Delayed diagnosis of cluster headache in African-American women

The male-to-female ratio has fallen in cluster headache over the last several decades and is now 2.1:1. Unfortunately, women still are not diagnosed accurately. This lack of appropriate diagnosis appears related to the misconception that cluster headache rarely occurs in women. Compounding this misconception, there seems to be an ethnic bias. We report cluster headache in five African-American women in whom diagnosis was delayed due to gender, ethnicity, and, most importantly, an inability to make a correct diagnosis of cluster headache. Cluster headache diagnostic criteria are no different in men or women and have no ethnic boundaries. Clinical features such as disordered chronobiology and abnormal behavior often suggest the diagnosis. Migrainous features occur commonly in cluster headache and, when present, should not exclude the diagnosis. Likewise, neither race nor sex should exclude the diagnosis. The diagnosis of cluster headache is easily made by considering unilateral orbital, supraorbital or temporal location; short duration (15-180 minutes, untreated), and ipsilateral autonomic dysfunction involving the eye or nose.     

神经电生理检查在运动神经元病中的诊断价值

目的:研究神经电生理检查在运动神经元病(MND))中的诊断价值。方法:分别对25例MND患者进行了磁刺激运动诱发电位(mMEP)、肌电图(EMG)、神经传导速度(NCV)、体感诱发电位(SEP)测定,并与健康对照组20例进行比较。结果:MND组mMEP皮层潜伏期和中枢运动传导时间(CMCT)均明显长于对照组;EMG神经原性损害占70％;NCV 30％患者异常;SEP未见明显异常。结论:mMEP结合EMG检查在MND的诊断和分型中具有重要价值。     

The prevalence and diagnosis of headache in an urban practice

During a six-month study, one person in every 24 of the practice population consulted us about headache. There were more than twice as many females as males, and the largest group of females was in the 20 to 40 year age group.

The majority of patients were managed entirely in the practice; only 10·4 per cent were investigated and four per cent were referred to hospital. The commonest cause was tension. Two patients had headaches due to serious pathology and one of these died.

     

Mathematical methods in medical diagnosis

This work presents an underlying mathematical framework within which mathematical medical diagnosis can be discussed. Ten mathematical models of disease diagnosis, including those which have been most commonly used or suggested, are derived and compared within this framework. The results of attempting to diagnose cases from a large, high-quality data set using these ten models are presented. All the models produce similar diagnostic results, indicating that the development of increasingly more sophisticated models of this type may be a fruitless exercise. Other lines for future work are suggested.     

66例儿童可疑头痛性癫癎随访分析

目的:探讨头痛性癫的诊断及与偏头痛的鉴别诊断。方法:分析由基层医院诊断为头痛性癫的66例患儿的临床资料,经详细询问病史,进行仔细的体格检查,复查脑电图(EEG)1~3次后,重新确定诊断,实施治疗并进行临床随访。结果:在此66例患儿中,28例纠正诊断为偏头痛,32例纠正诊断为神经性头痛。复查EEG结果显示大部分在正常范围,部分异常EEG中以弥漫性慢波增多为主,仅有6例EEG显示有散在样波,结合临床表现符合头痛性癫的诊断。结论:头痛性癫临床少见,单纯以头痛表现诊断为癫是不可靠的,必须依靠临床表现、EEG检查结果综合判断,并和偏头痛进行鉴别。以头痛为主诉的儿童不应轻易诊断为癫。     

Neurophysiological testing in long-standing cystinosis

Neurophysiological data of two brothers with long-standing cystinosis are presented. Both patients showed a distally symmetrical myopathy affecting the arms more than the legs. Myopathy occurred before the onset of polyneuropathy or signs of central nervous involvement.     

Current methods of immunologic diagnosis in parasitology

This review of the immunological diagnosis of parasitic diseases defines the various indications, the means of collection and preparation, the various levels of specificity and the choice of parasitic antigen which should be used for immuno-diagnosis. The detection and assay of circulating antibodies relies on the techniques of immuno-precipitation (immunodiffusion, immunoelectrophoresis, electrosyneresis), indirect agglutination (latex and haemagglutination) or the use of labelled compounds (immunofluorescence, enzymo-immunoassay, radio-immunoassay). Their respective advantages and disadvantages are discussed. The detection and assay of circulating antigens involve the use of agglutination techniques (mycoses), radio-immunoassay or enzymo-immunoassay (protozooses and helminthiases). The authors review the applications of immunological diagnosis for the helminthiases (Trichinosis, Toxocarosis, Filariasis, Anguillosis, Ascaridiasis, Echinococcosis, Taeniasis and Cysticercosis, Distomatosis and Schistosomiasis), the protozoan infections (malaria, Toxoplasmosis, Amebiasis, Trypanosomiasis, Leishmaniasis) and the mycoses (Aspergillosis, Candidiasis, Cryptococcosis). They also discuss the prospects for the development of immunological diagnosis by identification, purification and standardization of parasitic antigens and the study of circulating antigens and idiotypic anti-parasitic antibodies. Finally, they outline the respective responsibilities of the biologist and the prescribing doctor for the proper use of immunological diagnosis of parasitic diseases.     

Neurophysiological mechanisms of aphasia in epilepsy

Translated from Zhurnal Nevropatologii i Psikhiatrii imeni S. S. Korsakova, Vol. 90, No. 5, pp. 34–40, May, 1990.     

Ultrasonography methods in the diagnosis of renal osteodystrophy

Bone disease, i.e. renal osteodystrophy, is commonly seen in patients with chronic renal failure. It encompasses all the disorders of mineral and bone metabolism associated with chronic renal insufficiency, i.e. secondary hyperparathyroidism, retention and accumulation of beta 2 microglobulin and aluminum. The most frequent cause of renal osteodystrophy is secondary hyperthyroidism, with a consequence of high turnover bone disease. Secondary hyperparathyroidism, i.e. increased parathyroid hormone (PTH) secretion and parathyroid gland hyperplasia, develops early in the course of chronic renal insufficiency. Hypocalcemia, phosphate retention and deficiency of calcitriol stimulate PTH synthesis and secretion and parathyroid cell proliferation, i.e. hyperplasia. Parathyroid cell proliferation is initially polyclonal (diffuse hyperplasia), and later it is monoclonal or multiclonal (nodular hyperplasia). Calcitriol receptors as well as calcium-sensing receptors are significantly reduced in parathyroid glands in nodular hyperplasia. Patients with such parathyroid gland hyperplasia are often resistant to vitamin D therapy. A specific form of bone disease is beta 2 amyloidosis. Destructive arthropathy, cystic changes and carpal tunnel syndrome are clinical manifestations of dialysis-related amyloidosis, which is one of the major complications in patients on longterm hemodialysis. Aluminum intoxication leads to the low turnover bone disease and consequential osteomalacia or aplastic bone lesions, the cause of which has not yet been fully clarified. Ultrasound can be a useful, economical and noninvasive method in the evaluation of renal osteodystrophy. Ultrasound waves are very important for noninvasive imaging of soft tissue, especially parathyroid glands, pathologic changes of the joints, and for detection of metastatic calcifications. They are also useful in the evaluation of skeletal status in dialysis patients. Ultrasound waves of a frequency above the limit of human hearing are used in the morphological diagnosis of parathyroid gland. Today, because of its simplicity and non-invasiveness, it is a generally accepted method for the detection of enlarged parathyroid gland in patients with secondary hyperparathyroidism, for the monitoring of pathologic changes, and for making decisions on the method of treatment based on the size and number of parathyroid glands. Ultrasound can distinguish nodal from diffuse parathyroid hyperplasia. Under ultrasound guidance it is possible to perform fine needle aspiration biopsy, to confirm ultrasound findings, and percutaneous inactivation of parathyroid gland (PEI) with alcohol. Ultrasound is useful in the diagnosis of pathologic changes of the musculoskeletal system in patients with beta 2 amyloidosis, to assess the process of its spread, especially in the shoulder joint where the changes are most pronounced (rotator cuff thickness, amyloid deposits as hyperechogenic pads, and detection of fluid in the joint), but it can also be used to examine other joints as well as soft tissue in which metastatic calcifications may occur. Standard ultrasound equipment (pulse-echo) and linear probe of 5-13 MHz are used, also serving for ultrasound examination of the neck, joints and soft tissue. Quantitative bone ultrasonometry is based on different physical characteristics of the ultrasound including: transmission, Speed Of Sound (SOS) in meters/sec and Broad Band Attenuation (BUA) in dB/MHz, and different concepts of the apparatus. These parameters depend on the strength and architecture of the bones and describe better the changes in bone structure in dialysis patients by calculation of the Stiffness Index (QUI), better than the standard bone densitometry by dual-energy x-ray absorptiometry, which only measures bone density. Combined ultrasound measurement of the bone in several locations may be successful in monitoring dialysis patients.     

Modern methods for diagnosis ofGardnerella infection

Comparison of morphological, bacteriological, serological, and genetic methods for diagnosis ofGardnerella infection in vaginosis showed that the first three methods are preferable, while the genetic method (polymerase chain reaction) is more efficient for identification ofGardnerella vaginalis in culture. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 130, No. 8, pp. 196–199, August, 2000