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1 year ago

An unusual headache

Una M Graham, specialist trainee year 7, endocrinology and diabetes1, Mark Magorrian, consultant physician2, Paul Burns, consultant neuroradiologist3, John R Lindsay, consultant physician11Department of Diabetes and Endocrinology, Mater Hospital, Belfast BT14 6AB, UK2Department of Stroke and Elderly Care Medicine, Mater Hospital, Belfast, UK3Department of Neuroradiology, Royal Victoria Hospital, Belfast, UKCorrespondence to: U Graham qublbc8athotmail.comA 68 year old woman presented to the emergency department with a 10 day history of gradual onset left temporal headache and scalp tenderness, which had increased in severity over this period. She had a 40 year history of migraine, for which she had been prescribed sumatriptan. She described her presenting headache as different from her usual migraine. She was otherwise well with no recent illness or head injury. On examination she was normotensive and her temperature was also normal. There was no evidence of meningism. Her temporal arteries were pulsatile and non-tender on palpation. She had no neurological deficit and no papilloedema on fundoscopy. Her left temporomandibular joint was tender.

Initial investigations showed normal inflammatory markers and an erythrocyte sedimentation rate (ESR) of 2 mm in the first hour. A computed tomogram of the brain was normal, with no evidence of haemorrhage. Lumbar puncture was performed with an opening pressure of 16.5 cm H2O (reference range 8-21). The results of cerebrospinal fluid analysis were normal. There was no evidence of haemorrhage on spectrophotometrya sensitive method of detecting blood products in the cerebrospinal fluid.

Three days after admission she noted swelling of the tongue and difficulty in eating. She was able to swallow but found it difficult to move her tongue. She had no hoarseness. On examination her speech was dysarthric, and she had swelling over the left side of her tongue, with leftward deviation on tongue protrusion (fig 1). Taste and tongue sensation were normal. Careful examination of palatal movement identified no weakness.

Questions1. What is the differential diagnosis of headache in this patient?

2. What is the neurological deficit described?

3. How would you investigate this patient further?

4. How would you manage this patient?

5. What is the prognosis?

Answers1. What is the differential diagnosis of headache in this patient?Short answerIn this age group unilateral

1 year ago

In defence of the NHS Diabetes Prevention Programme

We read with interest the editorial by Barry and colleagues on their perspectives of the planned NHS Diabetes Prevention Programme (NHS DPP). Whilst we agree on some issues, we feel there are a number of errors regarding their interpretation of the evidence and that the projected relevance to the NHS has been underestimated.

The authors make two incorrect assertions with regards to the prevalence of non-diabetic hyperglycaemia and risk score use.

Firstly, the use of HbA1c to identify non-diabetic hyperglycaemia does not, as stated, identify twice as many people compared to oral glucose tolerance test (OGTT) criteria. The prevalence of impaired fasting glucose and/or impaired gl

2 years ago

7 Health Advantages Of Eating Carrots

Some History About KnittingIn man's quest for better, more practical and much more beautiful textiles, the art of knitting was historically later than weaving. When someone features a habit of imagining things turning out very badly, rational thinking can show suggest to them that they often exaggerate. To make it possible to knit faster, many supports for your needles and other such aids were invented to consider some of the strain off the hands.

As of the late 1970's such methods were still noticed in remote areas of England, Scotland, Ireland or Wales. Although it contains caffeine, which sometimes lead to insomnia (the only negative complication reported), the caffeine content in tea is relatively small. It will seriously cleanse your system and you may lose a lot of water in 7 days.

Certainly it may take time to nurture plants, flowers and vegetables, but the organic taste packs far more nutrients to your health than the shop bought varieties do. It is imperative to help keep a watch on what we eat. The first knitting needles were shaped rather like long crochet hooks, but the technique was that relating to knitting.

The link between genetics and wonder and health can be a powerful one.

2 years ago

What Are The Negative Results Of Black Mold on My Health?

Beauty and health are the 2 sides of exactly the same coin. Health is the metabolic efficiency in most people and sweetness brings joy towards the beholder. Health is the metabolic efficiency in every people and beauty brings joy for the beholder. If you find yourself jumping from diet to diet, quitting before you decide to lose a pound, this can be the diet for you.

It is likewise true that positive thinking can provide an effect on our physical health, and you might be conscious of the placebo effect on those who feel ill. It is imperative to help keep a watch about what we eat. DNA protectionKiwifruit contains several nutrients and phytochemicals that protect the DNA within the human cells from oxygen-related damage.

It is told, that the terrible Madame Defarge in Tale of Two Cities even knitted while she watched the executions at the guillotine. It causes it to be very tasty and much more like a treat then a diet. It makes it very tasty and far more just like a treat then a diet. Other common mold health effects include weaker immune system, sickness, diarrhea and even death in some cases.

Natural black mold killer can be a better option, because they are free from negative effects and also prevent future mold growth efficiently. Your skin also needs some sunlight every day. When green tea was consumed throughout the study, it was discovered that the periodontal pocket depth, attachment loss of gum tissue and bleeding on probing of the gum tissues (three indicators) decreased its potential on having periodontal disease. Reduce the intake of cheese, butter, nuts, sauces etc. It will seriously cleanse your system and you will lose a lot of water in 7 days.

The next of the tips is - learn to decline to fried foods, burgers and other fatty meats. . The best anti-aging skincare goods that can aid one to hydrate your skin have become available at your favorite skincare product store online. It is also vital that you practice oral hygiene and stay in the pollution free environment to keep healthy.

Firstly, find ways to move your body. Therefore, keeping as numerous brain cells intact as is possible is only going to act to assist prevent or delay the onset of this type of condition. It is mandatory being a non smoker to be able to enhance the overall beauty and health of the individual.

Natural black mold killer is really a better option, because they cost nothing from negative effects and also prevent future mold growth efficiently. This is really a beverage that is an easy task to find. Finally, stay positive. This is as it contains actinidin also as calcium oxalate crystals. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before you take any medication, or if you've or suspect you may have a health problem.