Intra-arterial injection of lidocaine into middle meningeal artery to treat intractable headaches and severe migraine.

BACKGROUND AND PURPOSE: We report the results of intra-arterial injection of lidocaine in the middle meningeal artery in patients with intractable headache or status migrainosus. METHODS: We treated four patients with intra-arterial lidocaine (2 mg/ml) in doses up to 50 mg in each middle meningeal artery via a microcatheter bilaterally (except in one patient). In two patients with intractable headache, the daily maximum intensity of headache (graded by 11-point numeric rating scale) was recorded for 7 days postprocedure. In two patients with status migrainosus, migraine-related disability 3 months prior and after treatment using MIDAS (Migraine Disability Assessment) questionnaire was recorded. RESULTS: Intra-arterial lidocaine reduced the headache intensity from 8/10 and 10/10 to 0/10 in the two patients with intractable headaches for 2 days (day 0 and day 1) postprocedure. Despite recurrence of headache on day 2, the intensity was less than preprocedure intensity up to the last day recorded (by 3 and 2 points on day 7). In the two patients with status migrainosus, there was immediate reduction in headache intensity following intra-arterial lidocaine. The post treatment 3-month MIDAS score was lower in both patients compared with pretreatment 3-month score; 3 versus 30 and 55 versus 90. Severe disability preprocedure by MIDAS was reduced to little or no disability postprocedure in one patient. CONCLUSIONS: Intra-arterial lidocaine resulted in amelioration of headache in patients with intractable headache and those with status migrainosus with improvement lasting longer than the short half-life of lidocaine possibly related to central desensitization.

Femoral Neuropathy Following Transfemoral Neuroendovascular Procedures. An Analysis of a Prospective Registry.

BACKGROUND AND PURPOSE: Although femoral neuropathy is recognized as an adverse consequence following transfemoral neuroendovascular procedures, no reliable estimates are available. We analyzed data from a prospective registry to ascertain the frequency and characteristics of femoral neuropathy following transfemoral neuroendovascular procedures. METHODS: Consecutive patients who underwent neuroendovascular procedures through the transfemoral route were included. Detailed assessment was performed if any patient reported occurrence of sensory or motor symptoms in the femoral or lower extremity region including neurological examination (sensory/motor deficits) and femoral region ultrasound. RESULTS: Femoral neuropathy was diagnosed following 4 of 270 neurovascular procedures with an occurrence rate of 1.5% (95% confidence intervals = .4-3.7%). The symptoms were exclusively sensory without any motor involvement. The femoral neuropathy appeared to involve anterior femoral cutaneous nerves in all and medial cutaneous branches in 2 patients, and more than one nerve distribution in 1 patient in whom lateral cutaneous nerve appeared to be involved. All patients reported resolution of symptoms within a period ranging from 1 week to 2 months. No local hematoma or arterial pseudoaneurysm was identified at femoral region ultrasound. CONCLUSIONS: Femoral neuropathy is a rare occurrence following transfemoral neuroendovascular procedures and it usually occurs with pure sensory manifestations with complete resolution.

Vertebral Artery Occlusive Disease: Data from the Angiographically Confirmed Vertebral Artery Disease Registry.

BACKGROUND: We performed this study to identify demographic, clinical, and angiographic characteristics of adult patients with angiographically confirmed vertebral artery occlusive disease (VAOD) and associated risk factors. METHODS: The demographic and clinical characteristics, and angiographic features were ascertained using predefined criteria. Controls were selected from the National Health and Nutrition Examination Surveys matched according to age, sex, and ethnicity. A stepwise logistic regression for odds ratio (OR) was performed to identify the effects of risk factors on occurrence of VAOD. RESULTS: Of 56 patients with VAOD (mean age ± standard deviation [SD]; 65.4 ± 11.7years, 44.6% women), 37.5% were classified as suffering from moderate stenosis (50%-69%), 16.1% from severe stenosis (70%-99%), and 46.4% from occlusion of at least 1 vertebral artery. There was a significantly higher severity of stenosis (percentage with SD; 88.1 ± 16.5 versus 75.4 ± 20.8, P = .02) and frequency of bilateral vertebral artery disease in patients with ischemic symptoms (40.9% versus 8.8%, P = .004). In the multivariate analysis, hypertension (OR 3.0; 95% confidence interval [CI], 1.4-6.5), diabetes mellitus (OR 2.5; 95% CI, 1.4-4.6), coronary artery disease (OR 3.2; 95% CI, 1.7-6.0), and active cigarette smoking (OR 3.1; 95% CI, 1.5-6.3) were significantly associated with vertebral artery disease. CONCLUSIONS: Severity of stenosis and bilateral involvement were associated with symptomatic VAOD. Hypertension, diabetes mellitus, coronary artery disease, and active cigarette smoking were associated with occurrence of VAOD.