to increased appetite and induce a dose-dependent weight gain of up to 4 kg during the first months of the treatment period (74,76). The mechanism is not known, but an appetite stimulating effect involving brain dopa-mine and other central neurotransmitters has been suggested.
Caused by a persistent leak of CSF from the needle hole in the lumbar dura. The incidence is greatest with large holes, that is, when a hole is made accidentally with a Tuohy needle, and least after spinal anaesthesia using fine needles (e.g. 26 gauge) with a pencil or tapered point (90 ) by injecting 20-30 mL of the patient's own venous blood into the epidural space (epidural blood patch) under strict aseptic conditions.
EEG changes may occur during and after migraine attacks. Unfortunately, the literature is beset with frequent imperfections that may mislead the unsuspecting reader. This consists of the grouping of dissimilar patients, the lack of adequate controls, and vague definitions of what constitutes an EEG abnormality. Phenomena consistent with spreading depression and alterations of cerebral blood flow underlie the acute-appearing EEG abnormalities that occur principally, if not exclusively, in patients with migraine with aura. Several studies of migraine have employed a variety of methods to measure cerebral blood flow including single photon emission computed tomography (SPECT) scan, transcranial Doppler, and perfusion weighted imaging studies. Unilateral or bilateral hypoperfusion have been noted during these attacks (66-71). Hyperperfusion has been found in a minority of patients, usually following an episode of hypoperfu-sion (67,68). Spreading depression has been considered a likely...
Nonprescription drugs are drugs that are designated by the FDA to be safe (if taken as directed) and obtained without a prescription. These drugs are also referred to as over-the-counter (OTC) drugs and may be purchased in a variety of settings, such as a pharmacy, drugstore, or in the local supermarket. OTC drugs include those given for symptoms of the common cold, headaches, constipation, diarrhea, and upset stomach.
The patient commonly complains of fever, headache, and aches and pains elsewhere in the body, and occasionally of abdominal pain and diarrhoea. In a young child there may be irritability, refusal to eat and vomiting. On physical examination fever may be the only sign. In some patients the liver and spleen are palpable. This clinical presentation in non-endemic or low-endemic areas may be misdiagnosed as influenza. Unless the condition is diagnosed and treated promptly the clinical picture may deteriorate at an alarming rate and often with catastrophic consequences.
Mild impairment of cell-mediated immunity occurs during gestation, and pregnant women are prone to developing listerial bacteremia with an estimated 17-fold increase in risk (Weinberg 1984 Mylonakis et al. 2002). Listeriae proliferate in the placenta in areas that appear to be unreachable by usual defense mechanisms, and cell-to-cell spread facilitates maternal-fetal transmission (Bakardjiev et al. 2005). For unexplained reasons, CNS infection, the most commonly recognized form of listeriosis in other groups, is extremely rare during pregnancy in the absence of other risk factors (Ciesielski et al. 1988 Gellin et al. 1994 Bucholz and Mascola 2001). Bacteremia manifests clinically as an acute febrile illness, often accompanied by myalgia, arthralgia, headache, and backache. Illness may occur at any time during pregnancy but usually occurs in the third trimester, probably related to the major decline in cell-mediated immunity seen at 26-30 weeks of gestation (Weinberg 1984). Twenty-two...
The nonmedical clinician is advised to inquire of clients as to whether any medical evaluation of their condition has been performed prior to initiating an hypnotic intervention. Common presentations to the hypnotherapist such as headaches, insomnia, and back pain may have organic etiologies that require surgical or pharmaceutical treatment (Olness & Libbey, 1987). A hasty hypnotic intervention may delay proper diagnosis, cloud symptoms or actually worsen a client's condi
An unusual form of listerial encephalitis involves the brain stem (Armstrong and Fung 1993) and is similar to the unique zoonotic listerial infection known as circling disease of sheep (Gill 1993). In contrast to other listerial CNS infections, this illness usually occurs in healthy older children and adults neonatal cases have not been reported. The typical clinical picture is one of a biphasic illness with a prodrome of fever, headache, nausea, and vomiting lasting about 4 days, followed by the abrupt onset of asymmetrical cranial nerve deficits, cerebellar signs, and hemiparesis or hemisensory deficits, or both. Nuchal rigidity is present in about 50 , CSF is only mildly abnormal, and CSF culture is positive in about 40 almost two-thirds are bacteremic. Respiratory failure develops in about 4 of cases. Magnetic resonance imaging is superior to computed tomography for demonstrating rhombencephalitis (Armstrong and Fung 1993 Faidas et al. 1993). Mortality is high, and serious...
Common symptoms are nausea, vomiting, retching, abdominal cramping, and prostration. Some individuals do not demonstrate all the symptoms associated with the illness. In more severe cases, headache, muscle cramping, and transient changes in blood pressure and pulse rate may occur. Recovery generally takes 2 days, but it is not unusual for complete recovery to take 3 days or longer. Death from staphylococcal food poisoning is very rare, although such cases have occurred among the elderly, infants, and severely debilitated persons.
Been documented (Ooi and Lorber 2005). In the largest outbreak to date, 1,566 individuals, most of them children between the ages of 6 and 10, became ill after eating caterer-provided cafeteria food at two schools, and 19 were hospitalized (Aureli et al. 2000). Illness typically occurs 24 h after ingestion of a large inoculum of bacteria (range from 6 h to 10 days) and usually lasts 1-3 days (range 1-7 days) attack rates have been quite high (52-100 ). Common symptoms include fever, watery diarrhea, nausea, headache, and pains in joints and muscles. Vehicles of infection have included chocolate milk, cold corn and tuna salad, cold smoked trout, and delicatessen meat. L. monocytogenes should be considered to be a possible etiology in outbreaks of febrile gastroenteritis when routine cultures fail to yield a pathogen.
A 30-year-old patient came to the hospital emergency department because of a terrible headache that began several hours ago and did not improve. Previously he had experienced only mild, infrequent tension headaches associated with stressful days. Because of the intensity of this new headache, he is treated with injectable analgesics and is admitted to the hospital for further observation.
Multifocal neurologic signs and symptoms are the hallmark of LM. Symptoms can be divided into CNS, cranial neuropathies or spinal radicular (Table 2). The mechanisms in which LM cause neurological signs and symptoms include obstruction of CSF flow or drainage with resultant increased intracranial pressure (ICP), meningeal irritation, or focal signs from local invasion or irritation of the brain, cranial nerves, spinal cord or spinal nerves. LM can cause cerebral infarction from a cerebral vasculopathy changes in brain metabolism and reduction in cerebral blood flow may cause a diffuse encephalopathy.62, 106 Isolated neurologic symptoms occur in 30-53 of patients with LM,9,61,85,131,135,137 with CNS85 and spinal radicular61 the most common. Multifocal involvement is seen in 40-80 of cases.9,61,85, 131, 135 137 In one study, a combination of two sites was seen in 47 of cases (CNS 29 , CNS and spinal radicular 10 , and spinal radicular 8 ) and involvement of all levels was seen in 13 of...
Headache Any pituitary adenoma (or any other tumor or disease affecting the pituitary region, for that matter) can cause headaches. The headaches may vary from mild to severe, and the severity is not always proportional to tumor size. The headaches are commonly retro-orbital but may be more generalized and can be mistaken for other types of headaches, such as tension or migraine headaches. Because these tumors usually grow slowly and can become quite large before they are discovered, the headaches are often present for many years. On the other hand, some patients with very large tumors are surprisingly free of headaches. Rarely, patients will have sudden onset of a severe headache or give a history of a severe headache that spontaneously resolved. Such a history raises the possibility of acute hemorrhage or infarction of the tumor.
In the last 50 years, an increasing number of diseases and patients have been treated with immunoglobulins. Mild adverse reactions (headache, flushing, backache, and nausea) are often associated with fast infusion rates. Only rarely are hematologic, neurologic, or renal adverse effects seen with high doses of IVIG.
The antiviral drugs are not given intramuscularly or subcutaneously. It is important to prepare the antiviral drugs according to the manufacturer's directions. The administration rate is ordered by the primary health care provider. The nurse takes care to prevent trauma because even slight trauma can result in bruising if the platelet count is low. If injections are given, pressure is applied at the injection site to prevent bleeding. Occasionally, headache or a slight fever may occur in patients taking antiviral drugs. An analgesic may be prescribed to manage these effects.
Specific symptoms of AIDS-lymphoma will depend upon the organ(s) involved. Patients with primary CNS lymphoma often complain of headache, seizures, focal neurologic defect, or altered mental status (40). Headache or cranial nerve palsy may occur in patients with leptomeningeal involvement, although approx 20 of patients with lymphoma cells in the spinal fluid will be asymptomatic (41). Gastrointestinal lymphoma may present with abdominal pain or distension, anorexia, nausea, or vomiting. Involvement of the rectum and or perianal region often presents as a rectal mass, or
The patient with a musculoskeletal disorder commonly receives salicylates or NSAIDs (see Chap. 17) to help control inflammation and pain. In addition, these drugs are readily available over the counter (OTC). So a patient who is prescribed one drug, such as NSAIDs, may also take an OTC salicylate, such as aspirin, for headaches or additional pain relief. When taken alone, these drugs may cause gastrointestinal (GI) irritation, possibly leading to GI bleeding. If taken in combination or with high doses, or for long periods of time, your patient's risk for GI bleeding increases dramatically. Be sure to teach your patient how to look for signs and symptoms of GI bleeding. Instruct the patient to report any of the following If taking a salicylate, notify the primary health care provider if any of the following symptoms occur ringing in the ears, gastrointestinal pain, nausea, vomiting, flushing, sweating, thirst, headache, diarrhea, episodes of unusual bleeding or bruising, or dark...
Ca2+ ions play crucially important roles in regulating a variety of cellular functions. They initiate muscle contraction, trigger the release of neurotransmitters from nerve terminals and of hormones from secretory cells, regulate gene expression and the cell cycle, and mediate cell death. The intracellular Ca2+ concentration ( Ca2+ i) is very much lower than that outside the cell (10 7 M as compared with 1-2 mM), and a transient rise in internal Ca2+ acts as a second messenger coupling receptor activation to many cellular processes. This increase in Ca2+ is mediated by voltage- or ligand-gated Ca2+ channels that regulate Ca2+ influx across the plasma membrane and or by ligand-gated Ca2+ channels which control the release of Ca2+ from intracellular stores. The ligand-gated Ca2+ channels are considered in Chapter 14. In this chapter we look at the properties of the voltage-gated Ca2+ channels and see how mutations in the genes that encode these proteins lead to defective channel...
Although there is seldom a sharp analytic synthetic distinction to be drawn in the case of our concepts, there are clearly things that are more and less central. When I was young I believed that headaches were caused by events inside the brain, where the problem seemed to be located. Perhaps there were not really little animals gnawing away, but something along those lines seemed to be going on. I gave up that belief, without changing my concepts of pain and headache significantly. The fact that headaches hurt is much more central, to put it mildly. In the case of our concepts of experiences, it seems that the most central parts, at least in many cases, will have to do with what the experience has been and will be like for us, the possessor of the concept. Remembering and anticipating sensations is, in some bewildering way, like having them. It does not hurt to remember the last time I hit my thumb with a hammer, nor does it hurt to anticipate the next time. But the memory and the...
Consider a case-control study of the role of cocaine use in relation to migraine headache, built on a case register from a regional referral hospital that specializes in the treatment of migraine headaches. If we select controls by random-digit dialing from the same geographic area as the cases, we will have to contend with the potential biases arising from differential tendency to seek medical care and particularly, medical care from this institution. Socioeconomic status is likely to be one such influence on the opportunity and ability to access care at this referral center, so that we recognize and accept that there will not be a natural balance between the social class distribution of selected controls and the true (but unknown) study base for these cases seen at this health care facility. Furthermore, social class is one predictor of cocaine use, with greater prevalence among lower social class persons. Adjusting for socioeconomic status will be beneficial to the extent that this...
The adverse reactions associated with the administration of adrenergic drugs depend on the drug used, the dose administered, and individualized patient response. Some of the more common adverse reactions include cardiac arrhythmias, such as bradycardia and tachycardia, headache, insomnia, nervousness, anorexia, and an increase in blood pressure (which may reach dangerously high levels). Additional adverse reactions for specific adrenergic drugs are listed in the Summary Drug Table Adrenergic Drugs.
The causes and detailed mechanisms of these long-lasting depolarizations remain unclear. However, it has been shown that long-lasting increases in extracellular potassium concentrations, which are buffered in part by glia cells, simultaneously depolarize neurons. The depolarization does not involve all structures of the neurons simultaneously, and thus an intracellular current may result. A similar phenomenon appears to be the basis for the development of a migraine, which however does not result from cell damage (Bowyer et al., 2001).
Headache is probably the most frequent symptom of TA, occurring in 50 to 75 of patients it is often the first manifestation of disease. It is described as extracranial, dull, boring, and burning. Classically, patients complain of temporal headaches, and the temporal arteries on physical examination may be prominent, beaded, tender, and pulseless. Patients with occipital artery involvement may have difficulty combing their hair or experience discomfort from the pressure of a pillow on their head.
The pathology of atherosclerosis is well described. Lipids and macrophages accumulate on the endothelium, initially as a fatty streak. Over time, a plaque develops with a central lipid core and a fibrous cap. The fibrous cap has an endothelial covering and contains vascular smooth muscle cells and collagen. In carotid disease, this plaque may expand to cause severe stenosis or occlusion. As discussed above, this limits flow only if collateral sources are not adequate. In addition, as there is no global increase in flow with neuronal activation, there is no angina-equivalent in the brain you don't get a headache from thinking.
Hypoglycemia can be the result of too much insulin, too little food (i.e., skipped or delayed meals and snacks), alcohol intake, or exercise. It can often be prevented by monitoring blood glucose levels, taking insulin and oral medications as prescribed, following a meal plan, limiting alcohol intake, and planning extra snacks if needed to cover the hypoglycemic effects of exercise. The symptoms of hypoglycemia include hunger, headache, irritability, confusion, lethargy, and, in severe cases, seizure or loss of consciousness. Patients treated with insulin or oral hypoglycemic medications should know how to recognize and promptly treat hypoglycemic reactions.
Melatonin is a hormone produced by the pineal gland in the brain. The use of melatonin obtained from animal pineal tissue is not recommended because of the risk of contamination. The synthetic form of melatonin does not carry this risk. However, melatonin is an over-the-counter dietary supplement and has not been evaluated for safety, effectiveness, and purity by the FDA. All of the potential risks and benefits may not be known. Supplements should be purchased from a reliable source to minimize the risk of contamination. Melatonin has been used in treating insomnia, overcoming jet lag, improving the effectiveness of the immune system, and as an antioxidant. The most significant use is for the short-term treatment of insomnia at low doses. Individuals wishing to use melatonin should consult with their primary health care provider or a pharmacist before using the supplement. Possible adverse reactions include headache and depression. Drowsiness may occur within 30 minutes after taking...
Excessive drowsiness and headache the morning after a hypnotic has been given (drug hangover) may occur in some patients. The nurse reports this problem to the primary health care provider because a smaller dose or a different drug may be necessary. The nurse assists the patient with ambulation, if necessary. When getting out of bed the patient is encouraged to rise to a sitting position first, wait a few minutes, then rise to a standing position.
Zidovudine is rapidly absorbed following oral administration and rather rapidly metabolized by hepatic glucuronidation (half-life about 1 hour) so that the drug needs to be given 2 or 3 times daily. Very ill hospitalized patients may be treated by continuous intravenous infusion. Side effects of zidovudine are frequent. The most important result Irom the toxicity of the drug for bone marrow, namely, macrocytic anemia (often requiring red cell transfusions) and granulocytopenia (neutropenia). Headache, nausea, and insomnia are common, and many patients develop a myopathy resulting in (reversible) wasting of proximal muscle groups. Severe side effects may demand suspension of treatment, reduction in the daily dosage, combined therapy with another nucleoside analog or interferon a or another cytokine displaying synergism, or replacement or alternation with another drug.
From the time of ingestion, symptoms typically begin within 7-21 days but can take as long as 56 weeks to appear. In classical enteric fever the onset of malaise, weakness, headache, and fever is slow and insidious. The fever rises gradually, is usually higher at night, until it reaches 39-40 C. In some geographic areas, diarrhea lasting several days may precede systemic illness. Respiratory symptoms (e.g., dry cough), constipation, abdominal pain, and anorexia are often encountered early in disease. Relative bradycardia and mild splenomegaly are common, and, as disease progresses, patient confusion can turn to stupor and delirium. During the second week of disease, about half of all cases exhibit rose spots on the abdomen, chest, and back due to dissemination of the organisms to peripheral skin foci (22,23). Enteric fever can be difficult to diagnose because any of these symptoms, including fever, can be absent. Recovery can be observed typically by the third week of illness, but in...
The range and severity of symptoms in primary HIV infection varies considerably, with an acute 1-month mononucleosis-like viral syndrome developing in about 40 -60 of patients (Levy 1993). Symptoms can include fever, headache, lymphadenopathy, malaise, myalgia, rash, stiff neck, and other meningeal signs and symptoms, accompanied by transient intense viremia and an acute fall in CD4 T cell count in the peripheral blood from its normal range of 800-1,200 cells per cubic millimeter (Staprans and Feinberg 1997). The more severe this syndrome is, the more likely that the untreated patient will progress rapidly to AIDS (Keet et al. 1993). Clinicians are now hoping to slow down progression to AIDS by initiating
HIV infection presents a spectrum of neuropsychiatric sequelae that can pose diagnostic and treatment quandaries to clinicians. In patients with serious and persistent psychiatric illness, some of the early, subtle neuropsy-chiatric symptoms may be difficult to differentiate from preexisting symptoms of their psychiatric illness. HIV is neurotropic (O'Brien 1994), enters the CNS soon after infection (Resnick et al. 1988), and can acutely induce headache and meningeal signs as already noted. Long-term clinical sequelae of CNS infection range from subtle neurocognitive impairment to frank dementia, and their incidence increases with HIV illness progression. OIs and neoplasms that follow immunosuppression can also affect the CNS, resulting in mood disorders, psychosis, cognitive disorders, de
L. was a 24-year-old woman who had the onset of spells at 22 years of age. Episodes were characterized by a headache and tired feeling, followed by loss of consciousness and jerking movements of the trunk and extremities. Loss of consciousness lasted up to 5 min. The patient reported that incontinence occurred rarely. The frequency of episodes varied from one per week at the onset of her illness, to one per day at the time of referral. She was treated with phenytoin, gabapentin, and lamotrigine without control. Etiological factors included a motor vehicle accident that resulted in less than 5 min of impaired consciousness just prior to the onset of events. There were no neurological sequelae following the accident. The examination was normal.
Namdar et al. (1998) suggested the following guidelines for treatment in case of associated nasal obstruction or rhinosinusitis, medical therapy with antibiotics, decongestants, and steroids may be appropriate. Whenever medical therapy fails because of tumor location, the lesion is adjacent to frontal sinus os-tium or more than 50 of the frontal sinus is occupied, or a noticeable increase in size has been documented by serial CT scans, surgery is recommended. Finally, chronic headache may be an indication for surgery when other causes are excluded.
Another neurosurgical transmission of CJD was reported in which the primary case, a 59 year-old woman, previously in apparent good health, began to feel tired and stopped working 17 . Soon after, she fell down a staircase at home. She was admitted to the hospital and electroencephalogram results were suggestive of CJD. In the course of testing, she was referred to the neurosurgery department and underwent a right frontal cortical biopsy, which confirmed the diagnosis. Her condition rapidly degenerated and she died two months after the first recorded symptom. The secondary patient was admitted for a severe headache following head trauma, also from a fall down stairs. He underwent a left fronto-temporal trephination followed by biopsy in the same operating room as the primary case, 3 days later. There were three sets of surgical instruments in the operating room used for this procedure, one of which had been used on the primary CJD patient a few days earlier. After washing with soap,...
Even though painless facial and skull deformities are the most frequently observed signs, symptoms such as nasal obstruction, headache, epistaxis, anosmia, loosening of teeth, facial paralysis, hearing loss, trigeminal neuralgia-like pain, and recurrent rhinosinusitis due to drainage impairment may develop (Bollen et al. 1990 Camilleri 1991 Ferguson 1994 Slootweg et al. 1994 Wenig et al. 1995 Redaelli De Zinis et al. 1996 Chong and Tang 1997 Commins et al. 1998 Muraoka et al. 2001 Cheng et al. 2002). Diplopia, proptosis, loss of visual acuity due to optic nerve compression, epiphora, limitation of ocular motility are other important symptoms and signs indicating an involvement of the orbit and or of the lacrymal pathways (Moore et al. 1985 Osguthorpe and Gudeman 1987 Johnson et al. 1991 Slootweg et al. 1994 Wenig et al. 1995 Redaelli De Zinis et al. 1996). Since both diseases display a submucosal pattern of growth, nasal endoscopy is often negative or shows a lesion covered by intact...
The most common pituitary macroadenomas seen in adults are classified as clinically nonfunctioning pituitary adenoma (NFPA). Although termed nonfunctioning, many display positive immunostaining for gonadotropins LH and FSH, whereas silent corticotroph and somatotroph tumors may also occur. Presentation may be incidental when neuroimaging has been performed for reasons other than pituitary assessment. Alternatively, a macroadenoma causes mass effects including headache and visual failure. In general, pituitary function is preserved in early cases, although hyperprolactinemia related to disinhibition related to stalk compression is frequently present. As the tumor enlarges, progressive loss of GH, the gonadotropins, and eventually ACTH and TSH axes will occur.
Yellow fever is a hemorrhagic fever with a difference the liver is the major target, with virus replicating in Kupffer cells and massive necrosis of hepato-cytes leading to a decrease in the rate of formation of prothrombin as well as to jaundice. Although most cases are mild, presenting with fever, chills, headache, backache, myalgia, and vomiting, a minority progress (sometimes after a brief remission) to severe jaundice, massive gastrointestinal hemorrhages (hematemesis and rnelena), hypotension, dehydration, proteinuria, and oliguria signaling kidney failure. Mortality from this severe form of the disease is of the order of 20-50 . Dengue fever is typical of the painful but nonlethal fever arthritis rash syndrome which is the common presentation of so many arbovirus diseases sudden onset of fever (characteristically biphasic, or saddle back ), chills, retroorbital headache, conjunctivitis, and severe pains in the back, muscles, and joints, followed by a rash and rapid resolution....
The DBPCFCs are necessary to confirm food allergic reactions but they are not without risk to the patient. Double-blind testing is necessary because of the known discrepancy between subjective observations (e.g., migraine headaches and intestinal symptoms) and the challenge tests (Anonymous, 1997). In addition, the risk of anaphylactic reactions is an inherent danger in testing skin-test-positive patients.
An additional determinant of susceptibility to biased recall is the degree of subjectivity in defining the exposure. Events such as prior surgery or level of education, for example, are unambiguous and not subject to varying interpretation. In contrast, history of diseases based on self-diagnosis, such as frequent headaches or conditions that are inherently subjective such as perceived stress are much more vulnerable to differential misclassification in that the reporting contains an element of judgment.
The management of acute pain (including some aspects of terminal cancer pain and chronic transient headaches Evans, 1989) involves the direct management of anxiety. The growing anxiety about the short- and long-term consequences of an injury or illness which accompanies the increasing intensity of the noxious stimulation is usually relieved by adequate treatment such as pain medication, hypnosis, or any other intervention that reduces anxiety, facilitates relaxation and refocuses attention (Evans, 1990b, 2001). future fear give way to the frightening awareness that a painful injury or condition may have a permanent effect. Despair and despondency develop as the suffering remains partially unrelieved, and activities become restricted. The seductiveness of seeking, demanding, and receiving help from significant others, including doctors and family, the mildly pleasant and or euphoric effects of medication, or the sedation and induced sleep which avoids pain, can produce a reinforcement...
Few studies have examined the development of impaired hypoglycaemia awareness during pregnancy although most clinicians would agree that this is particularly problematical during the first trimester. Evers et al. (2002a) observed that severe hypogly-caemia in the first trimester was more likely to occur in women with reduced symptomatic awareness of hypoglycaemia. In laboratory-induced hypoglycaemia Bjorklund et al. (1998a) did measure symptomatic responses to hypoglycaemia during the third trimester, and also postnatally, and found that symptoms such as 'inability to concentrate', 'headache' and 'pounding heart' were less prominent during pregnancy compared with during the postnatal period. However, it is difficult to ascertain whether this is a consequence of differences in glycaemic control or the incidence of hypogly-caemia during these two time periods. Fear of hypoglycaemia is also greater in women who have experienced severe hypoglycaemia (Evers et al., 2002a) and this is an...
Each year, several thousand tons of aspirin (acetyl-salicylate) are consumed around the world for the relief of headaches, sore muscles, inflamed joints, and fever. Because aspirin inhibits platelet aggregation and blood clotting, it is also used in low doses to treat patients at risk of heart attacks. The medicinal properties of the compounds known as salicylates, including aspirin, were first described by western science in 1763, when Edmund Stone of England noted that bark of the willow tree Salix alba was effective against fevers, aches, and pains. By the 1830s, German chemists had purified the active components from willow and from another plant rich in salicylates, the meadowsweet, Spiraea ulmaria. However, salicylate itself was bitter-tasting and its use had some unpleasant side effects, including severe stomach irritation in some cases. To address these problems, Felix Hoffmann and Arthur Eichengrun synthesized acetyl-salicylate at the Bayer company in Germany in 1897. The new...
The signs and symptoms of HME described in a well documented series of cases diagnosed at the Centers for Disease Control and Prevention included fever (97 ), headache (81 ), myalgia (68 ), anorexia (66 ), nausea (48 ), vomiting (37 ), rash (36 ), cough (26 ), pharyngitis (26 ), diarrhea (25 ), lymphadenopathy (25 ), abdominal pain (22 ), and confusion (20 ) 16 . More than 60 were hospitalized. An active, prospective population-based study in Cape Girardeau, Missouri observed similar signs and symptoms, with more than 40 requiring hospitalization, indicating that HME is a relatively severe, multisystem disease 35 . Severity has been compared with Rocky Mountain spotted fever and toxic
Panic attacks are very common and more common in young people in both men and women. People feel that they are extremely ill, feel their heart beating fast and forcefully in their chest, notice a change in their breathing pattern, and may breathe very fast and deep (hyperventilation). Sweating, having a headache or intense fear, not wanting to leave the house (agoraphobia), wanting to run away into the open air, not being able to tolerate being in a room (claustrophobia), are other features of panic attacks. Some people may hyperventilate and lose consciousness.
The nurse assesses the patient for relief of the symptoms of anemia (fatigue, shortness of breath, sore tongue, headache, pallor). Some patients may note a relief of symptoms after a few days of therapy. Periodic laboratory tests are necessary to monitor the results of therapy.
Hallucinations occur in a wide variety of situations such as with migraine headaches, epilepsy, advanced syphilis and, particularly since the 1960's, as a result of external stimulus by drugs such as the extremely dangerous LSD and mescaline (derived from the peyote cactus). General descriptions are given by Oster (1970) and, with much more detail, by Kluver (1967).
Acute neurological effects of cannabis administration include headache, tremor, impaired balance, and impaired gross and fine motor coordination (37,38,40). The latter, especially in conjunction with drowsiness, increases the risk of motor vehicle accidents, falls, and other unintended injuries (41). Physical activity by subjects under the influence of cannabis should be limited and performed only in a protected environment that minimizes the risk of injury. Subjects should be advised not to drive, operate machinery, or engage in other potentially hazardous activities until it is clear that their coordination (and mental alertness) has returned to normal.
Esthesio-neuroblastoma, or olfactory neuroblastoma, is a rare tumor of neural crest origin that arises from olfactory epithelium (117). Having a peak incidence in the third decade of life and occurring most commonly in males, esthesioblastomas usually begin high in the nasal cavity, extend into the paranasal sinuses, and eventually erode intracranially via the cribriform plate. Transgression of dura, brain invasion, intraorbital extension, and cavernous sinus infiltration are potential sequelae of intracranial disease. Metastatic dissemination, usually to regional lymph nodes, lungs, or bones, occurs in up to 30 of patients at some time during their lifetime. Nasal obstruction, epistaxis, ocular symptoms, and headache are the most common presenting features. More than half of all tumors are of advanced stage at the time of diagnosis. The optimal treatment for this tumor is unsettled (117-119). When intracranial extension is demonstrated, a common, but not universally endorsed...
While many clinicians view headaches as primarily a psychological manifestation, it is imperative that a complete medical dental workup be performed. One of the prime causes of muscle tension headaches in the temporal area may be attributed to bruxism and dental malocclusion. To understand the relation between muscle tension headaches and the mouth, place the tips of the fingers of the right hand on the right temple and the left fingers on the left temple, as though ready to massage the sides of the head. Clench the teeth together, and feel the muscles bulge. When the mouth is closed, do all the teeth fit together comfortably When the mouth is opened, does the jaw shift to the right or to the left Do the muscles on the right and left temple contract equally on both sides If the teeth don't close comfortably and are sensitive to cold or to pressure, if the mouth can't be opened wide without the jaw deviating, if there are popping or grating sounds around the ears when the jaw is opened...
Two to three weeks after infection there is often a brief illness similar to but distinguishable from mononucleosis. Features include acute-onset fever with or without night sweats, myalgia, arthralgia, lethargy, malaise, diarrhea, depression, lymphadenopathy, sore throat, skin rash and mucocutaneous ulceration, and sometimes neurologic manifestations, often presenting clinically as headache, photophobia, and retroorbital pain. Examination of the blood reveals a temporary reduction in CD4V (and CD8+) T cell count, followed by a predominantly CD8+ lymphocytosis. This illness is often disregarded or misdiagnosed a high level of clinical suspicion should be triggered if there are relevant lifestyle considerations. Virus, viral nucleic acid, or viral p24 antigen may be detectable during the illness. Seroconversion (development of antibodies) coincides with resolution of the illness or follows shortly thereafter.
The negative outcomes of sexual harassment include physical, emotional, and job-related factors. In general, severity of sexual harassment determines strength of the reaction (Baker, Terpstra, & Larntz, 1990). Michelle Paludi describes the psychological effects of sexual harassment in her formulation of the Sexual Harassment Trauma Syndrome (Paludi & Barick-man, 1991). The syndrome contains a constellation of reactions emotional (anxiety, denial, anger, fear, shame) physical (headaches sleep disturbances stomach, respiratory, and urinary problems substance abuse) self-perception (negative self-concept, hopelessness, powerless-ness, isolation) social (withdrawal, lack of trust, fear of others, sexual problems, changes in dress or physical appearance) and career (drop in performance, loss ofjob or promotion, absenteeism, changes in career goals). It is important to note that both male and female sexual harassment victims are equally traumatized by the experience the psychological...
Five patients received 2-12 subcutaneous and or intracutaneous injections of DC vaccine. No adverse effects were observed. DHT reaction was documented in three of of five cases. Disease stabilization was achieved in two patients (4 and 5 months, respectively). In two patients, the administration of vaccine was combined with low doses of cytostatic drugs (5-FU 500 mg plus cisplatin 20 mg at days 1-5, followed by DC vaccine injection, or cyclophosphamide 300 mg m2 3 days prior to the vaccine administration). Four vaccine injections were performed. No toxic reactions were noticed. DTH reaction was not achieved, and tumor progression was observed in both cases. One patient received intracutaneous injection of DC vaccine in combination with IL-1 p. Grade 1 fever and asthenia were observed within the first hour after injection but were easily compensated. Each vaccine administration was accompanied by DTH reaction of 2-14 mm in diameter. Minimal regress (
Vasopressin is used cautiously in patients with a history of seizures, migraine headaches, asthma, congestive heart failure, or vascular disease (may precipitate angina or myocardial infarction) and in those with perioperative polyuria. The drug is classified as a Pregnancy Category C drug and must be used cautiously during pregnancy and lactation.
Evidence indicates that migraine headaches may result from excessive blood flow in the brain area. To overcome this process, biofeedback techniques have been used to teach a person to adjust blood flow so that more blood goes to other parts of the body, such as the hands or feet, thus decreasing the headache symptoms. The monitoring device helps the person learn conscious control of blood flow increases to areas other than the head.
Or parasite) which must multiply within the gastrointestinal tract, producing widespread inflammation. The most commonly implicated microorganisms include species of Salmonella, Shigella, E. coli 0157 H7, etc. These infections have longer incubation periods than those experienced with food intoxications, usually commencing from 6-24 hours or longer after ingestion. Symptoms may include fever, headache, nausea, vomiting, diarrhea, abdominal pain or distress, and prostration. The causative organism may be identified by laboratory examination of the vomitus, feces, or blood and the suspected food, when available.
Evidence for caffeine dependence is found in the weekend headache. Many people become accustomed to early-morning ingestion of coffee, tea, or soft drinks but vary this routine on the weekend. Failure to have the early-morning beverage produces headaches and in some cases may produce depression as well.
48 million 21.6 million 13.6 million 14 4 billion 65 million 3 billion 100 billion Cancer pain, lower back pain, arthritis, headaches, fibromyalgia For others, chronic pain defined as that which no longer serves a biologically useful function is terribly debilitating and, according to researchers, can actually change the wiring in the brain, spinal cord, and nerve cells by triggering the release of proteins that cause tissue damage. Pain can actually become a disease in itself. Treating it is often a trial-and-error process in which sufferers consult numerous physicians and therapists trying to find the magical cure. Low-back pain is second only to the common cold as the most common cause of illness. Other common causes of pain are migraine headaches, fibromyalgia, arthritis, cancer pain, and that which results from traumatic injuries and degenerative disk disease. Table 4-10 shows the impact and extent of the problem caused by chronic pain.
This group of disorders with clearly identified pathophysiologic origins and effects have been traditionally understood to have significant psychoemotional components. Examples include asthma, migraine, encopresis, Tourette's Syndrome, and inflammatory bowel disease, all of which are known to include psychological stress as just one stimulus which may 'trigger' exacerbations or promote difficulties with the disease. Teaching self-hypnosis as an integral component of a comprehensive The effectiveness of hypnosis to regulate functions previously thought to be involuntary has now been well established in research. These include demonstration of self-regulation of peripheral temperature (Dikel & Olness, 1980), brainstem audio-evoked response (Hogan, Olness & MacDonald, 1985), transcutaneous oxygen flux (Olness & Conroy, 1985), salivary immunoglobulin (Olness, Culbert & Uden, 1989), migraine headaches (Olness, MacDonald & Uden, 1987), pulmonary function (Kotses, Harver, Segreto et al.,...
The most common side effects, occurring in up to one-third of patients, include anorexia, headache, nausea, vomiting, gastric distress, and apparently reversible oligospermia. Rash, pruritus, urticaria, fever, and hemolytic anemia are less frequent. Rare reactions such as blood dyscrasia (especially leukopenia), hypersensitivity reaction, and central nervous system reaction have been reported.
The system for case recording is widely accepted, and indeed many hospital units now supply printed proformas as aides-memoire. At first, case records can seem baffling because of the extent to which abbreviations are used. Because of pressure of time in clinical practice, these are acceptable but should not be overused. Those which are widely recognised have been included in the texl. A particular feature is the use of the prefix to signify no', for example tenderness, or headache. Obscure acronyms should be avoided.
In excessive menstrual bleeding, alleviation of premenstrual syndrome, and some protection against pelvic inflammatory disease. Adverse effects include nausea, headache, breast tenderness, water retention, and weight gain, some of which disappear after prolonged use. There is no evidence that fertility is reduced after discontinuation of the pill.
Chronic lymphocytic leukemia (CLL) is the most common form of leukemia representing approximately 30 of all leukemias.50 Chronic myelogenous leukemia (CML) accounts for 7-15 of leukemias in adults.50 Both leukemias have an initial chronic phase which transforms into an accelerated and blastic phase. The prognosis of patients in the blastic phase is poor with low response rates to treatment and a median survival of only two to three months.51 Leptomeningeal disease in both CLL and CML is extremely rare and, when it does occur, presents during the blastic phase of the disease. In a literature review of LM in CLL, Morrison found only 21 cases through 1998.52 Patients have presenting symptoms similar to those of LM in the acute leukemias. These include headache, mental status change, and cranial nerve palsies. The diagnosis is made by the presence of leukemic cells in the CSF. Treatment regimens used are IT methotrexate and adjuvant CNS radiation, or CNS radiation alone. The majority of...
In the Philadelphia outbreak (Tsai et al 1979) fever was present in 97 malaise in 89 cough in 86 chills 74 dyspnea 59 myalgias 55 headache 53 chest pain 52 sputum production 50 diarrhea 41 at presentation. Sixty percent had a white blood cell count 10,000 per mm3 and 34 had bilateral pulmonary infiltrates on chest radiograph. When patients with LD are compared with those with community-acquired pneumonia due to other agents the patients with LD are more likely to have myalgias, headache, diarrhea, and a higher mean oral temperature at the time of presentation (Marrie et al 2003). They also present to hospital sooner after the onset of symptoms 4.7 days vs. 7.7 days (p 0.02). When patients with LD were compared with patients with bacteremic pneumococcal pneumonia, the following features were associated with Legionella pneumonia male sex odds ratio (OR) 4.6 95 confidence interval ( CI) 1.48-14.5 heavy drinking 4.8 (1.39-16.42) previous -lactam therapy 19.9 (3.47-114.2) axillary...
B.C., a 6-year-old first-grade student, was referred to a pediatric neurologist by his primary pediatrician for a neuro consult. He had presented with an acute onset of headaches, vomiting on waking in the morning, and progressive ataxia. The neurologist conducted a thorough neuro exam and ordered a CT scan, MRI, and lumbar puncture (LP) to look for possible tumor cells. When the LP revealed suspicious cells and the scans showed a tissue density, he was referred to a neurosurgeon for treatment of a suspected infratentorial astrocytoma of the posterior fossa.
The paroxysmal features and neurology of alternating hemiplegia of childhood are remarkable and fascinating. In their original report, Verret and Steele (128) described eight cases from the Hospital for Sick Children, Toronto they regarded the condition as infantile onset complicated migraine. Casaer (129) only managed to include twelve cases in a multicenter European flunarizine trial. Since then, ten patients were reported from Montreal (130), a further twenty-two patients from Aicardi's group in Paris (131), and most recently forty-four patients from Boston (132). These and other figures suggest that the condition has in the past been both underdiagnosed and underreported. Developmental delay, ataxia, and persistent choreoathetosis develop in the majority of children, and a few develop migraine with aura (case 3, Casaer 129 Silver and Andermann 130 ).
The most common neoplasm causing hypothalamic-pitu-itary dysfunction and hypogonadotropic hypogonadism is craniopharyngioma. It is a congenital tumor, which most commonly becomes symptomatic between the ages of 6 and 14 yr. At presentation, the most common symptoms are headache, visual disturbances, short stature, delayed puberty, polyuria, and polydipsia. Skull radiographs may show suprasellar or intrasellar calcification or an abnormality of the sella turcica. Computed tomography (CT) or magnetic resonance imaging (MRI) scans may reveal fine calcifications that are not apparent on routine skull radiographs. The structure of the tumor varies from solid to cystic. Treatment consists of surgery and radiotherapy, but the recurrence rate is high, even when complete surgical removal is attempted.
Benign paroxysmal torticollis in infancy (BPT). In BPT, infants have attacks of retro-, latero-, or torticollis that may last minutes to hours (115). In rare instances, they may last days. Typically, attacks begin in early infancy and remit by age 5. They may be triggered by movement, often in the early morning, and are heralded by irritability, pallor, vomiting, and in older children, clear ataxia. BPT is both a movement disorder and a migraine equivalent (116). Two patients with BPT in a recent series came from a family with familial hemiplegic migraine linked to a mutation in the voltage-gated calcium channel gene CACNA1A on chromosome 19 (117).
The typical enteric caliciviruses are also common, especially in young children. In contrast, the Norwalk group of viruses, now classified as members of the family CaHciviridae, tend to infect older children and adults, often in common-source outbreaks. The illness consists of an explosive episode of nausea, vomiting, diarrhea, and abdominal cramps, sometimes accompanied by headache, myalgia, and or low-grade fever.
Robert Stevens felt sicker and sicker, until he finally went to the emergency room of a hospital near his home in Boca Raton, Florida. The medical staff noted his fever, vomiting, and headache and tested his spinal fluid for infectious agents. They saw a few spores of Bacillus bacteria, which they might have dismissed as contamination if some of the hospital staff had not just taken a course on identifying possible germ warfare agents at the U.S. Centers for Disease Control and Prevention.
Isolated angiitis of the central nervous systen is a recently recognized vasculitic disorder primarily involving the
Patients are in their forties or fifties. Onset is highly variable, usually with a prodrome of 6 months. The most common symptoms are headaches, which can spontaneously remit for long periods. Nonfocal neurologic deficits are characteristic, including a decrease in cognitive function. Any anatomic area can be involved with signs and symptoms, which range from transient ischemic attacks, strokes, paraparesis, and cranial neuropathies to seizures. Cerebrospinal fluid analysis findings are abnormal in more than 90 of patients and include modest pleocytosis, normal glucose levels, and increased protein. The cerebrospinal fluid should be cultured and infection ruled out. MRI and CT have made diagnosis easier suggestive findings include multiple, bilateral supratentorial infarcts. Angiography has proved less useful. Histologic confirmation through leptomeningeal biopsy is the gold standard. Therapy is with corticosteroids and cyclophosphamide (CTX) and is usually continued for 6 to 12...
Torticollis is an abnormal sustained posture of the head and neck in which the head tilts to one side and the face rotates to the opposite side. In paroxysmal torticollis, the events begin and end suddenly. The attacks can be brief or prolonged. The child is alert and responsive during an attack although the patient may appear uncomfortable and irritable. The EEG is normal during the event. The etiology of the attacks is unknown, although both a focal dystonia and labyrinth dysfunction have been suggested as the cause, as has migraine. Often a family history of migraines is noted, and children with benign paroxysmal torticollis may develop typical migraines later in life. Paroxysmal torticollis usually begins in the first few months of life, and resolves by age 3 years. No treatment is required (24).
A CT-guided fibrin patch may be successful in treating postlaminec-tomy headache secondary to dural tear (Figure 17.2). MRI may be helpful to help identify and characterize the site of the tear and the extent of pseudomeningocele formation (Figure 17.3). CT guidance can then be used to drain the pseudomeningocele and patch the tear at the same time, thereby saving the patient from a major repeat surgery. Most spine surgeons dread such a complication and are grateful for this service. The fibrin patch can also be administered under fluoroscopic guidance by means of the same technique described for EBP.
There are a few patients with unusual forms of XALD. Patients have been reported with predominantly cerebellar ataxia or a spinocerebellar syndrome. One patient, aged 57 years, has been reported who showed rapid neuropsychiatric deterioration and signs of cerebral demyelination at the site of a severe cerebral contusion suffered several months previously. Cerebral XALD presents rarely as an acute encephalopathy with seizures, status epilepticus, headache, vomiting, lowering of consciousness, or even coma. Papilledema may be seen. The presence of fever may suggest encephalitis. After this acute episode, the patient recovers with temporary en-cephalopathic signs, which resolve in the course of days and weeks.
Rhinology 39 233-235 Bollen E, Vielvoye J, Van Dijk JG et al (1990) Trigeminal neuralgia-like pain in an aged woman with fibrous dysplasia of the skull. Headache 30 277-279 Boysen ME, Olving JH, Vatne K et al (1979) Fibro-osseous lesions of the cranio-facial bones. J Laryngol Otol 93 793807 sinus causing headaches. J Laryngol Otol 98 1147-1149 Liens D, Delmas PD, Meunier PJ (1994) Long term effects of intravenous pamidronate in fibrous dysplasia of bone. Lancet 343 953-954 Lim CC, Dillon WP, McDermott MW (1999) Mucocele involving the anterior clinoid process MR and CT findings. AJNR Am J Neuroradiol 20 287-290 Lloyd G, Lund VJ, Savy L et al (2000a) Optimum imaging for
The lids normally cover the upper and lower margins of the iris. The palpebral fissures should be symmetrical. The palpebral aperture is narrowed in blepharospasm (spasm of the eyelids) and photophobia (light sensitivity), which are often associated with painful eye conditions. Photophobia also occurs in migraine and in association with meningeal irritation.
Postmenopausal women are, by definition, already hypogonadal and markedly hypoestrogenemic. Hyperprolactinemia in this age group does not, therefore, present with classic symptoms and may be recognized only when a large pituitary adenoma produces headache and or visual disturbance. Headache
Common allergic symptoms Anaphylactic shock, angioedema, asthma attack, bronchospasm, chest pain, chill, choking, confusion, conjunctivitis, coughing, cyanosis, death, dermatitis, diaphoresis, dyspnoea, edema, erythema, feeling of imminent death, fever, flush, headache, hypertension, hypotension, hypoxemia, low back pain, lumbar pain, metabolic acidosis, nausea, pruritus, rash, rhinitis, skin eruptions, sneezing, tachypnea, tingling sensations, urticaria, and wheezing Unique symptoms
Subacute or chronic meningitis is characterized by a gradual onset, often without any predisposing factor. These syndromes run their course over weeks, months or years. The clinical signs include headache, fever, stiff neck, and altered consciousness. Lower cranial nerve palsies may accompany basilar meningitis.
Of migraine, which contains both an analgesic and an anti-emetic. Similarly, some nonprescribed herbal or alternative remedies contain constituents that cause PRL elevation. Thus, a comprehensive drug history is essential. With regard to pathologic causes of hyperprolactinemia, it is important to exclude primary hypothyroidism. Modest hyperprolactinemia is present in 40 ofpatients, although only 10 have levels 600 mU L (24 g L). Nevertheless, some young women with hypothyroidism may present with menstrual disturbance and galactorrhea, together with few typical hypothyroid symptoms. Once venipuncture stress, pregnancy, interfering drugs, and primary hypothyroidism are excluded, significant hyperprolactinemia is usually associated with a pituitary adenoma (Table 2).
Children with ALL most often have clinically silent leptomeningeal disease diagnosed by lumbar puncture. When symptoms do occur, they are identical to other patients with leptomeningeal lymphoma and include headache, nausea, cranial nerve palsies, radicular pain and weakness. In a review of 83 children with ALL, Ritchey et al found that 75 of the patients were asymptomatic at the time of diagnosis of CNS disease.36
In the meantime, clinical applications of electrical brain stimulation have gained world-wide acceptance in the treatment of movement disorders. Indications have been extended and Medtronic Inc., the major manufacturer of such implants, uses its products in clinical tests to pulse the thalamus for the treatment of epilepsy another region of the deep brain to treat migraines, depression, and obsessive-compulsive disorder the hypoglossal nerve in the neck to treat sleep apnea the sacral nerve to treat bowel disorders and the stomach to treat obesity. Parallel to the efforts of modelling and duplicating neural networks, efforts are underway to establish improved connections between electrodes and neurons.
Many patients with chronic rhinosinusitis present nasal obstruction as the primary complaint. Other symptoms include nasal discharge, postnasal drip, facial pain, dysosmia, chronic cough, and headache. Headache is usually dull and radiating to the top of the calvarium or bitemporal for sphenoid or posterior ethmoid disease. Pain at the glabella, inner can-thus, or between the eyes suggests anterior ethmoid or frontal rhinosinusitis. Pain over the cheeks most frequently suggests maxillary rhinosinusitis.
To summarise, different types of mutations in the a1A-subunit of the voltage-gated Ca2+ channel produce three human diseases episodic ataxia type-2, familial hemiplegic migraine and spinocerebellar ataxia type-6. EA-2 is caused by truncation of the protein within the third repeat, FHM is associated with missense mutations, and SCA6 is produced by expansion of a polyglutamine repeat in the C-terminal coding region of the protein. All three diseases result in cerebellar atrophy, but they differ in the extent and rate of progression of neuronal degeneration. The relative severity of other symptoms also varies for example, migraine is most severe in FHM patients. The key question is how the different mutations in CACNL1A4 relate to the different phenotypes. The answer to this question, however, will have to await analysis of the properties of the mutant Ca2+ channels.
Metastatic deposits from any systemic and hemopoietic malignancies occasionally involve the sellar region (1). A favored anatomic target for such deposits is the posterior lobe of the pituitary. The predilection of metastatic tumors for the posterior lobe of the pituitary relates to its blood supply. In contrast to the anterior pituitary, which has a somewhat tenuous and indirect supply from the portal circulation, the posterior lobe derives its circulation directly from the carotid arterial system. Although the majority of metastatic tumors in this region occur in the context of advanced malignancy, occasional posterior lobe metastases may be the first sign of an unrecognized neoplastic process (150,151). Of the metastatic cancers, breast is the most common primary, followed by lung and prostate (150,151). Hemopoietic malignancies that may present with a posterior lobe deposit include the solitary plasmacytomas (which usually evolve into multiple myelomas) as well as various...
The differential diagnosis of claudication should also include occupational diseases with recurrent blunt trauma. Claudication can be iatrogenic in etiology, particularly among patients who suffer from migraine attacks and consume high doses of ergot containing preparations. Ergotamine derivatives can cause coronary spasm, peripheral vasospasm, and claudication (4). Arteritis associated with collagen vascular disorders, temporal arteritis (4), and Takayasu's disease (70,71) can also be causes of claudication. Infrequently, claudication can be the presenting symptom of congenital arterial narrowing or of fibromuscular hyperplasia (4). Popiteal artery aneurysm, almost always related to atherosclerosis, is another surgical disease that causes claudication, rest pain, skin ischemia, and gangrene. Ultrasonography is the most useful
Patients with intermittent CSF leak frequently complain of headache, which appears whenever rhinorrhea stops and CSF pressure increases (Beckhardt et al. 1991). Symptoms and signs such as headache, vomit, or edema of the papilla are suggestive for intracranial hypertension. If CSF leak is secondary to a neoplasm of the sinonasal tract invading the skull base, nasal obstruction, mucous rhinorrhea, epistaxis, visual impairment, and alterations of eye motility may be present. Both intracra-nial neoplasms and lesions involving the skull base from adjacent sites may cause neurologic signs and symptoms.
Be radicular and can be aggravated by stretching, coughing, or straining (22). Commonly discomfort may be localized to the back or may be felt in the extremities. Neoplasms of the spine can also compress and irritate the dura to create referred pain such as headaches. Motor deficits, paresthesias, and numbness in the legs are also associated with tumors of the spine. Invasion of the posterior elements can cause focal tenderness but neurological symptoms are often absent. Lesions that are destructive to the bone of the spine can cause pathological fractures that result in cord compression. Tumor causing cord compression or epidural extension along the nerve root can create spinal pain, myelopathy, and or radiculopathy. Primary benign lesions, such as osteoid osteoma, are often symptomatic at night and present with spinal stiffness, torticollis, and scoliosis. Therefore, because of the varied presentations, the most obvious cause of the pain or neuropathy from tumors and metastases may...
The clinical presentation of LM in patients with NHL is similar to that seen in patients with LM from solid tumors. However, patients with hematologic malignancies present with a higher frequency of cranial nerve signs as initial manifestations of LM.3 Since LM involve the entire neuroaxis, their clinical symptoms and signs are typically divided into three general groups 1) cerebral hemispheres, 2) cranial nerves and, 3) spinal cord and nerve roots. The most frequent presenting symptoms signs are mental status change and headache followed by cranial nerve palsy and focal weakness or numbness.
The symptoms of malaria are recurrent chills, fever, and sweating. The symptoms peak roughly every 48 h, when successive generations of merozoites are released from infected red blood cells. An infected individual eventually becomes weak and anemic and shows splenomegaly. The large numbers of merozoites formed can block capillaries, causing intense headaches, renal failure, heart failure, or cerebral damage often with fatal consequences. There is speculation that some of the symptoms of malaria may be caused not by Plasmodium itself but instead by excessive production of cytokines. This hypothesis stemmed from the observation that cancer patients treated in clinical trials with recombinant tumor necrosis factor (TNF) developed symptoms that mimicked malaria. The relation between TNF and malaria symptoms was studied by infecting mice with a mouse-specific strain of Plasmodium, which causes rapid death by cerebral malaria. Injection of these mice with antibodies to TNF was shown to...
Chronic fatigue syndrome (CFS) involves persistent fatigue of no known cause that may be associated with impaired memory, sore throat, painful lymph nodes, muscle and joint pain, headaches, sleep problems, and immune disorders. The condition often occurs after a viral infection. Epstein-Barr virus (the agent that causes mononucleosis), herpesvirus, and other viruses have been suggested as possible causes of CFS. No traditional or alternative therapies have been consistently successful in treating CFS.
The arthropodborne flaviviruses cause diseases of different levels of severity. The infections are typically biphasic with an initial, not very characteristic phase including fever, headache, muscle pain, and in some cases exanthem (Denguelike disease). This phase in-
From the stimulation of facial and scalp nerves. Between 5 and 20 of patients experience headaches after rTMS sessions. Some transient cognitive changes have been observed. However, there is no indication that TMS causes brain damage. rTMS on the dorsolateral prefrontal cortex has been used in healthy subjects to elucidate the basic neurophysiology of mood modulation. In depressed patients, antidepressant effects of rTMS are transitory and, therefore, a maintenance strategy needs to be developed in order to make rTMS useful in a clinical setting. As a research tool, though, rTMS definitely seems to be a promising technique.
Was, until recently, a regular practice in the radiological evaluation of pituitary adenomas further emphasizes the fact that aneurysms do periodically involve the sellar region, and their exclusion is essential. Fortunately, one of the many benefits of MRI is its ability to exclude an aneurysm as a potential aetiology of a sellar region mass, thus obviating the routine use of angiography. The majority of aneurysms involving the sellar region derive from the intracavernous segment of the carotid artery, and less often from the supraclinoid carotid and the anterior communicating artery complex. The clinical picture may be indistinguishable from a NFPA or other sellar mass headache and retro-orbital pain, visual symptoms, low-grade hyperprolactinemia, and, less commonly, hypopituitarism and DI may all be presenting features. Should such aneurysms erode into and occupy the sella, the resulting sellar enlargement can be indistinguishable from that occurring with pituitary adenomas or...
Cerebrospinal fluid leaks are a natural consequence of placing catheters in the subarachnoid space. The opening created in the dura mater by the introducing needle will be larger than the entering catheter, creating a predisposition to some potential leakage. The dura mater has a moderate amount of elasticity, and this property probably accounts for why the incidence of leaks is not higher. If the particular technique used seems to result in a relatively high incidence of spinal headache or CSF collection under the skin, a blood patch injecting 10 to 20 mL of autologous venous blood one level above the catheter entry point or at the entry point under fluoroscopic control may prevent CSF leakage.
Another study reported the results following treatment with sustained-release cytarabine in 43 patients with carcinomatous meningitis from breast cancer.14 Sustained release ara-C 50 mg was administered every two weeks for one month responding patients were then given up to three months of consolidation therapy. The intent-to-treat response rate was 21 (CI 95 1234 ). Median time to neurologic progression was 49 days (range, 1-515+), median survival 88 days (range, 1-515+). The major adverse events were headache and transient arachnoiditis. Headache occurred on 11 of cycles 90 were grade 1 or 2. Transient arachnoiditis occurred on 19 of cycles 88 were grade 1 or 2. three months of consolidation therapy and then four months of maintenance therapy. The response rate was 71 for SR-ara-C and 15 for ara-C on an intent-to-treat basis (P 0.006). There were no significant differences in time to neurologic progression or survival however, when comparing SR-ara-C to conventional ara-C (median,...
With the exception of headaches, there is nothing at all about what it is like to have experiences, in and of itself, that would suggest to one that they are states of the brain. Focusing on our experiences and mental states and asking the question of what sort of things they might be is something we may do for the first time in an introductory philosophy class perhaps reading Descartes' Meditations. It does not seem that we are encountering our own brains' states. But that does not mean that if one is antecedently convinced that mental states are states of the brain, dwelling on what it is like to have experiences should persuade one to give up that view or to deny, as some physicalists think they must, that experiences and their subjective characters have a straightforward and robust existence.
Evolution of a tumor in a young patient with intractable partial seizures of 2 years' duration. The CT findings were negative. A. First MR image axial (2000 30) study shows a heterogeneous lesion on the left mesial temporal region. Calcifications were present. Pathologic examination demonstrated oligodendroglioma. B. Follow-up MR image (675 10) 1 year after surgery. The patient was seizure-free and not receiving medication. C. Follow-up MR image 2 years after initial surgery. Headaches had developed. An abnormal signal was detected with a lesion in the posterior temporal lobe. Biopsy revealed an anaplastic astrocytoma. FIG. 4.62. Evolution of a tumor in a young patient with intractable partial seizures of 2 years' duration. The CT findings were negative. A. First MR image axial (2000 30) study shows a heterogeneous lesion on the left mesial temporal region. Calcifications were present. Pathologic examination demonstrated oligodendroglioma. B. Follow-up MR image (675 10) 1...
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Are Headaches Taking Your Life Hostage and Preventing You From Living to Your Fullest Potential? Are you tired of being given the run around by doctors who tell you that your headaches or migraines are psychological or that they have no cause that can be treated? Are you sick of calling in sick because you woke up with a headache so bad that you can barely think or see straight?