Occipital nerve stimulation for non-migrainous chronic headaches: a systematic review protocol.

BACKGROUND: Defined as a headache lasting at least 15 days per month, chronic headache is reported by 3% of the general population, and a substantial proportion of them are refractory to current therapies. Occipital nerve stimulation (ONS) is a treatment option, but is still considered as a last resort treatment especially because of its invasive nature and the cost associated. Some reviews reported a limited efficacy of ONS for the treatment of migraines, with a high risk of complications. However, results reporting its efficacy and safety on other headache disorders are unclear. The aim of this review is to assess the efficacy and safety of ONS in regards to non-migrainous chronic headaches. METHODS: We will conduct a systematic review and meta-analysis of studies evaluating the use of ONS in comparison to sham stimulation or the best available treatment in patients with chronic headache. MEDLINE, CINHAL, EMBASE, PsycINFO, ECRI Institute Library, WIKISTIM, the Cochrane Library databases, and clinical trial registries will be searched for eligible studies. The review will include adult patients diagnosed with chronic headache excluding migraine. Two independent reviewers will process to the screening of studies according to titles, abstracts, and then full texts. The primary outcome is the overall reduction of head pain severity. The secondary outcomes are rates of reduction in the severity of head pain, headache frequency, and duration, use of medication, impairment, quality of life, healthcare utilization, return to work, and adverse events. Extracted data will include patients' and procedure characteristics, details on comparative treatment or sham, and clinical outcomes. The risk of bias of the studies will be also independently assessed using the Cochrane risk of bias tools. DISCUSSION: This systematic review will allow us to better evaluate the potential role of ONS for the treatment of patients with chronic headache that are refractory to less invasive therapies. It will help to determine the degree of safety of ONS. Moreover, it will help to design and conduct future randomized controlled trials focused on patients who may better respond to such treatment. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019121623.

Elastoma perfurante em cicetrizes antigas de queimaduras térmicas associado a aneurismas cerebrais múltiplos / Elastoma perforans in old scars of thermal burns associated to multiple cerebral aneurysms

Os autores descrevem um caso de elastoma perfurante que se desenvolveu em cicatrizes antigas de queimadura térmica em uma mulher de 33 anos que apresentou aneurisma cerebral múltiplo e hemorragia subaracnóide devido à ruptura de um aneurisma na artéria carótida interna esquerda, seis anos após o evento dermatológico. O quadro clinicopatológico demonstrou características de elastose perfurante serpiginosa focal e adquirida, doença que pode estar associada a outras anomalias do tecido conjuntivo e a aneurismas do polígono de Willis. Foram discutidos os prováveis mecanismos patogênicos da doença. Os achados justificam o conceito de um distúrbio localizado do tecido elástico na pele e nas artérias

Cerebral aneurysms: assessment of 50 cases operated on and comparison with previous series

A retrospective analysis of 50 patients who suffered subarachnoid hemorrhage (SAH) treated at UNICAMP between April 1988 and March 1992 is made, distributed as 34 percent in Hunt & Hess grade 1,38 percent in grade II , 16 percent in grade III, and 12 percent in grade IV. Males were predominant (66.6 percent), and patients age varied around 47+12.13 years old. Only 13 patients (26 percent) were admitted within the first 24 hours after bleeding, with an overall average of 20.45 days of delay. From all cases only one had a rebleeding, survived and was submitted to surgery. Four patients died after surgery (8 percent). Timing of operation and prognostic chances were available, being 27.30 days after SAH for Hunt & Hess group I. It is analyzed also the timing for diagnosis - which responded for the most delay, and treatment for the other groups, and a historical comparison with previous series since year 1956 of the same Hospital were documented. Good results were observed in 38 cases (76 percent). The overall results in terms of mortality and morbidity is, in comparison, in accordance with the literature, and is ameliorated from the past series due to technical improvement, despite worsen difficulties in managing admittance, diagnosis and treatment faster, which is required to deal with the disease.

Hemorragia de tronco cerebral após remoçäo cirúrgica de cisto aracnóide da fissura silviana: relato de caso / Brainstem hemorrhage after surgical removal of arachnoid cyst of the sylvian fissure: a case report

Os autores relatam um caso de hemorragia de tronco cerebral após craniotomia para ressecçao de grande cisto aracnóide de fissura silviana esquerda. A sintomatologia inicial pré-operatória incluía sinais de hipertensao intracraniana e a tomografia computadorizada mostrava desvio de linha média. Diversos fatores sao discutidos para explicar o sangramento parenquimatoso pós-operatório: edema cerebral, diminuiçao do retorno venoso e de fluxo sanguíneo no lado comprimido. Entretanto a fisiopatologia da hemorragia perenquimatosa em casos como o relatado permanece obscura. uma abordagem cirúrgica mais cutelosa é proposta nesse pacientes com de hipertensao intracraniana.

Cisticercose medular: relato de dois casos, revisäo da literatura e comentários sobre a patogenia / Medullary cysticercosis: report of 2 cases, review of the literature and comments about its pathogeny

Relato de dois casos de cisticercose medular, sendo o primeiro referente a uma paciente de 13 anos de idade, apresentando a forma intramedular, e o segundo a uma paciente de 51 anos de idade com cisticercose espinhal leptomeníngea. Numa revisäo de literatura (desde 1856), foram encontrados 95 casos publicados de cisticercose medular somados a dois de nossa casuística, mostrando a freqüência da doença. Dentro da patogenia da forma extramedular, os autores defendem a hipótese da migraçäo dos cisticercos do espaço subaracnóide intracranianao para o espinhal, baseando-se na distribuiçäo topográfica dos parasitos na medula