1/62. ophthalmoplegic migraine and periodic migrainous neuralgia, migraine variants with ocular manifestations.The spectrum of migraine has been outlined with particular attention to two entities: ophthalmoplegic migraine and Periodic Migrainous neuralgia. Although quite different in many respects from classical migraine, the relationship of a periodic localized vascular phenomenon giving rise to headache and transient neurologic signs, classify PMN and OPGM as migraine variants. Supportive of this concept, the literature has been reviewed in both entities, and some observations are made on the validity of earlier reports. It is the author's opinion that Raeder's syndrome should be reserved for patients with a lesion localizing in the paratrigeminal area. This does not exclude migraine as an etiologic agent but also recognizes tumors, infections and fractures as being more common.- - - - - - - - - - ranking = 1keywords = syndrome (Clic here for more details about this article) |
2/62. Bilateral median nerve compression at the level of Struthers' ligament. Case report.Struthers' ligament syndrome is a rare cause of median nerve entrapment. Bilateral compression of the median nerve is even more rare. It presents with pain, sensory disturbance, and/or motor function loss at the median nerve's dermatomal area. The authors present the case of a 21-year-old woman with bilateral median nerve compression caused by Struthers' ligament. She underwent surgical decompression of the nerve on both sides. To the authors' knowledge, this case is the first reported bilateral compression of the median nerve caused by Struthers' ligament. The presentation and symptomatology of Struthers' ligament syndrome must be differentiated from median nerve compression arising from other causes.- - - - - - - - - - ranking = 2keywords = syndrome (Clic here for more details about this article) |
3/62. sunct syndrome responsive to gabapentin (Neurontin).A 48-year-old male suffering with SUNCT (severe unilateral neuralgiform headache with conjunctival injection and tearing, rhinorrhea and sub-clinical sweating) presented in 1996 after a 10-year history of multiple failed therapies. The symptoms included strictly left-sided ocular, as well as facial and temple pain. The pain attacks were burning, sharp, shooting and occurred 25 times daily, lasting 2 to 3 minutes with tearing and conjunctival injection. There was no associated nausea or vomiting, but there was photophobia. No other autonomic changes were reported and the pain was not triggerable. Initially Indocin (indomethacin) was tried without significant benefit. Gabapentin (Neurontin) was then started with improvement at 1800 mg per day. The patient was then lost to follow-up for 3 years, as he moved from the los angeles area. He returned in 1999 having stopped the gabapentin after his prescription ran out in 1996, reporting the pain returned immediately. Again gabapentin was prescribed and at 900 mg three times daily he has been pain free for 12 months.- - - - - - - - - - ranking = 4keywords = syndrome (Clic here for more details about this article) |
4/62. Neuropathic pain--from mice to men.The past decade has seen great progress in understanding the syndrome of neuropathic pain, its causes and in finding new drugs that promise great benefit. For example, an early outcome of the research has been the observation that the new drugs do not blunt normal pain sensation--a pattern beginning to find explanation through the realisation that neural pain circuits rewire themselves, both anatomically and biochemically, after nerve injury. In this article, we discuss a case of a known diabetic patient with intractable pain and the course of management provided by the use of novel tools and devices coming to the fore in this rapidly expanding specialty.- - - - - - - - - - ranking = 1keywords = syndrome (Clic here for more details about this article) |
5/62. Management of post-traumatic pain syndromes (causalgia).A number of post-traumatic pain syndromes may be grouped under the two headings: causalgia and mimocausalgia states. Our concern is the early recognition of patients whose complaints have a real organic basis but whose physical signs are not of sufficient degree to make this fact readily apparent. These patients are all too often mismanaged or neglected for sufficiently long periods of time to permit the underlying pathologic physiology to secure supremacy over normal function. Recognized and treated properly by means of sympathetic ablation, either medical or surgical, the vast majority can be relieved of their symptoms. The extremities can then be rehabilitated by appropriate measures.- - - - - - - - - - ranking = 5keywords = syndrome (Clic here for more details about this article) |
6/62. Extraforaminal, thoracic, epidural cavernous haemangioma: case report with analysis of magnetic resonance imaging characteristics and review of the literature.BACKGROUND: A case of a solitary, thoracic, extradural, extraforaminal cavernous haemangioma causing a chronic neuralgia syndrome is presented. In the spectrum of spinal axis cavernous malformations, extradural lesions are exceedingly rare. A purely extraforaminal, paraspinal cavernous haemangioma has never been previously reported. METHOD: A 56-year-old woman suffered from a chronic neuralgia syndrome at the right D3 dermatome. Conservative treatment was ineffective. MRI revealed an extraforaminal mass at T3-4 which homogeneously enhanced after gadolinium administration mimicking a schwannoma. The lesion was completely removed via an extraforaminal approach. FINDINGS: Histopathological investigation revealed a cavernous haemangioma. The patient recovered completely within 4 weeks after surgery. Interpretation: Cavernous haemangiomas are developmental vascular hamartomas representing a single entity regardless of their location. As purely epidural lesions are rare, their clinical and radiological presentation could be confusing if located foraminally or extraforaminally. Thus, their signal characteristics providing valuable information will facilitate diagnosis and treatment.- - - - - - - - - - ranking = 2keywords = syndrome (Clic here for more details about this article) |
7/62. pain management of chronic nonmalignant neuropathic pain.Chronic nonmalignant neuropathic pain is difficult to manage. A challenging case dealing with chronic neuropathic pain subsequent to thoracotomy syndrome and reflex sympathetic dystrophy syndrome is presented. Strategies and approaches to aggressively manage this type of pain are presented.- - - - - - - - - - ranking = 2keywords = syndrome (Clic here for more details about this article) |
8/62. tacrolimus-induced pain syndrome in a pediatric orthotopic liver transplant patient.Post-transplant complications are common among patients receiving immunosuppressive medications, including pain syndromes. Recently, a pain syndrome, calcineurin-inhibitor induced pain syndrome (CIPS) has been described. To our knowledge, this article is the second report of tacrolimus-associated CIPS, and the first report in the pediatric setting.- - - - - - - - - - ranking = 7keywords = syndrome (Clic here for more details about this article) |
9/62. sunct syndrome responsive to lamotrigine.BACKGROUND: Short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection, tearing, rhinorrhea (sunct syndrome) is a headache form generally refractory to drug therapy. Occasional patients with SUNCT have been reported with a successful response to lamotrigine. OBJECTIVE: To report two patients with SUNCT treated with lamotrigine. methods: Clinical history, neurologic examination, and brain magnetic resonance imaging. RESULTS: Both patients with sunct syndrome were successfully treated with lamotrigine. In both cases, when lamotrigine was tapered off, the attacks reappeared, only to disappear when the dose was again increased. In addition, lamotrigine was well tolerated and no undesired side-effects were reported. CONCLUSION: If the positive effect of lamotrigine in patients with SUNCT is confirmed in other cases, lamotrigine could become the first specific treatment for sunct syndrome.- - - - - - - - - - ranking = 7keywords = syndrome (Clic here for more details about this article) |
10/62. Neuropathic pain and dysesthesia of the feet after Himalayan expeditions.High altitude peripheral nerve disease secondary to frostbite or trauma is a well-recognized medical problem during mountaineering expeditions. However, in our experience as medical professionals on 19 expeditions to the Himalayas in the years 1977 to 2000, an unusual syndrome of neuropathic pain and/or dysesthesia in both feet apparently unrelated to frostbite or trench foot was observed in 8 (4.8%) of 165 European mountaineers. Mountaineers complained of persistent and continuous pain, which was consistently described as a "corky" sensation in their feet, associated with severe lancinating exacerbations. Pain improved with cold and worsened with heat and gentle pressure. Symptoms were incapacitating in a third of the cases. Treatment with carbamazepine was effective, and the disorder evolved to total resolution in 4 to 8 weeks. We present the case of a patient who had this syndrome and in whom complete work-up studies done on his arrival home, 14 days after its presentation, were unrevealing. The paucity of information regarding this particular variety of neuropathic pain of the feet may be due to lack of clinical suspicion in the field, favorable outcome, and difficulties for further study and evaluation.- - - - - - - - - - ranking = 2keywords = syndrome (Clic here for more details about this article) |
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