:
a more or less localized sensation of discomfort, distress, or agony, resulting
from the stimulation of specialized nerve endings. It serves as a protective
mechanism insofar as it induces the sufferer to remove or withdraw from
the source.
Table of contents :
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A history of analgesia and anesthesia :
,
and tenderness along the nose as a result of neuralgia of the nasociliary
nerve
alterations
);
it may last for a few weeks or many months.
medicated plasterref1,
ref2
,
the pain is increased when the patient bends his body toward the normal
side, whereas in intercostal neuralgia it is increased by bending toward
the affected side.
are stoics, while people with Met158 SNP COMT (less active in
catabolyzing dopamine) suffer most pain.
;
during the duration of the cluster ethanol
induces attacks in 70% of the patients
,
ipsilateral lacrimation, nasal erythema and obstruction, rhinorrhea,
palpebral
ptosis
and nausea; attacks last from 15' to about 2 hours and tend to occur in
clusters,
1-3 times a day (at least 1 of the attacks occurs at the same hour
of the day for all the duration of the attack cluster in 85%; 50% have
onset at bedtime within 2 hours of sleeping) for 4-8 weeks followed
by months or years without occurrence
(600-900 mg/die), prednisone (60 mg/die for 7 days + decrease and withdrawal
within 10 days), metisergide, ergotamine (1-2 hours before attack< 14
mg/week); inhaled 100% O2 for 15' (9 L/min through air-tight
mask); s.c. sumatriptan reduces duration of attack to 10-15'
if peristing > 30 minutes
or straining.,
stretching or tearing of ligaments and muscles in the neck, and injury
to cervical soft tissues.
(from aneurysm of circle of Willis) (violent headache lasting 3 hrs);
due to lowering of intracranial pressure by leakage of CSF through the
needle tract.
or other noninflammatory diseases,
local or general.
and hypercapnia).,
eyes,
etc
(anterior region of eye)
(eye pain irradiated to forehead, temporal and occipital regions)
(deep pain within orbit)
(pain irradiated from eyes to forehead, temporal regions, cheek, occiput,
above and behind eyes).),
sinusal tumors or rhinopharyngeal tumors (according to location and extension
of the tumor)
(deep endoauricular pain irradiated to temporomandibular region)
(retroauricular and mastoid regions)
(localized to the involved tooth and surrounding tissues, irradiated to
ear)
(deep pain arund involved tooth, irradiated to ear),
mutations in D2)
in females (usually changing side)-free
interval : very common and may be extremely severe, long-lasting and poorly
responsive to analgesics (status migrainosus). It is associated with impaired
prolactin and cortisol responses following m-CPP challenge. Transdermal
E2 supplementation is able to restore neuroendocrine response
to this specific 5-HT agent, exerting a positive clinical effect on the
course of menstrually related migraineref,
substance
P,
neurokinin
A)
by trigeminal nerve leads to the relay of pain impulses from peripheral
sensory neurons to second-order brain-stem trigeminal nuclei (which may
become stressed over time).
(87%)
(82%)
(56%)
(33%)
(16%)
for 20-30 minutes)
are prominent..
2 alleles (L764P and W887R) showed loss-of-function, whereas a third (T345A)
is fully functional but with altered Na,K-ATPase kinetics. 2 additional
mutants, R689Q and M731Tref,
are also functional and kinetically altered. Both mutants have reduced
catalytic turnover and increased apparent affinity for extracellular K+.
For both R689Q and M731T, sensitivity to vanadate inhibition is decreased,
suggesting that the steady-state E1 <=> E2 poise of the enzyme is shifted
toward E1. Whereas the K'ATP is not affected by the R689Q replacement,
the M731T mutant has an increase in apparent affinity for ATP. Analysis
of the structural changes effected by T345A, R689Q, and M731T mutations,
based on homologous replacements in the known crystal structure of the
sarcoplasmic reticulum Ca-ATPase, provides insights into the molecular
bases for the kinetic alterations. It is suggested that the disease phenotype
is the consequence of lowered molecular activity of the a2
pump isoform due to either decreased K+ affinity (T345A) or
catalytic turnover (R689Q and M731T), thus causing a delay in extracellular
K+ clearance and/or altered localized Ca2+ handling/signaling
secondary to reduced activity in colocalized Na+/Ca2+
exchangeref.
: photophobia, fever, nuchal rigidity
: nuchal rigidity without fever
(insomnia in 3%, at awakening in 10%
: claudication, malaise, age > 50 years
: nausea and vomiting),
stiffness of cervical or temporal muscles (in tension
headache), abormal neurological examination (nuchal rigidity in meningitis
and subarachnoid
hemorrhage (SAH)),
examination of fundus oculi if there is severe hypertension (hypertensive
emergency)
),
severe hypertension with sensory obnubilation
,
myogenic pain, ischial bursitis, and subarachnoid
hemorrhages,
flexion of the hip evokes pain in the back or the lower limbs when the
knee is extended, but painless when the knee is flexed (due to stirring
of L5 and S1 roots and of sciatic nerve which passes behind the hip). This
distinguishes the disorder from disease of the hip joint. When foot is
passively dorsiflexed, flexion of the hip is painful before the normal
80°. The critical distinction is made by the sciatic stretch test
: this test is performed after a straight leg raising test by lowering
the affecting leg a few degrees below the point and applying compression
to the popliteal fossa (this helps tether the sciatic nerve and should
help provoce symptoms with a lesser degree of a SLR (removing hamstring
irritation as a cause of symptoms); the reverse sciatic tension test
is performed by plantar flexing rather than dorsiflexing the foot : if
this results in increased complaints of pain, then pt is malingerer,
pregnancy,
scoliosis)
(pyelonephritis)
or MRI
subtype, providing a rational basis for new analgesic strategies going
beyond COX inhibitionref
that is normally stimulated by noxious and disgusting substances,
often recognizable by its lack of correspondence with nerve distributions
Copyright © 2001-2014 Daniele Focosi.
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