Biomedical subjects
Publications and source records attributed to B R Chambers.
The diagnosis of functional seizures is difficult and emotional factors may be important in the cause and triggering of seizures. This paper describes the evaluation to fo 15 patients with suspected functional seizures.
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The symptom of vascular neck pain, known as carotidynia, refers to throbbing pain of the neck and face with tenderness of the carotid artery. Recent publications suggest that carotidynia is a benign complaint, frequently associated with migraine, and often responding to migraine therapy. Past experience, and our own, indicates that carotidynia may be a symptom of other more serious disorders whose identification is essential to prevent subsequent catastrophic complications. 7 patients discussed in this publication presented with carotidynia. 4 have been reported previously. The associated disorders were dissecting aneurysm of the internal carotid artery (2 patients), long intraluminal clots with incomplete vessel obstruction of the internal carotid artery (2 patients), spontaneous aneurysm of the common carotid bifurcation (2 patients) and giant cell arteritis. We conclude that carotidynia is a symptom to be regarded with suspicion. The majority of patients encountered will have 'benign' carotidynia and angiography or exploratory surgery should not be routine. A rational approach to evaluation, investigation and treatment is presented.
Acute infarction confined to the territory of the white matter medullary arteries is a poorly characterised acute stroke subtype. 22 patients with infarction confined to this vascular territory on CT and/or MRI were identified from a series of 1,800 consecutive admissions to our stroke unit (1.2%) between August 1993 and March 1997. 19 patients had small infarcts (< 1.5 cm maximum diameter) and 3 large infarcts (> 1.5 cm). Small infarcts were associated with a history of smoking (69%), hypertension (58%), and hyperlipidaemia (37%), and less frequently with atrial fibrillation (21%). Significant (>50%) ipsilateral carotid stenosis (16%) was a less frequent finding in this group. Patients most commonly presented with weakness and/or sensory disturbance affecting mainly the upper limbs, but dysarthria, dysphasia, and ataxia were also seen. Large infarcts were infrequent in our series, but did not differ significantly from small infarcts with respect to clinical presentation or risk factor profiles (p > 0.05 for all comparisons). The majority of symptomatic patients with white matter medullary infarcts are associated with small (< 1.5 cm diameter) lesions and a risk factor profile consistent with small vessel disease. More data are required to elucidate the mechanism of larger (> 1.5 cm) infarcts. Because of the potential overlap between white matter medullary infarcts and internal watershed infarcts, suggested criteria for each are presented.
Asymptomatic cervical bruits with their implication of underlying carotid artery disease, carry an established but low risk of stroke. In spite of the rising numbers of patients subjected to carotid endarterectomy for this condition, there is little evidence that the benefits outweight the risks. Outcome data from community studies and the current prospective Toronto study of patients with asymptomatic neck bruits indicate that the annual stroke rate is 1-2%, and the annual cardiac death rate is 2-4%. Published data of the results of carotid surgery suggest that surgical risks outweigh any possible benefits, unless a subgroup with spontaneous stroke risk of at least 5% can be identified.