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Annals of Indian Academy of Neurology (2)
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Ravishankar, K. (4)
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The art of history-taking in a headache patient
Annals of Indian Academy of Neurology
Headache is a common complaint that makes up for approximately 25% of any neurologists outpatient practice. Yet, it is often underdiagnosed and undertreated. Ninety percent of headaches seen in practice are due to a primary headache disorder where there are no confirmatory tests, and neuroimaging studies, if done, are normal. In this situation, a good headache history allows the physician to recognize a pattern that in turn leads to the correct diagnosis. A comprehensive history needs time, interest, focus and establishment of rapport with the patient. When to ask what question to elicit which information, is an art that is acquired by practice and improves with experience. This review discusses the art of history-taking in headache patients across different settings. The nuances of headache history-taking are discussed in detail, particularly the questions related to the time, severity, location and frequency of the headache syndrome in general and the episode in particular. An emphasis is made on the recognition of red flags that help in the identification of secondary headaches.
Headache; history-taking; migraine
Shear Bond Strength of Composite Veneers and Acrylic Veneer Bonded to Ni–Cr Alloy: A Laboratory Study
The Journal of the Indian Prosthodontic Society
A growing number of composite materials are being used as an alternative for veneering cast restorations. The objective of this investigation was to evaluate and compare the shear bond strength of UDMA based composite, restorative composite, and heat cure acrylic when veneered to Ni–Cr alloy and to evaluate the type of bond failure. Three different veneering materials were used: heat cure acrylic, UDMA based composite and a restorative composite. 10 samples were fabricated, each with heat cure acrylic and restorative composite and 20 samples were fabricated with UDMA based composite; thus, the total number of samples amounted to 40. All the samples were subject to shear bond stress fracture tests and observed for the type of bond failure. The greatest mean shear bond strength was recorded in relation to the UDMA based composite material when thermal conducting paste was used during the curing (10.51 MPa). The mean bond strength values of UDMA based composite without thermal conducting paste (8.92 MPa), heat cured acrylic veneering material (4.24 MPa) and restorative composite material (5.03 MPa) were significantly different from each other (p > 0.05). Samples veneered with heat cure acrylic veneering material and restorative composite material showed adhesive failure. Samples prepared with UDMA based composite veneering composite showed cohesive or predominantly cohesive failure. UDMA based composite veneering material when used with heat protection paste exceeds the shear bond strength requirement as suggested by Matsumura et al. (>10 MPa). A statistically significant association between the test groups and the type of failure was observed.
Veneering composite; Shear bond strength; Bond failure
Guidelines on the diagnosis and the current management of headache and related disorders
Annals of Indian Academy of Neurology
Quality of life in patients with epilepsy in India
Shetty, Pushparaja H
Journal of Neurosciences in Rural Practice
People with epilepsy have impairment in their quality of life (QOL) due to effect of epilepsy on various aspects of their life and the medication effects. Systematic studies on QOL in epilepsy from developing countries are sparse.
To assess the QOL in people with epilepsy and to evaluate various factors affecting the QOL in them.
Materials and Methods:
People with generalized and partial epilepsy on medication aged more than 18 years were included in the study. The QOL was assessed with QOLIE-89 instrument. Statistical significance was evaluated by the use of Chi-square test and one-way analysis of variance (ANOVA).
Sixty people with epilepsy were studied among whom the older patients had lower overall QOL scores compared to younger patients. Female patients had lower scores compared to males. Married people had lower quality of health score. Patients with simple partial seizures had lowest overall QOL mean score. There was reduction in the overall QOLIE scores with increasing duration of the epilepsy. Patients who had their last seizure within 10 months prior to evaluation had lower mean overall scores.
QOL was impaired in people with epilepsy with increased impairment in women, older patients, simple partial seizures, and those with recent seizure.
Epilepsy; marriage; quality of life
Intracranial hypotension secondary to spinal arachnoid cyst rupture presenting with acute severe headache: a case report
Jones, Wendy D
Journal of Medical Case Reports
Headache is a common presenting complaint and has a wide differential diagnosis. Clinicians need to be alert to clues that may suggest an underlying secondary aetiology. We describe a novel case of headache secondary to intracranial hypotension which was precipitated by the rupture of a spinal arachnoid cyst.
A 51-year-old Indian female presented with sudden onset severe headache suggestive of a subarachnoid haemorrage. Investigations including a computed tomography brain scan, cerebrospinal fluid examination and a magnetic resonance angiogram were normal. The headache persisted and magnetic resonance imaging revealed bilateral thin subdural collections, a spinal subarachnoid cyst and a right-sided pleural effusion. This was consistent with a diagnosis of headache secondary to intracranial hypotension resulting from spinal arachnoid cyst rupture.
Spinal arachnoid cyst rupture is a rare cause of spontaneous intracranial hypotension. Spontaneous intracranial hypotension is a common yet under-diagnosed heterogeneous condition. It should feature significantly in the differential diagnosis of patients with new-onset daily persistent headache.
Post radiation chylous ascites: a case report
Shelat, Vishal G
Pandya, Garvi J
We report a 64 years old gentleman with unresectable right-sided retroperitoneal liposarcoma, who underwent radiotherapy & subsequently developed chylous ascites. He failed conservative management of chylous ascites and this was successfully managed with a peritoneovenous shunt. The pathophysiology and management of post radiational chylous ascites is discussed.
The Global Campaign (GC) to Reduce the Burden of Headache Worldwide. The International Team for Specialist Education (ITSE)
Haimanot, R. T.
Lainez, M. J. A.
Rapoport, A. M.
Silberstein, S. D.
Steiner, T. J.
The Journal of Headache and Pain
The social perception of headache, everywhere at low levels in industrialised countries, becomes totally absent in developing ones. Headache disorders came into the World Health Organization’s strategic priorities after publication of the 2001 World Health Report. Among the leading causes of disability, migraine was ranked 19th for adults of both sexes together and 12th for females. The Global Campaign (GC) to Reduce the Burden of Headache Worldwide was planned by the major international headache organizations together with WHO in order to identify and remove those cultural, social and educational barriers recognised as responsible factors for the inadequate treatment of headache disorders worldwide. Within the GC activities, the education of the medical body will represents a central pillar. An International Team for Specialist Education (ITSE) has been created to train physicians from all over the world through the acquisition of a university level Master Degree in Headache Medicine. Once trained as headache specialists, physicians will become trainers, offering education in this field to other health care providers in their own countries. In this way they will give life to a cultural chain raising awareness locally of headache, its burden and its medical control.
Academic formation; Master in Headache Medicine; Global Campaign Against Headache; Headache specialist education
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