[Autoimmune polyglandular syndrome, type 2 associated with myasthenia gravis].

INTRODUCTION: Autoimmune polyglandular syndrome type 2 is defined as adrenal insufficiency associated with autoimmune primary hypothyroidism and/or with autoimmune type 1 diabetes mellitus, but very rare vith myasthenia gravis. CASE REPORT: We presented a case of an autoimmune polyglandular syndrome, type 2 associated with myasthenia gravis. A 49-year-old female with symptoms of muscle weakness and low serum levels of cortisol and aldosterone was already diagnosed with primary adrenal insufficiency. Primary hypothyroidism was identified with low values of free thyroxine 4 (FT4) and raised values of thyroidstumulating hormone (TSH). The immune system as a cause of hypothyroidism was confirmed by the presence of thyroid antibodies to peroxidase and TSH receptors. Myasthenia gravis was diagnosed on the basis of a typical clinical feature, positive diagnostic tests and an increased titre of antibodies against the acetylcholine receptors. It was not possible to confirm the immune nature of adrenal insufficiency by the presence of antibodies to 21-hydroxylase. The normal morphological finding of the adrenal glands was an indirect confirmation of the condition as well as the absence of other diseases that might have led to adrenal insufficiency and low levels of both serum cortisol and aldosterone. Hormone replacement therapy, anticholinergic therapy and corticosteroid therapy for myasthenia gravis improved the patient's general state of health and muscle weakness. CONCLUSION: This case report indicates a need to examine each patient with an autoimmune disease carefully as this condition may be associated with another autoimmune diseases.

[Contemporary treatment neuropathic pain].

INTRODUCTION: Neuropathic pain, or pain associated with disease or injury to the peripheral or central nervous system, is a common symptom of a heterogeneous group of conditions, including diabetic neuropathy; trigeminal neuralgia, postherpetic neuralgia and spinal cord injury. Chronic neuropathic pain should not be thought of as a symptom. It should truly be thought of as a disease with a very complicated pathophysiology. PATHOPHYSIOLOGY: The mechanisms involved in neuropathic pain are complex and involve both peripheral and central pathophysiologic phenomenon. The underlying dysfunction may involve deafferentation within the peripheral nervous system (e.g. neuropathy), deafferentation within the central nervous system (e.g. post-thalamic stroke) or an imbalance between the two (e.g. phantom limb pain). CLINICAL CHARACTERISTICS: Neuropathic pain is non-nociceptive, in contrast to acute nociceptive pain, and it can be described as "burning", "electric", "tingling", and "shooting" in nature. TREATMENT: Rational polypharmacy is often necessary and actually it is almost always the rule. It would be an exception if a patient was completely satisfied with his treatment. Treatment goals should include understanding that our patients may need to be titrated and managed with more than one agent and one type of treatment. There should be the balance of safety, efficacy, and tolerability. CONCLUSION: There are many new agents and new applications of the existing agents being currently studied which will most certainly lead to even more improved ways of managing this very complicated set of disorders.

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.

[Menstrual migraine].

INTRODUCTION: The prevalence of migraine in childhood and adolescence has not changed to a great extent, but it increases in adolescence, especially in female adolescents. MENSTRUAL MIGRAINE--DEFINITION: There are two types of menstrual migraine: true menstrual migraine and menstrually related migraine. True menstrual migraine occurs predominantly around menstruation, whereas menstrually related migraine occurs during menstruation, but also at other times during the month. CAUSES: Exaggerated or abnormal neurotransmitter responses to normal cyclic changes in the ovarian hormones are probably the basic cause of menstrual migraines. The fall in estrogen levels during menstrual cycle is trigger for the menstrual migraine. SYMPTOMS: Menstrual migraine has the same symptoms as other types of migraine, but the pain is stronger, it lasts longer, and it is more frequent than other types of migraines. DIAGNOSIS: In order to make a diagnosis, women are asked to keep a headache diary for three months. If the migraine headache is severe and occurs regularly between two days before and three days after the start of menstrual bleeding, it is true menstrual migraine. THERAPY: Menstrual migraines are more difficult to treat than other types of migraines. Treatment principles for menstrual migraine are the same as for migraines in general, with certain particularities. CONCLUSION: Hormonally associated migraine is a specific clinical entity. It is important to diagnose the type of migraine, considering the fact that a decline in estrogen level at the end of menstrual cycle triggers migraine, so it can be treated by low levels of estrogen.

[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.