Cefalea en racimos sintomática: presentación de dos casos / Symptomatic cluster headache: report of two cases

La cefalea en racimos es una cefalea primaria con criterios bien definidos. No obstante, el 3-5 por ciento de los casos pueden ser secundarios a diversas alteraciones estructurales craneales. Los datos que sugieren un origen secundario o sintomático incluyen la ausencia de periodicidad y patrón horario fijo, la persistencia de cierto grado de cefalea de fondo que no cede entre los episodios, una respuesta insatisfactoria al tratamiento y la presencia de otros signos neurológicos además de ptosis o miosis. Presentamos a dos pacientes con cefalea en racimos secundaria (cluster-like). En el primero la cefalea se asociaba a una fístula de la arteria temporal superficial derecha. Tras embolización los episodios del dolor cedieron. El segundo presentaba un xantoma ventricular en el asta occipital; tras la exéresis quirúrgica no hubo recurrencia de la cefalea. El aumento progresivo de la frecuencia de los apisodios de la cefalea y ausencia de regularidad horaria fue un dato común en ambos casos. Comentamos y revisamos la fisiopatología de este síndrome, haciendo hincapié en el caso del xantoma ventricular, ya que no hemos encontrado ningún caso similar descrito. Se concluye que, ante la sospecha de cefalea en racimos sintomática, se deben realizar estudios de neuroimagen (AU)

[Symptomatic cluster headache: presentation of 2 cases]. / Cefalea en racimos sintomática: presentación de dos casos.

Cluster headache is a primary headache with well-defined diagnostic criteria. Nevertheless, in 3-5% of patients this syndrome is secondary to diverse cranial structural abnormalities. Atypical features which suggest a secondary or symptomatic origin include absence of periodicity and regular hourly recurrence, persistence of background pain among attacks, unsatisfactory response to treatment, and presence of neurological signs other than ptosis or miosis. We present two patients with symptomatic cluster-like headache. In one, the syndrome was associated with a fistula of the right superficial temporal artery. After embolization the pain attacks ceased. The second patient presented a ventricular xanthoma, located in the occipital horn; after surgical excision, the pain attacks did not recur. The progressive increase in frequency and absence of regularly hourly recurrence of pain episodes was a common feature in both cases. We comment and revise the pathophysiology of this syndrome, with emphasis on the case of the xanthoma, since we did not find a similar case described. If a secondary cluster-like headache is suspected, neuroimaging studies should be done.

Treatment of a recurrent traumatic carotid-cavernous fistula: vertebro-basilar approach after surgical occlusion of the internal carotid artery.

A case of a post-traumatic carotid-cavernous fistula treated by endovascular approach through the vertebrobasilar system is reported. The 16 year old female patient was hurt in a car accident. The instantly-occurring carotid-cavernous fistula was treated with a Fogarty catheter, the internal carotid artery being occluded during this procedure. Ten years later the fistula recurred with a predominantly cortical venous drainage. The fistula was closed with two detachable balloons by an endovascular approach from the vertebrobasilar system via the posterior communicating artery. The small residual fistula, fed by the external artery was occluded by a venous approach via the internal jugular.

[Management by transcutaneous intravascular treatment of angioma of the mandible and adjacent soft tissues]. / Guérison par traitement endovasculaire transcutané d'un angiome de la mandibule et des parties molles adjacentes.

Intra-mandibular arteriovenous malformations are very serious conditions, the treatment of which up to now has been extremely mutilating. This report concerns the first case, to the best of the author's knowledge, of conservative treatment involving elective polymerizing embolisation after prior dental devitalization, which even itself may not be necessary.

Pre-operative embolization of naso-pharyngeal angiofibromas. Report of 58 cases.

58 patients with a juvenile nasopharyngeal angiofibroma have been treated by a combined neuroradiological-surgical method. In the cases with smaller tumor extension, fed only by the external carotid arteries or with only slight participation of the internal carotid arteries, the external carotid arteries alone have been embolized using particles. In the cases with marked participation of the internal carotid arteries these vessels were also embolized. In the first group there have been no complications and no recurrences. In the latter (31 cases) there have been three temporary minor complications and 11 recurrences.

[Computed tomographic examination in orbitofacial injuries]. / Exploration tomodensitométrique dans les traumatismes orbito-faciaux.

Eighty patients with craniofacial injuries were investigated using a CT scan apparatus of the second generation. The advantages of this examination over conventional methods of exploration are discussed and details provided of projections used. Conventional tomography imaging has now been completely abandoned.

Examination of epidural tumors of the spinal canal. Comparative study with magnetic resonance imaging, computed tomography and tomo-myelography.

To delimit the vertical extension of epidural tumors of the spinal canal, tomo-myelography and magnetic resonance imaging (MRI) are the most accurate examinations, MRI appearing to us to be even superior to tomo-myelography. To evaluate precisely the bone extension of tumor growth as compared with the epidural lesions, computed tomography (CT) is more accurate than the other methods mentioned. The choice between these three techniques is of great importance as an aid in selection the best therapeutic method in each particular case.