Occipital neuralgias: clinical recognition of a complicated headache. A case series and literature review.

The objective of this study was to assist clinicians in the diagnosis of the occipital neuralgia syndrome by describing its clinical characteristics. Bibliographies and clinical descriptions of occipital neuralgia syndrome were identified through a review of literature published between 1966 and 1993. A prospective case series was performed by the authors in a university emergency department during a 1-year period. Patients with unilateral aching pain of the head, coupled with pain in the distribution of the occipital nerve, Tinel's sign, and relief of pain after local anesthetic injection, were included. Patients rated pain relief on a 10-point scale. Twelve patients met the criteria for occipital neuralgia and were included in the study. All patients reported at least 80% decrease of pain after injection, and 42% had complete relief. Clinical features, other than headache, that were common in patients included tinnitus in 33%; scalp paresthesia, 33%; nausea, 42%; dizziness, 50%; and visual disturbances, 67%. Occipital neuralgia is a benign extracranial cause of headache, and it may be confused with other more serious headache syndromes. Recognition depends on an understanding of the symptoms along with a careful history and physical examination. Local anesthetic injections produce significant relief of the headaches and can aid in the diagnosis of the syndrome.

Psychomotor performance defects in cirrhotic patients without overt encephalopathy.

Psychometric tests were administered to 36 alcoholic patients with cirrhosis without overt portal systemic encephalopathy and to 32 alcoholics without liver diseases. Verbal ability was preserved in both groups. The cirrhotic patients scored worse than the alcoholics without liver disease on most of the tests of psychomotor performance. Based on the three most discriminative tests, 50% of the cirrhotic patients had one or more scores that were more abnormal than those of any member of the alcoholic group. Significant correlations were found between the severity of liver disease and most tests of performance in the cirrhotic group, due primarily to the influence of serum albumin as a component of the severity index. We conclude that psychomotor tests are sensitive tools for the detection of latent encephalopathy, and that nutritional status probably plays a role in determining test performance.