Update on headache and brain tumors.

Headache is one of the leading symptoms often associated with brain tumours. Secondary headaches attributed to intracranial neoplasias have been included in subchapter 7.4 of the third edition of the International Classification of Headache Disorders (ICHD-3). According to ICHD-3, the headache may be attributed to a brain tumour if it has developed in close temporal relation with the development of the neoplasia, has significantly worsened in parallel with the worsening of the tumour, and/or has significantly improved following the successful treatment of the neoplasia. Brain tumour headache was traditionally thought to display some specific clinical characteristics, including worsening in the morning and/or when lying down, being aggravated by Valsalva-like manoeuvres and accompanied by nausea and/or vomiting; however, the studies performed after the advent of modern neurodiagnostic techniques have pointed out that the "classic" brain tumour headache is uncommon, particularly at the time of clinical presentation. Therefore, it becomes critical to seek some specific factors associated with the presence of an intracranial mass (the so-called "red flags") that can guide the physician to establish an accurate diagnosis.

Progressive multifocal leukoencephalopathy following chemotherapy for lung cancer.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the JC virus infection and with a frequent lethal outcome. PML usually occurs in immunocompromised subjects, such as HIV-positive individuals, as well as in other conditions characterized by depletion of cellular immunity, including hematological malignancies, autoimmune diseases, and immunomodulatory therapies. We describe the case of a 76-year-old man affected by advanced non-small cell lung cancer who developed PML after six cycles of carboplatin/gemcitabine therapy, during which a transitory leucopenia developed. The patient deceased a few months after the onset of the symptoms. Chemotherapy appears to be uncommon, but definite condition associated to PML.

Influence of physiologic hormonal modification and of hormonal treatment in a patient with a history of migraine with aura.

We present the case of 48-year-old woman suffering from migraine with aura (MA) since menarche. During her life the patient frequently presented catamenial MA attacks with an increasing frequency during pregnancy in particular in the second and third trimesters, and then during breast-feeding. Treatment with oral contraceptive (OC) for endometriosis and later with cyclophosphamide, methotrexate, fluorouracil (CMF) for breast cancer produced a higher number of attacks. Instead, she referred an improvement with gonadotropin releasing hormone agonist (GnRH-a) for the treatment of endometriosis and then with tamoxifen as hormonal therapy after mastectomy and chemotherapy for breast cancer. We highlight the importance of physiological hormonal modification and hormonal therapies on the course of MA.

Lung cancer presenting with unilateral facial pain: remission after laryngeal nerve palsy.

A 39-year-old woman presented with a 2-month history of intractable, left-sided facial pain. A CT scan of the thorax disclosed a large lung mass surrounding supra-aortic vessels and hilus. The symptoms underwent a rapid and spontaneous remission after laryngeal nerve palsy with dysphonia developed. Referred facial pain secondary to the compression of the vagus nerve can rarely be the first manifestation of an underlying lung cancer. All cases of unexplained unilateral facial pain should be investigated for a mediastinal pathology, especially in smoker subjects.

Measuring the 13C/12C isotope ratio in atmospheric CO2 by means of laser absorption spectrometry: a new perspective based on a 2.05-microm diode laser.

The potential use of high sensitivity laser absorption spectroscopy for measuring the 13C/12C isotope ratio in atmospheric CO2 has been demonstrated, using a GaSb-based diode laser at 2.05 microm. In this spectral region, the overlapping between relatively strong 12CO2 and 13CO2 absorption features gives rise to several line pairs which are well suitable for a spectroscopic determination of the isotope ratio. Preliminary results have demonstrated that a short-term precision better than 1 per thousand can be easily obtained, for a CO2 concentration of 1000 ppm. We extensively discuss the influence of a possible non-linearity in the detectors' response on the delta-value and suggest an instrumental development that would allow to eliminate this effect.