1/83. Cranial arteritis: a medical emergency with orofacial manifestations.BACKGROUND: Cranial arteritis, or CA, a vascular disease affecting primarily elderly people, may result in permanent blindness if untreated. Since it frequently mimics temporomandibular joint, myofascial or odontogenic pain, dentists must be familiar with this condition. CASE DESCRIPTION: The authors present reports of two patients who had signs and symptoms of CA, some of which were suggestive of other head and neck pain disorders. In both cases, the diagnosis of CA was confirmed by temporal artery biopsy, and treatment with systemic steroids resulted in rapid resolution of symptoms. CLINICAL IMPLICATIONS: Prompt diagnosis and treatment of CA not only results in resolution of symptoms, but also may prevent blindness, the most serious sequela of the condition.- - - - - - - - - - ranking = 1keywords = stem (Clic here for more details about this article) |
2/83. An 11-year-old girl with syndrome of inappropriate antidiuretic hormone secretion.An 11-year-old girl presented with a syndrome of inappropriate antidiuretic hormone secretion, which was transitory and, initially, of obscure origin. Subsequently, the patient's hypothalamic disorder emerged as a component of a steroid-responsive relapsing encephalomyelitis with cerebral pathology restricted to the basal ganglia and brainstem. Where such a disorder fits in the spectrum from acute disseminating encephalomeylitis to multiple sclerosis is discussed.- - - - - - - - - - ranking = 5.3600287319215keywords = brain, stem (Clic here for more details about this article) |
3/83. Parietal and cingulate processes in central pain. A combined positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) study of an unusual case.Parietal, insular and anterior cingulate cortices are involved in the processing of noxious inputs and genesis of pain sensation. Parietal lesions may generate central pain by mechanisms generally assumed to involve the 'medial' pain system (i.e. medial thalamic nuclei and anterior cingulate cortex (ACC)). We report here PET and fMRI data in a patient who developed central pain and allodynia in her left side after a bifocal infarct involving both the right parietal cortex (SI and SII) and the right ACC (Brodmann areas 24 and 32), thus questioning the schematic representation of cortical pain processing. No rCBF increase was found in any part of the residual cingulate cortices, neither in the basal state (which included spontaneous pain and extended hypoperfusion around the infarct), nor during left allodynic pain. Thus, as previously observed in patients with lateral medullary infarct, neither spontaneous pain nor allodynia reproduce the cingulate activation observed after noxious pain in normal subjects. Conversely, both PET and fMRI data argue in favour of plastic changes in the 'lateral discriminative' pain system. Particularly, allodynia was associated with increased activity anteriorly to the infarct in the right insula/SII cortex. This response is likely to be responsible for the strange and very unpleasant allodynic sensation elicited on the left side by a non-noxious stimulation.- - - - - - - - - - ranking = 2keywords = stem (Clic here for more details about this article) |
4/83. cimetidine and a delayed hypersensitivity reaction.Oral cimetidine for the treatment of verruca continues to be a topic of discussion and controversy. Although its usage has gained popularity because it offers an alternative to conventional topical and surgical verruca therapy, its reported efficacy in managing warts lacks consistency in outcomes. Using high doses of oral cimetidine, therefore, raises concern about possible untoward effects. cimetidine relies on effecting a change in the immune system to eradicate the verruca, but such a change in the immune system may cause patients to develop responses detrimental to their well being. The authors present an unusual case of severe delayed hypersensitivity with the use of oral cimetidine.- - - - - - - - - - ranking = 2keywords = stem (Clic here for more details about this article) |
5/83. Parietal cheiro-oral syndrome.Cheiro-oral syndrome due to a parietal lesion has been reported in conjuction with a brain tumor, infarction and migraine. Only six reports of cheiro-oral syndrome due to a parietal infarction have been reported to date. We treated a 45-year-old woman with cheiro-oral syndrome due to a parietal infarction. Her sensory disturbance was characterized by paresthesia in the lower face and hand on the left side, and severe involvement of stereognosis and graphesthesia in the left hand. The pathogenesis of parietal cheiro-oral syndrome is discussed.- - - - - - - - - - ranking = 4.3600287319215keywords = brain (Clic here for more details about this article) |
6/83. Diagnosis of acromegaly in orofacial pain: two case reports.acromegaly is an uncommon condition, with an annual incidence in the UK of three per million. The gradual onset of the clinical features mean that often friends and relatives are unaware of the underlying pathology. In view of the morbidity, and indeed mortality, arising from undiagnosed cases, general dental practitioners and other healthcare workers should routinely take note of systemic as well as intra-oral changes occurring in their patients when seen on review. The association of paraesthesia, anaesthesia and pain with acromegaly is well documented. However, there appear to be few reports linking acromegaly with orofacial pain or dysaesthesia. This paper describes two such cases.- - - - - - - - - - ranking = 1keywords = stem (Clic here for more details about this article) |
7/83. Dysesthesia perceived as painful spasticity: A report of 3 cases.Lesions of the central nervous system often involve the pyramidal tracts and the sensory pathways to produce spasticity, paresthesias, and dysesthesia. Three patients with intractable spasticity were treated with intrathecal baclofen. Two had an implanted Medtronic SynchroMed pump for long-term delivery of the muscle relaxant. The third patient had undergone a screening trial in which the baclofen was delivered into the intrathecal space through a lumbar catheter. All had excellent relief of spasms on clinical examination, but they reported painful spasms particularly at night. Two of the patients were successfully treated for dysesthesia.- - - - - - - - - - ranking = 1keywords = stem (Clic here for more details about this article) |
8/83. Post-apopletic trigeminal trophic syndrome.Trigeminal trophic syndrome is an uncommon clinical entity in which cutaneous trophic ulceration develops with continuous manipulation of trigeminal dermatomes. patients spontaneously refer picking, rubbing and/or scratching at the affected areas because of hypo-anaesthesia, paraesthesia and/or pain following damage of the sensory trigeminal fibres or nuclei. We herein describe a patient who developed the syndrome as a sequela of brain stem infarction. Diagnosis by scrape cytology in ruling-out basal cell carcinoma and other ulcerative skin diseases is discussed and the importance of neurological examination in disclosing hemi-anaesthesia of trigeminal dermatome(s) is emphasized.- - - - - - - - - - ranking = 5.3600287319215keywords = brain, stem (Clic here for more details about this article) |
9/83. Metastatic head and neck squamous cell carcinoma to the brain.BACKGROUND: To evaluate the natural history of patients with metastatic squamous cell carcinoma (SCCA) of the head and neck to the brain. methods: A retrospective review of patients with brain metastases treated over a 20-year period identified five that had a head and neck SCCA primary. RESULTS: Five cases of patients with SCCA of the head and neck that developed brain metastases are presented in detail. CONCLUSION: In patients with aggressive disease, large infiltrative lesions, and in late survivors with initially advanced disease, metastasis to the brain should be considered. Perineural metastasis appears to be the most common mode of spread of head and neck SCCA to the brain. Pain, paresis, or paresthesias in the distribution of cranial nerves or other neurological symptoms should alert the otolaryngologist to neural or central nervous system involvement in patients with SCCA of the head and neck. Surgery with or without post-operative whole brain radiation therapy is the mainstay of treatment in most patients. Stereotactic radiosurgery may play a major role in treating brain metastases from head and neck primary tumors.- - - - - - - - - - ranking = 48.960316051136keywords = brain, stem (Clic here for more details about this article) |
10/83. Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency.Vitamin B12 deficiency is common, with most patients lacking classic features of advanced severe deficiency. early diagnosis and treatment prevent severe anemia and irreversible damage to the nervous system. We describe a 34-year-old man with pernicious anemia who presented with clinical and radiologic features of early myelopathy and borderline low serum levels of vitamin B12. Prompt diagnosis based on the measurement of serum methylmalonic acid and treatment with cyanocobalamin injections led to rapid resolution of clinical manifestations and magnetic resonance imaging abnormalities. We review the literature of magnetic resonance imaging in vitamin B12 deficiency myelopathy and discuss the issues relating to diagnosis and early treatment of this potentially reversible condition.- - - - - - - - - - ranking = 1keywords = stem (Clic here for more details about this article) |
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