[Pseudomigraine with CSF pleocytosis: intermittent measurement of the intracranial pressure. Case report]. / Pseudomigrânea com pleocitose liquórica: monitorização intermitente da pressão intracraniana. Relato de caso.

Pseudomigraine with pleocytosis is a self-limited and rather benign disorder, characterized by recurrent bouts of migrainous headaches, associated to focal neurological symptoms and to cerebrospinal fluid abnormalities. We have submitted an individual with pseudomigraine to three lumbar punctures. The first and the third lumbar punctures, carried out during symptomatic periods, revealed a cerebrospinal fluid with aseptic lymphomonocytic pleocytosis, and an opening pressure of 400 and 440 mmH2O, respectively. The cerebrospinal fluid pressure measured during an asymptomatic period was normal (190 mmH20). Although the underlying mechanisms of this disorder remain elusive, there is some evidence that suggests an involvement of autoimmune mechanisms leading to a reduction of the cerebral blood flow, similar to that seen in the cortical spreading depression. In this report, we raise the possibility of a contributory role to be played by the elevated cerebrospinal fluid pressure on the pathophysiology of this disorder.

[Change in the biological pattern of migraine with aura after the use of tetrabenazine: case report]. / Mudança no padrão biológico da migrânea com aura após a utilização da tetrabenazina: relato de caso.

The influence of the dopaminergic system on the pathophysiology of migraine has been suggested as a result of recent genetic discoveries. A possible hyper-reactivity of the dopaminergic receptors DRD2 reinforced the evidence regarding this. We describe a 31 years-old male patient affected by a generalized dystonia secondary to perinatal hypoxia. At age 16, the patient started having headache crises that met the criteria for migraine with aura. After three years of treatment for dystonia with tetrabenazine, a clear reduction in the frequency, intensity and duration of the crises was perceived. During two periods longer than two months, the interruption of the treatment with tetrabenazine brought about an aggravation of the migraine crises. We present this case as being the first description in the literature showing the beneficial effects of tetrabenazine, a blocker of dopaminergic receptors, on the behavior of migraine with aura.

Neurofibromatosis, stroke and basilar impression. Case report.

Neurofibromatosis type 1 (NF1) can virtually affect any organ, presenting most frequently with "cafe au lait" spots and neurofibromas. Vasculopathy is a known complication of NF1, but cerebrovascular disease is rare. We report the case of a 51-year-old man admitted to the hospital with a history of stroke four months before admission. On physical examination, he presented various "cafe au lait" spots and cutaneous neurofibromas. Neurologic examination demonstrated right-sided facial paralysis, right-sided hemiplegia, and aphasia. Computed tomography scan of head showed hypodense areas in the basal ganglia and centrum semiovale. Radiographs of cranium and cervical spine showed basilar impression. Angiography revealed complete occlusion of both vertebral and left internal carotid arteries, and partial stenosis of the right internal carotid artery. A large network of collateral vessels was present (moyamoya syndrome). It is an uncommon case of occlusive cerebrovascular disease associated with NF1, since most cases described in the literature are in young people, and tend to spare the posterior cerebral circulation. Basilar impression associated with this case may be considered a pure coincidence, but rare cases of basilar impression and NF1 have been described.

[Headache in patients with pheochromocytoma. Influence of arterial hypertension]. / Cefaléia em pacientes com feocromocitoma. Influência da hipertensão arterial.

Headache is an important diagnostic element in pheochromocytoma and it may characterize a body reaction to pathological hormonal oscillations. We observed the pheochromocytoma instability in 20 patients during arterial hypertension and tried to correlate with headache. We found that isolate hypertension is not the only factor in headache pathogenesis. It is possible that changes in catecholamines, adrenomedullin and other neuropeptides may cause some of these symptoms.

[Statistics of bone mineral density determined with a double-energy X-ray equipment]. / Statistica dei valori di densità minerale ossea determinati utilizzando una apparecchiatura a raggi X con doppia energia.

This study was aimed at analyzing the bone mineral density values measured in a non-selected sample of more than 2,500 Italian women from the Treviso province. The subjects were divided into nine 10-year age groups. The figures (%) in each age group are presumed to be constant over time, although arranged on a Gaussian curve because of high interperson variability. The tables with normal rates, made on the basis of the data obtained, represent the reference parameters to evaluate bone mineral content in all the women referred to our hospital for this particular reason. The tables mirror, with the highest possible accuracy, the typical figures of the female population in Treviso, inasmuch as those findings were obtained from a statistically homogeneous sample (that is, uniform in nature). On the other hand, slight differences were observed relative to the figures of population segments other than our study population. Since the risk of bone fractures is related to how quickly bone mass decreases over time, seriated measurements should be compared with the normal curve which is similar in women of every race. Thus, the tables indicate probable normality whenever the figure found for one woman falls within the normal age and race ranges the patient belongs to. If the patient belongs to a population with different lifestyle and environmental factors, the tables are but indicative; for more accurate evaluation, a late control should be made. On the contrary, if rates are markedly lower than normal, a control should be made much sooner. Moreover, the correlations between the bone density rates found in different bone segments indicate the very poor chance of predicting fracture risk at a different point from the examined one. This means that the body areas at greater risk must be studied separately. Finally, we stress the reason why it is impossible to obtain the very same information from bone mineral content measurements on the whole skeleton and how these data can be used.

[The hypothesis of a diagnostic-prognostic assessment of intestinal invagination with the aim of treatment by echo-guided pneumatic reduction]. / Ipotesi di valutazione diagnostico-prognostica della invaginazione intestinale finalizzata al trattamento con riduzione pneumatica ecoguidata.

The authors investigated the role of US in the diagnostic-prognostic evaluation of enteric intussusception, for the use of US-guided pneumatic reduction (RPEG). In the last 5 years, 59 young patients were examined; 44 of them had clinically suspected enteric intussusception which was confirmed by US. US allowed site and nature of the condition to be demonstrated (sensitivity and specificity: 100%), while supplying helpful predictive prognostic elements as to the extent of intussuscepted loop involvement (predictive prognostic value: 100%). On the contrary, its etiological screening capabilities were poor (11%) in the identification of secondary forms (5 ileal diverticula). A grading score was introduced to select the patients undergoing RPEG. Six clinical and US parameters were considered, with values increasing according to severity of the condition. The higher the score, the lower the chances of therapeutical success with RPEG. In 3 cases (2 loop necroses and 1 severe intestinal obstruction) with US score greater than 6 [9] and clinical score greater than 11 [15], RPEG, was replaced by surgery. Fourteen patients underwent RPEG: positive results were obtained in 12 cases (85%). In one case, a short-term relapse (within 6 hours) was observed.

[Ultrasonography of the borderline between normal and pathological state of the hip in newborn infants (borderline hip)]. / Reperti al confine fra normale e patologico nell'ecografia dell'anca neonatale (anca "borderline").

Infant hips are classified, according to Graf, in 4 US types on the basis of the morphologic changes in both the cartilaginous and the bony roofs (type I, II, III, IV). Out of 6,000 examined hips, 170 (2.8%) were considered, which could be classified neither as type I (mature) nor as type II (delayed/immature ossification). These hips were called borderline hips. They exhibited some characteristic US features: good bone modeling, rounded cotyle, and alpha angle 60 degrees +/- 2. They were always observed during the first month of the patients' life. Anamnestic data were not specific (27.5% breech delivery, and 13% oligohydramnios); clinics sometimes overestimated the actual anatomic development (64/170 cases with positivity of Ortolani's sign and/or restricted abduction; 25% of patients presented with no suspicious signs). Dynamic hip examination showed only physiological cranial deflection of the cartilaginous roof. Finally, borderline hips developed into type I hips in 99% of cases, within the third month of the patients' life.

[Diagnostic errors in the echography of the hip in newborns]. / Errori nell'ecografia dell'anca neonatale.

Neonatal hip sonography according to Graf employs a standardized image in a frontal section plane ("3-point system") and a good scanner adjustment (the femoral head must be anechoic, like the hyaline cartilage roof triangle). Pathologic conditions can change some of these parameters. The authors examined 6,000 neonatal hips in order to point out the commonest causes of diagnostic error. Two types of error were considered: method errors and interpretation errors. Method errors: they are due to the choice of transducer and frequency, to scanner adjustment and definition of the standard section plane. Their incidence was 2.25% and supported by an uncorrect definition of the standard section plane. Interpretation errors: they come from the wrong localization of some reference points--i.e., lower iliac margin, labrum--, uncorrect evaluation of increased echogenicity of the cartilaginous roof, infant age, application of radiographic criteria and uncorrect measurements of alpha and beta angles. Interpretation errors had 5.5% incidence; they were all due to the uncorrect measurement of alpha (3.18%) and beta (2.33%) angles, especially in pathological hips (68%). To reduce the number of errors, the authors suggest to strictly apply Graf's method, to make a diagnosis based on the morphological changes of the cartilaginous and osseous acetabular roof and, only later on, to measure alpha and beta angles to confirm the diagnosis or in the follow-up.