The long-term effect of craniotomy on temporalis muscle function.

OBJECTIVE: The objective of this study was to evaluate jaw movements and the masticatory muscle in patients who underwent craniotomy for treatment of cerebral aneurysm. STUDY DESIGN: Descriptive study. RESULTS: There were 71 patients evaluated between 4 and 6 months after craniotomy, by means of a systematized approach. Their mean age was 45.3 years. Thirty-four (47.9%) patients complained of headache during dental evaluation. Twenty (28.2%) patients reported pain during normal jaw movements. There was a correlation between pain complaints and jaw movements during dental examinations (P = .03). Patients with postcraniotomy headache had more masticatory muscle tenderness on palpation than those without post-craniotomy headache (P < .02). Jaw protrusion was worse than the reference values (P < .01). CONCLUSIONS: Headache was the complaint in 47.9% of the sample. Jaw movement was statistically a pain-precipitating factor. Patients who suffered from postcraniotomy headache had more masticatory muscle tenderness. There were functional jaw limitations.

[Gabapentin in the treatment of SUNCT syndrome]. / Uso de gabapentina no tratamento da Síndrome SUNCT.

We report the cases of two women who presented a clinical condition compatible with the SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) syndrome. Both presented normal clinical and neurological examination and MRI compatible with microangiopathy. The first one related headache attacks for three years, occurring several times a day when she masticated or yawned. She had a history of multiple failed therapies. The pain was controlled after the use of gabapetin (600 mg per day). The second one related she had daily headaches for six months that occurred from 20 to 40 times per day. At the first visit to the ambulatory, she related she was using carbamazepine (600 mg per day) and chlorpromazine (15 mg per day) having a partial response. Administration of gabapentin (1200 mg per day) led to complete resolution of the pain attacks, but the patient continue to have episodes of conjunctival injection.

Uso de gabapentina no tratamento da Síndrome SUNCT / Gabapentin in the treatment of SUNCT syndrome

Relatamos o caso clínico de duas mulheres com quadro compatível com síndrome SUNCT (cefaléia de curta duração, unilateral, neuralgiforme com hiperemia conjuntival e lacrimejamento). As duas apresentavam exames clínico e neurológico normais e RM com sinais de microangiopatia. A primeira apresentava cefaléia há três anos, que ocorria várias vezes por dia, sempre que mastigava ou bocejava. Havia feito uso várias medicações sem melhora. A dor foi controlada após o uso de 600 mg de gabapentina ao dia. A segunda paciente referia cefaléia há seis meses. A dor era diária, ocorrendo de 20-40 vezes por dia. Na ocasião da primeira avaliação no ambulatório, já fazia uso 600 mg de carbamazepina ao dia e 15 mg de clorpromazina, com melhora parcial. Após introdução de gabapentina- 1200 mg/ dia, a paciente evoluiu sem dor, porém com episódios de hiperemia conjuntival.

We report the cases of two women who presented a clinical condition compatible with the SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) syndrome. Both presented normal clinical and neurological examination and MRI compatible with microangiopathy. The first one related headache attacks for three years, occurring several times a day when she masticated or yawned. She had a history of multiple failed therapies. The pain was controlled after the use of gabapetin (600 mg per day). The second one related she had daily headaches for six months that occurred from 20 to 40 times per day. At the first visit to the ambulatory, she related she was using carbamazepine (600 mg per day) and chlorpromazine (15 mg per day) having a partial response. Administration of gabapentin (1200 mg per day) led to complete resolution of the pain attacks, but the patient continue to have episodes of conjunctival injection.

SUNCT syndrome associated with pituitary tumor: case report.

For twelve years, the subject of this report, a 38-year-old man, presented a clinical condition compatible with the SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) syndrome. He presented a stabbing and intense daily pain located in the left pre-auricular and temporal regions. Each of these intense pain attacks lasted around one minute and presented a frequency of two to eight times per day. The pain was associated with ipsilateral lacrimation, conjunctival injection and rhinorrhea. MRI revealed a pituitary tumor with little suprasellar extent. The subjects serial assays of prolactin, GH, TSH and ACTH were within normal levels. Following transsphenoidal hypophysectomy, with complete removal of the tumor, the subject no more presented pain. The pathological diagnosis was non-secreting adenoma. Fourteen months after the surgery, he remains symptom-free.

SUNCT syndrome associated with pituitary tumor: case report

O paciente relatado neste artigo apresentou uma condição clínica compatível com síndrome SUNCT (cefaléia de curta duração, unilateral, neuralgiforme com hiperemia conjuntival e lacrimejamento). Ele referia dor diária, intensa, em facada, localizada na região pré-auricular e temporal esquerdas. Cada ataque de dor permanecia por cerca de um minuto, com freqüência de duas a oito vezes por dia. A dor se acompanhava de lacrimejamento ipsolateral, congestão conjuntival e rinorréia. A RM mostrou um tumor de hipófise com pouca extensão suprasselar. Dosagens de prolactina, GH, TSH e ACTH estavam em níveis normais. Foi então submetido a hipofisectomia transesfenoidal com remoção completa do tumor após o que a dor cessou completamente. O diagnóstico anátomo-patológico foi adenoma não secretor. Quatorze meses após a cirurgia, o paciente permanecia livre de dor.

Aspectos clínicos e terapêuticos das cefaléias agudas / Clinical and therapeutic aspects of the acute headaches

O autor revisa os aspectos clínicos, diagnósticos e terapêuticos das cefaléias agudas. As cefaléias agudas representam, muitas vezes, uma emergência médica e necessitam de atuaçäo rápida e precisa, com diagnóstico perfeitamente estabelecido. O sucesso do tratamento depende dessas condiçöes. Embora cefaléias primárias sejam importantes diagnósticos diferenciais, cefaléias secundárias ocorrem freqüentemente.

Polirradiculoneurite aguda e vírus da imunodeficiência adquirida / Acute polyradiculoneuritis and th human immunodeficiency virus

Polirradiculoneurite aguda possivelmente causada pelo vírus da imunodeficiência humana, tratada com plasmaferese, é relatada em paciente com anticorpos anti-HIV positivos por enzimaimunoensaio, confirmados pelo Western-blot. Este revelou bandas p-24, p-38 (fraca) e p-119. Sem evidências clínicas de AIDS, o paciente desenvolveu manifestaçöes psico-orgânicas e severa neutropenia medicamentosa. Säo discutidas: a etiologia da manifestaçäo neurológica na ausência de infecçöes oportunistas, pela açäo própria do retrovírus; a patogenia das lesöes desmielinizantes pela resposta imune cruzada entre homologias químicas dos epitopes da proteína P2 e o HIV, nas lesöes do sistema nervoso periférico, e entre similaridades dos determinantes entre o vírus com proteína de mielina básica, nas agressöes ao sistema nervoso central