Zebras and hoof sounds
“When you hear the sound of hooves, think horses, not zebras.” This phrase is taught to medical students throughout their training. In medicine, the term “zebra” is used in reference to a rare disease or condition.
Saying this all kinds of rare syndromes are taught and emphasized in medical school with scant attention to run of the mill problems .due to the tertiary academic nature of thesemedical teachers
Options for long term prevention in non-responders to tricyclic antidepressants include levetiracepam (Keppra), propranolol, ciproheptadine and Sumatriptan (even nasally), the latter being particularly valuable where migraine headaches remain in the background.2,12,13,14 Treatment goals are to: Prevent episodes, abort episodes, terminate episodes using sedation until cycle passes, limited re-feeding to avoid triggering relapse,1 optimal control of blood glucose to minimize relapses and co-management with psychiatry and psychology if indicated which was needed in this patient since anxiety stress and panic disorders are known risk factors as well as depression
Old drugs ergot preparations
Episodes may cause affected individuals to withdraw from social interaction. The behavior of drinking water to dilute the bile and induce vomiting and hence reduce nausea is common, and should not be confused with a psychogenic cause. More commonly described in adults but also occurring in children, many take continuous prolonged hot shower or baths to alleviate the nausea.
Additional symptoms may occur during an episode including paleness of the skin (pallor), lack of energy (lethargy), fever, and drooling. The emesis is typically bilious (green or yellow). Repetitive vomiting may cause loss of vital fluids (dehydration). Gastrointestinal symptoms such as severe abdominal pain, diarrhea, and retching (gagging) are not uncommon. Affected individuals have a reduced appetite and weight loss may occur. Some individuals may exhibit a variety of migraine-like neurological symptoms including headaches, abnormal sensitivity to light (photophobia), increased sensitivity to sound (phonophobia), and dizziness or vertigo
No comments:
Post a Comment