Cranial diagnosis

Strains are non-physiologic dysfunctions and are usually induced by trauma or systemic visceral disease. There are vertical and lateral strains, and a generalized compression strain. Dysfunctions of the facial bones, although relevant to complete cranial diagnosis and treatment, are beyond the scope of this chapter. 

The prevalence of CNS disease at diagnosis of AML ranges from 5% to 30% in various treatment series. Features associated with the risk of CNS leukemia include hyperleukocytosis, monocytic or myelomonocytic leukemia (FAB M4 or M5), and young age. In most cases, intrathecal cytarabine with or without methotrexate and systemic high-dose cytarabine provide adequate CNS prophylaxis.3 Results from studies have shown that patients with CNS disease at diagnosis can be cured with intrathecal therapy alone without the use of cranial irradiation.11... 

Suggested Alternatives for Differential Diagnosis Rabies, hepatoencephalopathy, leukoen-cephalomalacia, protozoal encephalomyelitis, equine herpes virus 1, verminous men-ingoencephalomyelitis, cranial trauma, botulism, and meningitis. In birds Newcastle disease virus, avian encephalomyelitis virus, botulism, and listeriosis. 

The Headache Classification Committee of the International Headache Society (1988) has developed diagnostic criteria for classification of headache disorders, cranial neuralgias, and facial pain the criteria include painful and nonpainful disorders of the entire head and are based on the diagnosis rather than on the underlying pain mechanisms. 

A major type of headache that must be considered in differential diagnosis is that caused by underlying disease intracranial disturbances (e.g., vascular anomalies, infections, tumors, trauma) diseases involving the head and neck but not the brain (e.g., cervical osteoarthritis disorders of eye, ear, nose, sinuses, and throat cranial neuralgias) and systemic diseases (e.g., sudden and severe hypertension, hyperthyroidism). These headaches usually can be relieved by specific therapy for the underlying disorder (e.g., surgical correction of tumors, antibiotics for infections, antiarthritic drugs for osteoarthritis). 

The diagnosis of GBS is primarily clinical. In the AIDP variant the majority of cases have some sensory symptoms or paresthesias at the onset of the disease however, abnormalities on sensory examination are less frequent. Pain, particularly low back, buttock, or thigh pain, is an early symptom in approximately 50% of patients. Subsequently the clinical picture is dominated by weakness often progressing to paralysis. Muscle weakness may begin in the low er limbs and ascend upw ards, characteristically involving both proximal and distal muscles. Respiratory muscles can be involved in up to one-third of the hospitalized patients. Complete or partial loss of reflexes is seen in almost all patients. Cranial nerve involvement is seen... 

A patient presents with a complaint of muscle weakness following exercise. Neurological examination reveals that the muscles supplied by cranial nerves are most affected. You suspect myasthenia gravis. Your diagnosis is confirmed when lab tests indicate antibodies in the patient s blood against... 

A few special considerations apply to the perinatal care of male infants of hemophiha carriers. Intracranial or extracranial hemorrhage has been estimated to occur in 1% to 4% of newborns with hemophUia. Vacuum extraction and forceps delivery increase the risk of cranial bleeding. Elective cesarean section has not prevented intracranial bleeding. There is no clear consensus on the optimal mode of delivery or the use of prophylactic factor replacement in male infants of hemophilia carriers. Circumcision should be postponed until a diagnosis of hemophilia is excluded. Factor levels can be assayed from cord blood samples or from peripheral venipuncture. Arterial puncture should be avoided because of the risk of hematoma formation. Intravenous factor replacement therapy to treat or prevent bleeding is the mainstay of treatment for hemophilia. It is common... 

Because SCLC has the propensity to disseminate early on in the disease, surgery is not usually indicated. SCLC is radiosensitive, and radiotherapy is used in combination with chemotherapy in patients with limited disease. Prophylactic cranial irradiation is used in select patients to reduce the risk of CNS metastases. Combination chemotherapy will prolong the survival of most patients with SCLC. Patients with limited disease are more likely to have a complete response to chemotherapy and longer survival than those who have extensive disease at the time of diagnosis. The most widely used chemotherapy regimens for SCLC include cisplatin or carboplatin plus etoposide. Despite very high response rates to chemotherapy, most patients with SCLC eventually have disease progression and die from this disease. 

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