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Cefaleia unilateral contínua por lúpus eritematoso sistêmico: relato de caso
No full textBackgroundHemicrania continua is a rare form of cephalalgia featuring a chronic and persistent headache in only one side of the head.ObjectivesIn this report, we present a case of a patient with hemicrania continua and systemic lupus erythematosus (SLE).MethodsWe collected patient data through the electronic medical record. Afterward, we reviewed the literature regarding hemicrania continua and its pathophysiology and correlation with neurovascular alterations, inflammation, and SLE.ResultsA 42-year-old woman visited the emergency department due to worsening constant unilateral cephalalgia that had been present for the past 6 months. The patient reported a highly intense (10/10) headache in the entire left hemicrania that radiated to the left shoulder. During physical examination, she presented with nystagmus, vertigo, and aggravated cephalalgia associated to body movement and, despite having no optic nerve thickening. In addition, she had jaundice, tachycardia, and splenomegaly. Complimentary exams found deep anemia, depletion in complement system and anti-nuclear factors, suggesting a possible hemolytic anemia (AIHA) due to SLE. Treatment was initiated with hydrocortisone and prednisone, associated with amitriptyline, fluoxetine and diazepam, reaching full remission. These syndromes have aggravated each other, and possibly the explanation for the cephalalgia remission was the control of AIHA and SLE. It features a rare case in literature and thus warrants discussion
RELAÇÃO ENTRE DISTÚRBIOS GASTROINTESTINAIS E MIGRÂNEA: UMA REVISÃO INTEGRATIVA
No full textIntroduction
Migraine is a highly incapacitating type of primary headache, characterized by high prevalence and symptoms lasting from 4 to 72 hours. It is typically unilateral and pulsatile, often accompanied by nausea, hypersensitivity to sensory stimuli, vomiting and intense fatigue, and it may or may not be preceded by an aura. Although the pathophysiology of migraine is not completely understood, several mechanisms involving the gut-brain axis may explain the association between migraine and gastrointestinal disorders.
Objective
This review aims to analyze the influence of gastrointestinal disorders on migraine.
Methods
An integrative review was conducted by surveying articles in the LILACS, PubMed, and Scielo databases using relevant descriptors related to migraine and gastrointestinal disorders.
Results
The research identified 31 articles, of which only 11 met the previously established criteria. All eligible articles demonstrated a correlation between migraine and gastrointestinal disorders, with Irritable Bowel Syndrome (IBS) being the most frequently mentioned condition.
Conclusion
Gastrointestinal disorders influence migraine, possibly through tryptophan metabolism and its associated pathways. Understanding these mechanisms may lead to new treatments. IBS stands out among the disorders associated with migraine, suggesting an integrative approach. Changes in diet and lifestyle, along with medications, are recommended. Early identification of comorbidities can facilitate more effective migraine management. However, further research is needed to develop more effective treatments.Introdução
A migrânea é um tipo de cefaleia primária altamente incapacitante, com alta prevalência e sintomas que podem durar de 4 a 72 horas. Geralmente, é unilateral e pulsátil, acompanhada de náuseas, hipersensibilidade a estímulos sensoriais, vômitos e fadiga intensa, podendo ou não ser precedida por aura. Embora a fisiopatologia da migrânea não esteja completamente elucidada, vários mecanismos envolvendo o eixo cérebro-intestino podem explicar a associação entre migrânea e alterações gastrointestinais.
Objetivo
Esta revisão tem como objetivo analisar a influência dos distúrbios gastrointestinais na migrânea.
Métodos
Foi realizada uma revisão integrativa, sendo feito um levantamento de artigos nas bases de dados LILACS, PubMed e Scielo, utilizando descritores relevantes relacionados à migrânea e distúrbios gastrointestinais.
Resultados
A pesquisa encontrou 31 artigos, dos quais apenas 11 preencheram os critérios previamente estabelecidos. Todos os artigos elegíveis mostraram uma correlação entre migrânea e distúrbios gastrointestinais, com a síndrome do intestino irritável (SII) sendo a condição mais frequentemente mencionada.
Conclusão
Os distúrbios gastrointestinais influenciam a migrânea, possivelmente pelo metabolismo do triptofano e suas vias associadas. Compreender esses mecanismos pode levar a novos tratamentos. A SII é destacada entre os distúrbios associados à migrânea, sugerindo uma abordagem integrativa. Mudanças na dieta e estilo de vida, junto com medicamentos, são recomendadas. A identificação precoce de comorbidades pode facilitar uma gestão mais eficaz da migrânea. Contudo, mais pesquisas são necessárias para desenvolver tratamentos mais eficazes
Prevalence of allergic diseases in individuals with headache - preliminary data from a Brazilian cohort
Full text linkIntroduction: The first description of the relationship between headaches and allergies dates back to 1927 when Vaughn reported that 36% of patients with migraines had allergic triggers. Another study showed that 58% of individuals with migraines had a history of allergies, and more than 50% of them had a family history of allergic diseases. Since then, contradictory data has been published. Objective: To analyze the prevalence of allergic diseases in individuals with headaches. Verify whether these diseases are associated with headaches, and whether there is an association between these diseases and episodic/chronic headaches. Methods: An analytical and descriptive study from a cohort of live births (1978/79) in Ribeirao Preto/SP. The questions of interest were: 1. The presence and frequency of headache in the last 3 months; 2. The history of medical diagnosis of asthma/bronchitis, allergic rhinitis, skin allergy/eczema, and allergic conjunctivitis. Results: 1775 individuals attended this interview, with an average age of 38.13±0.579, 52.3% of whom were female. Sixty-three percent (n=1113) reported having had a headache in the last three months, with 16.3% of these having chronic headaches. Among patients with headaches, the diagnosis of asthma/bronchitis was reported by 17.80%, allergic rhinitis by 39.35%, skin allergy by 13.32%, and allergic conjunctivitis by 13.84%. There was an association between headache and allergic rhinitis [X2(2)= 27.262, p=<0.001] and headache and allergic conjunctivitis [X2(2)= 7.859, p= 0.017]. No association was observed between headache and asthma/bronchitis [Χ2(1)= 1.008, p= 0.327] or skin allergy [X2(2)= 1.243, p= 0.514]. An association between the presence of episodic headache and a diagnosis of asthma/bronchitis [X2(1)= 4.411, p= 0.043] and a diagnosis of allergic rhinitis [X2(2)= 6.110, p= 0.047 ] was observed. There was no association between episodic/chronic headache and skin allergy [X2(2)= 0.636, p= 0.728} or conjunctivitis [X2(2)= 8.828, p=0.661]. Conclusion: In patients with headaches in the last 3 months, the prevalence of asthma/bronchitis was 17.80%, allergic rhinitis 39.35%, skin allergy 13.32%, and allergic conjunctivitis 13.84%. Patients with headaches had more diagnoses of allergic rhinitis and allergic conjunctivitis. Those with episodic headaches had more diagnoses of asthma/bronchitis and allergic rhinitis when compared to those with chronic headaches
Inglês
No full textIntroduction:
Intracranial hypertension is a common complication of cerebral venous thrombosis. In the literature, recommendations regarding the management of intracranial hypertension in cerebral venous thrombosis are scarce due to the lack of controlled studies. The use of acetazolamide, corticosteroids, shunt and lumbar puncture have already been described. The shunt modalities most described in the literature are external ventricular, ventriculoperitoneal, ventriculoatrial and ventriculojugular shunts. There are few descriptions of lumboperitoneal shunts in the literature.
Goal:
Our aimed to describe the case of management of intracranial hypertension secondary to cerebral venous thrombosis with lumboperitoneal shunt.
Case report:
We report the case of acute management of intracranial hypertension with lumboperitoneal shunt in a young, obese, smoker female patient, who presented with an acute case of intracranial hypertension, with headache, nausea, vomiting, diplopia, papilledema and severe bilateral visual loss (counting fingers less than 1 meter) secondary to extensive venous thrombosis involving the right sigmoid sinus and internal jugular vein.
Upon admission, the patient underwent neuroimaging with study of intracranial vessels (magnetic resonance imaging and magnetic resonance venography) in addition to a diagnostic lumbar puncture – the latter showing an opening pressure greater than 100 cm H2O.
The patient received acetazolamide 1000mg every 6 hours until a lumboperitoneal shunt was performed for the acute treatment of intracranial hypertension, followed by the introduction of anticoagulation with enoxaparin.
He presented progressive improvement in his headache and visual symptoms throughout the hospitalization period. Acetazolamide was reduced and discontinued due to mild metabolic acidosis. She was discharged with vitamin K antagonist and was reevaluated after 18 days, without papilledema and with improvement in visual function.
Discussion:
Our patient underwent lumboperitoneal shunt to manage severe intracranial hypertension secondary to cerebral venous thrombosis with good clinical outcome – improvement in papilledema, headache and visual function. More studies are needed to evaluate this shunt modality in the management of intracranial hypertension in these patients.Introdução:
A hipertensão intracraniana é uma complicação frequente da trombose venosa cerebral. Na literatura as recomendações a cerca do manejo da hipertensão intracraniana na trombose venosa cerebral são escassas pela falta de estudos controlados, já foram descritos uso de acetazolamida, corticoides, shunt e punção lombar. As modalidades de shunt mais descritas na literatura são o shunt ventricular externo, ventriculoperitoneal, ventriculoatrial e ventriculojugular. Poucas são as descrições na literatura de shunt lomboperitoneal.
Objetivo:
Relatar um caso de manejo da hipertensão intracraniana secundária a trombose venosa cerebral com shunt lomboperitoneal.
Relato de caso:
Relatamos o caso de manejo agudo de hipertensão intracraniana com shunt lomboperitoneal em um paciente do sexo feminino, jovem, obesa e tabagista, que apresentou um quadro agudo de hipertensão intracraniana, com cefaleia, náusea, vômitos, diplopia, papiledema e perda visual severa bilateral (contar dedos a menos de 1 metro) secundário a trombose venosa extensa envolvendo o seio sigmoide e a veia jugular interna direitos.
Na admissão a paciente foi submetida a neuroimagem com estudo de vasos intracranianos (ressonância magnética e angiorressonância venosa) além de punção lombar diagnóstica – essa última evidenciando uma pressão de abertura maior que 100 cm H2O.
A paciente recebeu acetazolamida 1000mg a cada 6 horas até a realização de shunt lomboperitoneal para tratamento agudo da hipertensão intracraniana, seguida de introdução de anticoagulação com enoxaparina.
Apresentou melhora progressiva da cefaleia e dos sintomas visuais ao longo do período de internação. A acetazolamida foi reduzida e suspensa devido a acidose metabólica leve. Recebeu alta em uso de antagonista da vitamina K e foi reavaliada após 18 dias, sem papiledema e com melhora da função visual.Discussão: A paciente em questão foi submetida a shunt lomboperitoneal para manejo da hipertensão intracraniana severa secundária a trombose venosa cerebral com bom desfecho clínico – melhora do papiledema, cefaleia e função visual. Mais estudos são necessários para avaliar essa modalidade de shunt no manejo da hipertensão intracraniana nesses pacientes
Epidemiological analysis of hospitalizations for headaches in the regional health departments of Paraná, between 2019 and 2023
Full text linkIntroduction: Headache is one of the most common complaints in the medical practice of neurology outpatient clinics. The treatment of headaches is in outpatient clinics, however, sometimes emergency measures or even hospitalization of the patient are necessary. Objectives: To analyze the profile of hospitalizations due to headaches in the regional health departments of Paraná in the last 5 years. Method: Descriptive ecological study, through data collection by the SUS Hospital Information System (SIH/SUS), linked to the Department of Informatics of the Unified Health System (DATASUS) in may 2024. The number of hospital admissions due to headaches in the population of Paraná from 2019 to 2023 was analyzed. The variables used were: age group, gender, race, year of hospitalization, health region, municipality, average length of stay and average value. Results: A total of 8,152 hospitalizations due to headaches were recorded in regional health departments of the state of Paraná between 2019 and 2023. Of this total, the second Metropolitan RS was the one with the highest number of hospitalizations (66.4%, 5,414), and the city of Campo Largo accounted for 3,659 cases. The year 2019 had the highest number of registrations (2,833), while in 2023, there was a drop of 50.7% compared to that year (1,397). There was a higher predominance of headaches in females (61.3%, 4,995) and white race/color prevailed (6,457). The predominant age group was 40-59 years (35%, 2,852). Regarding the average length of stay, the third RS Ponta Grossa had the highest average (4.8) and the 20th RS Toledo the lowest (1.5). Regarding the average value of hospitalizations, the second Metropolitan RS had the highest value, 706.16 reais. Conclusion: In view of the analysis, it was possible to observe that the profile of hospitalizations in Paraná in the period is characterized by female, white, age group between 40 to 59 years, led mainly by the 2nd Metropolitan RS, which had the highest average hospitalization value. Thus, this conclusion will be important for the development of public health policies for the treatment and prevention of headaches in the state
The ENHANCED TMJ ARTHROCENTESIS FOR DISC DISPLACEMENT WITHOUT REDUCTION: EFFICACY OF VACUUM-ASSISTED TECHNIQUE VERSUS CONVENTIONAL APPROACH: TMJ ARTHROCENTESIS FOR DISC DISPLACEMENT WITHOUT REDUCTION
No full text-Introduction: Temporomandibular joint (TMJ) disorders, such as disc displacement without reduction (DDWOR), pose significant clinical challenges due to the associated pain and functional limitations. Arthrocentesis is a minimally invasive technique employed to manage these conditions. This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis—with and without the addition of catheters and a vacuum pump—in managing TMJ DDWOR.
Objective: The primary objective of this study was to evaluate and compare the clinical outcomes of TMJ arthrocentesis performed with the addition of catheters and a vacuum pump versus without any additional devices. This comparison aims to identify the technique that provides superior symptomatic relief and functional improvement.
Methods: A total of 48 patients diagnosed with DDWOR were randomly and blindly allocated into two treatment groups (N = 24 each). Group 1 underwent TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle, while Group 2 received TMJ arthrocentesis without any additional devices. The variables recorded and compared between the groups included: patient’s pain perception (measured using the visual analogue scale [VAS; 0–10]), maximal interincisal distance (MID; measured in millimeters), joint effusion (JE; noted as presence or absence), facial edema (FE; noted as presence or absence), and operation duration (OP; recorded in minutes).
Results: Patients in Group 1, who received TMJ arthrocentesis with the addition of catheters and a vacuum pump, presented significantly lower VAS scores (p < 0.001) and a reduced presence of FE (p = 0.03) in the postoperative period. Furthermore, these patients demonstrated an increase in MID values (p = 0.026) and a reduction in JE (p = 0.022) after 3 months. Additionally, the procedure in Group 1 was performed significantly faster (p < 0.001).
Conclusion: The results indicate that performing arthrocentesis with the addition of a vacuum pump enhances the efficiency of the procedure, yielding better outcomes in terms of pain reduction, facial swelling mitigation, improved mouth opening, and decreased joint effusion. This technique, therefore, offers a superior approach for managing TMJ DDWOR, improving both immediate and long-term patient outcomes
Português ( Brasil ) Português ( Brasil )
No full textIndivíduos com cefaleia apresentam redução da força muscular de flexão e extensão isométrica, mas não se sabe se essa redução já está presente nos primeiros anos da doença. Avaliar a força dos músculos flexores e extensores da coluna cervical em adultos jovens com e sem cefaleia. Este estudo incluiu adultos jovens de ambos os sexos, com idade entre 18 e 30 anos, com e sem diagnóstico de cefaleia e excluindo aqueles com histórico de trauma cervical; gestação; hérnia ou abaulamento de disco cervical e patologias articulares; tumores cervicais e ósseos. Um questionário pré-elaborado foi usado para avaliar os dados gerais, o Headache Screening Questionnaire (HSQ) para rastrear cefaleia e o Neck Disability Index (NDI) foi usado para avaliar o nível de incapacidade relacionado ao dor no pescoço. A força muscular flexora e extensora foi medida usando um dinamômetro portátil (Lafayette Instrument Company). A normalidade dos dados foi testada pelo teste de Shapiro-Wilk, os dados foram resumidos por média e desvio padrão, uma análise de variância (ANOVA) foi utilizada para verificar a diferença entre os grupos, o nível de significância estatística estimada foi de p≤ 0,05. Foram avaliados n=60 indivíduos, n=30 com cefaleia en=30 do grupo controle, com média de idade, altura e peso de 23,33±6,28 anos, 1,64±0,09m2 e 64±12,14 kg e 22,07±2 anos, 1,62±2m2 e 64,54±14,11 respectivamente (p=0,34), média de tempo, frequência, duração e intensidade da cefaleia de 3,26±2,4 anos, 10,9±8,20 dias, 18±8 horas, 8,82±1,07 EVA. Dor leve no pescoço foi mais comum em ambos os grupos. Foi observada diferença significativa entre os grupos para os músculos extensores (p=0,043). Adultos jovens com dor de cabeça apresentaram redução da força nos músculos flexores da coluna cervical quando comparados aos controles.
Palavras-chave : Cefaleia, Índice de Incapacidade do Pescoço (NDI), Nível de incapacidade.Indivíduos com cefaleia apresentam redução da força muscular isométrica de flexão e extensão, mas não se sabe se essa redução já está presente nos primeiros anos da doença. Avaliar a força dos músculos flexores e extensores da coluna cervical em adultos jovens com e sem cefaleia. Foram incluídos neste estudo adultos jovens de ambos os sexos, com idade entre 18 e 30 anos, com e sem diagnóstico de cefaleia e excluídos com histórico de trauma cervical; gravidez; hérnia ou disco cervical e patologias articulares; tumores cervicais e ósseos. Um questionário pré-elaborado foi utilizado para avaliar dados gerais, o Headache Screening Questionnaire (HSQ) para triagem de cefaleia e o Neck Disability Index (NDI) foi utilizado para avaliar o nível de incapacidade relacionada à dor cervical. A força muscular flexora e extensora foi medida por meio de um dinamômetro portátil (Lafayette Instrument Company). A normalidade dos dados foi testada com o teste de Shapiro-Wilk, estes foram resumidos por médias e desvio padrão, análise de variância (ANOVA) foi utilizada para verificar a diferença entre os grupos, nível de significância estatística estimada foi de p≤ 0, 05. Foram avaliados n=60 indivíduos, n=30 com cefaleia en=30 do grupo controle, com média de idade, altura e peso de 23,33±6,28 anos, 1,64±0,09m2 e 64±12 ,14 kg e 22,07± 2 anos, 1,62±2m2 e 64,54±14,11 respectivamente (p=0,34), média de tempo, frequência, duração e intensidade da cefaleia de 3,26±2 ,4 anos 10,9±8,20 dias, 18±8 horas, 8,82±1,07 EVA. O nível de cervicalgia foi mais presente em ambos os grupos. Foi observada diferença significativa entre os grupos para os músculos extensores (p=0,043). Adultos jovens com cefaleia sofreram redução da força dos músculos flexores da coluna cervical quando comparados ao controle.
Palavras-chave : Cefaleia, Índice de Incapacidade do Pescoço (NDI), Nível de incapacidade
Migrânea e Zumbido: Implicações para o Manejo Multidisciplinar
No full textIntroduction
Patients with migraines often experience vestibular and audiological symptoms, especially tinnitus. Both conditions are linked to vertigo, neck pain, and depression, which can affect the disease burden.
Objective
To examine the correlation between tinnitus characteristics and disability with measures of disability, central sensitization, and depression in migraine patients.
Methods
Forty-six women with migraine and tinnitus (aged 18-55 years) were recruited. All participants underwent audiological evaluations to exclude hearing loss and acuphenometry assessments to determine tinnitus intensity (dB) and frequency (Hz). Questionnaires administered included the Tinnitus Handicap Inventory (THI), Headache Impact Test (HIT-6), Central Sensitization Inventory (CSI), Neck Disability Index (NDI), Patient Depression Questionnaire (PHQ-9), and Dizziness Handicap Inventory (DHI). Spearman correlations were classified as weak (rho<0.3), moderate (0.3<rho<0.6), and strong (rho>0.7).
Results
Moderate, significant correlations were observed between tinnitus intensity in the right ear (RE) and left ear (LE) with THI (RE: rho=0.335, p=0.037; LE: rho=0.373, p=0.025), HIT-6 (RE: rho=0.371, p=0.020; LE: rho=0.344, p=0.040), CSI (RE: rho=0.385, p=0.015; LE: rho=0.432, p=0.008), NDI (RE: rho=0.347, p=0.030; LE: rho=0.386, p=0.020), and PHQ-9 (RE: rho=0.377, p=0.018; LE: rho=0.397, p=0.016). Negative, moderate, significant correlations were found between tinnitus frequency and NDI (RE: rho=-0.402, p=0.011; LE: rho=-0.491, p=0.002), and between LE tinnitus frequency and THI (rho=-0.437, p=0.008), CSI (rho=-0.357, p=0.032), and PHQ-9 (rho=-0.383, p=0.021). Positive, moderate, significant correlations were noted between THI and PHQ-9 (rho=0.483, p=0.001), CSI (rho=0.543, p=0.000), NDI (rho=0.568, p=0.000), and HIT-6 (rho=0.344, p=0.019). A strong, significant correlation was found between THI and DHI (rho=0.768, p=0.000).
Conclusion
The perception of low-pitched and loud tinnitus, indicated by lower frequency and higher intensity sounds, and tinnitus-related disability correlate with greater disability related to headaches, neck pain, and dizziness, alongside increased central sensitization and depressive symptoms in migraine patients. These results emphasize the need for a multidisciplinary approach in audiological, psychological, and functional evaluations for better management of migraines and tinnitus.Introdução: Pacientes com migrânea podem apresentar sintomas vestibulares e audiológicos, especialmente zumbido. Ambas as condições estão associadas à vertigem, dor cervical e depressão, que podem influenciar a carga das doenças.
Objetivo: Investigar a correlação entre as características e a incapacidade relacionada ao zumbido e medidas de incapacidade, sensibilização central e depressão em pacientes com migrânea.
Métodos: Foram recrutadas 46 mulheres com migrânea e queixa de zumbido (18-55 anos). Todas realizaram avaliação audiológica convencional para excluir perda auditiva e avaliação acufenométrica para caracterizar a intensidade (dB) e a frequência (Hz) do zumbido. Foram aplicados os questionários: Tinnitus Handicap Inventory (THI), Headache Impact Test (HIT-6), Central Sensitization Inventory (CSI), Neck Disability Index (NDI), Patient Depression Questionnaire (PHQ-9) e Dizziness Handicap Inventory (DHI). A correlação de Spearman foi classificada como fraca (rho<0,3), moderada (0,3<rho<0,6) e forte (rho>0,7).
Resultados: Correlações positivas, moderadas e significativas foram observadas entre a intensidade do zumbido nas orelhas direita (OD) e esquerda (OE) e com os questionários THI (OD: rho=0,335, p=0,037; OE: rho=0,373, p=0,025), HIT-6 (OD: rho=0,371, p=0,020; OE: rho=0,344, p=0,040), CSI (OD: rho=0,385, p=0,015; OE: rho=0,432, p=0,008), NDI (OD: rho=0,347, p=0,030; OE: rho=0,386, p=0,020) e PHQ-9 (OD: rho=0,377, p=0,018; OE: rho=0,397, p=0,016). Por outro lado, correlações negativas, moderadas e significativas foram encontradas entre a frequência do zumbido e o NDI (OD: rho=-0,402, p=0,011; OE: rho=-0,491, p=0,002) e entre a frequência do zumbido na OE e o THI (rho=-0,437, p=0,008), CSI (rho=-0,357, p=0,032) e PHQ-9 (rho=-0,383, p=0,021). Correlações positivas, moderadas e significativas foram identificadas entre o THI e os questionários PHQ-9 (rho=0,483, p=0,001), CSI (rho=0,543, p=0,000), NDI (rho=0,568, p=0,000) e HIT-6 (rho=0,344, p=0,019). Uma correlação positiva, forte e significativa foi observada entre o THI e o DHI (rho=0,768, p=0,000).
Conclusão: A percepção de zumbidos mais graves e altos está associada a maior incapacidade relacionada a cefaleia, cervicalgia e tontura, além de maior sensibilização central e sintomas depressivos, em pacientes com migrânea. Esses achados destacam a necessidade de uma abordagem multidisciplinar nas avaliações audiológicas, psicológicas e cinético-funcionais em pacientes com migrânea e zumbido para a melhor abordagem terapêutica
Worsening of cluster headache pattern associated with glioblastoma multiforme: a case report
Full text linkINTRODUCTION: Cluster headache is the most common trigeminal autonomic cephalalgia, characterized by intense, unilateral headache accompanied by autonomic symptoms1. The recommended investigation includes Brain Magnetic Resonance Imaging (MRI), which is expected to show no abnormalities. On the other hand, glioblastoma multiforme (GBM) is the most common and aggressive primary tumor in adults2, with headache being an unusual presentation. OBJECTIVE: To present an unusual case of worsening cluster headache associated with the onset of GBM. CASE REPORT: An 88-year-old male patient attended the headache clinic at PUC-PR, Londrina-PR, complaining of very severe, right-sided, pulsating headaches, associated with facial flushing, tearing, and ipsilateral rhinorrhea, lasting between 15-20 minutes and occurring 2-3 times a day. The events did not improve with common analgesics. He had been experiencing this pain for over 20 years; however, in the past year, it had become more frequent and unremitting. His neurological examination and fundoscopy examination were unremarkable. A brain MRI was requested, and an occipital anesthetic block was performed. Before the MRI was performed, the patient suffered a fall with head trauma and began to exhibit mental confusion. The MRI showed an expansive lesion located in the right occipito-temporal region with invasion of the splenium of the corpus callosum and water diffusion restriction measuring 4.5x2.7x4.0 cm, suggestive of GBM. The same examination also identified a subdural hematoma with a thickness of 2 cm which was drained. The family chose not to address the tumor lesion. After 4 months, the patient returned to the headache clinic, with his daughter reporting that since the anesthetic block, the patient had not experienced any headache episodes. Finally, 8 months after the initial consultation, the patient died. CONCLUSION: Imaging studies are essential in trigeminal autonomic cephalalgias and should not be neglected despite long disease evolution and favorable response to implemented therapy
The effect of age and sex on absolute volume and fractional anisotropy values of the trigeminal nerve in healthy young adults
No full textIntroduction: Some chronic orofacial pain diseases have a well-defined etiology, such as classic neuralgia of the trigeminal nerve (TN). However, in idiopathic TN neuralgia the symptoms suggest problems directly in the NT. Studies that evaluate the absolute volume (AV) in different regions of interest (ROIs) of the TN in young, healthy adults contribute to defining a standard of normality, but are scarce in the current literature and have a small number of individuals. Additionally, Diffusion Tensor Imaging (DTI) allows white matter integrity to be assessed by calculating diffusion metrics such as fractional anisotropy (FA).
Purpose: To evaluate the VA in different portions of the NT of healthy young adults, and verify the effect of volume, age and sex on the TN FA values in the General Linear Model (GLM).
Method: Structural and diffusion MRI data from 300 healthy individuals, 150 men and 150 women, aged between 22 and 35 years, were obtained from the Human Connectome Project (HCP) database, separated into 6 groups considering age and sex. T1w images were used for bilateral marking of the ROIs: total TN, root entry zone, middle portion of the cistern and Merckel\u27s cave. The marking of ROIs, FA maps, calculation of FA and AV of the ROIs were done using the MRTrix3 software. The results were analyzed using the Kurskal-Wallis test (p<0.05) and correlations using GLM.
Results: The median AV is higher in men. Sex had a significant effect on the AV of the ROIs, for example: AV of the right root (median for men (56.55 mm3), median for women (52.65 mm3); p = 0.0006). Age had no significant effect on the AV of the ROIs. In the GLM involving AV, age, sex and FA, age had no significant effect on FA values, but it showed that the variation in FA values is explained by the effect of AV and sex, with the effect of sex being stronger for the model.
Conclusion: AV is affected by sex, as are FA values in any portion of the TN in young adults. Age had no effect on AV or FA values