Hemicrania continua secondary to neurogenic paravertebral tumor- a case report

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mythili Kalladka ◽  
Osamah Al-azzawi ◽  
Gary M. Heir ◽  
Suresha Kodapala ◽  
Mohan Thomas Nainan ◽  
...  
Keyword(s):  
Comprehensive Evaluation ◽  
Hemicrania Continua ◽  
Neurogenic Tumor ◽  
Sympathetic Chain ◽  
Complete Relief ◽  
Case Presentation ◽  
Facial Region ◽  
Sympathetic Dysfunction ◽  
Essential Knowledge ◽  
Paravertebral Region

Abstract Objectives Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where sympathetic dysfunction and autonomic dysfunction resulting in parasympathetic over activation with some evidence of sympathetic inhibition have been suggested as probable causes. However, cases of hemicrania continua secondary to sympathetic dysfunction due to neurogenic paravertebral tumor impinging on the sympathetic chain has not been previously reported. In this case, the probability of the sympathetic dysfunction was more likely based on the clinical features and management. Case presentation A 23-year-old female presented with a chief complaint of right unilateral pain in the retro-bulbar, head and facial region for the past three years. An initial MRI of the brain was negative, whereas an MRI of the spine was advised to rule out a cervicogenic origin of the pain. The MRI revealed a well-defined mass lesion within right paravertebral region at T3 indicative of a neurogenic tumor. The patient was diagnosed with probable hemicrania continua secondary to neurogenic tumor impinging on adjacent sympathetic chain. A trial of indomethacin 75 mg/day was advised, which provided complete relief of the headache. The patient was referred to a neurologist for management of the neurogenic tumor. Conclusions Headache disorders may be secondary to pathologies and comprehensive evaluation and accurate diagnosis are essential. Knowledge of neuroanatomy is paramount to understand and explain underlying pathophysiological mechanisms. Multidisciplinary management is essential in complex orofacial cases.

Dependent Erythema of the Legs Associated With Mild Autonomic Nervous System Dysfunction

2017 ◽  
Vol 21 (6) ◽  
pp. 556-558
Author(s):  
Bahar Bahrani ◽  
Christopher S. Sladden
Keyword(s):  
Literature Search ◽  
Chronic Diarrhea ◽  
Autonomic Nervous System Dysfunction ◽  
Erect Posture ◽  
Case Presentation ◽  
Sympathetic Dysfunction ◽  
Full Physical Examination ◽  
History Of ◽  
Artery Disease ◽  
Shed Light

Introduction: Dependent erythema or rubor is an erythematous discoloration of the limbs, most commonly associated with peripheral artery disease. We present a case of florid dependent erythema, associated with additional autonomic symptoms. Methods: Examination and full workup of a 16-year-old healthy girl with an 8-year history of dependent erythema, chronic diarrhea, and mild hyperhidrosis. A literature search was performed to review any similar cases and generate a differential diagnosis. Results: Examination of our patient showed symmetrical, asymptomatic fiery to dusky erythematous patches of the lower legs and feet, with intermittent areas of pallor. These florid changes occurred with erect posture. Resolution to near normal occurred within minutes when the patient was in the supine position. Full physical examination revealed mild erythema and hyperhidrosis of the hands. Conclusions: To our knowledge, there have been no reports of painless dependent rubor associated with sympathetic dysfunction. Literature search reports a few cases of gravitational erythema and angiodyskinesia. This case presentation is most likely part of the spectrum of dependent erythema and may shed light on the underlying aetiology.

scholarly journals Transthoracic 3D Echocardiographic Imaging of Type A Aortic Dissection – Case Presentation

2017 ◽  
Vol 63 (3) ◽  
pp. 152-154
Author(s):  
István Adorján Szabó ◽  
Ildikó Kocsis ◽  
Zoltán Fogarasi ◽  
Boglárka Belényi ◽  
Attila Frigy
Keyword(s):  
Aortic Dissection ◽  
3D Imaging ◽  
Surgical Repair ◽  
Comprehensive Evaluation ◽  
Type A ◽  
Case Presentation ◽  
Type A Aortic Dissection ◽  
Noninvasive Imaging Technique ◽  
3D Transthoracic Echocardiography ◽  
Full Volume

AbstractIn type A aortic dissection (AoD) an early and accurate diagnosis is essential to improve survival, by applying urgent surgical repair. 3D transthoracic echocardiography (3D-TTE), an advanced noninvasive imaging technique, could offer a comprehensive evaluation of the ascending aorta and aortic arch in this regard. Both modalities of real-time 3D imaging – live 3D and full-volume aquisition – proved to be useful in evaluating the localization and extent of AoD. Our case illustrates the utility of 3D-TTE in the complex assessment AoD. By providing the proper anatomical dataset, 3D-TTE could facilitate considerably the diagnosis of type A AoD.

scholarly journals Treatment of Localized Vulvar Pain with Neural Therapy: A Case Series and Literature Review

2021 ◽  
pp. 1-7
Author(s):  
Modesto Rey Novoa ◽  
Montserrat Muñoz-Sellart ◽  
Marta Catalán Soriano ◽  
David Vinyes
Keyword(s):  
Randomized Clinical Trials ◽  
Case Series ◽  
Complete Relief ◽  
Neural Therapy ◽  
Vulvar Pain ◽  
Case Presentation ◽  
Low Concentrations ◽  
Local Injections

<b><i>Background:</i></b> Localized vulvar pain (LVP) is a common condition among fertile women, with physical and psychosexual implications. Treatment is complex with limited benefits. Neural therapy is a regulatory therapy that uses injections of local anesthetics in low concentrations in specific points to treat different conditions. <b><i>Case Presentation:</i></b> We present the cases of 5 women, ages 33–44 years, with LVP treated with procaine 0.5% injections in painful points. Complete relief from pain occurred in 2 patients, and significant improvement in 3. Only 1 or 2 sessions were required. Initial VAS score was ≥70 and decreased to ≤30 after the intervention. The improvement was maintained over time, with a minimum follow-up period of 6 months. None of the patients were able to have sex or use tampons due to pain, but they were able to resume after the intervention. <b><i>Conclusions:</i></b> In this case series, local injections of procaine showed a favorable outcome. Future randomized clinical trials could help elucidate the role of this intervention in LVP.

scholarly journals Why is it important to diagnose hemicrania continua?

2020 ◽  
Vol 4 (1) ◽  
pp. 2514183X2090677
Author(s):  
Marilena Wagner ◽  
Peter S Sandor ◽  
Andreas R Gantenbein
Keyword(s):  
Prophylactic Treatment ◽  
Medication Overuse ◽  
Clinical Course ◽  
Therapeutic Option ◽  
Medication Overuse Headache ◽  
Correct Diagnosis ◽  
Primary Headache ◽  
Hemicrania Continua ◽  
Case Presentation ◽  
Missed Diagnosis

Hemicrania continua (HC) is an indomethacin-responsive primary headache which belongs to the trigeminal autonomic cephalalgias. Although the first description of HC was 35 years ago, there are still different views regarding the clinical course, the diagnostic criteria, and the treatment. The high clinical heterogeneity of HC, missed diagnosis, and the delay to the correct diagnosis are important in patient care. Central features of HC are continuous side-locked headaches (with superimposed exacerbations) and the response to indomethacin. We are describing the case of a 29-year-old women who developed right-sided headache 3 weeks after the excision of a right-sided vestibular schwannoma. She tried different painkillers and also was started on a prophylactic treatment with oxcarbazepine, acupuncture, and physiotherapy. But nothing really helped. She was then admitted for an inpatient withdrawal program for medication overuse headache. Again the pain did not change. She has then been treated with indomethacin 50-mg tds, where after the headache improved rapidly within 3 days. This educational case presentation and review of the literature aims to consider HC as a possible differential diagnosis in chronic headache, especially when side-locked and shows that indomethacin maybe a quick therapeutic option before putting the patients on a long treatment odyssey with analgesics and other drugs.

“Hemicrania Continua”: A Case Report

Cephalalgia ◽  
1987 ◽  
Vol 7 (3) ◽  
pp. 171-173 ◽  
Author(s):  
Eliova Zukerman ◽  
Suzanmeire Negro Minatti Hannuch ◽  
Deusvenir de Souza Carvalho ◽  
Yara Dadalti Fragoso ◽  
Klaus Augusto Jenger
Keyword(s):  
Case Report ◽  
Hemicrania Continua ◽  
Complete Relief ◽  
History Of

The case of a 42-year-old woman with a 31-year history of continuous unilateral, pulsating headache with occasional exacerbations is described. Complete relief was obtained with 150 mg indomethacin daily.

scholarly journals A Case Report of a Malignant Peripheral Nerve Sheath Tumor of the Paravertebral Region

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ghasem Miri-Aliabad ◽  
Hamid Dahmardeh ◽  
Seyed Hosein Soleimanzadeh Mousavi
Keyword(s):  
Peripheral Nerve ◽  
Radiographic Evaluation ◽  
Nerve Sheath Tumor ◽  
Case Presentation ◽  
Peripheral Nerve Sheath Tumor ◽  
Nerve Sheath ◽  
One Year ◽  
The Right ◽  
Paravertebral Region ◽  
Tissue Cancer

Introduction: Malignant peripheral nerve sheath tumor (MPNST) is a type of connective tissue cancer, which may also have genetic backgrounds. More than half of patients have neurofibromatosis. The treatment of this tumor is a combination of surgery, radiotherapy, and chemotherapy. As usual, the tumor may be present anywhere with several manifestations. Case Presentation: A 4-year old boy presented with sweating and pain in the right forearm that was diagnosed with MPNST developed in the paravertebral region after laboratory and radiographic evaluation. Conclusions: The patient was treated successfully and followed up for one year without any complications.

scholarly journals Headache from clinically confirmed hemicrania continua arising from the sternocleidomastoid muscle: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Osnat Wende ◽  
Shira Markowitz
Keyword(s):  
Case Report ◽  
Hemicrania Continua ◽  
Autonomic Nerve ◽  
Case Presentation ◽  
Trigeminal Autonomic Cephalalgia ◽  
Crucial Component ◽  
History Of ◽  
The Right ◽  
Cluster Headaches

Abstract Background A patient with a history of cluster headaches, now in remission, presented with confirmed hemicrania continua that resolved with a local anaesthetic injection into the Sternocleidomastoid (SCM) muscle. To the best of our knowledge, this is the first reported case of a trigeminal autonomic cephalalgia arising from a soft tissue source in the neck. Case presentation A 66-year-old man with a history of cluster headaches presented with a six-month history of a new constant right-sided headache. The new headaches were associated with tearing and redness of the right eye and responded to indomethacin, thus meeting the International Classification of Headache Disorders (ICHD-3) diagnostic criteria for hemicrania continua. The history and physical examination suggested a cervical source of the headache arising from the ipsilateral SCM muscle. Injection of the muscle with 1% lidocaine resulted in the elimination of the pain for 1 month without indomethacin. Conclusions Due to the convergence of trigeminal, cervical and autonomic nerve fibres, various combinations of headache syndromes can result. This case report demonstrates how a meticulous examination is a crucial component of headache evaluation. Treatment directed to this muscle spared this patient further daily indomethacin and associated side effects.

An adrenocortical oncocytoma with unusual mitochondrial inclusions and cytoplasmic crystals

1994 ◽  
Vol 52 ◽  
pp. 250-251
Author(s):  
W.T. Gunning ◽  
G.D. Haselhuhn ◽  
E.R. Phillips ◽  
S.H. Selman
Keyword(s):  
Adrenal Gland ◽  
Salivary Glands ◽  
Mitotic Activity ◽  
Diagnostic Criteria ◽  
Vascular Invasion ◽  
Benign Neoplasm ◽  
Benign Tumors ◽  
Nuclear Morphology ◽  
Case Presentation ◽  
Microscopic Evidence

Within the last few years, adrenal cortical tumors with features concordant with the diagnostic criteria attributed to oncocytomas have been reported. To date, only nine reported cases exist in the literature. This report is the tenth case presentation of a presumptively benign neoplasm of the adrenal gland with a rare differentiation. Oncocytomas are well recognized benign tumors of the thyroid, parathyroid, and salivary glands and of the kidney. Other organs also give rise to these types of tumors, however with less frequency than the former sites. The characteristics generally used to classify a tumor as an oncocytoma include the following criteria: the tumor is 1) usually a solitary circumscribed mass with no gross nor microscopic evidence of metastasis (no tissue nor vascular invasion), 2) fairly bland in terms of mitotic activity and nuclear morphology, and 3) composed of large eosinophillic cells in which the cytoplasm is packed full of mitochondria (Figure 1).

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