1/41. The perils of a sneeze. A 51-year-old woman had a 3-day history of severe left supraorbital pain associated with blurred vision of the left eye. Examination revealed visual acuity of 20/20 OD and 20/100 OS. A left relative afferent pupillary defect was present. neuroimaging revealed a large intra-, supra-, and parasellar mass that had eroded through the sphenoid sinus into the maxillary sinus. Secondary pneumocephalus was present. Pathologic examination of the tissue revealed a pituitary adenoma of the null cell type. To the best of our knowledge, there is only one other case in the literature in which a spontaneous pneumatocele represents the initial manifestation of a pituitary adenoma. ( info) |
2/41. Transient ischaemic attacks related to carotid stenosis precipitated by straining, bending, and sneezing. Three patients are described in whom one or more carotid territory transient ischaemic attacks (TIAs) were preceded by sneezing, straining, or bending over. It is argued that the mechanism involved dislodgment of embolic material from the site of carotid atheroma. This mechanism should be considered as an alternative to paradoxical embolism when TIAs are precipitated by such physiological manoeuvres. Furthermore, TIAs should be added to the list of medical hazards associated with such events. ( info) |
3/41. Sudden sensorineural hearing loss with fracture of the stapes footplate following sneezing and parturition. Three rare cases of sudden high frequency sensorineural hearing loss with longitudinal fracture of the stapes footplate are presented. In two patients it occurred after they suppressed a sneeze. In the third patient after the exertion of parturition. At exploratory tympanotomy all were found to have longitudinal fractures of the stapes footplate and two had a perilymph fistula at that site. The history and audiometric profiles in such patients should raise a high index of suspicion regarding the possibility of a stapes footplate fracture. ( info) |
| Four consecutive patients with lateral medullary syndrome reported reversible inability to complete a reflex sneeze, despite retaining the urge to do so and the ability to mimic the motor act. This previously undescribed feature of a relatively common syndrome is in keeping with the known location of a "sneeze center" in the lateral medulla of cat. In man, unilateral brainstem lesion is sufficient to abolish the sneeze reflex temporarily. ( info) |
5/41. Sneeze-induced visual and ocular motor dysfunction. PURPOSE: The purpose of this report is to describe two neuroophthalmic complications that are related by their temporal association with a sneeze. DESIGN: We describe observational case reports of two patients. methods: Both patients were examined, and their conditions were diagnosed and treated according to standard indications for each neuroophthalmic condition. RESULTS: The first case describes a patient who had previously undergone intracranial surgery, including removal of the clivus and later developed a trochlear nerve paresis after a sneeze. The second case describes a patient who repeatedly demonstrates transient decreased perfusion to his right central retinal artery and an associated afferent papillary defect after sneezing. CONCLUSION: The mechanical and hemodynamic forces involved in sneezing are formidable and may cause permanent cranial neuropathy or temporarily alter ocular blood flow in certain patients. ( info) |
6/41. Intractable paroxysmal sneezing. Intractable paroxysmal sneezing is a rare disease primarily affecting teenage girls. We present the case of a 12-year-old girl who demonstrated the classical features of intractable paroxysmal sneezing of psychogenic origin. Most of the reported cases are psychogenic in origin, but a number of other conditions may cause intractable paraoxysmal sneeze. Apart from a detailed history, clinical examination and relevant investigations, topical nasal anaesthesia should be tried for control of symptoms--that will help to differentiate psychogenic sneezing from organic sneezing. A timely diagnosis can avoid unnecessary medical trials, parental anxiety and poor school performance, as most of the patients are very young. ( info) |
7/41. Chiari-associated exertional, cough, and sneeze headache responsive to medical therapy. Benign exertional headache is coded as a separate entity within the International headache Society's classification system, but the pathophysiological mechanisms underlying this clinical headache subtype are unknown and possibly are similar to those generating migraine. Coexistence of migraine and benign exertional headache in the same patient is not unusual, and antimigraine pharmacologic treatments are often effective in both headache types. Regardless, optimal management mandates that the clinician exclude any intracranial or systemic disease that could mimic "primary" exertional headache. The same holds for primary headaches induced by coughing or sneezing; congenital malformations or neoplasms, particularly within the posterior fossa, are not rare in these patients. The neurologic examination may not be sufficiently sensitive to detect the offending lesion. We describe a patient with migraine without aura and exertional secondary headache due to Chiari malformation type I whose headaches responded to treatment with propranolol and indomethacin. ( info) |
8/41. Unilateral upper cervical posterior spinal artery syndrome following sneezing. A 35 year old man experienced severe transitory neck pain following a violent sneeze. This was followed by neurological symptoms and signs indicating a left sided upper cervical cord lesion. MRI showed an infarct at this site in the territory of the left posterior spinal artery. This discrete infarct was probably due to partial left vertebral artery dissection secondary to sneezing. ( info) |
9/41. sneezing as a cause of acute angle-closure glaucoma. We report the case of a patient who had an attack of acute angle-closure glaucoma precipitated by sneezing, probably as a result of a sudden increase in venous back pressure. This young woman had a history of allergic sinusitis. ( info) |
10/41. Psychogenic intractable sneezing: case reports and a review of treatment options. OBJECTIVE: To report 2 cases of the uncommonly seen diagnosis of psychogenic intractable sneezing, to review the clinical presentation, workup, and various previous treatment modalities, and to present a unique method of treatment. DATA SOURCES: The literature was reviewed using a medline search of the following keywords: psychogenic intractable sneezing, paroxysmal sneezing, factitious sneezing, respiratory disorders, conversion disorders, habit cough, and psychogenic cough. The search was restricted to articles published from 1966 onward, although older references were cross-referenced from more recent articles. RESULTS: sneezing alone can be caused by foreign substances, odors, chemical irritants, allergies, and other less common factors. Psychogenic intractable sneezing, although not a particularly common disease, occurs mainly in adolescent girls for which a cause may not be found. patients are usually refractory to various medications and have an otherwise unremarkable extensive workup. Treatments have included corticosteroids, antihistamines, hydroxyzine hydrochloride, and decongestants among other pharmacologic agents, as well as psychotherapy. Based on the presented case reports, a trial of isotonic sodium chloride solution with suggestion therapy was able to rid the patients of their intractable sneezing. CONCLUSIONS: Psychogenic intractable sneezing is a real disease. Although other diseases may be considered, the workup may merely include an extensive history and physical examination. Many treatments have been tried with varying success, including those that incorporate psychotherapy. A variation of suggestiontherapy is offered as a unique treatment modality. ( info) |