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Biomedical subjects

D K Ziegler

Publications and source records attributed to D K Ziegler.

At least 19 recordsLinked to original sources
PubMed1992

Headaches preceded by visual aura among adolescents and young adults. A population-based survey.

Clinical descriptions of migraine preceded by visual aura often include a composite of striking and severe symptoms of several attacks in individual patients, but few studies have characterized the spectrum of such attacks. In a population-based telephone survey of 8920 Washington County, Maryland, residents 12 through 29 years old, the attack rate for visual aura headaches during the week prior to the standardized interview was 3.7% in male and 6.1% in female subjects. Among female subjects, the risk for visual aura headache with tension-type symptoms increased with age, whereas the risk for visual aura headache without tension symptoms decreased with increasing age. No clear age-related patterns were observed among male subjects for either type of aura headache. The severity of visual aura headache with and without tension symptoms increased with age among female subjects, but showed an inconsistent pattern among male subjects except for decreasing disability with increasing age. The median interval between the onset of aura symptoms and the onset of headache (aura interval) was 15 minutes in male subjects and 25 minutes in female subjects, with aura intervals longer than 60 minutes reported by 12% of male subjects and 20% of female subjects. In one of the first large population-based studies to characterize the spectrum of visual aura headache, differing age, gender, and subtype patterns were found.

Adolescent↗
PubMed1992

Familial migraine in a Mexican population.

We investigated the frequency of migraine in first-degree relatives of a group of migraine patients in two Mexican populations, one urban and one rural, and in control groups from the same populations. In the urban population, familial aggregation of migraine was found in 52.7% of patients and in the rural in 38.7%. The differences between controls and subjects were statistically significant in both populations. Our findings support the importance of a hereditary factor in migraine but not an autosomal dominant inheritance pattern.

Adolescent↗
PubMed1992

Osteomyelitis of the skull base.

Three cases of osteomyelitis of the skull base with associated problems in diagnosis and therapy are discussed. Patients with atypical skull base osteomyelitis are difficult to diagnose as they have no ear abnormalities, but they often develop multiple cranial nerve deficits mimicking symptoms of a posterior fossa mass. We conclude that computed tomographic scans, magnetic resonance imaging studies, bone scans indium-labeled white blood cell scans, and gallium scans are useful in making the diagnosis. A biopsy of the bony lesion often is needed to identify the causative organism and to rule out a tumor. Intravenously administered antibiotics are the mainstay of therapy and should be continued until 1 week after the gallium scan shows no abnormalities. Follow-up gallium scans then are done at 1 week and 3 months after the cessation of antibiotic therapy to search for a recurrence.

Adult↗
PubMed1992

Headache and migraine.

That the 'primary' phenomenon in migraine with aura is neuronal ('spreading depression') seems increasingly probable, but the relationship of migraine with and without aura and of both to tension headache remains uncertain. Depression and migraine are related, but other psychological correlates are controversial. Two new therapeutic agents, with action on 5-hydroxytryptamine (5-HT; serotonin) receptors are of promise.

Arousal↗
PubMed1991

Magnetic resonance image abnormality in migraine with aura.

Cerebral magnetic resonance imaging (MRI) was performed on 18 patients with migraine characterized by aura consisting of both visual symptoms and paresthesias. Fifteen headache-free individuals of the same age range were used as controls. Records were randomized and read in blind fashion by two neuroradiologists. Small subcortical white matter lesions were seen in three migraine cases and two controls. In one migraine case cortical infarctions were seen. In two controls, small areas of increased density similar to those in migraine were seen. No consistent correlation of migraine or its duration with cerebral atrophy was found. It is concluded that identification of both these MRI findings (small subcortical white lesions and cerebral atrophy) as significantly associated with migraine is doubtful.

Adult↗
PubMed1991

Prevalence survey of headache in a rural Mexican village.

Prevalence of headache was studied by house-to-house survey of a small remote Mexican village where the population was characterized by a low income and high rate of illiteracy. Severe headache was found in 8.9% of the male population and in 10.6% of the females. Approximately half of these individuals gave a history suggestive of headache with aura, but reinterview by a neurologist revealed that in one third of such histories the visual phenomena were probably not true aurae. Only in the over 35-year age-group was headache more prevalent in females. 'Incapacitating' headache was usually equated with 'severe' headache and was 10 times as frequent in the over 55-year age-group as in younger people. Sophisticated interviewers (neurologists) obtained different results from less trained interviewers.

Adolescent↗
PubMed1991

Access to health care.

Explore the source record for details and available documents.

Health Services Accessibility↗
PubMed1990

Specific headache phenomena: their frequency and coincidence.

The correlation of specific headache attack characteristics derived from a standardized questionnaire was studied in a consecutive series of 392 patients attending a headache clinic. In patients reporting headache with aura such attacks tended to be infrequent, and the percentage of their headache attacks that were preceded by aura varied widely, many cases having very low percentages. Paresthesias as auras were uncommon and rarely occurred without visual aura. Unilateral headaches were associated with nausea to widely varying degrees. Most patients reported both unilateral headache and headache with tension characteristics. Definite history of hypertension was significantly correlated specifically with migraine with aura (classic migraine).

Adult↗
PubMed1990

HIV-related neuromuscular syndrome simulating motor neuron disease.

A young homosexual man presented with slowly progressive weakness and diffuse fasciculations. Muscle biopsy was compatible with clinical diagnosis of motor neuron disease. The patient died from opportunistic infections related to acquired immunodeficiency syndrome. Autopsy revealed evidence of myelopathy, patchy fiber loss from anterior nerve roots, marked demyelination within intramuscular twigs of peripheral nerves, and primary myopathic features superimposed on advanced neurogenic atrophy of the skeletal muscles.

Adult↗
PubMed1990

Headache. Public health problem.

Headache is, and apparently always has been, a frequent pain syndrome. It is reported in American and Western European societies in very high percentages of the population. Headache, and specifically severe headache, have also been reported as prevalent from a variety of societies worldwide, although prevalence rates have varied (they are very low, for example, in the People's Republic of China). Whether prevalence varies with different socioeconomic groups remains uncertain. Severe headache and specifically migraine is, for reasons still unknown, much more common in women, and, in most studies, is reported to decrease in prevalence in older age groups. Positive family histories are common, but the precise role of genetics is unknown. A major problem in the epidemiologic studies remains the difficulty of uniform definition of headache syndromes.

Cross-Cultural Comparison↗
PubMed1989

Clinical and electrophysiological responses to dietary challenge in migraineurs.

Thirty eight patients with a history of diet-induced migraine were studied with recording of clinical responses, electroencephalography in resting state, in response to photic stimulation, and to hyperventilation and visual evoked potentials. Tests were carried out on an initial baseline day and on a second day, after challenge with chocolate, red wine, cheese, and fasting. Lateralized headache occurred in sixteen subjects (42%), four with scintillating scotomata. Electroencephalograms were abnormal on Day 1 and/or Day 2 in twelve subjects (32%), most abnormalities being non-specific slow waves. In three cases there were paroxysmal features. Electroencephalographic response to hyperventilation was calibrated and was found to be exaggerated in eight subjects (21%) on either Day 1 or Day 2; such response was not related to the occurrence of a headache. Photic simulation showed high frequency driving response (so called "H" response) in all 16 individuals who developed headache but in only 14 out of 22 (64%) who did not (p less than 0.01). Pattern reversal visual evoked responses were normal and failed to show any difference in latency or amplitude between headache responders and non-responders.

Adolescent↗
PubMed1988

Patients' perspectives of the role of care providers in amyotrophic lateral sclerosis.

Interviews with 41 patients with amyotrophic lateral sclerosis regarding their perspectives of the roles of doctor, nurse, and allied health personnel showed that emotional support, information, and access to assistive devices were the primary expectations that they held for each of these professional roles. In addition, physicians were expected to evaluate the progress of the disease, help with immediate problems, and continue research to find a cure. Patients wanted to see a physician at each clinic visit. In being given the diagnosis of amyotrophic lateral sclerosis, patients expected the physician to be straightforward, honest but not premature, sensitive to patients' readiness for information, and to convey some degree of hope. Patients were accurate in their knowledge of the disease, but came to the clinic expecting help in managing the illness.

Allied Health Personnel↗
PubMed1979

Circadian rhythms of plasma cortisol in migraine.

Diurnal rhythm of plasma cortisol, of psychological state, and of pain was measured for two days in 25 migraine patients and eight control subjects. Fourteen of the migraine patients and none of the controls displayed either consistently high plasma cortisol or an occasional aberrant peak. Abnormal psychological findings, particularly depression, were found in the Minnesota Multiphasic Personality Inventory only in migraine patients with abnormal plasma cortisol levels. Neither psychological abnormality nor pain seemed the single cause of elevation of plasma cortisol.

Adult↗