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2.
Acta otorrinolaringol. cir. cuello (En línea) ; 51(2): 150-154, 20230000. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1442517

ABSTRACT

Introducción: los quistes epidermoides son el tercer tumor más común del ángulo pontocerebeloso (APC). Es infrecuente detectar simultáneamente un colesteatoma infiltrativo del oído medio (OM). Caso clínico: paciente de 51 años acude a urgencias por cefalea hemicraneal intensa, pulsátil secundaria a hidrocefalia aguda, requirió ventriculostomía. En la resonancia magnética nuclear (RMN) cerebral contrastada se reporta una masa en el APC sugestivo de quiste epidermoide y simultáneamente un colesteatoma infiltrativo del OM. La paciente fue intervenida primero con resección de colesteatoma del OM; en un segundo tiempo resección del quiste epidermoide del APC por vía translaberíntica. El posoperatorio la evolución clínica fue satisfactoria. Discusión: los quistes epidermoides del APC son histopatológicamente idénticos al colesteatoma del OM y pueden ser secundarios a estos. Conclusión: se debe individualizar el manejo sin descartar la posibilidad de tener las dos enfermedades de manera simultánea.


Introduction: cysts are the third most common tumor of the cerebellopontine angle (CPA). It is rare to simultaneously detect an infiltrative cholesteatoma of the middle ear (OM). Clinical case: a 51-year-old patient attended the emergency department due to intense throbbing hemicranial headache secondary to acute hydrocephalus, requiring ventriculostomy. Contrast-enhanced cerebral magnetic resonance imaging (MRI) reported a mass in the APC suggestive of an epidermoid cyst and simultaneously an infiltrative cholesteatoma of the OM. The patient underwent first surgery with resection of the OM cholesteatoma; in a second stage, resection of the epidermoid cyst of the APC through a translabyrinthine approach. The postoperative clinical evolution was satisfactory. Discussion: APC epidermoid cysts are histopathologically identical to OM cholesteatoma and may be secondary to them. Conclusion: management must be individualized without ruling out the possibility of having both diseases simultaneously.


Subject(s)
Humans , Male , Female , Ear , Epidermal Cyst , Cerebellopontine Angle , Cholesteatoma , Headache
3.
Acta otorrinolaringol. cir. cuello (En línea) ; 51(2): 155-159, 20230000. ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1442531

ABSTRACT

Introducción: la cefalea rinogénica es secundaria al contacto permanente de la mucosa nasal y puede ser secundario a concha bullosa, si se infecta puede ser mucocele o mucopiocele. Caso clínico: paciente de 34 años con cefalea hemicraneal izquierda, dolor periocular ipsilateral, congestión y rinorrea hialina con cambios en consistencia y coloración del moco. En la tomografía computarizada (TAC) de senos paranasales (SPN) desviación septal derecha por concha bullosa izquierda, ocupación de líquido. Se sospecho mucocele y cefalea rinogénica secundaria, prueba de lidocaína positiva. Se detecto por cultivo, Eikenella corrodens. Manejo con antibiótico y posterior resolución de patología. Conclusiones: debe incluirse en el diagnóstico diferencial de cefalea y concha bullosa, realizarse endoscopia nasal y TAC de SPN. El manejo quirúrgico ha demostrado reducir la intensidad y la frecuencia de la cefalea a corto y largo plazo, y es exitoso si hay test de lidocaína positivo.


Introduction: rhinogenic headache is secondary to permanent contact with the nasal mucosa and may be secondary to concha bullosa, if infected it may be mucocele or mucopiocele. Clinical case: 34-year-old patient with left hemicranial headache, ipsilateral periocular pain, congestion, and hyaline rhinorrhea with changes in consistency and coloration of the mucus. In the computed tomography (CT) of the paranasal sinuses (SPN) right septal deviation due to left concha bullosa, fluid occupation. Mucocele and secondary rhinogenic headache were suspected, lidocaine test positive. Eikenella corrodens was detected by culture. Management with antibiotics and subsequent resolution of pathology. Conclusions: nasal endoscopy and SPN CT should be included in the differential diagnosis of headache and concha bullosa. Surgical management has been shown to reduce headache intensity and frequency in the short and long term, and is successful if there is a positive lidocaine test.


Subject(s)
Humans , Male , Female , Headache , Mucocele , Turbinates , Rhinorrhea , Nasal Mucosa
4.
Braz. J. Anesth. (Impr.) ; 73(1): 108-111, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1420638

ABSTRACT

Abstract Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.


Subject(s)
Humans , Female , Pregnancy , Post-Dural Puncture Headache/therapy , Spinal Puncture/adverse effects , Blood Patch, Epidural/methods , Postpartum Period , Anesthesiologists , Headache/etiology
5.
Chinese Journal of Internal Medicine ; (12): 507-512, 2023.
Article in Chinese | WPRIM | ID: wpr-981048

ABSTRACT

Migraine is a highly disabling primary headache disease, accompanied by nausea, emesis, photophobia and phonophobia. Chronic migraine is usually developed from episodic migraine, and usually comorbids with anxiety, depression, and sleep disorders, further aggravating the disease burden. At present, the clinical diagnosis and treatment of migraine in China are not standard, and the migraine medical quality control evaluation system is lacking. In order to achieve standardized diagnosis and treatment of migraine, headache collaborators of Chinese Society of Neurology, based on national and international clinical research on diagnosis and treatment of migraine and combined with the current situation of China's medical system, drafted the expert consensus on the medical quality evaluation of inpatients with chronic migraine.


Subject(s)
Humans , Consensus , Migraine Disorders/diagnosis , Nausea , Photophobia/diagnosis , Headache
6.
Chinese Journal of Internal Medicine ; (12): 494-506, 2023.
Article in Chinese | WPRIM | ID: wpr-981047

ABSTRACT

Migraine is the most common disabling primary headache with a significant socioeconomic burden. At present, some emerging drugs for migraine preventive treatment are under investigation internationally, which significantly promote the progress of migraine treatment. However, only few of this trial for migraine treatment are explored in China. In order to promote and standardize controlled clinical trials of migraine preventive therapy in China, and to provide methodological guidance for the design, implementation and evaluation of clinical trials, the Headache Collaborators of Chinese Society of Neurology formulated this consensus.


Subject(s)
Humans , Adult , Consensus , Migraine Disorders/therapy , Headache , China , Neurology
7.
Chinese Acupuncture & Moxibustion ; (12): 479-482, 2023.
Article in Chinese | WPRIM | ID: wpr-980747

ABSTRACT

The basic constituent elements of ancient acupuncture prescriptions and moxibustion prescriptions for migraine and headache are extracted and summarized. The frequency and proportion of each element are counted and its characteristics are analyzed. The basic constituent elements of ancient acupuncture and moxibustion prescriptions includes five aspects: disease symptoms (main symptoms, concurrent symptoms, etiology and pathogenesis), disease type, acupuncture and moxibustion site (acupoint name, site name, meridian name), manipulation method (acupuncture method, reinforcing and reducing method, blood pricking method, moxibustion method) and curative effect. Acupuncture and moxibustion prescriptions are essential for recording the disease symptoms, while the acupuncture and moxibustion site and manipulation methods are the two core elements of ancient acupuncture and moxibustion prescriptions, which are also the premise to ensure that acupuncture and moxibustion prescriptions have good reference value.


Subject(s)
Humans , Moxibustion , Acupuncture Therapy , Meridians , Acupuncture Points , Headache/therapy , Migraine Disorders/therapy
8.
Chinese Acupuncture & Moxibustion ; (12): 427-431, 2023.
Article in Chinese | WPRIM | ID: wpr-980740

ABSTRACT

OBJECTIVE@#To observe the clinical effect of bloodletting at auricular dorsal vein combined with auricular point sticking on menstrual migraine (MM) of qi stagnation and blood stasis, and explore its possible mechanism.@*METHODS@#A total of 102 cases of MM with qi stagnation and blood stasis were randomly divided into an observation group (51 cases, 3 cases dropped off) and a control group (51 cases, 2 cases dropped off). The patients in the observation group were treated with bloodletting at auricular dorsal vein combined with auricular point sticking. The bloodletting was performed at vein at upper 1/3 of the dorsalis near the ear helix; the auricular point sticking was performed at Pizhixia (AT4), Neifenmi (CO18), Jiaogan (AH6a), Nie (AT2), Zhen (AT3), Shenmen (TF4) and Yidan (CO11). The auricular points of both ears were alternate used. From 7 days before the onset of menstruation, bloodletting at auricular dorsal vein was given once every 7 days, 3 times were taken as a course of treatment, and 1 course of treatment was given; the auricular point sticking was given once every 3 days, and 6 times of treatment were given. The patients in the control group were treated with oral administration of flunarizine hydrochloride capsules. From 7 days before the onset of menstruation, flunarizine hydrochloride was given 2 capsules per time, once a day for 3 weeks. The menstrual headache index and visual analogue scale (VAS) score of the two groups were observed before treatment, one menstrual cycle into treatment and the first and the second menstrual cycle after treatment; the migraine-specific quality of life questionnaire (MSQ) score and the serum levels of estradiol (E2) and 5-hydroxytryptamine (5-HT) were compared before treatment and one menstrual cycle into treatment; the clinical efficacy was evaluated at one menstrual cycle into treatment.@*RESULTS@#Compared before treatment, the menstrual headache index and VAS scores were reduced at one menstrual cycle into treatment and the first and second menstrual cycle after treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). Compared before treatment, the MSQ scores and the serum levels of E2 and 5-HT in the two groups were increased at one menstrual cycle into treatment (P<0.05), and those in the observation group were higher than the control group (P<0.05). The total effective rate was 95.8% (46/48) in the observation group, which was higher than 73.5% (36/49) in the control group (P<0.05).@*CONCLUSION@#Bloodletting at auricular dorsal vein combined with auricular point sticking could relieve headache intensity, improve the quality of life in patients with MM of qi stagnation and blood stasis, which may be achieved by raising the serum levels of E2 and 5-HT to improve the level of hormone in the body.


Subject(s)
Female , Humans , Acupuncture, Ear , Bloodletting , Serotonin , Capsules , Flunarizine , Qi , Quality of Life , Migraine Disorders/drug therapy , Headache/therapy , Treatment Outcome , Acupuncture Points
9.
Arq. ciências saúde UNIPAR ; 27(3): 1512-1527, 2023.
Article in English | LILACS | ID: biblio-1426460

ABSTRACT

Rocky Mountain spotted fever is a tick-borne rickettsiosis. The main clinical signs and symptoms are fever, severe headache, rashes and myalgia. It is considered difficult to diagnose and underreported. The study aims to descriptively analyze the epidemiology of cases of Rocky Mountain spotted fever in Brazil from 2010 to 2021. This is a retrospective cohort study that statisticall analyzes the cases of spotted fever in Brazil between 2010 and 2020 through data obtained by the Information System of Notifiable Diseases. The proportions of spotted fever cases were calculated according to: sex, age, race/color, infection environment and evolution. There are 1967 cases were confirmed. The regions with the most cases were the Southeast (n%=72.24) and the South (n%=24). However, there are 4 deaths in the south while the lethality coefficient from the southeast is 47.78%. The most affected age group was 40-59 years old (n%=34.87), and 20-39 years old (n%=28.98). 71.17% of the cases are male. As for color/race, 60% of the cases are in whites. As for the infection environment, 35.23% are at home, 15.3% are at work, 26.13% are leisure places. The prevalence in males and the predominant age group 20-59 years can be linked to work activity, which leaves hem more exposed to ticks. The high numbers in adulthood can also be related to ecotourism. The lethality of the disease differs between the South and Southeast regions. One explanation for this phenomenon would be the different etiological agents, R. rickettsi, predominant in the Southeast, generating more severe clinical conditions.


A febre maculosa é uma riquetsiose transmitida por carrapatos. Os principais sinais e sintomas clínicos são febre, cefaleia intensa, erupções cutâneas e mialgia. É considerada de difícil diagnóstico e subnotificada. O estudo visa analisar descritivamente a epidemiologia dos casos de febre maculosa do Brasil no período de 2010 até 2021. Trata-se de um estudo de coorte retrospectivo que analisa estatisticamente os casos de febre maculosa no Brasil entre 2010 e 2020 por meio de dados obtidos pelo Sistema de Informação de Agravos de Notificação. As proporções de casos de febre maculosa foram calculadas segundo: sexo, idade, raça/cor, ambiente de infecção e evolução. Foram confirmados 1967 casos. As regiões com mais casos foram Sudeste (n%= 72,24) e Sul (n%= 24). No entanto, há 4 óbitos no Sul enquanto o coeficiente de letalidade do Sudeste é de 47,78%. A faixa etária mais acometida foi de 40 a 59 anos (n%= 34,87) e de 20 a 39 anos (n%= 28,98). 71,17% dos casos são do sexo masculino. Quanto à cor/raça, 60% dos casos são de brancos. Quanto ao ambiente de contágio, 35,23% são em casa, 15,3% são no trabalho, 26,13% são locais de lazer. A prevalência no sexo masculino e a faixa etária predominante de 20 a 59 anos pode estar ligada à atividade laboral, que os deixa mais expostos aos carrapatos. Os altos números na idade adulta também podem estar relacionados ao ecoturismo. A letalidade da doença difere entre as regiões Sul e Sudeste, sendo que uma explicação para esse fenômeno seriam os diferentes agentes etiológicos,


La fiebre maculosa es una rickettsiosis transmitida por garrapatas. Los principales signos y síntomas clínicos son fiebre, cefalea intensa, erupciones cutáneas y mialgias. Se considera difícil de diagnosticar y poco notificada. El estudio tiene como objetivo analizar descriptivamente la epidemiología de los casos de fiebre manchada en Brasil en el período de 2010 a 2021. Se trata de un estudio de cohortes retrospectivo que analiza estadísticamente los casos de fiebre manchada en Brasil entre 2010 y 2020 a través de datos obtenidos del Sistema de Información de Agraves de Notificación. Se calcularon las proporciones de casos de fiebre manchada según: sexo, edad, raza/color, ambiente de infección y evolución. Se confirmaron 1967 casos. Las regiones con más casos fueron el Sudeste (n%= 72,24) y el Sur (n%= 24). Sin embargo, hubo 4 muertes en el Sur, mientras que el coeficiente de letalidad en el Sureste fue del 47,78%. El grupo de edad más afectado fue el de 40 a 59 años (n%= 34,87) y el de 20 a 39 años (n%= 28,98). El 71,17% de los casos eran varones. En cuanto al color/raza, el 60% de los casos son de raza blanca. En cuanto al entorno de la infección, el 35,23% se produce en el domicilio, el 15,3% en el trabajo y el 26,13% en lugares de ocio. La prevalencia en los hombres y el grupo de edad predominante de 20 a 59 años pueden estar relacionados con la actividad laboral, que los deja más expuestos a las garrapatas. El elevado número en la edad adulta también puede estar relacionado con el ecoturismo. La letalidad de la enfermedad difiere entre las regiones Sur y Sudeste, y una explicación para este fenómeno serían los diferentes agentes etiológicos, R. rickettsi, predominante en la región Sudeste, generando cuadros clínicos más severos.


Subject(s)
Humans , Adult , Middle Aged , Rocky Mountain Spotted Fever/transmission , Health Services Research/statistics & numerical data , Rural Population , Tick Infestations/parasitology , Brazil/epidemiology , Evaluation Studies as Topic , Health Information Systems/statistics & numerical data , Headache/complications
10.
Psicol. ciênc. prof ; 43: e252098, 2023. tab
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1440797

ABSTRACT

Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)


This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)


Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Pain , Wounds and Injuries , Wounds, Gunshot , Psychic Symptoms , Risk , Psychological Distress , Anxiety , Anxiety Disorders , Phobic Disorders , Prisons , Psychology , Runaway Behavior , Safety , Attention , Sleep Wake Disorders , Stress Disorders, Post-Traumatic , Suicide , Suicide, Attempted , Therapeutics , Violence , Behavioral Symptoms , Work Hours , Burnout, Professional , Adaptation, Psychological , Catatonia , Cognitive Behavioral Therapy , Occupational Health , Self-Injurious Behavior , Civil Defense , Civil Rights , Panic Disorder , Public Sector , Cognition , Efficiency, Organizational , Contusions , Crime Victims , Substance-Related Disorders , Wit and Humor , Crime , Emergency Watch , Civil Protection Program , Civil Protection , Legal Process , Death , Diagnostic and Statistical Manual of Mental Disorders , Aggression , Depression , Dizziness , Dreams , Alcoholism , Escape Reaction , Disease Prevention , Surveillance of the Workers Health , Surveillance of Working Environment , Mental Fatigue , Fear , Catastrophization , Medicalization , Hope , Mindfulness , Criminal Behavior , Trauma and Stressor Related Disorders , Psychological Trauma , Physical Abuse , Cortical Excitability , Work-Life Balance , Occupational Stress , Gun Violence , Disaster Risk Reduction , Kinesiophobia , Psychological Well-Being , Suicide Prevention , Accident Prevention , Guilt , Headache , Health Promotion , Homicide , Sleep Initiation and Maintenance Disorders , Job Satisfaction , Mental Disorders
11.
Acta Medica Philippina ; : 76-80, 2023.
Article in English | WPRIM | ID: wpr-984479

ABSTRACT

@#COVID-19 primarily presents as a pulmonary problem, ranging from mild respiratory illness to fatal acute respiratory distress syndrome. Most common manifestations are fever (89%) and cough (72%), while headache and arrhythmia are found in 28% and 17%, respectively. We aim to present a confirmed COVID-19 case presenting with both neurologic and cardiac manifestations. A 33-year-old Filipino male nurse initially consulted at the emergency room due to progressive diffuse headache, with associated localized seizures progressing to generalized tonic clonic seizure and arrhythmia. He had no coryza, cough, sore throat, and diarrhea. He was previously well and had no known co-morbidities or direct exposure to confirmed COVID-19 patients. Physical examination showed elevated blood pressure, tachycardia, and sensory and motor deficits in the left upper and lower extremities. Pertinent diagnostic test results included the detection of SARS-CoV-2 viral RNA via RT-PCR. Imaging studies demonstrated cortical venous thrombosis with hemorrhagic venous infarction in the right parietal lobe. Ground glass appearance on the middle lobe of the left lung was also evident. ECG showed supraventricular tachycardia. Prothrombin time, activated partial thromboplastin time, and D-dimer were all within the normal limits. Carotid massage was done. He was treated with anti-epileptics, anticoagulants, antiarrhythmics, antivirals, antibiotics, and supportive management. During the hospital stay, his symptoms resolved; he was discharged after 21 days. Follow-up done after 3 weeks revealed no recurrence of severe headache, seizure, or tachycardia. It is theorized that an interplay exists between ACE-2 tropism, systemic inflammation, cytokine storm, and hypoxemia in the background of COVID-19 infection. These mechanisms may lead to thrombosis and arrhythmia resulting to neurologic derangements and myocardial injury. Underlying mechanisms make the cerebro-cardiovascular systems vulnerable to the coronavirus disease 2019 infection. COVID-19 should therefore be part of the differential diagnoses in patients presenting with headache, seizures, and arrhythmias.


Subject(s)
COVID-19 , Headache , Seizures , Tachycardia, Supraventricular
12.
Rev. cuba. reumatol ; 24(4)dic. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1530177

ABSTRACT

El lupus eritematoso sistémico es una enfermedad inflamatoria sistémica cuyo proceso inflamatorio genera un importante número de manifestaciones clínicas articulares y extraarticulares. Entre las manifestaciones extraarticulares destaca la afectación neurológica, y el compromiso puede ser tanto a nivel del sistema nervioso central o periférico. El objetivo de la presente investigación es presentar el caso de una paciente de 56 años de edad, con diagnóstico de lupus eritematoso sistémico de 18 años de evolución quien presentó un cuadro crónico de cefalea, neuropatía periférica y miastenia gravis como manifestaciones neurológicas de la enfermedad. Con el tratamiento de ciclofosfamida y el aumento de la dosis de esteroide, en la actualidad la paciente se encuentra estable. El reporte de este caso hace hincapié en la importancia que revisten las manifestaciones neurológicas como parte de las manifestaciones extraarticulares de esta enfermedad, ya que este tipo de afección es determinante en el curso del lupus eritematoso sistémico y en la calidad de vida de los pacientes(AU)


Systemic lupus erythematosus is a systemic inflammatory disease whose inflammatory process generates a significant number of articular and extra-articular clinical manifestations. Within the extra-articular manifestations, neurological involvement stands out, among others, the commitment can be both at the level of the central or peripheral nervous system. The objective of the present investigation is to present the case of a 56-year-old patient, diagnosed with systemic lupus erythematosus of 18 years of evolution and who has presented chronic symptoms of headache, peripheral neuropathy and myasthenia gravis as neurological manifestations of the illness. The report of this case is considered important to publicize the importance of neurological manifestations as part of the extra-articular manifestations of this disease; this type of condition is decisive in the course of the disease and in the quality of life of patients(AU)


Subject(s)
Humans , Male , Female , Rheumatic Diseases/epidemiology , Headache , Lupus Erythematosus, Systemic/epidemiology , Myasthenia Gravis , Neurologic Manifestations
13.
Arq. ciências saúde UNIPAR ; 26(2): 187-192, maio-ago. 2022.
Article in Portuguese | LILACS | ID: biblio-1372977

ABSTRACT

O vírus da imunodeficiência humana é o agente etiológico da AIDS, doença crônica que destrói o sistema imunológico e é caracterizada pela baixa contagem de células TCD4, alta contagem de partículas virais no sangue e manifestações clínicas da doença. O diagnóstico se dá com o aparecimento de infecções oportunistas, que levam a contagem de TCD4 a níveis menores que 200 céls/mm³. Os exames laboratoriais para o diagnóstico do HIV foram os principais avanços para o início do tratamento, reduzindo a transmissão. Detecção de anticorpos, detecção de antígenos e amplificação do genoma do vírus são alguns dos exames laboratoriais utilizados para diagnóstico. Os dois principais biomarcadores são os exames de contagem de células TCD4, que verifica o sistema imune, e a quantificação de carga viral, que informa a quantidade de partículas virais, mostrando a progressão da infecção. Quanto maior a carga viral, maior o dano ao sistema imune. Uma carga viral indetectável é inferior a 50 cópias/mL, mas valores menores ou iguais a 200 cópias/mL também impedem a transmissão. Uma declaração de consenso afirma que Indetectável é igual a Intransmissível. Portanto, quando indetectável, a transmissão inexiste. O presente estudo relata e discute o caso clínico de uma paciente diagnosticada com HIV/AIDS aos 28 anos, que sobreviveu, apesar do diagnóstico tardio, e sob presença de doença oportunista com um grave grau de diminuição de células TCD4 (22 cél/mm³). Por meio do diagnóstico, introdução e adesão correta da terapia antirretroviral e monitorização de exames laboratoriais, conseguiu evitar a morte e ter uma vida semelhante à de um HIV negativo. Ultrapassou a expectativa de vida que na descoberta era de 10 anos, com uma qualidade de vida considerável, não sendo transmissora do vírus, diminuindo assim o estigma e preconceito. O biomédico é peça fundamental nesse contexto, considerando que deve fornecer informações precisas e fidedignas, tão necessárias ao acompanhamento de pessoas vivendo com HIV, para que autoridades e profissionais de saúde adotem medidas adequadas, tanto na prevenção, quanto no diagnóstico e monitoramento da doença.


The human immunodeficiency virus is the etiological agent of AIDS, a chronic disease that destroys the immune system and is characterized by low TCD4 cell count, high viral particle count in blood and clinical manifestations of the disease. The diagnosis is due to the appearance of opportunistic infections, which lead to TCD4 counts below 200 cells / mm³. Laboratory tests for the diagnosis of HIV were the main advances in starting treatment, reducing transmission. Antibody detection, antigen detection and virus genome amplification are some of the laboratory tests used for diagnosis. The two main biomarkers are the TCD4 cell count tests, which checks the immune system, and viral load quantification, which reports the number of viral particles, showing the progression of infection. The higher the viral load, the greater the damage to the immune system. An undetectable viral load is less than 50 copies / mL, but values less than or equal to 200 copies / mL also prevent transmission. A consensus statement states that Undetectable equals Non-Transmissible. Therefore, when undetectable, transmission does not exist. The present study reports and discusses the clinical case of a patient diagnosed with HIV / AIDS at age 28, who survived despite late diagnosis and under the presence of opportunistic disease with a severe degree of TCD4 cell reduction (22 cells / mm³). Through the diagnosis, introduction and correct adherence of antiretroviral therapy and monitoring of laboratory tests, she was able to avoid death and have a life similar to that of an HIV negative. Exceeded the life expectancy that in the discovery was 10 years, with a considerable quality of life, not transmitting the virus, thus reducing the stigma and prejudice. The biomedical is a key player in this context, considering that he must provide accurate and reliable information, which is so necessary for the monitoring of people living with HIV, so that authorities and health professionals adopt appropriate measures, both in prevention, diagnosis and monitoring of the disease.


Subject(s)
Humans , Female , Adult , HIV Infections/drug therapy , HIV , Toxoplasmosis/virology , AIDS-Associated Nephropathy/virology , Acquired Immunodeficiency Syndrome , AIDS-Related Opportunistic Infections , Viral Load , Cryptococcosis/drug therapy , Antiretroviral Therapy, Highly Active , Fever/virology , Headache/virology , Anemia/virology , Meningitis/virology
14.
Rev. chil. neuro-psiquiatr ; 60(2): 167-175, jun. 2022.
Article in Spanish | LILACS | ID: biblio-1388431

ABSTRACT

RESUMEN: La migraña es una cefalea primaria frecuente y debilitante. Los pacientes con crisis de migraña agudas y severas usualmente deben consultar por servicios de guardia, y el tratamiento convencional para el ataque de migraña incluye diversos fármacos como antiinflamatorios no esteroideos, triptanes, ergotamina, antidopaminérgicos, entre otros. Los corticoesteroides han sido ampliamente prescriptos, tanto como monoterapia o como en tratamiento coadyuvante a otros fármacos abortivos, para la crisis de migraña en los servicios de emergencia. Diferentes estudios han sido llevados a cabo con el objetivo de evaluar la efectividad de estos para abortar la crisis aguda de migraña y para evitar su recurrencia. En la presente revisión, realizamos una evaluación crítica sobre la bibliografía publicada en relación a la utilidad de los corticoesteroides en al abordaje de la crisis de migraña. En conclusión, estos podrían ser considerados como una opción razonable como tratamiento coadyuvante en las crisis de migraña resistentes, recurrentes o prolongadas (status migrañoso).


ABSTRACT Migraine is a frequent and debilitating primary headache. People with acute severe migraine attack often present to the emergency department, and standard treatment for the migraine attack generally includes the use of several drugs such as are nonsteroidal antiinflammatory drugs, triptans, ergotamine, antidopaminergic agents, among others. Steroids have been widely prescribed, either as monotherapy or as add-on treatment, to manage migraine attacks in the emergency setting. Several clinical studies have been conducted to assess the efficacy of corticosteroids in aborting acute migraine attacks and avoiding their recurrence. In this review, we make a critical appraisal of the published literature about corticosteroids treatment for the migraine attack. Overall, they could be considered as an adjunctive therapy for resistant, recurrent o prolonged (migraine status) migraine attacks.


Subject(s)
Humans , Adrenal Cortex Hormones/therapeutic use , Migraine Disorders/drug therapy , Headache/drug therapy
15.
Arch. argent. pediatr ; 120(2): e75-e79, abril 2022. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1363969

ABSTRACT

La morfea lineal en golpe de sable es una entidad dermatológica caracterizada por la inflamación esclerosante y progresiva del tejido cutáneo en la región frontal y/o en el cuero cabelludo. La cefalea y las crisis convulsivas son dos de los síntomas extracutáneos más frecuentes y están causados por el crecimiento subyacente de la lesión. Es importante un diagnóstico temprano para frenar la progresión e intentar evitar las complicaciones secundarias, principalmente neurológicas. El diagnóstico se basa en el cuadro clínico y el estudio histológico, que permite la confirmación definitiva. El tratamiento de elección es la terapia combinada con corticoides orales y metotrexato. Aun con el tratamiento farmacológico adecuado, esta patología puede presentar un curso recidivante y dejar secuelas a largo plazo. Se presenta el caso de una niña en quien se realizó un diagnóstico rápido de esta enfermedad, a pesar de un cuadro clínico inespecífico. Fue tratada con metotrexato oral con buena respuesta, sin efectos secundarios.


Linear morphea in coup de sabre is a dermatological entity characterized by progressive, sclerosing inflammation of the skin tissue in the frontal region and on the scalp. Headache and seizures are two of the most frequent extracutaneous symptoms and they are caused by the growth of the lesion towards underlying structures. An early diagnosis is important to stop cranial progression and try to avoid secondary complications, mainly neurological. The diagnosis is relied on compatible clinical signs and a pathological study that allows a definitive confirmation. The treatment of choice is combination therapy with oral corticosteroids and methotrexate. Despite an adequate pharmacological treatment, this pathology can present a recurrent course and cause long-term sequelae. We present the case of a girl who was diagnosed quickly, despite a not very noticeable symptoms. She has been treated with oral methotrexate with a good response, without side effect


Subject(s)
Humans , Female , Child , Scleroderma, Localized/complications , Scleroderma, Localized/diagnosis , Scleroderma, Localized/drug therapy , Methotrexate , Disease Progression , Headache
16.
Acta neurol. colomb ; 38(1,supl.1): 1-22, ene.-mar. 2022. tab
Article in Spanish | LILACS | ID: biblio-1383394

ABSTRACT

RESUMEN INTRODUCCIÓN: El desarrollo de anticuerpos monoclonales (mAbs) contra el péptido relacionado con el gen de la calcitonina (CGRP) ha determinado una nueva era terapéutica en la profilaxis de migraña, demostrando su efectividad en pacientes con migraña episódica (ME) y migraña crónica (MC), con respuesta desde pacientes naïve hasta refractarios a múltiples medicamentos. La disminución del 50% de los ataques de migraña al mes (DMM) durante los primeros 3 meses de uso es el desenlace aproximado en el 50% de los pacientes que reciben esta terapia. OBJETIVO: Este consenso de la Asociación Colombiana de Neurología (ACN) tiene el objetivo de guiar la selección y uso racional de los mAbs antiCGRP en pacientes con ME y MC. MATERIALES Y MÉTODOS: El comité de cefalea de la ACN mediante la aplicación de la metodología Delphi y discusiones en reuniones posteriores desarrolló un documento en formato de consenso soportado en literatura y recomendaciones de expertos. RESULTADOS: Se obtuvieron respuestas de 14 expertos en cefalea sobre moléculas utilizadas en profilaxis de migraña, analizando su aplicabilidad en situaciones clínicas frecuentes. DISCUSIÓN: Los mAbs antiCGRP han demostrado efectividad con adecuado soporte fisiopatológico, considerando que son moléculas de alto precio en una enfermedad de alta prevalencia, existe la necesidad de guíar la selección del paciente que mejor puede beneficiarse de su administración CONCLUSIONES: Los mAbs antiCGRP están recomendados en pacientes con ME y MC que presentan falla terapéutica a otras moléculas profilácticas.


ABSTRACT INTRODUCTION: The development of monoclonal antibodies (mAbs) against Calcitonin Gene Related Peptide (CGRP) has determined a new therapeutic era in migraine prophylaxis, demonstrating its effectiveness in patients with episodic migraine (EM) and chronic migraine (CM), obtaining a response in naive patients and in those who are refractory to multiple medications. A 50% decrease in migraine attacks per month during the first 3 months of use is the approximate outcome in 50% of patients receiving this therapy. OBJECTIVE: This consensus from the Colombian Association of Neurology (ACN) has the objective of serving as a guide for the rational use of antiCGRP mAbs in patients with EM and CM. METHODS AND MATERIALS: The headache committee through the application of the Delphi methodology and discussions in subsequent meetings, develops this consensus, supported in the published literature and expert recommendations. RESULTS: Fourteen answers from headache experts were received regarding the use of drugs for migraine prophylaxis, analyzing their applicability in frequent clinical situations. DISCUSSION: AntiCGRP mAbs have proved their effectiveness with adequate pathophysiological support, but with a high price in a highly prevalent disease, there is then a need to select the patient who best benefits from this therapy. CONCLUSIONS: AntiCGRP mAbs are recommended in patients with EM and CM that have previously failed to other prophylactic drugs.


Subject(s)
Migraine with Aura , Consensus , Antibodies, Monoclonal , Chronic Pain , Headache , Migraine Disorders
17.
Rev. chil. neuro-psiquiatr ; 60(1): 26-39, mar. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1388418

ABSTRACT

Resumen Introducción: Los marcadores clínicos de la cefalea por uso excesivo de medicación (CMA) se basan en la clasificación de las cefaleas desarrollada por la Sociedad Internacional de Cefaleas (IHS). Esta clasificación incluye sólo dos criterios: la frecuencia de los días de cefalea debe ser de 15 o más días al mes durante al menos tres o más meses; - y el número de días de uso excesivo de la medicación debe ser de 10 o 15 días al mes dependiendo del tipo de medicación. Sin embargo, los pacientes suelen tener otros marcadores clínicos asociados distintos, que la mayoría de los médicos pasan por alto durante la evaluación inicial. Metodología: Este estudio es un estudio prospectivo, longitudinal y observacional de 76 pacientes ingresados en la Unidad de Cefaleas del hospital DIPRECA. Todos ellos fueron diagnosticados de HMO según los criterios establecidos por su ICHD III beta.(1) Los pacientes recibieron un tratamiento estándar que incluía desintoxicación y medicación preventiva y fueron seguidos durante 6 meses. Se registraron los síntomas de interés en cada visita de seguimiento clínico y se administraron escalas de evaluación como Zung, MIDAS, HIT-6. Resultados: Los medicamentos sobreutilizados incluyeron antiinflamatorios no esteroideos (AINE), triptanes y cornezuelos. Los síntomas clínicos más significativos asociados fueron: despertar por la mañana con dolor de cabeza, despertar al paciente al amanecer por dolor de cabeza, dificultades de atención, depresión, dolor cervical y síndrome de dolor miofascial. Todos los síntomas mejoraron significativamente al iniciar el tratamiento, al igual que la calidad de vida medida por las escalas MIDAS y HIT-6. Discusión: Al evaluar a los pacientes con HMO, hay que tener en cuenta tanto los criterios diagnósticos de la ICHD III beta como los síntomas comunes y específicos que se observan en la mayoría de los casos de HMO.


Introduction: Clinical markers of medication overuse headache (MOH) are based on headache classification developed by the International Headache Society (IHS). This classification include only two criteria: frequency of headache days must be 15 or more days per month for at least three or more months; - and the number of days of overuse medication must be either 10 or 15 days per month depending on the type of medication. However, patients often have others distinct associated clinical markers, which are overlooked by most physicians during the initial evaluation. Methodology: This study is a prospective, longitudinal and observational study of 76 patients admitted to DIPRECA´s hospital Headache Unit. They were all diagnosed with, MOH according to the criteria established by the his ICHD III beta.(1) Patients were given standard treatment including detoxification and preventive medications and followed for 6 months. Symptoms of interest were recorded in at each clinical monitoring visit and assessment scales such as Zung, MIDAS, HIT-6 were administered. Results: Overused medications included nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and ergots. The most significant clinical symptoms associated were: awaking in the morning with headache, awaking the patient at dawn by headache, attention difficulties, depression, cervical pain and myofascial pain syndrome. All symptoms significantly improved when treatment began, as did quality of life as measured by MIDAS and HIT-6 scales. Discussion: In evaluating patients with MOH consider both the ICHD III beta diagnostic criteria and the common and specific symptoms seen in most cases of MOH.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Drug Misuse/adverse effects , Headache/chemically induced , Quality of Life , Prospective Studies , Migraine Disorders/chemically induced
18.
19.
Arq. neuropsiquiatr ; 80(2): 129-136, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364370

ABSTRACT

ABSTRACT Background: Headache is one of the most frequent symptoms that occur during hemodialysis sessions. Despite the high prevalence of dialysis headache, it has been little studied. Objective: To evaluate the characteristics, impact and factors associated with dialysis headache. The behavior of the cerebral vasculature was also compared between patients with and without dialysis headache. Methods: This was a cross-sectional study. Consecutive patients who underwent hemodialysis were assessed through a semi-structured questionnaire, the Headache Impact Test (HIT-6), the Hospital Anxiety and Depression Scale and the Short Form-36 Health Survey (SF-36). Transcranial Doppler ultrasonography was performed in the first and fourth hours of hemodialysis. Results: A total of 100 patients were included; 49 of them had dialysis headache. Women (OR=5.04; 95%CI 1.95-13.04), younger individuals (OR=1.05; 95%CI 1.01-1.08), individuals with higher schooling levels (OR=3.86; 95%CI 1.4-10.7) and individuals who had spent longer times on dialysis programs (OR=0.99; 95%CI 0.98-1) had more dialysis headache (logistic regression). Individuals with dialysis headache had worse quality of life in the domains of pain and general state of health (56.9 versus 76.4, p=0.01; 49.7 versus 60.2, p=0.03, respectively). Dialysis headache was associated with significantly greater impact on life (OR=24.4; 95%CI 2.6-226.6; logistic regression). The pulsatility index (transcranial Doppler ultrasonography) was lower among patients with dialysis headache than among those without them. Conclusions: Dialysis headaches occur frequently and are associated with worse quality of life and patterns of cerebral vasodilatation.


RESUMO Antecedentes: A cefaleia é um dos sintomas mais frequentes que ocorrem durante as sessões de hemodiálise. Apesar da alta prevalência, essa cefaleia é pouco estudada. Objetivo: Avaliar as características, impacto e fatores associados à cefaleia da diálise. O comportamento da vasculatura cerebral também foi comparado entre pacientes com e sem cefaleia da diálise. Métodos: Este foi um estudo transversal. Pacientes consecutivos submetidos à hemodiálise foram avaliados por meio de questionário semiestruturado, do Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale e Short Form-36 Health Survey (SF-36). Foi realizada ultrassonografia Doppler transcraniana na primeira e na quarta horas de hemodiálise. Resultados: Foram incluídos 100 pacientes, 49 deles tinham cefaleia da diálise. Mulheres (OR=5,04; IC95% 1,95-13,04), indivíduos mais jovens (OR=1,05; IC95% 1,01-1,08), com maior escolaridade (OR=3,86; IC95% 1,4-10,7) e que passaram mais tempo em programas de diálise (OR=0,99, IC95% 0,98-1) tiveram mais cefaleia da diálise (regressão logística). Indivíduos com cefaleia dialítica tiveram pior qualidade de vida nos domínios dor e estado geral de saúde (56,9 versus 76,4, p=0,01; 49,7 versus 60,2, p=0,03, respectivamente). A cefaleia da diálise foi associada a um impacto significativamente maior na vida (OR=24,4; IC95% 2,6-226,6; regressão logística). O índice de pulsatilidade (ultrassonografia Doppler transcraniana) foi menor entre os pacientes com cefaleia da diálise do que entre aqueles sem. Conclusões: A cefaleia da diálise ocorre com frequência e está associada a pior qualidade de vida e a padrões de vasodilatação cerebral.


Subject(s)
Humans , Male , Female , Quality of Life , Renal Dialysis/adverse effects , Cross-Sectional Studies , Surveys and Questionnaires , Headache/etiology , Headache/diagnostic imaging
20.
Rev. Pesqui. Fisioter ; 12(1)jan., 2022. ilus, graf, tab
Article in English, Portuguese | LILACS | ID: biblio-1398167

ABSTRACT

INTRODUÇÃO: Cefaleias tensionais podem ser induzidas pela postura da cabeça para frente, e há uma grande quantidade de evidências disponíveis para o manejo de cefaleias crônicas. Os dados corroboram uso de abordagens de terapia manual para gerenciar dores de cabeça do tipo tensional. Devido à postura anterior da cabeça, a região do músculo suboccipital torna-se curta, resultando em aumento da lordose e dor no pescoço. Pacientes com uma postura de cabeça ainda mais para frente têm um ângulo craniovertebral menor, o que, por sua vez, causa cefaleia do tipo tensional. OBJETIVO: O objetivo deste estudo é comparar os efeitos da terapia de liberação miofascial (LMF) e da técnica de energia muscular (TEM) com exercícios gerais do pescoço no ângulo crânio-vertebral e na cefaleia em pacientes com cefaleia do tipo tensional. MÉTODOS: No total, 75 indivíduos com cefaleia tensional e sensibilidade muscular suboccipital foram recrutados e randomizados cegamente em três grupos: o grupo LMF, o grupo TEM e o grupo controle (25 indivíduos em cada grupo). Um ângulo pré-crânio vertebral foi obtido por método fotográfico e um questionário de índice de incapacidade pré-cefaleia foi preenchido. O grupo LMF recebeu liberação crânio-basal na região suboccipital com exercícios de pescoço; o grupo TEM recebeu relaxamento pós-isométrico na região suboccipital com exercícios, e o grupo controle recebeu apenas exercícios por 2 semanas. Após duas semanas, o ângulo pós-craniano e o questionário de cefaleia foram coletados e medidos. RESULTADOS: O ângulo crânio-vertebral e o índice de cefaleia mostraram melhora significativa nos grupos TEM e LMF. Não houve diferença significativa quando os grupos TEM e LMF foram comparados. Quando comparados com o grupo controle, tanto o TEM quanto o LMF apresentaram aumento significativo do ângulo crânio-vertebral. Houve melhora significativa no índice de cefaleia após TEM, LMF ou exercício de rotina no pescoço. CONCLUSÃO: Comparado ao grupo controle, o LMF apresenta melhores resultados do que o TEM no ângulo crânio-vertebral e cefaleia.


INTRODUCTION: Tension headaches can be induced by forward head posture, and there is a wealth of evidence available for managing chronic headaches. The data support the use of manual therapy approaches to manage tension-type headaches. Because of the forward head posture, the suboccipital muscle region becomes short, resulting in an increase in lordosis and neck pain. Patients with an even more forward head posture have a smaller craniovertebral angle, which in turn causes tension-type headache. OBJECTIVE: This study aims to compare the effects of Myofascial release therapy (MFR) and Muscle energy technique (MET) with general neck exercises on the craniovertebral angle and headache in tension-type headache patients. METHODS: In total, 75 subjects with tension-type headache and suboccipital muscle tenderness were recruited and randomized blindly into three groups: the MFR group, the MET group, and the control group (25 subjects in each group). A pre-craniovertebral angle was taken by photographic method, and a pre-headache disability index questionnaire was filled in. The MFR group receives cranio-basal release in the suboccipital region with neck exercises, the MET group receives post­isometric relaxation in the suboccipital region with exercises, and the control group receives only exercises for two weeks. After two weeks, the postcranial angle and the headache questionnaire were taken and measured. RESULTS: Craniovertebral angle and headache index showed significant improvement in both the MET and MFR groups. There was no significant difference when MET and MFR groups were compared. When compared with the control group, both MET and MFR showed a significant increase in craniovertebral angle. There was a significant improvement in the headache index following MET, MFR, or routine neck exercise. CONCLUSION: Compared to the control group, MFR shows better results than MET on craniovertebral angle and headache.


Subject(s)
Tension-Type Headache , Patients , Headache
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