RESUMO
BACKGROUND: Occipital nerve stimulation (ONS) is a treatment with evidence in refractory chronic cluster headache (CCH). However, the variable response rate and cost make it necessary to investigate predictors of response. METHODS: This is a cross-sectional study conducted through the review of medical records of CCH patients from six hospitals in Madrid. Epidemiological and clinical variables were compared between patients with ONS failure and the rest. ONS failure was defined as the need for device withdrawal or switch off because of lack of response or adverse events. RESULTS: From a series of 88 CCH, 26 (29.6%) underwent ONS surgery, of whom 13/26 (50.0%) failed because lack of response. ONS failure group had an earlier headache onset (mean ± SD) of 27.7 ± 6.9 vs. 36.7 ± 11.8 years, p = 0.026) and a higher smoking rate (100% vs. 42.9%, p = 0.006). Stational fluctuations (58.3% vs. 7.7%, p = 0.007) and nocturnal exacerbations (91.7% vs. 53.9%, p = 0.035) were more frequent in the ONS failure group as well. There was no difference between groups in diagnostic delay, years of evolution prior to surgery, mental illness, comorbidity with other headache disorders or chronic pain conditions or prior response to occipital nerves anesthetic blocks. CONCLUSIONS: Some clinical features such as an early debut, smoking and seasonal or circadian fluctuations could be related to failure of ONS in refractory CCH.
Assuntos
Cefaleia Histamínica , Terapia por Estimulação Elétrica , Falha de Tratamento , Humanos , Cefaleia Histamínica/terapia , Feminino , Masculino , Adulto , Estudos Transversais , Terapia por Estimulação Elétrica/métodos , Pessoa de Meia-Idade , Nervos Espinhais , Estudos RetrospectivosRESUMO
BACKGROUND: To assess the diagnostic agreement of cognitive status (dementia, mild cognitive impairment (MCI), normal cognition) among neurologists in the field of neurological disorders in Central Spain 2 study. METHODS: Full medical histories of 30 individuals were provided to 27 neurologists: 9 seniors, 10 juniors and 8 residents. For each case, we were asked to assign a diagnosis of dementia, MCI or normal cognition using the National Institute on Aging-Alzheimer's Association workgroup (NIA-AA) core clinical criteria for all-cause dementia, Winblad et al. criteria for MCI, and analyze intensity and etiology if dementia was diagnosed. Inter-rater agreement was assessed both with percent concordance and non-weighted κ statistics. RESULTS: Overall inter-rater agreement on cognitive status was κ = 0.76 (95% CI 0.65-0.86), being slightly higher among junior neurologists (κ = 0.85, 95% CI 0.73-0.95) than among seniors (κ = 0.71, 95% CI 0.59-0.83) and residents (κ = 0.69, 95% CI 0.54-0.81) but without statistical significance among groups. Dementia severity showed an overall κ of 0.34, 0.44 and 0.64 for mild, moderate and severe dementia respectively. CONCLUSIONS: Substantial agreement was demonstrated for the diagnosis of cognitive status (dementia, MCI and normal cognition) among neurologists of different levels of experience in a population-based epidemiological study using NIA-AA and Winblad et al. CRITERIA: The agreement rate was lower in the diagnosis of dementia severity.
Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Variações Dependentes do Observador , Humanos , Neurologistas , Reprodutibilidade dos Testes , EspanhaAssuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Mielite Transversa/diagnóstico , Prurido/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/fisiopatologia , Pessoa de Meia-Idade , Mielite Transversa/tratamento farmacológico , Mielite Transversa/fisiopatologia , Prurido/tratamento farmacológico , Prurido/fisiopatologia , Medula Espinal/diagnóstico por imagemAssuntos
Isquemia Encefálica/etiologia , Embolia Paradoxal/complicações , Embolia Intracraniana/complicações , Embolia Paradoxal/diagnóstico , Embolia Paradoxal/fisiopatologia , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Hiperlipidemias/complicações , Embolia Intracraniana/fisiopatologia , Trombose do Seio Lateral/complicações , Pessoa de Meia-Idade , Fumar/efeitos adversos , Ultrassonografia Doppler Transcraniana , Manobra de ValsalvaRESUMO
TITLE: Ptosis fluctuante como presentacion del sindrome de hipotension licuoral espontanea.