Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coordination of respiratory care with protection of the brain is critical in neurosurgical intensive care. Therefore, in addition to hyperventilation, adequate sedation and muscle relaxation are applied to mitigate the difficulties with control of intracranial pressure (ICP) during routine tracheobronchial suctioning (TBS). Although hypnotics have been shown to be effective in mitigating increases in ICP in response to endotracheal suctioning in paralyzed patients, brisk bucking and coughing with further increases in ICP may occur without muscle relaxation. Long-term neuromuscular (nm) paralysis may be undesirable in neurosurgical critical care because clinical evaluation with early detection of neurological deterioration will be impossible in the paralyzed patient. Therefore, the effects of TBS without and after nm blockade with an intermediate-acting nondepolarizing muscle relaxant on ICP were studied. PATIENTS AND METHODS. Nine patients with moderate increases in mean ICP of 19.2 +/- 8 mmHg due to head injuries and spontaneous subarachnoid hemorrhage were investigated. All patients were on-line sedated with midazolam and sufentanil and controlled ventilation was adjusted to maintain a paCO2 of 30 +/- 2 mmHg. Respiratory and hemodynamic parameters and ICP (epidural probe) were continuously monitored and recorded on an integrated data bank. After a bolus dose of propofol, routine TBS was performed without the use of muscle relaxants. Before the next TBS, nm monitoring was initiated and train-of-four (TOF) stimulation was imposed at the ulnar nerve using supramaximal pulses. The response of the adductor pollicis muscle was recorded by accelerometry. After supramaximal stimulation had been achieved, a bolus dose of 2 times the ED95 of vecuronium (0.12 mg/kg) was given. Depth of nm blockade was quantified by the posttetanic count (PTC). ICP and CPP were measured before, during, and after TBS. Diaphragmatic movement, bucking, and coughing were registered by visual observation and graded as absent, slight, moderate, or severe. STATISTICS. Student's t-test and the Wilcoxon test for paired data (P less than 0.05; values as mean +/- SD) were used. RESULTS. (see Table and Figure). Despite adequate sedation, moderate to severe diaphragmatic movements in response to carinal stimulation with significant increases in ICP (18.2 +/-7 to 24 +/- 8 mmHg) an d subsequent decreases in cerebral perfusion pressure (CPP) (68.9 +/- 2 to 62.4 +/- 8 mmHg) could be observed without muscle relaxation. After a bolus of vecuronium, profound nm paralysis quantified by a PTC of 5 was observed after an onset time of 4.2 +/- 1 min. ICP (20.2 +/- 8 vs. 20.1 +/- 8 mmHg) and CPP (64.0 +/- 13 vs. 64.8 +/- 13 mmHg) remained unchanged. Slight diaphragmatic movements could be elicited in only two patients during TBS. DISCUSSION. TBS is a potent trigger of diaphragmatic movement, bucking, and coughing by reflex activation of the phrenic nerve. A major determinant of the magnitude of ICP increase during TBS is the transmission of the cough-induced increase in intrathoracic pressure to the cerebral venous system. Vecuronium was utilized for nm blockade because of its proven lack of cerebral and cardiovascular side effects, its relatively short onset, and its intermediate duration of action. Despite the postulated faster onset of nm blockade in the diaphragm, suppression of thumb-twitch response to TOF stimulation does not necessarily predict absence of diaphragmatic movement elicited by excessive tracheal stimulation. As demonstrated, intense nm blockade quantified by a PTC of 5 is necessary to rule out any bucking and coughing, i.e., to ensure total diaphragmatic paralysis in response to tracheal stimulation. On-line neurological evaluation, one of the essentials in the approach to the neurosurgical patient, will not be prevented by the intermittent bolus regime utilized in this study.
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PMID:[Requisite muscle relaxation using vecuronium for tracheobronchial suction in neurosurgical intensive care patients]. 167 3

We have discussed several miscellaneous headache disorders not associated with structural brain disease. The first group included those headaches provoked by "exertional" triggers in various forms. These include benign cough headache, BEH, and headache associated with sexual activity. The IHS diagnostic criteria were discussed. Benign exertional headache and cough headache were discussed together because of their substantial similarities. In general, BEH is characterized by severe, short-lived pain after coughing, sneezing, lifting a burden, sexual activity, or other similar brief effort. Structural disease of the brain or skull was the most important differential diagnosis for these disorders, with posterior fossa mass lesions being identified as the most common organic etiology. Magnetic resonance imaging with special attention to the posterior fossa and foramen magnum is the preferred method for evaluating these patients. Indomethacin is the treatment of choice. The headache associated with sexual activity is dull in the early phases of sexual excitement and becomes intense at orgasm. This headache is unpredictable in occurrence. Like BEH, the headache associated with sexual activity can be a manifestation of structural disease. Subarachnoid hemorrhage must be excluded, by CT scanning and CSF examination, in patients with the sexual headache. Benign headache associated with sexual activity has been successfully treated with indomethacin and beta-blockers. The second miscellaneous group of headache disorders includes those provoked by eating something cold or food additives, and by environmental stimuli. Idiopathic stabbing headache does not have a known trigger and appears frequently in migraineurs. Its occurrence may also herald the termination of an attack of cluster headache. Indomethacin treatment provides significant relief. Three headaches triggered by substances that are eaten were reviewed: ingestion of a cold stimulus, nitrate/nitrite-induced headache, and MSG-induced headache. For the most part, avoidance of these stimuli can prevent the associated headache. Lastly, we reviewed headache provoked by high altitude and hypoxia. The headache is part of the syndrome of AMS during its early or benign stage and the later malignant stage of HACE. The pain can be exacerbated by exercise. The best treatment is prevention via slow ascent and avoidance of respiratory depressants. Acetazolamide and dexamethasone have proved useful in preventing this syndrome.
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PMID:Cough, exertional, and other miscellaneous headaches. 202 Feb 26

The reliability of lumbar intraspinal epidural pressure (ISEDP) as an index of intracranial pressure was investigated in seven patients with high intracranial pressure following neurosurgery. ISEDP and intracranial epidural pressure (ICEDP) were measured simultaneously, the latter by the conventional method. ISEDP was measured with a Gaeltec catheter-tip pressure transducer placed percutaneously in the lumbar epidural space via Touhy's needle. In five of seven patients, the ISEDP value was consistently 70 to 100% of the ICEDP value. In all patients, ISEDP always fluctuated in parallel with ICEDP, and the time courses of both were quite similar in response not only to normal cardiac pulsation but also to various manipulations, such as neck compression, coughing, breath holding, mannitol administration, and compression at the cranial defect. In one patient with communicating hydrocephalus following subarachnoid hemorrhage, the relationship between ISEDP and cerebrospinal fluid (CSF) pressure was studied. Upon gradual withdrawal of CSF, ISEDP decreased in parallel with CSF pressure until the latter reached 8 mmHg. Below 8 mmHg CSF pressure, ISEDP did not correlate with CSF pressure. This phenomenon was attributed to slackness of the dural sac due to lowering of CSF pressure, which severed contact between the spinal dural theca and the sensor. Although the discrepancy between ISEDP and ICEDP was prominent in some patients, especially those with low intracranial pressure or blockage of the subarachnoid space, in this study ISEDP reliably reflected ICEDP. The results suggest that ISEDP measurement is useful in monitoring intracranial pressure in patients with increased intracranial pressure. Also, the procedure is simple and relatively noninvasive.
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PMID:[The usefulness of lumbar epidural pressure as an index of intracranial pressure]. 247 50

A patient presented with spontaneous subarachnoid hemorrhage after a prolonged episode of coughing. A preoperative computed tomographic (CT) scan confirmed subarachnoid hemorrhage, but demonstrated no other lesion. Arteriography revealed an ophthalmic artery aneurysm. Operation revealed the aneurysm to be intracavernous without sign of prior rupture; however, a small hemorrhagic meningioma was removed from the ipsilateral anterior clinoid process. In this case, coincidental meningioma and aneurysm presented as a subarachnoid hemorrhage secondary to tumor hemorrhage. The follow-up of cases of subarachnoid hemorrhage with negative arteriography with sequential CT scans is discussed.
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PMID:Meningioma associated with aneurysm and subarachnoid hemorrhage: case report and review of the literature. 380 67

A review of the literature on Spontaneous Dissecting Aneurysms (DA's) of cerebral arteries is presented with 3 personal cases of DA's of the Internal Carotid Artery (ICA). Patients with spontaneous DA's of the extracranial ICA are of middle age (30 to 60 year old) and present with an ipsilateral pain in the neck or face and/or with TIAs (45 p. 100 and 50 p. 100 of the cases respectively). Claude Bernard-Horner's sign is frequent. The clinical, radiological and pathological data suggest that in most cases, if not all, neurological deficits are due to embolism and/or anterograde thrombus. This has led to recommend anticoagulant therapy. Nevertheless, surgery may be indicated is some situations such as in DA's on kinking arteries. The treatment of spontaneous DA's of extracranial vertebral arteries is still a detectable matter, though they have common features with DA's of the extracranial ICA. The DA's of the basilar and intracranial vertebral arteries are often associated with a subarachnoid haemorrhage and most of them have a severe outcome. Lesions of the arterial wall such as cystic medial necrosis and fibromuscular dysplasia play a role in the extent, and presumably in the initiation, of the so-called spontaneous DA's at least in some cases. Minor trauma, high blood pressure (20 p. 100 of the cases), oral contraceptives and coughing have been as well suspected.
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PMID:[Spontaneous dissecting aneurysms of the cerebral arteries]. 636 8

Benign cough headache (BCH) presents as an intermittent, usually bilateral, severe bursting or explosive pain brought on by coughing. Some of the known conditions which can mimic the pain experienced in BCH are subarachnoid hemorrhage, increased intracranial pressure, intracranial tumors, and even toothache. Careful evaluation must be carried out in order to differentiate between these conditions. A case of BCH which presented as a toothache is reported. The evaluation for exertional headaches, and for headaches brought on by coughing, is discussed.
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PMID:Cough headache presenting as a toothache: a case report. 832 98

Sudden, explosive headache is rather rare. Though dramatic for the patient and the physician, it does not necessarily herald an intracranial catastrophe. Benign and dangerous thunderclap headaches cannot be distinguished from the features of headache itself, but rather on the basis of the situation, the additional symptoms and the findings. This means that every sudden headache should be considered potentially dangerous and be investigated immediately. The dangerous forms comprise intermittent hydrocephalus, acute bacterial meningitis and above all vascular complications. Subarachnoid hemorrhage frequently must be ruled out by computed tomography and lumbar puncture. Intracerebral, especially cerebellar hemorrhage, as well as hypertensive crisis require immediate treatment. Fatal cerebral embolism complicating spontaneous dissection of craniocervical arteries (carotid or vertebral arteries) can be prevented by early anticoagulant therapy. To confirm diagnosis, additional investigations such as CT, lumbar puncture or cerebrovascular ultrasound, and in rare cases MRI, should be performed early as the available time for effective therapy in many situations is short. Many of the benign forms of sudden headache can be diagnosed with a focused interview (cold or drug induced and food dependent headaches, sinusitis, glaucoma). Others, such as neuralgia, cough and coital headache, can be diagnosed as benign only when additional investigations have ruled out symptomatic forms.
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PMID:[Acute headache]. 848 83

To evaluate the usefulness of measuring lumbar intraspinal epidural pressure (ISEDP) measurements for the estimation of intracranial pressure, we studied the relationship between ISEDP and intracranial epidural pressure (ICEDP) in 12 patients with high intracranial pressure after neurosurgical procedures. ISEDP was measured with a Gaeltec catheter-tip pressure transducer placed percutaneously in the lumbar epidural space with a Touhy needle. ICEDP was determined by the conventional method. During the measurement, some manipulations were carried out. ISEDP and ICEDP measurements exhibited a linear correlation. In all but one patient with normal cerebrospinal fluid, ISEDP was 84 to 100% of ICEDP. In patients with mild subarachnoid hemorrhage, ISEDP was 82 to 86% of ICEDP. In patients with severe subarachnoid hemorrhage, ISEDP was 45 to 57% of ICEDP and always fluctuated in parallel with ICEDP. ISEDP accurately reflected ICEDP in response to manipulations such as breath holding, neck compression, compression at the cranial defect, mannitol administration, and coughing. These data suggest that ISEDP measurement is useful in monitoring intracranial pressure in patients with intracranial hypertension. In addition, the measurements can be obtained easily and safely.
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PMID:Clinical investigation of lumbar epidural pressure. 849 52

The rural CGW population has not yet undergone the metamorphosis experienced by its urban counterparts. Reminiscent of a past era, suicides far outweight homicides. Although many rural firearm injuries involve hunting accidents, these comprise only a small fraction of CGW at best. Similarly, although many rural firearm injuries involve shotguns or rifles, few CGW result from these weapons. Although the number of patients is small, those with shotgun or rifle injuries manifest lower mortality rates. The authors have confirmed the notion that caliber of civilian weapons is difficult to correlate with outcome. The geographic size of the rural catchment area is an important consideration because it must select a population able to withstand transfer. The authors noted an inverse relationship between length of time before arrival at the facility and mortality. The selection phenomenon probably accounts for the reduced mortality found in the authors series versus most others. Prognostic features of individual gunshot wounds are likely to be similar among varied populations when circumstances of the injury are matched. Thus, one expects similar features on initial examination and CT scan to have similar predictive value. The authors confirmed that CGS and specific deficits were strong predictors of outcome. No patient with a GCS score of 5 or less on admission survived. Absent pupillary response, absent brain stem function, presence of respiratory drive or cough only, and posturing were strong indicators of impending death. The authors confirmed the prognostic value associated with CT evidence of intraventricular hemorrhage, transventricular trajectory, transtentorial herniation, massive edema, and bihemispheric injury. Interestingly, presence of extensive facial fractures, an indicator of trajectory, suggested better outcome. Subarachnoid hemorrhage did not reach prognostic significance. Roughly half of the authors' patients had positive serum ethanol levels, although the test was unable to discern prognosis. Abnormality of any coagulation parameter and frank disseminated intravascular coagulation were correlated with poor outcome. Likewise, thrombocytopenia occurring within the first 24 hours was an indicator of poor prognosis. Although prophylactic antibiotics were not used in all cases, the authors encountered no deep or superficial infections in surviving patients. The prevalence of seizures in the authors' series despite prophylactic AED is unusually high. This feature merits further study.
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PMID:Characteristics of cerebral gunshot injuries in the rural setting. 852 5

We analyzed our experience with cough, exertional, and vascular sexual headaches, evaluated the interrelationships among them, and examined the possible symptomatic cases. Seventy-two patients consulted us because of headaches precipitated by coughing (n = 30), physical exercise (n = 28), or sexual excitement (n = 14). Thirty (42%) were symptomatic. The 17 cases of symptomatic cough headache were secondary to Chiari type I malformation, while the majority of cases of symptomatic exertional headaches and the only case of symptomatic sexual headache were secondary to subarachnoid hemorrhage. Although the precipitant was the same, benign and symptomatic headaches differed in several clinical aspects, such as age at onset, associated clinical manifestations, or response to pharmacologic treatment. Although sharing some properties, such as male predominance, benign cough headache and benign exertional headache are clinically separate conditions. Benign cough headache began significantly later, 43 years on average, than benign exertional headache. By contrast, our findings suggest that there is a close relationship between benign exertional headache and benign vascular sexual headache. We conclude that benign and symptomatic cough headaches are different from both benign and symptomatic exertional and sexual headaches.
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PMID:Cough, exertional, and sexual headaches: an analysis of 72 benign and symptomatic cases. 864 40


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