Faculty Bibliography

We discuss four patients with the clinical diagnosis of basilar migraine and suspected coexisting epilepsy who were referred to our epilepsy center. Their symptoms suggested episodic dysfunction in the distribution of the basilar artery, followed by pulsating headache with nausea. Verbal unresponsiveness and sensory symptoms occurred in all four patients; two also had focal paresis or jerking movements. Diagnostic studies excluded other disorders with similar symptoms. None of the patients improved with antimigraine or antiepileptic drugs. Provocation tests with suggestion elicited typical events in three patients and aura and headache in one patient. There were no EEG or ECG abnormalities during spontaneous or provoked episodes. Two patients improved with psychiatric treatment. Conversion disorder or malingering should be considered in patients whose symptoms of basilar migraine are atypical or refractory to treatment

Low back injuries occur commonly in tennis, but the pathophysiologic, biomechanical, and clinical characteristics are not well defined. Tennis players may be at an increased risk of lumbar disc pathology from rotational and hyperextension shearing effects. Treatment of low back injury at present is empiric, but sport-specific lumbar stabilization and unloading of the lumbar disc should be developed. Prospective longitudinal research protocols are needed to study the lumbar spine in tennis players

Headache is very common among women of childbearing age and can be influenced by hormonal fluctuations. When pregnant women develop headache, the cause is usually tension-type headache or migraine, but headache may be a symptom of a more serious neurologic or medical condition. This article discusses the differential diagnosis and management of major causes of headache during pregnancy

Sports medicine physicians should be able to recognize and manage peripheral nerve injuries in athletes. Most often, the injury is a result of repetitive microtrauma, linking peripheral nerve injury to other musculoskeletal injuries in athletes. As with other musculoskeletal injuries, rest and a modification of the athlete's regimen often lead to clinical improvement. If the physician is uncertain about the diagnosis, if the athlete develops a rapid worsening of symptoms and signs, or if the athlete is refractory to treatment, a physician who specializes in peripheral nerve injuries should be consulted

Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compression. Eight had known cancer, the ninth an epidural abscess. Lower-extremity dysmetria, gait ataxia, or both, were the only neurologic signs in five patients. An incorrect initial diagnosis led to delay in treatment and subsequent neurologic deterioration in six patients. Failure to recognize isolated, painless ataxia as the initial manifestation of spinal cord compression and appropriately treat the disorder can result in irreversible spinal cord deterioration