Neurological diseases







ALGONEURODYSTROPHY

ALGONEURODYSTROPHY

Frequent illness, most often favored by a triggering factor (trauma, intervention). Algoneurodystrophy manifests itself in its early phase by pain in one or more articular regions, of variable intensity, permanent or occurring during the mobilization of the joint or its loading, leading to significant functional impotence : patient "protects" his joint.

The affected area is red, hot, swollen, its appearance is inflammatory. The radiography at this stage is often normal or shows an aspect of decalcification: the merit of this examination is to eliminate another pathology. Bone scintigraphy reveals hyperfixation of the affected joint : this confirms the diagnosis. The biological assessment does not reveal any inflammatory biological syndrome.

At this stage, calcitonin or beta blockers are often effective.

The evolution of this acute phase is extremely variable. It sometimes leads, despite a well conducted treatment, to a "cold" phase characterized by reduced pain and the appearance of trophic disorders leading to a limitation of joint mobility as well as skin retraction and therefore significant functional impotence.

However, algoneurodystrophy still heals after an unpredictable period of time, from a few weeks to several months. This disease, still poorly explained, sometimes recurs.

Copyright photo :  Patientenvereniging CRPS — Travail personnel, CC BY-SA 3.0,

ALZHEIMER

An elderly subject who has memory problems, unexplained forgetfulness, gets lost in known places, is wrong about the dates, reasons slowly and wrongly, cannot find his words, can not get dressed , must be brought by his family to consult his doctor.

Other times, it is insomnia with nocturnal agitation, aggressiveness, gluttony, aberrant sexual or urinary behaviors that reveal the disease. Troubledness, indifference, apathy or paradoxical euphoria, or even a real delirium, can be the first signs.

The specialist detects early dementia by tests that highlight the deterioration. It eliminates what is not dementia, especially stroke and mental confusion. He is looking for a possibly curable cause, which is rare: chronic intoxication, intercranial hematoma called subdural, hydrocephalus, metabolic disorder, tumors, syphilis. He has a blood study, an electroencephalogram, a fundus, or even a scanner. Otherwise, the evolution is slow and inexorable towards dementia disintegration: childishness, indifference, movement disorders, food or excremental spoiling. The lunatic must be protected medically and legally.

Alzheimer's disease, often revealed by memory impairment; sometimes early onset (45 years), it is complicated, in 2 to 3 years, of neurological manifestations: aphasia, apraxia and sometimes epilepsy.

Copyright photo : National Institute on Aging, Progress Report on Alzheimer's Disease 2004-2005,public domain

Bibliography : Clinical Diagnosis and Management of Alzheimer's Disease de Serge Gauthier 

APHASIA

A person, most often elderly, suddenly presents language difficulties; she can no longer find the words to express herself, tulse one for another, and, if she manages to decline her name, her age, or to express herself through acquired formulas, she cannot however construct a complete sentence. When asked to name objects, she finds the first but is mistaken for the following or gives only the meaning, for a clock for example she declares that it is to read the time.

When the disorder is significant, the patient can only say one or two words to express himself or expresses himself in incomprehensible jargon. In this case, it is probably aphasia.

Aphasia is always due to a lesion of the dominant cerebral hemisphere, that is to say left in the right-handed and vice versa for the left-handed. Neurological examination can also detect paralysis on the right side of the body.

The electroencephalogram, the scanner, and sometimes the arteriography will look for the causes of which the most frequent is a cerebrovascular accident, in which case it settles suddenly. More rarely, aphasia is due to a brain tumor, and its installation is progressive.

The treatment of aphasia calls for often prolonged speech therapy and treatment of the cause.

Copyrith photo : Par Bertyhell CC BY-SA 3.0,

Bibliography : A Cognitive Neuropsychological Approach to Assessment and Intervention in Aphasia: A clinician's guide by Anne Whitworth , Janet Webster 

VASCULAR FACE ALGIA

You are under the age of 50 and suffer from pulsating pain (beating like a pulse). This lasts from half an hour to a few hours, gradually increasing, affecting the eye, temple, teeth, the maxilla on one side of the face only, and is accompanied by vasomotor disorders, tearing, feeling of nasal blockage or discharge from the nose on the pain side, sometimes redness of the hemiface. It is probably a cluster headache.

The diagnosis is established on the basis of the characteristics of the pain and its evolution over a period of a few weeks or months with daily attacks occurring almost always at the same time. But, there are factors that trigger seizures. Free intervals of a few months to a few years separate the painful periods and recurrences almost always occur on the same side of the face.

Additional examinations will provide little diagnostic information : cranial radiographs will seek to check if there is no other local cause for these pains : sinusitis, dental or maxillary pain.

We treat facial cluster headache like a migraine, but this therapy is often less effective in the case of cluster headache. Other therapies, such as external electrical stimulation or electro-acupuncture, associated with psychological care in a pain treatment center, sometimes have good results.

In the case of a cluster headache that is resistant to any treatment, a phenolization of the sphenopalatine ganglion is carried out.

Copyright photo :  CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=24584012

Bilbiography : Céphalées : du "mal de tête" aigu et chronique : Le point des connaissances médicales de Dr Shanan Khairi

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