Assuntos
Neuropatias Diabéticas/epidemiologia , Determinação de Ponto Final , Transtornos de Sensação/epidemiologia , Ensaios Clínicos como Assunto/métodos , Diabetes Mellitus/terapia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/psicologia , Humanos , Transtornos de Sensação/classificação , Transtornos de Sensação/diagnóstico , Transtornos de Sensação/psicologia , Resultado do TratamentoRESUMO
BACKGROUND: Several anticonvulsant agents, including carbamazepine, phenytoin, and valproate, are effective in some patients for the treatment of pain and tremor. This study reports on a trial of the newly introduced anticonvulsant, gabapentin, for pain and tremor control. METHODS: A large case series of patients with centrally mediated pain, peripherally mediated pain, migraine, and tremor were treated in an open-label study with gabapentin (maximum of 2,700 mg/day). RESULTS: Thirty-nine patients (65%) had moderate-to-excellent improvement in symptoms, with the best responses occurring in patients with peripherally mediated neuropathic pain. The other conditions treated that showed some improvement were benign essential/familial tremor, restless legs syndrome, centrally mediated pain, and periodic nighttime leg movements. CONCLUSIONS: Gabapentin offers an effective, safe alternative therapy or co-therapy for the listed painful conditions and tremor; it does not affect the metabolism of other medications and is well tolerated.
Assuntos
Acetatos/uso terapêutico , Aminas , Analgésicos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Ácidos Cicloexanocarboxílicos , Dor/tratamento farmacológico , Tremor/tratamento farmacológico , Ácido gama-Aminobutírico , Acetatos/administração & dosagem , Acetatos/efeitos adversos , Adulto , Idoso , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/efeitos adversos , Aracnoidite/tratamento farmacológico , Neoplasias Cerebelares/tratamento farmacológico , Feminino , Gabapentina , Herpes Zoster/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Estudos Prospectivos , Síndrome das Pernas Inquietas/tratamento farmacológico , Neuralgia do Trigêmeo/tratamento farmacológicoRESUMO
The distinction between true papilledema and pseudopapilledema rests on characteristics of the optic disc when examined ophthalmoscopically. Buried disc drusen frequently simulate papilledema and often result in misdirected diagnostic maneuvers in search of a cause for presumed intracranial hypertension. When an elevated optic disc exhibits an irregular, "lumpy, bumpy" border, a diagnosis of buried drusen of the optic nerve is usually made. We report a case with papilledema secondary to increased intracranial pressure in which the margins of the swollen optic disc presented this lumpy, bumpy border characteristic of buried drusen. The lumpy character of the disc border disappeared with resolution of the papilledema, and ultrasonography demonstrated the absence of any buried drusen. Other characteristics of papilledema, including extension of the disc swelling into the peripapillary nerve fiber layer, telangiectasia of the superficial vessels of the optic disc, and obscuration of the retinal vessels as they crossed the margins of the optic disc, provided strong evidence of true papilledema and remain the most reliable findings allowing a distinction between true papilledema and pseudopapilledema.
Assuntos
Neoplasias Cerebelares/complicações , Ganglioneuroma/complicações , Doenças do Nervo Óptico/diagnóstico , Papiledema/diagnóstico , Adulto , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/cirurgia , Feminino , Ganglioneuroma/diagnóstico , Ganglioneuroma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Doenças do Nervo Óptico/patologia , Papiledema/etiologia , Papiledema/patologiaRESUMO
Lhermitte-Duclos disease is a benign, presumably hamartomatous lesion of the cerebellum which presents clinically as a mass lesion. Pathologically, it consists of thickening of both the molecular and granular cell layers of the cerebral cortex which enlarges the folia but allows for preservation of the gyral pattern of the cerebellar cortex. Preoperative diagnosis with computerized tomography and other studies has not been possible, and even at surgery the diagnosis may be missed because of the preservation of the gyral pattern. The sensitivity of magnetic resonance imaging allows recognition of the cortical nature of the mass lesion, and especially the gyral pattern within the mass lesion, providing a diagnostic image which is unlikely to be confused with any other pathological process in the cerebellum. Preoperative diagnosis of Lhermitte-Duclos disease allows surgeons to plan an appropriate decompressive procedure.
