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A lawyer with a drink problem
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Patients should receive treatment to counteract the increase in sympathetic activity. Benzodiazepines are the drug of choice; chlordiazepoxide (Librium) or diazepam is commonly used. The dose should be titrated so the patient is calm (many hospitals have a protocol for the safe prescription of a detoxification regimen). Care should always be exercised in patients with cirrhosis, due to the effect on the half-life of benzodiazepines.
Developmental Trauma
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
The early years are vital. We are biologically predisposed to respond to potential danger by flight, flight or freeze, and quick surges of adrenalin and the release of cortisol are essential and lifesaving when a predator such as a man-eating tiger appears. Generally, after such shocks the body quickly goes back to normal, with blood pressure and heart rate reducing as we relax. The psychiatrist and neuroscientist Bruce Perry has described how traumatised children can barely relax, are constantly on the move and are in a desperately anxious and hyper-vigilant state. Such heightened physiological responses are a sign of a highly activated sympathetic nervous system. There is another response to the nervous system to stress and trauma, an activation of the parasympathetic nervous system. Here the body closes down, rather like a creature ‘playing dead’ in front of a predator. Blood pressure and heart rate drop and parts of the brain that specialise in logical thought often shut down, while primitive survival mechanisms take over. This can give rise to the phenomenon of dissociation, in which an individual can seem to be cut off from their own experience. This may be part of the explanation why many children from highly stressful backgrounds often do not achieve well academically. They have learned to cope by being hyper-alert to danger, which impedes ordinary relaxed concentration, or they may go into a shut-down dissociative mode in which the thinking part of the brain shuts down.
Horner's Syndrome
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Common causes of a dilated pupil include: Mydriatic eye drops (atropine/homatropine).3rd cranial nerve lesion (absent or sluggish light and accommodation responses).Sympathetic over activity.2nd cranial nerve lesion, e.g. optic atrophy (direct light and accommodation reflex absent but consensual reflexes are intact).Myotonic pupil (Holmes Adie pupil) seen commonly in young women; is usually unilateral; slow reaction to bright light; incomplete constriction to convergence; often associated with decreased or absent tendon reflexes.
Anterior cervical discectomy and fusion is more effective than cervical arthroplasty in relieving atypical symptoms in patients with cervical spondylosis
Published in British Journal of Neurosurgery, 2022
Giovanni Grasso, Fabio Torregrossa, Brian A. Karamian, Jose A. Canseco, Alexander R. Vaccaro
The wide range of atypical symptoms, including vertigo, tinnitus, palpitations, headache, blurred vision, hypomnesia, and nausea, was previously deemed unrelated to spondylosis due the lack of explanation for their root cause. The mechanism behind these sympathetic symptoms is poorly understood, although several theories have been proposed. Barre and Lieou noted that pathologic changes in the cervical metamers can affect the blood flow in the vertebral arteries, causing cervical pain, dizziness, and headaches.30 This symptomatic presentation was termed ‘Barré-Liéou syndrome’ or ‘cervical vertigo’.31 Over time, other sympathetic symptoms were added, such as vomiting, blurred vision, and palpitations.23,32–34. It has also been proposed that direct mechanical compression of vertebral arteries by osteophytes stemming from the uncovertebral joint or segmental instability of the cervical spine could also be contributors of atypical symptoms.35–37. However, it seems unlikely that a reduction in vertebral artery flow could present as atypical symptoms in the absence of ischemic complications in the territories they perfuse.
Effects of psychosocial stress on prosociality: the moderating role of current life stress and thought control
Published in Stress, 2022
Lisa Hensel, Nicolas Rohleder, Cornelia Niessen
This study examined whether and when acute stress responses impact prosociality. We considered a broad range of responses to stressors in the laboratory and in daily life, such as subjective stress responses (negative affect), heart rate and alpha-amylase as indicators of an activated sympathetic nervous system, and cortisol as indicator of hypothalamic-pituitary-adrenal axis activation. The sympathetic nervous system is the initial response to stress and rapidly promotes physiological changes, some time later, the activation of the hypothalamic-pituitary-adrenal axis follows in response to signals of the sympathetic nervous system (Everly & Lating, 2019). Contrary to our hypothesis, acute stress responses (e.g., negative affect, alpha-amylase, cortisol) were positively rather than negatively related to prosociality, but in the case of salivary cortisol, only when individuals’ general stress level was low. Additionally, our research indicated that applying a thought control strategy resulted in weaker stress responses (negative affect) compared to participants in the control group. Thought control ability had no impact on acute stress responses and prosociality.
Adrenal disorders in pregnancy, labour and postpartum – an overview
Published in Journal of Obstetrics and Gynaecology, 2020
Madhavi Manoharan, Prabha Sinha, Shabnum Sibtain
The signs and symptoms of pheochromocytoma mimic those of severe pregnancy-induced hypertension. This can be associated with other sympathetic symptoms and signs such as palpitations, tachycardia, sweating, seizure disorders, anxiety attacks, chest pain, dyspnoea, nausea and vomiting, pallor, and flushing. Pheochromocytoma should be considered in cases of refractory hypertension in pregnancy and appropriate investigations should be carried out to differentiate from pre-eclampsia. The presence of paroxysmal hypertension after 20 weeks of pregnancy with orthostasis and absence of proteinuria and oedema helps in differentiating from other causes of hypertension in pregnancy. It is also necessary to distinguish from hyperthyroidism, where significant diastolic hypertension is not seen.