RESUMO
Hemiplegic migraine (HM) is a rare migraine with aura; it can be familiar or sporadic. A 46-years-old man presented left migraine followed by right hemiparesis with bilateral plantar flexion of cutaneous plantar reflex (CPR). Brain CT and CT-angiography were normal. The next day patient got worse. The EEG showed left fronto-temporal cuspidate delta waves and brain MRI showed a minimal hyperintensity at T2-sequences in the left frontal cortex with a minor representation of the cortical veins at susceptibility weighted imaging sequences. After 3 days, he had a progressive neurological improvement. After 2 weeks, EEG and brain MRI were normal. He was discharged with diagnosis of probably first attack of sporadic HM and after 8 months he was asymptomatic. The normal CPR on the hemiplegic side might be a clinical marker of functional hemiplegia. For the international classification of headache disorder (ICHD-3) two attacks are necessary for HM diagnosis. We propose for the first attack of HM to make diagnosis of "probable" HM as expected to the same ICHD-3 for migraine. Further studies are necessary to support our hypotheses.
Assuntos
Enxaqueca com Aura/diagnóstico por imagem , Enxaqueca com Aura/fisiopatologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Diagnóstico Diferencial , Eletroencefalografia/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Enxaqueca com Aura/complicações , Acidente Vascular Cerebral/complicaçõesAssuntos
Cefaleia/complicações , Linfocitose/líquido cefalorraquidiano , Linfocitose/complicações , Doenças do Sistema Nervoso/complicações , Adulto , Eletroencefalografia , Serviço Hospitalar de Emergência , Cefaleia/diagnóstico por imagem , Humanos , Linfocitose/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Doenças do Sistema Nervoso/diagnóstico por imagemAssuntos
Placa de Sangue Epidural/efeitos adversos , Encefalopatias/complicações , Vazamento de Líquido Cefalorraquidiano/complicações , Vazamento de Líquido Cefalorraquidiano/etiologia , Forame Magno/patologia , Hipotensão Intracraniana/complicações , Feminino , Humanos , Imageamento por Ressonância Magnética , Adulto JovemAssuntos
Meningite/complicações , Cefaleia Pós-Punção Dural/complicações , Adolescente , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Meningite/diagnóstico por imagem , Cefaleia Pós-Punção Dural/diagnóstico por imagem , Medula Espinal/diagnóstico por imagemAssuntos
Imunossupressores/efeitos adversos , Linfopenia/induzido quimicamente , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Propilenoglicóis/efeitos adversos , Esfingosina/análogos & derivados , Adulto , Feminino , Cloridrato de Fingolimode , Gadolínio , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla Recidivante-Remitente/complicações , Esfingosina/efeitos adversosAssuntos
Hemiplegia/diagnóstico , Doença dos Neurônios Motores/diagnóstico , Neurônios Motores/fisiologia , Progressão da Doença , Hemiplegia/patologia , Hemiplegia/fisiopatologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Doença dos Neurônios Motores/patologia , Doença dos Neurônios Motores/fisiopatologia , Neurônios Motores/patologiaRESUMO
The appropriate treatment approach for elderly patients with glioblastoma multiforme (GBM) is unclear, although different studies suggest survival benefit in fit patients treated with radiotherapy and chemiotherapy after surgery. We performed a retrospective analysis of 151 patients older than 65years with GBM treated in 3 Lombardia Hospitals. In univariate regression analysis higher KPS (p=0.02), macroscopical total resection (p<0.003), radiotherapy (p<0.0001), chemotherapy (p<0.0001) and second line chemotheraphy (p=0.02) were of positive prognostic value. On the contrary older age (>70years), presence of seizure at onset and additional resection after tumor recurrence did not influence OS. Multivariate analysis revealed radiotherapy (HR 0.2 p<0.0001) and extent of surgery (HR 0.3, p=0,0063) as positive independent prognostic factors. Patients receiving radio-chemiotherapy displayed more treatment-related toxicities with a slightly prolonged OS versus those receiving hypofractionated radiotherapy. With the limits of a retrospective study, our data suggest that in elderly fit patients extensive surgery should be considered, moreover adjuvant treatments led to an increase in OS. Randomized controlled study are needed to develop treatment guidelines for elderly GBM patients and to assess whether the combination of post-surgical radio and chemiotherapy may be superior to hypofractionated radiotherapy and chemiotherapy in fit patients.
Assuntos
Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Procedimentos Neurocirúrgicos , Modelos de Riscos Proporcionais , Análise de Regressão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: A persistent primitive trigeminal artery (PTA) is the most common type of fetal carotid-basilar anastomosis in adulthood; however, its prevalence is low and estimated between 0.1% and 0.7% in angiographic studies. PTA is usually diagnosed incidentally during an angiographic examination, though some symptomatic cases associated with cranial nerve dysfunction have been described. We describe the unusual association between PTA and ipsilateral Horner syndrome triggered by hypertensive crisis. CASE REPORT: A 40-year-old man presented to medical attention for recurrent episodes, over the last 3 years, characterized by hypertensive crisis (up to 220/150 mm Hg), dizziness, tachycardia, flushing of the forehead on the left side, ptosis, miosis, and conjunctival injection of the left eye without pain. Imaging revealed a left PTA originating from the carotid siphon with moderate ectasia of the proximal tract. We speculate that the recurrent Horner syndrome observed in our patient could be due to the disruption of the postganglionic peripheral fibers in the pericarotid plexus. Adequate antihypertensive therapy led to resolution of signs and symptoms. CONCLUSIONS: To our knowledge, we present the first case of persistent PTA and ipsilateral Horner syndrome during hypertensive crisis. Adequate antihypertensive therapy can be useful in patients bearing trigeminal artery variants.