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Chronic Headache on One Side and Newly Lost Vision in an Eye of the Other Side

发表于 11-19-2020 16:39:03 | 显示全部楼层 |阅读模式
本帖最后由 choi 于 11-21-2020 07:54 编辑

Lisa Sanders, She Had a Headache for Months. Then She Could Barely See. New York Times Magazine, Nov 1, 2020
https://www.nytimes.com/2020/10/ ... tinua-melanoma.html
https://mednerds.tumblr.com/post ... nths-then-she-could

(a) The neurologist "referred the patient to Dr Robert Lesser [age 78; MD Cornell 1967; Clinical (meaning not 'Research'] Professor Yale School of Medicine; not certified by any board: all in his LinkedIn page], a neuro-ophthalmologist just outside New Haven, Conn [in private practice]. * * * The constant presence of the headache, and for weeks at a time, immediately brought to Lesser's mind a rare condition called hemicrania continua. As the name suggests, it's a unilateral headache that persists long past the normal duration [of a migraine] and is often accompanied by eye redness or tearing. It's a strange kind of headache, related to other odd headaches — like cluster headaches — in which the underlying causes are still mysterious. He'd seen maybe 20 cases in the past. While those patients often had eye symptoms, they were always on the same side as the headache. This patient reported changes in the other eye. What would cause pain on one side and a loss of vision on the other? * * * Lesser sat down with the woman. It was a good news-bad news type of conversation. She may be able to get rid of her lifetime headache with a pill she would take twice a day. But she also may have one of the most dangerous forms of cancer known [malignant melanoma of the retina]. * * * she started taking indomethacin right after she saw Lesser. It took a couple of weeks, but finally her headache melted away and, for the most part, has stayed away. She had a hint of a recurrence and started the indomethacin immediately, and the throbbing pain vanished and hasn't come back."
(A) migraine
("from Old French migraine, migraigne (13c.), from the vulgar pronunciation of Late Latin [noun feminine] hemicrania * * * from [Ancient] Greek hēmikrania, from hēmi- half + kranion skull")
(B) vulgar (adj; from Latin [adjective masculine or feminine] vulgaris [common], from [noun neuter or masculine] vulgus [uncountable] common people): "dated  characteristic of or belonging to ordinary people"
(ii) hemicrania continua
(A) Latin-English dictionary:
* continua (adj): "nominative feminine singular of [adj masculine] continuus [continuous]"
(B) The description of headache in this NYT article is typical of migraine, except long duration.
(C) The cause of hemicrania continua (English: continuous headache) is unknown. Somehow, indometacin is powerful in its treatment.  (The cause of migraine is also unknown. Indomethacin is also helpful. Due to its side effect, however, indomethacin is not the drug of first choice in managing migraine. The mechanism of action for indomethacin is unclear.)
(D) indometacin, whose United States Adopted Name
, or official name, is indomethacin. PubChem, undated
("is a non-steroidal anti-inflammatory drug (NSAID) * * * NSAIDs consist of agents that are structurally unrelated; the NSAID chemical classification of indometacin is an indole-acetic acid derivative")

One may click the chemical structure to enlarge it.
(E) indole
(section 2 History: in 1866, Adolf von Baeyer [different from the founder of Bayer] made it)

indole (n; from indigo [whose English and German spelling is same; from Ancient Greek Indikòn Indian dye, from India (Ancient Greek and Latin spelling is same for India)] + [Latin noun neuter] oleum [olive oil])

Historically, indigo was a natural dye extracted from the leaves of Indigofera tinctoria 木蓝 (legume 豆科) but is mostly synthesized. "Marco Polo (13th century) was the first European to report on the preparation of indigo in India." Wikipedia. The chemical structure of indigo can be found in
. Indole "was firstly isolated from indigo reduction process": from the Web. In other words, chemically indigo is made up of two indole molecules(each with an oxygen atom that needs to be removed to make indole) that molecules linked together.

(F) pyrrole
("is a colorless volatile liquid that darkens readily upon exposure to air"/ section 2 History: name)

The accented first syllable of pyrrole is same as that in pillow.

Hawkins SJ and Ratcliffe NM, A Study of the Effects of Acid on the Polymerisation of Pyrrole, on the Oxidative Polymerisation of Pyrrole and on Polypyrrole. Journal of Materials Chemistry 10: 2057 (2000)
https://pubs.rsc.org/en/content/ ... 01912g#!divAbstract
(abstract: "The polymer products arising from the hydrochloric acid treatment of aqueous pyrrole were shown to have spectroscopic data consistent with alternating pyrrole and pyrrolidine units with varying degrees of ring opening of the pyrrole units. The acid catalysed polymerisation of pyrrole offers a facile route to polymers with amine and carbonyl functional groups, which could be further derivatised")

(a colourless liquid)
has a ring of all single bond, compared with two double-bonds in pyrrole. The accent of pyrrolidine is in the second syllable.

(b) "He [Lesser] took pictures of the back of her eyes * * * There are two places of special interest in the retina. The optic disc is the area where the [optic nerves carrying visual information connect to the brain. Increased pressure in the eye, from a mass or from glaucoma, can cause swelling or atrophy in the nerves, which can often be seen. But in this woman, the optic nerve on both sides looked completely normal. Another region on the retina, called the macula, is where most of the visual receptors [cones (for color vision)] are located [rods for black-and-white vision are in other parts of the eye OTHER THAN MACULA]. This tiny region is responsible for most of our color and detail perception. In this patient, the macula was normal on the right but appeared swollen and discolored on the left [eye]. * * * The woman saw Dr Thomas Berenberg, a retina specialist in Lesser's group practice. It was melanoma. She had radiation therapy, which eliminated the growth in her eye. * * *  that was nearly a year and a half ago."
(i) The patient in this NYT article feels lucky. That is because her melanoma occurred in macula, which affected eyesight right away; if the melanoma had arisen elsewhere in the eye, it would have taken longer for symptoms to show up.
(ii) If one looks at a human eye from the top of the head, the macula is straight back and optic disc (the start of an optic nerve) deviates to the median plane.
(iii) One uses an ophthalmoscope to do ophthalmoscopy.

In ophthalmoscopy, the background of the eye is reddish (due to capillaries with blood in them); macula red and optic disc yellowish and round (when normal).

(c) Regarding eye melanoma. Whether it arises in macula or elsewhere in the eye, it is called choroidal melanoma or uveal melanoma.
(A) Paul T Finger, MD, Choroidal Melanoma. New York Eye Cancer Center, undated
https://eyecancer.com/eye-cancer ... choroidal-melanoma/
("The wall of the eye has 3 main layers. From outside to inside there is: the white sclera, a blood vessel layer called the uvea (choroid, ciliary body and iris) and an inner retinal layer. Further, the pigment producing cells, “melanocytes” are primarily found in the vascular uveal layer. It is those melanocytes that can turn into malignant melanoma. Therefore, when melanoma happens in the choroid, they are called “choroidal melanoma,” the most common primary intraocular malignancy in adults. That said, choroidal melanomas are rare with 5 to10 out of each million people diagnosed with a choroidal melanoma each year. Choroidal melanomas can spread to other parts of the body")
(B) Wikipedia uses uveal melanoma (uveal is adjective of the noun uvea, in English), because Wikipedia includes Iris melanoma (see photo), more than choroidal melanoma. See uveal melanoma
("Tumors arise from the pigment cells (melanocytes) that reside within the uvea and give [from brown (in iris) to purple to balck] color to the eye. These melanocytes are distinct from the retinal pigment epithelium cells underlying the retina that do not form melanomas")
(ii) The adjective choroidal (whose accent is on the second syllable) has a corresponding noun choroid (whose accent is on the first syllable).
(iii) uvea
(section 1 History and etymology: "The originally medieval Latin term [meaning the English noun uvea was Medieval Latin of the same spelling] comes from the Latin word [noun feminine, singular] uva grape and is a reference to its grape-like appearance (reddish-blue or almost black colour, wrinkled appearance and grape-like size and shape when stripped intact from a cadaveric eye)." * * * section 2 Structure: "The uvea is the vascular middle layer of the eye. It is traditionally divided into three areas, from front to back, the: • Iris   • Ciliary body   •Choroid")
(iv) choroid
("human choroid is thickest at the far extreme rear of the eye (at 0.2 mm), while in the outlying areas it narrows to 0.1 mm [citation omitted]. The choroid provides oxygen and nourishment to the outer layers of the retina. Along with the ciliary body and iris, the choroid forms the uveal tract" or uvea)

uveal melanoma
(iii) Henkes HE and Zrenner Cl (eds), History of Ophthalmology: Sub auspiciis Academiae Ophthalmologicae Internationalis. vol 3. kluwer academic publishers, 1990, at page 32
https://books.google.com/books?i ... mp;lpg=PA32&dq="ancient+greek"+choroid+grape&source=bl&ots=QdLW0YKz2Y&sig=ACfU3U28AeMQMlcXl9zsoUVaddDrMqtbmA&hl=en&sa=X&ved=2ahUKEwiUz8-K6o_tAhXhFVkFHc-SCtA4ChDoATABegQICRAC#v=onepage&q="ancient%20greek"%20choroid%20grape&f=false

Meletius was a Byzantine author.

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