Biomedical subjects

P Kruszewski

Publications and source records attributed to P Kruszewski.

At least 19 recordsLinked to original sources

PubMed1997

Trigeminal neuralgia. Clinical manifestations of first division involvement.

A series of 19 patients with what originally had been diagnosed as a first division (V1) trigeminal neuralgia was collected. The inclusion criteria were severe, rather short-lasting pain attacks within the V1 area, combined with trigger mechanisms. There were 10 women and 9 men, and the mean age of onset was 57.8 years. Fifteen of 16 with adequate information on attack duration had paroxysms of a "few seconds" duration or less, whereas 10 patients had paroxysms lasting < or = 2 seconds. In an exceptional case, only "more long-lasting" attacks (greater than 30 seconds' duration) were experienced. In regard to autonomic phenomena, lacrimation was most frequently present (in a total of 8 patients; 3 rather regularly, 5 more irregularly). The combination of lacrimation, conjunctival injection, and rhinorrhea was present in only 2 (of 19), and in neither of them in a major way. Typically, autonomic phenomena occurred during the later stages of disease and during particularly severe and long-lasting attacks. Seven of 14 with adequate information also had nocturnal attacks. Initially, a more or less complete carbamazepine effect was reported by 10 of 13 patients. Precipitation mechanisms were the same as with second and third division tic, but were mainly located within the V1 area, particularly initially. A comparison with SUNCT syndrome has been made. SUNCT is a predominantly male disorder, with only exceptional attacks of < or = 10 seconds' duration, and generally with attacks of 15 seconds or longer. Autonomic symptoms and signs are more pronounced than in V1 tic. Carbamazepine generally provides minor, if any, benefit in SUNCT. The present work strongly indicates that the two disorders are essentially different.

Adult↗

PubMed1997

SUNCT syndrome. Diagnosis morbi. Shortlasting Unilateral Neuralgiform headache attacks, with Conjunctival injection, Tearing and rhinorrhoea.

The present communication represents an updating of the clinical features of SUNCT. The characteristics of SUNCT have been weighed against other orbital/periorbital headache syndromes towards which differential diagnosis is mandatory. In this group, there are various headaches: cluster headache syndrome, first branch trigeminal neuralgia, and idiopathic stabbing headache (jabs and jolts syndrome). SUNCT emerges as a fairly clear-cut, clinical syndrome. A set of diagnostic criteria of SUNCT syndrome is also given.

Adult↗

PubMed1996

Reproducibility of the cold pressor test: studies in normal subjects.

The reproducibility of the cold pressor test was studied in healthy subjects. A non-invasive method was utilized for estimating beat-to-beat arterial blood pressure (BP) and heart rate (HR). The study population of 17 healthy volunteers consisted of two groups. In the first group (Group 1, n = 11), a 1-min test was performed three times during the same day. In the second group (Group 2, n = 6), a 2-min test was repeated at the same time of the day on three consecutive days. In both groups, the test response was defined as the 46- to 60-s mean, minus the prestimulus 15 s baseline mean. In Group 1, a fair test-retest reliability was observed for the systolic BP response (intraclass correlation coefficient R = 0.57). Large intraindividual HR and diastolic BP variabilities were found. The intraindividual testretest difference in Group 1 ranged from -8 to 11 beats/min (SD = 4.3, R = 0.49) for the HR, from -16 to 13 mmHg (SD = 6.3) for systolic BP, and form -21 to 20 mmHg (SD = 9.7, R = 0.23) for diastolic BP. Even larger variability was observed when the test was repeated on different days (Group 2). Thus, the maxim that the response pattern to the cold pressor test is fairly constant for each individual may not be true. It does not seem to be advisable to use the results from one solitary cold pressor test. The use of replicated measurements and large sample sizes in comparative studies to compensate for the low to moderate reliability of the cold pressor test is recommended.

Adolescent↗

PubMed1996

SUNCT syndrome: duration, frequency, and temporal distribution of attacks.

Duration, frequency, and temporal distribution of attacks have been objectively estimated in 11 SUNCT patients (3 women and 8 men). The mean age at the time of the study was 69 years (range 52 to 81). The duration of a total of 348 attacks was measured from videotape records, polygraphic tracings, or by stopwatch. The duration of attacks ranged from 5 to 250 seconds, with an unweighted mean of 61 seconds. Both frequency and exact timing of attacks were assessed in four patients who filled in a time chart with the exact onset of 585 consecutive attacks. The majority of attacks occurred during daytime, with a bimodal distribution; ie, morning and afternoon/evening peaks, and only a few attacks were noted at night (ie, 1.2% of the attacks). The unweighted mean frequency of attacks was 28 per day (range 6 to 77). Duration and timing of attacks in SUNCT syndrome may be of help in the differential diagnosis versus other disorders with the same localization, especially first division trigeminal neuralgia.

Aged↗

PubMed1995

SUNCT syndrome: trials of drugs and anesthetic blockades.

Nine patients with the SUNCT syndrome (Spanish and Norwegian patients) have, over many years, been given several drugs effective in the cluster headache syndrome, trigeminal neuralgia, and other headaches, as well as drugs not previously used in headache. Various cranial nerves were also anesthetized in an endeavor to ameliorate the suffering of those patients. Although a partial effect was obtained with carbamazepine and corticosteroids in some patients, none of the drugs or anesthetic blockades had consistent, lasting, complete effect on headache paroxysms in SUNCT. The essentially negative outcome of this study aids in further characterizing SUNCT as a separate disorder, and, above all, in distinguishing it from trigeminal neuralgia and the cluster headache syndrome.

Cluster Headache↗

PubMed1995

Respiratory studies in SUNCT syndrome.

Seven SUNCT patients (six men, one woman) took part in this study. In four patients, respiratory variables were compared during and outside attacks. In five patients, peripheral chemosensitivity was tested and compared with a control group matched with respect to age, sex, and smoking habits. The results indicate that SUNCT patients hyperventilate during attacks. Moreover, they appear to hyperventilate slightly under basal conditions. The tests for peripheral chemoreceptor activity indicated no differences between the SUNCT and the control groups except for one variable, namely the mean ventilatory response to a single breath of 13% CO2. It is possible that this indicates a blunted response of the peripheral chemoreceptors. On the other hand, it may also represent a chance finding, since none of the other results presented suggested such a conclusion, and the size of the test group was very small. The results do not indicate that a reduction in oxygen saturation can trigger SUNCT since low levels of oxygen saturation were only rarely accompanied by SUNCT, whereas many attacks were not associated with any appreciable lowering in arterial oxygen saturation.

Aged↗

PubMed1995

Cluster headache: cardiovascular responses to head-up tilt.

Head-up tilt tests were performed in six cluster headache patients in a bout of attacks, but in a pain-free interval at the time of investigation; and in eleven controls matched for age, basal blood pressure, and heart rate. A Doppler servomethod was used for a noninvasive, beat-to-beat blood pressure determination. There were no significant differences between the cluster headache and control groups for heart rate and systolic blood pressure response to the head-up tilt. However, the average diastolic blood pressure seemed to drop more after the tilt in the cluster headache group than in the control group; in particular, in the later part of the test. This might suggest a dysfunction of the baroreflex in cluster headache patients in a bout, also outside of attacks, and most probably of the sympathetically-mediated vasomotor response.

Adult↗

PubMed1994

Cluster headache: the peripheral chemosensitivity as indicated by the single-breath CO2 test.

A single-breath CO2 test was carried out in cluster headache patients both during bout and remission, and in matched healthy individuals (n = 10 for each group) to assess peripheral chemosensitivity. The test subjects inhaled one tidal breath of 13% CO2 in air. The response was expressed as the maximal increase in inspiratory minute ventilation (Vi) within 20 seconds from the exposure to CO2, divided by the increase in end-tidal PCO2 (PETCO2) (the difference in PCO2 between the test breath and the preceding control breaths): delta Vi/delta PETCO2. Under the initial resting condition, cluster headache patients within the bout showed a slight hyperventilation in that there was a significantly reduced PETCO2 (P < 0.05, Student's paired t-test), and during remission, higher Vi, and a lower PETCO2 (P < 0.05, Wilcoxon signed rank test), in comparison with the controls. There was no statistically significant difference as regards the peripheral chemosensitivity between cluster headache and control groups. These results indicate that cluster headache patients have an intact and properly-functioning carotid body.

Administration, Inhalation↗

PubMed1993

SUNCT syndrome: forehead sweating pattern.

The forehead sweating function has been assessed in SUNCT syndrome--a short-lasting, unilateral, neuralgiform headache syndrome with autonomic phenomena on the symptomatic side (conjunctival injection, lacrimation, etc.). In the three patients (of a total of six) who could be studied during paroxysms, increased evaporation was present on the symptomatic side of the forehead compared to the non-symptomatic side during attacks or to the symptomatic side between attacks. Basal sweating was generally within control limits, so long as the attack frequency was not so high as to influence the interictal level. During attacks precipitated by eating chocolate or sour apple (in the case of one of the patients), forehead sweating was also increased on the symptomatic side. The forehead sweating responses to heating and pilocarpine were without any notable or systematic asymmetries. The forehead sweating pattern in SUNCT syndrome may differ from the patterns in unilateral headaches like cluster headache, on the one hand (in which there is generally an asymmetry during heating and pilocarpine tests), and chronic paroxysmal hemicrania (CPH) and cervicogenic headache, on the other (where there is no systematic increase during attacks.

Aged↗

PubMed1993

Respiratory sinus arrhythmia in cluster headache syndrome.

Respiratory sinus arrhythmia is regarded as indicative of cardiac vagal integrity. A ratio of the longest R-R interval to the shortest R-R interval during deep breathing test (E:I ratio) was calculated in controls (n = 49), cluster headache (n = 33) and CPH (n = 4) patients. E:I ratio decreased with age but was not dependent upon sex or upon smoking habits. Furthermore, there were no significant differences as regards E:I ratio between cluster headache patients in and outside a bout, or between patients with right-sided and left-sided headaches. However, the E:I ratio was found to be significantly lower in the cluster headache group as such, when compared with controls, but the number of patients disclosing pathological or borderline results was small, 2 and 2, respectively. This may indicate that a putative vagal dysfunction in cluster headache is usually less marked than in patients with e.g. diabetic autonomic neuropathy. Significant attack-related changes in the E:I ratio were detected in all individual patients though these changes were not of a uniform nature from individual to individual. E:I ratios were rather high in 3 out of 4 CPH patients examined. However, the number of patients in this group is too small to allow definite statements about the difference between CPH and cluster headache with regard to E:I ratios. There was no significant difference between E:I ratios outside and during a mild, short, mechanically precipitated attack in a single CPH patient.

Adult↗

PubMed1993

Cluster headache: the ventilatory response to transient hypoxia with pure nitrogen.

To determine whether the carotid body plays a pathogenetic role in cluster headache, 20 cluster headache patients have been studied. Of these, 11 patients were in the interparoxysmal cluster phase, and 9 were in remission. Comparison was made with healthy subjects matched for sex, age, and smoking habits. Transient hypoxia was induced by inhalation of 1-8 breaths of 100% nitrogen (N2), until the arterial oxygen saturation (SaO2) decreased to around 80%. Changes in ventilation (tidal volume, inspiratory minute ventilation (VI), and end-tidal PCO2 (PETCO2)), were analyzed breath-by-breath. Under basal conditions, cluster headache patients had a slightly higher SaO2 and VI when compared to controls. PETCO2 was significantly lower (P < 0.05) during the cluster period as measured by Wilcoxon signed rank test for paired data, and during remission, according to the Student's paired t-test, in comparison with controls. After exposure to N2, no significant difference was found in the rate of reduction of SaO2 between any of the groups. A higher absolute increase in VI, but a relative (%) decrease in VI at moderate hypoxia were measured, the differences between patients and controls being on the border of the level of significance. Chemoreceptor sensitivity of the carotid body, expressed as the slope of a regression curve obtained by plotting the increase in VI against the reduction in SaO2, showed no statistical difference between the groups. The results do not support the hypothesis of a pathogenetic role for the carotid body in cluster headache.

Administration, Inhalation↗

PubMed1992

Cluster headache: alterations in heart rate, blood pressure and orthostatic responses during spontaneous attacks.

Changes in heart rate and blood pressure (BP) have been monitored beat-to-beat in a cluster headache patient with and without attacks using a non-invasive Doppler servo method. Two attacks were monitored and during one of them a tilt test was carried out. The variability of heart rate and BP was greater during the attack than during the interparoxysmal period. A marked bradycardia occurred during attacks. Systolic BP increased slightly. There was no heart rate increase after tilting during the attack, whereas this was present invariably during tests carried out interparoxysmally. BP changes during "attack tilt" were difficult to evaluate because of large variation. This may be the first observation of a baroreflex arc dysfunction during a cluster headache attack.

Blood Pressure↗

PubMed1992

Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome): V. Orbital phlebography.

We studied six patients with SUNCT, a unilateral headache syndrome with shortlasting attacks and ipsilateral autonomic phenomena with orbital phlebography and MRI. All but one orbital phlebogram showed abnormalities on the headache side (in one patient bilaterally), involving the superior ophthalmic vein or/and the cavernous sinus. No systematic changes were demonstrated on MRI. The phlebography findings were similar to those observed in the Tolosa-Hunt syndrome and in cluster headache.

Aged↗

PubMed1992

Short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome): IV. Respiratory sinus arrhythmia during and outside paroxysms.

SUNCT is a headache syndrome characterized by short-lasting (usually 15-120 sec), unilateral head pain paroxysms localized in the peri-ocular area, accompanied by conjunctival injection, lacrimation, nasal stuffiness, rhinorrhea, and subclinical forehead sweating, all on the symptomatic side. A relative bradycardia seems to be an integral part of the paroxysm; a parasympathetic stimulation could theoretically be the causative factor for the bradycardia. In 3 SUNCT patients, vagal nerve function (E:I ratio) has been monitored outside and during pain paroxysms, while 3 other patients could be studied in the attack-free period only. E:I ratio is obtainable in the course of a maximally deep breath and represents the ratio of the longest R-R interval during a 5 sec long expiration to the shortest R-R interval during a 5 sec long expiration. The mean E:I ratio of SUNCT patients outside paroxysms was significantly higher than the mean E:I ratio in an aged-matched control group. The E:I ratio was, however, significantly decreased during paroxysms in comparison with ratios obtained outside the pain paroxysms. After 0.6 mg atropine administration s.c. to one of the patients in the symptomatic phase, the heart rate increased, and the relative bradycardia during headache paroxysm was diminished (but not completely abolished). The E:I ratio was lowered but it was still slightly larger outside than during attacks. The reason for the abrupt and seemingly clear attack-related decrement in E:I ratio together with the previously described relative bradycardia remains enigmatic, however the possibility of increased parasympathetic tone cannot be excluded.

Aged↗

PubMed1992

SUNCT syndrome: VII. Ocular and related variables.

SUNCT is a unilateral headache syndrome with shortlasting attacks, accompanied by e.g. conjunctival injection and lacrimation on the painful side. Intraocular pressure (IOP), corneal indentation pulse (CIP) amplitudes, episcleral venous pressure, and corneal, tympanic, and facial temperature have been studied in 6 SUNCT patients. IOP and CIP amplitudes increased on the painful side during headache paroxysms, while episcleral venous pressure remained unchanged. Corneal temperature seemed to increase during attack on both sides. However, the number of observations during attacks is scanty. Outside of attacks, the corneal temperature on the symptomatic side seemed to be higher when compared with the non-symptomatic side (generally > or = 0.5 degrees C), provided that the attack frequency was high. The facial temperature seemed to be even on both sides or slightly higher on the symptomatic than on the non-symptomatic side in the periocular area. This pattern seems to be different from the one in trigeminal neuralgia, in which the temperature has been reported to be lowest on the painful side of the face. During attacks, there seemed to be a tendency for the temperature to increase in the periocular area, but not over the mandible or in the neck. The results obtained could be caused by increased blood supply to the eye (and the surrounding skin) on the symptomatic side because of vasodilatation during repeated pain attacks. As far as the ocular changes are concerned, probably the arteriolar side of the vascular bed is involved.

Aged↗

PubMed1991

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, etc. (SUNCT): III. Another Norwegian case.

"SUNCT" is a recently reported head pain syndrome characterized by shortlasting, unilateral neuralgiform paroxysms with conjunctival injection and tearing, and to a lesser extent nasal secretion, and (subclinical) sweating. Another case--that of a 56 year old male--is reported herein. The attacks lasted 1/2-1 min. and occurred only infrequently, i.e. once or twice in 1-4 weeks, except for a week recently when there were up to 20 or more typical attacks per day, with the usual ipsilateral, autonomic accompaniments. Due to the benign nature and low frequency of attacks, the diagnosis would have been most difficult to establish prior to the occurrence of this shortlasting period with more marked symptoms. A variety of precipitation mechanisms were present, partly concerning the V 2-3 areas, partly concerning the neck. Precipitation mechanisms in "SUNCT" to some extent seem to differ from those in trigeminal neuralgia. It is remarkable that all four hitherto reported cases are males.

Conjunctiva↗

PubMed1991

Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection, tearing, and subclinical forehead sweating ("Sunct" syndrome): II. Changes in heart rate and arterial blood pressure during pain paroxysms.

The recently described "Sunct" syndrome is a rare picture of unilateral, shortlasting headache attacks accompanied by autonomic phenomena (conjunctival injection, tearing, etc.) on the symptomatic side. Heart rate and blood pressure were monitored in two elderly "Sunct" patients during and outside headache attacks. An ultrasound Doppler servo method was used for the non-invasive, continuous, beat-to-beat determination of instantaneous arterial blood pressure. In a third patient, systolic and diastolic blood pressure, both outside and during pain paroxysms, were assessed using the standard Korotkoff method. Heart rate was found to be significantly decreased during pain paroxysms. Systolic blood pressure was observed to be significantly increased during attacks, when compared with the inter-attack period, while a less consistent pattern was observed for diastolic blood pressure. Some of the changes in the cardiovascular system seemed to start prior to pain onset. Therefore, it seems unlikely that these changes were caused by pain activation of the sympathetic nervous system or the oculocardiac reflex.

Aged↗

PubMedDate not supplied

Trigeminal neuralgia and "SUNCT" syndrome: similarities and differences in the clinical pictures. An overview.

SUNCT is a recently described unilateral headache with frequently occurring, shortlasting pain attacks in the ocular area accompanied by ipsilateral conjunctival injection, lacrimation, and (subclinical) forehead sweating. In some patients, attacks may be triggered by cutaneous stimuli. In this communication, SUNCT patients (n = 5) are compared with the considerable clinical series of trigeminal neuralgia in the literature (e.g. Harris, 1940, 1433 cases). In several respects (unilaterality, triggering, brevity and frequency of paroxysms), SUNCT shows similarity to trigeminal neuralgia. SUNCT seems to differ clearly from trigeminal neuralgia in other respects: sex distribution (SUNCT patients are often males), pain localization (SUNCT patients have the pain in the ocular area), the carbamazepine effect, presence of conjunctival injection, lacrimation, etc. SUNCT may accordingly altogether seem to be distinct from trigeminal neuralgia.

Carbamazepine↗