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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 42-year-old patient with acute left-ventricular failure is described in whom pheochromocytoma was diagnosed only after prolonged and fruitless efforts. Pheochromocytoma may present without the typical features of paroxysmal or sustained hypertension, headache, increased sweating, and palpitations. Therefore, in cases of acute left-sided cardiac failure of primarily undetermined origin, pheochromocytoma should be considered in differential diagnosis.
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PMID:[Acute left heart insufficiency: possible leading symptom of a pheochromocytoma]. 157 67

A 35-year-old previously healthy woman started using oral contraceptives in May 1965. In June ergotamine was prescribed for right temporal headaches. On November 4 she took 5 ergotamine tablets between 4-7 AM. By 9 AM she was confused and did not answer when spoken to. She was admitted to the hospital at 11 AM with an apoplexy picture. On November 6 carotid angiography on the right side showed a total occulsion of the internal carotid artery. An attempt at thrombectomy proved fruitless. In spite of intensive therapy, the patient died in cardiac arrest on the 3rd post operative day. Autopsy showed thrombotic masses in the right carotid artery and left ventricle. A contributory cause may have been the use of oral contraceptives in conjuction with ergotamine medication.
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PMID:A case of multiple arterial thromboses after oral contraceptives and ergotamine. 602 55

This article illustrates that the diagnostic evaluation as well as the management of the patient presenting with chronic fatigue can be done in an orderly manner. If a medical illness is the cause of the patient's fatigue, this is usually evident on initial presentation. A thorough history and complete physical examination, in conjunction with some screening laboratory tests, can rule out most medical causes of fatigue, and any remaining cases declare themselves over the next several visits. If a medical cause is not evident, a further "fishing expedition" is fruitless. Psychiatric illness, such as depression or generalized anxiety disorder, accounts for another significant proportion of cases of chronic fatigue. As with medical illness, psychiatric illness should be suspected based on history and is not a diagnosis of exclusion. Some patients presenting with chronic fatigue have a history and symptom pattern consistent with the diagnosis of CFS. The cause of this syndrome is controversial and is still unknown. The clinician, however, can offer the patient care in an environment that is respectful of their physical and psychological discomfort and can provide significant symptomatic improvement to the patient. Lastly, some patients with fatigue do not fit any diagnostic category, including CFS. As with many other common complaints, such as headaches or abdominal pain, although a diagnosis may not be given to the patient, the clinician can do a lot to reassure the patient and assist the patient in living with his or her symptoms. As Solberg eloquently wrote: "[E]valuation of the fatigued patient requires all of a physician's best attributes--a broad view of disease, psychosocial sensitivity, and a good ongoing relationship with the patient."
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PMID:The chronically fatigued patient. 787 93