Bell's Palsy-Retroauricular Pain Threshold.

Background and objectives: Non-motor symptoms in the form of increased sensitivity are often associated with the onset of idiopathic Bell's palsy (IBP). The aims were to determine whether the pain threshold in the retroauricular regions (RAR) in IBP patients and the time of its occurrence is related to IBP severity. Materials and Methods: The study was conducted among 220 respondents (142 IBP patients, 78 healthy subjects (HS)). The degree of IBP was graded using the House-Brackmann and Sunnybrook Grading Scales (II-mild dysfunction, VI-total paralysis), whereas the pain thresholds were measured using the digital pressure algometer. Results: We found no difference in the degree of the pain threshold between the right and left RAR in the HS group. IBP patients belonging to groups II, III, IV, and V had lower pain thresholds in both RARs than HS and IBP patients belonging to group VI. There was no difference in the degree of pain threshold in RAR between the affected and unaffected side in IBP patients. The incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups II and III of IBP patients is noticeably lower and the incidence of retroauricular pain that occurred only after the onset of paralysis is more frequent. Also, we found that the incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups V and VI of IBP patients was more frequent. Conclusions: The degree of pain threshold lowering in RAR (bilaterally) is inversely related to the severity of IBP. We suggest that the occurrence of retroauricular pain before the onset of facial weakness is associated with higher severity of IBP while the occurrence after the onset is associated with lower severity of IBP.

Hemicranial Cough-Induced Headache as a First Symptom of a Carotid-Cavernous Fistula-Case Report.

Background and objectives: Spontaneous carotid-cavernous fistulas (CCFs) are rare, and they may be caused by an aneurysm rupture. Materials and Methods: A case of a man hospitalized for high-intensity hemicranial headache with sudden cough onset as part of an upper respiratory tract infection is presented. The pain was of a pulsating character, localized on the right, behind the eye, followed by nausea and vomiting. Neurological finding registered a wider rima oculi to the right and slight neck rigidity. Laboratory findings detected a mild leukocytosis with neutrophil predominance, while cytobiochemical findings of CSF and a computerized tomography (CT) scan of the endocranium were normal. Results: Magnetic resonance imaging (MRI) angiography indicated the presence of a carotid cavernous fistula with a pseudoaneurysm to the right. Digital subtraction angiography (DSA) was performed to confirm the existence of the fistula. The planned artificial embolization was not performed because a complete occlusion of the fistula occurred during angiographic examination. Patient was discharged without subjective complaints and with normal neurological findings. Conclusions: Hemicranial cough-induced headache may be the first sign of carotid cavernous fistula, which was resolved by a spontaneous thrombosis in preparation for artificial embolization.

Environmental Neurotoxin ß-N-Methylamino-L-alanine (BMAA) as a Widely Occurring Putative Pathogenic Factor in Neurodegenerative Diseases.

In the present review we have discussed the occurrence of ß-N-methylamino-L-alanine (BMAA) and its natural isomers, and the organisms and sample types in which the toxin(s) have been detected. Further, the review discusses general pathogenic mechanisms of neurodegenerative diseases, and how modes of action of BMAA fit in those mechanisms. The biogeography of BMAA occurrence presented here contributes to the planning of epidemiological research based on the geographical distribution of BMAA and human exposure. Analysis of BMAA mechanisms in relation to pathogenic processes of neurodegeneration is used to critically assess the potential significance of the amino acid as well as to identify gaps in our understanding. Taken together, these two approaches provide the basis for the discussion on the potential role of BMAA as a secondary factor in neurodegenerative diseases, the rationale for further research and possible directions the research can take, which are outlined in the conclusions.

Appearance of fetal pain could be associated with maturation of the mesodiencephalic structures.

Fetal pain remains a controversial subject both in terms of recognizing its existence and the time-frame within which it appears. This article investigates the hypothesis that pain perception during development is not related to any determined structures of the central nervous system (CNS), on the contrary, the process of perception could be made with any structure satisfying conditions that the perception of pain is the organization, identification, and interpretation of sensory information in order to represent and understand the environment. According to this definition, chronic decerebrate and decorticate experimental animals, anencephalic, and hydranencephalic patients demonstrate that the basic, most general, appropriate interaction with the environment can be achieved with a functional mesodiencephalon (brain stem, and diencephalon) as the hierarchically highest structure of the CNS during development. In intact fetuses, this structure shows signs of sufficient maturation starting from the 15th week of gestation. Bearing in mind the dominant role of the reticular formation of the brain stem, which is marked by a wide divergence of afferent information, a sense of pain transmitted through it is diffuse and can dominate the overall perception of the fetus. The threshold for tactile stimuli is lower at earlier stages of gestation. The pain inhibition mechanisms are not sufficiently developed during intrauterine development, which is another factor that leads to increased intensity of pain in the fetus. As a conclusion it could be proposed that the fetus is exposed to rudimentary painful stimuli starting from the 15th gestation week and that it is extremely sensitive to painful stimuli.

Significance of adequate postural control in the appearance of habitual upright bipedal locomotion.

Analysis of qualitative indicators of stability of the body during different types of locomotion in primates suggests that bipedal locomotion is not variation of some other type of locomotion. Transition from quadrupedal to bipedal locomotion is accompanied by a qualitative difference in body stability. Because of assuming an upright bipedal posture, the center of mass is lifted, the surface of the base of support is reduced, and the body structure does not provide passive stability in relation to inertial moments of the body around Y-axis. Additional head movements, trunk rotations, forelimb manipulations with objects and surveying the surroundings are necessary for survival, but they increase the degree of freedom of movement and further complicate the task of maintaining balance in the case of a postural change from erect quadrupedal to erect bipedal. This article presents a hypothesis that the transition from quadrupedal to habitual upright bipedal locomotion was caused by qualitative changes in the nervous system that allowed controlling the more demanding type of locomotion. The ability to control a more demanding posture increases possibilities of interactions between the organism and the complex environment and consequently increases the survival rate, breeding possibilities, and chances for occupying a new environmental niche. Existing data show that ability to execute the more demanding type of locomotion was made possible because of changes in the frontal lobe and pyramidal system. Only after the more demanding posture was enabled by changes in the nervous system, could advantages of bipedal over quadrupedal locomotion be utilized, including better scanning of the environment, carrying food and infants, simultaneous upper extremity movements and observation of the environment, limitless manipulation of objects with upper extremities above the individual, and less space for rotating around the Z-axis. The aforementioned advantages of habitual bipedal over quadrupedal locomotion are present in physically complex environments, such as the forest, which is associated with the appearance of habitual bipedal locomotion.

Quality of life research in patients suffering from tension type headache.

The tension type headache is the most common headache type, which many men and women suffer from in one period of their life and aggravates business productivity, family and social functioning. Quality of life estimation in patients suffering from tension type headache enables us to get a better insight into the impact of the disease on the patient. The comparison among the quality of life in the patients suffering from tension type headache and the quality of life in the control group subjects has been carried out in a research by applying the QVM questionnaire. The obtained results have shown a significant difference in the quality of life and its sub domains indicating worse quality in the patients suffering from tension type headache.

The impact of headache severity on quality of life of patients with migraine.

Migraine is a chronic disease characterized by episodic headache attacks, most often on one side of the head with pulsating, moderate to severe pain. We conducted an assessment of headache severity by using the MIGSEV questionnaire, and the quality of life assessment by using the QVM questionnaire, on a sample of 30 patients suffering from migraine. Afterwards, the research results were compared. The research results indicate that the majority of patients suffer from severe and moderate headaches. The quality of life is poorer in patients suffering from severe headaches.

[Multiple brain abscesses: a case report]. / Prikaz slucaja multiplih apscesa mozga.

CASE REPORT: 10 days before admission a 45-year old female experienced general weakness, and T 38 degrees C. During that period she had no cardio-respiratory nor neurological complaints, and the temperature varied between 37.5 degrees C and 38 degrees C. Her medical history was unremarkable, without immunodeficiency. The day before admission she presented with left arm paresis and during the next day it progressed to paralysis. She had no headache. On admission the following diagnostic procedures were performed: the cranial CT scan showed two lesions (possibly meta lesions). Chest X-ray was normal. WBC=15x10(9)/L, ESR=90/120. On the second day following admission brain MRI showed multiple abscesses in both hemispheres, mostly in the gray/white junction. High doses of IV metronidasol, cephtriaxon and cipfloxacin were administered without obtaining specimens for micro-biological diagnosis. In next two days she developed coma, respiratory insufficiency and septic temperature. Brain surgery was not performed due to severe involvement of the brain with multiple abscesses. Repeated chest X-ray revealed bilateral pneumonia. A lethal outcome occurred on the third day, regardless of all efforts. Autopsy showed multiple brain abscesses as well as on the lungs and liver. A beta-hemolytic streptococcal infection was established. CONCLUSIONS: Prevention includes treatment of the infection source. The classic triad of headache, fever and focal deficit occur in less than 50% of patients. Even in such cases brain abscess must be reconsidered CT appearance of brain abscess is similar to that of neoplastic and other infectious and non infectious diseases--especially in the stage of early cerebritis. If the CT findings are not clear, MRI should be performed.