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Volume 6, No 4 - Fall 2009

Volume 6, No 4 - Fall 2009

Table of Contents

The Use of Optical Coherence Tomography in Neurology Diagnostic Update
Optical coherence tomography (OCT) is a noninvasive imaging technique routinely used in ophthalmology to visualize and quantify the layers of the retina. OCT allows direct visualization and measurement of the topography of the optic nerve head and retinal nerve fiber layer thickness in the peripapillary and macular regions with micron-scale resolution. These measurements are of particular interest in optic neuropathies and in numerous neurologic disorders in which there is axonal loss, such as multiple sclerosis. This article provides a detailed overview of OCT and its potential applications in neurology.[Rev Neurol Dis. 2009;6(4):E105-E120 doi: 10.3909/rind0243]
Management of Daily Headache Unresponsive to Preventive Treatment: Daily Triptans Versus Daily Opioids Management Update
Daily headache affects an estimated 3% to 6% of the general population and affects women 2 to 3 times more frequently than men. The vast majority of daily headache is nonparoxysmal, or chronic daily headache. In the general population, the distribution of chronic tension-type headache and chronic migraine is fairly equal, but in medical practice chronic migraine accounts for the vast majority of nonparoxysmal headache. The first step in the management of chronic daily headache is to identify potential overuse of analgesic and vasoconstrictor medications. Preventive treatment is then initiated with a tricyclic antidepressant, _-blocker, calcium-entry blocker, and/or anticonvulsant.Chronic migraine patients who are refractory to specific headache treatment may take a triptan frequently, if not daily, or a (long-acting) opioid. Both management strategies of refractory daily headache are controversial but appear safe and effective, although daily opioid treatment should be reserved for a relatively small, selected subpopulation. Through a practice survey, we looked at potential differences between daily (long-acting) opioid and daily triptan treatment in 53 patients. We found patient satisfaction with either treatment to be relatively favorable, although there was an implication that triptans outperform opioids in providing headache relief. However, it was also evident that in both treatment groups, despite the relatively positive patient satisfaction results, chronic migraine patients clearly continued to experience a negative impact from their headaches.[Rev Neurol Dis. 2009;6(4):E121-E130 doi: 10.3909/rind0244]
Presentation: Bilateral Vision, Hearing Impairment, and Decreased Level of Consciousness in a Patient Hospitalized for New-Onset Seizure
Middle-aged patients who present with new-onset visual loss, hearing impairment, or decreased level of consciousness usually represent a broad differential diagnosis. We present a 57-year-old man who developed all these symptoms a few days after hospitalization for new-onset seizures.[Rev Neurol Dis. 2009;6(4):E131-E132 doi: 10.3909/rind0232a]
Presentation: Headaches, Rapidly Progressive Visual Loss, and Bilateral Disc Edema
The diagnosis and management of a 28-year-old obese woman who presented with neck pain, headache, and rapidly progressive visual loss is discussed here. Results of her initial general examination were normal. Thorough medical follow-up resulted in a rare diagnosis.[Rev Neurol Dis. 2009;6(4):E133-E134 doi: 10.3909/rind0236]© 2009 MedReviews®, LLC
Chronic Cluster Headache: Preventive Treatment Headache
[Rev Neurol Dis. 2009;6(4):E135-E136 doi: 10.3909/rind0238]© 2009 MedReviews®, LLC
Discussion: Bilateral Vision, Hearing Impairment, and Decreased Level of Consciousness in a Patient Hospitalized for New-Onset Seizure
Middle-aged patients who present with new-onset visual loss, hearing impairment, or decreased level of consciousness usually represent a broad differential diagnosis. We present a 57-year-old man who developed all these symptoms a few days after hospitalization for new-onset seizures.[Rev Neurol Dis. 2009;6(4):E137-E140 doi: 10.3909/rind0232b]© 2009 MedReviews®, LLC
Discussion: Headaches, Rapidly Progressive Visual Loss, and Bilateral Disc Edema
The diagnosis and management of a 28-year-old obese woman who presented with neck pain, headache, and rapidly progressive visual loss is discussed here. Results of her initial general examination were normal. Thorough medical follow-up resulted in a rare diagnosis.[Rev Neurol Dis. 2009;6(4):E141-E145 doi: 10.3909/rind0236b]© 2009 MedReviews®, LLC