Cervicogenic Pain

Treatment Options ◽

Cervicogenic Headache ◽

Common Source ◽

Secondary Headache ◽

Cervical Pain ◽

Imaging Studies ◽

Head Pain ◽

Upper Cervical ◽

Cervicogenic pain is a common source of pain in many patients who present with neck and head pain. It is a secondary headache believed to be caused by referral of pain from a variety of upper cervical pain generators. The typical pain generators of cervicogenic headache are structures that are innervated by the upper three cervical nerves and that relay these signals through the trigeminocervical nucleus, resulting in head pain. Imaging studies may help to rule out other pathologies but cannot be used to make a diagnosis of cervicogenic headache. Treatment options include a multidisciplinary approach using physical therapy, medications, and interventional treatments.

Dysphagia due to anterior cervical osteophytosis: case report

Coluna/Columna ◽

10.1590/s1808-18512014130400r65 ◽

2014 ◽

Vol 13 (4) ◽

pp. 325-327

Author(s):

Frederico Miguel Santos Silva Marquez Correia ◽

João Paulo de Sousa Goucha Jorge ◽

Ana Sofia Teixeira Neves ◽

Gabriel Filipe Gonçalves Xavier ◽

Marco Miguel Barroso de Oliveira ◽

...

Keyword(s):

Case Report ◽

Complete Resolution ◽

Surgical Excision ◽

Pulmonary Aspiration ◽

Cervical Pain ◽

Imaging Studies ◽

Geriatric Population ◽

Cervical Osteophytes ◽

Progressive Dysphagia

The objective of this study is to highlight the possibility of dysphagia induced by anterior cervical osteophytes. When not diagnosed early this condition may be responsible for complications such as severe dysphagia and potential lung aspiration, especially in elderly patients. Analysis of a case report of a 72-year old woman who presented cervical pain and progressive dysphagia. Imaging studies have shown anterior cervical osteophytosis and multilevel degenerative changes in the cervical spine. The patient underwent surgical excision of the cervical anterior osteophytes (C4, C5 and C6) and C5/C6 arthrodesis through anterior approach. The postoperative period was uneventful and symptoms resolved within 2 weeks. Early diagnosis and treatment led to complete resolution, avoiding late and serious complications associated with this pathology in the geriatric population, especially severe and progressive dysphagia and risk of pulmonary aspiration, and the consequent morbidity and mortality associated. A multidisciplinary approach is essential for the correct assessment of this condition

Congenital Horner and Scimitar syndrome in a newborn: a previously unreported combination

BMJ Case Reports ◽

10.1136/bcr-2020-238018 ◽

2020 ◽

Vol 13 (11) ◽

pp. e238018

Author(s):

Joana Carvalho ◽

Mariana Maia ◽

Ágata Mota ◽

Teresa Martins

Keyword(s):

Septal Defect ◽

Inferior Vena ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Scimitar Syndrome ◽

Left Superior Vena Cava ◽

Dilated Coronary Sinus ◽

Here we report a case of a term newborn presenting with left palpebral ptosis, anisocoria and heterochromia as well as cleft palate and heart murmur. Congenital Horner syndrome was suspected and a thoracoabdominal CT scan was performed to rule out neuroblastoma. This revealed an anomalous drainage of right pulmonary veins to a collector that drains to the inferior vena cava, leading to the diagnosis of Scimitar syndrome. Echocardiogram showed an ostium secundum atrial septal defect, enlarged right chambers and a dilated coronary sinus due to a persistent left superior vena cava. The combination of Horner and Scimitar syndrome has never been described before. This case should encourage clinicians to use a multidisciplinary approach in order to guarantee an adequate diagnosis and management.

Rheumatic Immune-Related Adverse Events—A Consequence of Immune Checkpoint Inhibitor Therapy

Biology ◽

10.3390/biology10060561 ◽

2021 ◽

Vol 10 (6) ◽

pp. 561

Author(s):

Anca Bobircă ◽

Florin Bobircă ◽

Ioan Ancuta ◽

Alesandra Florescu ◽

Vlad Pădureanu ◽

...

Keyword(s):

Immune System ◽

Adverse Events ◽

Immune Checkpoint ◽

Malignant Tumors ◽

Checkpoint Inhibitors ◽

Treatment Options ◽

Cancer Cell Growth ◽

Inhibitory Mechanisms ◽

Checkpoint Inhibitor Therapy

The advent of immunotherapy has changed the management and therapeutic methods for a variety of malignant tumors in the last decade. Unlike traditional cytotoxic chemotherapy, which works by interfering with cancer cell growth via various pathways and stages of the cell cycle, cancer immunotherapy uses the immune system to reduce malignant cells’ ability to escape the immune system and combat cell proliferation. The widespread use of immune checkpoint inhibitors (ICIs) over the past 10 years has presented valuable information on the profiles of toxic adverse effects. The attenuation of T-lymphocyte inhibitory mechanisms by ICIs results in immune system hyperactivation, which, as expected, is associated with various adverse events defined by inflammation. These adverse events, known as immune-related adverse events (ir-AEs), may affect any type of tissue throughout the human body, which includes the digestive tract, endocrine glands, liver and skin, with reports of cardiovascular, pulmonary and rheumatic ir-AEs as well. The adverse events that arise from ICI therapy are both novel and unique compared to those of the conventional treatment options. Thus, they require a multidisciplinary approach and continuous updates on the diagnostic approach and management.

Episodic versus Chronic Dizziness: An Analysis of Predictive Factors

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211025416 ◽

2021 ◽

pp. 000348942110254

Author(s):

Eric J. Formeister ◽

Ricky Chae ◽

Emily Wong ◽

Whitney Chiao ◽

Lauren Pasquesi ◽

...

Keyword(s):

Multivariate Regression ◽

Treatment Options ◽

Depression And Anxiety ◽

Imaging Studies ◽

Comorbid Depression ◽

Cross Sectional ◽

Tertiary Center ◽

Chronic Dizziness ◽

Associated Symptoms ◽

History Of

Objectives: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. Methods: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). Results: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière’s disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo- R2 = 0.15; P < .001). Conclusions: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients.

Epiphysiodesis for the treatment of tall stature and leg length discrepancy

Wiener Medizinische Wochenschrift ◽

10.1007/s10354-021-00828-8 ◽

2021 ◽

Author(s):

Madeleine Willegger ◽

Markus Schreiner ◽

Alexander Kolb ◽

Reinhard Windhager ◽

Catharina Chiari

Keyword(s):

Surgical Planning ◽

Treatment Options ◽

Bone Age ◽

Leg Length Discrepancy ◽

Tall Stature ◽

Complication Rates ◽

Leg Length ◽

Growth Prediction ◽

Length Discrepancy

SummaryPainful orthopedic conditions associated with extreme tall stature and leg length discrepancy (LLD) include back pain and adopting bad posture. After failure of conservative treatment options, blocking of the growth plates (epiphysiodesis) around the knee emerged as gold standard in patients with tall stature and LLD in the growing skeleton. Surgical planning includes growth prediction and evaluation of bone age. Since growth prediction is associated with a certain potential error, adequate planning and timing of epiphysiodesis are the key for success of the treatment. LLD corrections up to 5 cm can be achieved, and predicted extreme tall stature can be limited. Percutaneous epiphysiodesis techniques are minimally invasive, safe and efficient methods with low complication rates. In general, a multidisciplinary approach should be pursued when treating children and adolescents with tall stature.

Cervicogenic Headache: Lack of Influence of Pregnancy

Cephalalgia ◽

10.1046/j.1468-2982.2002.00408.x ◽

2002 ◽

Vol 22 (8) ◽

pp. 667-671 ◽

Cited By ~ 9

Author(s):

O Sjaastad ◽

TA Fredriksen

Keyword(s):

International Headache Society ◽

Biological Marker ◽

International Study ◽

Cervicogenic Headache ◽

Lower Number ◽

Control Group ◽

Study Group ◽

Head Pain ◽

International Study Group ◽

A Minor

The influence of pregnancy upon the head pain of cervicogenic headache (CEH) has been studied in 14 patients (number of pregnancies 25). Migraine was used as control group ( n = 49; number of pregnancies 116). CEH was diagnosed according to The Cervicogenic Headache International Study Group guidelines. Migraine was diagnosed according to International Headache Society (IHS) guidelines; a further requirement was that at least eight of nine solitary IHS diagnostic requirements of migraine were present. In 79%—or more—of CEH patients, attacks seemed to appear just as usual during pregnancy; in one patient, attacks stopped completely, and in two there may have been a minor reduction of attacks. A significantly lower number of migraine patients (up to 18%) were more or less uninfluenced by pregnancy (CEH vs. migraine P < 0.0001, X2 test). The lack of response to pregnancy may be a sort of biological marker in CEH. It may also help in clinically distinguishing CEH from migraine when CEH starts early in life, i.e. prior to pregnancies.

Do we achieve the Montgomery standard for consent in orthopaedic surgery?

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0504 ◽

2021 ◽

pp. 1-7

Author(s):

Xenia N Tonge ◽

Henry Crouch-Smith ◽

Vijay Bhalaik ◽

William D Harrison

Keyword(s):

Treatment Options ◽

Information Provision ◽

Common Source ◽

Health Board ◽

Improvement Project ◽

Specific Patient ◽

Written Information ◽

Orthopaedic Patients ◽

Recorded Data

Aims/Background The Montgomery v Lanarkshire Health Board (2015) case set a precedent that has driven the modernisation of consenting practice. Failure to demonstrate informed consent is a common source of litigation. This quality improvement project aimed to provide pragmatic guidance for surgeons on consent and to improve the patient experience during decision making. Methods Elective orthopaedic patients were assessed and the quality of documented consent was recorded. Data were collected over two discrete cycles, with cycle 1 used as a baseline in practice. The following criteria were reviewed: grade of consenting clinician, alternative treatment options, description of specific risks, place and timing of consent and whether the patient received written information or a copied clinic letter. Cycle 1 results were presented to clinicians; a teaching session was provided for clinicians on the standard of consent expected and implementation of a change in practice was established with a re-audit in cycle 2. Results There were 111 patients included in cycle 1, and 96 patients in cycle 2. Consent was undertaken mostly by consultants (54%). Specific patient risks were documented in 50% of patients in cycle 1 and 60% in cycle 2. Risks associated with a specific procedure were documented in 42% in cycle 1 and 76% in cycle 2, alternative options in 48% (cycle 1) and 66% (cycle 2). A total of 14% of patients in cycle 1 and 8% in cycle 2 had documented written information provision. Copied letters to patients was only seen in 12% of all cycles. Documentation from dedicated consenting clinics outperformed standard clinics. Conclusions Highlighting poor documentation habits and refining departmental education can lead to improvements in practice. The use of consenting clinics should be considered and clinicians should individually reflect on how to address their own shortcomings. Other units should strongly consider a similar audit. This article provides stepwise advice to improve consent and specifics from which to audit.

Upper Cervical Facet Joint and Spinal Rami Blocks for the Treatment of Cervicogenic Headache

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.2010.01623.x ◽

2010 ◽

Vol 50 (4) ◽

pp. 657-663 ◽

Cited By ~ 27

Author(s):

Linqiu Zhou ◽

Zarinah Hud-Shakoor ◽

Christopher Hennessey ◽

Avi Ashkenazi

Keyword(s):

Facet Joint ◽

Cervicogenic Headache ◽

Upper Cervical ◽

Cervical Facet ◽

Cervical Facet Joint

A rare clinical case: schwannoma of tongue

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20191464 ◽

2019 ◽

Vol 5 (3) ◽

pp. 789

Author(s):

Chandra Veer Singh ◽

Sheetal Radia ◽

Saalim Sheikh ◽

Vijay Haribhakti

Keyword(s):

Head And Neck ◽

Rare Case ◽

Neck Region ◽

Surgical Excision ◽

Imaging Studies ◽

Head And Neck Tumours ◽

Head And Neck Region ◽

Complete Surgical Excision ◽

Slow Growing ◽

<p class="abstract">Schwannoma are slow growing tumours, which can arise from any peripheral nerve. 10% of schwannomas that occur in the head and neck region mostly originate from the vagus or sympathetic nervous system. Extracranial schwannomas in the head and neck region are rare neoplasm. Intraoral schwannoma are only 1% of the all head and neck tumours. Diagnosis is established by imaging studies such as magnetic resonance imaging or computed tomography, while FNAC is used to rule out other conditions. We report a rare case of lingual schwannomas generally present as a painless lump schwannoma of the tongue in a 27-year-old male complaining of asymptomatic swelling over a posterolateral surface of the tongue, treated by complete surgical excision. The diagnosis was established on the basis of clinical, histopathological, and immunohistochemical examination. We report a rare case of schwannoma over the posterolateral surface of tongue. Prognosis is good for the patient when this condition is correctly diagnosed as the condition rarely recurs after complete resection.</p>

Pyogenic Granuloma of the Foot with Satellitosis: A Role for Conservative Management

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2010.09068 ◽

2011 ◽

Vol 15 (1) ◽

pp. 58-60

Author(s):

Janice Bacher ◽

Dalal Assaad ◽

David N. Adam

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Conservative Management ◽

Treatment Options ◽

Pyogenic Granuloma ◽

Conservative Approach ◽

Review Of The Literature ◽

Atypical Case ◽

Over Time ◽

Background: Pyogenic granuloma (PG) with satellitosis is a rare phenomenon that typically occurs in children and teenagers. It can be seen after excision or trauma to the original lesion. Objective: The aim is to review an atypical case of PG with satellitosis and to highlight a conservative approach to management. Methods: This article includes a case report of a 48-year-old woman developing PG with satellitosis in her right foot and includes a review of the literature. Results: There are few cases of PG with satellitosis in the literature. Our patient differs from most given her age and the location of the lesions. She was managed differently with a conservative observational approach, and, over time, her symptoms abated. Conclusion: PG with satellitosis can occur in varying patient populations with varying presentations. Although several treatment options exist, managing patients conservatively should be considered an approach to management. Early investigations should be conducted to rule out more sinister items in the differential diagnosis.