Migraine Homeopathic Remedies

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. Continue reading...

The Migraine And Headache Program Overview

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Migraine Prevention

A case reported the use of ginger for the prevention of migraines (30). A 42-year-old woman suffered migraine with aura once or twice every 2 or 3 months for 10 years. Because the frequency and duration of migraine increased, the patient was prescribed 500-600 mg of powdered ginger to be taken at the onset of aura, then every 4 hours for the next 3-4 days. The patient reported some relief within 30 minutes of the first dose. Then she added uncooked fresh ginger to her diet. In a 13-month period, she reported only six migraines. These results should be confirmed in a double-blind, controlled trial.

Cerebral Venous Dural Sinus Thrombosis

Thrombosis of the dural venous sinuses is an unusual cause of stroke in HIT patients that was first reported by Stevenson (1976). Often, there is a second hypercoagulable state, such as pregnancy (Van der Weyden et al., 1983 Calhoun and Hesser, 1987) or myeloproliferative disease (Kyritsis et al., 1990), that may have interacted with HIT to cause this complication. Platelet-rich white clots were identified in the superior sagittal venous sinus in one necropsy study (Meyer-Lindenberg et al., 1997). Clinicians should have a high index of suspicion for dural sinus thrombosis when a patient develops progressive focal neurological signs, decreased level of consciousness, seizures, or headache during or soon after stopping heparin treatment (Beland et al., 1997 Pohl et al., 1999, 2000 Warkentin and Bernstein, 2003). Treatment includes immediate discontinuation of heparin, use of an alternative anticoagulant, and possibly, intravenous gammaglobulin (see Chapter 12).

Clinical Presentation

The clinical presentation will depend on the exact location ofthe tumor within the brainstem, the rate of growth, and whether or not the flow of CSF is disturbed. In general, there is often involvement of individual or multiple cranial nerves, long-tract signs and disturbances of coordination. Bulbar symptoms, including swallowing and speech difficulties, are very common. If CSF flow is disrupted, headache and vomiting may occur, along with limitation of upgaze and alteration ofmotor tone. Exophytic lesions and those involving the cervicomedullary junction may not cause cranial nerve dysfunction early in the course of the illness, but tend

Brainstem Malignant Glioma Subtypes

This tumor may occur at any age but is most common between 5 to 10 yr of age, and is distinctly uncommon before 2 yr of age (38). The typical presentation of this tumor is a triad of cranial nerve palsies, ataxia, and cerebrospinal tract dysfunction. Most often the VIth and VIIth cranial nerves are involved (sometimes unilaterally), and the motor and cerebellar signs often involve contralateral limbs. Symptoms may be present for several weeks but some patients come to medical attention within hours of their first complaint. On occasion, signs and symptoms of hydrocephalus (headache, irritability, and limited upgaze) may be the factor that brings the patient to medical attention. The MRI (Fig. 1) appearance and clinical course for these tumors is quite typical and there is seldom a question of diagnosis. These tumors are hypointense on T1 weighted images and hyperintense on T2 weighted images. They may involve the entire pons and appear to expand the entire body of the affected portion...

Dorsal Exophytic Brainstem Tumors

Symptoms can be insidious, and patients may have a mild set of symptoms for months or years before the diagnosis is made. The initial symptoms may be caused by intermittent obstruction of CSF flow. Occasional vomiting and failure to thrive without overt neurologic signs may result in prolonged evaluations by specialists without correct diagnosis. Because of the location, the child may have only mild or intermittent cranial nerve paresis, and may not have any pyramidal tract findings unless the tumor is invasive. Symptoms will vary by age, with failure to thrive and chronic vomiting seen in infants, whereas older patients present with a combination of headache, vomiting, and ataxia (4).

Firerelated Injuries And Fatalities

Asphyxia is always a risk when an individual is exposed to smoke. While many wildland firefighters use particulate masks, private citizens may be unprepared and have no form of airway protection. Wildland firefighters are not as likely to experience the extreme, acute exposures that structural firefighters encounter. However, they are more likely to have prolonged exposure to smoke. Common compounds found in the air of wildland fires include carbon monoxide, sulfur dioxide, particulate carbon and silica, polyaromatic hydrocarbons, aldehydes, and benzene. Of greatest concern are aldehydes and carbon monoxide. Aldehyde exposure results in local irritation, while carbon monoxide exposure is associated with nonspecific warning signs such as headache, and high levels can be potential fatal. While the long-term effects of respiratory contaminants are not fully known, studies have shown decreased short-term pulmonary function in wildland firefighters. Also of concern are exacerbations of...

Extragonadal Germ Cell Tumors

Primary intracranial GCTs occur in the pineal and suprasellar regions15 (see also Chapter 28). They represent approximately 1 of all primary intracra-nial cancers, and may be slightly more common in Japan and Taiwan. These tumors also may be either seminomas or nonseminomas. The presentation of pineal tumors is usually with headache, nausea and vomiting, and evidence of raised intracranial pressure. There may be signs of Parinaud's syndrome (paralysis of conjugate upward gaze). The usual

What should be clarified beforehand

Interactions are important in the choice of combination regimens. Whereas interactions between antiretroviral drugs are well known, interactions with other concomitant medications are often less well characterized (see Interactions). The urgent need for more research was demonstrated in a study investigating the interactions between HAART and statins. In healthy volunteers, the measurement of plasma levels showed that levels of simvastatin were elevated by 3.059 after concurrent dosing with ritonavir or saquinavir (Fichtenbaum 2002). One fatal rhab-domyolysis on simvastatin and nelfinavir has been described (Hare 2002). Many drugs should not be combined with particular antiretroviral drugs, as incalculable interactions may occur. These include certain contraceptives. Even drugs that seem unproblematic at first glance can have unfavorable effects for example, the plasma levels of saquinavir can be reduced by half due to concurrent administration of garlic capsules (Piscitelli 2002)....

Glioblastoma Multiforme

Glioblastoma multiforme is classified as a WHO grade IV neoplasm and is among the most common primary intracranial neoplasms. Glioblastomas account for the majority of glial tumors, over half ofastrocytic tumors, and up to 20 of all intracranial tumors (1,11). Although uncommon in the pediatric population, glioblastomas make up more than half of primary intracranial neoplasms in adults with a peak incidence during the sixth and seventh decades of life. Similar to the AA, the glioblastomas generally arise within the cerebral hemispheres and symptoms at presentation usually include headache, seizures, focal neurologic deficit, change in personality, and or signs of increased intracranial pressure.

Prototypes Creating Representations of Illness and Targets for Management

The CSM provides a detailed description of the processes involved in the activation of prototypes, the process that elaborates the meaning of implicit and explicit observations of somatic and functional cues. The core of the process is an ongoing scanning, checking, and comparing of somatic sensations, as well as physical and mental function, to the underlying prototype and schemata of the physical and functional self. A representation of illness is activated when the scanning or check process detects a deviation in somatic sensations and or physical and mental function that exceeds normally expected variability in the self and matches an underlying illness prototype. The representation formed at that moment is an operating hypothesis about the nature and meaning of the experienced deviations. For example, the deviations may reflect one of several acute conditions such as a migraine headache, common cold, heartburn, and or stomach ache from bad food, or a potentially chronic condition...

Safety Of Alphavirus Vectors

The pathogenicity of the alphavirus family varies significantly, but the three most commonly used vectors, SFV, SIN, and VEE, are considered only mild pathogens (1). There are descriptions of some SFV-related epidemics of febrile illnesses in the Central Republic of Africa (48). The typical symptoms of the infected individuals were fever and persistent headache. Some SIN and SFV strains have additionally showed strong neurovirulence and pathogenicity in young mice.

Vaccination Against Typhoid Fever A Century of Research End of the Beginning or Beginning of the

As its name implies, typhoid fever is a septicemic illness associated with alteration in consciousness (the Greek word typhos means stupor). It is cause by the Gram-negative bacillus Salmonella typhi which belongs to the enterobacteriaceae family. In its untreated form, the disease is marked by increasing fever, headache, insomnia, and general malaise. More serious complications include intestinal perforations and bleeding, severe alteration in consciousness, and possibly shock, which can be fatal. Similar but usually less severe cases, called paratyphoid fever, are caused by Salmonella paratyphi A, B, and C. Together, S. typhi and S. paratyphi infections are referred to as enteric fevers.

Significance to humans

Overall impact of cubozoans is much greater as stings are not always reported. Carukia barnesi is now recognized as the cause of Irukandji syndrome, which results in severe backache, muscle pains, chest and abdominal pains, headache, localized sweating, and piloerection, as well as nausea and reduced urine output. There is a box jelly antivenom that binds to both C. fleckeri and C. barnesi, and vinegar can inhibit unfired nematocysts from firing (although it stimulates nematocyst firing with other cnidarians).

Thioamine Acetylase Paradigm for Studying Illness Cognition

In the same experiment, participants also were asked to report whether they had recently experienced several common symptoms (e.g., headache, backache) or engaged in certain risk behaviors (e.g., use of aspirin, getting less than 7 h of sleep per night) that were purportedly related to the deficiency. Those participants who were led to believe that they lacked the TAA enzyme, and thus were supposedly at greater risk of pancreatic disorder, reported more diagnostic-consistent symptoms and behaviors than those without the deficiency. Similar results have been reported by individuals who were led to believe that they had elevated blood pressure (Baumann et al, 1989). Hence, believing that they were at risk prompted individuals to mislabel ambiguous, common sensations as signs of illness and to recall otherwise ordinary or innocuous behaviors that they believed might have placed them at risk.

Drug Dependency Assessment

Similar withdrawal symptoms can also occur with sedatives, anticonvulsants such as clonazepam and carbamazepine, and muscle relaxants such as carisoprodol (11-13,127). Frequent nicotine and caffeine use is also an important consideration in pain management. Nicotine abstinence symptoms can cause restlessness, palpitation, and irritability, and caffeine abstinence can precipitate headaches.

The functional properties of vitamin D in preventing heart disease

Excessive intake of vitamin D in fortified food, over-the-counter supplements or excessive ingestion of anti-rickets pharmaceuticals can result in vitamin D poisoning. An acute toxic dose has not been established but the chronic toxic dose is more than 5O OOO IU day in adults for 1-4 months and, in children, 4OO IU day is potentially toxic. Acute toxicity effects may include muscle weakness, apathy, headache, anorexia, nausea, vomiting, and bone pain. Chronic toxicity effects include the above symptoms and constipation, anorexia, polydipsia, polyuria, backache, hyperlipidemia, and hypercalcemia. Hypercalcemia may cause permanent damage to the kidney (see http www.emedicine.com emerg topic638.htm). Arterial hypertension and aortic valvular stenosis can also result from hypervitaminosis D.

Signs and symptoms

Clinical symptoms depend on the localization of lesions, with acute or peracute onset within a few days. The major signs include focal neurological deficits such as paresis, speech problems or sensory loss (Porter 1992). A febrile psychosyndrome with confusion is also frequently an early sign. It is not unusual to see an epileptic seizure as the initial presentation, in the absence of other symptoms. Headaches with fever or subfebrile temperatures are suspicious. Meningitic signs, however, are less typical. Atypical manifestations in the presence of IRIS have been described (Ghosn 2003).

Clinical features of a major haemolytic reaction

Haemolytic shock phase - this may start within minutes after a few millilitres of blood have been transfused or may take 1-2 h after the end of the transfusion to develop. Symptoms include urticaria, lower backache, flushing, headache, shortness of breath, precordial pain and hypotension. These symptoms may be difficult to identify in the anaesthetized patient or the unconscious intensive therapy unit (ITU) patient. Laboratory examinations will reveal evidence of blood cell destruction, jaundice and disseminated intravascular coagulation. Urinalysis will demonstrate haemoglobinuria.

Central Nervous System Manifestations

Macrocephaly, often quite pronounced, is common, with head circumference > 2 SD above the mean in greater than 40 of patients (26). More specifically, the increased head circumference is due to megalencephaly, an increase in brain volume. In addition, the head is often dolichocephalic even when head circumference is normal. Developmental delay is described but is less common in CS than in BRRS. Adult onset Lhermitte-Duclos disease (LDD) has recently been moved to the pathognomonic criteria (previously a major criteria) for the diagnosis of CS (Table 1) (15). LDD is characterized by cerebellar enlargement secondary to granule cell and Purkinje cell hypertrophy (30). Resulting signs and symptoms include those of increased intracranial pressure (e.g., headache, vomiting, and altered level of consciousness) and ataxia from cerebellar dysfunction. Thus, even though LDD is not a malignancy, the morbidity and the mortality of this disorder are very significant. Patients with LDD...

Pharmacological Toxicological Effects 51 Neurological Effects

Feverfew's mechanism of action in the prevention of migraine headaches is not known. It is speculated that feverfew affects platelet activity or inhibits vascular smooth-muscle contraction, perhaps by inhibiting prostag-landin synthesis (4). Results of in vitro studies suggest that rather than acting as a cyclooxygenase inhibitor, feverfew inhibits phospholipase A2, thus inhibiting release of arachidonic acid from the cell membrane phospholipid bilayer (11,12). Drugs that are serotonin antagonists are used in migraine prevention (e.g., methysergide) (9). During a migraine, serotonin is released from platelets (9), and in vitro studies using a bovine platelet bioassay have shown that parthenolide, as well as other sesquiterpene lactones, inhibits platelet serotonin release (13). Both parthenolide and a chloroform extract of dried, powdered leaves were also able to inhibit serotonin release and platelet aggregation in an in vitro study using human platelets and a variety of...

Mutagenicity CarcinogenicityTeratogenicity

In 30 patients with migraine who had been taking feverfew leaves, tablets, or capsules for at least 11 months, there was no increase in chromosomal aberrations or sister chromatid exchange in circulating lymphocytes compared to patients with migraine not taking feverfew matched for age and sex. The Ames salmonella mutagenicity test was also performed on urine samples from 10 patients using feverfew and 10 matched nonusers, with no indication of mutagenicity (26).

Clinical Manifestations

Fever, headache, and cough may be the only symptoms. The presence of epistaxis, sinonasal ulceration or eschar, palatal eschar, proptosis, decreased vision, or facial swelling is alarming and suggestive of invasive disease (21). Rapid disease progression follows. Patients may initially report facial pain that progresses to facial anesthesia as trigeminal nerve invasion occurs. Once infection reaches the frontal lobes, mental status changes and obtundation ensues. Spread from the sphenoid sinus to the adjacent cavernous sinus is heralded by cranial nerve palsy or visual loss.

Toxicity Of Stereotactic Radiosurgery

Acute complications from SRS are generally minimal and usually transient. These side effects may include infection or numbness at a pin site, headache, seizure, nausea, vomiting, fatigue, and exacerbation of existing neurologic symptoms. To prevent some of these side effects, many centers premedicate and discharge patients on corticosteroids. For those patients with a history of seizures, some centers also give antiseizure medications. The most common late toxicities include radiation necrosis, steroid dependency, and exacerbation of neurologic symptoms such as motor weakness, numbness, or gait difficulties. Given the difficulty in distinguishing between radiation necrosis and recurrent persistent tumor, the reoperation rates have varied widely. In the RTOG 9305 study, the incidence of Grade III or higher toxicity was not significantly different in either arm (34).

Clinical Manifestationssystemic

An extensive discussion of the systemic manifestations of HIV AIDS would be quite lengthy and beyond the scope of this chapter. Note will be made of the PHI, which presents with fever, myalgias, pharyngitis, arthralgias, headache, and malaise. Nonpruritic maculo-papular rash of the face and trunk is reported in 30 to 70 of cases (10) Generalized lymphadenopathy, nausea, vomiting, neurological complications, oral ulceration, and candidiasis might be observed. Since PHI can present before antibody test seroconversion, diagnostic testing should utilize measurement of specific viral antigens or viral load for detection of HIV infection.

Myeloproliferative Disorders

PRV is frequently discovered incidentally when a complete blood count is performed for another reason. When symptoms are present, they are usually nonspecific. Fatigue, headache, and diaphoresis are common. Pruritis, often following a hot shower, is a frequent complaint. Up to 15 of patients may present with a thrombotic episode. Thrombotic cerebrovascular accidents, coronary artery thrombosis, Budd-Chiari syndrome, and pulmonary embolus all occur. Cavernous sinus thrombosis may also occur in untreated or poorly controlled disease. Erythromelalgia is specific to PRV and ET, and it is associated with an elevated platelet count and paradoxical vasodilation. It is characterized by redness, warmth, and a burning pain affecting the digits and responds promptly to aspirin. Gout may be a presenting manifestation of an MPD. There is an increased incidence of peptic ulcer disease in patients with PRV. Iron deficiency may occur and may initially mask the diagnosis. An elevated hematocrit with...

Clinical Presentation And Diagnostic Evaluation

Patients may present with a variety of manifestations of their CNS metastases, including headache, focal neurologic deficit, focal or nonspecific visual changes, confusion, vomiting, and or seizures. Alternatively, they may be asymptomatic and may be diagnosed only when CNS imaging is undertaken.9 The intensity of diagnostic evaluation of the CNS in patients with testicular germ cell cancer is based on individual risk stratification. Patients with higher-risk

Cerebrospinal Fluid Marker Concentrations

Metastatic mixed nonseminomatous germ cell tumor. The patient was a 24-year-old man who presented with testicular pain and abdominal bloating. Examination revealed right testicular induration and an upper abdominal mass on the right side. His abdominal computed tomography (CT) scan (A) demonstrated a large retroperitoneal mass. There were no lung metastases seen on chest CT. The preoperative serum a-fetoprotein (AFP) level was 18,345 ng mL, the serum beta-human chorionic gonadotropin (p-hCG) level was 302 ng mL, and the lactate dehydrogenase (LDH) level was 704 U L. Inguinal orchiectomy was undertaken, and histopathologic study showed a mixed pattern including major elements of embryonal malignant teratoma and seminoma as well as a small element of choriocarcinoma. Postoperative serum AFP was 7,435 ng mL, serum p-hCG was 76 ng mL, and the LDH was 673 U L. The patient then commenced his first cycle of POMB ACE chemotherapy. Midway through the first cycle of chemotherapy,...

Adverse Effects and Toxicity

Clinical studies have reported very few adverse effects that are of a mild nature (usually gastric distress or headache) following saw palmetto administration at normal doses. One randomized, double-blind study of finasteride, tamsulosin, and saw palmetto for 3 months observed no differences among the three treatments in terms of the effectiveness measures and no change in sexual function in those individuals receiving saw palmetto, though ejaculation disorders were noted as the most common side effect in those individuals receiving either tamsulosin or finasteride (26).

Musculoskeletal Measures

Much research on musculoskeletal disorders relies on self-report or physical examination, but direct measurement of muscle tension using surface electromyography (EMG) has been used in behavioral medicine research to provide valuable additional information. Miniaturized transducers and telemetric equipment are available that allow readings to be obtained from free-moving individuals. Positive correlations have been reported between objectively assessed muscle tension and feelings of stress and exhaustion during work, and recently these findings have been correlated with lower pressure pain thresholds and higher pain intensity in people suffering from chronic neck and shoulder pain (Larsson et al, 2008). Surface EMG is also used extensively in headache research, with monitoring of muscles of the neck, back, and forehead. A meta-analysis of studies of frontal EMG indicated that patients with tension-type headache have higher muscle tension than controls on average, but with wide...

Tickborne Relapsing Fever

Tick-borne relapsing fever is a spirochete disease caused by at least 13 different Borrelia species and is present worldwide. The vector is the soft tick Ornithodoros, and rodents are commonly infected. The soft tick bite is usually painless. The incubation period is 4-18 days. Relapsing fever presents as a viral-like illness with high fever, myalgias, chills, and headache, and many patients have an eschar at the bite site. The clinical course will usually involve the initial syndrome for 3 days followed by an asymptomatic period of 7 days then another relapse. Neurologic symptoms are common. Diagnosis is made by demonstration of borreliae in peripheral blood during a febrile episode (thick and thin smear preparation, Wright or Giemsa stain can be used). Treatment is with Doxycycline, Penicillin, Erythromycin, or Ceftriaxone.

Rocky Mountain Spotted Fever Rmsf

RMSF is an acute febrile systemic tick illness with significant mortality caused by the organism Rickettsia rickettsii. The infection is most commonly seen in the southeast United States. The incubation period is between 2 and 14 days. The symptoms are nonspecific, with fever, severe headache, myalgias, prostration, and nausea vomiting. The characteristic maculopapular rash usually appears on the fourth febrile day on the wrists, ankles, palms, soles, and forearms. A vasculitis may develop that can cause hypotension, edema, and petechiae. Specific organ involvement includes cardiac (car-diomegaly, myocarditis, EKG changes), pulmonary involvement (interstitial pneumonitis), and neurologic (mild headache to lethargy, seizures, coma, transient deafness, tremor, rigidity, paralysis, ataxia, aphasia, blindness). The initial diagnosis is often made clinically. Confirmation is obtained by serology, skin biopsy, or direct isolation and identification of the organism. Treatment is with...

Surveys of Sick Individuals about their Use of OTC Healthcare Products

In a random-digit-dialing survey of 1505 adults, 77 of those who reported an illness in the past six months had self-treated with an OTC medication, in contrast to 43 who said they visited a physician for their illness (Labrie, 2001). Of those reporting headache symptoms, 81 self-treated of those reporting cold, cough, flu, or sore throat symptoms, 72 self-treated. This survey did not determine the time between OTC use and first contact with the healthcare system. However, it did ascertain whether OTC use was an individual's first action after the onset of symptoms. Of the individuals reporting headache symptoms, 54 said their first course of action was to take an OTC medication (34 said their first course of action was to wait and see if the symptoms would go away, and only 4 said their first course of action was to consult a physician). For individuals with cold, cough, flu, and sore throat symptoms, the first course of action was self-treatment with an OTC product in 42 , watchful...

Jugular foramen syndrome

Primary lesions of the jugular foramen include glomus jugulare tumors, schwannomas, and meningiomas. Metastatic lesions to the jugular foramen are more common than primary neoplasms (36,38-42). Glomus jugulare tumors are the most common primary neoplasms of the jugular foramen. These are vascular tumors arising from neuroectodermally derived paraganglia present at the jugular fossa, the inferior tympanic canaliculus, the promontory, and within the vagus nerve. Paraganglia are very similar histologically and embryologically to the adrenal medulla. They, along with their derivative glomus tumors (jugulare and tympanicum), are typically supplied by the inferior tympanic branch of the ascending pharyngeal artery (43) however, the blood supply to glomus tumors may be very extensive, originating from the external carotid, the internal carotid, and the vertebral arteries (44). These tumors are more common in females (6 1 female-to-male ratio) and usually present in middle age. Functional...

Presentation And Clinical Course

After an incubation period of 2-20 days (10 days on average), patients typically experience the sudden onset of fever, chills, nausea, vomiting, headache, and myalgia. This corresponds to the septicemic phase, which lasts 3-7 days. Physical exam findings at this time are relatively nonspecific, and include maculopapular skin rash, pharyngeal injection, lymphadenopathy, organomegaly, and muscle tenderness. The presence of conjunctival suffusion or muscle tenderness involving the calves and lumbar region should raise the suspicion of leptospirosis. The illness may progress to a second stage, after a 1- to 4-day asymptomatic period, resulting in a biphasic illness. This immune phase, characterized by the appearance of IgM antibodies, is again difficult to distinguish from other febrile illnesses, and is thought to result from the host immune response rather than the pathogen itself. Fever is generally lower than in the septicemic phase. Signs and symptoms of meningitis are often present,...

Agents Of Atypical Pneumonia

Infection by Legionella is frequently heralded by an abrupt onset of malaise, weakness, headaches, and myalgia (Bentley 1984). Most patients cough hemoptysis occurs in one-third of patients. Mental status changes are reported in 25 to 75 of older patients. Other associated features are bradycardia, liver dysfunction, diarrhea, and hyponatriemia, but none of these features are specific and all may occur with severe pneumonia of other etiologies.

Somatosensory Symptoms

Although headache has not been particularly associated with MS, one report cited a patient with severe acute headache, associated with a solitary new lesion in the periaqueductal gray region (55). This unusual case supports observations in patients with implanted electrodes, in which perturbation in this area can produce headache. In another unusual case, headache, mimicking subarachnoid hemorrhage occurred. A patient with a history of facial myokymia developed apoplectic headache and a third nerve palsy. Investigations revealed no evidence of subarachnoid hemorrhage or aneurysm, but MRI showed more than 30 white matter lesions, and CSF examination revealed oligoclonal bands (56).

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is often referred to by other names or used interchangeably with similar disorders, such as chronic fatigue and immune dysfunction syndrome (CFIDS), fibromyalgia (FM), myalgic encephalomyelitis (ME), Gulf War Syndrome, and chronic Epstein-Barr disease. Recently, the Centers for Disease Control (CDC) has published epidemiologic figures estimating that approximately 800,000 Americans are affected by CFS. The associated economic loss is estimated in the billions of dollars, due to disability, medical expenses, and loss of wages. CFS is an incompletely understood, yet severely disabling disease of unknown etiology. It is characterized by profound, debilitating fatigue, of greater than 6 months duration that cannot be resolved with rest. Associated symptoms include fever, sore throat, myalgias, lymphadenopathy, sleep disturbance, headaches, neurocognitive difficulties (such as memory and concentration impairment and mental fog''), and symptoms associated with...

Melkersson Rosenthal Syndrome

Melkersson-Rosenthal syndrome is characterized by a triad of recurrent episodes of facial paralysis and facial edema along with a fissured tongue. Other neurologic sequelae have been documented, including headache, trigeminal neuralgia, cranial nerve dysfunction, and autonomic dysfunction. Although the etiology is unknown, recent investigation points toward a granulomatous disease leading to recurrent attacks of edema and inflammation of the face and oral cavity with a predilection for facial nerve involvement. Facial nerve involvement may be unilateral or bilateral, with varying frequencies of attacks and progression. No confirmatory blood test, histopathology, or radiographic evaluation is available, as the diagnosis is entirely clinical.

Intracranial vascular disease

The patient complains of a sudden very severe headache the like of which they have never experienced before. They may then lose consciousness (coma-producing haemorrhage) or remain unwell without going into coma (non-coma producing) approximately 20 die immediately or very soon after the haemorrhage. The survivors develop meningism due to the blood passing into the spinal subarachnoid space meningism causes painful stiffness of the neck and lumbar region, which worsens with movement, and must not be confused with spinal pathology (see Chapter 20). Patients may develop neurological deficit either from the site of the aneurysm (e.g. a 3rd nerve palsy from an aneurysm of the internal carotid artery) or from ischaemia resulting from spasm of the major vessels and or narrowing or occlusion of more distal vessels within the cerebral substance.

Changing Ones State Of Consciousness A Motivated

This chapter argues that people generally use drugs (legal and illegal) on purpose, because they wish to, because it makes them feel good or better, rather than because they are forced to do so by the pharmacology of the drugs they choose to take. People, it is argued, use drugs to make the world an easier place to live in, to assist coping with a painful mental state, for pure fun, to help with a physical infirmity, and so forth. Taking drugs is a motivated act people do it to achieve certain ends, both desirable and undesirable. Some people use drugs to alleviate withdrawal symptoms. This too is a motivated act, comparable to taking paracetamol for a headache, except that the symptoms are caused in part by the drug itself in the first place. We say in part since there is clear evidence that severity of withdrawal symptoms is context dependent (e.g. Hinson et al., 1986 McRae and Seigal, 1990). In the McRae and Seigal study, for instance, rats that lever-pressed to receive opiates...

Pagets disease of bone

Paget's disease of bone (PDB) is one of the most common chronic skeletal diseases affecting up to 3 of many White populations over the age of 60 years. Its ethnic and geographic distribution is variable, with a high prevalence in Whites from the United Kingdom, Australia, North America and Western Europe. PDB is characterized by focal areas of increased bone resorption and formation, leading to deformity and or enlargement. The axial skeleton (pelvis, lumbar and thoracic spine, and sacrum) is most frequently involved, followed by the femur, skull, and tibia. The newly formed bone in pagetic lesions is disorganized, frequently resulting in bowing and increased fracture. Bony overgrowth in the skull may lead to nerve entrapment, headache, and deafness.

RHuGMCSF and rHuGCSF

The adverse events reported in subjects receiving either filgrastim or sargramostim are similar. The most frequently reported adverse events attributed to filgrastim are bone pain, injection site reaction, rash, acute neutrophilic dermatoses, allergic reactions, worsening of inflammatory conditions, and splenic enlargement. For sar-gramostim, they are bone pain, fever, headache, chills or muscle ache, rash or injection site reactions, shortness of breath, and edema or capillary leak (93). To date, little published information exists about the adverse event profile associated with pegfilgrastim treatment, which is understandable given the recent approval of peg-filgrastim. Adverse events with this growth factor appear to be similar to those observed with its parent compound (filgrastim) (129,130). Mild-to-moderate bone pain that is easily managed with non-narcotic analgesics is the most frequently observed adverse event, being reported by approx 25 of patients receiving pegfilgrastim...

Captivity and Posttraumatic Stress Disorder

In reaction to the mistreatment of prisoners of war during the nineteenth century, beginning in 1864 a series of international meetings known as the Geneva Convention was held. The result was a set of rules regarding the humane treatment of prisoners of war, as well as the sick, the wounded, and those who died in battle. Despite some improvements as a result of the Geneva Convention and the rules for the treatment of prisoners of war that were defined at the Second Hague Conference of 1907, the conditions under which prisoners existed continued to be atrocious in many instances. During World War II for example, American soldiers captured by the Japanese were subjected to inhuman treatment and forced to survive on a near-starvation diet. In many ways, however, American soldiers who were taken prisoner by the Viet Cong or North Vietnamese during the Vietnam War suffered an even worse fate. Reminiscent of the treatment of inmates in concentration camps during World War 11, prisoners in...

Nucleoside Analogue Reverse Transcriptase Inhibitors

Zidovudine is a NRTI which has been studied extensively.12 It is highly bioavailable and can be given in two daily doses. It crosses the placenta and can be detected in amniotic fluid, fetal tissues, and cord blood. When given to infants and children, it is associated with increases in weight, growth rate, and neurocognitive function.13-17 It reduces viral copy number, decreases HIV p24 antigen levels, and transiently improves the CD4 counts as a mono-therapy. When given to children with advanced disease, it improves growth and survival.18 The primary toxicity is myelosuppression, which results in a macrocytic anemia (not responsive to B,, or folate) and neutropenia. Patients may experience nausea, headache, increase in liver function, and myositis. Cardiomyopathy, a complication of HIV itself, can also occur secondary to zidovudine toxicity. Mutations in the reverse transcriptase gene which result in amino acid changes at positions 41,67,70,215, and 219 confer in a progressive...

Potential Use Of Dna In Nanoengineering

It has been estimated that half of the genes in the human genome are central nervous system specific. For such genes, one must wonder how adequate a model the mouse will be for the human. Even if there are similar genes in both species, it is not easy to see how the counterparts of particular human phenotypes will be found in the mouse. Do mice get headaches, do they get depressed, do they have fantasies, do they dream in color How can we tell For such reasons it is desirable, as the technology advances to permit this, to bring into focus the genomes of experimental animals more amenable to neurophysiologi-cal and psychological studies. Primates like the chimp are similar enough to the human that it should be easy to study them by starting with human material as DNA probes. Yet the differences between humans and chimps are likely to be of particular interest in defining the truly unique features of our species. Other vertebrates, like the rat, cat, and dog, while more distant from the...

Reactive Lymphocytosis In Common Disease States

Lymphocytosis Photo

It is normal for young children between the ages of 1 and 4 to have a relative lymphocytosis. The white cell differential in this age group will show a reversal in the number of lymphocytes to segmented neutrophils from the adult reference range. The lymphocytes, however, will have normal morphology (Fig. 10.11). By far the most common disease entity displaying variation in lymphocytes is infectious mononucleosis. This is viral illness caused by the Epstein-Barr virus (EBV), a member of the human herpes virus family, type 4. Although young children may become infected with EBV, the virus has a peak incidence at around 20 years of age. Most adults have been exposed to EBV by midlife, and this is recognized by demonstratable antibody production whether or not they have had an active case of infectious mononucleosis. The virus is found in body fluids, especially saliva, and is frequently passed through exchanges such as kissing, sharing food utensils, or drinking cups. The virus, which...

Insulinlike Growth Factor1 Igf1

In a metabolic ward study in patients with HIV associated wasting fed a weight-maintaining diet, daily infusions of rhIGF-1 (4 g kg h for 12 h) produced significant short-term retention of nitrogen, averaging approx 1.7 g d (39). However, a waning effect was noted after 9 d of therapy. Notably, infusion of a higher dose of rhIGF-1 (12 g kg h for 12 h) produced no significant nitrogen retention. This reverse dose-response relationship may have resulted from the suppression of IGF binding protein-3 (IGFBP-3) in patients given the higher dose, reducing thereby the bioavailability of the exogenous rhIGF-1. Leucine and glycine flux, measured by stable isotope techniques, were unaffected by treatment at either dosing level. The predominant side effect of this treatment was headache, which occurred in 10 of 13 subjects treated.

Some Diseases Of The Visual System Retina and Optic Nerve Lesions

Giant Cell Arteritis of the Central Retinal Artery This disease occurs in those age 60 or older, with a sudden onset of central blindness. Superficial temporal arteries are typically tender, pulseless, and tortuous. There is almost always an elevated erythrocyte sedimentation rate and a low-grade fever. The history will often contain complaints of headache and stiff, aching, weak shoulder and hip muscles. Funduscopy shows total retinal ischemia (see the following section). Diagnosis, including temporal artery biopsy, is an emergency.

Acute Systemic Reactions Following Intravenous Bolus Heparin

ASR refers to a variety of symptoms and signs that characteristically begin 5-30 min after an intravenous heparin bolus is given to a patient with circulating HIT antibodies (Nelson et al., 1978 Warkentin et al., 1992, 1994 Popov et al., 1997 Ling and Warkentin, 1998 Warkentin, 2002b Mims et al., 2004) (Table 5 Fig. 3). Only about one quarter of at-risk patients who receive a heparin bolus develop such a reaction. The most common signs and symptoms are fever and chills, hypertension, and tachycardia. Less common are flushing, headache, chest pain, dyspnea, tachypnea, and large-volume diarrhea. In some patients, severe dyspnea is the predominant sign, termed pseudo-pulmonary embolism (Popov et al., 1997 Hartman et al., 2006) multiple small perfusion defects on radionuclide lung scans can be shown (Nelson et al., 1978 Ling and Warkentin, 1998). Fatal cardiac and respiratory arrest has been reported (Ansell et al., 1986 Platell and Tan, 1986 Hewitt et al., 1998). cardiopulmonary arrest...

Invasive Fungal Sinusitis

These patients typically suffer from a longstanding history of upper respiratory allergies, asthma, and nasal polyposis. The disease can take months or years to progress and symptoms include the erosion of barriers separating the paranasal cavities, as well as adjacent structures such as the orbits, brain, and pituitary gland (Stringer, 2000). Additionally patients suffer from mycotic aneurysms, carotid artery ruptures, erosion of the maxillary floor which results in palatal degradation, and erosion of the cribriform plate which results in chronic headaches, seizures, and decreased mental status. Etiological agents found in clinical cases are the same as those in the noninvasive and the acute invasive forms (Schell, 2000).

Rhinocerebral Mucormycosis

And soft-tissue swelling are initially seen, followed in a few days by double vision, increasing fever, and obtundation. Examination reveals a unilateral generalized reduction of ocular motion, chemosis, and proptosis. Facial skin adjacent to paranasal sinuses may be invaded by direct extension, turning progressively red, purple, and black. Fever, decreased vision, and facial swelling are the most common complaints in the first 72 hours of the disease (6). Other common complaints include facial pain and nasal congestion or discharge. Headache was found early in the disease in only 25 of patients in one large study but may be a common late finding.

Health Precautions For Researchers Handling Bats

Symptoms of rabies usually develop 10-14 days after exposure and include pain, burning and numbness at the site of infection, headaches, insomnia, fever, and difficulty swallowing. However, usually by the time the symptoms are apparent, the progression of the disease can no longer be prevented, ultimately resulting in fatal inflammation of the brain and spinal cord. Therefore, it is imperative that a person seek immediate medical attention after any potential exposure. People handling bats should obtain pre-exposure immunization, which is conferred by 3 doses of vaccine, and check their titers regularly. Additionally, they should simply avoid exposure. Bats captured to establish a captive colony should be quarantined for at least 6 months to assess possible sickness. Always wear gloves when handling bats and avoid rapid and unpredictable movements which increase the chance of bites.

Representations Create a Context for Management

In summary, the system is dynamic and the representations and actions are fluid. The underlying prototypes can vary from highly stable (e.g., the self) to moderately stable (e.g., lifetime experience with colds and migraine), to vague and readily changeable (e.g., SARS). Given its complexity and flexibility, the model speaks to a wide range of situations and poses challenges to our ingenuity in creating interventions and measures to test specific hypotheses.

Allergic rhinosinusitis

The sinuses and in uncomplicated allergic rhinosinusitis, sinus radiographs may demonstrate mucosal thickening. Some patients may appreciate nasal congestion as headache rather than as facial pressure pain. Abnormal mobility of the tympanic membrane and the presence of otitis media commonly are noted. Fatigue, perhaps due to sleep disturbances caused by nasal airflow obstruction, commonly accompanies allergic rhinosinusitis (6).

Neurocognitive Changes in AIDS Evolution of Treatment of HIV Infection

During the first 2 years this agent was employed (most often in doses of 600 mg but sometimes in doses as great as 1,500 mg day), side effects, especially nausea, headache, and anemia, were common. Follow-up studies over several years demonstrated that the clinical benefit of monotherapy with zidovudine was transient. In 1990, a state-of-the-art panel convened by the NIH suggested that azidothymidine, because of the demonstrated short-term survival benefit, should be given in divided doses of 600 mg daily to all persons living with HIV infection who had CD4 counts < 500 mm3. The recommendation of a CD4 count of 500 as the threshold for initiation of treatment was made on an arbitrary basis (7).

Pharmacological Toxicological Effects

There are numerous accounts of anecdotal evidence supporting the use of St. John's wort for premenstrual syndrome (PMS) (36). One open, uncontrolled study was conducted to determine the efficacy of St. John's wort in treating PMS. The primary outcome was measured by a daily symptom checklist of 17 symptoms rated on a scale of 0 to 4 based on the Hospital Anxiety and Depression (HAD) scale and modified Social Adjustment Scale (SAS-M) broken down into four subscales mood, behavior, pain, and physical. A total of 25 women were selected to participate in the study in which they received 300 mg hypericum standardized to 900 g hypericin daily. The results from the daily symptoms survey after the first cycle show a statistically significant reduction from the baseline value of 128.42 to 70.11. After the second cycle, there was a further reduction to 42.74. Of the four subscales, St. John's wort had the greatest improvement on the mood subscale (57 ) and the least improvement on the physical...

Mechanism of action

Nucleoside analogs were the first drugs to be used in HIV treatment, and therefore, most of the experience is based on them. They are easy to take, and once-daily dosing is sufficient for most. Overall initial tolerability is fairly good. However, frequent complaints during the first weeks are fatigue, headache and gastrointestinal problems, which range from mild abdominal discomfort to nausea, vomiting and diarrhea. The gastrointestinal complaints are easily treated symptomatically (see Side Effects).

Airways and Lungs

Visual symptoms and signs are common in GCA, and blindness is one of its most feared complications. These symptoms may be the initial manifestation of GCA, and in 20 of patients with visual findings, visual loss is the only or initial symptom (3,14,15). Most patients, however, have had complaints consistent with GCA, including headache and jaw pain, as well as fevers, for several weeks or months prior to the onset of visual loss. Ultimately, permanent partial or complete loss of vision in one or both eyes occurs in 20 of patients, with a range according to series of 10 to 60 (3,14,15). Most patients with GCA-related visual loss have an elevated sedimentation rate and often have thrombocytosis.

Presentation

Heat exhaustion is a condition of both salt and water depletion that usually strikes people in a hot environment who are without adequate water repletion. Salt losses are expected with heavy sweating and hypotonic replacement. This condition is sometimes difficult to diagnose, as it presents with myriad nonspecific symptoms, including headache, fatigue, nausea, vomiting, diaphoresis, weakness, irritability, and muscle cramps. The rectal temperature will be less than 40 C, and mental status should be normal. This is important in distinguishing this state from that of heat stroke, which will usually have a temperature above 40 C (unless treated prior to arrival) and mental status changes. This is classically seen in debilitated patients during disaster conditions, such as heat waves. The signs and symptoms of heat exhaustion are unfortunately nonspecific, and include weakness, fatigue, nausea and vomiting, headache, and orthostatic syncope. By comparison, key features of heat stroke...

Side Effects

The side effect profiles of the various PG analogs are compared in table 2.1. Eye irritation, conjunctival hyperemia, and eyelash changes are the most frequently reported side effects. Eye irritation, burning, and pain are reported with variable frequency in the various studies, and the rates of these symptoms with the various PG analogs are not substantially different from each other or from timolol. A wide range of other signs or symptoms such as superficial punctate keratitis, blurred vision, cataract, and headache have been reported at low rates in various clinical studies. The side effects of iris color changes, eyelash changes, and periocular skin color changes are specifically associated with the PG analogs.

Clinical Features

Lassa Fever does not have a pronounced hemorrhagic component (17 ), and neurological impairment is rare except for sensorineural deafness (the most common cause of deafness in West Africa). On the other hand, Bolivian Hemorrhagic Fever has neurological impairment as a prominent feature (headache, tremor, encephalitis). After an incubation period of 3 to 9 (Marburg) or 3 to 18 (Ebola) days, an abrupt onset of headache, backache, and myalgias begins. Nausea, vomiting, and profuse watery and bloody diarrhea occur about 3 days later. A maculopapular rash erupts, and by days 4-5 diffuse hemorrhage occurs. Death occurs frequently by day 8 or 9. Leukopenia, thrombocytopenia, clotting abnormalities, proteinuria, and amylasemia will occur. EKG changes may also reflect myocardial involvement. Case fatality reaches 30 with Marburg and 90 with Ebola. Yellow Fever. Yellow fever is named for the jaundice it causes secondary to liver dysfunction failure. The disease has a spectrum of presentation...

Relaxation

In behaviour therapy, relaxation exercises are applied much more widely than merely as a component of systematic desensitization. Relaxation training has been an important component of various treatments, most notably in the treatment of generalized anxiety disorder. Relaxation training can also be useful in treating tension headaches and disturbed sleep.

Case

A 26-year-old female was examined because of short stature (Splitt and Good-ship, 1997). She had low birthweight (2 kg at term, < 3rd percentile), her menarche begun at age 8 years, and she had a history of migraine from age 6. Her height was 132 cm she had very small hands and feet, cubitus valgus, mild lumbar scoliosis, and mild obesity. Head cicumference was 51 cm (< 3rd percentile) and brain CT did not show any evidence of ventricular dilatation. The karyotype showed a Robertsonian t(14 14) translocation. Analysis of DNA polymorphisms revealed maternal UPD14 (isodisomy). No evidence for mosai-cism involving trisomy 14 was found.

Stress And Coping

Among the symptoms of prolonged stress are persisting anxiety, depression, irritability, fatigue, loss of appetite, headache, and backache. Continuing stress can affect the course and severity of physical disorders such as peptic ulcers, migraine headaches, skin conditions, chronic backache, and bronchial asthma.

Treatment

Pediatric co-trimoxazole suspension can be used for desensitization, by slowly increasing exposure within six days from 12.5, 25, 37.5, 50 and 75 to 100 of the dose in the 480 mg tablet. In a study of almost 200 patients, no cases of severe allergy occurred, and there was a reduction of fever and headaches. Approximately three quarters of all patients are thus able to tolerate co-trimoxazole again. However, re-exposure should only be attempted after an interval of eight weeks (Leoung 2001).

Stress Syndromes

Three of the most publicized states associated with prolonged stress are burnout, bereavement, and posttraumatic stress disorder. The symptoms of burnout, a condition precipitated by the stress of overwork, include emotional exhaustion, reduced productivity, and feelings of depersonalization. The emotional exhaustion in burnout may be accompanied by physical symptoms such as headaches and backaches, in addition to social withdrawal. Compulsive, insecure workaholics whose jobs have ceased to provide them with self-fulfillment are particularly prone to burnout. Such individuals attempt to compensate for low self-esteem from off-the-job activities by dedicating themselves to their jobs and becoming workaholics. In retirement, otherwise perfectly healthy men and women may develop headaches, depression, gastrointestinal symptoms, and oversleeping . . Irritability, loss of interest, lack of energy, increased alcoholic intake, and reduced efficiency are all familiar and common reactions.

Richard L Kingston

Although feverfew has been demonstrated to provide therapeutic benefit to isolated patient groups and at varying dosage levels, its clinical effectiveness has not been consistently reported. A variety of caveats associated with study design, identification or concentration of appropriate substance, or duration of evaluation from previous clinical studies complicate the assessment of the overall benefit of the herb. Despite inconsistent reports of effectiveness, the favorable safety profile and low risk of use suggest a positive risk benefit for patients looking for migraine prophylaxis treatment alternatives. Key Words Tanacetum partheium migraine parthenolide oral ulceration sesquiterpene lactones.

Regulation

In Canada, the Health Protection branch allows sale of tablets and capsules made from feverfew crude dried leaves for decreasing the frequency and severity of migraine headaches. The products should be standardized to contain no less than 0.2 parthenolide. In France, feverfew has traditional use in the treatment of heavy menstrual flow and prevention of migraine headache (4).

Asphyxiant Gases

Ical means, as occurs with carbon monoxide. Carbon monoxide is the second most common atmospheric pollutant after carbon dioxide. It is produced by incomplete combustion from fires, faulty heating systems, volcanic eruptions, and internal combustion engines, as well as a variety of industrial processes. Carbon monoxide is an odorless, tasteless gas. Early symptoms (headache, sore throat, shortness of breath, and fatigue) can mimic the flu, especially when an entire family is affected from an exposure related to a faulty home heating system. Serious clinical effects such as tachycardia, arrhythmias, angina, and mental status changes can occur when carboxy-hemoglobin concentrations exceed 20 (especially in nonsmokers) and effects are nearly always fatal when carboxyhemoglobin concentrations exceed 60 . Clinical effects may occur at lower concentrations in subjects already suffering from cardiopul-monary diseases. Carbon monoxide toxicity is related to decreased oxygen transport due to...

Viral Infections

Primary infection with HIV usually presents as a mono-nucleosis-like syndrome after an incubation period of one to four weeks, as previously mentioned. The clinician should consider acute HIV infection in a mononucleosis-like presentation with negative serologies. The symptoms reported, by decreasing order of frequency, are fever (95 ), lymphadenopathy, pharyngitis, maculopapular rash, myalgias arthralgias, nausea, vomiting or diarrhea, headache, hepatosplenomegaly, neuropathy, oral or upper GI ulcerations, purpura, and conjunctivitis. Large painful oral ulcers are reported with acute HIV infection, which are associated with gram-negative bacterial colonization. Those are usually self-limited, but help in the differential diagnosis of acute PHI from other viral illnesses.

Encephalitis

Clinical manifestations include headache, fever, altered level of consciousness, disturbances in behavior and speech, and generalized seizures. Focal neurologic findings generally indicate HSV infection and include ataxia, cranial nerve defects, hemi-paresis, or focal seizures. Skin lesions such as the characteristic exanthem of varicella or vesicles that suggest HSV type 1 or 2 may be present. History may reveal the bite of a potentially rabid animal, and knowledge of disease outbreaks in the community (such as mosquito-borne viruses) may help to guide diagnosis. Differential diagnosis includes metabolic diseases, toxic disorders, mass lesions, and acute demyelinating disorders.

Botulinum Toxins

When used for treatment of whiplash, botulinum toxin relived pain significantly compared with a placebo treatment, but showed a nonsignificant trend in improving subjective functioning (71). In another study, 46 patients with coexisting chronic tension headaches and temporomandibular disorders reported a 50 or greater improvement in headache pain. A randomized, double-blind study found that 11 of 15 subjects who received botulinum toxin A injections for low back pain had more than 50 pain relief vs 4 of 16 who received saline injections (72). By 8 weeks, these figures were 9 of 15 and 2 of 16, respectively, and function had improved in the treatment group.

Clinical

AIDS must be considered in any of the following clinical presentations oral can-didiasis (thrush) with or without dysphagia and weight loss large, painful genital or perianal ulcers (herpes simplex) dyspnea, dry cough, and fevers, often of gradual onset, associated with clear or diffuse interstitial pattern on chest x-ray, arterial blood hypoxia, and exertional arterial oxygen desaturation (Pneumocystis carinii pneumonia). Cryptococcal meningitis can be a very indolent disease with subtle symptoms of mild headache or photophobia and can present with fever and progress to profound obtundation. Asymptomatic cases of disseminated cryptococcosis have occasionally been diagnosed on the basis of a persistently positive serum cryptococcal antigen tests. Chronic unrelenting diarrhea with weight loss and wasting has long been identified as a classic presentation of AIDS, and the list of possible etiologies is extensive, with cryptosporidiosis, microsporidiosis, cytomegalovirus colitis as but a...

Rat lungworm

Especially dangerous to humans because it ruptures vessels in the brain. The presence of juveniles in the blood vessels, meninges, or tissue of the human brain can result in symptoms such as headache, fever, paralysis, neurological disorders, and even coma and death. The appearance of worms is often associated with eosinophilia, and is the primary cause of eosinophilic meningoenciphalitis, a disease that occurs when humans eat infected, raw snails.

IL13PEI001 Study

Patients if one dose limiting systemic or CNS toxicity (DLT) was observed. At the initial concentration level (0.125 g mL), the cohort was expanded to six patients as one of the first three patients developed cerebral edema and symptoms of mass effect shortly after completion of the first infusion that responded rapidly to corticosteroid. No other DLTs were observed at the initial concentration. A second infusion at week 9 was given to three patients and was well tolerated. After the initial concentration, cohorts of 3 patients each received escalating concentrations of 0.25, 0.5, 1.0, 2.0, and 4.0 g mL of IL13-PE. One patient in the 4.0 g mL cohort had a DLT including a seizure associated with imaging histopathologic changes consistent with nonspecific necrosis of tumor-infiltrated and possibly normal brain parenchyma. Three additional patients have been treated at 4.0 g mL and are being followed. A total of 24 patients were treated in this study (82). In general, drug-related...

Tumefactive MS

MS may occasionally be present as a mass lesion indistinguishable clinically and radiographically from a brain tumor (153). Patients may present with headache, aphasia, disturbance in consciousness, or seizures. Neuroimaging often reveals unifocal or multifocal enhancing lesions with associated mass effect and edema. With neuroimaging, the presence of open-ring enhancement toward the cortical surface is more likely associated with demyelinating lesions (Figure 12) (154). These patients pose considerable diagnostic difficulty and often require brain biopsy to confirm a diagnosis. Pathologically, the biopsy specimen may be mistaken for a neoplasm given the hyper cellular nature of these lesions, and the association with bizarre astrocytic forms (i.e., Creutzfeld-Peters cells) limited necrosis (Figure 12). These features are a potential trap for the pathologist, and such cases are common causes of medicolegal litigation. The histological features detailed above (intimate admixture of...

Ehrlichiosis

The incubation period ranges from a week to a month. Common symptoms are fever, headache, and myalgias. Leukopenia, thrombocytopenia, and elevated liver function tests can be seen in anywhere from 50 to 90 of patients. Rashes occur in approximately a third of patients with HME but in only 2-11 of those with HGE. Other findings such as ARDS, meningitis, pancarditis, renal failure, and DIC have been reported. Fatality rates have been reported at 2.7 for HME and 0.7 for HGE.

Babesiosis

After an incubation period of 1 to 4 weeks the clinical presentation is with nonspecific flu-like symptoms, including fever, chills, headache, fatigue, and anorexia. Other less common symptoms are nausea, diaphoresis, depression, photophobia, myalgias, arthralgias, dark urine, emotional lability, and hyperesthesias. Unlike Lyme disease, rash is not a feature of the illness. Splenomegaly is present on exam in patients. More severe disease occurs in splenectomized patients. The diagnosis is established by examination of thick and thin Giemsa-stained blood smears. Characteristic intra-ery-throcytic forms may be present.

Colorado Tick Fever

Endemic to the Rocky Mountain area, Colorado tick fever (CTF) is an acute tickborne viral infection characterized by headache, back pain, biphasic febrile course, an occasional maculopapular rash (around 10 ), and leukopenia. The etiologic agent of CTF is an arbovirus in the genus Orbivirus. CTF occurs in altitudes from 4,000 to more than 10,000 feet, in the Canadian provinces of British Columbia and Alberta and the western parts of the United States. The tick vector is Dermacentor andersoni, the same vector as RMSF. It is important to contrast CTF and RMSF because the treatments are different. Even though RMSF was described in the Rockies, it is actually less common than CTF, which is twenty-fold more common in Colorado.

Spreading depression

There is much evidence linking the development of spreading depression with astroglial networks particularly important are the demonstration of the effective inhibition of spreading depression by pharmacological inhibition of gap junctions and the discovery of circulating currents passing through the glial syncytium during a course of spreading depolarization. An apparent similarity between propagating astroglial calcium waves and the propagation of spreading depression led to a hypothesis of a triggering role for the former this remains controversial, however as in mouse neocortex, for example, it was possible to pharmacologically dissociate astroglial calcium waves and spreading depression. Nonetheless, the leading role played by astrocytes in the development of spreading depression remains firm although the underlying mechanisms require further elaboration. The pathological potential of spreading depression also requires further attention at present it is implicated in the...

Initial Assessment

Once the tumor is diagnosed, the second phase of assessment, clinical staging and anatomic localization of the tumor, begins. This involves obtaining a careful history and physical examination and performing computed tomography (CT) of the chest and abdomen, barium swallow, endoscopic ultrasonography, and positron emission tomography (PET). Because a bone scan and CT or magnetic resonance imaging of the brain yield little diagnostic information in asymptomatic patients, these tests are performed only if symptoms (i.e., new onset of bone pain or neurologic changes, such as headaches or visual disturbances) are present.

Adverse Effects

Bleeding is the major adverse effect of bivalirudin and occurs more commonly in patients with renal impairment. Injection site pain has been reported in individuals given sc bivalirudin (Fox et al., 1993). Mild headache, diarrhea, nausea, and abdominal cramps have also been reported (Fox et al., 1993). In the Hirulog Angioplasty Study (HAS) (now known as the Bivalirudin Angioplasty Trial BAT ), the most frequent adverse effects included back pain, nausea, hypotension, pain, and headache. Approximately 5-10 of patients reported insomnia, hypertension, vomiting, anxiety, dyspepsia, bradycardia, abdominal pain, fever, nervousness, pelvic pain, and pain at the injection site (Bittl et al., 1995 Sciulli and Mauro, 2002) (Table 3).

RHuInterleukins

White blood cell counts were observed in 7 9 patients and 2 6 patients at dose levels of 1-2 pg kg d and 4-16 pg kg d, respectively, administered as 21-d continuous iv infusions (148). Responses were not elicited in other blood lineages. In a phase 1-2 study of 21 AA and MDS patients evaluating rHuIL-3 dose levels of 0.5-10 pg kg d sc for 21 d, 2 AA patients experienced improvements in red cell transfusion requirements (74). Two additional small trials reported neutrophil and platelet responses in a few patients, but erythroid responses were not observed (73,149). Studies of both rHuIL-1 and rHuIL-6 in patients with refractory severe AA patients have not shown any efficacy (150,151). Nonhematologic side effects produced by rHuIL-6 included fever, headache, arthralgia, tachycardia, and hypertension. Hematologic toxicity included worsening of pre-existing anemia and thrombocytopenia. The study was discontinued early because of the toxicities attributed to rHuIL-6.

Mycoplasma

Mycoplasma pneumoniae is a small bacterium that lacks a cell wall and commonly causes upper respiratory tract infections and pneumoniae. The overall incidence of infection in the United States has been estimated at 1.7 cases 1000 people year (38) with 6.8 of all pneumonia caused by this pathogen (39). Symptoms include fever, cough, malaise, and headache, but as many as 25 of patients are asymptomatic. Extrapulmonary manifestations do occur, with neurologic sequelae estimated in 0.1 of all cases (39). Neurologic findings are variable and include psychosis, meningitis, transverse myelitis, ataxia, peripheral neuropathies, and cranial neuropathies. Facial nerve involvement, alone or in conjunction with other neurologic sequelae, is considered rare but has been reported by several authors (40-42). Bilateral facial paralysis has also been associated with mycoplasm infections (43,44).

Cat Scratch Disease

Cat-scratch disease is caused by a systemic infection with Bartonella henselae, a bacteria colonizing cat saliva. The infection typically presents as a skin lesion at the site of a cat scratch with ensuing local lymphadenopathy. Infection is manifested by lymphadenopathy, but infected individuals may display fever, fatigue, anorexia, or headaches. It is most commonly a pediatric disorder, affecting individuals usually younger than 21 years of age. Neurologic involvement is estimated to affect 2 to 3 of patients, presenting as encephalopathy, seizures, cerebellar ataxia, hemiparesis, myelitis, or cranial neuropathies. Curiously, neurologic involvement has an increased incidence in adult patients. Facial nerve involvement is considered rare (65).

Primary Prophylaxis

Mastroianni and coworkers (35) evaluated the use of rHuG-CSF in combination with ABV administered every 14 d. Patients received rHuG-CSF 5 pg kg before and after ABV administration. Concomitant antiretroviral therapy with didanosine and Pneumocystis carinii prophylaxis with trimethoprim sulfamethoxazole was allowed. The overall response rate to ABV was 58 , and the complete response rate was 18 . Median survival was 11 mo. Administration of rHuG-CSF decreased the incidence of hematologic toxicity and morbidity from febrile neutropenia (FN) and increased patient quality of life. Serious bacterial infections occurred in five (20 ) and opportunistic infections in three (12 ) patients. Adverse effects occurring in > 40 of patients included nausea, vomiting, and headache.

Porphyrias

Thyroid hormone plays a critical role in regulating metabolism. In hypothyroidism, the basal metabolic rate is decreased due to a lack of thyroid hormone, resulting in bradycardia, cold intolerance, alopecia, and weight gain. Neurologic symptoms are relatively common in hypothyroidism and include paresthesias in up to 80 of patients as well as ataxia, coma, headache, seizure, cerebellar signs, and psychosis (132,133). Cranial nerve involvement has also been reported, with the vestibulocochlear nerve most commonly affected in 15 to 31 of patients with hypothyroidism (132). Involvement of the facial nerve is considered rare. Its mechanism is thought to be a compressive phenomenon. In hypothyroidism, myxedematous infiltration and swelling of the soft tissue are hypothesized to have a compressive effect on the facial nerve through the tight confines of the fallopian canal. Anecdotal reports of facial nerve decompression in hypothyroidism have been described (134), but additional reports...

Cytomegalovirus

CMV is a double-stranded DNA virus that, in normal individuals, induces a febrile illness that resembles mononucleosis from EBV, with chills, fatigue, headache, and malaise (Gandhi and Khanna 2004). In immunocompromised patients, such as those who have undergone bone marrow or other organ transplantation or who have advanced human immunodeficiency virus (HIV) disease, CMV can cause considerable morbidity and mortality. CMV may be reactivated in a previously infected person who becomes immunosuppressed. Alternatively, a de novo CMV infection may be transmitted to a CMV-negative recipient of an organ from a CMV-positive donor. Many organs can be affected by CMV infection, including the retina, lung, liver, esophagus, or colon. CMV can also cause complications to a fetus infected in utero, including hearing loss, visual loss, and neurological complications (Fowler et al. 1992). CMV hyperimmune globulins (CMVIG) first demonstrated efficacy in the treatment of disease associated with...

Biofeedback

Biofeedback for conditions thought to relate more closely to brain function would be expected to more directly alter the disease state if successful. Our search terms again seemed to only sample this area. Siniatchkin et al (2000) provided feedback on a slow cortical potential related to attention preparation (contingent negative variation) in a group of children with migraine and a comparison group of healthy children. Training in control of the brain wave was used, i.e., both increasing and decreasing its amplitude. Children with migraine learned more slowly than control children but were able to achieve control. The frequency and duration of migraine episodes also decreased across training, but, as with the prior studies reviewed, change in the ERP was not clearly related to the clinical outcome. A similar result was obtained with biofeedback for fibromyalgia patients. Biofeedback was successful in altering frequency amplitude of EEG bands (Mueller et al, 2001), but the authors did...

Data Collection

In 1999 Wayne State University developed and tested the feasibility of a web-based surveillance program based on patients' chief complaints in the Emergency Department. Triage data was sorted into five chief complaint groups. Separate chief complaint groups were identified for all Category A threats. For example, the anthrax group consists of cough, dyspnea, fever, lethargy, pleuritic chest pain, headache, upper respiratory infection, weakness or fatigue, vomiting, and generalized abdominal pain. Historical data was used as a control. Using the anthrax criteria, they were able to successfully identify the influenza outbreak within the first week. They emphasize, as do other public agencies, that syndromic surveillance can only detect potential threat exposures. Once an aberrant signal is detected it is essential that public heath officials follow-up with field investigations.

Funeral Practices

Feelings of grief are not always expressed immediately after the loss of a loved one, but may be delayed for months or even years. On the other hand, so-called anticipatory grief may be expressed even before the death of a loved one. Typically, however, the grieving occurs after the death and consists of three phases (Gorer, 1965) initial, intermediate, and recovery. During the initial phase, which lasts from about 3-6 weeks, the bereaved person experiences shock and disbelief, and may feel cold, dazed, empty, numb, and confused. The initial phase is followed by an intermediate phase characterized by sorrow and loss punctuated by crying spells. In addition to deep sadness, it is fairly normal in the intermediate phase of grief to feel angry, anxious, and guilty. Anger may be expressed toward anyone whom the bereaved views as having contributed, either by commission or omission, to the death, or as having been unkind to the deceased while he or she was alive. Favorite targets of anger...

CNS infections

Clinically, meningitis manifests as fever, headache, neck stiffness, photophobia and a deteriorating level of consciousness. A transient petechial skin rash can occur in meningococcal meningitis. Seizures, cranial nerve signs including deafness can develop. Focal neurological deficits can occur usually from focal ischaemia or the development of an abscess. CNS involvement in viral infection can occur through massive viraemia or along peripheral nerves. The infection not only can lead to meningitis but also cause encephalitis, cerebritis or myelitis. Infection of the motor neurons and spinal nerves is poliomyelitis and of the dorsal root ganglia radiculitis. The commonest causal organisms are enteroviruses, mumps virus, or herpes simplex. The meningeal phase of infection with headache photophobia and drowsiness usually lasts about 7-10 days. CSF cell count is elevated and if obtained early can contain the virus. Treatment is for the symptoms apart from severe herpes simplex meningitis...

Case Example

A 51-year-old woman was transferred from a small community emergency department for subspecialty evaluation. The patient had presented to that facility the previous night complaining of headache and fever for three days with a sudden loss of vision in her left eye. During our evaluation, the patient reported that one week earlier, she fell, striking the left side of her face and sustaining several small abrasions. She denied other facial trauma. Further history revealed a general malaise and gradual weight loss for about one month's duration. She also admitted to falling occasionally in the past. Her past medical history included non-insulin-dependent diabetes mellitus for several years. She was non-compliant with her oral hypoglycemic medication. She denied other past medical history.

CNS Imaging

Metastatic malignant teratoma. The patient was a 29-year-old man with recurrent malignant teratoma in the retroperitoneum and lungs. He was originally treated with left orchiectomy and three cycles of bleomycin etoposide cisplatin (BEP) chemotherapy for a serum marker-negative high-risk stage I mixed nonseminomatous germ cell tumor of the right testis from August 1998. The orchiectomy specimen demonstrated elements of malignant teratoma. A computed tomography (CT) scan of the abdomen was normal at that time. The patient declined retroperitoneal lymph node dissection. Seventeen months later, the patient re-presented with abdominal and back pain as well as morning headaches and visual field changes. CT of the abdomen demonstrated a retroperitoneal mass 11 cm in maximal diameter. Chest radiography demonstrated as many as 100 small nodules consistent with metastases. Magnetic resonance imaging of the brain (A and B) demonstrated a single large metastasis. The patient was...

The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

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