Prodromal

Assess the patient complaint to yield a detailed description of headache precipitating factors presence or absence of prodromal symptoms location, intensity, and duration of pain changes in sensory acuity and neurologic alterations. 

C. Duration Continuous signs of disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet criterion A (i.e., active-phase symptoms), and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of disturbance may be manifested by only negative symptoms, or by two or more symptoms listed in category A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). 

Cenital herpes simplex virus. Characterized by vesicular or ulcerative lesions. Diagnosis confirmed by virologic or serologic testing. Prodrome manifests as pain, burning, or itching at the site where lesions will develop. 

Herpes simplex virus may be transmitted to the neonate if active vaginal lesions or the prodrome is present at the time of birth. Consequently, cesarean section often is recommended for these women. Vaginal delivery is indicated if vaginal lesions or the prodrome are not present. 

The clinical presentation of malaria can be quite variable. Normally, the appearance of a prodrome with headache, abdominal pain, fatigue, fever, and chills, which coincides... 

Prodrome Headache, anorexia, malaise, fatigue, and myalgia... 

The desired outcome is to curtail the number of episodic prodromes and to minimize any side effects experienced due to the antivirals. 

For patients with myelodysplastic syndrome or AML as a secondary neoplasm, there are a number of key features characteristic of the leukemia. Alkylator-related secondary leukemias after Hodgkin s disease usually have a myelodysplastic prodrome and a monosomy 5 or monosomy 7. Secondary ANLL with the use of epipodophyllotoxin (etoposide) demonstrates mainly M4 or M5 morphology and exhibits translocations within the MLL gene with 1 lq23 chromosomal alterations.8... 

Prodrome Early symptom(s) indicating the onset of an attack or a disease. 

Nonspecific prodromal symptoms that develop insidiously over weeks to months may include fatigue, weakness, low-grade fever, loss of appetite, and joint pain. Stiffness and myalgias may precede development of synovitis. 

The most common clinical signs of bronchiolitis are found in Table 43-4. A prodrome suggesting an upper respiratory tract infection, usually lasting from 2 to 8 days, precedes the onset of clinical symptoms. 

Prodrome with irritability, restlessness, and mild fever Cough and coryza... 

Requires initiation of therapy within 24 hours of lesion onset or during the prodrome that precedes some outbreaks. Valacyclovir 500 mg appears less effective than valacyclovir 1,000 mg in patients with approximately 10 recurrences per year. 

In closed-angle glaucoma, patients typically experience intermittent prodromal symptoms (e.g., blurred or hazy vision with halos around lights and occasionally, headache). Acute episodes produce symptoms associated with a cloudy, edematous cornea ocular pain nausea, vomiting, and abdominal pain and diaphoresis. 

Anthrax. A nonspecific prodrome (i.e., fever, dyspnea, cough, and chest discomfort) follows inhalation of infectious spores. Approximately 2-4 days after initial symptoms, sometimes after a brief period of improvement, respiratory failure and hemodynamic collapse ensue. Inhalational anthrax also might include thoracic edema and a widened mediastinum on chest radiograph. Gram-positive bacilli can grow on blood culture, usually 2-3 days after onset of illness. Cutaneous anthrax follows deposition of the organism onto the skin, occurring particularly on exposed areas of the hands, arms, or face. An area of local... 

Smallpox (variola). The acute clinical symptoms of smallpox resemble other acute viral illnesses, such as influenza, beginning with a 2-4 day nonspecific prodrome of fever and myalgias before rash onset. Several clinical features can help clinicians differentiate varicella (chickenpox) from smallpox. The rash of varicella is most prominent on the trunk and develops in successive groups of lesions over several days, resulting in lesions in various stages of development and resolution. In comparison, the vesicular/pustular rash of smallpox is typically most prominent on the face and extremities, and lesions develop at the same time. 

Ibrahim MZ, Briscoe PB, Bayliss OB, et al. 1963. The relationship between enzyme activity and neuroglia in the prodromal and demyelinating stages of cyanide encephalopathy in the rat. J Neurol Neurosurg Psychiatry 26 479-486. 

Leading up to the first break, most individuals with schizophrenia go through a prodromal phase of illness. This prodrome is a departure from the patient s usual behavior, but patients seldom seek treatment during this phase. The prodromal symptoms are usually limited to negative symptoms of apathy or social isolation or to lesser variants of the positive symptoms taking the form of eccentric beliefs or a... 

When approaching the treatment of schizophrenia, it is best to view the illness in one of four distinct phases prodromal phase, acute phase, maintenance phase, and residual phase. Let us take a look at the treatment options at each of these phases of the illness. 

In cases where there is a strong family history of schizophrenia and the symptoms are particularly ominous, many clinicians will recommend antipsychotic treatment during the prodromal phase. Low doses of an atypical antipsychotic (other than clozapine) probably offer the best promise of a treatment response with a minimal risk of problematic side effects. 

Some researchers have investigated the notion of intermittent treatment. Patients are intensively monitored off medication, and a medication is started once prodromal signs of an impending acnte exacerbation are detected. One thought is that this minimizes the risk of side effects snch as tardive dyskinesia. Althongh in theory this may sound attractive, nnfortnnately, it rarely is successful in practice. Patients receiving intermittent treatment are at exceptionally high risk for relapse. 

Kablinger AS, Freeman AM. Prodromal schizophrenia and atypical antipsychotic treatment. J Nerv Ment Dis 2000 188(10) 642-652. 

Intermittent therapy 200 mg every 4 hours 5 times daily for 5 days. Initiate therapy at the earliest sign or symptom (prodrome) of recurrence. 

Apply penciclovir every 2 hours while awake for 4 days. Start treatment as early as possible (eg, during the prodrome or when lesions appear). 

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