1/59. Use of cervical spine manipulation under anesthesia for management of cervical disk herniation, cervical radiculopathy, and associated cervicogenic headache syndrome.OBJECTIVE: To demonstrate the benefits of cervical spine manipulation with the patient under anesthesia as an approach to treating a patient with chronic cervical disk herniation, associated cervical radiculopathy, and cervicogenic headache syndrome. CLINICAL FEATURES: The patient had neck pain with radiating paresthesia into the right upper extremity and incapacitating headaches and had no response to 6 months of conservative therapy. Treatment included spinal manipulative therapy, physical therapy, anti-inflammatory medication, and acupuncture. magnetic resonance imaging, electromyography, and somatosensory evoked potential examination all revealed positive diagnostic findings. INTERVENTION AND OUTCOME: Treatment included 3 successive days of cervical spine manipulation with the patient under anesthesia. The patient had immediate relief after the first procedure. Her neck and arm pain were reported to be 50% better after the first trial, and her headaches were better by 80% after the third trial. Four months after the last procedure the patient reported a 95% improvement in her overall condition. CONCLUSION: Cervical spine manipulation with the patient under anesthesia has a place in the chiropractic arena. It is a useful tool for treating chronic discopathic disease complicated by cervical radiculopathy and cervicogenic headache syndrome. The beneficial results of this procedure are contingent on careful patient selection and proper training of qualified chiropractic physicians.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/59. Extensive ossification in a craniopharyngioma.A rare extensive ossification occurred in a suprasellar craniopharyngioma of a man who died at 21 years of age. The tumor produced headache, retarded physical and mental development, visual disturbances, and increased intracranial pressure. The neoplasm recurred after surgical and roentgenological treatments. Differentiation of multipotential mesenchymal cells or mesenchymal type cells within the tumor has been suggested as the mode of occurrence of bone in this craniopharyngioma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/59. Cervical headache.headache presents a diagnostic challenge for the physical therapist due to similarities of signs and symptoms among the many types of headache. Effective treatment depends upon accurate diagnosis and identifying the factors that may precipitate or perpetuate the symptoms. This commentary overviews some common forms of headache and specifically addresses cervical headache as a possible beneficiary of physical therapy intervention. Details of the history and physical examination, which is designed to diagnose cervical headache and rule out potential serious pathologies, are presented. Guidelines for treatment of articular and myofascial dysfunction are presented. A case report illustrating principles of examination, inherent ambiguities in diagnosis, and successful treatment is also presented.- - - - - - - - - - ranking = 8.2072637540435keywords = physical examination, physical (Clic here for more details about this article) |
4/59. A spectrum of exertional headaches.Headaches that have an explosive onset with exercise, including sexual activity, generally are benign in origin. A subarachnoid hemorrhage, a mass lesion in the brain, or an anomaly of the posterior fossa must be considered, however. The mechanisms that produce sexually induced or cough headaches of abrupt onset are unknown. It is known, however, that a rapid increase in intrathoracic pressure suddenly reduces right atrial pressure and presumably decreases venous sinus drainage from the brain. This situation results in a transient increase in intracranial pressure. jaw pain that occurs with chewing often is considered to be TMJ dysfunction when arthritic in quality and if subluxations of the jaw can be shown on the physical examination. giant cell arteritis and common or external carotid artery occlusive disease should be considered when the pain is ischemic in quality. An anginal equivalent is another possibility. Headaches that worsen with vigorous exercise are commonly migrainous. When their onset is apoplectic with exertion (particularly exertion against a closed glottis), the most likely diagnoses are increased intracranial pressure, a posterior fossa abnormality, or benign exertional headaches. Most cardiac induced headaches, but not all, are of a more gradual onset. If there are significant risk factors for coronary artery disease, an exercise stress test is appropriate. A therapeutic trial of nitroglycerin may help to establish a diagnosis if it improves the headache. Using antimigraine drugs as a diagnostic test is inappropriate because triptans and ergots are contraindicated in the presence of coronary artery disease, and a positive response is not diagnostic of migraine.- - - - - - - - - - ranking = 6.2072637540435keywords = physical examination, physical (Clic here for more details about this article) |
5/59. Psychosomatic disorders in pediatrics.Psychosomatic symptoms are by definition clinical symptoms with no underlying organic pathology. Common symptoms seen in pediatric age group include abdominal pain, headaches, chest pain, fatigue, limb pain, back pain, worry about health and difficulty breathing. These, more frequently seen symptoms should be differentiated from somatoform or neurotic disorders seen mainly in adults. The prevalence of psychosomatic complaints in children and adolescents has been reported to be between 10 and 25%. These symptoms are theorized to be a response to stress. Potential sources of stress in children and adolescents include schoolwork, family problems, peer pressure, chronic disease or disability in parents, family moves, psychiatric disorder in parents and poor coping abilities. Characteristics that favour psychosomatic basis for symptoms include vagueness of symptoms, varying intensity, inconsistent nature and pattern of symptoms, presence of multiple symptoms at the same time, chronic course with apparent good health, delay in seeking medical care, and lack of concern on the part of the patient. A thorough medical and psychosocial history and physical examination are the most valuable aspects of diagnostic evaluation. Organic etiology for the symptoms must be ruled out. Appropriate mental health consultation should be considered for further evaluation and treatment.- - - - - - - - - - ranking = 6.2072637540435keywords = physical examination, physical (Clic here for more details about this article) |
6/59. Spontaneous carotid and vertebral artery dissection in children.Carotid and vertebral artery dissection is a rarely reported cause of stroke in childhood and adolescence, especially if there is not a direct trauma to the neck. Four patients, under 15 years of age, presented with an internal carotid artery dissection, and one patient presented with a vertebral artery dissection. They were all making a physical effort when the event occurred. The five patients had ischemic symptoms, and in two the events were preceded by transient ischemic attacks. headache was associated in four patients. The diagnosis was made by magnetic resonance imaging and angiography, which included transfemoral angiography in two patients. All improved before leaving the hospital, and four patients did not suffer recurrent episodes. The diagnostic accuracy of artery dissection has improved because of noninvasive neuroimaging testing, but it should still be suspected in any pediatric ischemic stroke, especially if there is headache or cervical pain associated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/59. Identifying and managing adverse environmental health effects: 1. Taking an exposure history.Public concern and awareness are growing about adverse health effects of exposure to environmental contaminants. Frequently patients present to their physicians with questions or concerns about exposures to such substances as lead, air pollutants and pesticides. Most primary care physicians lack training in and knowledge of the clinical recognition, management and avoidance of such exposures. We have found that it can be helpful to use the CH2OPD2 mnemonic (Community, Home, hobbies, Occupation, Personal habits, diet and Drugs) as a tool to identify a patient's history of exposures to potentially toxic environmental contaminants. In this article we discuss why it is important to take a patient's environmental exposure history, when and how to take the history, and how to interpret the findings. Possible routes of exposure and common sources of potentially toxic biological, physical and chemical substances are identified. A case of sick-building syndrome is used to illustrate the use of the mnemonic.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/59. Physical symptoms under forced-phase advance treatment in a patient with delayed sleep phase syndrome: a case report.The physical symptoms that are observed with forced waking in patients with delayed sleep phase syndrome (DSPS) often prevent the successful treatment of patients. Better understanding of these symptoms will assist in providing appropriate treatment in such patients. Herein, a 19-year-old female patient with DSPS is described, in whom headache, fatigue, and dizziness were observed under forced-phase advance treatment. Statistical analysis showed that her headache was dependent on the therapeutic week, and her fatigue was dependent on the period of the day. There was no association between dizziness and either factor. Experience with this patient indicates that the fatigue observed with forced waking is related to the circadian system. This relationship should be explored for other physical symptoms as well.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
9/59. Acute urinary retention as an unusual manifestation of aseptic meningitis.A formerly healthy 32-year-old woman was hospitalized for a closer examination of undiagnosed fever with mild headache. Despite lack of distinct findings on physical and laboratory examinations at admission, she suddenly developed anuresis due to acontractile neurogenic bladder. On the basis of her symptoms and the faint nuchal rigidity revealed later, as well as the results of cerebrospinal fluid analyses, a diagnosis of aseptic meningitis was eventually reached. While aseptic meningitis subsided within 3 weeks, about 10 weeks, including a 26-day period of anuria, was necessary for complete restoration of normal voiding function, necessitating intermittent self-catheterization. Acute urinary retention should be considered an uncommon but critical manifestation of aseptic meningitis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/59. cavernous sinus thrombophlebitis in nijmegen breakage syndrome.The aim of the study was to present rarely reported neurologic complications in nijmegen breakage syndrome. A 13-year-old female was referred because of chronic progressive headaches. There were dysmorphic features on physical examination, which suggested a diagnosis of chromosomal instability syndrome. The results of genetic and immunologic examinations confirmed the diagnosis. Cerebral magnetic resonance imaging revealed an 8 mm thickening of the meninges over the left hemisphere, corresponding with a chronic inflammatory condition, and symptoms of left cavernous thrombophlebitis were detected. cerebrospinal fluid examination and an infusion test demonstrated disorders in its absorption. Antibiotic, anticoagulant and cerebral edema treatment was given and after 1 week improvement was observed. Regression of symptoms occurred after 14 days.- - - - - - - - - - ranking = 6.2072637540435keywords = physical examination, physical (Clic here for more details about this article) |
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