Normal pressure hydrocephalus remains a clinical diagnosis and standardized clinical assessments predict a positive response to shunting in most patients.
It is recognized that most cases of chronic tinnitus are generated by central brain mechanisms that may be amenable to treatment with cognitive therapies and magnetic stimulation protocols of the temporal and frontal lobes.
Celiac disease (CD), also known as gluten-sensitive enteropathy as well as two older and no longer recommended terms,3 nontropical sprue and celiac sprue, is a chronic immune-mediated disorder induced by dietary gluten in genetically susceptible individuals. In CD patients, the ingestion of gluten results in the development of small intestinal mucosal villous atrophy with crypt hyperplasia and mucosal inflammation. Patients may be asymptomatic or may manifest classic malabsorptive symptoms of abdominal pain, bloating, weight loss, diarrhea, and steatorrhea. They also may present along a spectrum with more subtle gastrointestinal and/or extraintestinal symptoms and signs of the disease; virtually every body system can be affected.
Sjogren's syndrome is an autoimmune condition that leads to chronic inflammation with salivary and lacrimal gland dysfunction. The diagnosis of Sjogren's often is delayed by several years because the initial presenting symptoms can be non-specific. However, some manifestations of Sjogren's may be life threatening, including brain damage and cancer. It is very important for the primary care physician to recognize the early signs and symptoms and to initiate the appropriate workup and treatment in coordination with consulting specialists to prevent further morbidity and mortality.
