Primary cerebral rhabdomyosarcoma presenting as haemorrhagic stroke.

Intracerebral haemorrhage (ICH) occurs mostly in the context of arterial hypertension, with typical localisations. Tumour-associated bleeding is the cause of 6-10% of ICHs, mostly from metastases. We present the case of a 40-year-old female admitted originally for neck pain of sudden onset, accompanied by nausea and marked right arm paresis. A CT-scan revealed left fronto-central cortico-subcortical haemorrhage. Cerebral angiography was normal. Two months after the initial event the residual paresis worsened and the patient developed neuropsychological deficits. A CT-scan showed oedema around the original bleeding site, on MRI a solid lesion with a diameter of 5 cm could be seen, with some cystic alterations and contact to the meninges. The tumour was surgically removed, and removal at the time was considered complete. Histological analysis proved it to be an embryonal rhabdomyosarcoma. The patient's neurological deficits gradually improved. Almost three months after the operation she complained of intense left-sided headache. On CT a hyperdense left fronto-central lesion with positive enhancement could be seen; MRI confirmed a relapse tumour and showed bleeding in the rostral portion of the tumour as well as oedema. The patient started radiation therapy with a total dose of 60 Gy. Whole body image studies at the time failed to reveal any other neoplastic lesions. Two months later a CT-scan showed continued tumour growth. We present this case as a rare aetiology of intracerebral haemorrhage, more frequently associated with arterial hypertension or vascular pathology, as well as being an unusual manifestation of embryonal rhabdomyosarcoma, rarely found in the brain. The case also serves to illustrate the importance of a thorough diagnosis including MRI imaging in patients with so-called atypical ICH.

[Role of arterial hypertension in comorbidity of chronic headaches]. / El papel de la hipertensión arterial en la comorbilidad de las cefaleas crónicas.

INTRODUCTION: The literature concerning the association between headache and arterial hypertension is very scarce, mostly prior to the actual IHS classification and based on very diverse methods, being therefore difficult to interpret. OBJECTIVES: To analyse the association between arterial hypertension and two types of chronic headache and to determine, if and how arterial hypertension may affect the outcome of prophylactic therapy for chronic headaches. PATIENTS AND METHODS: Sixty four files of our headache outpatient clinic, chosen randomly among patients suffering from migraine or tensional type headache (TTH), were analysed retrospectively. Patients were considered hypertensive, if blood pressure was higher than normal several times without an acute crisis present. Resistance to treatment was defined as lack of benefit concerning number and/or intensity of crisis. RESULTS: Age varied between 18 and 80 years, the mean age being 42,9 (SD 13,86) years. Eighty six percent were females. Twenty nine patients suffered from TTH and 35 from migraine. Prevalence of hypertension was 35,9% among all patients, 28,5% among migraine patients, 44,8% among patients with TTH. The prevalence of resistance to treatment was 39,8%, 34,3% and 41,3%, respectively. Of the patients resistant to treatment 60% were hypertensive and 62,5% of the hypertensive patients showed resistance to therapy. CONCLUSIONS: Arterial hypertension was more prevalent in the study sample than would be expected in an equivalent sample of the general population. Hypertension was significantly more prevalent among patients resistant to therapy, as was resistance to treatment among hypertensive patients. We therefore conclude that there is a relevant comorbidity between chronic headache and hypertension and that arterial hypertension complicates the control of chronic headaches.

Papel de la hipertensión arterial en la comorbilidad de la cefalea crónica / Resistance to pharmacological prophylaxis in hypertensive headache patients

Introducción. La literatura que hace referencia a la asociación entre cefalea e hipertensión arterial es bastante escasa, principalmente la anterior a la clasificación actual de la IHS, y se basa en métodos muy diversos, resultando por lo tanto difícil de interpretar. Objetivos. Analizar la asociación entre hipertensión arterial y los dos tipos de cefaleas crónicas y determinar cómo la hipertensión arterial puede afectar al resultado de la terapia profiláctica para el tratamiento de las cefaleas crónicas. Pacientes y métodos. Se analizaron retrospectivamente 64 historiales de pacientes externos con cefalea; los historiales fueron elegidos al azar, entre los pacientes que padecían migraña o cefalea de tipo tensional (CTT). Los pacientes se consideraron hipertensos si la presión sanguínea era superior a la normal en varias ocasiones, sin que se presentara una crisis aguda. La resistencia al tratamiento se definió como la falta de mejora en relación con el número o la intensidad de las crisis. Resultados. La edad varió entre los 18 y los 80 años, siendo la media de edad de 42,9 (DE 13,86) años. El 86 por ciento de los pacientes eran mujeres. Veinticinco pacientes sufrían CTT y 35 migraña. La prevalencia de la hipertensión fue del 35,9 por ciento entre todos los pacientes, 28,5 por ciento entre los pacientes con migraña y 44,8 por ciento entre los pacientes con CTT. La prevalencia de la resistencia al tratamiento fue del 39,8, 34,3 y del 41,3 por ciento, respectivamente. En cuanto a los pacientes resistentes al tratamiento, el 60 por ciento eran hipertensos y el 62,5 por ciento de los pacientes hipertensos ofrecieron resistencia a la terapia. Conclusiones. La hipertensión arterial fue más prevalente en la muestra estudiada de lo que se cabría esperar en una muestra equivalente de la población general. La hipertensión fue significativamente más prevalente entre los pacientes resistentes a la terapia, como la resistencia al tratamiento entre los pacientes hipertensos. Por lo tanto, nuestra conclusión es que existe una comorbilidad importante entre la cefalea crónica y la hipertensión y que la hipertensión arterial complica el control de las cefaleas crónicas (AU)