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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Basilar migraine is a complicated headache which the International Headache Society describes as 'migraine with aura symptoms clearly originating from the brainstem or from both occipital lobes'. For years this headache was thought to originate from a transient disturbance in the vertebrobasilar circulation, but more recent studies suggest that a central neuronal disorder may be the source of migraine. Basilar migraines may have certain symptoms which are similar to other neurologic, vascular, psychiatric and metabolic diseases, yet there are specific criteria which can help differentiate it from other diagnoses. It is characterized by a throbbing occipital headache which may be preceded by an aura. The unusual symptoms of basilar migraine, which may precede and continue throughout the duration of the headache and even after it, include bilateral visual symptoms, altered mental status, vertigo, gait ataxia, bilateral paresthesia, bilateral paralysis and dysarthria. We describe a 29-year-old black female whose husband brought her to the emergency department complaining of confusion, headache, and left-sided weakness for 2 h prior to arrival.
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PMID:Basilar migraine. 915 94

Familial hemiplegic migraine (FHM) is an autosomal dominant syndrome characterized by recurrent episodes of varying degrees of hemiparesis associated with migraine. The aura including hemiparesis may be prolonged and in severe attacks may often be associated with confusion or coma. We describe a case of FHM whose aura was atypically prolonged and resulted in irreversible brain deficit which on magnetic resonance imaging (MRI) was suggestive of cortical hyperperfusion. A subsequent MRI showed left brain atrophy.
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PMID:Familial hemiplegic migraine with irreversible brain damage. 955 May 87

This article presents an overview of the epidemiology and pathophysiology of posttraumatic headache. It reviews definitions of mild head injury (MHI), mild traumatic brain injury (MTBI), and concussion, and discusses the confusion that often occurs with these terms. Headache types and their pathophysiology are examined in detail. Just as the exact pathophysiology is unknown for migraine and other types of headache, the exact pathophysiology of headache after trauma is also still unknown in many cases. Possible connections between head or neck injuries and headache are reviewed, as well as hypothesized neurochemical changes that may occur in both migraine and traumatic brain injury (TBI). Psychological and legal factors are also considered.
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PMID:Epidemiology and pathogenesis of posttraumatic headache. 994 43

Scleromyxedema is a rare systemic disorder characterized by cutaneous sclerosis and papulosis, accompanied by deposition of mucin in the skin and other organs. We describe a case of scleromyxedema in a 62-year-old man. The cutaneous symptoms of the disorder were preceded by episodes of acute central nervous system dysfunction that included mental confusion, hemiparesis, tremor, and migraine. As the cutaneous symptoms progressed, the patient experienced persistent confusion and difficulty concentrating. Therapy with melphalan and plasmapheresis led to complete resolution of the cutaneous symptoms as well as near-resolution of the neurologic symptoms. This is the first report to describe the successful treatment of the cutaneous symptoms of scleromyxedema accompanied by reversal of chronic neurologic dysfunction.
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PMID:Scleromyxedema: successful treatment of cutaneous and neurologic symptoms. 1069 60

A case of basilar migraine (BM) with alternate numbness as the initial symptom is described. The patient's chief complaint was alternate numbness in the right and left upper extremities. After angiography the patient fell into a drowsy state, followed by excitation, and finally confusion. The EEG power topography showed slow alpha, theta and delta power in the right occipital area, and alternatively in the right and left parietal area. These findings suggest that the cause of BM is not only based on a vasoconstriction mechanism, but also cortical spreading depression. BM should be suspected as a cause of sensory symptoms.
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PMID:Alternate numbness in the upper extremities as the initial symptom of basilar migraine: an electrophysiological evaluation using EEG power topography. 1103 Feb 14

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.
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PMID:Ophthalmoplegic migraine with unusual features. 1127 64

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.
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PMID:Possible ergotamine-caffeine-associated delirium. 1179 25

Especially in the United States, homeopathy has not become integrated into mainstream medical practice; this is partly because of the historical paucity of quality published research studies or quality educational programs. More recently, there have been better-designed studies in reputable journals, although historically most studies have been inconclusive or of poor methodology. The confusion around homeopathy in the United States exists for several reasons: 1. One of the main reasons for the relative disinterest or opposition to homeopathy is that even well-designed clinical studies on homeopathy leave the reader without any protocol-driven tools to take into daily practice. Individualization of treatment, or, as it is called today, differential therapeutics, is the main requirement of successful homeopathic prescribing. Only well-trained homeopathic practitioners are able to carry out such a task. In many articles that reported positive outcomes for homeopathy, numerous homeopathic remedies had been prescribed for the same diagnostic category. Critics suggest that the pooling of data from trials using different therapeutic agents to assess the overall success of homeopathic prescribing is incorrect. Research protocols that employ combination remedies, in which a medication contains several homeopathic remedies, fall into the same category. 2. Many of the positive and negative studies published are flawed with numerous methodologic problems. One of the most common problems is a lack of objective validated outcome measures. Another common problem is a small sample size. In most positive and negative meta-analyses published to date, research data are pulled together artificially based on either a diagnostic category or a particular remedy. Frequently the concentration of the remedy used and the conditions to which it has been applied are different. Ernst and Pittler published a letter with a critique of the methodology used in one of the meta-analyses of clinical trials of homeopathy. Most importantly, professional homeopaths and conventional scientists criticize the choice of remedy or the condition to which it was applied or both. The design and follow-up in migraine studies has been criticized extensively by one of the world's leading homeopaths, Vithoulkas (personal communication, 1997). Most of the Arnica studies have been designed with either an inappropriate dosing regimen or an inappropriately chosen procedure. In most positive studies on homeopathy, the outcome measures were subjective and poorly quantifiable. 3. Few well-designed studies have been reproduced by independent research teams. This situation exists for two major reasons: lack of sufficient funding and lack of a sufficient number of well-trained homeopaths qualified and interested to participate in research. 4. More rigorous educational programs on homeopathy for professionals need to be encouraged. Most of the existing programs are designed for consumers; academic continuing medical education-quality courses are needed. Meanwhile, while the debate around homeopathy still continues in conventional medical circles, the general public has been using the services of homeopathic practitioners and homeopathic remedies increasingly. In many countries, homeopathy and other complementary modalities have been integrated successfully into a larger armamentarium for the modern physician. According to a study published in 1995 in the Journal of the American Board of Family Practice, 69% of family practice physicians expressed interest in learning more about homeopathy. Increasing public and professional interest calls for attempts to study homeopathy in a more systematic way and to provide quality academic overview for medical practitioners. The growing number of complementary and alternative medicine centers affiliated with major teaching hospitals should provide a solid interface between evidence-based biologic medicine and many emerging complementary and alternative medicine modalities, including homeopathy.
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PMID:Homeopathy. 1179 90

Lithium has many medical and psychiatric uses. These include cluster and migraine headaches, alcoholism, impulsive behavior, and bipolar disorder. Toxicity from lithium can occur by overdose (intentional or accidental) or, more commonly, from alteration in its clearance by the kidney. We present two cases of lithium toxicity. The first is a 57-year-old male who presented with confusion, ataxia, and lethargy. The second case involves a 52-year-old female with bizarre behavior who was unable to care for herself. Both patients received dialysis and recovered without sequelae.
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PMID:Lithium toxicity: two case reports. 1213 13

The main clinical features of CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy) are stroke, dementia, and migraine. A reversible acute encephalopathy was the principal presentation in six of 70 patients in a British prevalence study. The episodes lasted seven to 14 days, presenting with fever, acute confusion, coma, and fits; there was full recovery but in two cases identical episodes recurred some years later. All patients had a previous history of migraine with aura and were originally misdiagnosed as viral encephalitis. CADASIL should be considered in acute unexplained encephalopathies. MRI white matter changes, previous migraine with aura, and a family history of stroke and dementia may be useful pointers to the diagnosis.
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PMID:"CADASIL coma": an underdiagnosed acute encephalopathy. 1253 61


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