Rev Neurol France
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Epidural lipomatosis is a rare disease, most often associated with chronic administration of exogenous steroids. We report the case of a 69-year-old man treated with 20mg prednisolone daily for 11 years because of polyarthritis. ⋯ MRI showed epidural lipomatosis narrowing the epidural spaces from T-3 to T-10. Tapering of steroids was associated with slow but positive resolution of his symptoms.
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The study of pain integration, in vivo, within the human brain has been largely improved by the functional neuro-imaging techniques available for about 10 years. Positron Emission Tomography (PET), complemented by laser evoked potentials (LEP) and functional Magnetic Resonance Imaging (fMRI) can nowadays generate maps of physiological or neuropathic pain-related brain activity. LEP and fMRI complement PET by their better temporal resolution and the possibility of individual subject analyze. ⋯ Drug or stimulation induced analgesia are associated with normalization of basal thalamic abnormalities associated with many chronic pains. The need to investigate the significance of these responses, their neuro-chemical correlates (PET), their time course, the individual strategies by which they have been generated by correlating PET data with LEP and fMRI results, are the challenges that remain to be addressed in the next few years by physicians and researchers. To advance our knowledge of the mechanisms generating both abnormal pain and analgesia (drugs and surgical techniques) in patients is the main motivation of such anexciting challenge.
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Case Reports
[Thoracic myelopathy revealing a chronic ossificans arachnoiditis of the thoraco-lumbar spinal cord].
We report a case of chronic spinal, ossificans, thoraco-lumbar arachnoiditis, associated with an arachnoidal cyst at the level of TH7, and revealed by a rapidly progressive thoracic myelopathy. Two years ago, he had presented with a spinal intrathecal haemorrhage of unknown etiology. ⋯ The finding of several small cysts and angiomas in the liver of this patient lead us to suspect an associated spinal vascular malformation, not detected on the spinal magnetic resonance imaging. A partial neurologic improvement was observed after laminectomy and cysto-peritoneal derivation.
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Prophylactic treatment is mainly intended to reduce the frequency of migraine attacks. It is usually proposed to patients who suffer from two or more attacks per month. It should also be considered in patients who suffer from less frequent, but prolonged, disabling attacks with a poor response to abortive treatment, and who consider that their quality of life is reduced between attacks. ⋯ If the drug is judged ineffective, an overuse of symptomatic medications should be checked, as well as a poor compliance, either of which may be responsible. In case of a successful treatment, it should be continued for 6 or 12 months, and then, one should try to taper off the dose in order to stop the treatment or at least to find the minimum active dose. Relaxation, biofeedback, stress coping therapies, acupuncture are also susceptible to be effective in migraine prophylaxis.
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The normal female life cycle is associated with a number of hormonal milestones: menarche, pregnancy, contraceptive use, menopause, and the use of replacement sex hormones. Menarche marks the onset of menses and cyclic changes in hormone levels. Pregnancy is associated with rising noncyclic levels of sex hormones, and menopause with declining noncyclic levels. ⋯ Migraine may worsen during the first trimester of pregnancy and, although many women become headache-free during the last two trimesters, 25p. 100 have no change in their migraine (Silberstein, 1997). MM typically improves with pregnancy, perhaps due to sustained high estrogen levels (Silberstein, 1997). Hormonal replacement with estrogens can exacerbate migraine and oral contraceptives (OCs) can change its character and frequency