1/43. 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 = state (Clic here for more details about this article) |
2/43. ophthalmoplegic migraine with unusual features.We report the details of a patient with an unusual form of ophthalmoplegic migraine resulting in permanent vertical misalignment of the affected eye. The presentation, history, and ophthalmologic examination are reported as well as disease course and follow-up complications. We review the literature on ophthalmoplegic migraine with discussion regarding typical presentation, methods of diagnosis, and other diseases which may cause diagnostic confusion. In light of current case reports on ophthalmoplegic migraine, this is the first documented example with a permanent deficit.- - - - - - - - - - ranking = 53.355532955293keywords = confusion (Clic here for more details about this article) |
3/43. hypoglycemia rebound migraine.OBJECTIVE: To describe a patient with specific hypoglycemia rebound migraine. BACKGROUND: There is an increased prevalence of headache in persons with diabetes. Although hypoglycemia may precipitate headache in some diabetic (and nondiabetic) patients, it is not a universal pathogenetic mechanism responsible for headache in those individuals or in normal fasting subjects. methods: Clinical history, review of past medical records, neurologic examination, follow-up evaluation, electroencephalogram, and computerized tomography of the head. RESULTS: A 56-year-old man with unstable diabetes mellitus had recurrent monthly episodes of profound hypoglycemia for 40 years. These episodes were followed by severe, global, pulsatile headache after glycemia became normal subsequent to intravenous infusion of glucose and the patient was no longer confused and lethargic. He had no headache preceding or throughout the actual hypoglycemic phase. His neurologic examination was normal when asymptomatic. His baseline electroencephalogram was normal, but showed mild slowing of the background in the immediate posthypoglycemic state. Computerized tomography of the head demonstrated mild atrophic changes. His severe bouts of hypoglycemia and migraine were ameliorated by prophylactic treatment with valproic acid. CONCLUSION: Posthypoglycemic migraine may occur exceptionally in patients with unstable diabetes as a rebound phenomenon, caused by an unidentified mechanism.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
4/43. Possible ergotamine-caffeine-associated delirium.An elderly patient with a history of chronic migraine was hospitalized with systolic hypertension and significant mental status changes, including increasing confusion, combative behavior, and remarkably detailed auditory hallucinations of several weeks' duration. Daily increased consumption of a product containing ergotamine 1 mg and caffeine 100 mg coincided with both onset and increasing severity of symptoms. To our knowledge, this is the first case reported in the contemporary literature of severe mental status changes and hallucination possibly due to ergotamine-caffeine.- - - - - - - - - - ranking = 53.355532955293keywords = confusion (Clic here for more details about this article) |
5/43. Triptans in the treatment of basilar migraine and migraine with prolonged aura.OBJECTIVE: To report on the use of triptans in migraine with prominent neurologic symptoms. BACKGROUND: As stated in their package inserts, the triptans are contraindicated in patients with basilar or familial hemiplegic migraine, and physicians are reluctant to prescribe these drugs to other patients with prominent or prolonged aura. methods: We evaluated 13 patients with basilar migraine, familial hemiplegic migraine, or migraine with prominent or prolonged aura who had received triptans. RESULTS: Excellent; no adverse events. CONCLUSION: The contraindication of triptans in basilar migraine should be reconsidered. Similarly, prominent or prolonged aura may not represent a reasonable contraindication to triptan therapy.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
6/43. Migraine, cortical blindness, multiple cerebral infarctions and hypocoagulopathy in celiac disease.We describe the case of a female patient affected by migraine and untreated adult celiac disease who presented with a state of acute migraine accompanied by multiple neurological deficits, including transient cortical blindness with ischemic CT and MRI alterations, and hypocoagulation due to factor vii deficiency. She was receiving estroprogestin therapy. There was a prompt response to cortisone therapy followed by a state of complete well-being, which also led to the disappearance of migraine attacks after five years of dietary treatment alone.- - - - - - - - - - ranking = 2keywords = state (Clic here for more details about this article) |
7/43. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study.Electrical stimulation of primary sensory afferents is known to have an antinociceptive effect. Animal and functional imaging studies suggest a role for supraspinal structures in this response. Eight patients with chronic migraine (> or =15 days per month of attacks of migraine without aura), who had shown a marked beneficial response to implanted bilateral suboccipital stimulators, were studied. Stimulation evoked local paraesthesia, the presence of which was a criterion of pain relief. On stimulation, the headache began to improve instantaneously and was completely suppressed within 30 min. On switching off the stimulation, the headache recurred instantly and peaked within 20 min. PET scans were performed using regional cerebral blood flow (rCBF) as a marker of neuronal activity. Each patient was scanned in the following three states: (1) stimulator at optimum settings: patient pain-free but with paraesthesia; (2) stimulator off: patient in pain and no paraesthesia; (3) stimulator partially activated: patient with intermediate levels of pain and paraesthesia. All scans were processed and analysed using Statistical Parametric Mapping (SPM) 99. There were significant changes in rCBF in the dorsal rostral pons, anterior cingulate cortex (ACC) and cuneus, correlated to pain scores, and in the ACC and left pulvinar, correlated to stimulation-induced paraesthesia scores. The activation pattern in the dorsal rostral pons is highly suggestive of a role for this structure in the pathophysiology of chronic migraine. The localization and persistence of activity during stimulation is exactly consistent with a region activated in episodic migraine, and with the persistence of activation of that area after successful treatment. The dorsal rostral pons may be a locus of neuromodulation by suboccipital stimulation. In addition, suboccipital stimulation modulated activity in the left pulvinar.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
8/43. Reevaluating spells initially identified as cataplexy.BACKGROUND AND PURPOSE: cataplexy, transient episodes of bilateral muscle weakness with areflexia provoked by emotions, is a state highly specific to narcolepsy. cataplexy is diagnosed based on clinical interview. Two screening tools have been developed recently but their usefulness has been limited because of length or current lack of psychometric data. Used effectively even these screening tests require the interpreting physician to have an understanding of the typical features of cataplexy. Most physicians encounter patients with cataplexy fairly infrequently, making it difficult to gain proficiency in detecting cataplexy based on clinical interview alone. Relatively little attention has been given to the differential diagnosis of cataplexy, which increases the likelihood of unnecessary sleep testing or false positive diagnosis. patients AND methods: This case series describes six cases where cataplexy was initially diagnosed. In all cases the weakness spells were eventually not attributed to cataplexy. The presentation and characteristics of these cases will be presented as a means to discuss the differential diagnosis of cataplexy. RESULTS: These cases represent a diverse set of medical disorders including bradycardia, migraine, delayed sleep phase syndrome, conversion disorder, malingering and a chronic psychotic disorder. CONCLUSIONS: A more in-depth understanding of the classic features of cataplexy should improve recognition of this fascinating state. Improved cataplexy recognition will enhance the appropriate usage of sleep tests and eventually increase the timeliness and accuracy of the diagnosis of narcolepsy with cataplexy.- - - - - - - - - - ranking = 2keywords = state (Clic here for more details about this article) |
9/43. Acute confusional migraine: case series and review of literature.Acute confusional state (ACS) as a manifestation of migraine in the pediatric age group was initially described by Gascon and Barlow. The characteristics and natural history of acute confusional migraine (ACM) have been elaborated on by other authors. The diagnosis of ACM is, however, easily overlooked in clinical practice, due to its peculiar presentation. We describe three children who had acute onset of confusion. The differential diagnosis of acute confusional state and the clinical features and management of ACM are discussed.- - - - - - - - - - ranking = 38503.133959207keywords = confusional state, confusion, state (Clic here for more details about this article) |
10/43. Imaging abnormalities in sporadic hemiplegic migraine on conventional MRI, diffusion and perfusion MRI and MRS.Prolonged hemiparetic migraine aura can cause diagnostic confusion and be mistaken for ischaemic stroke occurring during the course of a migraine--'migrainous infarction'. We report a case of prolonged hemiparesis occurring during the course of a migraine attack. Though initially confused with migrainous infarction, we suggest with sequential magnetic resonance imaging, magnetic resonance angiography, diffusion, perfusion images and magnetic resonance spectroscopy that the hemiplegia was not of vascular origin and that the patient had sporadic hemiplegic migraine. We hypothesize that the mechanisms of sporadic hemiplegic migraine probably lie at a cellular level, similiar to familial hemiplegic migraine.- - - - - - - - - - ranking = 53.355532955293keywords = confusion (Clic here for more details about this article) |
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