ABSTRACT
INTRODUCTION: There is some controversy concerning the need to perform neuroimaging studies in patient complaining of headache. 90% of the people had a complaint of headache during their life, and it is impossible to perform neuroimaging studies in all of them. OBJECTIVE: The aim of this study is knowing the reasons for indications neuroimaging studies in the evaluation of primary headaches and the effectiveness at the diagnosis. PATIENTS AND METHODS: The clinical records of patients who a neuroimaging study was performed for headache during 1998 were retrospectively studied. We analysed in all patients: the age, sex, diagnosis of headache, suspicion of diagnosis, reason and time for indication the neuroimaging study, and if the study modified the diagnosis. RESULTS: During 1998, were performed 107 neuroimaging studies in 96 patients. The mean age were 38 years. 60% were females. The suspicion of diagnosis was primary headache in 71% patients. Only one patient had an abnormality. The reasons for applying a neuroimaging study were: in 20 of the patients the migraine was more frequent and they didn t relieve with abortive drugs, in 20 there was a migraine aura, in 11 because the migraine turned to daily headache, in 17 the family asked for a neuroimaging study, there was a 17 of patients seemed to have an organic disease, in 2 the headache appeared daily, and in 7 of the cases weren't any reasons. CONCLUSIONS: Headache is the most frequent reason for asking a neuroimaging study. Primary headache is the type of headache that justifies most of indications. The most frequent reasons for performing a study were common changes in characteristics of migraine.
Subject(s)
Diagnostic Imaging/psychology , Headache/diagnosis , Motivation , Adolescent , Adult , Brain Neoplasms/complications , Brain Neoplasms/diagnosis , Craniocerebral Trauma/complications , Diagnostic Imaging/statistics & numerical data , Epilepsy/complications , Epilepsy/diagnosis , Female , Headache/classification , Headache/diagnostic imaging , Headache/etiology , Headache/pathology , Humans , Hydrocephalus/complications , Hydrocephalus/diagnosis , Male , Middle Aged , Migraine Disorders/diagnosis , Radiography , Retrospective Studies , Spain , Stroke/complications , Stroke/diagnosisABSTRACT
Introducción. La cefalea es un síntoma que aparece a lo largo de la vida en un 90 por ciento de la población, y es impensable la realización de neuroimagen a todo paciente con cefalea. La indicación de neuroimagen es un tema controvertido. Objetivos. Conocer los motivos de solicitud de neuroimagen en nuestra área en la cefalea primaria y la rentabilidad de la misma para el diagnóstico. Pacientes y métodos. Estudiamos retrospectivamente los pacientes de dos consultas externas de neurología a los que se realizaron TAC o RM por cefalea durante el año 1998. Analizamos: edad, sexo, tipo de cefalea, sospecha diagnóstica, momento y motivo de la indicación y si la neuroimagen modificó el diagnóstico. Resultados. Un total de 96 pacientes cumplían criterios de inclusión, el 60 por ciento eran mujeres con edad media de 38 años. En el 71 por ciento de los pacientes la impresión diagnóstica previa a la realización de neuroimagen fue de cefalea primaria. Sólo un 1 por ciento presentaron alteraciones en la neuroimagen. Los motivos de solicitud fueron: aumento de frecuencia de la migraña/falta de respuesta al tratamiento (20), existencia de aura (20), transformación de la migraña (20), presión familiar (17), inicio diario (2), signo neurológico o antecedente de sospecha (17), y sin motivo aparente (7). Conclusiones. La cefalea es la causa más frecuente de solicitud de neuroimagen en las consultas externas de neurología. Encontramos una elevada incidencia de solicitud de neuroimagen en la sospecha de cefalea primaria, siendo los motivos más frecuente cambios habituales en las características de la migraña. En el 99 por ciento de los pacientes la neuroimagen no modificó el diagnóstico (AU)
Subject(s)
Middle Aged , Child , Adolescent , Adult , Male , Female , Humans , Motivation , Brain Mapping , Spain , Retrospective Studies , Stroke , Attention Deficit Disorder with Hyperactivity , Diagnostic Imaging , Epilepsy , Headache , Craniocerebral Trauma , Migraine Disorders , Brain Neoplasms , HydrocephalusABSTRACT
Revisión de la clínica, diagnóstico y tratamiento de la neuralgia del trigémino, con especial atención a las nuevas opciones terapéuticas. De aparición menos frecuente, pero no de menor trascendencia clínica, son las neuralgias del glosofaríngeo, nervio intermediario, occipital y laríngeo superior (AU)
Review of clinical signs, diagnosis and treatment of trigeminal neuralgia, with special attention to new therapeutic options. Less frequent, but without less clinical relevance, are the neuralgias of glossopharyngeal, intermediate nerve, occipital and upper laryngeal nerves (AU)
Subject(s)
Humans , Male , Female , Trigeminal Nerve , Trigeminal Nerve/pathology , Trigeminal Neuralgia/complications , Trigeminal Neuralgia/drug therapy , Trigeminal Neuralgia/pathology , Cranial Nerves , Cranial Nerves/pathology , Diagnosis, Differential , Pain Management/methods , Facial Pain/complications , Facial Pain/drug therapy , Facial Pain/pathology , Laryngeal Nerves , Laryngeal Nerves/pathology , Recurrent Laryngeal Nerve Injuries/complicationsABSTRACT
INTRODUCTION: Due to the aging population in developed countries, epidemiological studies show an increasing tendency to the prevalence of epilepsy in the elderly. PATIENTS AND METHODS: During 54 months, we have studied the electroclinical and neuroimaging features in outpatients older than 60, with active epilepsy. Every patient was interviewed by one of the authors. Then, we have reviewed the medical records about the clinical features, EEG and neuroimaging (NI) studies and seizures frequency (SF) outcome. Differences in crude proportions were assessed by chi 2 test for independence by 2 x 2 tables. RESULTS: The study was been performed in 78 patients with 70.3 +/- 7.3 years of mean age at review. Partial seizures were significantly related with an higher SF at onset and, in the series of complex partial seizures was more frequent a temporal EEG topography. There was predominance of men, NI abnormal, symptomatic etiology and SF at onset > or = 1 by day in that patients who started their epilepsy after 60 years. A 51.3% was seizures-free in the last year and in 80% the SF was improved a 50% or more from the beginning. CONCLUSION: A significantly greater percentage of patients remained with seizures in four cases: in those with a SF at onset greater than 1 every day, in those suffering complex partial seizures, in women and in patients with temporal EEG topography.