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Intracranial hypertension associated with treatment of acute promyelocytic leukemia with all-trans retinoic acid (ATRA): a case report
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Female, 18 years-old, without relevant family history, referred to Neurology by Hematology for headache. 3 years ago, she was diagnosed with Acute Promyelocytic Leukemia (APL) currently on maintenance therapy with All-Trans Retinoic Acid (ATRA). The patient reports that in all previous cycles presented headache with the following characters: one-side temporal location, pulsating quality, moderate intensity, with nausea and vomiting, photophobia and phonophobia, uncertain duration, with simple analgesics response. In the current cycle, she relates continuous pain, severe intensity and unresponsive to medication. On examination, there were no focal neurological findings and on funduscopic examination there was no papilledema. MRI and laboratorial tests were normal. Cerebrospinal fluid (CSF) opening pressure was 35 cmH2O, no other alterations. 15 milliliters of CSF were removed, with a closing pressure of 25 cmH2O. A hypothesis of Intracranial Hypertension associated with use of ATRA was made. Afterwards, there was important improvement of the headache, with residual pain of mild intensity. Therefore, Acetazolamide was started at a dose of 250 milligrams every 12 hours with complete resolution of symptoms.
Discussion
Acute myeloid leukemia (AML) comprises a heterogeneous group of aggressive blood cell cancers that arise from clonal expansion of malignant hematopoietic precursor cells in the bone marrow. Acute promyelocytic leukemia (APL) is a biologically and clinically distinct variant of AML. APL is classified as acute promyelocytic leukemia with PML-RARA. The cytogenetic hallmark of APL is a translocation involving RARA, the retinoic acid receptor alpha locus on chromosome 17. Without treatment, APL is the most malignant form of AML, with a median survival of less than one month.
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Classificação Internacional de Dor Orofacial, Primeira Edição (ICOP) - versão Português Brasileiro
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It is with great satisfaction and enthusiasm that we present the Portuguese version of the ICOP (International Classification of Orofacial Pain, in English). ICOP is the result of an effort by several world representative entities in the area of Orofacial Pain. That initiative culminated in a comprehensive document that aims to standardize the classification of Orofacial Pain.
Originally published in 2020 by the International Headache Society (IHS), we now have our version in Portuguese, to be applied in research and clinical activities, also providing subsidies to discuss future steps. The ICOP is formatted in such a way that it provides a logical and coherent flow of reasoning for determining the diagnosis.
We must also remember that this document is part of the initiative of the World Health Organization (WHO), through the International Classification of Diseases (ICD), and should be part of the entity\u27s official document from 2022, which makes it even more important as a tool for “conversation” with other health specialties involved in the diagnosis and treatment of pain.
We would like to say a huge thank you to all the members of the Committee involved in the translation process and especially the Brazilian Headache Society (SBCe) for their support for the materialization of this project. We also thank Cephalalgia for allowing the translation of the ICOP originally published by them, and the publication of the Brazilian version.
We also emphasize that this is a “beta” version of the ICOP, which means that it must undergo adjustments and improvements after a period of use. Thus, we invite all of you to use, discuss, apply the criteria and, above all, give your opinion so that we can always take another step forward in the difficult but fundamental task of classifying Orofacial Pain.
Good reading!Prefácio da Tradução Brasileira
Classificação Internacional das Dores Orofaciais (ICOP)
É com muita satisfação e entusiasmo que apresentamos a versão em Língua Portuguesa da ICOP (International Classification of Orofacial Pain, em inglês). A ICOP é resultado de um esforço de várias entidades mundiais, representativas da área das Dores Orofaciais, que culminou com um documento completo, abrangente e que visa uniformizar e padronizar a classificação das Dores Orofaciais.
Publicada originalmente em 2020 pela Sociedade Internacional de Cefaleias (IHS, em inglês), temos agora a nossa versão em português, para podermos utilizar, aplicar em pesquisas e atividades clínicas e discutir os passos futuros. A ICOP documento formatado de tal forma que proporcione um fluxo de raciocínio lógico e coerente para a determinação do diagnóstico.
Devemos nos lembrar, ainda, que este documento faz parte da inciativa da Organização Mundial da Saúde (OMS), por meio da Classificação Internacional das Doenças (CID), devendo ser parte do documento oficial da entidade a partir de 2022, o que o torna ainda mais importante como instrumento de “conversa” com as demais especialidades da área da Saúde envolvidas no diagnóstico e tratamento da dor.
Gostaríamos de agradecer imensamente todos os membros do Comitê envolvido no processo de tradução, e de maneira especial a Sociedade Brasileira de Cefaleia (SBCe) pelo apoio e suporte para a materialização deste projeto.
Destacamos, também, que este documento é uma versão “beta”, o que significa que deve passar por adequações e melhorias após um período de utilização. Assim, convidamos todos vocês a usarem, discutirem, aplicarem os critérios e, principalmente, opinarem para que possamos sempre dar mais um passo à frente na difícil, mas igualmente fundamental tarefa de classificar as Dores Orofaciais.
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Popularização da ciência: proposta extensionista para divulgação de estudos em cefaleias e algias cranianas
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Popularization of science: extensionist proposal for the dissemination of studies on headaches and cranial algiasA produção de ciência é fundamental para o desenvolvimento da humanidade, e por muitos anos o conhecimento científico foi um assunto difundido somente entre pesquisadores e profissionais especializados. Dessa forma, a maioria da população acaba excluída do debate científico. Nesse contexto, faz-se importante a popularização da ciência como uma forma de democratizar o conhecimento e minimizar a disseminação de desinformação. Esse processo, no entanto, requer estratégias de comunicação para estabelecer um diálogo eficiente entre doutos e leigos. Tendo isso em vista, o papel das Universidades é essencial e exigiu, ao longo do tempo, adaptações nos modelos de ensino dentro delas, incluindo o ensino médico. Dentre essas adaptações, destaca-se a ascendente importância da extensão, por meio da qual os estudantes estabelecem um vínculo entre o meio científico e a comunidade. Com base nesses princípios, o Núcleo de Estudos em Cefaleias e Algias Cranianas do Oeste do Paraná (NECEFAC) foi criado no curso de medicina da Universidade Federal do Paraná - campus Toledo. Busca-se, assim, não apenas aprimorar o conhecimento técnico-científico dos membros do NECEFAC, como principalmente levar à populações informações de qualidade sobre cefaleias e algias cranianas
Drug management for migraine with aura and treatment alternatives: a case report
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Migraine is a chronic disease and affects about 15% of the World population. It is the second most disabling disease among young adults. Pathophysiology has not yet been fully clarified, but there is evidence for genetic alterations that cause a state of hyperexcitability and metabolic alterations that make the central nervous system more susceptible to external stimuli.
Objective
To present the evolution of a diagnosis of headache with aura treated with drugs and the results obtained.
Methods
Data collected through complete anamnesis.
Results/Case report
Woman, 26 years old, student, white, with hypothyroidism, denies smoking and alcohol consumption. Reports practicing physical activity and maintaining a healthy diet. Complains of headache for 9 years, with increased intensity and frequency. At the age of 18, period of onset of pain, frequency was every 10-15 days, with a maximum duration of one day and visual changes. She was using oral contraceptive pill (OCP) and dipyrone, without neurological consultation. At the age of 20, the use of OCP ceased, with worsening of the frequency and intensity of pain, the patient sought specialized medical care. Neurologist diagnosed migraine with aura triggered by stress. As treatment, he prescribed 50 mg/day of topiramate divided into two doses and alprazolam 0.5 mg, with return in 60 days. Reports no improvement and there was an increase in topiramate dosage to 100 mg and alprazolam dosage to 1 mg/day.
There was relative improvement for an approximate period of 4 months. Patient returned to daily pain, with episodes of throbbing pain, with exacerbated photo and phonophobia, need for hospital care twice a month and beginning of concentration problems. In hospital care, reports having received tramal, profenid and dramin.
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Release of CGRP in vivo from rat dura mater: Influence of capsaicin and topiramate
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Migraine is a disease that stands out for its high prevalence with changes in the nervous system, abnormal levels of neurotransmitters, neuromodulators, and neuropeptides. The main mechanisms of action of capsaicin are chemical induction through the activation of TRPV1 channels, allowing calcium influx into neurons in the trigeminal ganglion of the dura mater, activating mast cell degranulation, releasing pro-inflammatory (e.g., histamine, oxide nitric) and vasoactive (e.g., CGRP and substance P) substances. For treatment, classes of drugs are used to act on blood vessels and to prevent vasodilation, as well as depolarization of sensory fibers of the dura mater.
Objectives
To better understand sterile inflammation after exposing the dura mater bilaterally, we created an experimental model to study mechanisms of action of topiramate and capsaicin in mast cell degranulation and release of CGRP in a rat skull preparation in vivo using anesthetized animals.
Methods
Thirty-five Wistar rats were used, divided into two groups of chronic topiramate (GTC) treated with 20mg/kg/day, gavage/10 days, and acute topiramate (GTA) in situ in the dura mater (10-3M). The animals were anesthetized and cranial windows between the coronal and lambda sutures in the hemicraniums were performed with a drill to expose the dura mater bilaterally. 10-3M capsaicin was placed on the right side and synthetic interstitial fluid on the left side and exposed to contact for 10 minutes to a small cotton ball soaked with the respective solutions so that there is no leakage of the treatment, and posteriorly kept in the freezer (-20°C) for later quantification of CGRP. The percentage of degranulated mast cells was quantified after removal of the dura mater by staining it with toluidine blue. A commercial enzyme immunoassay quantified the release of CGRP from the cranial dura mater...
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Spontaneous pneumorrachia: a rare cause of thunderclap headache
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To present a rare cause of thunderclap headache
Case presentation
Female patient, 39 years old, was admitted to the emergency department of a private hospital in the city of São Paulo, after a sudden and explosive headache followed by two episodes of syncope and motor deficit in the left upper limb. Neurological examination showed weakness of the left upper limb without sensitive impairment. She had previous history of bipolar affective disorder, chronic anemia, and overweight with previous bariatric surgery.
The patient was submitted to computed tomography (CT), arterial angiotomography of the skull and cervical neck, which showed rare small gaseous foci in the perivertebral soft tissues and extradural site on the left side in the craniovertebral transition, near the foramen magnum. Small foci of pneumocephalus were found in the posterior fossa, near the left sphenopetrous fissure. Electroneuromyography (ENMG) of four limbs and brain and cervical magnetic resonance imaging (MRI) were performed 48 hours after initial CT scan. ENMG was normal and MRI showed no more expression of the changes described on CT. She was treated with analgesia and was discharged with full reversion of initial symptoms.
Conclusion
Spontaneous pneumorrhachia is rare disease and is characterized by the presence of air in the spinal canal, both in the intradural and extradural compartments. It is usually benign with spontaneous resolution. Our patient was included in a stroke investigation protocol, due to the thunderclap headache and focal motor deficit. CT revealed the diagnosis. The cervical CT that was performed in the context of cervical CT angiography of the stroke protocol allowed the correct diagnosis.
Key-words: Thunderclap headache, Spontaneous Pneumorrhachia, Cervical Computed Tomography Angiography
Cura da Enxaqueca: a Perspectiva do Paciente
No full textObjective
To conduct a web-based survey concerning patient’s perspective in the migraine cure.
Material and Methods
A total of 1,102 patients fitting the International Classification of Headache Disorders (ICHD-3) migraine criteria, seeking medical care at the Brain Research Institute at Albert Einstein Hospital in Sao Paulo, Brazil, from January to December 2015, participated in the survey. The online-based survey was accessed via the institute’s website and consisted of demographic data, a description of migraine symptoms, diagnosis and treatment, and the patient’s opinion of migraine cure and which treatment they would consider taking.
Results
Migraine intensity was significantly higher in female participants than male participants. Chronic migraine tended to affect female participants more than male participants. There was a significant difference in the rate of migraine cure belief between patients with episodic and chronic migraine.
Conclusion
Some points that were important to migraineurs have been identified in this study. Ultimately, the findings of this study may facilitate the migraine treatment decision process, by providing a better understanding of patients’ perspectives and beliefs, thus creating a more friendly communication between migraineurs and care providers and hopefully, improving the quality of life of patients
Oxytocin, vasopressin and nitric oxide levels in cerebrospinal fluid in women with migraine and fibromyalgia (Abstract)
Get PDFAbstract: Thesis (Doctorate in Neurosciences). Postgraduation in Neuropsychiatry and Behavioral Sciences. Federal University of Pernambuco, Recife, Brazil. 2017. 86 f. Supervisor: Prof. Dr. Marcelo Moraes Valença
Tips on when to request an imaging assessment (RMI, CT, or angiography) in a patient suffering from a headache
Get PDFThis article is a mini-narrative review covering practical aspects of when to request an imaging evaluation of a headache patient. The vast majority of patients who seek help in a medical office receive as a diagnostic hypothesis one of the primary headaches, such as migraine, tension-type headache, or cluster headache. The vast majority of patients who arrive with a headache at the neurologist\u27s office are migraineurs; individuals who suffer from tension-type headaches rarely seek the neurologist\u27s help. In the emergency scenario, there is a more significant occurrence of secondary headaches when compared to patients treated in an outpatient clinic. In evaluating a patient with a headache, the physician should pay attention to red flags or signs that may indicate a secondary cause for the pain the patient reports. In primary headaches, with the exception of trigeminal-autonomic headaches, there is no need to investigate by imaging. In cluster headaches, in some cases, intracranial lesions may be found as the cause, mainly parasellar lesions such as cerebral aneurysms. Thus, image evaluation is indicated. Depending on the diagnostic suspicion in secondary headaches, different imaging examinations should be requested, the most frequent being MRI, CT, and angiography.
Keywords: Headache, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Migraine Disorders, Cluster Headache, Red flagsThis article is a mini-narrative review covering practical aspects of when to request an imaging evaluation of a headache patient. The vast majority of patients who seek help in a medical office receive as a diagnostic hypothesis one of the primary headaches, such as migraine, tension-type headache, or cluster headache. The vast majority of patients who arrive with a headache at the neurologist\u27s office are migraineurs; individuals who suffer from tension-type headaches rarely seek the neurologist\u27s help. In the emergency scenario, there is a more significant occurrence of secondary headaches when compared to patients treated in an outpatient clinic. In evaluating a patient with a headache, the physician should pay attention to red flags or signs that may indicate a secondary cause for the pain the patient reports. In primary headaches, with the exception of trigeminal-autonomic headaches, there is no need to investigate by imaging. In cluster headaches, in some cases, intracranial lesions may be found as the cause, mainly parasellar lesions such as cerebral aneurysms. Thus, image evaluation is indicated. Depending on the diagnostic suspicion in secondary headaches, different imaging examinations should be requested, the most frequent being MRI, CT, and angiography.
Keywords: Headache, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Migraine Disorders, Cluster Headache, Red flags