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Occipital Nerve Stimulation
Occipital nerve stimulation (ONS), also called peripheral nerve stimulation (PNS) of the occipital nerves, is used to treat chronic migraine patients who have failed to respond to pharmaceutical treatments. The treatment involves the use of mild electrical impulses to stimulate the greater occipital nerve and lesser occipital nerve which are part of the peripheral nervous system and are located at the back of the head just above the neck area. The electrical impulses are generated by a small device called a neurostimulator – similar to an artificial cardiac pacemaker – which is implanted in the buttock, chest, low abdomen, beneath the shoulder blade or below the clavicle. The electricity is delivered to the greater occipital nerve and lesser occipital nerve by small metal electrodes which are arranged on thin leads and implanted just under the skin. The intensity of the electrical impulses can be adjusted using a small remote control device. History The history of PNS is thoro ...
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Migraine
Migraine (, ) is a complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea, and light and sound sensitivity. Other characterizing symptoms may include vomiting, cognitive dysfunction, allodynia, and dizziness. Exacerbation or worsening of headache symptoms during physical activity is another distinguishing feature. Up to one-third of people with migraine experience aura, a premonitory period of sensory disturbance widely accepted to be caused by cortical spreading depression at the onset of a migraine attack. Although primarily considered to be a headache disorder, migraine is highly heterogenous in its clinical presentation and is better thought of as a spectrum disease rather than a distinct clinical entity. Disease burden can range from episodic discrete attacks to chronic disease. Migraine is believed to be caused by a mixture of environmental and genetic factors that influe ...
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Aura (symptom)
An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is actually a minor seizure. Epileptic and migraine auras are due to the involvement of specific areas of the brain, which are those that determine the symptoms of the aura. Therefore, if the visual area is affected, the aura will consist of visual symptoms, while if a sensory one, then sensory symptoms will occur. Epileptic auras are subjective sensory or psychic phenomena due to a focal seizure, i.e. a seizure that originates from that area of the brain responsible for the function which then expresses itself with the symptoms of the aura. It is important because it makes it clear where the alteration causing the seizure is located. An epileptic aura is in most cases followed by other manifestations of a seizure, for example a convulsion, since the epileptic discharge spreads to other parts of the brain. Rarely it remains isolated. Auras, when they occur, allow some people who h ...
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Paresthesia
Paresthesia is a sensation of the skin that may feel like numbness (''hypoesthesia''), tingling, pricking, chilling, or burning. It can be temporary or Chronic condition, chronic and has many possible underlying causes. Paresthesia is usually painless and can occur anywhere on the body, but most commonly in the arms and legs. The most familiar kind of paresthesia is the sensation known as ''pins and needles'' after having a limb "fall asleep" (''obdormition''). A less common kind is formication, the sensation of insects crawling on the skin. Causes Transient Paresthesias of the hands, feet, legs, and arms are common transient symptoms. The briefest electric shock type of paresthesia can be caused by tweaking the ulnar nerve near the elbow; this phenomenon is colloquially known as bumping one's "funny bone". Similar brief shocks can be experienced when any other nerve is tweaked (e.g. a pinched neck nerve may cause a brief shock-like paresthesia toward the scalp). In the older a ...
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Fluoroscopy
Fluoroscopy (), informally referred to as "fluoro", is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a surgeon to see the internal anatomy, structure and physiology, function of a patient, so that the pumping action of the heart or the motion of swallowing, for example, can be watched. This is useful for both medical diagnosis, diagnosis and therapy and occurs in general radiology, interventional radiology, and image-guided surgery. In its simplest form, a fluoroscope consists of an X-ray generator, X-ray source and a fluorescence, fluorescent screen, between which a patient is placed. However, since the 1950s most fluoroscopes have included X-ray image intensifiers and cameras as well, to improve the image's visibility and make it available on a remote display screen. For many decades, fluoroscopy tended to produce live pictures that were not recorded, bu ...
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Tuohy Needle
A Tuohy (/tOO-ee/) needle is a hollow hypodermic needle, very slightly curved at the end, suitable for inserting epidural catheters. Epidural needle Literally, an epidural Epidural administration (from Ancient Greek ἐπί, "upon" + '' dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians ... needle is simply a needle that is placed into the epidural space. To provide continuous epidural analgesia or anesthesia, a small hollow catheter may be threaded through the epidural needle into the epidural space, and left there while the needle is removed. There are multiple types of epidural needles as well as catheters, but in modern practice in developed nations, disposable materials are used to ensure sterility. Epidural needles are designed with a curved tip to help prevent puncture of the dural membrane. But following accidental dural puncture, hea ...
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Local Anesthetic
A local anesthetic (LA) is a medication that causes absence of all sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensation in the entire body and causes unconsciousness. Local anesthetics are most commonly used to eliminate pain during or after surgery. When it is used on specific nerve pathways ( local anesthetic nerve block), paralysis (loss of muscle function) also can be induced. Classification LAs are of 2 types: *Clinical LAs: ** amino amide LAs ** amino ester LAs *Synthetic LAs **Cocaine derivatives Synthetic cocaine-derived LAs differ from cocaine because they have a much lower abuse potential and do not cause hypertension vasoconstriction (with few exceptions). The suffix "-caine" at the ends of these medication names is derived from the word "cocaine", because cocaine was formerly used as a local anesthetic. Examples Short Duration of Act ...
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Seroma
A seroma is a pocket of clear serous fluid (filtered blood plasma). They may sometimes develop in the body after surgery, particularly after breast surgery, abdominal surgery, and reconstructive surgery. They can be diagnosed by physical signs, and with a CT scan. Seromas can be difficult to manage. Serous fluid may leak out naturally, and a persistent leak can cause problems. Fluid can be drained, including by inserting a drain surgically. Seromas can be prevented through careful surgery, and drains can be inserted before they form. Patient posturing and position can reduce risk, as well as breast binding after breast surgery. Etymology Around 16th century CE, the word originated from , meaning "watery" later the meaning changed to "of, secreting, or containing serum". It is directly derived from , meaning "watery fluid, whey". It was joined with a word-forming element from , with -o-, lengthened stem vowel + -ma suffix, especially taken in medical use as "tumor" or " mor ...
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Hematoma
A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is benign and is initially in liquid form spread among the tissues including in sacs between tissues where it may coagulate and solidify before blood is reabsorbed into blood vessels. An ecchymosis is a hematoma of the skin larger than 10 mm. They may occur among and or within many areas such as skin and other organs, connective tissues, bone, joints and muscle. A collection of blood (or even a hemorrhage) may be aggravated by anticoagulant medication (blood thinner). Blood seepage and collection of blood may occur if heparin is given via an intramuscular route; to avoid this, heparin must be given intravenously or subcutaneously. Signs and symptoms Some hematomas are visible under the surface of the skin (commonly called bruise ...
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Infection
An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable disease, is an Disease#Terminology, illness resulting from an infection. Infections can be caused by a wide range of pathogens, most prominently pathogenic bacteria, bacteria and viruses. Hosts can fight infections using their immune systems. Mammalian hosts react to infections with an Innate immune system, innate response, often involving inflammation, followed by an Adaptive immune system, adaptive response. Treatment for infections depends on the type of pathogen involved. Common medications include: * Antibiotics for bacterial infections. * Antivirals for viral infections. * Antifungals for fungal infections. * Antiprotozoals for protozoan infections. * Antihelminthics for infections caused by parasi ...
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Informed Consent
Informed consent is an applied ethics principle that a person must have sufficient information and understanding before making decisions about accepting risk. Pertinent information may include risks and benefits of treatments, alternative treatments, the patient's role in treatment, and their Right to refuse medical treatment, right to refuse treatment. In most systems, healthcare providers have a legal and ethical responsibility to ensure that a patient's consent is informed. This principle applies more broadly than healthcare intervention, for example to conduct research, to disclose a person's medical information, or to participate in high risk sporting and recreational activities. Within the United States, definitions of informed consent vary, and the standard required is generally determined by the state. As of 2016, nearly half of the states adopted a reasonable patient standard, in which the informed consent process is viewed from the patient's perspective. These standards ...
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Migraine Disability Assessment Test
The Migraine Disability Assessment Test (MIDAS) is a test used by doctors to determine how severely migraines affect a patient's life. Patients are asked questions about the frequency and duration of their headaches, as well as how often these headaches limited their ability to participate in activities at work, at school, or at home. The test was evaluated by the professional journal ''Neurology'' in 2001; it was found to be both reliable Reliability, reliable, or unreliable may refer to: Science, technology, and mathematics Computing * Data reliability (other), a property of some disk arrays in computer storage * Reliability (computer networking), a category used to des ... and valid. Questions The MIDAS contains the following questions: # On how many days in the last 3 months did you miss work or school because of your headaches? # How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? (Do no ...
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Phonophobia
Phonophobia, also called ligyrophobia or sonophobia, is a fear of or aversion to loud sounds (for example firecrackers)—a type of specific phobia. It is a very rare phobia which is often the symptom of hyperacusis. Sonophobia can refer to the hypersensitivity of a patient to sound and can be part of the diagnosis of a migraine. Occasionally it is called acousticophobia. The term ''phonophobia'' comes from Greek φωνή - ''phōnē'', "voice" or "sound" and φόβος - ''phobos'', "fear". Ligyrophobics may be fearful of devices that can suddenly emit loud sounds, such as computer speakers or fire alarms. When operating a device such as a home theater system, computer, television, or CD player, they may wish to have the volume turned down all the way before doing anything that would cause the speakers to emit sound, so that once the command to produce sound is given, the user can raise the volume of the speakers to a comfortable listening level. They may avoid parades and car ...
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