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Biomedical subjects

A Stolt-Nielsen

Publications and source records attributed to A Stolt-Nielsen.

15 recordsLinked to original sources
PubMed1999

Cervicogenic headache: long-term postoperative follow-up.

The patient, a 50-year old female had been suffering from right-sided head- and neck pain since she was 31 years of age. It started in connection with an indirect neck trauma. Analgesics were of little or no avail and operative procedures, including liberation of the greater occipital nerve (GON) (n = 2) and decompression of the C2 ganglion/root, had only a transitory effect. At 42, a magnetic resonance scan of the cervical spine demonstrated a degenerated disk C5-C6, with encroachment on the foramina and the cord. At 42 years of age, a stabilization operation at C5-C6 (Robinson-Smith) alleviated her discomfort--only some motor complaints in the ipsilateral upper extremity remaining and only in the first 12-18 months.

Cervical Vertebrae↗
PubMed1999

Supraorbital neuralgia. On the clinical manifestations and a possible therapeutic approach.

The clinical manifestations of supraorbital neuralgia are apparently only incompletely known. The lack of awareness of this head pain may possibly be due to its rarity and problems with making the diagnosis. In the present work, the long-term result of minor, decompressive surgery of the supraorbital nerve in five patients is reported. The immediate improvement was good and, after a mean observation time of more than 6 years, an improvement of 50% to 100% was observed (mean, circa 85%). In the two patients with the longest postoperative observation time, approximately 8 years, pain has not recurred. The pain was severe, leading to suicidal thoughts in several patients. The long-term course was intermittent or continuous. The pain was generally unilateral, but was bilateral in one patient. Generally, there was lack of, or only minor benefit from drug treatment, including carbamazepine and indomethacin. There was clearly tenderness over the supraorbital nerve, especially at its outlet, and in some subjects occasionally, a slight local loss of sensation. Definite trigger zones were not present. Supraorbital nerve blockade generally provided instant and considerable pain relief. The persistence of protracted unilateral forehead/ocular pain, tenderness over the nerve, and repeated blockade effect strongly suggests the diagnosis.

Adult↗
PubMed1995

Headache due to an extra joint between head and neck.

A girl, born in 1973, started having headache in preschool age. After a head trauma in 1985, there was a clear worsening of the headache, and the headache became chronic at around 14 years, making regular school attendance impossible. The headache was "symptom poor," bilateral-occipital, but with a clear left-sided preponderance and occasionally spreading to the forehead. The headache was always worst in the morning hours, easing up by noontime. Neck rotation to the right could provoke long-lasting exacerbations. Neck movement was restricted on rotation to the left. A sore bony structure was discovered on palpation just underneath the mastoid process of the left side. This proved to correspond to a bony "bridge" with an extra joint between the first vertebra on the left side and the skull, medially to the mastoid process that could be demonstrated on x-ray tomography and CT scanning. This bony bridge was removed surgically more than 2 years ago, and the pain disappeared on the day of operation and has not recurred in the intervening time. Such bony bridges have in the past been considered to be innocuous and not symptom producing. Although this may be the general rule, the present case tends to show that even to this rule, there are exceptions.

Adolescent↗
PubMed1995

CPH and hemicrania continua: requirements of high indomethacin dosages--an ominous sign?

Two female patients, one with chronic paroxysmal hemicrania and one with hemicrania continua, had a continuously high requirement of indomethacin, ie, > or = 225 mg per day, for 4 and 7 years, respectively. In the hemicrania continua patient, a right (symptomatic side) C7 root affection due to disc herniation was demonstrated. Removal of the disc relieved the arm pain completely, and reduced the head pain and indomethacin requirement considerably initially. The other patient suffered from the unremitting form of chronic paroxysmal hemicrania with right-sided attacks from the age of 16. Indomethacin, 200 to 250 mg per day generally kept the headache at bay, but during exacerbations, especially during menstrual periods, the dosage transitorily had to be increased to 250 to 350 mg per day. A CT scan with contrast at aged 18 (1987) was negative. In 1992, she started having new symptoms, including numbness on the ipsilateral side of the face and arm and difficulty swallowing. An MR scan showed a meningioma originating in the roof of the cavernous sinus on the symptomatic side. The meningioma was surgically removed. The postoperative indomethacin requirement was reduced, but only transiently. Patients with chronic paroxysmal hemicrania (CPH) and hemicrania continua (HC) with a continuously high indomethacin requirement may have grave additional disorders and should consequently be followed closely.

Adolescent↗
PubMed1992

Neurolysis of the greater occipital nerve in cervicogenic headache. A follow up study.

Entrapment of the greater occipital nerve (GON) in its peripheral course has been thought to be of possible pathogenic significance in cervicogenic headache. We have performed a "liberation" operation ("neurolysis") of the nerve in the nuchal musculature, with special attention to the trapezius insertion, and the follow-up results in 50 patients are presented. The immediate effect of the operation was quite good, but the pain gradually recurred in the majority (46/50) of the patients. Eventually, all operated patients will probably have recurrence of pain episodes. Nevertheless, most patients claim that the overall disability is less after the operation, and 40% actually want to undergo a new, identical procedure. The justification for doing a second "liberation" operation is clearly less than for a first operation. In our opinion, this operation should not be performed in patients with cervicogenic headache in general. The present study shows that other therapeutic approaches should be searched for in cervicogenic headache.

Adult↗
PubMed1992

Hemorrhage in a highly vascularized subependymoma of the septum pellucidum: case report.

A 63-year-old man was admitted to our hospital because of loss of memory, disorientation, nausea, and urinary incontinence. Cerebral computed tomographic and magnetic resonance imaging scans revealed a tumor with intratumoral hemorrhage affecting the corpus callosum and the septum pellucidum. A partial resection of the tumor was performed, but the patient died the next day from an episode of bleeding. Postmortem examination revealed a highly vascularized subependymoma with acute bleeding in the tumor and in the surrounding brain parenchyma. The importance of considering a highly vascularized subependymoma is noted when a tumor related to the ventricular system is diagnosed.

Brain Neoplasms↗
PubMed1991

Topographic variations in the peripheral course of the greater occipital nerve. Autopsy study with clinical correlations.

The description of the peripheral course of the greater occipital nerve (GON) varies in the literature. An autopsy study was done on 20 cases without known headache problems. These findings showed a marked variation in the relation between the GON and nuchal muscles. The trapezius muscle was penetrated by the GON in 45% of cases, the semispinal muscle of the head was penetrated in 90% of cases, and the inferior oblique muscle of head was penetrated in 7.5% of cases. Macroscopic findings of possible compression were made in 11 cases (27.5%), indicating that nerve compression per se may be of minor importance since it seems to exist in the absence of headache.

Aged↗
PubMed1991

Vascular complications of lumbar disc surgery. Case report.

Four patients were successfully treated for vascular complications associated with lumbar disc surgery, one as an emergency case and three from 1 to 3 months postoperatively. Acute complications are often identified by severe bleeding. Knowledge of the anatomy is essential for appropriate surgical repair, which may consist of patch-graft angioplasty or graft interposition. Treatment of late complications (usually arteriovenous fistula or false aneurysm) is often impeded by adhesions. Fistula repair is performed from inside the artery. Precautions against vascular complications during lumbar disc surgery are discussed.

Acute Disease↗
PubMed1990

[Microsurgery in lumbar nucleus prolapse].

The article describes the cases of 83 patients with lumbar herniated discs operated by means of microsurgical technique since August 1987. In 69 patients the result was good and they had no symptoms. Ten patients had improved, but were not free of symptoms. Four patients had not improved. The time spent in hospital postoperatively varied from one to ten days, with a mean of five days. The mean period off work after operation was two months and three days. The method is an alternative to standard discectomy in patients with lateral herniated discs.

Adolescent↗
PubMed1986

Electrical stimulation in multiple sclerosis. Comparison of transcutaneous electrical stimulation and epidural spinal cord stimulation.

Forty-nine multiple sclerosis patients with bladder symptoms and/or walking disability were subjected to a therapeutic trial with electrical spinal cord stimulation and transcutaneous electrical stimulation, a second aim being to compare these two treatments. A clear subjective improvement in bladder symptoms was achieved in the majority of the cases, and this was substantiated by objective parameters. In a proportion of cases a more moderate improvement seems to have been achieved in a variety of symptoms. Transcutaneous electrical stimulation seems to be a useful selection procedure for later electrical spinal cord stimulation.

Adult↗
PubMedDate not supplied

Coexistence of cervicogenic headache and migraine without aura (?).

It is well known that migraine with aura may coexist with various unilateral headaches, like cluster headache and chronic paroxysmal hemicrania. It may also coexist with cervicogenic headache. The diagnosis of migraine without aura ("common migraine") poses greater problems than the diagnosis of migraine with aura. Cervicogenic headache diagnosis also poses problems when these two headaches coexist, since they have symptoms in common. Therefore, the scientific demonstration of coexistence of migraine without aura and cervicogenic headache is bound to be a difficult task. In the present study, migraine without aura and cervicogenic headache seemed to coexist in 4 patients (3 F and 1 M, mean age 50). Attacks with migraine characteristics fulfilled the IHS and IASP migraine criteria. Out of a maximum of 13 migraine characteristics based on the IHS/IASP migraine criteria, such as unilaterality, aggravation on minor physical activity, etc., none of the patients presented less than 11, as opposed to a mean of < or = 4 of these criteria in the cervicogenic type attacks. A similar system, based on criteria such as: reduction of range of motion in the neck, mechanical precipitation of attacks, etc., was also developed for cervicogenic headache. The mean number of cervicogenic headache criteria was 4.3 (out of a total of 5) in the "cervicogenic part of the picture", as opposed to 1.5 (1.8 if laterality is considered, see text) in the "migraine part of the picture". Drug regimens and anaesthetic blocks also showed different results in the two different headaches in the same patient. All in all, this study seems to support a coexistence of the two headache types.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Cervicogenic headache. Long-term results of radiofrequency treatment of the planum nuchale.

Seven female patients, all fulfilling the current criteria for cervicogenic headache, underwent radiofrequency treatment of the periosteum of the external surface of the occipital bone ("planum nuchale") on the symptomatic side, as described by Blume. The patients were followed up for approximately 4.5 years postoperatively. In three patients, the operation was considered completely successful (43%), whereas it was completely unsuccessful in two patients. In the two remaining patients, a considerable improvement (60-70%) was obtained. Thus, in 71% of the patients, an improvement of varying degree was obtained. In one of the patients who did not improve, a local effusion developed in the wake of the procedure. In the future, this procedure will probably be one of the therapeutic options for cervicogenic headache. These results provide further evidence establishing cervicogenic headache as a disorder, distinguishable from common migraine ("migraine without aura").

Adult↗