Presenting Complaint In Patients Research Articles

Tests of thyroid function in chronic headache patients.

SYNOPSISChronic, poorly localized headaches have been reported to be a not uncommon presenting complaint in patients with hypothyroidism. A study was performed to test the hypothesis that TSH measurement and TRH stimulation testing would identify some patients with hypothyroidism presenting as headache. Twenty‐one patients were tested, and none were found to be hypothyroid by these two measures. Thyroid testing may still be useful where the headache is accompanied by other symptoms of hypothyroidism, however.

Sudden deafness as the presenting symptom of acoustic neurinoma.

Sudden hearing loss is an unexpected presenting complaint in patients with acoustic neurinomas. In our series of patients with eighth cranial nerve tumors, approximately 10% (four of 44 patients) had such a history and their cases are discussed here. All four patients had sensorineural hearing loss and abnormal vestibular responses, but only one showed overt neurological disturbance otherwise. Internal auditory canal roentgenograms and cerebellopontine-cistern myelogram results were abnormal in each case. The factors causing sudden deafness are reviewed, although acoustic neurinomas rarely have been reported. It is suggested that patients with sudden hearing loss be carefully evaluated, including routine internal auditory canal roentgenograms and cerebellopontine-cistern myelography in equivocal cases.

Impotence in the Low-Back Syndrome

To the Editor:— We should like to disagree with the answer given to the questioner who asked for an explanation of the difficulty in erection and sexual intercourse associated with herniated lumbar disks. The answer given implies that the sexual impotence in the male patient with lumbar disk disease is related to psychologic causes secondary to "a nearly fatal assault on his manhood." We have found that impotence can often be associated with lumbar disk disease, and that the cause is organic and not psychologic in these cases. It is not necessary that there be a massive posterior protrusion of the L4-5 disk with paraplegia in order for impotence to occur. Indeed, impotence may occasionally be the presenting complaint in patients with occult lumbar disk disease ( New York Med J 69 :2465, 1969), and can be completely relieved following surgical correction of the herniated disk. Clinical experience in patients with

Hernia as the Presenting Complaint in Patients with Cirrhosis of the Liver and Ascites

Hernia as the Presenting Complaint in Patients with Cirrhosis of the Liver and Ascites