Differential diagnosis of tension headache and basic principles of treatment

Headache (cephalalgia) is one of the most common symptoms and is a manifestation of more than 50 diseases. According to the World Health Organization, at least one episode of headache during a lifetime has occurred in almost every inhabitant of the Earth, and about half of them noted periodic headaches. In its etiology, cephalalgia can be primary, not associated with organic damage to tissues and organs, and secondary, which is based on pathological changes. In particular, cephalalgia in inflammatory lesions of the paranasal sinuses, brain tumors, encephalitis and meningitis, acute cerebrovascular accident, head trauma, arterial hypertension, aneurysm of the cerebral vessels, etc., should be attributed to the secondary headache. In 95–97 % of cases, the headache is not based on organic lesion, and in this case, the headache is primary. Primary cephalalgia can be based on both vegetative-vascular and metabolic-destructive changes. Primary headache can be noted with emotional or physical overstrain, exposure to a number of light, sound or olfactory stimuli, liquorodynamic or dysmetabolic disorders, when taking certain medications. Conventionally, primary headache can be divided into three groups — tension headache, migraine and cluster headache.

MANAGEMENT OF ASRIGDARA THROUGH VIRECHANA KARMA

Dysfunctional uterine bleeding is a state of Abnormal uterine bleeding (AUB) without any clinically detectable organic, systemic & iatrogenic cause (pelvic pathology like tumor, inflammations excluded). DUB represents a particular type of AUB and is defined as excessive, prolonged and irregular bleeding of endometrium with frequency less than 21 days, duration more than seven days that does not cause pain and does not involve any organic lesion. Based on the clinical features it can be compared with Asrigdara mentioned in Ayurvedic classics. Asrigdara is one of the commonly met problems in Gynae OPD among peri menopausal women. One half of women among the AUB will have DUB. 10 – 15% of women experience episodes of DUB at some time during their reproductive age. This study was conducted in a single patient. A lady of age 41 years, having problem of prolonged bleeding since one and half years came to OPD of Prasuti and Stri roga, National Institute of Ayurveda, Jaipur. She had taken hormonal preparations and haemostatics for five continuous months along with D& C done for same problem, after wards bleeding increased even more and then doctors have given hysterectomy advice as the last resort. Patient was posted for Virechan Karma as classical schedule owing to her Agni and Vyayamshakti. Snehapan was done by plain Go Ghrita and Virechan was done by Trivritalehyam. Followed by few oral medicines after Samsarjana Karma. The patient was followed up for three months. There is significant reduction in amount of blood flow along with increased inter – menstrual period. Thus, we can conclude from the study that Ayurveda regimen plays an effective role in management of Asrigdara.

For casuistic cases of pronounced Cheyne - Stokes respiration in case of diffuse organic lesions of the brain

We had to observe a case of a very pronounced and prolonged Cheyne-Stokes breathing in a patient, representing the manifestation of diffuse organic lesion of the brain with simultaneous organic suffering of the heart and lungs. Since this case, in our opinion, is rare, then we allow ourselves to give a description of it here.

Functional gait disorders

Functional gait disorders are common in clinical practice. They are also usually disabling for affected individuals. The diagnosis is challenging because no single walking pattern is pathognomonic for a functional gait disorder. Establishing a diagnosis is based not primarily on excluding organic gait disorders but instead predominantly on recognizing positive clinical features of functional gait disorders, such as an antalgic, a buckling, or a waddling gait. However, these features can resemble and overlap with organic gait disorders. It is therefore necessary to also look for inconsistency (variations in clinical presentation that cannot be reconciled with an organic lesion) and incongruity (combination of symptoms and signs that is not seen with organic lesions). Yet, these features also have potential pitfalls as inconsistency can occur in patients with dystonic gait or those with freezing of gait. Similarly, patients with dystonia or chorea can present with bizarre gait patterns that may falsely be interpreted as incongruity. A further complicating factor is that functional and organic gait disorders may coexist within the same patient. To improve the diagnostic process, we present a sign-based approach—supported by videos—that incorporates the diverse clinical spectrum of functional gait disorders. We identify 7 groups of supportive gait signs that can signal the presence of functional gait disorders. For each group of signs, we highlight how specific clinical tests can bring out the inconsistencies and incongruencies that further point to a functional gait disorder.

Ulnar Neuropathy—Guyon’s Canal Syndrome

The chapter describes ulnar nerve compression at the wrist secondary to a mass lesion. The clinical picture can mimic pathology of the nerve roots or the brachial plexus or ulnar nerve entrapment at the elbow. Meticulous clinical examination and electrodiagnostic study help to differentiate ulnar nerve compression at the wrist from radiculopathy and to localize the site of compression. Imaging of the wrist is essential, as compression by an organic lesion is common. Conservative management is recommended when organic pathology has been ruled out and there is no motor involvement. Surgery is indicated when conservative treatment fails, there is motor weakness, or a mass lesion has been identified.

The role of individual-typological features in the perception of radiation threat

The object of the study was to determine the role of individual typological features in the perception of the radiation threat. A retrospective and comparative analysis of the psychometric and neurophysiological parameters of participants in the liquidation of the Chernobyl accident (liquidators) was conducted. In the post-accident period the liquidators have a deformation of the personality, which is characterized by the growth of introversion and neuroticism, the sharpening of the character traits of the personality and the increase in the number of accentuations of the emotiveness, pedantry, anxiety, cyclothymia, dysthymia and excitability type. The neurophysiological basis of individual-typological characteristics of personality is defined. Which consists in the growth of the relative and absolute spectral power of the delta band, a decrease in the relative and absolute spectral power of the beta band and a decrease in the dominant frequency. Such changes may indicate an organic lesion of the brain, mainly in the cortico-limbic system. The radiation dose positively correlated with the relative spectral power of the delta and theta band, negatively with the relative and absolute spectral power of the beta band and the dominant frequency. Such features of personality as extraversion, neuroticism, cyclothymia and excitability are positively correlated with the dose of irradiation. At the liquidators, the perception of radiation factors is inadequate: diseases associated with the action of ionizing radiation occupy the fifth rank, the danger from the presence of radiation in the air is rank 8, while the dangerous factors "smoking" and "alcohol use" occupy the last ranked places. The hypertrophied perception of the radiation threat positively correlates with personality traits, such as emotiveness, pedantry, demonstrativeness, anxiety and exaltation.