Zh Nevrol Psikhiatr
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Zh Nevrol Psikhiatr · Jan 2015
Randomized Controlled Trial[Ways to optimize the treatment of patients with discogenic-venous lumbosacral radiculomyeloischemia].
Treatment of patients with neurological manifestations of degenerative-dystrophic lesions of the spine must be integrated and optimized from the perspective of pathogenesis. Antiedematous therapy is an important moment that takes into account the development of localized swelling affected the spinal structures. We studied the efficacy of L-lysine aescinat in the treatment of patients with discogenic-venous lumbosacral radiculomyelopathy. ⋯ The comparison of neurological status dynamics during treatment of inpatients has shown that neurological symptoms reduce more effectively in patients treated with L - lysine aescinat (by 75% during the first 3-5 days) and in a greater number of the patients (77.5% vs 55% in the control group). The authors' experience has shown that venous micro- and macro-circulation disorders play an important role in the pathogenesis of lower lumbar disk hernia. Clinical manifestations of these disorders are segmental and conductive spinal motor disorders in myotomes and sensitivity. Quantitative determination of vibration sensitivity (tuning fork test) is pathognomonic for radiculomyeloischemia. Vein tonics and antiedemics, including L - lysine aescinat as one of the most effective drugs, exert a pathogenetic effect on spondylic and discogenic nervous system disturbances.
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To analyze the results of examination and treatment of patients with poststroke shoulder pain. ⋯ Dysfunction of nervous system plays the main role in this pain syndrome. The efficacy of the drugs in the early/late recovery period was estimated as follows: nonsteroidal anti-inflammatory drugs - 33%/12%, amitriptyline - 24%/42%, gabapentin - 10%/13%, lidocaine - 95%/100%, tizanidine - 29%/33%. Seventy-six percent of patients were free of pain after treatment using a regimen suggested by the authors.
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Migraine is a common disease characterized by severe headache with nausea, vomiting and hypersensitivity to sounds, light, smell. Neurological symptoms during aura period develop in 25% of patients. Genes responsible for migraine development have been identified. ⋯ It was described the syndrome of migraine-like headache occurring due impaired serotonin metabolism in patients with celiac disease. Celiac disease is a chronic polysyndrome disease, enteropathy. Arteriopathies associated with migraine are cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (syndrome CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL), hereditary systemic angiopathy (HSA), mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS).
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Review of literature on the trigeminal autonomic cephalgias are presented. Trigeminal autonomic cephalgias are primary headaches with phenotype consisting of trigeminal pain with autonomic sign including lacrimation, rhinorrhea and miosis. Discussed are issues of classification, pathogenesis, clinical picture, diagnosis, differential diagnosis and treatment of this headache. Special attention is paid to cluster headache, paroxysmal hemicrania, SUNCT syndrome, hemicrania continua.