1/12. Objective assessment of autonomic signs during triggered first division trigeminal neuralgia.A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 /- 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
2/12. Erythrodermia to pseudoephedrine in a patient with contact allergy to phenylephrine.BACKGROUND: phenylephrine and pseudoephedrine are sympathomimetic drugs belonging to the phenylamine family. Adverse cutaneous effects associated with these drugs have been reported but, in view of their frequent use, appear to be rare. The very close chemical structures of these drugs could explain potential cross-reactions among them but the results reported in the literature are controversial. CASE REPORT: An 18-year-old woman developed blepharoconjunctivitis after application of phenylephrine and tropicamide eye drops. Four years after this reaction, she took 1 tablet of Narine (pseudoephedrine and loratadine) and 3-4 hours later developed a generalized erythrodermic reaction. Cutaneous biopsy revealed hydropic changes in the basal layer and, in the dermis, moderate edema with slight perivascular lymphocyte and eosinophil infiltrates. patch tests with European standard series, commercial eye drops, tropicamide, phenylephrine, pseudoephedrine and other sympathomimetic agents were applied to the patient's back. After 47 and 96 hours, only the patches with pseudoephedrine and phenylephrine were positive. CONCLUSIONS: We believe that our patient has presented two different reactions with different clinical outcome and histopathology, which are unlikely to be due to cross-reactivity between the drugs involved. We have found no similar coincidences reported int the literature.- - - - - - - - - - ranking = 0.078590889652397keywords = back (Clic here for more details about this article) |
3/12. intracranial hypotension syndrome: a comprehensive review.intracranial hypotension may have variable clinical presentations, but has a rather uniform component of postural headache among its symptomatology. Its symptoms are explainable given the effects of the hypotension and attempts within the craniospinal axis to maintain volume homeostasis in the face of cerebrospinal fluid leakage (Monro-Kellie hypothesis). The imaging corollaries of the consequences of intracranial hypotension are especially well depicted on magnetic resonance imaging studies.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
4/12. Incidental diagnosis of pregnancy on bone and gallium scintigraphy.Bone and gallium scintigraphy were performed as part of the diagnostic workup of a 21-yr-old woman who presented at our institution with a history of progressively worsening low back pain over a 1-wk period of time. The angiographic phase of the bone scan demonstrated a well-defined radionuclide blush within the pelvis just cephalad to the urinary bladder with persistent hyperemia noted in the blood-pool image. We attribute these findings to a uterine blush secondary to the pronounced uterine muscular hyperplasia, hyperemia, and edema that accompany pregnancy. gallium scintigraphy demonstrated intense bilateral breast accumulation of the imaging agent in a typical doughnut pattern which is commonly found in the prelactating and lactating breast. Also demonstrated was apparent gallium accumulation in the placenta. This case is presented to emphasize the radionuclide findings that occur during pregnancy, particularly the incidental finding of radionuclide blush during the angiographic phase of a radionuclide scintigraphy which should alert the nuclear physician to the possibility of pregnancy in a woman of childbearing age.- - - - - - - - - - ranking = 0.078590889652397keywords = back (Clic here for more details about this article) |
5/12. Delayed hyperemia following hypoperfusion in classic migraine. Single photon emission computed tomographic demonstration.Regional cerebral blood flow (rCBF) was measured in seven patients during classic migraine attacks. Single photon emission computed tomography was performed soon after hospital admission, and three to eight hours, 20 to 24 hours, and one week later after the onset of symptoms. Initially reduced rCBF persisting up to three hours was observed in the hemisphere appropriate to the focal neurologic deficit; hyperperfusion was noted later in the same region in these patients. At 24 hours rCBF was normal in four patients, hyperemia persisted in two patients, and one patient was not restudied. The area of interest demonstrated a mean decrease of 19% /- 7% in side-to-side asymmetry when compared with the contralateral region. In three to eight hours this reversed to a mean increase of 19% /- 4% (delayed hyperemia). No asymmetries were observed after one week. The late hyperemic asymmetry often persisted beyond the duration of the clinical headache. It is postulated that this tardive regional hyperperfusion is a consequence of previous focal arteriolar vasoconstriction. This vascular sequence of events further delineates the diagnostic merit of studying rCBF by noninvasive single photon emission computed tomography in migraine.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
6/12. Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine.Regional cerebral blood flow (rCBF) was measured in 254 areas of a hemisphere with the xenon 133 intraarterial injection method. Six cases of classic migraine were followed from the normal state into the prodromal phase, and in 3 cases further into the headache phase. One patient with common migraine was similarly followed during his only classic attack. The attacks were initiated by focal hyperemia in 3 patients. During prodromes all patients displayed occipitoparietal rCBF reduction (oligemia), but in only 1 case did the reduction approach critical values. Oligemia gradually spread anteriorly in the course of 15 to 45 minutes. In 4 patients a global oligemia was observed. In 4 patients severe headache was present concomitantly with oligemia and with no sign of hyperemia or nonhomogeneous brain perfusion. The normal rCBF increase during cortical activity (hand movement, speech, and similar activities) was impaired in 6 patients. The results indicate that the vasospastic model of the migraine attack is too simplistic.- - - - - - - - - - ranking = 2keywords = headache (Clic here for more details about this article) |
7/12. A new syndrome of symptomatic cutaneous mastocytoma producing vasoactive intestinal polypeptide.An 8-mo-old male child presented with generalized flushing and apnea which followed irritation of a 1.5 x 0.5 cm cutaneous mastocytoma on the left upper arm. Peripheral venous blood samples were drawn before and after manipulation of the tumor, immediately after excision, and again 30 days later. The plasma vasoactive intestinal polypeptide level before excision was high (345 pg/ml) and was accompanied by low acid secretion (15.4 mEq/L) and hypergastrinemia (209 pg/ml), all of which returned to normal after excision of the tumor (50 pg/ml, 35.7 mEq/L, and 131 pg/ml, respectively). serum histamine levels were undetectable. histology of the tumor showed only mast cells and no enterochromaffin tissue. The immunoreactive vasoactive intestinal polypeptide content of the tumor was 28 ng/g wet wt and the extracted vasoactive intestinal polypeptide was immunologically indistinguishable from natural porcine vasoactive intestinal polypeptide. The child has remained asymptomatic postoperatively. We conclude that the symptoms associated with this mastocytoma may have been produced by oversecretion of vasoactive intestinal polypeptide and not histamine.- - - - - - - - - - ranking = 0.15209446420935keywords = upper (Clic here for more details about this article) |
8/12. Late onset of total eversion of the upper eyelids.A case of total eversion of both upper eyelids of late onset is reported. There were no associated ocular or general anomalies. No apparent cause was found. The treatment was directed toward diminishing the swelling of the lids and preventing corneal involvement, secondary infections, and epidermalization of the conjunctiva. Within the first week, the eyelids returned to their normal position. In a three-month follow-up period, no complication or other anomalies were found.- - - - - - - - - - ranking = 0.76047232104674keywords = upper (Clic here for more details about this article) |
9/12. Common migraine attacks preceded by focal hyperemia and parietal oligemia in the rCBF pattern.Regional cerebral blood flow (rCBF) was measured in the dominant hemisphere with the xenon-133 injection method, using the 254 multidetector gamma camera. Two patients developed a common migraine attack during the rCBF studies. The headache was preceded by focal oligemia in the occipitoparietal region in one of the patients and in the parietocentral region in the other. Neurological examination was normal. These results indicate that the initiating cerebral hemodynamics in common migraine are, at least in particular patients, the same as in patients with classic migraine.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
10/12. pulmonary edema following relief of acute upper airway obstruction.Five children, aged one to five years, with severe upper airway obstruction, three of whom had epiglottitis and two of whom had laryngotracheobronchitis, developed acute pulmonary edema after the obstruction had been relieved by placement of an artificial airway. Although major physiologic changes, such as hypoxemia and massive sympathetic discharge, play a significant role in the development of acute pulmonary edema, we have postulated a possible etiological cause for the development of pulmonary edema in these children which involves a series of physiologic events. The generation of very high transpulmonary pressure gradients during inspiration is opposed by a decreased venous return due to the obstruction during exhalation. Airway pressures then fall abruptly with the insertion of the artifial airway, resulting in a sudden increase in venous return to the central circulation and marked increase in the intravascular hydrostatic pressures. The final result of this series of events is the development of pulmonary hyperemia and edema. The prevention of this situation must begin the moment the airway is inserted and involves the application of moderate amounts of continuous positive pressure to the airway, thus allowing time for circulatory adaption to take place.- - - - - - - - - - ranking = 0.76047232104674keywords = upper (Clic here for more details about this article) |
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