Fuel Production and Other Requirements
In addition to developments in transport technology, two complementary fuel production trends emerge in the sustainable transport scenario described here. The first is an increasingly important role of biomass as a primary feedstock, and the second, somewhat related, is the development of a hydrogen and alcohol-based energy system. Creating the production and distribution infrastructure required for largescale deployment of these fuels poses a number of challenges.
In the case of alcohols some of these challenges may be relatively easily overcome, since alcohol fuels have some advantages in that they can be distributed using similar infrastructure to that employed for petroleum fuels. However, the emergence of a sustainable transport and energy system may well require the deployment of hydrogen-based technologies. To supply these technologies with fuel, it is likely that major capital-intensive investment in hydrogen production and distribution infrastructure will be necessary. Moreover, as is often cited, much of this infrastructure will need to be developed before there exists sufficient demand to make it commercially viable. However, because of the significant social benefits of sustainable development that may arise from H2 deployment it is important that adequate investment is directed towards this infrastructure. This identifies an important role for public support, or innovative schemes to share the risk of large-scale capital-intensive infrastructure investment. Moreover, given the likely monopoly nature of a hydrogen distribution network, there exists an important role for government in overall strategic co-ordination of investment to guarantee an efficient network, in addition to more traditional roles in regulation.
In the sustainable transport scenario presented here, both alcohols and hydrogen are synthesized predominantly from biomass. This is despite the fact that creating an energy system in which biomass is one of the main primary feedstocks poses a number of significant challenges. Biomass is favoured because without major technological breakthroughs—for example, that result in a large surplus of cheap renewable energy for large-scale electrolysis, or very large-scale carbon capture and storage—there are relatively few long-term cost-effective alternatives to biomass for transport fuel synthesis. One possibility not included in the modelling framework applied here is hydrogen produced from high-temperature nuclear reactors (for example, see DOE although nuclear energy is already heavily exploited for electricity generation in this scenario suggesting there may be limited scope for further applications.
|
|
|
The challenges facing large-scale sustainable biomass mobilization relate particularly to finding sufficient productive land to devote to fuel production, while satisfying increasing human needs for food and fibre, and at very least maintaining environmental amenity. The scale of biomass production is best illustrated by considering that the resource potential identified by Rogner (and used here) was based on the availability of an additional 1.3 billion ha of land globally. Clearly, biomass production on a scale of this order of magnitude must address other aspects of sustainable development, including effective water and soil management, nutrient recycling and preservation of organic matter In addition to a significant transformation to land management systems, and utilization of all organic waste streams, sustainable biomass production faces other challenges. Harvesting and transporting biomass to fuel synthesis plants represents a significant logistical challenge, although this may promote smaller-scale decentralized alcohol and hydrogen synthesis close to the feedstock source. Such decentralization, however, may merely shift logistical difficulties further down the production chain. On the other hand, there may also be benefits compared to today’s relatively centralized oil industry because fuel production and demand centres may be proximate (compared to today’s oil industry which relies on long-distance transport), and the fuel production system will no longer necessarily depend on a small number of large critical infrastructures—such as pipelines, shipping terminals and refineries—but instead on a less vulnerable network of energy producers.
However, developing such a sustainable biomass-based energy production system is likely to require a long-term overall strategic vision and substantial investment, and face long lead-times before becoming profitable. This highlights the need for innovative approaches to investment, including public–private partnerships. Moreover, the major transformations to the energy and complementary systems described here may be particularly challenging in the developing world, where many of the systems may need to be established from scratch. Accordingly, realizing longterm sustainability is likely to also require major international partnerships to promote technology transfer and investment in new energy, transport and supporting system infrastructure.
|
|
|
Text 7
Fighting For the Planet
The giddy price of oil subsumed most talk of the environment in 2008; in 2009 the price of carbon will be the most pressing question. In America, the new president has pledged to cut emissions by instituting a cap-and-trade scheme: expect a drawn-out battle in Congress. Meanwhile, the European Union will be fine-tuning the rules for the next phase of its carbon-trading scheme. New Zealand is launching one too. And all around the world politicians will be debating how to update the Kyoto protocol, the United Nations' treaty on climate change, a successor to which is supposed to be agreed upon at a summit in Copenhagen in December.
As with free-trade deals, the proliferation of regional and local carbon-trading schemes is likely both to spur efforts to reach a global accord and to complicate them. In America, ten north-eastern states have grouped together to form the Regional Greenhouse Gas Initiative, a cap-and-trade scheme among utilities that starts running on January 1st. Opponents of emissions-trading will hold up every glitch as an example of how misguided the whole concept is; proponents will insist it proves emissions-trading is viable, whatever its flaws.
Western states plan another, more ambitious programme, while Midwestern states are working on a third. To make matters even more complicated, several Canadian provinces plan to participate in the various American initiatives, in protest at the relative modesty of Canada's own national scheme. Australia and New Zealand will try to link up their respective systems. And there will be a row, complete with legal battles, over the eu's plan to levy a carbon tax on flights to or from Europe. As a negotiating stance, the regions and countries with more stringent policies will insist that national and global arrangements must not pander to the lowestcommon denominator. But they will also be quick to scale back their green ambitions if efforts to set up broader trading schemes founder.
|
|
|
All this uncertainty will not be good for the carbon markets. Prices will be volatile, providing more ammunition to those who dislike the idea of emissions-trading, in particular, the market for the sort of offset sanctioned by the Kyoto protocol will dry up, as buyers wait to see what the future holds. That will make life difficult for the firms that have sprung up to take advantage of the Clean Development Mechanism, as the offset provision is known, and so hamper the launch of a future global carbon market, if one is set in motion at Copenhagen.
Text 8
More Silicon, Less Carbon
"Please consider the environment before printing this message." Those words, appearing at the bottom of many e-mails, are a visible manifestation of a trend that will gather momentum in 2009: the move towards more environmentally friendly information technology, or "green it". Advertisements for pcs already tout their meagre energy consumption just as prominently as their number-crunching prowess.
Overall, computing and telecommunications today produce 2% of global emissions, according to the Global e-Sustainability Initiative (Gesi), an industry group. Of these, 49% come from pcs and printers, 37% from telecoms networks and devices, and 14% from data centres—the large warehouses full of computers operated by companies.
The overall volume of emissions is comparable with that from aviation. But the it industry, unlike aviation, has not provoked the wrath of environmental campaigners. Perhaps that is because computers are less visibly polluting, or their use is not deemed, like air travel, to be frivolous and unnecessary.
The aviation industry has found itself on the defensive, emphasising its efforts to switch to less fuel-hungry aircraft in the coming years. Makers of computer and
telecoms gear, by contrast, have chosen to highlight the volume of emissions their machines produce, because they already have newer, greener products to sell today. New processing chips, clever software that lets one machine do the work of many, and smarter cooling systems can all reduce energy consumption and thus carbon-dioxide emissions.
|
|
|
For vendors, in other words, the large environmental footprint of computing presents a sales opportunity. That is one reason why the hubbub about green it will increase in 2009.
A second reason is that companies like to tell everyone about their efforts to reduce their own carbon emissions, and technology is a relatively easy place to start. Hardly a week goes by without a large company announcing that it has just installed fancy new videoconferencing suites to reduce its carbon footprint. вSkyв, a British satellite-television and telecoms operator, was one of the first companies to go carbon-neutral by reducing its emissions as much as possible (by programming its set-top boxes to switch themselves to standby when not in use, for example), and offsetting the rest. Vodafone, a mobile-telecoms giant, has been turning down the air-conditioning in its base-stations, which accounts for a quarter of its carbon footprint. Allowing the base-stations to operate at 25°C instead of 21°C can cut energy use by 10% in some cases, and newer base-stations can happily run at 35°C. This will, the company says, help it to meet its target of cutting its emissions by 50% between 2006 and 2020. Expect more such announcements, in particular from telecoms and financial-services firms, since a large part of their carbon footprints is associated with computers and networks.
Green it is also being pushed for a third reason: the computer industry's desire to stay in the limelight. It has become apparent that clean technology will be the "next big thing" as the internet becomes pervasive and, correspondingly, less exciting. Venture capitalists and executives have been jumping from computing to clean-tech companies. Promoting computing itself as a clean technology may help those left behind to convince themselves that their field is still at the cutting edge.
Text 9
Want to Drive Green?
Onе way to save fuel and be kinder to the environment is to drive a smaller car. Or you can buy a hybrid, which is also cleaner and meaner with petrol by using a combination of an internal-combustion engine and an electric motor. Then there are all-electric cars that don't use any petrol at all, and hydrogen-powered ones, some of them using fuel cells. And increasingly there will be variations in between. Picking a new green drive in 2009 will not be an easy decision.
For a start, the choice will be much bigger. Plug-in versions of Toyota's Prius hybrid will allow that groundbreaking vehicle to be charged from a mains socket. But it will face tough competition from a new Honda Insight hybrid capable of 80mpg or more. Watch out too for a new six-seater Renault hybrid and a four-wheel drive Citroen with a diesel engine powering the front wheels and an electric motor operating the rear ones.
Other fuel-saving cars will appear at motor shows. General Motors will also start road testing the Chevy Volt before it goes into mass production. The Volt is a compact plug-in hybrid able to travel on a full charge for about 40 miles (64km)—a typical daily commute—but with a small petrol engine kicking in as a range-extending generator thereafter. It will cost around $30,000.
Better batteries will give electric cars a boost. Some already leave petrol ones in the dust—at a price. The Tesla Roadster, based on a British Lotus, uses a power-pack of more than 6,000 beefed-up versions of the lithium-ion batteries found in laptop computers. It can accelerate from 0-60mph in under four seconds and reach around 125mph. It is already on sale in California; Europeans will be able to get their hands on one in 2009—at around €100,000 ($140,000). If you do not mind 0-60mph in eight seconds and one less wheel, then zap, a Californian maker of electric vehicles, will offer a sleek three-wheeler called Alias for around $32,000. Classed as a motorcycle, it resembles a souped-up Reliant Robin.
More hydrogen-powered vehicles will arrive, but remain constrained by a lack of refuelling stations. Not so for petrol and diesel cars, which will be getting better, too. Fiat's new Multiair engine will start appearing in its cars. These engines use hydraulics and electronics to optimise valve settings. When combined with a tur-bocharger, this will allow tiny two-cylinder engines to perform like four-cylinder ones, but use 20% less fuel.
With such tricks, some small petrol and diesel cars will be able to achieve around 80mpg—and, with a light foot on the accelerator, break 100mpg. But big cars will become more frugal too. A new Daimler engine will operate as a petrol engine when power is needed and like a diesel when economy is required. Daimler has called it the DiesOtto after two German engineers, Rudolf Diesel and Nicolaus Otto. The internal-combustion engines they helped to pioneer may be more than 100 years old, but they have yet to reach the end of the road.
Text 10
Copenhagen Conference
The most important year for climate change since 2001, when the Kyoto protocol (which set targets for cutting carbon-dioxide emissions) was agreed, will be 2009. The first period of the protocol runs out in 2012. The deal to replace it is supposed to be done at the United Nations' Climate Change Conference in Copenhagen, which starts on November 30th 2009 and is due to end on December 11th. No deal means that mankind gives up on trying to save the planet.
The accord needs to be a substantial one, not just a face-saving agreement to declare that the issue must be tackled. The rich world (especially America) needs to commit itself to legally enforceable carbon-emissions reductions for the second period of Kyoto, from 2012 to 2016 and beyond. The big emitters from the developing world, such as China, need to commit themselves to something substantive—not economy-wide emissions-reductions, but, for instance, carbon-intensity targets (cuts in carbon emissions per unit of gdp) or measures directed at the power sector in particular.
The rich world, which has been responsible for most emissions so far and recognises that it needs to pay up because of that, also needs to find a way of transferring money to the developing world to help it pay for cutting carbon. The Clean Development Mechanism, which was set up under Kyoto to allow rich countries to buy carbon credits from poor countries that have cut their emissions, does that already, but is probably not robust enough to do the job on the scale needed. There needs to be some new vehicle, such as the Superfund proposed by Jagdish Bhagwati, professor of economics at Columbia. He thinks the world should copy America's approach to other forms of pollution: make polluters contribute to a fund which pays
for the costs of cleaning up.
Text 11
The Strength of Europe
The European Union has led the fight against climate change. As part of its implementation of the Kyoto protocol, it set up its ground-breaking Emissions-Trading Scheme which allows companies in EU member-states' dirty industries to trade carbon-emissions permits and has thus put a price on carbon. And in 2007 the European Commission produced the "20/20/20 by 2020" plan: emissions cuts of
20% below 1990 levels (plus a 20% gain in energy efficiency and 20% of energy from renewables) by 2020. But the plan must be approved by the Council of
Ministers and the European Parliament in 2009, and it is meeting hefty opposition—from heavy industry, and coal-dependent countries such as Poland. Getting the package through will be hard; but any backtracking in Europe will undermine America's efforts.
A change of attitude in Beijing is also crucial to a deal in Copenhagen. It was China's refusal to agree to any form of constraint that led America to walk away from Kyoto in 2001. These days China, now the world's biggest emitter of carbon dioxide, accepts the need to take action against climate change; it argues that, through energy-efficiency and renewable-energy targets, it is doing as much as can reasonably be expected. But the American Congress will want China to take on extra commitments—perhaps in the form of targets for particular industries—if it is to legislate cuts. And the Chinese government resists the idea that it should have to give ground in order to get America to move.
Getting progress on climate change in these three places would be tough at the best of times, and the year ahead looks like being one of the worst of times. A substantive deal in Copenhagen therefore looks unlikely; but the world's leaders are not likely to give up trying to save the planet there and then. Perhaps the likeliest outcome in Copenhagen in 2009 is a repetition of what happened in Kyoto in 2000—abig bust-up, another meeting called and a deal done the following уеаr.
Text 12
Judicial Systems
Judicial systems are formal institutions that not only enforce restraints designated by the government for the good of society, but also clarify the meanings of formal rules. North explains, “Institutions are the rules of the game in a society or, more formally, are the humanly devised constraints that shape human interaction”. Formal or informal institutions of judgment are undeniably important in any society; my thesis focuses on how the role of these institutions affects society in an ever changing, contemporary manner. Present issues in society, and their various, either temporary or permanent solutions, are notably prevalent in social discourse. I examine how formal institutions, such as Judicial Systems, influence issues in present society and the discourse concerning those issues. There are always several factors that can be analyzed with relation to social causation, for rarely, if ever, is there simply one factor that can be distinguished from the rest as a main influence on the outcomes. The choice to focus on judicial systems and their effects on society arose from my interest not only in the judicial systems themselves, but from the fact that they are often viewed as less powerful than other parts of the government. For example, the American system of government is divided into three branches, the Executive, the Legislative and the Judicial. Even in the constitution of the United States of America the powers given to the Supreme Court in Article III are limited, and therefore the powers of the court are also derived from common law and precedent.
France and the United States of America are often compared with one another for various reasons depending on the comparison being made. The United States of America, while typically thought of as only an English colony, has had a long history of involvement with France. Not only did France have colonies in the United States, but also there were often consorted efforts in wars, treaties, and world affairs. It should not be confused however that while there are similarities in the histories of France and the United States of America, as well as intertwining in the histories, there are undeniably certain differences in the pasts of each country that had an effect on the countries and their governmental systems as well as certain parts of society. Many look to the French and American revolutions as a point of reference for where to start a comparison. However, it should be recognized that the revolutions did not occur because of similar plights of the people, nor did the revolutions occur with the same series of events. As with any cause and effect relationship, the introduction of different variables will naturally lead to a different effect.
Due to the past history of France, there is a greater sense of social stratification, more specifically with how members of society identify themselves. The reason for greater sense of social stratification is due to the fact that “classes, once they have come into being, harden in their mold and perpetuate themselves, even when the social conditions that created them have disappeared”. In France there is a long history of class identification and social stratification being a prevalent part of society. While formal social stratification no longer exists as such, there is still informal class identification present in France today. Class identification is an important aspect to acknowledge, especially because of my focus on labor union. This factor leads to different effects on group solidarity, which later plays a role in collective efforts in labor unions. Differences in the histories of France and America can are reflected in the societies of each country.
The collective conscience of the countries is different not only because of the differences in the histories, but also due to cultural differences. These cultural differences in turn manifest themselves in different ways such as national pride, group solidarity, and so on. The many distinct attributes of each country compile upon each other and are noticeable in the government, specifically the government organization. Therefore differences in the judicial systems can be seen as well.
Text 13
Derivation of Judicial Power
The Supreme Court of the United States is the highest court in the country. The powers of the judicial branch are stated in Article III of the Constitution. The powers delineated are very limited, and as such the powers that the Supreme Court now holds, while originated from Article III, have also in fact been appropriated over time. Article III is divided into three sections. The first section states that there is one supreme court that rules over the lower courts and the conditions under which judges in both the lower and higher courts shall hold their offices (Article III of the United States Constitution).
Like its American counterpart, the Cour de Cassation is the highest court in the French Judicial System. The Cour de Cassation is the final recourse in the judicial system in France, as such, “civil, commercial, social or criminal cases are first ruled upon by courts of first instance or lower courts (tribunaux d’instance and tribunaux de grande instance, commercial courts and industrial or labour courts (conseils de prud’hommes) etc)”. The main role of the Cour de Cassation is not to rule on a case specifically, but rather to assess whether the lower courts have applied statutes properly to the case when making their decisions. The distinction of how the higher court rules in France and America is important to recognize because the delegation of power to rule on cases impacts how the court is then able to affect the other branches of government and thus the implications on society. As the Cour de Cassation is unable to rule on a case specifically, the effects of the decisions of the lower courts in France are similar to the Supreme Court in the United States. The lower courts in France, in essence create the precedent and the Cour de Cassation then rules on whether the court acted within its jurisdiction and whether the rules and reasoning were applied correctly. The French Judicial Authority‟s powers are explained in Articles 64 through 66-1 in the French Constitution of 4 October 1958 (Assemblee National 2008). In these articles, the organization of the court, as well as limitations of the jurisdiction of the court is delineated. Article 64 establishes the Judiciary, as well as the fact that there are governing rules by which the judiciary must conform to, and that the “judges shall be irremovable” (Assemblee National 2008). Article 65 establishes who the judiciary consists of, and Articles 66 and 66-1 dictates that no one shall be “arbitrarily detained,” similarly to the right of Habeas Corpus in the United States, and no one “shall be sentenced to death”. The judicial system in the United States is a part of the system of checks and balances in the government. Even though the powers of the judicial system in the Constitution of the United States are not clearly defined and are in fact limited, the Supreme Court over time has appropriated the power of judicial review. One of the first, most notable cases of judicial review occurred in 1803 in the landmark decisions of Marbury v. Madison, written by Chief Justice Marshall. Contrary to the freedom of the judicial system in the United States, the judicial branch in France is severely limited. Jerome B. King explains: The complete rejection of judicial independence by the revolutionaries in the Constitution of 1791 reflected a longstanding feeling that the separation of powers in the American sense of the term could only be a device to maintain, not destroy, the special interests which lay at the heart of the social system of the ancient regime.
During the ancien regime, judges were from the dominant, upper classes in society. Often times they used their positions of power for corruptive purposes. This discredited the institution of the judicial branch as a whole, which is why after the French Revolution people were weary to give too much power to the judicial system. But as King explains, “it would be a mistake to assume that as a consequence the French judicial tradition is one of nothing but servility to the existing power, or that the judges have ever been as the beck and call of transient causes”. King asserts that the judicial system in France, despite its imposed limitations, is not powerless. While it may be easy to recognize that the judiciary in France does not have as much independence as the judiciary in the United States, one should not disregard the judicial system in France as inconsequential. Many notable scholars such as Lasser interpret the limitations placed on the French judiciary as indicative that there cannot be lasting resonance from their decisions.
Text 14
Common Law Countries
Because of our colonial history we had a common law legal system strongly influenced in its structure and functioning by that of the colonial power which had been England. There was a unitary court system in which there was a Supreme Court, consisting of an Appellate Division, which was the highest court, and Provincial and
Local Divisions which functioned as superior courts of first instance.3 Statutes were superior to the common law, but there were only a few general codes4 and much of the law was made and developed by judges on the basis of precedent. Decisions of the Appellate Division were binding on all other courts. The Appellate Division followed its own decisions unless it was satisfied that an earlier decision was “clearly wrong”. Parliament was supreme and could pass laws to vary court decisions with which it disagreed.
Countries which had formerly been part of the British Empire had similar court systems, adapted where necessary to deal with federal issues. Invariably in these Commonwealth countries, which differed in this respect from the United States where the jurisdiction of the US Supreme Court is more restricted because of its particular federal structure, there is a single highest court which is a court of general jurisdiction with the competence to deal with all law whether it be common law, state law or federal law. I will call this model the Supreme Court model. There is not a career judiciary. Instead, Judges are usually appointed to the superior courts from the practicing legal profession. Appeal courts are usually, though not invariably, staffed by judges promoted from superior courts of first instance, and where there is a three tier system, from judges of appeal. The Supreme Courts had a general jurisdiction, and in those countries where constitutions with entrenched rights were later adopted as the supreme law, their jurisdiction included the judicial review of legislative action and the conduct of organs of the state.
Text 15
Civil Law Countries
Constitutional courts were then a feature of civil law countries. Unlike common law countries where constitutional adjudication was conducted within and as part of the normal court system, Constitutional Courts were established apart from the ordinary courts. Specialised constitutional courts fitted well into the judicial architecture of civil law countries with their detailed codes and different court systems where there is less emphasis on judge-made law and precedent than is the case in common law countries. A specialised constitutional court with exclusive jurisdiction in constitutional matters was calculated to promote legal certainty in constitutional matters, and to avoid conflicting decisions being given on the constitutionality of legislation in the different courts. What is also relevant is that constitutional norms are expressed in general terms and leave greater room for interpretation than the detailed codes do.
This calls for different techniques than those used by judges of civil law courts in the application of codes to the facts of a particular case. Constitutional adjudication also has a greater political impact than other forms of adjudication. The establishment of constitutional courts allowed specialists in constitutional law to be appointed as judges to these courts, and for the adoption of special procedures for the
appointment of such judges.
Text 16
International Law
Among the United Nations most pervasive achievements has been the development of a body of international law — conventions, treaties and standards — that play a central role in promoting economic and social development, as well as international peace and security. Many of the treaties brought about by the United Nations form the basis of the law that governs relations among nations. While the United Nations work in this area does not always receive attention, it has a daily impact on the lives of people everywhere.
The United Nations Charter specifically calls on the Organization to help in the settlement of international disputes by peaceful means, including arbitration and judicial settlement (Article 33),and to encourage the progressive development of international law and its codification (Article 13). Over the years, the United Nations has sponsored over 500 multilateral agreements, which address a broad range of common concerns among states and are legally binding for the countries that ratify them.
In many areas, the United Nations legal work has been pioneering, addressing problems as they take on an international dimension. It has been in the forefront of efforts to provide a legal framework in such areas as protecting the environment, regulating migrant labour, curbing drug trafficking and combating terrorism. This work continues today, as international law assumes a more central role across a wider spectrum of issues, including human rights law and international humanitarian law.
Text 17
Headache
Headache is such a common complaint and can occur for so many different reasons that its proper evaluation may be difficult. Chronic headaches are commonly due to migraine, tension, or depression, but they may be related to intracranial lesions, head injury, cervical spondylosis, dental or ocular disease, temporomandibular joint dysfunction, sinusitis, hypertension, and a wide variety of general medical disorders. Although underlying structural lesions are not present in most patients presenting with headache, it is evertheless important to bear this possibility in mind. About one-third of patients with brain tumors, for example, present with a primary complaint of headache.
The intensity, quality, and site of pain—and especially the duration of the headache and the presence of associated neurologic symptoms—may provide clues to the underlying cause. Migraine or tension headaches are often described as pulsating or throbbing; a sense of tightness or pressure is also common with tension headache. Sharp lancinating pain suggests a neuritic cause; ocular or periorbital icepick-like pains occur with migraine or cluster headache; and a dull or steady headache is typical of an intracranial mass lesion. Ocular or periocular pain suggests an ophthalmologic disorder; bandlike pain is common with tension headaches; and lateralized headache is common with migraine or cluster headache. In patients with sinusitis, there may be tenderness of overlying skin and bone. With intracranial mass lesions, headache may be focal or generalized; in patients with trigeminal or glossopharyngeal neuralgia, the pain is localized to one of the divisions of the trigeminal nerve or to the pharynx and external auditory meatus, respectively.
Inquiry should be made of precipitating factors. Recent sinusitis or hay fever, dental surgery, head injury, or symptoms suggestive of a systemic viral infection may suggest the underlying cause. Migraine may be exacerbated by emotional stress, fatigue, foods containing nitrite or tyramine, or the menstrual period. Alcohol may precipitate cluster headache.
Temporomandibular joint dysfunction causes headache or facial pain that comes on with chewing; trigeminal or glossopharyngeal neuralgia may also be precipitated by chewing, and masticatory claudication sometimes occurs with giant cell arteritis. Cough-induced headache occurs with structural lesions of the posterior fossa, but in many instances no specific cause can be found.
The timing of symptoms is important. Headaches are typically worse on awakening in patients with sinusitis or an intracranial mass. Cluster headaches tend to occur at the same time each day or night. Tension headaches are worse with stress or at the end of the day.
The onset of severe headache in a previously well patient is more likely than chronic headache to relate to an intracranial disorder such as subarachnoid hemorrhage or meningitis. The need for further investigation is determined by the initial clinical impression.
A progressive headache disorder, new onset of headache in middle or later life, headaches that disturb sleep or are related to exertion, and headaches that are associated with neurologic symptoms or a focal neurologic deficit usually require cranial MRI or CT scan to exclude an intracranial mass lesion. Signs of meningeal irritation and impairment of consciousness also indicate the need for further investigation (cranial CT scan or MRI and examination of the cerebrospinal fluid) to exclude subarachnoid hemorrhage or meningeal infection. The diagnosis and treatment of primary neurologic disorders associated with headache are considered separately under these disorders.
Text 18
Дата добавления: 2019-07-15; просмотров: 301; Мы поможем в написании вашей работы! |
Мы поможем в написании ваших работ!