ABSTRACT
Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme.
Subject(s)
Lower Extremity , Peripheral Nervous System Diseases/pathology , Child , Disease Progression , Electric Stimulation , Electrophysiological Phenomena , Evoked Potentials, Somatosensory , Humans , Lower Extremity/innervation , Magnetic Resonance Imaging , Male , Neurologic Examination , Sensation Disorders/etiology , Tibial Nerve/physiologyABSTRACT
INTRODUCTION: Although it is well known that ES alters cortical excitability, little is known about the relationship between ES outcome and cortical excitability. Transcranial magnetic stimulation has been successfully used to evaluate cortical excitability in epilepsy patients. The present study aimed to assess the value of the motor threshold (MT) and cortical silent period (CSP) as predictors of the outcome of temporal lobe epilepsy surgery (TLES). MATERIALS AND METHODS: Epileptic foci in the epilepsy patients were identified via video-electroencephalography (v-EEG) monitoring, brain magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), and neurophysiological testing. MT, CSP-150, and CSP-max were measured in 10 epilepsy patients on both the ipsilateral and contralateral side of the epileptic focus 1 week before and 3 months after TLES. Pre- and post-operative MT and CSP measurements were compared, and the results were interpreted based on the clinical outcome of TLES. RESULTS: Mean follow-up period was 28.8 months. In all, 8 patients were seizure-free post TLES, whereas in 2 patients seizures persisted. No significant differences were observed in ipsilateral or contralateral hemisphere MT measurements before and after surgery. Both CSP-150 and CSP-max values in the non-focal hemispheres decreased in the 8 patients that were seizure-free post TLES, whereas no differences were observed in the 2 patients with seizures that persisted post TLES. CONCLUSIONS: The present findings indicate that monitoring pre- and post-TLES CSP changes may be predictive of the early clinical outcome of TLES.
Subject(s)
Cerebral Cortex/physiopathology , Epilepsy, Temporal Lobe/physiopathology , Epilepsy, Temporal Lobe/surgery , Evoked Potentials, Motor/physiology , Adult , Cerebral Cortex/surgery , Electroencephalography , Feasibility Studies , Female , Humans , Magnetic Resonance Imaging , Male , Neuropsychological Tests , Neurosurgical Procedures , Positron-Emission Tomography , Tomography, Emission-Computed, Single-Photon , Transcranial Magnetic StimulationABSTRACT
A few cases of airplane headache (AH) have been reported in the literature. Treatment strategies of AHs are also controversial. We followed-up five patients with AH. They were symptom-free during the daytime. Their physical, neurological, and ear-nose-throat examinations were all normal. Blood chemistries, cerebral magnetic resonance imaging, cerebral magnetic resonance imaging angiography, and paranasal sinus tomography studies of the patients were also normal. We preferred triptans because of the possible effect on the mechanism of AH. Patients were recommended to use single-dose of their drugs half an hour prior to flights. All of the patients had a good response to single dose triptan treatment and became headache-free during flights. This is the first study which puts forward the usefulness of the triptans as a safe treatment choice for airplane AH.
