Foods to avoid if you have Migraines

The Migraine And Headache Program

In this simple program you'll learn: 5 Body balancing techniques that free your diaphragm to do its actual job of pumping fresh air into your lungs. This will ensure that your body will have enough resources to do what needs to be done including healing your headaches. Simple breathing technique that boost your oxygen level. In a few minutes of practice, your blood may carry 20% more oxygen to your brain. This can immediately reduce even the worst headaches. Other breathing exercises that spread the oxygen delivered to the brain evenly. The parts of the brain that are often highly oxygen deprived will finally receive fresh oxygen on a plate. Simple head muscle exercises that remove tension from the muscles around the head such as the the jaw, the tongue, the throat, and the eyes. These exercises can quickly relieve tension from the head and eliminate headaches in just a few seconds. New revolutionary neck exercise that removes tension from the neck. Tension in the neck muscles does not only block blood flow to the brain, but will also not support the veins in pumping the blood which is their actual function. Some people experience blast of energy rushing up to their head after doing this exercise. Read more here...

The Migraine And Headache Program Overview


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Psychological Treatment Outcome of Headache

A beneficial manner of reporting outcome is the average proportion or fraction of a sample of headache patients who achieve a clinically significant reduction in headache activity, as documented by a daily headache diary. In chronic pain, a patient with 50 or greater reduction in pain activity has traditionally been considered a treatment success. The three primary psychological approaches to headache are relaxation therapy, biofeedback, and cognitive-behavioral therapy. Because they are felt to have both psychological and physiological effects, the first two approaches are frequently called psychophysiological interventions. In practice, they are often combined with each other as well as cognitive-behavioral therapy. Please refer to the appropriate sections of this encyclopedia for more detail concerning these treatments.

Cluster headaches migrainous neuralgia

Seventy-five per cent of cluster headaches occur during sleep and they often appear at the same time each night for several weeks before going into remission. They are most common in REM sleep, and at the transition between REM and NREM sleep. Metabolic activity is increased during these episodes in the cingulate gyrus and hypothalamus close to the supra-chiasmatic nuclei. This probably alters the balance between parasympathetic and sympathetic systems to cause the unilateral vascular and secretory changes which underlie the clinical features. The headaches may worsen during REM sleep rebound when REM sleep suppressant drugs such as tricyclic antidepressants are discontinued, and may be exacerbated by obstructive sleep apnoeas.

Special Headache Populations

There is now a sizable body of research attesting to the efficacy of thermal biofeedback with pediatric migraine. In addition, headaches in the elderly can also be effectively treated with biofeedback and relaxation techniques, as can those individuals who consume excessive levels of medication. A number of investigators have demonstrated that a combination treatment including relaxation therapy and biofeedback is efficacious for treating headaches during pregnancy. Because pregnant women are not able to use most pain medications, many experts have suggested that techniques such as the psychophysiological interventions and psychotherapy should be the first-line intervention for headaches during pregnancy.

Description of the Major Types of Headache

Migraine headache is episodic and characterized by a throbbing, pulsating, or pounding type of pain that generally starts on one side of the head, although, as the headache progresses, it often encompasses both sides. It typically starts over an eye or in the temple region and can last anywhere from 2 hours to 3 days. Frequently it is accompanied by nausea and, sometimes, vomiting, as well as sensitivity to noise (termed phonophobia) and, especially, light (termed photophobia). A migraine can occur on a frequency of two a week to only one or two a year the average migraineur has one to two headaches a month. Approximately 10 of migraine headache patients have a prodrome that is, preheadache symptoms that can occur up to 30 minutes before a headache, such as seeing flashing lights or squiggly lines, experiencing a disturbance in speech, or experiencing a tingling, burning, or pricking feeling in the arms or hands (termed paresthesia). Those migraine headache sufferers with a prodrome...

Combined Migraine Tension Headache

For patients with both kinds of the primary benign headache disorders (migraine and tension-type), the results with thermal biofeedback alone are a bit lower, averaging 30-45 success relaxation training alone leads to 20-25 success. The best results come when thermal biofeedback and relaxation training are combined. With this combination treatment, results show 50-55 success rates (adding thermal biofeedback to relaxation raises success from 20 to 55 adding relaxation therapy to thermal biofeedback increases success from 25 to 55 ). Most experts strongly recommend a combination of the two treatments for these headache sufferers.


Migraines have a complex relationship to sleep. They are often relieved during the day by sleep but, conversely, may develop after waking from sleep, particularly REM sleep, at night. Migraines are commoner when the subject is tired, and possibly after oversleeping, and they are often followed by sleepiness. They are commoner in sleep walkers and narcolepsy than in normal subjects, and changes in 5HT neurotransmission may be responsible. The link between migraine and sleep may reflect alterations in autonomic function, possibly related to changes in 5HT transmission, between sleep and wake states.

Malignant Migraine

Various oxidative phosphorylation defects occur in the brain, although how they relate to the production of migraine is speculative. Migraine affects as much as 25 percent of the population and is frequently seen in maternal relatives of patients with diseases of oxidative phosphorylation. Malignant migraine refers to three situations migraine patients who turn out to have MELAS migraine patients who are maternal relatives of patients with oxidative phosphorylation diseases and who are unresponsive to the usual prophylactic medications and migraine patients who develop strokes. Blood should be tested for biochemical and mtDNA defects of oxidative phosphorylation. If the blood tests are negative, muscle biopsy should be done for routine pathology, histochemistry and electron microscopy, oxidative

Tension Headache

With tension headache, the biofeedback approach used is electromyographic (EMG muscle tension) feedback from the forehead, neck, and or shoulders. For relaxation therapy alone, successful treatment outcomes generally range from 40 to 55 for EMG biofeedback alone, this value ranges from 50 to 60 , and for cognitive therapy, from 60 to 80 . When EMG biofeedback and relaxation are combined, the average number of treatment successes improves from about 50 to about 75 when relaxation and cognitive therapy are combined, success increases from 40 to 65 .

Migraine Headache

For patients with pure migraine headache, hand surface temperature (or thermal) is the biofeedback modality of choice, and it leads to clinically significant improvement in 40 to 60 of patients. Cognitive therapy by itself achieves about 50 success. A systematic course of relaxation training seems to help when added to thermal biofeedback (increasing success from about 40 to 55 ), but cognitive therapy added to the thermal biofeedback and relaxation does not improve outcome on a group basis. Relaxation training alone achieves success in from 30 to 50 of patients, and adding thermal biofeedback boosts that success (from about 30 to 55 ).

Rays Ultrasounds and Other Diagnostic Pictures

A number of additional x-ray tests may use contrast dye with iodine that can interfere with radioactive iodine. Most blood vessel x-rays, called angiograms (including cardiac catheterizations), and special gallbladder x-rays use iodine dyes. If your physician considers your chest pain to be an emergency, needing a heart catheterization evaluation, or you have a severe headache that makes your doctor worry about an aneurysm in your brain, then you should permit the doctor to use any iodine contrast dye needed to evaluate and take care of you. On the other hand, if it isn't a life-threatening situation, ask the physician to avoid using iodine contrast dye until your thyroid cancer physician can be consulted.

Evaluation Guidelines Table31

Electroencephalography (EEG) is helpful in the evaluation of seizure disorders and metabolic encephalopathy and, to a lesser extent, for documentation of regional physiological malfunctions. In patients with psychosis, the EEG should be normal, whereas metabolic disorders can cause disorganization and generalized slowing. The EEG can reveal physiological abnormalities that may not be reflected on structural imaging studies. Old trauma, a postictal state, or migraine headache may be associated with behavioral abnormalities and may cause focal EEG findings when the mRi is normal. Rarely, disorders of emotion, mood, or thought with subclinical seizures or complex partial status epilepticus may be diagnosed only with EEG. The use of evoked responses in neuropsychiatric disorders remains a research tool except when organic explanations such as multiple sclerosis are being actively considered.

Clinical Presentations

Acute effects from CNS-directed therapy are relatively uncommon. Acute radiation changes to the CNS can result in significant edema at the irradiated site (often following single dose therapies such as gamma knife or stereotactic radiosurgery) and may present with worsening of pre-existing symptoms (i.e. seizure, weakness, headaches). These symptoms, when they occur, are usually manageable with corticosteroid therapy 56 . Acute effects of chemotherapy on the CNS are also relatively uncommon. Ifosfamide has been associated with changes in mental status, cerebellar function, cranial nerve function, and cere-bellar and motor system function, as well as with seizures 57 . The risk of this acute toxicity may be exacerbated by prior chemotherapy exposure, specifically exposure to cis-platinum 58 . Ara G, a new antimetabolite with selective efficacy against T-cell leukemia, is also associated with acute neurotoxicity. Somnolence and other acute CNS changes may be dose-limiting for this new...

Health Effects Of Indoor Fungal And Bacterial Growth

It is well established that fungi and bacteria have known health effects in humans.3'12'25 Many species of fungi and bacteria can cause infections. They also produce a wide range of chemical byproducts, from microbial volatile organic compounds (MVOCs), endotoxins, and fungal glucans, to mycotoxins. Fungi include allergens and triggers of asthma. Fungal glucans are inflammatory in the lung and have been reported to be associated with headaches. Mycotoxins have a wide range of health effects, primarily in ingestion exposures. Although airborne

Transient Global Amnesia

In the posterior circulation, but seizure activity and migraine attacks have also been posited as a mechanism in some cases. In patients with this syndrome, an EEG may show abnormalities, although in most cases the findings are nonspecific. Attacks recur in less than 25 percent of patients, and fewer than 5 percent have more than three. The frequency of seizures or subsequent strokes is no different from that in a comparable age-matched population. No special treatment is indicated for these unusual cases of transient but traumatic memory impairment.

Writing Topics and Your Career

If you are in private practice with no aspirations to an academic career or research grant funding, then you might skip this short section. However, if you are a faculty member seeking academic advancement (promotion and tenure) or a research position, the following can be important career advice. Here it is Find your topic early in your career and stick with it as long as your can. The career topic will be what you write about. It will also be the subject of your research, and perhaps why you receive patient referrals. For example, for years I have written on migraine headaches. Clearly because of my writing review articles and book chapters on this topic, I as a family physician became a leading headache referral physician in our academic medical center. I received more headache patient referrals than I really wanted, all because of writing on the topic.

Bolivian Hemorrhagic Fever Machupo

This disease is localized in several provinces of Bolivia in the Amazonian lowlands and is endemic in local rodent (Calomys) populations. Exposed humans have an incubation period of about 2 weeks. Patients manifest high fever for at least 5 days, along with myalgia, headache, conjunctivitis, cutaneous hyperesthesia, nausea, and vomiting. Hemorrhagic manifestations occur in some 30 percent of patients serious bleeding is possible. Hypotension in the second week of illness is seen in about 50 percent of patients - in many proceeding to hypovolemic shock and death. Symptoms of central nervous system involvement appear in almost half of the cases. The death rate in several epidemics has been about 25 percent. Convalescence is protracted. Pathological findings include generalized adenopathy and focal hemorrhages in various organs. No specific therapy is known. Treatment is limited to supportive measures. Rodent control in homes and villages has proven effective in controlling epidemics as...

Clinical Presentation

In cases of cervical myelopathy secondary to cervical spondylosis, symptoms are usually insidious in onset, often with short periods of worsening followed by long periods of relative stability.77 Acute onset of symptoms or rapid deterioration may suggest a vascular etiology.71 Unlike cervical radiculopathy, cervical myelopathy rarely presents with neck pain instead, patients report an occipital headache that radiates anteriorly to the frontal area, is worse on waking, but improves through the day.72 Patients also report deep aching pain and burning sensations in the hands, loss of hand dexterity, and verte-brobasilar insufficiency, presumably due to osteophytic changes in the

Clinical Manifestations

As the disease is currently found less frequently, its clinical presentation can be easily confused. A high index of suspicion is necessary for establishing diagnosis, depending mainly on epi-demiological grounds, as the classic triad of fever, headache, and rash, which are considered the prominent manifestations of the disease, is of limited usefulness for an immediate or early diagnosis. The illness usually presents with an abrupt onset of symptoms following an incubation period of 6 to 14 days (73). In our study of 83 consecutive cases of murine typhus in the island of Crete, Greece (14), the most common clinical manifestations were fever (l00 ), headache (88 ), chills (87 ), and rash (80 ). Forty-nine patients (59 ) presented with rash, whereas 17 additional patients (20 ) developed rash during hospitalization. Similar rates were found in another study at the island of Euboea, Greece (34). Other investigators report the following most common presenting symptoms fever (in 96 of...

Other actions and sideeffects

3 Peripheral sympathetic and motor effects, including a rise in body temperature, tachycardia, palpitations, mild hypertension, nausea, vomiting, abdominal cramps, dry mouth, headaches and tremor. Hypertension may be severe, particularly during exertion, and lead to intracranial haemorrhage. Amphetamines

Antibiotic Susceptibility And Therapy

The in vivo efficacy of tetracyclines and chloramphenicol antibiotics against R. akari was recognized soon after the initial clinical recognition of rickettsialpox (146,147). Chloramphenicol and chlortetracycline (aureomycin) were utilized as effective therapies for patients with rick-ettsialpox as early as 1949 (148), and oxytetracycline (terramycin) was used therapeutically beginning in 1950 (149). Most patients defervesce and show improvement of constitutional symptoms (e.g., headache and myalgias) within one day after starting therapy with these drugs. Tetracyclines, particularly doxycycline, remain the drugs of choice for the treatment of rick-ettsialpox. In two contemporary case series documenting antibiotic responses in 28 patients who received tetracycline or doxycycline treatment for rickettsialpox, fever and other systemic symptoms resolved in most patients within 24 hours, and all patients became asymptomatic within 48 hours (22,24). Interestingly, two young children in...

Emtricitabine In Pediatric Patients Pharmacokinetics Efficacy And Safety

In the phase I study reported by Wang et al. (FTC-105), 13 of 29 adverse events (45 ) were considered drug-related. The most frequently reported adverse events were vomiting, diarrhea, abdominal pain, and headache. All drug-related adverse events were mild, and no subject experienced a treatment-emergence event of grade 3 or greater intensity. None of the abnormal test results was felt to be clinically significant (39).

Pathogenicity And Clinical Features

The pathogenic role of R.felis in humans was demonstrated by PCR and or serologic tests in many patients throughout the world (7,9,12,13). In 2000 in Mexico, three patients with fever, exanthem, headache, and central nervous system involvement were diagnosed as infected by R.felis by specific PCR on blood or skin and seroconversion to rickettsial antigens (12). Since then, high antibody titers to R.felis were found in two French patients with clinical rickettsial disease and 2 of 16 Brazilian patients with febrile rash (9). Serum of one of the Brazilian patients had specific sequences of R. felis (9). In 2002, two cases of typical spotted fevers were reported in an adult couple in Germany (13). Clinical features included fever, marked fatigue, headache, generalized maculopapular rash, and a single black, crusted, cutaneous lesion surrounded by a halo (on the woman's right thigh and the man's abdomen). The man had enlarged, painful lymph nodes in the inguinal region. Serologic...

Preoperative Evaluation

Preoperative evaluation of the sinus patient begins with a complete otolaryngologic history and physical examination 20 . The typical complaints that a patient with hyperplastic rhinosinusitis presents with polyposis are nasal obstruction and anosmia 24 . A significant number of patients will have a history of repeated sinus infections, headache, and may have a medical history significant for asthma and aspirin sensitivity 11 . Environmental allergy may also be prevalent 1 . Since the major complaint associated with hyperplastic rhinosinusitis and nasal polypo-sis is subjective in nature, many institutions advocate the use a preoperative sinonasal questionnaire. Many different questionnaires exist in the literature and all are focused on defining the baseline symptomatology of the disease as well as the level of exacerbation of the disease process 13 . (b) Headaches Facial pain

What are the symptoms in adults

The second stage starts when one or more areas of the skin break into a rash that usually does not itch. Rashes can appear as the chancre is fading or can be delayed up to 10 weeks. The rash often appears as rough, copper penny spots on the palms of the hands and bottom of the feet. The rash may also appear as a prickly heat rash, as small blotches or scales all over the body, as a bad case of old acne, as moist warts in the groin area, as slimy white patches in the mouth, as sunken dark circles the size of a nickel or dime, or as pus-filled bumps like chicken pox. Some of these rashes on the skin look like those of other diseases. Sometimes the rashes are so faint they are not noticed. Rashes last 2-6 weeks and clear up on their own. In addition to rashes, second stage symptoms can also include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness. A person can easily pass the disease to sex partners when first or second stage...

Rickettsia Heilongjiangensis Fareastern Tickborne Rickettsiosis

In 1992, several patients presenting with fever, headache, rash, eschar, regional lympadenopathy, and conjunctivitis following a tick bite in the same area were reported to have antibodies when tested with antigen of this rickettsia. Although complement-binding assays do not allow discrimination between spotted fever rickettsioses, Chinese investigators strongly suspected this species as a human pathogen (43).

Rickettsia Sibirica Mongolitimonae Lymphangitisassociated Rickettsiosis

A second human case of infection with R. sibirica mongolitimonae was diagnosed in 1998 in an HIV-positive patient who had gardened in a rural area of Marseille. The patient presented with fever, headache, an eschar, lymphangitis, and painful satellite lymphadenopathy (98). Following this case, a number of patients were diagnosed with R. sibirica mongolitimonae infection. From January 2000 to June 2004, seven additional patients were observed in France. In three of them, the bacterium was cultivated from the inoculation eschar. The other four patients were diagnosed using PCR from the eschar (two patients) or blood (two patients), plus specific Western blot before (two patients) and after (two patients) cross-adsorption. headache, and fever. An eschar biopsy was used for PCR amplification of the rickettsial rOmpA gene which showed > 99 similarity with the corresponding rOmpA fragment of R. sibirica mongololimonae (100). More recently, a second African case was documented in a patient...

Rickettsiae Classified As Candidatus Species Candidatus Rickettsia amblyommii

Some investigators have speculated that R. amblyommii may be the same agent as R. texi-ana, a putative rickettsial pathogen associated with an epidemic of febrile, presumably tickborne, infectious disease known as Bullis fever that afflicted more than 1000 soldiers participating in field training exercises at Camp Bullis, Texas, during the spring and summer months of 1942 and 1943 (95). Considerable epidemiologic and entomologic evidence collected during the outbreak implicated an infectious agent transmitted by the bite of lone star ticks (96). Because all patients reported a history of tick bites, most notably bites from A. americanum, the disease was also initially referred to as Texas tick fever and lone star fever. Clinical features included fever, chills, orbital and postoccipital headache, weakness, weight loss, and leu-copenia. All patients demonstrated enlargement of at least some lymph nodes and many had a generalized lymphadenopathy. A maculopapular rash involving the trunk...

Cortical Sensory Activity Associated with Hallucinations

Regardless of the mechanism by which they are generated, hallucinations appear to be associated with activity in cortical sensory regions corresponding to their modality and complexity. The hallucinations previously described may be categorized as complex or formed. Noncomplex hallucinations are referred to interchangeably as simple, unformed, or crude. In the visual system, these are known as photop-sias. Occurring most frequently with migraines, they may also be seen at the onset of partial seizures, for the first few days following an infarction of the central visual system, and with disorders of visual input. Photopsias may consist of colored or colorless glittering spots, or black and white zigzag patterns known as fortification lines. They often occur unilaterally, but they may fill the entire visual field. Simple hallucinations are believed to reflect activity in primary sensory or adjacent early unimodal association areas and to correspond, in form, to the area's functional...

Other Valuable Uses for Beta Blockers

Beta-blockers are also effective medications to treat high blood pressure, prevent angina or heart attacks in people with cardiovascular disease, reduce the frequency of migraine headaches, and prevent panic attacks. This makes their appropriate use, in thyroid cancer patients, multifunctional. Sara has told me that her beta-blocker has also eliminated her panic attacks and feelings of jitteriness after eating (which she had wrongly attributed to hypoglycemia). In this context, the beta-blocker nicely balances the thyroid hormone suppression therapy (to keep TSH low) that is a mainstay of thyroid cancer treatment.

Subarachnoid Hemorrhage Syndrome

The clinical presentation of SAH is usually an abrupt onset of a severe headache, photophobia, nausea, vomiting, meningismus, and, often, unconsciousness and other neurological deficits (see Table 22.-2 ). In some instances, a premonitory headache, representing a sentinel bleed, may occur days to weeks before the presenting hemorrhage. Misdiagnosis of SAH occurs in up to 25 percent of cases. y A ruptured aneurysm should be suspected in patients complaining of sudden onset of the worst headache of my life, later onset of migraine headache with no family history of migraine, a change in the headache pattern in a known migraineur, severe localized and persistent headache, and severe vascular headaches that are refractory to conventional therapy.

Cerebral Venous Thrombosis

Intracranial venous occlusive disease is significantly less common than arterial disease. The symptoms can be nonspecific. The symptoms that are present depend upon the venous structure that is affected, the extent and rapidity of thrombosis, and the extent of venous collaterals. Common symptoms include headache, nausea, vomiting, altered consciousness, and seizures. Examination may show papilledema,

Types of Detectable Abnormalities

Figure 23-3 Middle-aged woman presenting with what she reported as the worst headache of her life and third nerve palsy. Acute subarachnoid hemorrhage is present in left-sided basal cisterns secondary to rupture of a posterior communicating artery aneurysm. Central lucency represents the aneurysm.

Neurological Applications in Diagnosis and Treatment

CT can often identify lesions responsible for cerebral dysfunction and is ordered in the acutely ill neurological patient with a history of trauma, stroke, worst headache of life, anticoagulation or bleeding diathesis, or seizure. In any case of suspected acute intracranial hemorrhage, intravenous contrast medium should not be administered because contrast medium enhancement and acute extravascular blood have similar attenuation characteristics. Likewise, evaluation for infarction should be performed without contrast medium enhancement to exclude hemorrhage and also because subacute infarction may show mild enhancement such that it is indistinguishable from normal cortex. Scans performed within the first 24 hours of clinical symptomatology of infarct may not reveal any detectable abnormality. Early signs of middle cerebral artery infarct include hyperdensity of the artery (thrombus, embolus), loss of differentiation of insular cortex and lentiform nucleus from...

Other paroxysmal neurological disorders

Understanding the phenotypic expression of the rare, monogenic channelo-pathies presented in this chapter may help elucidate similar mechanisms in other paroxysmal neurological disorders, such as familial paroxysmal dyskinesia, migraine and epilepsy. Familial paroxysmal dyskinesia is a rare group of disorders characterized by episodic involuntary hyperkinetic movement (Demirkiran & Jankovic 1995). A familial paroxysmal choreoathetosis syndrome associated with progressive spasticity mapped to chromosome 1p (Auburger et al 1996), while paroxysmal dystonic choreoathetosis not associated with spasticity mapped to chromosome 2q34 (Fouad et al 1996). Ion channels are candidate genes for these episodic movement disorders. Since migraine shares many features with known channelopathies, ion channels are likely sites of genetic defects in this heterogeneous and possibly polygenic disorder. In addition to CACNA1A mutations discussed in this chapter, two other loci on chromosome 1q have been...

A phagocytophilum Human Granulocytic Ehrlichiosis

A. phagocytophilum is an agent which causes human granulocytic ehrlichiosis. The disease is characterized by fever, headache, myalgia, leucopenia, anemia, and thrombocytopenia. The agent also causes granulocytic ehrlichiosis in horses. The clinical findings include fever, depression, anorexia, limb edema, icterus, ataxia, and reluctance to move (1) however, the disease is not fatal. In ruminants, it causes disease known as tick-borne fever or Pasture fever. The agent primarily infects neutrophils and other granulocytes of sheep, goat, cattle, and deer. Fever, moderately disturbed general condition, and reduced milk production and growth rate are reported as the main clinical findings (2). Respiratory signs such as nasal discharge and cough may also be present. Mortality is generally low, but secondary infection may cause death to the patients.

Abnormal EEG Activity

Slow activity sometimes occurs with a localized distribution and varies in rhythm, rate, and amplitude with time. Such a focal polymorphic slow-wave disturbance, when present continuously, suggests an underlying structural lesion involving the cerebral white matter ( iiFig. 24-2 ) but provides no clue as to its nature. Transient polymorphic slow-wave activity is suggestive of either migraine or a postictal state after a partial (focal) seizure.

Complications and Outcomes

The average length of stent placement was 5 weeks. More recently, in a 22-patient series by Batra et al. 1 , endoscopic patency of the frontal sinusotomy was 86 with a mean follow-up of 16 months. Headache and orbital symptom resolution or improvement was noted in 82 and 88 of the patients, respectively.

Mitochondrial Encephalopathy Lactic Acidosis and Strokelike Episodes

Patients may present sporadically or in maternal pedigrees, in infancy, childhood, or adulthood. Ihe overall course is of a progressive degenerative disease with strokelike episodes and a mitochondrial myopathy. Various symptoms appear singly or in combination and include hemiplegia, sudden cortical blindness, hemianopia, episodes of confusion and hallucination with fever, aphasia, migraine headaches in a maternal lineage preceding strokelike episodes, and maternally inherited diabetes mellitus type II and deafness. Multisystem complaints and signs include myalgia, fatigability, weakness, ophthalmoplegia, pigmentary retinal degeneration, cardiomyopathy, cardiac conduction defects and block, dementia, deafness, ataxia, myoclonus, seizures, lactic acidosis, and proximal renal tubule dysfunction.

Various Transporter Defects Hartnups Disease

Leading to the pellagra-like rash in late infancy or early childhood. Later, episodic neuropsychiatric symptoms appear--intermittent cerebellar ataxia and emotional lability to psychoses--together or separately and often triggered by poor nutrition and diarrhea, fever, or sun exposure. EEGs are nonspecific, and CSF studies are normal. Partial expressions, such as intestinal or renal tubular defects alone, may be seen. The differential diagnosis includes any cause of acute cerebellar ataxia in childhood postinfectious cerebellitis, brain stem encephalitis, posterior fossa tumor, and vestibular neuronitis. When attacks are intermittent, particularly with the mental symptoms, episodic disturbances such as nonconvulsive status epilepticus, acute confusional migraine, other toxic-metabolic encephalopathies, or demyelinating disease should be considered. The rash with neurological signs should bring to mind other vitamin deficiency diseases, such as thiamine or biotinidase deficiency.

Other Antiobesity Pills

Another antiobesity drug, sibutramine, was approved for use in 2001. Sibutramine is meant for people whose body mass index (BMI) registers at 27 or higher. But if you're on thyroid hormone, as well as medications for depression, seizures, glaucoma, osteoporosis, gallbladder disease, liver disease, heart disease or stroke prevention, kidney disease, migraines, or Parkinson's disease, you should discuss whether sibutramine is appropriate.

Toxicity And Adverse Events

The most frequent adverse events reported in patients enrolled in clinical trials of delavirdine were headache, fatigue, gastrointestinal complaints, and rash. Slightly more than one-third of patients receiving delavirdine had a rash. In North American and European trials, rash was the only side effect found to be associated with delavirdine by the various safety monitoring boards (25). This rash usually occurs 1 to 2 wk after therapy is started, is maculopapular in nature, and is more common in patients with more advanced immune disease. In 85 of cases, treatment can be continued, and the rash usually resolves during 2 wk. In the first 1000 patients, only one case of mild Steven's Johnson syndrome (with no long-term sequelae) was noted (25).

Congenital Myopathies

Presentation in these disorders is a floppy baby who has delayed motor milestones. In school, these individuals usually have difficulty in keeping up with their peers, either in sports or simply in walking. Some patients may present in later childhood or even as adults. Early weakness usually becomes manifest as difficulty in rising from a chair or the floor and in climbing stairs. In some patients with congenital myopathies, facial weakness or ophthalmoplegia is seen. In those in whom the disease has an early onset, the muscle weakness can lead to skeletal defects, causing dysmorphic features, kyphoscoliosis, and pes cavus. Diaphragmatic or chest wall involvement can give rise to respiratory weakness with carbon dioxide retention, particularly at night, causing morning headaches or daytime somnolence. Such respiratory weakness is usually a late feature of the congenital myopathies, but in nemaline myopathy it occurs early. As a rule, the congenital myopathies are stable or only...

Variations in Q Fever Clinical Presentation

We had the opportunity to compare the two main presentations (189 hepatitis, 79 pneumonia) the patients with hepatitis were younger, less frequently immunocompromised, had more often fever, headaches, myalgia, thrombocytopenia, and elevated ESR. Those with pneumonia more often had EKG abnormalities. Also, patients who presented without hepatitis or pneumonia were more frequently females.

Patrice L Weiss1 Rachel Kizony12 Uri Feintuch23 and Noomi Katz2

Patients under all circumstances (Kennedy and Stanney, 1996 Kennedy et al., 1997). Effects noted while using some VR systems can include nausea, eye-strain and other ocular disturbances, postural instability, headaches and drowsiness. Effects noted up to 12 h after using VR include disorientation, flashbacks and disturbances in hand-eye coordination and balance (e.g., Kennedy and Stanney, 1996 Stanney et al., 1998). Many of these effects appear to be caused by incongruities between information received from different sensory modalities (Lewis and Griffin, 1998). Other factors that may influence the occurrence and severity of side effects include characteristics of the user and the display, the user's ability to control simulated motions and interactivity with the task via movement of the head, trunk or whole body (Lewis and Griffin, 1998). VR systems which include the use of a head mounted display (HMD), have a greater potential of causing short-term side effects, mainly oculomotor...

Herta Flor1 and Frank Andrasik2

As an altered representation of the painful area in the brainstem (Tinazzi et al., 2000), thalamus (Vos et al., 2000) and cortex (Benoist et al., 1999). In chronic pain patients both perceptual and cerebral hyper-reactivity to tactile or noxious stimuli have been observed. For example, Kleinbohl et al. (1999) showed that patients with back pain as well as patients with tension headache sensitize more than healthy controls, that is, they show steeper increases in perceived pain intensity with repetitive painful stimulation. In addition, perception and pain thresholds as well as pain tolerance levels were found to be significantly lower in patients with chronic back pain compared to persons with episodic headaches and healthy controls, and these thresholds varied as a function of chronicity (the more chronic pain, the lower the threshold) (Flor et al., 2004). This chronicity distinction is particularly important when considering tension-type headache. Chronic forms of tension-type...

Hypercapnic respiratory failure

Chronic hypercapnia during wakefulness is an infrequent, but well-recognized complication of OSA 18 . It may present with early morning headaches in addition to excessive daytime sleepiness and other features of OSA. It is often associated with right heart failure and this combination represents the clinical picture of what was in the past known as the 'Pickwickian syndrome' or obesity hypoventilation syndrome (OHS). This comprises obesity, which is a risk factor for OSA, with excessive daytime sleepiness and respiratory and right heart failure, which is due to pulmonary hypertension.

Snake Scorpion and Spider Venoms

Clinical Features and Associated Findings. The clinical presentation of persons with a snake bite include localized pain and swelling, headache, vomiting, loss of consciousness, paresthesias, ptosis, loss of vision secondary to coagulation disturbances, and hemorrhage into the retina. Symptoms after snake bite may develop in from 1 to 10 hours. Beginning signs of paralysis include difficulty with swallowing and opening the mouth. Depending on the species, scorpion stings may include both local and systemic complications. Early symptoms include pain, swelling, excessive salivation, sweating, and abdominal pain. Death may result from hypertension, peripheral circulatory collapse, and cardiac failure. Neurological sequelae are more common in children than in adults and include overexcitement, muscle rigidity, convulsions, and alteration of mental status, which is probably secondary to hypoxia. In those with spider bites, neurological sequelae include paresthesias, fasciculations, tremor,...

Natural history of obstructive sleep apnoeas in adults

OSA is usually preceded by many years of stable snoring which then worsens gradually or sometimes quite rapidly before the symptoms of OSA become prominent. Weight gain may accelerate the deterioration at the time that OSA is evolving from simple snoring. Snoring which can be reliably dated to childhood and which is still a problem in adult life is often due to enlarged tonsils or a skeletal abnormality of the face or mandible. Occasionally, OSA arises suddenly in adult life, in which case it is usually due to an identifiable event such as a stroke or facial injury, or to the development of a contributory disorder such as hypothyroidism. Nocturia, early morning headaches due to hypercapnia, and features of right heart failure develop late in the natural history of OSA.

Depression and Behavioral Disorders

Although many healthcare providers may believe that high rates of depression or behavioral disorders are common in cancer survivors, there is little evidence that this is the case. While parents tend to see higher than average levels of somatic symptoms in children (e.g. headaches, stomachaches, toileting issues 39, 43 ), most research indicates no unusual levels of psychological symptoms in survivors during childhood and adolescence. Across a number of studies, overall rates of depression 42 ,behavioral disorders 41,43 and other general psychological symptoms 9, 31, 55 reported by children and their parents have been comparable to rates reported by children who have never had cancer. Similarly, survivors appear to have no more social anxiety, loneliness or body image concerns than do their never-ill peers 46 , and they may even have a more positive self-image than their peers 3,35 .

Clinical Features and Associated Findings

Patients who developed paralytic poliomyelitis may initially have had clinical symptoms of fever, malaise, headache, and gastrointestinal or upper respiratory tract symptoms. These symptoms subsided, only to recur after several days in association with increasing signs of meningeal irritation, headache, and stiff neck. When the illness progressed to the paralytic form, muscle soreness was prominent, particularly in the back and neck. Patients who developed paralysis usually did so on the second to fifth day after meningeal signs and fever became evident. Once weakness began, it typically progressed for only the first few days after its onset. The fever persisted for several days but often subsided before the paralysis was complete. Patients complained of severe muscle pain and spasms with asymmetrical flaccid muscle weakness that usually affected a lower extremity. Severe bulbar weakness occurred in 10 to 15 percent of patients with paralysis. The disease was most common in...

School Refusal Behavior

Many cases of school refusal behavior involve diverse symptoms. For example, these youth often have general and social anxiety, fear, depression, somatic complaints (e.g., headaches and stomachaches), and withdrawal. In addition, however, these youth also show many disruptive behaviors such as noncompliance, defiance, aggression, tantrums, clinging, refusal to move, and running away from school or home. In many cases of school refusal behavior, a mixture of these symptoms is present. In general, school refusal behavior is not largely related to gender, income level, or race, although dropout rates tend to be highest for Hispanics and African Americans. Treatment for youth with school refusal behavior usually begins with a systematic assessment by a school or mental health professional. In most cases, assessment includes the child, parents, school officials, and relevant others. Assessment may consist of interviews, questionnaires, observations of the family and child, standardized...

Cryptococcus neoformans

Cryptococcus neoformans is an encapsulated yeastlike fungus. Infection is acquired through direct exposure to bird droppings. The infection is initially characterized by a localized pneumonitis, but when dissemination occurs the CNS is a preferential site for disease presumably because the CSF is a good culture media for cryptococci. 115 The most common symptoms of cryptococcal meningitis are headache, fever, and malaise. Cryptococcal skin lesions may precede the development of meningitis, and when they are present, are an indication for lumbar puncture, even in the absence of signs and symptoms of meningitis. 116 Diagnosis is made by the examination of the CSF, and the following are typical abnormalities (1) normal or slightly elevated opening pressure (2) lymphocytic pleocytosis (usually of less than 100 cells mm3 ) (3) elevated protein concentration (4) decreased glucose concentration and (5) positive cryptococcal antigen. The cryptococcal antigen is a highly sensitive and specific...

Histoplasma capsulatum

Histoplasma capsulatum is a dimorphic fungus that is endemic to the Ohio and Mississippi river valleys of the central United States. The fungus is acquired by inhalation. Dissemination is rare and occurs primarily in patients with defective cellular immunity, such as patients with AIDS, patients with lymphoreticular malignancies, and organ transplant recipients. 115 The most common presentation of CNS histoplasmosis is meningitis. The typical presentation includes fever, sweats, weight loss, headache, mental status abnormalities (including decreased level of consciousness, confusion, personality changes, and or memory impairment), cranial nerve palsies, stroke, or seizures. 115 CNS histoplasmosis may also be a solitary abscess or multiple lesions, but meningitis is the much more common presentation. The majority of patients with CNS histoplasmosis have an abnormal neuroimaging study with meningeal enhancement, hydrocephalus, solitary or disseminated contrast-enhancing lesions, or...

Blastomyces dermatitidis

As discussed previously, infection with Blastomyces dermatitidis is primarily associated with outdoor activities including occupational exposure such as construction work, mining, and recreational activities. The AIDS epidemic has not affected the epidemiology of blastomycosis. 115 Initial infection with this fungus is essentially a pulmonary disease. The chest radiograph demonstrates nonspecific infiltrates predominantly at the bases. y Dissemination to the CNS presents as single or multiple intracranial abscesses or granulomas, cranial and spinal extradural abscesses and acute or chronic meningitis. Meningitis due to B. dermatitidis presents as a subacute infection with headache, anorexia, and weight loss. B. dermatitidis brain abscess or abscesses present with focal neurological deficits, seizures, and signs of increased ICP. Neuroimaging demonstrates evidence of a single or multiple homogeneously enhancing lesions. Chronic blastomycotic meningitis predominantly involves the...

Neuroses and psychoses

A common belief among many members of the medical profession is that the majority of skin diseases are due to nerves or are a neurotic manifestation. This old idea is undoubtedly based on the familiar sight of the scratching skin patient he just looks nervous, and it makes one nervous and itchy merely to look at him. It is hard to know which came first for most patients, the itching or the nervousness. In practice, it is good to deemphasize the nervous element but not ignore it. An answer to patients and physicians who question the role of nerves in a particular case is to say that they play a definite role in many skin eruptions, but rarely are nerves the precipitating cause of a dermatosis. If a patient has an emotional problem and also has an itching dermatitis, a flare-up of the problem will intensify the itch, as it would aggravate another patient's duodenal ulcer or migraine headache.

Intracranial hypertension

Raised intracranial pressure causes headaches which are usually bifrontal, and may be associated with nausea and vomiting. They usually clear within 20-60 min after waking in the morning. They are associated with space-occupying intracranial lesions, severe hypertension, hypercapnia, particularly in REM sleep, causing cerebral vasodilatation, cerebral oedema following a hypoglycaemic episode, and benign intra-cranial hypertension.

Increased Cns Hiv1 Viral Load

The differential diagnosis of HIV dementia is often problematic, particularly in the early period. Initial symptoms overlap with and can be mistaken for adjustment and mood disorders, alcohol and other substance abuse, medication effects, metabolic encephalopathy, and other brain disorders. '106 It is important to pursue information from those close to the patient regarding the individual's history and current behavior, in order to rule out psychiatric or substance abuse complications as causes of an apparent dementia. Metabolic derangements (e.g., hypoxia and sepsis) must be considered. Other cNs processes, such as CMV encephalitis, toxoplasmosis, primary lymphoma, progressive multifocal leukoencephalopathy (PML), and cryptococcus can complicate the diagnostic process and must be excluded as causes of cognitive deterioration. Time course, level of consciousness, presence of fever and headache, and focal signs and symptoms on neurological examination may help...

Bayesian methods

Consider two clinical trials of equal size for the treatment of headache. One is an analgesic against placebo, and the other is a homoeopathic treatment against placebo. Both give identical P values (< 0.05). Which would you believe The traditional frequentist approach described in the book does not enable one formally to incorporate beliefs about the efficacy of treatment that one might have held before the experiment, but this can be done using Bayesian methods.1

Primary Intracerebral Hemorrhage

Bleeding is limited by the resistance of tissue pressure in the surrounding brain structures. If a hematoma is large, distortion of structures and increased intracranial pressure (ICP) cause headache, vomiting, and decreased alertness. Because the cranial cavity is a closed system, enlargement of hematoma or development of severe edema may shift brain tissues into another compartment, so-called herniation, and cause deterioration in the clinical condition. gait ataxia. As the hematomas enlarge the focal symptoms increase. If the hematoma becomes large enough to raise intracranial pressure, then headache, vomiting, and decreased alertness develop. Some hematomas remain small and the only symptoms relate to the focal collection of blood. y Iable notes the most important features of hematomas at the most common sites. This material is discussed in detail elsewhere y and in another section of this book.

Inhalation of Exogenous Carbon Monoxide

Recovering patients are likely to have been exposed to a lower concentration of CO but for a longer period. Nonspecific symptoms of CO exposure include headache, nausea, fatigue, mental confusion, clumsiness, impaired judgment, stupor, and coma. Neurologic consequences of CO exposure include traditional cerebrovascular malfunctions, peripheral neuropathies, acute psychosis, cortical blindness, and memory problems (Choi, 1983). Neuroimaging studies indicate that the perivascular zone is a primary target for CO toxicity. Secondary hemorrhagic necrosis may generate focal pathology (Silverman, Brenner, & Murtagh, 1993). Most of the neurologic damage has been reported to occur within the first 6 hours of acute CO exposure, although delayed neurologic complications (e.g., disorientation, bradykine-sia, gait disturbances, aphasia, aprasia, incontinence, and cogwheel rigidity) are evident up to 40 days postexposure (Hardy & Thom, 1994). Close monitoring and follow-up of these patients...

Drugs For Treating Trypanosomiasis

Trypanosomiasis is a disease that is better known by the name sleeping sickness. It is expressed as chronic sleepiness, headaches, impaired motor coordination, apathy, loss of intellect, and when not treated, death. In Africa, trypanosomiasis is transmitted by the tsetse fly that has been infected with trypanosomiasis (Trypanosoma gambience and Trypanosoma rhodesience). In South America, this disease is also transmitted by bloodsucking insects. There is a group of diamidinic compounds that are active against try-panosoma. The most widely used compound for this purpose is pentamidine. Nifutrifox and an older drug, suramine, also are used quite often.

Anticholinergic Drugs Central Cholinoblockers

The first drugs used in treating parkinsonism were the alkaloids, atropine and scopo-lamine, and over the course of many years they were the only drugs used for this purpose. However, in treating Parkinsonism today, these alkaloids are used extremely rarely and have been practically replaced by synthetic drugs that exhibit central anticholinergic properties (central cholinoblockers). They suppress stimulatory cholinergic effects by suppressing cholinoreceptors. It is believed that they do not affect the synthesis, release, or hydrolysis of acetylcholine. Their action facilitates the reduction or alleviation of motor disturbances associated with damage to the extrapyramidal system. They reduce rigidity and to a lesser extent akinesia, and have a minimal effect on tremors. The therapeutic value of such drugs is relatively small and they are used either in combination with levodopa, or in cases of minor Parkinsonism, primarily for alleviating rigidity. In addition, they cause a number of...

Cranial and Spinal Subdural Empyema

A patient with a cranial subdural empyema appears acutely ill with headache that is often localized initially to the side of infection and has fever, chills, and nuchal rigidity. In children and adults, the triad of sinusitis, fever, and an acute neurological deficit should be treated with a high index of suspicion for a

Gasserian Ganglion Syndromes

Numerous pathological processes occurring within the middle cranial fossa can result in trigeminal dysfunction by affecting the gasserian ganglion. In children, osteitis of the petrous apex following suppurative otitis media or mastoiditis, which leads to inflammation and infection affecting the trigeminal ganglion, may result in Gradenigo's syndrome. The syndrome is characterized by facial pain, headache, or sensory loss and a sixth cranial nerve palsy, facial palsy (due to seventh nerve involvement), and deafness (due to eighth nerve involvement). The pain is described as boring or throbbing, worse at night. Pain is aggravated by jaw or ear movement. It has been hypothesized that some of the dysesthetic sensation patients experience before or during episodes of Bell's palsy may reflect involvement of the trigeminal ganglion or nuclei in the brain stem. y A benign, self-limited trigeminal sensory neuropathy has been reported in children 7 to 21 days following a nonspecific febrile...

Pupillary Syndromes Anisocoria

HEADACHE AND FACIAL PAIN Migraine, cluster headaches Postganglionic ocular sympathetic palsy is commonly associated with pain in the ipsilateral orbit and eye. In the early part of this century, a Norwegian ophthalmologist named Raeder reported this combination of pain, meiosis, and ptosis as a paratrigeminal syndrome with localizing value for mass lesions in the middle cranial fossa.y It is important to note that all four of his patients had, in addition to ocular sympathetic palsy, findings referable to the ipsilateral cranial nerves III through VI, either singly or in combination. During the past 2 decades, there has been growing awareness of patients with painful ocular sympathetic palsy without demonstrable middle fossa mass lesions. These patients often have histories of episodic retrobulbar and orbital pain that, in many cases, is typical of cluster or histamine headache (see Chaptei.53, ) i ' The ocular sympathetic lesion occurs during a cluster of headaches and sometimes...

Candidatus Rickettsia Marmionii

During 2003-2005, six patients from Australian states of Queensland (four cases), Tasmania, and South Australia were diagnosed with an SFG rickettsiosis characterized by fever (all patients), headache (83 ), arthralgia (50 ), cough (50 ), maculopapular rash (33 ), and pharyngitis (33 ) (Fig. 12). An eschar was reported in only one patient. Genetic analysis of an isolate obtained from a patient showed close similarity to, but distinction from, R. honei, with 99.0 , 99.7 , and 99.6 homology of the 17-kDa antigen, gltA, and 16S rRNA genes, respectively. Investigators have proposed the name R. marmionii to describe this rickettsia and Australian spotted fever to describe the rickettsiosis it causes. The definitive status of R. marmionii as a distinct species or as a subspecies of R. honei remains to be determined. Potential vectors include H. novaeguineae and I. holocyclus (162).

Specific Epileptic Syndromes

Lennox Gastaut Syndrome Lgs Eeg

There are now two defined occipital epilepsy syndromes in children, also called childhood epilepsy with occipital spikes or childhood epilepsy with occipital paroxysms the early onset form (Panayiotopoulos type) and the late-onset (Gastaut type). Panayiotopoulos estimates that the early onset form comprises approx 6 of childhood epilepsies. The typical age of onset is 2 to 12 yr, with a median onset of 5 yr. The typical seizure consists of autonomic and behavioral disturbances, with vomiting, eye deviation, and altered awareness. Headaches and vomiting may occur, with migraines in the differential. The late-onset type consists of visual seizures with elementary visual hallucinations, which may evolve to a feeling of ocular movements or pain, eye deviation, ictal blindness, or focal or secondarily generalized seizures. The typical age of onset is 3 to 16 yr, with a mean age of 8 yr. Migraine is in the differential diagnosis. Neuropsychological dysfunction is also seen in these two...

Attention Deficit Hyperactivity Disorder

Stimulant medications are usually well tolerated. The most common side effects include impaired sleep, poor appetite, headaches, or irritability. Although several preliminary animal studies of these medications suggest the possibility of neurotoxic effects (Moll et al., 2001) or potential longer-term behavioral effects (Nocjar and Panksepp, 2002 Panksepp et al., 2002), long-term neuroimaging studies of children with ADHD have thus far not provided evidence of anatomical changes associated with chronic stimulant use (Castellanos and Tannock 2002). Moreover, behavioral studies in humans suggest that psychostimulants may reduce the long-term risks of substance abuse associated with the presence of ADHD earlier in life (Biederman et al., 1999 Barkley et al., 2003 Wilens et al., 2003). Stimulants also seem to improve peer, parent, and teacher ratings of the child's social skills (Group, 1999a, b). These longer-term benefits of stimulant medications for children with ADHD would seem likely...

Mycobacterium tuberculosis

The clinical presentation of tuberculous meningitis is either an acute meningoencephalitis characterized by coma, raised intracranial pressure, seizures, and focal neurological deficits or a slowly progressive illness with persistent and intractable headache followed by confusion, lethargy, and cranial nerve deficits. Fever may or may not be present in the course of this infection. The sixth cranial nerve is the most frequently affected by Evaluation. The combination of an unrelenting headache (+ - low grade fever) with malaise and anorexia and a CSF lymphocytic pleocytosis with a mild decrease in the glucose concentration is suggestive of tuberculous meningitis. The initiation of therapy should not await bacteriological proof of tubercle bacilli by smear or culture. The development of hydrocephalus and the clinical scenario just described is additional strong evidence for tuberculous meningitis. The absence of radiographical evidence of pulmonary tuberculosis and...

Abridged Dictionaryindex

Pustular Bacterid

Described in the South Pacific and in the desert in World War II. Soldiers showed increased sweating of neck and face and anhidrosis (lack of sweating) below the neck. It was accompanied by weakness, headaches, and subjective warmth and was considered a chronic phase of prickly heat.

Syndromes of Lesions Involving Peripheral Branches of Cranial Nerve V

Another disorder similar to both cluster headache and trigeminal neuralgia is Raeder's paratrigeminal neuralgia. y This syndrome is characterized by intense pain in the distribution of V1, lacrimation, conjunctival injection, rhinorrhea, and ipsilateral pupillary mydriasis (Horner's syndrome). This syndrome may be idiopathic or may result from pathology affecting the ipsilateral carotid artery or structures within the middle cranial fossa. In the idiopathic form, patients tend to be middle-aged or elderly males who develop a severe throbbing orbital or retro-orbital headache upon awakening. Additional signs such as lacrimation, conjunctival injection, and oculosympathetic dysfunction develop later. Therapy includes ergotamine tartrate, methysergide, and systemic corticosteroids. In both cluster headache and Raeder's syndrome, the pain in V1, duration of attacks, and associated features help distinguish the condition from trigeminal neuralgia. Raeder's paratrigeminal neuralgia may not...

Is Csm An Epidemic Or Sporadic Disease

The late identification of meningitis did not delay study of its etiology. By 1860, researchers widely assumed that a specific poison or agent was involved. In 1887, Austrian pathologist Anton Weichselbaum described the meningococ-cus. This organism was suspected of being the meningitis pathogen, but its role was not proven until the early twentieth century. By 1910, researchers recognized that the meningococcus was responsible for epidemics and that other bacteria could cause sporadic cases. Lumbar puncture, introduced in 1891 by Heinrich Quincke, made cerebrospinal fluid available for study and sometimes relieved the headaches caused by CSM. The crucial epidemiological role of asymptomatic carriers was appreciated by the turn of the twentieth century.

Somatopsychics Definition

Somatopsychics needs to be contrasted with psychoso-matics. Psychosomatic mechanisms operate when psychological conditions produce physical symptoms, such as dry mouth and nervous sweating as a result of stress. The distinction between psychosomatic and somatopsychic is clear in most cases and in theory, but in reality, when phenomena of both kinds become intertwined and feed on each other, causes and effects are difficult to disentangle. When somatic and psychological causes successively bring about effects that begin to serve as the cause for the next level of effects, an etiological spiral evolves, making it difficult to identify the degrees to which psychosomatic or somatopsy-chic factors contributed to the final outcome. For example, stress leads to tachycardia (psychosomatic effect), which in turn causes uneasiness and anxiety (somatopsychic outcome), resulting in a headache (psychosomatic effect), which may trigger irritability (somatopsychic effect). Light availability affects...

Systemic bacterial infections

Systemic Bacterial Infection Pictures

Scarlet fever is a moderately common streptococcal infection characterized by a sore throat, high fever, and a scarlet rash. The eruption develops after a day of rapidly rising fever, headache, sore throat, and various other symptoms. The rash begins first on the neck and the chest but rapidly spreads over the entire body, except for the area around the mouth. Close examination of the pale scarlet eruption reveals it to be made up of diffuse pinhead-sized, or larger, macules. In untreated cases the rash reaches its peak on the 4th day, and scaling commences around the 7th day and continues for 1 or 2 weeks. The strawberry tongue is seen at the height of the eruption.

Radioactive Thyroid Tests

On the other hand, there are several disadvantages. Thyrogen is very expensive and may not be covered on some insurance plans. Some people experience side effects of headache and nausea with Thyrogen, although it's fair to say that Thyrogen-related side effects are dwarfed by the side effects of hypothyroidism. Even more important, since the entire body, particularly the kidney, is not hypothyroid, the radioactive iodine tracer is quickly lost in the urine. This reduces the opportunity for tumor cells to take up this tracer and makes the scans less sensitive than similar scans prepared by hypothyroid withdrawal. For this reason, the recommendations of the U.S. Food and Drug Administration (FDA) are to (1) give a high enough tracer dose (at least 4 mCi of I-131), (2) take a much longer time to perform the scan pictures (at least thirty minutes for each view compared to ten minutes for the hypothyroid withdrawal preparation method), (3) obtain a thyroglobulin level to assess for...

Hepatic Encephalopathy and Cerebral Edema

Cerebral edema should be managed aggressively. Neurologic physical examination is not sensitive enough for detecting increased ICP, so clinical suspicion should be maintained.5 The earliest signs and symptoms suggestive of development of cerebral edema include systolic hypertension and increased muscle tone. Headache, vomiting and papilledema are present inconsistently. Later in its course, cerebral edema presents with decerebrate posturing, hyperventilation, myoclonus, seizures, trismus and opisthotonos.

Side Effects of Antidepressants

Potent 5-HT reuptake inhibitors are the most likely to cause nausea, anorgasmia, and sometimes myoclonus. When these drugs are used in combination with MAOIs, a hypermetabolic syndrome can occur consisting of gastrointestinal distress, headache, agitation, hyperpyrexia, increase heart rate, increased respiratory rate, hypotension or hypertension, muscular rigidity, myoclonus, convulsions, coma, and often death (Sternbach, 1991) The hypermetabolic symptoms reported with this syndrome closely resemble the symptoms of malignant hyperthermia and neuroleptic malignant syndrome, raising questions as to whether these may be manifestations of a common mechanism. Many preclinical and clinical studies have shown that 5-HT reuptake inhibitors have effects on the DA system, and it has been suggested that changes in DA function may be a common element to these conditions (see Beasley et al., 1993, for comprehensive review). Withdrawal Reactions. Several types of withdrawal reactions...

Syndromes of Intracerebral Hemorrhage

A headache is present in approximately one half of patients. Nausea and vomiting are present in over 50 percent of patients. The level of consciousness may be variable. Seizures rarely occur at the onset. There is usually no history of any prodromal attacks. There is often a history of arterial hypertension. On examination, meningeal irritation can be seen if the bleeding extends to the subarachnoid space. Retinal hemorrhages may be present on funduscopic examination (see Table.2.2-2. ). There are a number of potential etiologies of intracerebral hemorrhage (see Table.22-3 ). Caudate hemorrhages can cause headache, nausea, vomiting, meningismus, confusion, and decreased short-term memory. y Findings that are variably present include a transient contralateral conjugate gaze paresis, contralateral hemiparesis, transient hemisensory deficits, and, rarely, ipsilateral Horner's syndrome.

Cranial and Spinal Epidural Abscess

The clinical presentation of an intracranial epidural abscess is an unrelenting hemicranial headache or persistent fever that develops during or after treatment for frontal sinusitis, mastoiditis, or otitis media. Focal neurological deficits, seizures, and signs of increased ICP do not develop until the infection extends into the subdural space. y Approximately 10 percent of epidural abscesses are associated with a subdural empyema. y An epidural abscess that develops near the petrous bone and involves the fifth and sixth cranial nerves presents with ipsilateral facial pain and lateral rectus weakness (Gradenigo's syndrome). A spinal epidural abscess presents as fever and pain at the affected spinal level. Heusner y described a characteristic clinical pattern of symptom progression. Back pain is

Glucose Metabolism Disorders Hypoglycemia

Clinical Features and Associated Disorders. Symptoms of hypoglycemia can be divided into adrenergic and neuroglycopenic (low CNS glucose). The adrenergic symptoms (e.g., diaphoresis, tachycardia, enhanced physiological tremor) are inversely correlated to the rate of development of hypoglycemia, being most pronounced with acute onsets. Hunger, visual disturbances, and altered temperature perceptions are other possible adrenergic features. The neuroglycopenic features include headache, malaise, impaired concentration, confusion, disorientation, irritability, lethargy, stupor, coma, generalized seizures, myoclonus, and psychiatric disturbance. Focal CNS dysfunction, including focal seizures, hemiplegia, paroxysmal choreoathetosis, and patchy brain stem and cerebellar involvement mimicking basilar artery thrombosis, have also been reported. yj With subacute onsets, drowsiness, lethargy, decreased psychomotor activity, and confusion may be observed,y and when chronic, the insidious onset...

Supranuclear Syndromes

Facial sensory loss may occur in the setting of lesions involving the trigeminothalamic pathways, corona radiata or internal capsule white matter projections from the VPM nucleus of the thalamus to primary sensory cortex, or within sensory cortex itself. Specific pathological processes affecting these pathways include ischemia, hemorrhage, neoplasm, and demyelinating diseases. All result in contralateral hemifacial and hemibody numbness. In seizures, facial tingling often occurs in association with hand numbness and suggests a lesion in the postcentral gyrus. In the cheiro-oral syndrome, ipsilateral numbness in the hand and at the corner of the mouth reflects an insult, typically vascular, at adjoining portions of the ventroposterolateral and VPM nuclei of the thalamus where the anatomical distributions of these regions are directly adjacent to one another. In contrast, a persistent deep, aching, poorly localized facial pain has been reported in patients with thalamic lesions...

Bone and Connective Tissue

Varying degrees of facial asymmetry, including hemifacial microsomia and other craniofacial abnormalities, may necessitate interventions, including bimaxillary osteotomies and reconstruction with prostheses. The clinical effects of chemotherapy and radiation on dental and craniofacial development will be discussed later in this chapter. Radiation has been associated with malocclusion, reduced mobility of the temporomandibular joint, fibrosis, soft tissue necrosis and osteoradionecrosis. Eventual fibrosis of the temporomandibular joint results in muscle pain and headaches 11 . Tumor invasion of the temporo-mandibular joint, surgery and the use of large daily fractions further increase the risk of radiation-induced trismus. Combined modality therapy has a greater impact on facial structures when radiation doses are high children receiving doses of 24 Gy or less to the temporomandibular joint have not demonstrated clinical signs of trismus 37 . The facial skeleton appears to be the most...

Suggested Reading

The Quality Standards Subcommittee of the American Academy of Neurology The Practice Committee of the Child Neurology Society. Practice parameter evaluation of children and adolescents with recurrent headaches report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002 59 490-498.

Triple Flexion Is A Spinal Reflex

Baclofen is most effective for the treatment of spasticity secondary to spinal cord injuries, but is also approved for the treatment of spasticity of cerebral origin (Albright et al., 1993). The advantages of baclofen are that it is less sedating than the benzodi-azepines, especially when started at a low dose and titrated slowly upward and works extremely well in treating painful flexor and extensor muscle spasms (Fromm, 1994). Its major drawback is that it can cause muscle weakness at moderate and high doses, although much less than dantrolene (Roussan et al., 1985). Less common side effects include ataxia, confusion, headache, hallucinations, dyskinesias, respiratory, and cardiovascular depression (Young and Delwaide, 1981). Baclofen can also lower seizure threshold and should be used cautiously in epileptic

Occlusive Disease of Small Penetrating Arteries

Autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a familial arterial disease of the brain that begins in early adult life. Its gene is mapped to chromosome 19. The CADASIL vasculopathy affects the media of leptomeningeal and perforating arteries of the brain. The media is thickened by an eosinophilic granular material of unknown origin. Clinically, patients present with recurrent subcortical infarcts, progressive or stepwise dementia, migraine with aura, and depression. Usually, there is no hypertension or other vascular risk factors. Prominent subcortical white matter and basal ganglia hyperintensities are noted on T2-weighted MRI. Vascular studies are usually not helpful diagnostically. y

Melanocortin receptor MCR agonists

A major problem with this new MCR agonist may be its side effect profile, with nausea rates up to 36 after 6mg s.c and 17 after intranasal application 3,4 . Further drug related side effects > 5 were headache (up to 27 ), flushing (up to 17 ) vomiting (up to 9 ), back-pain (up to 9 ), muscle cramps (up tp 9 ), and fatigue (up to 8 ).

Simulation And Design

The power and capabilities of SA for model building in CTS& D can be illustrated by an example from our experiences. In a recent exercise (Chapter 16), we needed to simulate an early phase II clinical trial with a second in line orally administered (in a tablet form) antimigraine drug. The pharmacokinetics of the drug was modeled by a classical two-compartment model with first-order absorption and an effect compartment (30-32), as described by Eq. (4) and Figure 4. The parameters of the PK model were estimated from phase I information with i.v., s.c., and p.o. (oral solution) data after administration of the drug to healthy volunteers. The headache severity experienced by the patients was coded in a categorical scale with four categories 0 no headache, 1 mild headache, 2 moderate headache, and 3 severe headache. The effect of the drug is pain relief and is measured on a binary scale. It is assumed that there is a therapeutic effect if a transformation from headache categories 2 or...

Ischemic Priapism Treatment

Agonist with no indirect neurotransmitter-releasing action. This agent minimizes the risk of cardiovascular side effects that are more commonly seen with other sympathomimetic agents. For intracaver-nosal use in adult patients, phenylephrine is diluted with normal saline to a concentration of 100 to 500 g mL. One mL injections are made every five minutes as needed, up to one hour. During treatment, patients should be observed for symptoms, such as acute hypertension, headache, reflex bradycardia, tachycardia, palpitations, and cardiac arrhythmia.

Monoclonal Antibodies That Are Currently Used In Cancer Therapy

Been shown to prolong survival (Dearden, 2002). Treatment-related toxicity, which occurs most often with the first infusion of the antibody, is generally mild. Infusion-related reactions included rigors, nausea, urticaria, fatigue and headache (Dillman, 2002). One advantage of rituximab therapy is that, as it induces minimal adverse effects, it can be given to patients as short-course, outpatient therapy (375 mg m2 weekly for 4-8 weeks).

Acute Bacterial Meningitis

Clinical Features and Differential Diagnosis. The classic presentation of bacterial meningitis is headache, fever, stiff neck, and an altered level of consciousness, but the clinical symptoms and signs may vary depending on the age of the patient and the duration of illness before presentation. The symptoms and signs of bacterial meningitis in the neonate are often subtle and typically nonspecific, and include fever or hypothermia, lethargy, seizures, irritability, bulging fontanel, poor feeding, vomiting, and respiratory distress. Meningitis should always be considered when sepsis is suspected in the neonate. 1 , y In children and adults, the symptoms and signs of bacterial meningitis are fever, headache, vomiting, photophobia, nuchal rigidity, lethargy, confusion, or coma. Meningitis in children typically presents as either a subacute infection that gets progressively worse over several days, following an upper respiratory tract or ear infection or as an acute fulminant illness that...

Arteriovenous Malformations

Clinical Features and Associated Disorders. As AVMs enlarge, symptoms are related to a number of mechanisms. They can cause bleeding, seizures, vascular headache, and chronic ischemia. Bleeding is most likely due to fragility of the abnormal vessels. The angiomas that most frequently rupture are of the AV type. Symptoms and signs depend on the location of hemorrhage. There are usually signs of meningeal irritation due to bleeding into the CSF. Not all ruptures are symptomatic but evidence of previous bleeding is often observed at necropsy. About one half of the patients present with epilepsy. Progressive neurological signs may develop secondary to a mechanism called intracerebral steal or compression of adjacent brain tissue by the pulsating blood vessels. Chronic migrainous headaches are also a frequent complaint in patients with vascular malformations. Patients with unruptured AVMs may present with increased ICP and papilledema. Angiomas in the brain stem may cause serious bleeding...

Oligodendroglioma and Oligoastrocytoma

Headache, and sudden focal neurological findings consistent with acute hemorrhage into the tumor. There is also a higher risk of dissemination through the cerebrospinal pathways resulting in spinal cord or patchy symptoms within the neuroaxis, which are sometimes confused with metastatic disease. y Rarely, oligodendrogliomas can metastasize outside the central nervous system.

Cushings Syndrome Cushings Disease

If it is present, an enlarging pituitary adenoma may produce headaches, visual changes (e.g., bitemporal hemianopia due to optic chiasm compression), and hypopituitarism (e.g., decreased ACTH or TSH levels due to anterior pituitary destruction), as well as DI (posterior pituitary involvement) and diplopia (due to cavernous sinus invasion). The lack of correlation between headache and tumor size reported in some series '111 suggests that headache may also be a feature of GH hypersecretion. The hypersecretion of GH produces various forms of disfigurement and other physical changes (, Tab.leii.SSzl.I). Central sleep apnea has been reported in one third of acromegalic patients with sleep apnea. W Importantly, the presence of sleep apnea increases the risk for hypertension, myocardial infarction, and stroke, as well as accident susceptibility due to daytime sleepiness. '110 Mononeuropathies, especially compression neuropathies such as carpal tunnel syndrome (CTS), may be noted. CTS occurs...

Brief Review Of The Clinical Features Of Lyme Disease

Tion defects, myopericarditis, and very mild congestive heart failure. The organism has been seen in myocardial biopsies and grown from one biopsy specimen. Approximately 10-15 of patients with untreated early localized disease will develop neurological features of early disseminated LD in the same time period as carditis. This neurological syndrome was first described over 70 years ago as tick-borne meningopolyneuritis or Bannwarth's syndrome. Headache, mild neck stiffness, and photophobia may occur. Fever may be mild or absent, fatigue and malaise are common, and mild encephalopathy, usually difficulty with memory and concentration and emotional lability, may be prominent features. Cranial neuropathies, often associated with a lymphocytic meningitis, are common, most often affecting the facial nerve (occasionally bilateral). Peripheral neuropathy and radiculoneuropathy may affect the limbs or trunk. A lymphocytic pleocytosis is typically found in the cerebrospinal fluid (CSF),...

Monoamine Reuptake Inhibitors

Duloxetine has been shown to be effective in reducing physical symptoms (back pain, shoulder pain, headache) in depressed patients as well as the core depressive symptoms (Detke et al., 2002), possibly due to its dual action on 5-HT and NE systems (Stahl, 2002). These findings have stimulated a renewed interest in reevaluating the diagnostic criteria for major depression given the relative underrepresentation of physical symptoms in the DSM-IV criteria (Fava, 1996).

Case Reports Editorials Letters to the Editor Book Reviews and Other Publication Models

One cannot set out today to write a case report without a case. I might decide this weekend to write a review article about unusual types of primary headaches or an editorial about why we clinicians should receive more pay for what we do. But to write a case report I need a patient with a disease, and then I must sense that there is something unusual about what I have observed. The second type of case report includes more than one observation. It may be several patients with an uncommon disease, such as an increased incidence of leukemia in a single neighborhood. Or perhaps you have recently encountered three young adult patients with hypnic headache. Your case report will describe the characteristics of what may be an evolving disease cluster or a new manifestation of a known disease. One approach to assessing the value of a book is to look up your favorite topic, for example, headache, myocardial infarction, breast cancer, or myositis ossificans. Is the topic covered in the book If...

Discuss On Acclimatisation To Low Po2

Altitude of about 12,000 feet, are drowsiness, lassitude, mental and muscle fatigue, sometimes headache, occasionally nausea, and sometimes euphoria.These effects progress to a stage of twitchings or seizures above 18,000 feet and end, above 23,000 feet in the unaccli-matized person, in coma, followed shortly thereafter by death.

Biological Diagnosis Of Epidemic Typhus

The diagnosis of epidemic typhus is usually suggested by the presence of typical clinical findings such as fever, headaches, and skin rash in patients infested with body lice or in persons who are living in crowded, cold, and unhygienic circumstances. Thrombocytopenia and an increase of the hepatic enzymes may be observed particularly in severe cases. Typhus often occurs in clusters, but it may also occur as isolated illness.

Rickettsia Slovaca Tickborne Lymphadenopathy And Dermacentorbornenecrosiserythemalymphadenopathy


The clinical syndrome called (DEBONEL) has been recently reported in Spain (115). In half of the cases, patients were bitten by D. marginatus, which contributed to the name of the syndrome. Most cases occurred between October and April, with a peak in November. The incubation period was approximately four days (range one to eight days). All patients had an eschar at the tick-bite site (86 on the scalp) associated with regional painful lymphadenopathy, and all but one complained of headache. Low-grade fever was reported in 45 of patients. After antibiotic

Basic Principles and Techniques

The beginning of myelography has its roots in the early 1900s when subarachnoid injections of air were performed to localize spinal cord tumors. This technique of pneumomyelography was eventually supplanted by the subarachnoid injection of an iodized poppy seed oil, Lipiodol, the myelographic medium of choice during the 1930s. Lipiodol had its disadvantages, including a very high viscosity, its immiscibility with CSF (thereby making it difficult to perform satisfactory diagnostic studies as well as remove on completion of the study), and its irritating nature to the leptomeninges. In 1940, Pantopaque was introduced. This oil-based contrast agent was less viscid and less irritating to the leptomeninges than Lipiodol. Its lower specific gravity allowed it to flow more freely in the subarachnoid space with less tendency to form large irregular globules and, accordingly, removal on completion of the study was easier to perform than its predecessor. Pantopaque soon became the contrast...

The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

Are Constant Headaches Making Your Life Stressful? Discover Proven Methods For Eliminating Even The Most Powerful Of Headaches, It’s Easier Than You Think… Stop Chronic Migraine Pain and Tension Headaches From Destroying Your Life… Proven steps anyone can take to overcome even the worst chronic head pain…

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