Widening the spectrum of secondary headache: intracranial hypotension following a non-aneurysmal subarachnoid hemorrhage.

BACKGROUND: Intracranial hypotension has been associated with a wide spectrum of neurological conditions including chronic non-aneurysmal and acute aneurysmal subarachnoid hemorrhage. CASE: A 59-year-old man presented with a non-aneurysmal subarachnoid hemorrhage in a perimesencephalic pattern after a mild physical exertion. In the course of the disease, a magnetic resonance imaging of head and spine displayed intracranial hypotension that resolved spontaneously. DISCUSSION: Long-standing intracranial hypotension has been reported as the cause of chronic subarachnoid hemorrhage and a single case of intracranial hypotension as the consequence of intracranial pressure fluctuations after acute aneurysmal subarachnoid hemorrhage has been described. This is the first description of intracranial hypotension caused by acute non-aneurysmal subarachnoid hemorrhage. We hypothesize that blood in the subarachnoid space could have determined a spine cerebrospinal fluid leak through intracranial pressure fluctuations or mechanical action, causing arachnoiditis and possibly a dural tear.

Pelvic floor failure: MR imaging evaluation of anatomic and functional abnormalities.

Pelvic floor failure is a common disorder that can seriously jeopardize a woman's quality of life by causing urinary and fecal incontinence, difficult defecation, and pelvic pain. Multiple congenital and acquired risk factors are associated with pelvic floor failure, including altered collagen metabolism, female sex, vaginal delivery, menopause, and advanced age. A complex variety of fascial and muscular lesions that range from stretching, insertion detachment, denervation atrophy, and combinations of pelvic floor relaxation to pelvic organ prolapse may manifest in a single patient. Thorough preoperative assessment of pelvic floor failure is necessary to reduce the rate of relapse, which is reported to be as high as 30%. Magnetic resonance (MR) imaging of the pelvic floor is a two-step process that includes analysis of anatomic damage on axial fast spin-echo (FSE) T2-weighted images and functional evaluation using sagittal dynamic single-shot T2-weighted sequences during straining and defecation. This article presents high-resolution FSE T2-weighted MR images that permit detailed assessment of anatomic lesions and briefly describes pelvic floor pathophysiology, associated clinical symptoms, and patterns of dysfunction seen with dynamic MR imaging sequences. MR imaging is a powerful tool that enables radiologists to comprehensively evaluate pelvic anatomic and functional abnormalities, thus helping surgeons provide appropriate treatment and avoid repeat operations.

Bruxism elicited by inferior alveolar nerve injury: a case report.

The aim of this case report is to describe the history of a patient who received an injury to the right inferior alveolar nerve after placement of a dental implant, with bruxism noted afterward. The symptoms were managed by the use of an occlusal appliance worn at night and occasionally during the day, associated with increased awareness of parafunction during the day to reduce muscle pain and fatigue. Paresthesia of the teeth, gingiva, and lower lip persisted but were reduced during appliance use.

Temporomandibular joint disk fracture: a case report.

A case of a patient with a fracture of the temporomandibular joint (TMJ) disk is reported. The patient presented with posterior bilateral open-bite and difficulty to chew due to lack of contact between the posterior teeth. Diagnosis of disk fracture of the right TMJ was made based on magnetic resonance imaging (MRI), with posterior displacement of the posterior fragment of the disk, causing the posterior open-bite, and anterior displacement of the anterior fragment of the disk. TMJ manipulation failed to reposition the posterior fragment of the disk, and the patient refused to undergo TMJ arthroscopy to try to remove it. After four months, the posterior open-bite was reduced, probably because of remodeling of the posterior TMJ capsule and extrusion of the molars and premolars. Contact with the patient was lost after that time.

Use of ultrasonography for the diagnosis of temporomandibular joint disorders: a review.

PURPOSE: To evaluate the reliability of ultrasonography in the diagnosis of temporomandibular joint (TMJ) disorders. METHODS: A review of the literature was performed, searching for all articles published between 1966 and 2006, and examining the ones which met the selection criteria. RESULTS: Ultrasonography sensitivity ranged from 13-100% for the evaluation of disc displacement (DD), from 70.6-83.9% for the evaluation of joint effusion (JE), and from 70-94% for the evaluation of condylar erosion (CE). Specificity ranged from 62-100% for the evaluation of DD, from 73.7-100% for the evaluation of JE, and from 20-100% for the evaluation of CE. Accuracy ranged from 51.5-100% for the evaluation of DD, from 72.2-95% for the evaluation of JE, and from 67-94% for the evaluation of CE.

Diagnosis and treatment of atypical odontalgia: a review of the literature and two case reports.

AIM: This report presents two cases diagnosed with atypical odontalgia (AO) and successfully treated with amitriptyline as well as providing a review of the current literature on the subject. RESULTS: The literature indicates the most important issue is an accurate differential diagnosis to distinguish between AO, pulpal pain, myofascial pain, and trigeminal neuralgia. CONCLUSION: Once the correct diagnosis is made the prognosis of AO is usually fair and the administration of tricyclic antidepressants often resolves symptoms. An effort should be made to avoid any unnecessary dental treatment that would only aggravate the problem.

Migraine with aura and dental occlusion: a case report.

Migraine is defined as a primary headache; however, some reports may suggest a relationship with dental occlusion and dental parafunction (clenching or grinding of the teeth). A patient diagnosed with migraine with aura, with concomitant temporomandibular joint and masseter muscle pain, was treated by the use of a dental appliance. The treatment succeeded in eliminating headache and visual aura, and significantly reducing the other symptoms. A headache related to dental occlusion and dental parafunctions seems to be able to mimic a primary migraine headache. Therefore, dental evaluation is always advised for headache diagnosis.