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Human choroid plexus in a patient with intracranial hypertension and hydrocephalus: scanning electron microscopy
Get PDFIntroduction
The daily production of 500 ml of cerebral spinal fluid (CSF) is largely carried out by the choroid plexus (CP), which is located in the cerebral ventricles. In recent years, much importance has been given to studies of the choroid plexus for a better understanding of the mechanism of headache associated with idiopathic intracranial hypertension or other etiologies. A few drugs acting on the CP to reduce CSF secretion are used to treat headache in patients with benign intracranial hypertension.
Objectives
To show scanning electron microscopy images of CP obtained from a pediatric patient with hydrocephalus.
Method
The CP sample was collected during a surgical procedure of a third ventriculostomy and CP coagulation as a treatment for hydrocephalus in a 2-year-old boy. A sample of uncoagulated CP (5 mm) was removed and immediately immersed in glutaraldehyde solution and refrigerated at 4°C. In the electron microscopy laboratory of UFPE, the sample. The sample was fixed with Karnovsky solution (2.5% glutaraldehyde, 4.0% formaldehyde and 0.1M sodium cacodylate buffer), later postfixed with 1% osmium tetroxide, dehydrated in an increasing series of alcohol (30%, 50%, 70%, 90% and 100%) and carried out the critical point for total drying. The samples were placed in metallic stubs containing a double-sided carbon tape and then metalized with gold-palladium in the Ion Sputter JFC-1100 (JEOL) equipment. Images were performed using the EVO LS-15 scanning microscopy (ZEISS).
Results
We present images of CP segments at 20,000 to 40,000x magnification, showing surface projections suggesting microvilli. Due to ethical issues, we do not have a control sample of healthy individuals for comparative purposes.
Conclusion
To the best of our knowledge, this is the first time human CP images of a patient with hydrocephalus are presented using scanning electron microscopy.
Keywords: Choroid plexus, Headache, Intracranial hypertension, Hydrocephalus, Microscopy
Cefaléia em facadas relacionada à menstruação em paciente sem migrânea: relato de caso
No full textIntroduction
Stabbing headache is considered a primary headache and is a prevalent entity in the general population.
Objective
To present an unusual case of stabbing headache associated with menstruation.
Method
Data collected through complete anamnesis.
Case report
The authors report a case of a woman suffering from a stabbing headache which features that has not been previously described – a menstrual pattern in the presentation of stabbing headache attacks.
Conclusions
We conclude that this menstrual pattern of stabbing headache attacks is unusual in patients with primary stabbing headache and that it does not fulfil diagnostic criteria for migraine or tension-type headache.Introdução
A cefaleia em facadas é considerada uma cefaleia primária e é uma entidade prevalente na população em geral.
Objetivo
Apresentar um caso incomum de dor de cabeça aguda associada à menstruação.
Método
Dados coletados por meio de anamnese completa.
Relato de caso
Os autores relatam o caso de uma mulher que sofria de uma dor de cabeça em facadas que apresentava características não descritas anteriormente – um padrão menstrual na apresentação de crises de dor de cabeça em facadas.
Conclusões
Concluímos que esse padrão menstrual de ataques de cefaleia em facadas é incomum em pacientes com cefaleia em pontada primária e que não preenche os critérios diagnósticos para enxaqueca ou cefaleia do tipo tensional
Comparison between metamizole and triptans for migraine treatment: a systematic review and network meta-analysis
Get PDFObjective The aim of this systematic review was to evaluate the efficacy of metamizole and triptans for the treatment of migraine. MethodsRandomized controlled trials including people who received metamizole or triptan by multiple routes of administration and at all doses as treatment compared to subjects who received another treatment or placebo were included in the systematic review. The primary outcomes were freedom from pain at 2 hours; pain relief at 2 hours; sustained headache response at 24 hours; sustained freedom from pain at 24 hours. The statistical analysis of all interventions of interest were based on random effect models compared through a network meta-analysis. Results 209 studies meeting the inclusion and exclusion criteria were analyzed. Of these, 130 had data that could be analyzed statistically. Only 3.0% provided enough information and were judged to have a low overall risk of bias for all categories evaluated; approximately 50% of the studies presented a low risk of selection bias. More than 75% of the studies presented a low risk of performance bias, and around 75% showed a low risk of detection and attrition bias. ConclusionThere is no evidence of a difference between dipyrone and any triptan for pain freedom after 2 hours of medication. Our study suggests that metamizole may be equally effective as triptans in acute migraine treatment
What would be the correct translation of the terms "trigeminal nerve"? Let\u27s use "nervo trigêmeos" or "nervo trigeminal"
Get PDFWhat would be the correct translation of the terms "trigeminal nerve"? Let\u27s use "nervo trigêmeos" or "nervo trigeminal"What would be the correct translation of the terms "trigeminal nerve"? Let\u27s use "nervo trigêmeos" or "nervo trigeminal
Cefaleia Primária em Acadêmicos: um estudo transversal
No full textHeadache is a frequent, long-standing and universal neurological disorder with high prevalence worldwide.
ObjectiveTo verify the prevalence of headache and self-medication among healthcare academics.
MethodsThis was a cross-sectional, descriptive and quantitative study, carried out with 165 healthcare academics. A questionnaire was used as a methodological instrument to collect data.
ResultsThe academics were mostly female, aged between 18 and 54 years, from the State of Paraiba and single. The lifetime prevalence of headaches was 98.2%. Most volunteers (62.4%) have a probable diagnosis of primary headache. Of these, the most prevalent was migraine, especially with aura, and tension-type headache (TTH). Of the group under analysis, the majority have not had consultations because of the pain and therefore have no medical diagnosis and no treatment. Some treated the pain only in a crisis. Of these, most practiced self-medication, mainly with dipyrone and paracetamol.Stress, worry and sleep deprivation were the most cited factors among those that usually cause pain.
ConclusionClarifications, preventive measures, correct diagnosis and appropriate treatment can reduce the emotional, socioeconomic and academic losses of this frequent neurological complaint among students.A cefaleia é um distúrbio neurológico frequente, antigo e universal com alta prevalência mundial.
Objetivo
Verificar a prevalência de cefaleia e automedicação entre acadêmicos da saúde.
Métodos
O estudo foi de caráter transversal, descritivo e quantitativo, realizado com 165 acadêmicos da área da saúde. Utilizou-se, como instrumento metodológico, um questionário para coleta dos dados.
Resultados
Os acadêmicos eram, em sua maioria, do gênero feminino, idade entre 18 e 54 anos, paraibanos e solteiros. A prevalência de dor de cabeça ao longo da vida foi de 98,2%. A maioria dos voluntários (62,4%) tem diagnóstico provável de cefaleia primária. Destas, a enxaqueca, principalmente com aura, e a Cefaleia Tipo Tensão (CTT) foram as mais prevalentes. Do grupo em análise, a maioria não fez consultas por causa da dor e, portanto, não tem diagnóstico médico e não faz tratamento. Alguns trataram a dor apenas nas crises. Destes, a maioria praticou automedição, principalmente com dipirona e paracetamol. Estresse, preocupação e privação de sono foram os fatores mais citados entre os que costumam provocar a dor.
Conclusão: Esclarecimentos, medidas preventivas, diagnóstico correto e tratamento apropriado podem diminuir os prejuízos emocionais, socioeconômicos e acadêmicos dessa queixa neurológica frequente entre os acadêmicos
Correlation between sensitization and range of motion in children and adolescents with migraine
Get PDFIntroductionMigraine affects 7.7% of children and adolescents and presents with short duration, bilateral and generally frontotemporal localization, however, the relationship of pain and sensitivity symptoms and their correlations with physical tests as well as range of motion are not well understood in these groups.
ObjectiveCorrelate sensitization including allodynia and pressure pain threshold (PPT) of cervical muscles with neck mobility in children and adolescents with migraine.
MethodsFifty children (CH) and adolescents (AD) diagnosed with migraine by ICHD-III were screened, of both sexes, aged between 6 and 17 years at the tertiary headache outpatient clinic. Allodynia was assessed by the adapted allodynia questionnaire based on the ICHD-III and the sensitivity of the cervical muscles sternocleidomastoid, elevator, suboccipital, trapezius and scalene by the pressure pain threshold (PPT) using a digital algometer DDK-20 Kratos®. The active mobility of the cervical spine (ROM) was evaluated in the movements of flexion, extension, lateral flexion, and rotation by the Flexion Rotation Test (FRT), using the CROM®.
ResultsThe mean age of patients was 11.7 years (SD=3.0), most of them female (n=31/62%), adolescents (n= 28/56%) with a diagnosis of episodic migraine (n=32/64%), of low intensity (2.4; SD=0.6), pulsatile quality, duration in hours (18.0; SD=22.7) and more than half of the sample had no aura (n=32/64%). More than 70% of the sample had some comorbidity associated with the diagnosis of migraine, and neurological diseases, such as epilepsy, were more prevalent in both children (25.2%) and adolescents (26.3%), followed by respiratory diseases in children (20.1%) and psychological conditions in adolescents (19.8%). (To see the complete abstract, please, check out the PDF)
Intracranial hypertension secondary to low doses of vitamin A
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Chronic Vitamin A toxicity usually occurs with high doses of Vitamin A intake, usually after using >30,000mcg EA daily for several months. For treatment of skin disorders isused massive doses (50,000 to 150,000 mcg AE daily). Early signs and symptoms can be sparsely distributed rough hair, alopecia of the eyebrows, rough and dry skin, dry eyes and chapped lips. Later, severe headache, intracranial hypertension, and generalized weakness develop. Fractures can easily occur, especially in the elderly.
Objective
To present a case of intracranial hypertension secondary to chronic intake of low doses of Vitamin A.
Method
Revision of medical record.
Case
Woman, 60 years old, thin, presents with worsening headaches for two years. Since childhood, she has had migraine without aura in low-frequency. In the last two years, she has had some changes in headache characteristics, however she still met criteria for migraine. Pain occurred daily and there were four episodes of nocturnal awakenings by pain in the last year. Magnetic resonance imaging of the brain and venous-phase magnetic resonance angiography normal. A cerebrospinal fluid analysis was requested, which showed an opening pressure of 92cmH2O and a closing pressure of 40cmH2O. No futher abnormalities. Acetazolamide 250mg twice a day was started, with intolerance and metabolic acidosis after 3 days of use. It was replaced by topiramate, to which there was also intolerance at a dose of 25mg twice a day for 7 days of use. Asked again by the use of any medine/vitamin, patient revealed that use two capsules of propolis for fourteen years, whose leaflet showed the presence of 300 mcg EA of vitamin A in each capsule of the compound. Patient was advised to discontinue its use and to repeat cerebrospinal fluid analysis in three months, whose opening...
(To see the complet abstract, please, check out the PDF.
Red Ear Syndrome e enxaqueca: relato de caso e revisão dessa associação peculiar
No full textIntroduction: The "Red Ear Syndrome" (RES) is a rare condition (about 100 cases were published in 25 years). It is characterized by episodes of hyperemia of the ear associated with burning pain. Although the association of this syndrome and primary headaches is contemplated in literature, its etiology and treatments are still poorly defined.
The aim of this paper is to report a case of RES related to migraine and possible pathophysiologic mechanisms.
Case Report: A 31-year-old woman presented with stabbing pain and marked erythema and edema of the right ear accompanied by burning and local hyperhidrosis. These attacks lasted 2 hours on average, and either occurred spontaneously or were associated with migraine without aura. The only means of relief during the attacks was cooling the local with ice.
Extensive laboratory-chemical, microbiological, ear-nose-throat, clinical and neurological examinations, magnetic resonance of the brain and cervical spine were unremarkable.
Conclusion: Uncertainty about the etiology of this syndrome is an obstacle to treatment. The frequent relationship between RES and migraine suggests that is necessary to investigate the syndrome in migraineurs. Furthermore, new reports about this disorder are important to increase the knowledge of physicians, to reduce the delay in diagnosis and suffering of patients.Introdução: A "Red Ear Syndrome" (RES) é uma condição rara (cerca de 100 casos foram publicados em 25 anos). É caracterizada por episódios de hiperemia do ouvido associados à dor em queimação. Embora a associação entre a síndrome e cefaleias primárias seja contemplada na literatura, sua etiologia e tratamentos ainda são mal definidos.
O objetivo deste artigo é relatar um caso de RES relacionado à enxaqueca e possíveis mecanismos fisiopatológicos.
Relato do Caso: Mulher de 31 anos com quadro de dor em pontada e eritema acentuado e edema em orelha direita acompanhados de queimação e hiperidrose local. Essas crises duraram em média 2 horas e ocorreram espontaneamente ou foram associadas à enxaqueca sem aura. O único meio de alívio durante os ataques foi resfriar o local com gelo.
Exames laboratoriais químicos, microbiológicos, avaliação clínica, ressonância magnética do cérebro e coluna cervical foram normais.
Conclusão: A incerteza sobre a etiologia desta síndrome é um obstáculo para o tratamento. A relação frequente entre RES e enxaqueca sugere que é necessário investigar a síndrome em pacientes com enxaqueca. Além disso, novos relatos sobre esse transtorno são importantes para aumentar o conhecimento dos médicos, diminuir o atraso no diagnóstico e o sofrimento dos pacientes
Trigeminal neuralgia secondary to arteriovenous malformation in the brainstem: a case report and a brief review
Get PDFTrigeminal neuralgia, a condition characterized by high intensity, paroxysmal and unilateral pain, can be characterized as secondary when associated with conditions such as multiple sclerosis and tumors. However, among these secondary cases, there are also arteriovenous malformations, characterized by a nidus mass of vessels separated by parts of sclerotic tissues, responsible for a small portion of the neuralgias of the trigeminal nerve. The case report described is of a 54-year-old male patient who has a brainstem AVM and refers to lancing and paroxysmal pain in the right hemiface in the territories of V2 and V3 after feeding and brushing the teeth. The treatment of this patient was done from the insertion of a balloon from the foramen ovale, accessed by the Meckel fossa and the trigeminal ganglion. The literature review demonstrated, from the analysis of gender, age, vascularization, localization and treatments of reports of TGN secondary to brainstem AVM, the reduced number of cases described
Associação entre comportamento alimentar e hábitos de vida e aumento de crises de migrânea em universitários na pandemia da COVID-19
No full textBackground: The COVID-19 pandemic caused changes in the population\u27s lifestyle and dietary patterns, important triggers for migraine crises. Objective: Evaluating the association between eating behavior and lifestyle habits and the increase of migraine attacks in university students during the COVID-19 pandemic. Methods: Descriptive, cross-sectional, retrospective study carried out with university students from Salvador, Bahia, between December/2020 and June/2021. The university students were invited by Whatsapp® and institutional email and then directed to the free and informed consent form and questionnaire, filled through the research management application. This research was approved by the Research Ethics Committee under evaluation report 4.351.573. Data were analyzed by descriptive analysis. Results: Sample of 83 individuals, 89,2% women, 45,8% sedentary, 51,8% gained weight recently, 73,4% have low water intake, 59% have difficulty to conciliate and 50,6% have difficult to maintain the sleep. Before the pandemic, 7,3% reported 7-14 days of migraine per month and, after, increased to 24,1%. 36,1% of students associated food with migraine attacks, the main triggers are: coffee (20,5%), chocolate (14,5%), sausages (12%), alcohol (9,6%) and sugar (6%). The increase in migraine days was associated with difficulty in maintaining sleep (p < 0.002). Conclusion: Despite the statistically significant result only between difficulty to conciliate the sleep and greater frequency of migraine, changes in lifestyle and eating behavior caused by the COVID-19 pandemic also seem to imply in increase in days with migraine in university students.Introdução: A pandemia da COVID-19 provocou alterações nos hábitos de vida e padrão alimentar da população, importantes gatilhos para as crises migranosas. Objetivo: Avaliar a associação entre comportamento alimentar e hábitos de vida e aumento das crises de migrânea em universitários na pandemia da COVID-19. Material e Métodos: Estudo descritivo, de corte transversal, retrospectivo, realizado com acadêmicos de universidade de Salvador, Bahia, entre dezembro/2020 a junho/2021. Os universitários foram convocados pelo Whatsapp® e pelo e-mail institucional e direcionados ao termo de consentimento livre e esclarecido e questionário, preenchidos via aplicativo de gerenciamento de pesquisa. Esta pesquisa foi aprovada pelo Comitê de Ética em Pesquisa, sob parecer 4.351.573. Dados analisados por meio de estatística descritiva. Resultados: Amostra de 83 indivíduos, 89,2% mulheres, 45,8% sedentários, 51,8% ganharam peso recentemente, 73,4% apresenta baixa ingestão hídrica, 59% têm dificuldade para conciliar e 50,6% têm dificuldade de manutenção do sono. Antes da pandemia, 7,3% relataram 7-14 dias de enxaqueca por mês e, após, aumento para 24,1%. 36,1% dos acadêmicos associaram alimentos às crises de enxaqueca, sendo os principais gatilhos: café (20,5%), chocolate (14,5%), embutidos (12%), álcool (9,6%) e açúcar (6%). O aumento dos dias com enxaqueca associou-se à dificuldade de manutenção do sono (p < 0,002). Conclusão: Apesar do resultado estatisticamente significante apenas entre a dificuldade em conciliar o sono e maior frequência de enxaqueca, as mudanças no estilo de vida e comportamento alimentar ocasionadas pela pandemia da COVID-19 também parecem implicar no aumento de dias com enxaqueca em universitários