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1.
Cephalalgia ; 42(8): 730-738, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35301873

RESUMO

OBJECTIVE: To evaluate the frequency, distribution, and clinical associations of the dilated appearance of cerebral cortical veins, termed cortical veins sign on T2*-weighted gradient recalled-echo (T2*-GRE) in the acute setting of migraine with aura attack in adult patients. METHODS: We conducted a retrospective analysis of 60 consecutive patients admitted for acute neurological symptoms with a final diagnosis of migraine with aura (42%) or probable migraine with aura (58%) who underwent emergency brain magnetic resonance imaging and 60 non-migrainous control adults. The cortical veins sign was defined as a marked hypo-intensity and/or an apparent increased diameter of at least one cortical vein. We examined the prevalence, the spatial distribution, and the associations of cortical veins sign with clinical characteristics of migraine with aura. RESULTS: We detected the cortical veins sign in 25 patients (42%) with migraine with aura, compared to none in the control group (p < 0.0001). The spatial distribution of cortical veins sign was characterised by the predominantly bilateral and posterior location. Presence of cortical veins sign was associated with increased severity of aura (p = 0.05), and shorter delay to MRI (p = 0.02). CONCLUSION: In the setting of acute neurological symptoms, the presence of cortical veins sign is frequent in patients with migraine with aura and can be detected with good reliability. This imaging marker may help clinicians identify underlying migraine with aura.


Assuntos
Epilepsia , Transtornos de Enxaqueca , Enxaqueca com Aura , Adulto , Humanos , Imageamento por Ressonância Magnética , Enxaqueca com Aura/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos
2.
J Clin Neurosci ; 74: 253-255, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31948881

RESUMO

Spontaneous intracranial hypotension (SIH) is a rare syndrome, typically manifests as orthostatic headache. Sometimes considered asbenignillness, neurological complications are well described, in particular subdural hematoma and cerebral venous sinus thrombosis. Brain infarction as complication of SIH is rarely reported. The main mechanism supported in the literature is the stretching of arteries due to the sagging of the brain. We report a case of SIH followed with brain infarction, with a distinct presentation from previous literature, suggesting a different mechanism. A 35 year-old had severe orthostatic headache, responsible for prolonged bed rest. One month later, he had acute left hemiparesis secondary to stroke and right posterior cerebral artery occlusion. Stroke MRI showed arguments for intracranial hypotension (thickened meninges). He was successfully treated with intravenous rtPA thrombolysis. Headache were resolved after an epidural blood patch. A patent foramen ovale was detected. Clinical features of this description were compared with previous literature. This case suggest a different mechanism for cerebral infarction after intracranial hypotension. In case of prolonged lying down due to intracranial hypotension, the presence of patent foramen ovale could be a risk factor for embolic stroke.


Assuntos
Infarto Cerebral/etiologia , Hipotensão Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Placa de Sangue Epidural , Encéfalo/patologia , Feminino , Cefaleia/etiologia , Hematoma Subdural , Humanos , Imageamento por Ressonância Magnética , Masculino , Meninges/patologia , Síndrome , Ativador de Plasminogênio Tecidual/uso terapêutico
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