What are the main types of Myelodysplastic Syndrome. How is MDS diagnosed and what are the risk factors. What treatment options are available for patients with MDS. How does MDS affect blood cell production and what are the common symptoms.

What is Myelodysplastic Syndrome (MDS)?

Myelodysplastic Syndrome (MDS) is a group of disorders that affect blood cell production in the bone marrow. It is characterized by the production of abnormal and immature blood cells, which can lead to various health complications. MDS can range from mild to severe and may progress to acute myeloid leukemia (AML) in some cases.

How does MDS affect blood cell production?

MDS primarily impacts the bone marrow’s ability to produce healthy blood cells. The three main types of blood cells affected are:

• Red blood cells: Responsible for carrying oxygen to tissues
• White blood cells: Essential for fighting infections
• Platelets: Help prevent bleeding and form blood clots

In MDS, the bone marrow produces abnormal or immature versions of these cells, leading to various symptoms and health issues.

What are the main types of Myelodysplastic Syndrome?

There are five primary categories of MDS, each with varying levels of severity and prognosis:

1. Refractory anemia
2. Refractory anemia with ringed sideroblasts
3. Refractory anemia with excess blasts
4. Refractory anemia in transformation to acute leukemia
5. Chronic myelomonocytic leukemia

The severity of MDS increases as you move down this list, with refractory anemia being the mildest form and chronic myelomonocytic leukemia being the most serious.

How do these MDS types differ?

The main differences between these MDS types lie in the specific blood cells affected and the presence of immature cells (blasts) in the bone marrow:

• Refractory anemia and refractory anemia with ringed sideroblasts primarily affect red blood cells
• Refractory anemia with excess blasts involves an abnormally high number of immature white blood cells (5-20% bone marrow blasts)
• Refractory anemia with excess blasts in transformation occurs when blast levels exceed 20%, indicating a potential progression to acute leukemia

What are the common symptoms of Myelodysplastic Syndrome?

MDS symptoms can be subtle in the early stages and may develop gradually over time. The most common symptoms include:

• Fatigue and weakness
• Shortness of breath
• Pale skin
• Easy bruising or bleeding
• Frequent infections
• Fever
• Unexplained weight loss

How do low blood cell counts contribute to MDS symptoms?

The symptoms of MDS are directly related to the deficiencies in various blood cell types:

• Low red blood cell count (anemia): Causes fatigue, weakness, shortness of breath, and pale skin
• Low platelet count (thrombocytopenia): Leads to easy bruising, bleeding, and unexplained bruising
• Low white blood cell count (neutropenia): Results in frequent infections and fever

What are the risk factors and causes of Myelodysplastic Syndrome?

While the exact cause of MDS is often unknown, several risk factors have been identified:

• Age: MDS is more common in people over 60
• Previous cancer treatment: Chemotherapy or radiation therapy can increase the risk
• Exposure to certain chemicals: Benzene, pesticides, and heavy metals may contribute to MDS development
• Genetic disorders: Some inherited conditions can increase the risk of MDS
• Smoking: Tobacco use has been linked to an increased risk of MDS

Can MDS be prevented?

While it’s not always possible to prevent MDS, some steps can be taken to reduce risk:

• Avoid exposure to harmful chemicals and toxins
• Quit smoking or avoid starting
• Maintain a healthy lifestyle with regular exercise and a balanced diet
• Follow safety guidelines when working with potentially harmful substances

How is Myelodysplastic Syndrome diagnosed?

Diagnosing MDS can be challenging, as symptoms are often subtle or absent in the early stages. The following tests are commonly used to diagnose MDS:

1. Complete blood count (CBC): Measures the levels of red blood cells, white blood cells, and platelets
2. Peripheral blood smear: Examines the appearance of blood cells under a microscope
3. Bone marrow aspiration and biopsy: Collects a sample of bone marrow for analysis
4. Cytogenetic analysis: Examines chromosomes in bone marrow cells for abnormalities
5. Flow cytometry: Analyzes the types and percentages of blood cells
6. Molecular testing: Looks for specific genetic mutations associated with MDS

What is the importance of early diagnosis in MDS?

Early diagnosis of MDS is crucial for several reasons:

• It allows for prompt initiation of appropriate treatment
• Early intervention may slow disease progression
• It helps in managing symptoms and improving quality of life
• Regular monitoring can detect any progression to more severe forms of MDS or AML

What treatment options are available for patients with Myelodysplastic Syndrome?

Treatment for MDS depends on the specific type, severity, and individual patient factors. The main goals of treatment are to manage symptoms, improve blood cell counts, and prevent progression to AML. Common treatment options include:

1. Supportive care: Blood transfusions, growth factors, and antibiotics
2. Chemotherapy: Low-dose or high-dose regimens to destroy abnormal cells
3. Immunosuppressive therapy: Drugs to suppress the immune system and improve blood cell production
4. Hypomethylating agents: Medications that help bone marrow produce normal blood cells
5. Stem cell transplantation: A potential cure for some patients, involving the replacement of diseased bone marrow with healthy stem cells
6. Clinical trials: Access to new and experimental treatments

How do doctors determine the best treatment plan for MDS patients?

Selecting the most appropriate treatment for MDS involves considering several factors:

• The specific type and severity of MDS
• The patient’s age and overall health
• The presence of other medical conditions
• The patient’s preferences and goals
• The potential risks and benefits of each treatment option

What is the prognosis for patients with Myelodysplastic Syndrome?

The prognosis for MDS varies widely depending on the specific type and individual factors. Some patients may live for many years with minimal symptoms, while others may experience rapid progression to AML. Factors that influence prognosis include:

• The specific MDS subtype
• The presence of certain genetic mutations
• The percentage of blast cells in the bone marrow
• The patient’s age and overall health
• Response to treatment

Can MDS be cured?

While there is no definitive cure for most cases of MDS, some treatment options can lead to long-term remission or significant improvement in symptoms:

• Stem cell transplantation offers the potential for a cure in some younger, healthier patients
• Newer targeted therapies and immunotherapies show promise in improving outcomes
• Many patients can achieve stable disease and good quality of life with appropriate treatment and management

How can patients cope with the challenges of living with Myelodysplastic Syndrome?

Living with MDS can be challenging, but there are several strategies to help patients cope:

1. Stay informed about the condition and treatment options
2. Maintain open communication with healthcare providers
3. Join support groups or connect with other MDS patients
4. Practice stress-reduction techniques like meditation or yoga
5. Maintain a healthy lifestyle with proper nutrition and exercise
6. Seek emotional support from family, friends, or a mental health professional
7. Consider palliative care to manage symptoms and improve quality of life

What resources are available for MDS patients and their families?

Numerous resources exist to support MDS patients and their loved ones:

• The Myelodysplastic Syndromes Foundation: Offers education, support, and research updates
• The Leukemia & Lymphoma Society: Provides information, support services, and financial assistance
• Be The Match: Offers information on stem cell transplantation and donor registry
• Cancer Support Community: Provides emotional support, education, and resources for cancer patients
• Clinical trial databases: Help patients find and participate in research studies

By understanding Myelodysplastic Syndrome, its symptoms, and available treatments, patients and their families can better navigate the challenges of living with this condition. Regular communication with healthcare providers, participation in support networks, and staying informed about the latest developments in MDS research can all contribute to improved outcomes and quality of life for those affected by this complex group of disorders.

Myelodysplastic Syndrome | Cedars-Sinai

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Overview

Myelodysplastic syndromes affect blood cell production and behavior. Blood carries oxygen, chemicals and hormones to the cells in the body and helps remove toxins and waste. Bone marrow (the spongy middle part of the large bones) produces the three main types of blood cells.

• Red blood cells carry oxygen to the tissues (muscles, bones, nerves and organs). Low red blood counts or malfunctioning red blood cells can cause anemia. Symptoms are paleness, feeling tired, fast-beating or pounding heart, dizziness, shortness of breath or headaches.
• White blood cells fight infection. Symptoms of infection caused by low white blood counts may include temperature rising to 38.0 C or 100.4 F, coughing, stiff neck, pain or burning with urination, sore throat, mouth or lip sores and sores that do not heal.
• Platelets help to prevent bleeding. Signs of inadequate platelets include bleeding or bruising too easily. Patients may experience bleeding of the gums when brushing their teeth, blood in the urine or stool, severe headache or visual changes or a stiff neck.

The five categories of MDS are:

• Refractory anemia
• Refractory anemia with ringed sideroblasts
• Refractory anemia with excess blasts
• Refractory anemia in transformation to acute leukemia
• Chronic myelomonocytic leukemia

The disease categories on the lower end of this list are more serious and have a worse prognosis than those at the top. Refractory anemia and refractory anemia with ringed sideroblasts primarily affect the red blood cells and are the most common forms of MDS. Refractory anemia with excess blasts is present when immature white blood cells are found in the bone marrow in abnormally large numbers (five to 20 percent bone marrow blasts, compared to normal blasts of less than one percent). Refractory anemia with excess blasts in transformation occurs when blasts become markedly increased (more than 20 percent) and may indicate that MDS will change to an acute form of leukemia.

Symptoms

When symptoms of Myelodysplastic Syndrome appear, they are usually subtle. MDS may remain stable for several years, or it may get worse quickly and progress to acute myeloid leukemia.

The most common symptoms are:

• Signs of anemia, such as weakness, tiredness, headaches, heart palpitations and dizziness
• Low platelet counts cause easy and profuse bleeding, as well as unexplained bruising
• Women may experience heavy menstrual periods
• Susceptibility to infection due to low number of white blood cells

Causes and Risk Factors

MDS may begin without any apparent cause.

Possible risk factors include:

• Exposure to certain chemicals, such as pesticides
• Exposure to chemotherapy or non-chemotherapy drugs and radiation
• Age may also be a factor since MDS is most commonly diagnosed in people 60 and older

Diagnosis

MDS is difficult to diagnose because of the absence of symptoms in the early stage of the disease. Often it is accidentally discovered during a routine physical exam or blood test. Routine screening tests do not exist for MDS, but if the disease is suspected, the doctor may order these tests:

• Complete blood count. A small amount of blood is drawn from the arm, and the lab measures red blood cells, white blood cells and platelets in the sample.
• Bone marrow biopsy
• An examination of the chromosomes that carry genetic material

Treatment

MDS is a progressive disease. As bone marrow becomes more affected, blood cells become more abnormal. Since no current therapies are effective in preventing MDS from worsening, treatment usually focuses on relieving the symptoms. Doctors will discuss with the patient the various options available, including:

• Antibiotics
• Red blood cell or platelet transfusions
• Chemotherapy
• Biologic therapy
• Differentiating agents (drugs)
• Bone marrow transplant
• Leukemia treatment

MDS may change into acute myelogenous leukemia (AML). AML causes large numbers of immature white blood cells to be produced by the bone marrow. When this occurs, the patient is treated for AML rather than MDS. Patients with refractory anemia with excess blasts and chronic myelomonocytic leukemia have a higher risk of progression.

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Tension-type headache: pain, fatigue, tension, and EMG responses to mental activation

Twenty patients with tension-type headache (14 chronic and 6 episodic) and 20 group-matched controls were selected for this study. They participated in a 1-hour, complex, two-choice, reaction-time test, as well as 5-minute pretest and 20-minute posttest periods. Subjects reported any pain in the forehead, temples, neck, and shoulders, as well as any feelings of fatigue and tension during the pretest, and every 10 minutes during the test and posttest by visual analog scales. Superficial electromyography was recorded simultaneously from positions representing the frontal and temporal muscles, neck (mostly splenius), and trapezius muscles. The location of pain corresponded to the position of the electrodes, but extended over a larger area. The test provoked pain in the forehead, neck, and shoulders of patients, i.e., pain scores from these regions increased significantly during the test. The pain scores continued to increase posttest. In patients, the EMG response of the trapezius (first 10 minutes of the test) was elevated relative to pretest. In controls, only the frontal muscles showed an EMG test response. Patients showed significantly higher EMG responses than controls in the neck (whole test period) and trapezius (first 10 minutes of the test period). There were significant differences in pain and fatigue scoring between patients and controls in all three periods and in tension scoring posttest. Fatigue correlated with pain, with increasing significance for all locations examined, while tension was mainly associated with the neck pain. The meaning of the variables “tension” and “fatigue” in headache, and their association with recorded muscle activity in various regions is discussed. The EMG response of the trapezius muscle to the test is discussed in comparison with similar responses observed in patients with other pain syndromes.

Can Chronic fatigue syndrome and Myalgic encephalomyelitis be caused by cervical stenosis and cervical spine instability? – Caring Medical Florida

Ross Hauser, MD

Myalgic encephalomyelitis (muscle pain from nerve inflammation) or Chronic Fatigue Syndrome is/are very complex disorders. It is difficult to determine their true causes as the true cause can be extremely multifactorial. There are numerous hypotheses as to cause and treatments.  If you are reading this article it is more than likely that you have been on a long medical journey and you are very well educated in the ideas of yeast, molds, environmental illness, diet, hormones, thyroids and adrenals, and a runaway immune system that causes muscle pain. Sometimes this is diagnosed as Fibromyalgia.

You have been to many doctors, nutritional specialists, allergists, immunologists, endocrinologists, and other specialists. You may have even traveled to a few gurus. While you may have been helped, you still struggle. For people like you, even the smallest help in finding answers to your challenges of excessive fatigue and the many symptoms that usually accompany chronic fatigue syndrome is met with hopeful but guarded optimism.

Stories probably like yours

We get many emails about problems of the cervical spine and fatigue. They go something like this:

My problems have been going on for years. I have a lot of neck pain, I have pain going down my arms. My one elbow is particularly painful, I wear a large brace on it so I can squeeze an ice pack in there when it really hurts. I have my general practitioner, a chiropractor, an orthopedist, and a neurologist trying to help me. They are trying but nothing is helping. I also have a significant problem with fatigue. My general practitioner thinks it may be chronic fatigue syndrome based on other symptoms I am having, like feeling sick all the time. My surgeons think it may just be the stress and exhaustion of being in pain all the time. Either way, I am tired all day and find myself with the need to nap nearly every day.

Others we hear from have their diagnosis and simply want to know if treating their cervical spine problems will help their chronic fatigue. These emails are sometimes very short and matter of fact. Generally an indication of someone who has had a lot of previous medical care. They go something like this:

I have been diagnosed with chronic fatigue syndrome. I have severe migraines and headaches. I am looking for help.

-or-

I have been sick for years. I have been diagnosed with POTS, chronic headaches, chronic fatigue syndrome among other ailments. None of the treatments are working, I feel sick every day. Can you help?

-or-

I have chronic fatigue syndrome. Can you help me with craniocervical instability and Chiari malformation?

Before we begin this article and research findings, if you would like to contact our medical team with similar questions, please use our contact form page. We can help assess your candidacy for our treatments and answer your questions.

Can Chronic fatigue syndrome and Myalgic encephalomyelitis be caused by cervical stenosis and cervical spine instability?

In this article, we will present information and a case for cervical spine instability as a possible root cause of your health issues. It is not the grand unifying theory of Myalgic encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS), but a concept of what may be happening in some patients.

We will show evidence that the pressure exerted by loose and floating vertebrae that pinch nerves and compresses arteries that pass through the cervical neck region may be an answer for you.

It is important to point out that not every sufferer of chronic fatigue syndrome will find that the origins of their problems are related to neck instability. The case we make is that some sufferers may. We are going to go straight to a research study to set the tone for this article that there may be a cervical neck connection to the onset and worsening conditions of chronic fatigue syndrome.

Intracranial hypertension and craniocervical obstructions from cervical spine instability

In August 2020, a paper published in the journal Frontiers in Neurology (1). Here researchers tested their hypothesis that hypermobility, signs of intracranial hypertension, and craniocervical obstructions may be more common in patients with ME/CFS and thereby explain many of these patient’s symptoms.

How they tested their hypothesis:

• Two hundred twenty-nine (229) patients with ME/CFS were included in this study. A total of 190 women, average age 45 years, and 39 males, average age 44 years, were included.
  • Hypermobility was identified in 115 (50%) participants.
  • MRI of the brain was performed on 205 participants of whom 112 (55%) had an increased optic nerve sheet diameter (to assess intracranial pressure) and 171 (83%) had signs of possible intracranial hypertension, including 65 (32%) who had more severe states of intracranial hypertension.
  • Cerebellar tonsils protrusion (The tonsils can put pressure on the brainstem and spinal cord, blocking Cerebrospinal Fluid (CSF) flow, and result in the Chiari signs and symptoms).
  • MRI of the cervical spine was performed on 125 participants of whom 100 (80%) had craniocervical obstructions. Pain at harmless pressure, allodynia, was found in 96% of the participants, and fibromyalgia syndrome was present in 173 participants or 76%.
• Conclusion: Compared to a general population, the researchers found more symptoms of hypermobility, signs of intracranial hypertension, and craniocervical obstructions.

A cervical neck connection to the onset and worsening conditions of Chronic Fatigue Syndrome (ME/CFS)

While we practice regenerative medicine injection treatments to strengthen the cervical ligaments to bring stability to the neck, we are going to explore a surgical study from Johns Hopkins University School of Medicine. The point that we hope to show you is that if you treat cervical instability you may find relief from your chronic fatigue and muscle pain.

Writing in the Journal of Translational Medicine (2), the John Hopkins researchers described surgical outcomes for three patients here were their symptoms:

• Cervical stenosis in all three
• Positive Hoffman sign in 2 of 3 for twitching and spasmodic tendency
• A tremor in 2 of the 3 patients
• Absence of gag reflex in 1 of 3 signifying possible damage or compression of the vagus nerve
• two patients had single- or two-level cervical spondylosis.

Two patients underwent Anterior cervical disc replacement surgery and the other a hybrid anterior cervical disc fusion and disc replacement in the third was associated with a marked improvement in myelopathic symptoms, resolution of lightheadedness and hemodynamic dysfunction (increased positive blood flow), improvement in activity levels, and improvement in global Myalgic encephalomyelitis or chronic fatigue syndrome.

Here is the conclusion of this case study from the surgeons:

“The prompt post-surgical restoration of more normal function suggests that cervical spine stenosis contributed to the pathogenesis of refractory ME/CFS and orthostatic symptoms. The improvements following surgery emphasize the importance of a careful search for myelopathic examination findings in those with ME/CFS, especially when individuals with severe impairment are not responding to treatment.”

Comment: Here a treatment (surgery) improved the conditions of chronic fatigue and muscle pain and the related symptoms of lightheadedness, symptoms associated with decreased blood flow, and energy output. This helped patients who had no help before. For those of you who want to explore a non-surgical option, we will explain below.

Why did these people respond so favorably? Alleviation of compression.

Are Vagus nerve inflammation and compression the cause of Chronic fatigue syndrome and Myalgic encephalomyelitis?

In this illustration compression at C1, C2, C3 can cause vagus nerve inflammation and contribute to the development of Chronic fatigue syndrome and Myalgic encephalomyelitis

The Vagus nerve is part of a pair of nerves. You have the left side vagus nerve and the right side vagus nerve. Because the vagus nerves are so long, (vagus literally meaning wandering) they impact a large number of bodily functions and systems. When the vagus nerve is compressed by vertebrates as in cervical stenosis,  it can cause disruption in the body systems and many problems for the sufferer.

In the above research, the surgeons pointed out that the patients suffered from tremors, twitching, spasmodic tendency, absence of gag reflex. As noted these symptoms seemingly point to a connection between vagus nerve compression and Myalgic encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS).

Vagus nerve involvement in Myalgic encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS) has presented some interesting research and speculation as to what may be the origin or etiology of their problem for so many people. At the onset of this article, we discussed that these disorders are very complex disorders. It is difficult to determine the cause as a cause can be very multifactorial. BUT, sometimes you can connect some dots that may lead some to a realization that it is cervical spine instability causing these health issues.

Common symptoms shared by cervical neck instability patients and Myalgic encephalomyelitis and Chronic Fatigue Syndrome patients

Ross Hauser, MD discusses cervical instability and vagus nerve impairment in this discussion about cases with chronic idiopathic symptoms that include fevers, chronic fatigue, and hypersomnolence the desire to sleep all the time.

This is a summary transcript

Troubling temperatures – chronic fevers and “crippling fatigue”: People have fevers or they have the sensation of having a fever and nobody has figured out the cause. Another sensation that people tell us about is crippling fatigue.

• I’m going to talk about sleepiness, crippling fatigue, and I am going to present a case where the person had temperature problems and fever, and an intense desire to sleep

“my worst symptom is an intense desire to sleep I have suffered with it for 8 years”

• This is actually a quote from a patient: “my worst symptom is an intense desire to sleep I have suffered with it for 8 years. ” Even today (the day I filmed this discussion) I did a teleconference with a person who was on Adderall. Many people we talk to take stimulants, they will do anything to try to feel better and have more energy, so is their desperation to have more energy.

(1:30) A patient case: Desire to sleep, fatigue, fevers

The case that I have in front of me describes someone, who since 2012, has had an intense desire to take naps and sleep. It did not matter how much sleep this person had, they never felt refreshed and the interesting thing was that they intermittently also had very high fevers, in the 103 – 104 degree range for days at a time. Imagine if you went to the emergency room and you had a fever of 103-104, right away they would give you a diagnosis of something like encephalitis or all kinds of things. In this person’s case, their fever came from cranial cervical syndrome or atlantoaxial or upper cervical instability.

Testing for idiopathic hypersomnia and other sleep studies:

This particular person had multiple sleep studies and finally, they were diagnosed with idiopathic hypersomnia. Many of you probably have this diagnosis. It means that your doctors do not know why you are so tired and want to sleep all the time.

This person had functional brain tests where it was discovered that the blood supply and the nutrient supply to the brain were flowing too low. So if you think about what would cause moment-to-moment decreased flow of blood and nutrients to the brain, you would come up with the logical assessment that this person has something causing intracranial pressure, the build up of pressure inside their brain caused by some sort of blockage.  For some people, the blockage is caused by upper cervical spine instability.

For some people, the blockage is caused by upper cervical spine instability.

Here is an example. I had a teleconference with a person who had a Cine MRI scan to measure their cerebrospinal fluid flow.

• It showed that there was constriction, a narrowing of where the cerebrospinal fluid flow went through the foramen magnum which is where the spinal cord and other structures enter the brain.
• The constriction is there because the person has Atlas or C1 misalignment because of instability and it’s decreasing the CSF space in the foramen magnum.

(4:40) The fevers

Returning to the case I am discussing in this video. This person had fevers nobody could explain. When someone has fatigue and fevers no one can explain they are often diagnosed with multiple environmental chemical sensitivities, chronic fatigue syndrome, or Lyme disease.

(5:05) Inflammation

What these people’s doctors are trying to figure out is why this person has fevers. There must be an inflammation somewhere in the body. Another patient with whom I had a teleconference told me about an elevated C-reactive protein that was ten times normal. None of her doctors could figure out why. The fever/inflammation remained, even when she took strong doses of steroids. No one could figure out why. I told this patient to look up “The Cholinergic Anti-inflammatory Pathway. ”

Note: In a 2003 paper in the journal Molecular Medicine, (3) doctors described the Cholinergic Anti-inflammatory Pathway as the interaction between the nervous and immune systems in response to an immune challenge and a unique function of the efferent vagus nerve. This pathway plays a critical role in controlling the inflammatory response.

We all know fever comes from inflammation that the body is trying to mount an immune reaction to. The vagus nerve, as noted in the above landmark paper, controls the inflammatory response. If the vagus nerve is compressed, distorted messages about inflammation and fever regulation needs can go to the brainstem. The brainstem may then send distorted or incorrect messages to the hypothalamus and the hypothalamus nuclei which are the temperature controls in the body.

• So when your vagus nerve is impinged, stretched, or compressed, messages are getting blocked or distorted and fever and inflammation are not correctly regulating the body. So you could have very low body temperature or high body temperatures.
• If you had high temperatures and nobody can figure out the reason that you have chronic fatigue syndrome, it may be from upper cervical instability, impinging on the vagus nerve and that is treatable and you can resolve it by address upper cervical instability.

Cervical instability and craniocervical instability. Are common symptoms with Myalgic encephalomyelitis and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment?

The person who comes to us for problems related to the cervical spine or craniocervical instability does not come in presenting one problem. They come in presenting many problems. We rarely get a patient who comes in with Myalgic encephalomyelitis or chronic fatigue syndrome as the primary concern. But fatigue is a dominating secondary concern. If you are reading this article you do not have to be convinced of the complexity of your case. We would, however, like to show more research that makes the case for cervical spine or craniocervical instability for symptoms related to patients with Myalgic encephalomyelitis or chronic fatigue syndrome.

This is a patient of ours, she explains her myriad of symptoms that included fatigue:

In the video, the patient, Katelin tells her story. Here is a summary of her video:

• Katelin tells us that her life turned upside down quickly, three years prior to filming this video she developed a “slew,” of neurological issues within a span of three to four months. She went to her general practitioner, a neurologist, three or four physiotherapists, no one had any idea what was happening to her.
  • “I went from having something that felt like an ear infection to partial seizures.” Katelin’s symptoms included severe brain fog, tremors, episodes of partial blackouts, horrible fatigue, sleeping all the time, vertigo, and being totally disabled.
• At her visit with us from her home in Vancouver, we performed a digital motion x-ray which revealed cervical spine instability at C1 – C2. She had four initial treatments and was able to return to work within one year. Not all patients have the same results, Katelin’s result may not be typical. But they were her results.

Cervical Vertigo and Myalgic encephalomyelitis and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment? 87% Neck pain – 85% Fatigue seen in patients.

A 2013 study from Norwegian doctors published in the Scandinavian Journal of Pain (4) demonstrated that the patients in this study, with a primary diagnosis of chronic benign paroxysmal positional vertigo, that is dizziness with a change in head position, reported the following coexisting problems:

• The majority of patients (87%) reported neck pain as a major symptom
• Nearly as many reported Fatigue (85%) as a major symptom.
• Nearly as many reported visual disturbances (84%) as a major symptom. Nystagmus included – repetitive, uncontrolled movements of the eyes.
• Nearly as many reported decreased concentration ability (81%)

Visual disturbance, fatigue, and dizziness are well-known characteristics of patients with Myalgic encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS). So what is the origin of the problem?  Is ME/CFS the cause of these symptoms or is it cervical spine/neck instability? For a more detailed discussion see our article: Can neck problems cause vertigo? Cervical Vertigo and Cervicogenic Dizziness

Cervical Spine / Neck instability, vision problems, Myalgic encephalomyelitis, and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment?

At the onset of research into Chronic Fatigue Syndrome in the early 1990s (CFIDS – Chronic Fatigue Immune Dysfunction Syndrome) a connection between chronic fatigue and visual disturbances was immediately identified. In a 1992 study published in the journal Optometry and Vision Science (5): the official publication of the American Academy of Optometry, researchers wrote that:

• Chronic fatigue and immune dysfunction syndrome (CFIDS) is a disease presenting with systemic, sensory, cognitive, and psychological manifestations. Ocular symptomatology is reported in the visual, functional, perceptual, and pathological aspects of the visual system. It appears (based on our data) that the ocular symptoms of CFIDS are genuine.

In the 27+ years since there has been conflicting and confusing information in regard to using eye problems as a tool to verify Chronic Fatigue Syndrome or Myalgic encephalomyelitis. In 2000, researchers published a case-control masked study on 37 patients with Chronic Fatigue Syndrome to evaluate ocular signs, symptoms, and functional parameters. The research which appeared in the Annals of Ophthalmology (6) suggested “a significant association was between CFS and blurred vision at near (inability to make out fine details), foggy vision, shadowed vision, headaches, and photophobia (intolerance of light). Blurred vision, foggy vision, and headaches were associated with abnormal oculomotor function, and shadowed vision and photophobia were associated with tear deficiency.”

In their 2014 paper: “Characteristics of visual disturbances reported by subjects with neck pain,” Researchers at The University of Queensland wrote in the journal Manual Therapy (7) of the most difficult to treat and manage visual disturbances in their patients with neck pain.

• The most prevalent symptoms that they found in the patients of the study were:
  • ‘patient found that they had to concentrate to read‘ (70%) and
  • ‘patient found that they had a sensitivity to light‘ (58.6%).
• Lesser prevalent but still impacting many patients were:
  • double vision (28.6%) and
  • ‘dizzy reading‘ (38.6%).
• The most troublesome symptoms were:
  • ‘need to concentrate to read (visual fatigue)
  • ‘difficulty judging distances’
  • and ‘sensitivity to light’ (photophobia)

The commonality is unavoidable. People who have these vision problems and a diagnosis of Chronic Fatigue Syndrome or Myalgic encephalomyelitis should be checked for cervical spine instability.

Cervical Spine / Neck instability – Headaches and Myalgic encephalomyelitis and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment?

Many people with ME/CFS have headaches. These include classic migraine (aura) and accompanying visual disturbances to included flashes of lights and blackout areas in vision. Again, we want to point out that people with ME/CFS may have these problems as a result of their sensitivities to chemicals, environmental pollutants, and certain foods. We are not suggesting that migraine and headaches in ME/CFS have a singular cause in cervical spine neck instability. We are suggesting that it is a possibility in many.

In the medical journal, BMC Neurology (8) researchers at Georgetown University produced a detailed paper on migraines, headaches, and Chronic Fatigue Syndrome. This was part of the summation:

“Chronic Fatigue Syndrome subjects have a high prevalence of migraine headaches that may be overlooked and undertreated. The proportion of an aura was similar to other migraine groups. CFS (sufferers with migraine and aura) was associated with higher severity scores for neural problems such as numbness and dizziness, and alterations of the heartbeat. The lower pressure-induced pain thresholds and hyperalgesia (high sensitivity to pain) found in the CFS subgroup (migraines without aura) was suggestive of nociceptive hyperresponsiveness (tissue damage causing breathing problems set off by asthma or exposure to an irritant) and central sensitization (Sensitivity to pain).”

In this short paragraph, we have two types of CFS sufferers. The latter is the sufferer whose headaches and migraines were triggered by asthmatic or breathing problems. The former or first sufferer who has their migraines set off by events strongly linked to cervical neck instability.

In our 2014 research lead by Danielle R. Steilen-Matias, MMS, PA-C and published in The Open Orthopaedics Journal (9) our research team was able to demonstrate that when the neck ligaments are injured and cause cervical spine instability (excessive movement of the cervical vertebrae), in the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches.

A brief note on vertebrobasilar insufficiency. Typically this describes a narrowing of the arteries that is usually treated with blood thinners and cholesterol medication. In this context, vertebrobasilar insufficiency is describing a situation where hypermobility of the neck vertebrae is causing a “squeezing,” of the arteries by pinching movement. In the Georgetown research, it is worth noting again: “CFS (sufferers with migraine and aura) was associated with higher severity scores for neural problems such as numbness and dizziness, and alterations of a heartbeat. ”

Please refer to our article Vertebrobasilar insufficiency – Hunter Bow Syndrome – Cervical neck instability for more on this possible connection to problems in ME/CFS.

A link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome? Is Ehlers-Danlos syndrome involved as well?

In December 2018 study in the Journal of Pain Research (10) found that idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome shared many characteristic features.

Before we get to these research findings, let’s explore some explanatory notes. In our article Cervical Spine Instability, Vein blockage, fluid build up and intracranial hypertension, we note:

We see many patients who have a serious health challenge in having intracranial hypertension. In many of these people, intracranial hypertension was not initially thought of as a problem as their doctors instead tackled the symptoms that these people were facing. Symptoms included dizziness, headache, vision problems such as sensitivity to light where exaggerated pupillary hippus dilating and constricting which can cause problems with light sensitivity and the pupil fails to respond correctly to light sources. These people also faced symptoms and diagnosis of Tinnitus or ringing in the ears, neck pain, and tremors.

Now in this research, we get a confirmation of something else we were seeing in these patients. Excessive fatigue.

In this study the researchers made these observations:

• Common but underappreciated symptoms of Idiopathic intracranial hypertension are neck pain, back pain, and radicular pain in the arms and legs resulting from associated increased spinal pressure and forced filling of the spinal nerves with Cerebrospinal fluid.
• Widespread pain and also several other characteristics of Idiopathic intracranial hypertension share notable similarities with characteristics of fibromyalgia and chronic fatigue syndrome (CFS), two overlapping chronic pain conditions.
• The shared characteristics of Idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome that can be caused by increased intracranial pressure include headaches, fatigue, cognitive impairment, loss of gray matter, the involvement of cranial nerves, and overload of the lymphatic olfactory pathway.
• Increased pressure in the spinal canal and in peripheral nerve root sheaths causes widespread pain, weakness in the arms and legs, walking difficulties (ataxia), and bladder, bowel, and sphincter symptoms.
• Additionally, Idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome are frequently associated with sympathetic overactivity symptoms and obesity. These conditions share a strong female predominance and are frequently associated with Ehlers-Danlos syndrome.

Laryngeal Manifestations – voice and airway dysfunctions, Myalgic encephalomyelitis, and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment?

Here is an April 2020 (11) study published in the Journal of the American Medical Association (JAMA) Otolaryngology, Head & Neck Surgery from researchers at Johns Hopkins University.

• Fibromyalgia syndrome, irritable bowel syndrome, and chronic fatigue syndrome are traditionally considered as distinct entities grouped under the chronic pain syndrome of an unknown origin. However, these 3 disorders may exist on a spectrum with shared pathophysiology. (Our note: they all have something in common that has not yet been fully understood).
• All three of these disorders may share symptoms of voice and laryngeal disorders. This study sought to make a determination of the prevalence of voice and airway path dysfunction with Fibromyalgia syndrome, irritable bowel syndrome, and chronic fatigue syndrome.

Results:

• Conclusions and relevance: The voice and airway presentation of patients with Fibromyalgia syndrome, irritable bowel syndrome, and/or chronic fatigue syndrome appear to be indistinguishable from each other. This finding suggests that these 3 diseases share upper airway symptoms.

My note: What could be a shared cause? Upper cervical instability

Research on cervical instability non-surgical treatments

Caring Medical has published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including the problems described in this article which may impact the Myalgic encephalomyelitis and Chronic Fatigue Syndrome diagnosed sufferer.

In this video, a demonstration of treatment is given

Prolotherapy is referred to as a regenerative injection technique (RIT) because it is based on the premise that the regenerative healing process can rebuild and repair damaged soft tissue structures. It is a simple injection treatment that addresses very complex issues.

This video jumps to 1:05 where the actual treatment begins.

This patient is having C1-C2 areas treated. Ross Hauser, MD is giving the injections.

In our 2014 study mentioned earlier in this article, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments.

This is what we wrote: “To date, there is no consensus on the diagnosis of cervical spine instability or on traditional treatments that relieve chronic neck instability issues like those mentioned above. In such cases, patients often seek out alternative treatments for pain and symptom relief. Prolotherapy is one such treatment that is intended for acute and chronic musculoskeletal injuries, including those causing chronic neck pain related to underlying joint instability and ligament laxity. While these symptom classifications should be obvious signs of a patient in distress, the cause of the problems are not so obvious. Further and unfortunately, there is often no correlation between the hypermobility or subluxation of the vertebrae, clinical signs or symptoms, or neurological signs or symptoms. Sometimes there are no symptoms at all which further broadens the already very wide spectrum of possible diagnoses for cervical instability.”

What we demonstrated in this study is that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain and possibly in the case of Myalgic encephalomyelitis and Chronic Fatigue Syndrome type symptoms, cervical instability. (9)

Prolotherapy, the curve of the neck and blood flow

In this image, the progression and degeneration of the cervical spine are demonstrated, from the Lordotic curve to the Military curve to the Kyphotic curve to the “S” curve of severe osteoarthritis.

In February 2016 a paper appeared in the Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. (12) Here medical university researchers in Turkey made these observations:

• “The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in a close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. (Reduced blood flow into the brain).”
• “(Our) study revealed a significant association between a loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity.”

This is research with which we have seen empirical evidence in our over 27+ years of regenerative medicine practice. To fix the problems related to the cervical spine, you need to restore the natural curvature of the neck. This is part of our Caring Cervical Realignment Therapy (CCRT) developed by Ross Hauser, M.D. This program was the evolutionary product of decades of treating patients with neck disorders, including cervical instability and degenerative disc disease, to provide long-term solutions to cervical neck instability related symptoms. CCRT combines individualized protocols to objectively document spinal instability, strengthen weakened ligament tissue that connects vertebrae, and re-establish normal biomechanics and encourage the restoration of lordosis.

Research: Correct the problems of loss of lordosis: immediately increase cerebral blood flow

In the medical journal Brain Circulation (Jan-March 2019) (13), doctors wrote their analysis of case study patients who had cervical lordosis. They wrote that if you restored the natural curve to the neck, you could immediately increase cerebral blood flow as pressure is removed from the cerebral artery.

Here are the learning points of this research. They present a good summary of what we discussed in this article:

• Loss of lordosis of the cervical spine is associated with decreased vertebral artery hemodynamics (blood flow).
• Based on the close anatomical relationship between the cervical spine, the vertebral arteries, and cerebral vasculature, the researchers speculated that improvement in cervical hypolordosis increases collateral (from the side) cerebral artery hemodynamics and circulation.

The challenges of Vertebrobasilar insufficiency are many. Fixing cervical neck instability is not something that can be treated simply or easily, it takes a comprehensive non-surgical program to get the patient’s instability stabilized and the symptoms abated. We believe that if you have been going from clinician to clinician, practitioner to practitioner, doctor to doctor, there is a good likelihood that you have problems of cervical neck instability coming from weakness and damage to the cervical ligaments. Our treatments of dextrose Prolotherapy and in some cases Platelet Rich Plasma Prolotherapy can be an answer.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

We hope you found this article informative and it helped answer many of the questions you may have surrounding Chronic fatigue syndrome and Myalgic encephalomyelitis be caused by cervical stenosis and cervical spine instability. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit the Hauser Neck Center Patient Candidate Form

References

1 Bragée B, Michos A, Drum B, Fahlgren M, Szulkin R, Bertilson BC. Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Frontiers in Neurology. 2020 Aug 28;11:828. [Google Scholar]
2 Rowe PC, Marden CL, Heinlein S, Edwards CC. Improvement of severe myalgic encephalomyelitis/chronic fatigue syndrome symptoms following surgical treatment of cervical spinal stenosis. Journal of translational medicine. 2018 Dec;16(1):21. [Google Scholar]
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8 Ravindran MK, Zheng Y, Timbol C, Merck SJ, Baraniuk JN. Migraine headaches in chronic fatigue syndrome (CFS): comparison of two prospective cross-sectional studies. BMC neurology. 2011 Dec;11(1):30. [Google Scholar]
9 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]
10 Hulens M, Rasschaert R, Vansant G, Stalmans I, Bruyninckx F, Dankaerts W. The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology. Journal of pain research. 2018;11:3129. [Google Scholar]
11 Piersiala K, Akst LM, Hillel AT, Best SR. Chronic Pain Syndromes and Their Laryngeal Manifestations [published online ahead of print, 2020 Apr 30]. JAMA Otolaryngol Head Neck Surg. 2020;e200530. doi:10.1001/jamaoto.2020.0530 [Google Scholar]
12 Bulut MD, Alpayci M, Şenköy E, Bora A, Yazmalar L, Yavuz A, Gülşen İ. Decreased vertebral artery hemodynamics in patients with loss of cervical lordosis. Medical science monitor: international medical journal of experimental and clinical research. 2016;22:495. [Google Scholar]
13 Katz EA, Katz SB, Fedorchuk CA, Lightstone DF, Banach CJ, Podoll JD. Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis. Brain Circulation. 2019 Jan 1;5(1):19. [Google Scholar]

This page was last updated January 14, 2021

Medical experts try to establish ‘long Covid’ diagnosis for patients with lasting symptoms

Some Covid-19 patients are experiencing shortness of breath, fatigue, headaches and “brain fog” for months to nearly a year after their initial illness. Now, global medical experts are working to better diagnose and treat them for what they are tentatively calling “long Covid.”

Earlier this week, the World Health Organization hosted a global meeting with “patients, clinicians and other stakeholders” to advance the agency’s understanding of what’s medically referred to as post-Covid condition, also known as long Covid, WHO Director-General Tedros Adhanom Ghebreyesus said on Friday.

The gathering was the first of many to come. The goal will be to eventually create an “agreed clinical description” of the condition so doctors will be able to diagnose and effectively treat patients, he said. Given how many people have been infected with the virus globally — nearly 108 million people as of Friday — Tedros warned it’s likely many will experience these lingering symptoms.

“This illness affects patients with both severe and mild Covid-19,” Tedros said during a press briefing at the agency’s headquarters in Geneva. “Part of the challenge is that patients with long Covid could have a range of different symptoms that can be persistent or can come and go.”

Limited data

So far, there’s a limited number of studies that discern what the most common long-Covid symptoms are or how long they might last. Most of the focus has been on people with a severe or fatal illness, not those who have recovered but still report lingering side effects, sometimes referred to as “long haulers.”

Most Covid patients are thought to recover just weeks after their initial diagnosis, but some have experienced symptoms for six months, or even close to a year, medical experts say.

One of the largest global studies of long Covid published in early January found that many people suffering from ongoing illness after infection are unable to return to work at full capacity six months later. The study, which was published on MedRxiv and not peer-reviewed, surveyed more than 3,700 people ages 18 to 80 from 56 countries to identify the symptoms.

The most frequent symptoms experienced after six months were fatigue, tiredness after exercise and cognitive dysfunction, sometimes referred to as brain fog, the study found.

Is this unique to Covid-19?

“We really don’t know what’s causing these symptoms. That’s a major focus of the research right now,” Dr. Allison Navis, a professor at the Icahn School of Medicine at Mount Sinai, said during a call with the Infectious Diseases Society of America on Friday.

“There’s a question of whether this is something that’s unique to Covid itself — and it’s the Covid virus that’s triggering these symptoms — or if this could be part of a general post-viral syndrome,” Navis said, adding that medical experts see similar long-term symptoms after other viral infections.

Another study published in early January in the medical journal The Lancet studied 1,733 patients who were discharged from a hospital in Wuhan, China, between January and May of last year. Of those patients, 76% reported at least one symptom six months after their initial illness. The proportion was higher in women.

“We found that fatigue or muscle weakness, sleep difficulties, and anxiety or depression were common, even at 6 months after symptom onset,” researchers wrote in the study.

They noted that the symptoms reported months after someone’s Covid-19 diagnosis were consistent with data that was previously found in follow-up studies of Severe Acute Respiratory Syndrome, or SARS, which is also a coronavirus.

Post-Covid clinics come online

Some large medical centers are now creating post-Covid clinics to help care for patients with persistent symptoms. Navis said her clinic at Mount Sinai in New York City has treated a “fairly even” distribution of men and women experiencing lingering illness, and the average patient age is 40, she said.

Dr. Kathleen Bell, a professor at the University of Texas Southwestern Medical Center, said her hospital’s long-term Covid-19 clinic started last April as a wave of infections hit Italy and New York early in the pandemic.

Bell, speaking on the Infectious Diseases Society of America call Friday, said that a range of professionals are required to staff the clinics since the symptoms are uneven, including experts who can treat muscle weakness, heart-related illnesses and cognitive issues for those experiencing mental health problems after their diagnosis.

“It’s really, in many ways, forcing us all to get together and to make sure we have open lines of communication to be addressing all of these problems for patients,” Bell said.

Bell added that the Centers for Disease Control and Prevention hosted a call with long Covid centers across the country in January to discuss their model for treating patients.

“I do think that the CDC now is trying to pull centers together and get some some more firm guidelines for this, which is very exciting,” Bell said.

— CNBC’s Sam Meredith contributed to this report.

A 5-Year-Old With Fever, Headache, Neck Stiffness, and Leg Pain

Abstract

A 5-year-old boy presented with fever, headache, fatigue, neck stiffness, and 2 episodes of nocturnal urinary incontinence, prompting a visit to the emergency department. He had experienced intermittent frontal headaches and leg and buttock pain for several months, which had worsened over the previous 2 weeks. His history was notable for a spinal hemangioma with vascular tract, but he was otherwise healthy. On examination, he was febrile and tachycardic. He held his neck slightly rotated to the right with limited range of motion in all directions due to pain. No focal neurologic deficits were noted, and sensation and deep tendon reflexes were intact bilaterally. He was able to bear weight on both legs. There was no spinal tenderness or limitation in range of motion of his back and hips. There were no cutaneous manifestations, including no sacral dimple. A complete blood count with differential revealed leukocytosis of 31.98 × 103/µL (78.6% neutrophils, 16% bands). C-reactive protein was elevated at 2.4 mg/dL (0–1 mg/dL), and serum electrolytes, liver function tests, uric acid, and lactate dehydrogenase were within normal limits for age. Blood cultures were obtained before admission. Here we present his case, diagnostic evaluation, ultimate diagnosis, and complications.

Case History With Subspecialty Input

Drs Solano and Winningham (Pediatrics, Residents):

A 5-year-old boy was admitted to the general pediatrics inpatient service with fever, headache, fatigue, neck stiffness, buttock pain, and bilateral leg pain. During the 2 weeks before admission, he was less active than usual and complained daily of leg and buttock pain. His leg and buttock pain limited his ability to walk on some occasions. The patient’s mother noted that he had been complaining of frontal headaches and buttock pain intermittently over the past 2 to 3 months, which was unusual for him, and that these symptoms had increased in frequency and severity over the previous 2 weeks. The day before admission, he was noted to have a headache associated with a temperature of 100.8°F (38.2°C). He had a reported fever at home 2 weeks before admission, but it resolved within 24 hours and was associated with congestion. The patient’s mother did not report any other fevers during his illness. Additionally, he had 2 episodes of nocturnal enuresis within the few weeks before presentation, which was new for him. On the day of admission, the patient began holding his head in a fixed position and could not look from side to side due to pain.

Dr Barnett, what is the differential diagnosis at this point?

Dr Barnett (Pediatric Emergency Medicine):

Meningitis must be considered in any patient presenting with headache, fever, and neck stiffness.¹ The course of this patient’s illness was unusually intermittent and more indolent than one would expect with acute meningitis.¹ The additional complaints of leg pain and pain in the gluteal region led providers to broaden the differential diagnosis. The combination of this time course and history of symptoms involving both the lower extremities as well as the neck are concerning for an intraspinal or paraspinal abscess, vertebral osteomyelitis, discitis, sacroiliitis, or tumor, all with involvement of the meninges causing symptoms of meningitis. Trauma is less likely given the presence of fever and no history of repeated neck, back, or leg injuries.

Drs Solano and Winningham:

The patient had scabies 5 months before presentation but had an otherwise unremarkable past medical history per the initial report. After a more thorough review of his chart, it was discovered that the patient had a cutaneous hemangioma overlying the spine at birth. An ultrasound performed at 4 months of age revealed a thin curvilinear vascular track extending from the superficial posterior lumbosacral cutaneous region anteroinferiorly to the region of the deep fascial layer. No follow-up occurred. He had been taking ibuprofen and acetaminophen intermittently over the past few months for headaches as well as for fever on the day of admission. He did not take any daily medications.

On presentation to the emergency department, he had a temperature of 101.8°F (38.8°C) and a heart rate of 157 beats per minute. His respiratory rate was 28 breaths per minute, and his blood pressure was 120/68 mm Hg. His oxygen saturations were recorded at 97%. He was ill appearing, and his movements were restricted by pain, primarily in his neck. It was a severe, dull pain that did not radiate. It worsened with movement and stabilized with rest, but he could not find a position to give him complete relief. He held his neck slightly rotated to the right and moved his whole body with neck movement. His extraocular muscles were intact, and his pupils were equal and reactive. His pharynx was nonerythematous, but his mucus membranes were moderately dry. Aside from tachycardia, his heart, lung, and abdominal exams were normal. All parts of his spine were nontender to palpation and without abnormal cutaneous findings. No focal neurologic deficit was noted, and he had a normal motor examination. The perianal region was inspected and was normal.

Dr Barnett, what are the benefits to performing imaging before any other procedure or treatment based on the information that was known at this point?

Dr Barnett:

Fortunately, the patient was clinically stable and neurologically intact, so no intervention was emergently required. Excluding paraspinal abscess or tumor is essential before an invasive procedure involving the spine. Given the time course of his illness and clinical state, it seemed prudent to wait on treatment with antibiotics until a more definitive diagnosis was reached.¹ Ultrasound was not considered because there were no abnormal findings on skin examination. MRI of his brain and spinal cord was pursued.

Drs Solano and Winningham:

In the emergency department, laboratory results were as follows: white blood cell (WBC) count 31.98 × 10³/µL (78.6% neutrophils, 16% bands), hemoglobin 12.8 g/dL (11.5–13.5gm/dL), platelet count 406 × 10³/µL, erythrocyte sedimentation rate 8 mm/hour (0–13 mm/hour), C-reactive protein (CRP) 2.4 mg/dL (0–1 mg/dL), and creatinine kinase 34 unit/L (75–230 unit/L). Serum electrolytes, liver function tests, uric acid, and lactate dehydrogenase were within normal limits for age. Blood cultures were obtained and remained negative. Chest radiograph was normal. MRI of the brain and total spine was performed.

Dr Zinkus, what features on the patient’s imaging are important for the clinician to recognize?

Dr Zinkus (Pediatric Neuroradiologist):

The MRI of the patient’s brain revealed no intracranial pathology. However, the MRI of his spine demonstrated an intraspinal mass, which filled the distal spinal canal and produced ventral displacement of the nerve roots of the cauda equina (Fig 1). There was enhancement of the nerve roots of the cauda equina compatible with inflammation. The mass appeared intradural with expansion of the distal thecal sac. The mass was heterogeneously hyperintense on T2, hypointense on T1, and contained peripheral contrast enhancement. Because no internal or solid-appearing contrast enhancement was present, the mass was most likely cystic given the appearance on T1 and T2. In addition, the mass demonstrated mildly reduced diffusion on diffusion-weighted imaging. Diffusion signal abnormalities are nonspecific but may be seen with purulent material or highly cellular tumors in this context. Given the presence of reduced diffusion, the 3 primary differential considerations would include intraspinal abscess, cellular tumor, or intraspinal dermoid/epidermoid. In this case, however, T2-weighted imaging also demonstrated a sinus tract that extended between the L4–5 spinous processes and into the midline aspect of the spinal canal. Given the presence of a sinus tract, the main differential considerations for this mass could be narrowed down to intraspinal abscess and intraspinal dermoid/epidermoid with or without secondary infection.

FIGURE 1

The sagittal cut of the lower thoracolumbar spine and sacrum shows an intraspinal mass consistent with an abscess, which fills the distal thecal sac (solid arrow). There is an associated sinus tract that extends from the subcutaneous tissues into the spinal canal at the level of the mass (dashed arrow).

Drs Solano and Winningham:

In the emergency department, vancomycin and ceftriaxone were started for broad coverage to treat the suspected intraspinal abscess noted on the MRI. He received a total of 40 mL/kg of bolus isotonic fluid followed by the initiation of maintenance intravenous (IV) fluids. Acetaminophen and ibuprofen were given for pain management, and he was admitted to a general pediatrics team with a plan for operative debridement the next morning.

Dr Igbaseimokumo, what surgical interventions are considered once an intraspinal abscess is diagnosed? How urgently must surgery be performed?

Dr Igbaseimokumo (Pediatric Neurosurgery):

The surgical approach to a spinal abscess is guided by the presence or absence of mass effect from the collection. The presence of cauda equina syndrome (loss of bladder and bowel control, with or without leg weakness), compressive myelopathy or radiculopathy, or intolerable pain in the face of a sizeable collection generally indicates the need for urgent surgical decompression rather than antibiotic therapy only.

For this patient, given the large size of the lumbar abscess with compression of the nerve roots seen on MRI, surgical drainage of the abscess was prudent. This was achieved by a laminectomy and surgical dissection of the nerve roots and evacuation of the abscess. The lower part of the abscess was densely matted together with the nerve roots, and there was minimal pus collection within. Thus, it was considered unsafe and unnecessary to try to tease the nerve roots apart to wash out the semisolid granulation mass that constituted the abscess at this level.

The surgical path is mostly guided by whether the abscess is anterior or posterior to the spinal cord as well as the vertebral level of the abscess: that is, whether it is in the cervical, thoracic, or lumbar spine. The timing of surgery, whether it is emergent (immediately) or urgent (within 24 hours), is determined by the severity of the symptoms, especially the presence or absence of progressive neurologic deficit such as complete loss of bladder or bowel control, which this patient fortunately did not have. The extent of surgery is tailored to decompress the nerve roots and spinal cord. Reconstruction of collapsed vertebrae in the presence of a spinal abscess is beyond the scope of this discussion and fortunately not common.

Drs Solano and Winningham:

On day 2 of admission, neurosurgery performed a laminectomy, abscess incision and drainage, and resection of the sinus tract. Cerebral spinal fluid (CSF) was collected during the procedure revealing a white blood cell count of 3825 white blood cell/µL with 79% segmented neutrophils, glucose <20 mg/dL, protein 332 mg/dL, and red blood cells 286/µL. Gram stain was performed and revealed many Gram-positive cocci in clusters, few white blood cells, and few epithelial cells.

Pathology revealed a dermoid cyst with an associated sinus tract remnant. CSF and wound cultures grew Staphylococcus epidermidis, which was susceptible to oxacillin and rifampin. His therapy was switched to oxacillin and rifampin on day 3 of admission.

Drs Myers and Al Zubeidi, what are the most likely organisms identified in patients with an infected dermoid cyst associated with a dermal sinus tract? What is the most appropriate treatment regimen?

Drs Myers and Al Zubeidi (Pediatric Infectious Disease):

Empirical antibiotic choice should target the most common infectious pathogens, specifically skin flora, because infection in children is mostly secondary to direct contiguous spread from a preexisting congenital defect in the spinal cord. In contrast, these infections arise from hematogenous spread in adults. In a review of 29 cases of pediatric intradural spinal abscesses, Staphylococcus spp, Streptococcus spp, enteric Gram-negative bacilli, and anaerobes caused the majority of cases in which an isolated organism was identified highlighting the importance of both broad coverage and obtaining routine aerobic and anaerobic cultures.² Intraspinal abscesses caused by S epidermidis are well described in association with a congenital dermal sinus tract.³

Mycobacterium tuberculosis has been rarely reported and when present usually presents in patients with antecedent history of tuberculosis meningitis.^2,4,5 In children with recurrent urinary tract infections, one should consider Gram-negative bacteria, especially Escherichia coli, as a causative pathogen. Others such as Pseudomonas (in injection drug users), anaerobic bacteria (eg, Actinomyces spp), Nocardia spp, Mycobacteria spp, fungi, and parasites have been reported.⁶ The fact that this patient’s symptoms were prolonged with more of a chronic presentation makes S epidermidis a more likely pathogen because coagulase-negative staphylococci tend to cause more indolent infections without high spiking fevers and evolve over weeks to months. If the presentation had been acute in nature (eg, symptoms for a few days to a week) Staphylococcus aureus or an enteric Gram-negative organism would be a more likely pathogen. Thus, obtaining the patient history in terms of length of symptoms as well as symptom severity helps to tailor the differential diagnosis to the most likely pathogens. Pending surgical intervention and culture results, empirical antibiotic therapy should provide broad-spectrum coverage. A third- or a fourth-generation cephalosporin in addition to vancomycin is the preferred option. Intravenous therapy should continue for a minimum of 4 to 6 weeks.⁷

Drs Solano and Winningham:

Electrolytes were serially monitored, and the patient’s serum sodium level was noted to be 132 mmol/L (135–145 mmol/L) on postoperative day 2. Fluids were initially restricted, but a repeat sodium level drawn several hours later was 129 mmol/L (135–145 mmol/L). Urine sodium was above normal suggesting a cerebral salt wasting process. He was transferred to the Pediatric ICU for closer neurologic monitoring.

Dr Benton, what is the reason for his hyponatremia, and how is it related to his underlying disease process?

Dr Benton (Pediatric Intensivist):

The common 2 disorders associated with hyponatremia are syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting (CSW). Disorders of sodium homeostasis are common with central nervous system (CNS) injury. It is important to be able to distinguish between the 2 disorders because the treatments are different.⁸ The key difference between CSW and SIADH is volume status of the patient. CSW is characterized by decreased total body water, whereas SIADH is characterized by increased total body water. Typically, patients with CSW will have normal or elevated urine output in contrast to SIADH, which typically is associated with decreased urine output.⁸ All other laboratory markers (low plasma osmolality, high urine osmolality, hyponatremia) are similar. This patient’s hyponatremia was most consistent with CSW and was most likely related to meningitis rather than the epidural abscess itself.⁹ The exact pathophysiology of CSW is unknown, but the common end point of all theories is renal wasting of sodium. One theory suggests that there is a disruption in the sympathetic nervous system, which disrupts the renin-aldosterone axis leading to impaired sodium reabsorption in the proximal tubule. Another theory is that brain natriuretic peptide is released in response to the CNS injury which decreases sodium reabsorption in the kidney.¹⁰ The salt wasting results in water loss. Treatment of CSW focuses on rehydration and salt repletion. This disorder is typically transient.

Final Diagnosis and Discussion: Intradural Spinal Abscess

Drs Myers and Al Zubeidi:

Intradural spinal abscesses are uncommon in both children and adults. Hart reported the first case more than a century ago in 1830, and only 100 cases have been reported since, the majority in adults.¹¹ In adults, hematogenous seeding may occur from diabetes-associated infections, complicated urinary tract infections, surgical site infections, cardiac infections including bacterial endocarditis, bronchiectasis-associated infections, or, less frequently, infections due to spinal abnormalities.¹²

In contrast, most pediatric cases are caused by contiguous spread from the skin from an underlying congenital spinal defect.^13,14 In a recent review, more than half of the cases had an underlying dermal sinus tract, and similar to this patient’s case, a third of these cases had defects identified before presentation. The majority of children with intradural spinal abscesses present before 5 years of age (range 2 weeks–17 years of age). The clinical presentation varies depending on age, location of the abscess, duration of symptoms, and size and number of abscesses.¹⁵ This patient’s clinical presentation with fever, headache, back pain, gait abnormality, bladder dysfunction, and weakness are typical symptoms of patients with spinal intradural abscesses; although, in some cases, cauda equina syndrome is more prominent.¹³ Spinal cord injury is caused by compression from the abscess, but ischemia can also develop due to vascular occlusion, which may occur in the setting of septic thrombophlebitis.⁶ This patient’s additional symptoms of neck pain and stiffness suggest the infection had spread to his CSF, causing meningitis. The additional history of spinal dermal sinus tract in this patient supported this clinical suspicion and prompted more in depth evaluation.

Laboratory abnormalities are usually nonspecific. The white blood cell count is elevated in about two-thirds of patients, and C-reactive protein and erythrocyte sedimentation rate are elevated in most patients. When CSF is examined, pleocytosis and elevated protein levels are often seen due to parameningeal irritation. Radiologic imaging with MRI is able to provide detail with regard to size and location of the abscess, as well as involvement of surrounding structures.⁶

The mainstay of therapy is pain relief and surgical debridement of infected tissues with laminectomy combined with IV antibiotics, which are initially broad spectrum to provide coverage of Staphylococcus spp and Gram-negative bacilli. Definitive therapy is guided by culture and susceptibility results. Steroids may be used to decrease spinal cord compression and neurologic deterioration in patients awaiting surgical intervention, but there have been some reports of worse outcomes with steroid use. Outcome is variable and depends on duration of symptoms and degree of neurologic deficits before surgical decompression.¹⁶

Drs Solano and Dr Winningham:

With enteral NaCl supplementation, the patient’s sodium levels normalized. He was transferred from the ICU to the general pediatrics service on postoperative day 3. He continued to have fevers, headache, vomiting, and back pain, prompting repeat imaging, which showed meningeal enhancement. By postoperative day 6, he defervesced, and his pain was well controlled. His activity level increased, and his oral intake improved to baseline. He was discharged after 17 days of inpatient IV antibiotic therapy. A peripherally inserted central catheter was placed to allow for continued IV therapy at home. After 29 days of therapy, he had follow-up evaluation in the infectious diseases clinic. The peripherally inserted central catheter line was removed at that visit. The patient followed up in neurosurgery clinic 2 months after hospital discharge. Repeat MRI at that time showed no new fluid collections.

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xb“`a“d`g` Ȁ

Eyestrain – Symptoms and causes

Overview

Eyestrain is a common condition that occurs when your eyes get tired from intense use, such as while driving long distances or staring at computer screens and other digital devices.

Eyestrain can be annoying. But it usually isn’t serious and goes away once you rest your eyes or take other steps to reduce your eye discomfort. In some cases, signs and symptoms of eyestrain can indicate an underlying eye condition that needs treatment.

Symptoms

Eyestrain signs and symptoms include:

• Sore, tired, burning or itching eyes
• Watery or dry eyes
• Blurred or double vision
• Headache
• Sore neck, shoulders or back
• Increased sensitivity to light
• Difficulty concentrating
• Feeling that you cannot keep your eyes open

When to see a doctor

See your doctor if self-care steps don’t relieve your eyestrain.

Causes

Common causes of eyestrain include:

• Looking at digital device screens
• Reading without pausing to rest your eyes
• Driving long distances and doing other activities involving extended focus
• Being exposed to bright light or glare
• Straining to see in very dim light
• Having an underlying eye problem, such as dry eyes or uncorrected vision (refractive error)
• Being stressed or fatigued
• Being exposed to dry moving air from a fan, heating or air-conditioning system

Computer and digital device use

Extended use of computers and other digital devices is one of the most common causes of eyestrain. The American Optometric Association calls this computer vision syndrome, or digital eyestrain. People who look at screens two or more hours in a row every day have the greatest risk of this condition.

Computer use strains eyes more than reading print material because people tend to:

• Blink less while using computers (blinking is key to moistening the eyes)
• View digital screens at less than ideal distances or angles
• Use devices that have glare or reflection
• Use devices with poor contrast between the text and the background

In some cases, an underlying eye problem, such as eye muscle imbalance or uncorrected vision, can cause or worsen computer eyestrain.

Some other factors that can make the condition worse include:

• Glare on your screen
• Poor posture
• Setup of your computer workstation
• Circulating air, such as from air conditioning or a nearby fan

Complications

Eyestrain doesn’t have serious or long-term consequences, but it can be aggravating and unpleasant. It can make you tired and reduce your ability to concentrate.

Aug. 28, 2020

Show references

1. Digital devices and your eyes. Prevent Blindness. https://www.preventblindness.org/computers-and-your-eyes. Accessed Sept. 12, 2018.
2. Abujudeh HH, et al., eds. Radiology informatics. In: Radiology Noninterpretive Skills. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Sept. 12, 2018.
3. Eye health tips: Simple tips for healthy eyes. National Eye Institute. https://nei.nih.gov/healthyeyes/eyehealthtips. Accessed Sept. 12, 2018.
4. Computer vision syndrome (CVS). American Optometric Association. http://www.aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndreome. Accessed Sept. 12, 2018.
5. Ergonomics — Good for everybody. U.S. Department of Health and Human Services. https://www.ors.od.nih.gov/sr/dohs/HealthAndWellness/Ergonomics/Pages/prevention.aspx. Accessed Sept. 12, 2018.
6. Sheppard AL, et al. Digital eye strain: Prevalence, measurement and amelioration. BMJ Open Ophthalmology. 2018;3:1.
7. AskMayoExpert. Dry eye disease. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
8. Osada H, et al. Neuroprotective effect of bilberry extract in a murine model of photo-stressed retina. PLOS One. 2017;12:1.
9. Mannis MJ, et al. Dry eye. In: Cornea. 4th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Sept. 12, 2018.

90,000 reasons, treatment methods in Krasnoyarsk

Statistics show that over 70% of the population suffers from headaches. These depressing data indicate the presence of serious pathologies. However, one-time “seizures” can occur in a healthy person. But if the pain is long and unbearable, you need to immediately seek help from competent specialists. The duration of treatment depends on the degree of neglect.

Having visited the clinic of vertebrology of Dr. Savyak, many felt improvements after the first visit.A chronic problem requires thorough treatment, its success is confirmed by numerous positive reviews about our clinic.

Why does the head hurt?

Pain can be episodic or persistent. It occurs due to the following diseases and causes:

• colds, SARS, flu;
• Chronic fatigue and lack of sleep;
• severe stress;
• change in weather conditions;
• migraine;
• intracranial pressure;
• trauma;
• brain defects;
• Osteochondrosis, hernia, scoliosis, protrusion and other ailments of the musculoskeletal system.

The real scourge of modern people is diseases of the spine. This is facilitated by a sedentary lifestyle. A headache can be the first bell indicating the development of an unpleasant ailment. To prevent the progression of the disease, contact the Savyak Vertebrology Center, where a team of specialists works:

• Neurologists;
• chiropractors;
• Ultrasound diagnostics and CT doctors;
• physiotherapists;

90,011 massage therapists;

• vertebrologists;
• orthopedic traumatologists.

Exchange of professional opinions allows you to choose the most suitable therapy and rehabilitation.

Treatment tactics

Our clinic does not rely on taking medications. First, they can harm the body. And secondly, this is salvation for an hour, because the pill eliminates only vasospasm. This option is good only for one-time pain. If the problem is serious, the treatment should be comprehensive.

Surgical intervention is also not welcomed by us, because we are sure that in 90% of cases conservative methods can be dispensed with.Dr. Savyak has developed an author’s sparing therapy program. After a detailed “investigation” and diagnosis, our doctors apply the following methods of getting rid of headaches:

• massage , aimed at normalizing blood circulation and relaxing muscles;
• physiotherapy , which improves blood circulation and tissue nutrition, relieves spasms;
• manual therapy , which helps to reduce displaced vertebrae and improve blood flow and tissue nutrition;
• traction of the spine , thanks to which the muscular and bone apparatus takes the correct position and blood circulation is normalized.

Remember that it is spine diseases that often lead to prolonged and excruciating headaches.

Sign up for examination at the clinic of Oleg Savyak right now!

Headache: causes and how to get rid of

https://rsport.ria.ru/20210317/bol-1601607242.html

Headache: causes and how to get rid of

Headache: causes and how to get rid of – RIA Novosti Sport, 03/17/2021

Headache: causes and how to get rid of

The number of causes that cause headaches and migraines is currently known at least 400.According to statistics, women most often suffer from this ailment … RIA Novosti Sport, 17.03.2021

2021-03-17T11: 25

2021-03-17T11: 25

2021-03-17T11: 25

healthy

health

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MOSCOW, March 17 – RIA Novosti.The number of causes that cause headache and migraine is currently known at least 400. According to statistics, women most often suffer from this ailment. This pain is usually caused by excessive physical exertion, emotional stress, poor diet, or an uncomfortable sleeping position. However, you should not ignore this, because in addition to discomfort, headache also signals that the body has malfunctioned. A sedentary lifestyle, especially associated with regular work at the computer, can cause overstrain of the cervical vertebrae and cause pain.When the head is tilted, all its weight falls on the shoulders and cervical vertebrae. As a result, we get pinching, stiffness in the cervical spine, muscle congestion and headache. This can be avoided by following the rules of an ergonomic sitting at the table: Regular exercises to strengthen the muscles of the back and neck will also help in solving this issue. Headache can also be caused by scoliosis. Poor posture is not only a matter of aesthetics, it is primarily a matter of health. The curved spine compresses the nerve connections and blood vessels, which responds with a headache in the occipital and temporal parts.Impaired supply of oxygen and nutrients to the brain is subsequently fraught with not only chronic pain, but also cognitive impairment. Therefore, try to monitor your posture more often, pump your back muscles and massage the cervical spine. Besides physiological reasons, headaches are often the result of chronic fatigue and stress. Accumulated negative emotions such as anger, resentment, excessive anxiety, fear all lead to muscle spasms. To cope with a psycho-emotional headache, you need to start working with stress.Walking in the fresh air, yoga or other sports, an aroma lamp with mint, rosemary or lavender, a hot bath or shower before bed can help. Tulsi tea and vitamin complexes will help support the body, accelerating rehabilitation. It will also be useful to consult a psychologist. If everything is in order with the spine, you lead an active lifestyle, you know how to work with emotions, but the headache continues to torment you – it’s time to see a doctor. It is necessary to establish whether there have been any recent traumatic brain injuries, for example, as a result of an unsuccessful fall, a sudden stop of a car or a ball hit.Headaches, even after mild injury, can last for up to three months. Other reasons that the body signals in this way may be: brain tumors, HIV, endocrine disorders, epilepsy, pre-stroke condition. Therefore, if you lead a healthy lifestyle, but notice that the headache does not go away even after taking medication, you should consult a doctor.

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health

MOSCOW, March 17 – RIA Novosti, Daria Mikhailova. The number of causes of headache and migraine is known to date at least 400. According to statistics, women most often suffer from this ailment. This pain is usually caused by excessive physical exertion, emotional stress, poor diet, or an uncomfortable sleeping position.However, this should not be ignored, because in addition to discomfort, a headache also signals that the body has malfunctioned.

Sedentary lifestyles, especially those associated with regular work at the computer, can strain the cervical vertebrae and cause pain. When the head is tilted, all its weight falls on the shoulders and cervical vertebrae. As a result, we get pinching, stiffness in the cervical spine, muscle congestion and headache. Observance of the rules of ergonomic sitting at the table will help to avoid this:

• –

  an angle of 90 degrees in the knee joint, hip and elbow;

• –

  chair with lumbar spine support;

• –

  footrest;

• –

  Monitor screen at eye level.

March 11, 4:00 p.m. EDW What happens to the body if you regularly eat avocados?

Regular exercises to strengthen the muscles of the back and neck will also help in solving this issue.

Headache can also be caused by scoliosis. Poor posture is not only a matter of aesthetics, it is primarily a matter of health. The curved spine compresses the nerve connections and blood vessels, which responds with a headache in the occipital and temporal parts. Impaired supply of oxygen and nutrients to the brain is subsequently fraught with not only chronic pain, but also cognitive impairment.Therefore, try to monitor your posture more often, pump your back muscles and massage the cervical spine.

Besides physiological reasons, headaches are often the result of chronic fatigue and stress. Accumulated negative emotions such as anger, resentment, excessive anxiety, fear all lead to muscle spasms. To cope with a psycho-emotional headache, you need to start working with stress. Walking in the fresh air, yoga or other sports, an aroma lamp with mint, rosemary or lavender, a hot bath or shower before bed can help.Tulsi tea and vitamin complexes will help support the body, accelerating rehabilitation. It will also be helpful to see a psychologist.

March 12, 3:00 pm The endocrinologist told how to get rid of belly fat

If everything is in order with the spine, you lead an active lifestyle, you know how to work with emotions, but the headache continues to torment you – it’s time to see a doctor. It is necessary to establish whether there have been any recent traumatic brain injuries, for example, as a result of an unsuccessful fall, a sudden stop of a car or a ball hit.Headaches, even after mild injury, can last for up to three months.

Other reasons that the body signals in this way can be: brain tumors, HIV, endocrine disorders, epilepsy, pre-stroke condition. Therefore, if you lead a healthy lifestyle, but notice that the headache does not go away even after taking medication, you should consult a doctor.

March 11, 17: 50HOZH Endocrinologist told how to restore the gastric mucosa 90,000 Headaches in chronic fatigue syndrome

How to get rid of chronic fatigue syndrome

We hear more and more about chronic fatigue syndrome, but what is it? It turns out that already a couple of centuries ago, doctors were treating conditions that were called hypochondria and neurasthenia.People complained that they could not do anything and spent whole days in bed.
In 1988, the term CFS – “chronic fatigue syndrome” was introduced. During this time, many patients appeared. Who complained of chronic fatigue. They couldn’t do anything. We tried to lie more. And they had no apparent reason for such severe fatigue. It is this state that began to be called CFS. Doctors began to look for ways to treat this disease.
How to understand that this is CFS

How to get rid of a headache? The cause must be treated: chronic fatigue syndrome.Getting rid of it is not easy. It is necessary to improve the general condition of patients. Normalize sleep, restore physical fitness and mental activity.
Green Clinic employs specialists with extensive experience in the treatment of various types of headaches. You need to see a neurologist. He will listen carefully to the patient. Conduct a survey and survey. If necessary, appoint additional laboratory tests.
The treatment will be comprehensive. If necessary, the doctor will prescribe medications.Supplement the treatment with a complex of vitamins. Possibly
will recommend a massage and a kinesiologist’s consultation. One of the effective methods of treatment is kinesio taping. It improves the functioning of the autonomic nervous system, relieves the effects of stress.
Green Clinic experts recommend observing the work and rest regime, changing the daily routine, including walking in the fresh air and physical activity.
But if you need help getting rid of a headache, we will always help.
Still have questions? Call us and we will tell you how to make an appointment and what you need to do.

For more than 29 years, modern doctors and scientists have been studying the disease, but the causes of its occurrence and the exact methods of treatment are still unknown. Various studies suggest that viruses, genetics, weakening of immunity, and a violation of cellular metabolism are to blame for the occurrence of the disease.
Chronic fatigue syndrome is most often diagnosed in townspeople who have been functioning non-stop for many years, working a lot and sleeping and resting little.
According to statistics, the disease is often diagnosed in workaholics – those who are 30-45 years old, they are provided, successful. There are more women at risk than men.
If you have brought yourself to chronic fatigue syndrome, it is not so easy to get rid of it. With chronic fatigue syndrome, the blood circulation process is disturbed, therefore, the process of saturation of the blood with useful substances. The autonomic nervous system begins to work worse, the heart rate increases, and headaches occur.
Chronic fatigue headache
Headache is one of the signs of the disease. With chronic fatigue syndrome, it is aching, dull, spilled over the entire head. Medicines help mildly or relieve the headache for a short time, and then the pain occurs again.

Headaches in chronic fatigue syndrome. Diagnostics

Signs of chronic fatigue syndrome are:
• Constant severe fatigue, although there is no reason for it;
• Weakness, drowsiness;
• Myalgia;
• Joint pain;
• Insomnia at night;
• Subfebrile temperature;
• Photophobia;
• Soreness in the lymph nodes;
• Forgetfulness, memory impairment;
• Headache.
The difference from ordinary physical fatigue is that the patient does not recover even after a long rest. Any business is difficult. Studies show that with chronic fatigue syndrome, there are disturbances in the work of the gastrointestinal tract, kidneys, heart, sweating at night may occur.

Headaches in chronic fatigue syndrome. Treatment

How to get rid of a headache?
The cause must be treated: chronic fatigue syndrome.Getting rid of it is not easy. It is necessary to improve the general condition of patients. Normalize sleep, restore physical fitness and mental activity.
Green Clinic employs specialists with extensive experience in the treatment of various types of headaches. You need to see a neurologist. He will listen carefully to the patient. Conduct a survey and survey. If necessary, appoint additional laboratory tests.
The treatment will be comprehensive. If necessary, the doctor will prescribe medications.Supplement the treatment with a complex of vitamins. Possibly
will recommend a massage and a kinesiologist’s consultation. One of the effective methods of treatment is kinesio taping. It improves the functioning of the autonomic nervous system, relieves the effects of stress.
Green Clinic experts recommend observing the work and rest regime, changing the daily routine, including walking in the fresh air and physical activity.
But if you need help getting rid of a headache, we will always help.
Still have questions? Call us and we will tell you how to make an appointment and what you need to do.

Headaches in chronic fatigue syndrome. Treatment services

Cost of treatment

Excerpt from the general price list. Information about the cost of other services can be obtained by calling 8 (995) 905-03-03. Please check in advance the list of services and their cost. Consultations of a doctor of the same specialization, within the framework of one disease, until the cure or removal of an exacerbation of a chronic disease, or the end of the diagnostic case (diagnosis) are considered repeated.In disputable cases, the status of the consultation is finally determined by the doctor at the appointment. Prices are given as a reference and are not a public offer. Thank you for understanding!

View all service prices

90,000 Headache treatment.Neurology at TN-Clinic

Headache is one of the symptoms of a person’s ill health.

The presence of a headache can be a signal of the development of many diseases – diseases of the spine, problems with blood vessels, infectious and ENT diseases, endocrine and metabolic changes in the body, injuries.

Therefore, in the event of systematic headaches, it is necessary to consult a neurologist – a specialist in the treatment of headaches .

What is headache talking about?

Headaches – well-known to everyone, unpleasant, painful sensations, usually arising in the area of ​​the projection of the brain. They can be different in time – from very short to very long, can have variable intensity – from weak to unbearable, can be localized both in one area, and be “blurred” – all over the head. Headaches strongly depend in their manifestations on the cause that causes them.

Headaches are not a specific disease, they are one of the symptoms of a person’s ill health, and often patients tend to treat them superficially, eliminating the discomfort by taking widely advertised pain relievers. However, it is worth knowing that the presence of a headache can be a signal for the development of many pathologies – spinal lesions, problems with blood vessels in the form of acute circulatory disorders in the brain or strokes, neurological disorders, infectious and ENT diseases, endocrine and metabolic changes in the body, injuries and others. brain damage.

Headache affects people of different ages, its intensity is measured from very moderate – like a feeling of pressure, to simply intolerable, such as with migraines or with increased intracranial pressure. A headache can occur in completely healthy individuals with overwork or sudden changes in the weather, but such pains quickly disappear after rest and without the use of medications, or with a single dose of painkillers. But if you suffer from repeated attacks or prolonged pain in the head, it is very important to consult a neurologist in order to find out their true causes and eliminate them as quickly as possible.

The most common types of headaches

Migraines – acute throbbing pains that form as an attack lasting from several hours to several days. Often, such pains originate in one of the halves of the head, are accompanied by phobia and sound, nausea with bouts of vomiting. In such situations, the usual pain relievers do not help, and the causal factors are not fully understood. They can be triggered by hormonal fluctuations, acute stress, prolonged fasting, bright flashes of light and odors, food, and changes in the weather.The predisposition to migraine tends to be inherited.
Headaches with pressure fluctuations cerebrospinal fluid (CSF) inside the cranial cavity occur as a result of trauma or hemorrhage, hematomas or brain tumors. With such a pain in the head, vomiting, attacks of dizziness, severe drowsiness or agitation, general malaise, and visual disturbances are also characteristic. Pains are localized in the area of ​​the temples, on the surface of the forehead, in the back of the head or throughout the head, provoked by stress, overwork or changes in weather.

Headaches after trauma to the skull tend to last for several months from the moment of injury and can be supplemented by anxiety, decreased concentration and distracted attention, irritability and dizziness, depressive moods.

Tension headaches can be accompanied by a feeling of fatigue and muscle spasm, they are caused by physical or mental stress, can be provoked by muscle spasm in the neck, severe emotional distress or stress.
Neck headaches can be moderate or severe, localized from the neck to the back of the head, temples and eyes, while a person experiences nausea, dizziness and staggering when walking. May occur as a result of sudden movements in the neck, overwork and colds, osteochondrosis

Doctor neurologist Ambandaryan Anahit Genrikovna talks about what headaches are and in which cases the help of a neurologist is required.

Abuse headaches. An ordinary classic tension headache can be complicated by a second drug-induced headache if a person takes painkillers more than twice a week for more than 2 pcs. In this case, it is necessary to treat already two headaches.

Muscle pain

Considering that often the head hurts precisely because of the spasm of the neck muscles, it is worthwhile to dwell on this problem in more detail. Due to prolonged exertion, pains in the neck and back often occur, which are felt by patients as spasms or tension, or may go unnoticed for a long time.These muscle spasms disrupt normal blood circulation in the neck, spine and head, which can lead to fatigue, tension and headaches, impair performance and reduce activity.

Spasmodic muscles require increased energy consumption, they pinch nerve fibers and blood vessels, due to which the metabolism and the work of internal organs suffer, pain and stiffness in movements occur. The reasons for their occurrence are:

• Osteochondrosis with protrusions and herniated discs,
• Injuries and bruises of the spine, muscle injuries,
• prolonged static loads in case of incorrect posture, prolonged sitting, carrying bags on one shoulder,
• Emotional stress with increased muscle tone.

In this case, zones of pain, tension and spasm appear in the area of ​​the trapezius muscle, rectus muscles of the back, lifting the scapula and others. There are pains of a pressing, aching or boring character, they are unstable, can intensify and fade, give to the shoulder, eyes or head. Sometimes, muscle pain disrupts the full range of movement of the limbs or turns of the head.

Diagnostics and treatment of headaches in TN-Clinic

Any headache patient needs a physical examination and examination to identify the cause of the pain.The complex of examinations, depending on the patient’s complaints, may include:

After the examination, the doctor will be able to develop a treatment program. In each case, the method of treatment and the choice of drugs are carried out taking into account the individual characteristics of the course of the disease, research data and the state of the body. Methods in the treatment of headaches can differ significantly, include the use of drugs, manual therapy, reflexology and other methods of influencing the body.An individual treatment program is developed for each patient.

Manual therapy is a great help in curing headaches, which will eliminate both the pains themselves and their most common causes – spasms and muscle clamps. At the same time, an experienced manual therapist, through special manipulations, conducts a smooth and accurate spasm relief and restoration of full-fledged muscle work, which relieves pain and normalizes the range of motion. Doctors of TN-Clinic treat such conditions quite effectively.Another well-established method of headache treatment is lymphatic therapy.

Questions still

You can always make an appointment and get detailed information from the specialists of our advisory department by phones:

+7 (495) 210-02-48 +7 (495) 799-02-06

Make an appointment
90,000 Weakness after coronavirus, headache after coronavirus

Weakness after coronavirus, headache

Residual symptoms after recovery from coronavirus can persist for a long time.But the most unpleasant and exhausting feeling is constant fatigue, weakness after coronavirus, headaches.

When you urgently need to make an appointment with a therapist

• Weakness after coronavirus
• Headache after coronavirus
• Kidneys hurt after coronavirus
• After the coronavirus, the lungs hurt

In order to get rid of the consequences after the coronavirus as soon as possible, you must strictly adhere to all doctor’s prescriptions.
Make an appointment for the nearest free time by phone +7 (343) 345-16-85 or WhatsApp +7 (964) 486-67-04
We will help you!
You can pass all the necessary tests, undergo examinations with us at the IMC Health.90,033 90,246 Coronavirus recovery prices 90,247

The GP will draw up a recovery plan and refer you to our Day Hospital if necessary.Patients come in the afternoon, receive the necessary procedures, rest, return home or work.

Day hospital by appointment

Qualified medical personnel will guide you through your prescribed procedures (intramuscular and intravenous injections, drips, and other treatments).
You can sign up for a day hospital by calling +7 (343) 345-16-85 or WhatsApp +7 (964) 486-67-04

The day hospital in Yekaterinburg is located in the Medical Medical Center Health at the address: st.May Day, 104/1. We work only on weekdays. We don’t work on weekends.

FATIGUE AND PAIN IN THE SHOULDER BELT AND SPASM, TENSION OF THE MUSCLES IN THE COLLAR AREA

The tension of the muscles of the shoulder girdle and neck is often the cause of headaches, fatigue and discomfort in the muscles, pain of various kinds.

Although pain in the shoulder girdle can be present without muscle tension. It would seem that the muscles are soft on palpation, however, they also have trigger points, large seals that cause fatigue and pain.

In this case, points 6 and 2 should be palpated and inactivated first (shown in Fig. 5). They are located in the corner above the shoulder girdle at the shoulder joint and in the middle of the shoulder girdle surface, either slightly posteriorly or anteriorly.

Trigger points are quite large muscle compacted masses such as veins, which are quite amenable to inactivation. At the same time, they are often painful. More often there is a feeling of pain from the inside.

After inactivation of such trigger points, muscles often hurt for up to several days after the procedure.If the muscle tension has not gone away, you should work out the higher and lower lying zones.

Neck, cranio-vertebral region can lead to muscle spasm of the shoulder girdle. After inactivation of trigger points in the muscles of the neck and nape, tension in the muscles of the shoulder girdle is released

After inactivation of these trigger points, muscles
spasmodic in the upper part of the shoulder girdle, shoulder girdle and neck relax.

Tension of the lower part of the muscles between the shoulder blades may persist. In this case, one should look for trigger points that keep the spasm in the muscles, in the area between the shoulder blades from their wings to the spine and in the paravertebral region along the spine.These are points 7, 4, 5, 3 shown in Fig. 5 and closer to the spine.

These points are also often painful when they are inactivated.
May produce an itchy sensation. In one patient suffering from chronic bronchitis and diseases of the stomach and intestines, trigger points between the lower part of the scapula and the spine on the left side gave an itching sensation, which she associated with radicular syndrome. After inactivation of these trigger points, itching became less.

Often the tension of the muscles of the shoulder girdle causes trigger points in the muscles of the levator scapula, which makes it painful to raise the arm and in the suprascapularis muscle.In this case, trigger points should be inactivated in the muscles above the scapula and in the region of the deltoid muscle, the shoulder joint and the inner side of the shoulder.

With successful inactivation of these trigger points, the pain disappears, muscle spasm relieves, the arm rises more easily and the range of motion increases. Discomfort and painful sensations in the shoulders and between the shoulder blades disappear.

Also approximately in this area, the upper point in the area of ​​the transition of the shoulders to the neck can give pain when turning the head during lumbago and exacerbation.It is used in the DENS-therapy complex with a frequency of 77 Hz, for pains of 20 Hz, a reflex effect on the zones according to the Su-Jok system.

If the muscle spasm persists and one portion of the muscles remains tense and the inactivation of trigger points does not lead to success, you should look for trigger points in the paravertebral muscles. Along the spine, near the vertebrae, small trigger points are often located, which cause a spasm of a particular group or portion of a muscle.

Classification of headache and its treatment.

14 December 2018

Headache is the most common complaint among patients seen by a neurologist. According to the classification, there are 2 types of headaches: primary and secondary.

Primary headaches include tension headache, migraine, trigeminal neuralgia, and cluster headache. Secondary headaches can occur due to neck pathology, with the abuse of analgesics, after head injuries, against the background of infections.

Let’s consider the most common options.

Migraine is usually characterized by severe throbbing headache accompanied by nausea, intolerance to bright light and strong odors, and general weakness. The pain is usually one-sided. The duration of an attack can be from several hours to three days.
Tension headache is most often mild, but may recur regularly and last for up to a week. The nature of the pain is pressing or squeezing, can spread both to the entire head and to its part – the back of the head, forehead, crown.This type of pain occurs in those who, by the nature of their activity, often experience prolonged muscle tension (forced posture while working at a computer, driving a car, uncomfortable position during sleep), are constantly exposed to psycho-emotional stress.

Cluster headache of a pulsating nature, usually unilateral, in the forehead or eye area, sometimes accompanied by redness, swelling, lacrimation. Attacks usually last from 20 minutes to an hour and a half, but in severe cases, they can be repeated several times a day for several weeks.

Headache caused by infections, usually accompanied by fever, chills.

With meningitis, headache is acute, throbbing, with a temperature of 37.5 degrees and above, vomiting.

Post-traumatic headache occurs when a bruise or concussion of the brain, damage to the skull or cervical spine. The nature and location of pain directly depends on the type of injury.

Sinus headache occurs due to inflammation in the sinus area, usually accompanied by mucosal edema, nasal congestion, and a runny nose.