1/189. Incomplete nondisplaced tibial osteotomy for treatment of osteoarthritic knee pain.Intraosseous venous hypertension is considered a significant factor in the production of knee pain secondary to degenerative arthrosis, thus vascular decompression by means of tibial osteotomy is a rational option for treatment of selected patients. A preliminary report is presented of six patients with symptoms of primary or secondary degenerative arthrosis who were treated by incomplete nondisplaced proximal tibial osteotomy with good or excellent results. These patients were refractory to nonoperative treatment and were not deemed suitable candidates for angulated osteotomy, arthroscopic surgery alone, or total knee arthroplasty. patients ranged in age from 36 to 61 years (mean age: 47 years). Follow-up ranged from .8 to 6.7 years (mean: 3.1 years). The subjects were studied postoperatively by interview, physical examination, radiographs, and bone scans. Results were assessed using the knee rating system of The Hospital for Special Surgery.- - - - - - - - - - ranking = 1keywords = tension (Clic here for more details about this article) |
2/189. Spontaneous intracranial hypotension.PURPOSE: To describe a patient with classic presentation of spontaneous intracranial hypotension and subsequent improvement with targeted epidural blood patch. methods: Report of one case and review of the literature. RESULTS: Examination of cerebrospinal fluid after lumbar puncture disclosed a reduced opening pressure, an increased level of protein, and lymphocytic pleocytosis. magnetic resonance imaging of the brain with gadolinium showed diffuse enhancement of the pachymeninges, no evidence of leptomeningeal enhancement, and chronic subdural fluid collection. Radionuclide cisternography demonstrated reduced activity over the cerebral convexities, early accumulation of radiotracer in the urinary bladder, and direct evidence of leakage at the cervicothoracic junction (C7-T1). Clinical, laboratory, and radiologic features were consistent with the diagnosis of spontaneous intracranial hypotension. Therapy with a targeted epidural blood patch resulted in the rapid resolution of symptoms. CONCLUSIONS: In this report, we describe a classic case of spontaneous intracranial hypotension in a 63-year-old man with an initial presentation of postural headaches, blurred vision, pain in the left eye, diplopia on left gaze, and neck soreness.- - - - - - - - - - ranking = 107.89703031043keywords = headache, tension (Clic here for more details about this article) |
3/189. Cervical cord and dorsal medullary infarction presenting with retro-orbital pain.A 36-year-old woman experienced an excruciating right retro-orbital paroxysmal headache after a stroke of the anterior two-thirds of the right hemicord at the C1 level (anterior spinal artery territory) and the dorsal medulla (posterior spinal artery territory). A right vertebral artery dissection was demonstrated. This unusual infarct mimicked a cluster headache attack or paroxysmal hemicrania.- - - - - - - - - - ranking = 201.79406062086keywords = headache (Clic here for more details about this article) |
4/189. 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 = 303.69109093129keywords = headache, tension (Clic here for more details about this article) |
5/189. Painful seizures with allodynia in an 11-year-old boy.An 11-year-old boy's epileptic seizures started with a feeling of impending crisis, dizziness, headache, and a bad taste in the mouth. This was followed by swallowing and a burning sensation in the left hand. At the same time, other parts of the body experienced allodynia. MRI and CT scans showed a right anteromesial temporal lesion which proved at neuropathology to be a ganglioglioma. Lesionectomy resulted in complete cessation of seizures. seizures were absent at an 18-month follow-up. Allodynia is discussed in relation to the locality of the lesion.- - - - - - - - - - ranking = 100.89703031043keywords = headache (Clic here for more details about this article) |
6/189. Erdheim Chester disease: a rare cause of knee and leg pain.A case of Erdheim Chester disease in a 51-year-old Turkish patient is described. Erdheim Chester disease is a rare form of lipoid granulomatosis. knee and leg pain are the most common symptoms, and physicians working in orthopaedics and traumatology are the first to be consulted. Our patient demonstrated a typical bilateral, symmetric sclerosis of the metaphyseal region of long bones of the lower extremity, histologic examination revealed foamy, lipid-loaded histiocytes. The patient also suffered from arterial hypertension, diabetes insipidus and exophthalmos of the left eye. The diagnosis was confirmed by a bone biopsy, and the patient was treated with non-steroidal anti-inflammatory drugs, corticosteroids and vincristine.- - - - - - - - - - ranking = 1keywords = tension (Clic here for more details about this article) |
7/189. A ganglion cyst causing lumbar radiculopathy in a baseball pitcher: a case report.This report describes a case of a professional baseball pitcher who developed acute left lumbar radicular symptoms after a baseball game and was subsequently sidelined for the rest of the season. physical examination revealed depressed reflexes in the left posterior tibialis and left medial hamstring muscles, mild weakness in the left extensor hallucis longus, and positive dural tension signs. magnetic resonance imaging demonstrated an ovoid mass at the L4-L5 level, causing compression of the dura. Surgical resection of the mass resulted in resolution of his symptoms. pathology revealed that the mass was a ganglion cyst. A ganglion cyst is a rare cause of lumbar radiculopathy and should be considered in the differential diagnosis if a patient with lumbar radiculopathy fails to respond to conservative treatment.- - - - - - - - - - ranking = 1keywords = tension (Clic here for more details about this article) |
8/189. guillain-barre syndrome presenting with severe pain: report of one case.Most neurologists are familiar with pain in guillain-barre syndrome but some pediatricians may still miss or underestimate it. We report a 10-year-old girl who presented with headache and numbness in lower extremities. On examination, she could walk and showed hyporeflexia, mild muscle weakness, prominent neck rigidity and right facial nerve palsy. Headache and pain in neck, low back and calves were so severe that she could not fall asleep and the response to analgesic was very poor. On 8th day of illness, she needed mechanical ventilation and suffered tetraplegia. Symptoms of autonomic dysfunction including hypertension and sinus tachycardia appeared thereafter and lasted for a week. After receiving a high dose of intravenous immunoglobulin (2 g/kg in 2 days), her condition improved gradually although joint pain persisted for about three weeks. She could walk unaided by day 40 and run by day 70, and recovered completely 6 months later. We emphasize that pain in GBS needs proper evaluation and management in children as well as in adults.- - - - - - - - - - ranking = 101.89703031043keywords = headache, tension (Clic here for more details about this article) |
9/189. breast-feeding with ectopic axillary breast tissue.Axillary breast tissue, which may be an extension of the tail of Spence, is a normal variant that has been reported in the literature relatively infrequently, although it may be present in a number of asymptomatic women. If axillary breast tissue becomes symptomatic, this usually occurs during pregnancy or immediately postpartum when a woman begins breast-feeding. Symptoms are swelling and pain due to engorgement. A literature review revealed that management is generally conservative, with cessation of breast-feeding to allow regression of the tissue. This report describes a woman who successfully pumped her axillary breasts to relieve pain and engorgement; this allowed her to continue breast-feeding for several weeks. Axillary breast tissue should be monitored for pathologic change.- - - - - - - - - - ranking = 1keywords = tension (Clic here for more details about this article) |
10/189. arm pain as an unusual presentation of postdural puncture intracranial hypotension.Implications: We report a case of a patient experiencing severe arm pain after dural puncture. This complication has not been reported previously. The patient was successfully treated with an epidural patch.- - - - - - - - - - ranking = 4keywords = tension (Clic here for more details about this article) |
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