1/12. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/12. Fatal cerebral embolism in a young patient with an occult left atrial myxoma.We report a young patient with a fatal cerebral embolism from an occult atrial myxoma. The patient died before echocardiography was performed and at autopsy the definite diagnosis was made. Our patient suffered from migraine of increasing frequency. The physical exercise of sexual intercourse was the precipitating factor of this fatal embolism. The importance of early echocardiography is stressed, especially in view of the recent tendency of early and aggressive stroke treatment.- - - - - - - - - - ranking = 0.21246957427821keywords = physical (Clic here for more details about this article) |
3/12. 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 = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/12. diagnosis and management of migraine headaches.Migraine headaches afflict approximately 6% of men and 18% of women in the united states, and cost billions of dollars each year in lost productivity, absenteeism, and direct medical expendi tures. Despite its prevalence and the availability of therapeutic op tions, many patients do not seek treatment, and among those who do, a significant portion are misdiagnosed. Correct diagnosis can be made by identifying the historic and physical examination finding that distinguish primary headache disorders from secondary head ache disorders, as well as the key clinical features that distinguis migraine headaches from other types. Once diagnosis is made, im proper or inadequate management of headache pain, related symp toms such as nausea, and the possible aggravating side-effects of pharmacologic therapies represent further obstacles to effective ther apy. Dissatisfaction with migraine therapy on the basis of these factors is common. Among abortive therapy options there are de livery methods available which may avoid aggravating symptom such as nausea. Recommended pharmacologic agents include non steroidal anti-inflammatory drugs, intranasal butorphanol, ergota mine and its derivatives, and the triptans. Indications for prophylac tic in addition to abortive therapy include the occurrence o headaches that require abortive therapy more than twice a week, tha do not respond well to abortive therapy, and which are particularly severe. research is ongoing in the pathophysiology of migraines evaluation of nonpharmacologic treatment modalities, assessment of new drug therapies, and validation of headache guidelines.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/12. Serious neurological disorders in children with chronic headache.AIMS: To determine the prevalence of serious neurological disorders among children with chronic headache. methods: All children presenting to a specialist headache clinic over seven years with headache as their main complaint were assessed by clinical history, physical and neurological examination, neuroimaging where indicated, and by follow up using prospective headache diaries. RESULTS: A total of 815 children and adolescents (1.25-18.75 years of age, mean 10.8 years (SD 2.9); 432 male) were assessed. Mean duration of headache was 21.2 months (SD 21.2). neuroimaging (brain CT or MRI) was carried out on 142 (17.5%) children. The vast majority of patients had idiopathic headache (migraine, tension, or unclassified headaches). Fifty one children (6.3%) had other chronic neurological disorders that were unrelated to the headache. The headache in three children (0.37%, 95% CI 0.08% to 1.1%) was related to active intracranial pathology which was predictable on clinical findings in two children but was unexpected until a later stage in one child (0.12%, 95% CI 0.006% to 0.68%). CONCLUSIONS: Chronic headache in childhood is rarely due to serious intracranial pathology. Careful history and thorough clinical examination will identify most patients with serious underlying brain abnormalities. Change in headache symptomatology or personality change should lower the threshold for imaging.- - - - - - - - - - ranking = 0.21246957427821keywords = physical (Clic here for more details about this article) |
6/12. Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis?The differential diagnosis of headache is often challenging, with significant clinical and socioeconomic consequences of incomplete or inaccurate diagnosis. Overlapping symptoms contribute to the diagnostic challenge. Four female patients, ages 26 to 69 with standing diagnoses of migraine, were evaluated and treated for complaints of chronic, severe headaches. All had obtained limited relief from migraine therapies. On physical examination, all had occipital nerve tenderness or positive Tinel sign over the occipital nerve. All responded well to occipital nerve blocks with local anesthetic, achieving complete or substantial pain relief lasting up to 2 months. We conclude that accurate diagnosis of occipital neuralgia or cervicogenic headache as contributing factors can lead to substantial headache relief through occipital nerve blocks in patients with coexisting or misdiagnosed migraine. PERSPECTIVE: The pathophysiology of many types of chronic headaches is not well understood. Mixed mechanisms such as neurovascular, neuropathic, myofascial, and cervicogenic may all contribute. Our four patients with chronic headaches responded well to occipital nerve blocks. The neuroanatomical relationship between the trigeminocervical nucleus and occipital nerve may serve as the basis of efficacy for these blocks.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/12. Acute confusional migraine. Case report and review of literature.The history of a girl is described who experienced two separate episodes of acute confusion with agitation. The first occurred at the age of four after a mild head injury, the second recently at the age of thirteen after prolonged physical effort. EEG's performed during both episodes showed marked diffuse slowing. Both clinical picture and EEG normalized rapidly. Clinical features and prompt recovery made the diagnosis 'acute confusional migraine' most likely. The relevant literature and importance of recognizing the syndrome are discussed- - - - - - - - - - ranking = 0.21246957427821keywords = physical (Clic here for more details about this article) |
8/12. Biochemical victims: false negative diagnosis through overreliance on laboratory results--a personal report.The increasing tendency of doctors to base diagnosis on the results of laboratory investigations entails a corresponding decrease in the exercise of clinical judgment. This state of affairs can have harmful consequences for patients suffering from biochemically atypical forms of disorder, who may acquire functional psychiatric labels when they are in fact suffering from organic physical disorders. The author's personal experience of this invidious predicament is described. Although hypothyroidism was correctly diagnosed on clinical grounds within a few months of presentation, laboratory results were inconclusive and three years and three specialist consultations were to elapse before replacement therapy was obtained, and then only through unofficial channels. The handling of this case illustrates some unfortunate trends in contemporary medical practice with important implications for the health of patients.- - - - - - - - - - ranking = 0.21246957427821keywords = physical (Clic here for more details about this article) |
9/12. "food allergy": Fact or Fiction?Six patients with longstanding physical and mental symptoms who had not been helped by many years of conventional medical investigation and treatment experienced immediate relief of symptoms when they avoided certain foodstuffs. This clinical study supports the view that some foods may cause widespread and disabling symptoms in people who are sensitive to them.- - - - - - - - - - ranking = 0.21246957427821keywords = physical (Clic here for more details about this article) |
10/12. Carotidynia: a pain syndrome.Carotidynia is a common neck pain syndrome first described by Temple Fay in 1927. The pain is typically dull, throbbing, continuous, and localized over the carotid bifurcation, but may radiate to the ipsilateral mandible, cheek, eye, or ear. Symptoms are frequently aggravated by swallowing, chewing, and contralateral head movements. The cardinal physical finding is tenderness on palpation of the carotid bulb, sometimes accompanied by prominence or throbbing of the carotid pulse. Although several serious conditions should be excluded, most cases follow a benign course.- - - - - - - - - - ranking = 0.21246957427821keywords = physical (Clic here for more details about this article) |
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