[Chronic daily headache: clinical presentation]. / Cefaléia crônica diária primária: apresentação clínica.

Chronic daily headache (CDH) represents a group of any headache disorder that occurs on a daily or near daily basis, for longer than 6 months. Even though it is a common problem, it is not a well defined disorder, resulting in controversies regarding its identification, description and approach. Three hundred patients, 232 women and 68 men, ages 16 to 86 (mean 38 years old for the women and 42 for the men), attending a headache center and fulfilling the proposed criteria for CDH (Silberstein et al.) and presenting headache 28 days per month were retrospectively studied. The clinical features allowed the primary headache diagnosis, before the transformation into daily presentation as: transformed migraine (TM ) in 271 patients (90,3%), chronic tension-type headache (CTTH) in 26 patients (8,7%) and new daily persistent headache (NDPH) in 3 patients (1%). Among the TM patients, the most observed presentation was pressure or tightening, bilateral fronto-temporal, moderate non-continuous headache, with a progressive onset. The association with nausea and phonophobia was demonstrated in 60% and 32% of the patients respectively. The association with photophobia and sleep disturbances, as well as the occurrence of intermittent headache attacks, was different among male and female patients. With regard to the CTTH patients, pressure or tightening, bilateral fronto-temporal, moderate non-continuous headache, with sleep disturbances and no associated symptoms, was the predominant presentation.

[Update on migraine prophylactic treatment]. / Atualização no tratamento profilático das enxaquecas.

Among the primary headaches, patients with migraine are those that seek for medical help the most. Its prevalence is estimated in 12% of the population being more common in women with a prevalence of 18 to 20%, 6% of the men and 4 to 8% of the children. Its economic impact in the productivity and leisure is significant, and the headache attacks may incapacitate the patients for the usual activities. With a complex and still unknown pathophysiology, migraine may present with intermittent and peculiar episodes of intense headache. The most efficient approach for the treatment includes the avoidance of the trigger factors, preventive treatment, rescue treatment for the moments of pain and the accessory or non drug treatment. For the preventive treatment, scope of this update, various classes of substances are used and include the beta blockers, tricyclic antidepressants (and recently the selective serotonin reuptake inhibitors), calcium antagonists, serotonin antagonists, anticonvulsants and others. Even though its mechanisms of action in the treatment of migraine are unknown, it seems that all of the drugs influence the central serotonergic, noradrenergic and gabaergic functions. New proposals for the mechanisms of action of some of these drugs, also include the inhibition of the synthesis of nitric oxide and the modulation of the neuronal cationic channels. When individualized and correctly used, these preventive medications have been held responsible for important reductions in the frequency and intensity of migraine episodes, decreasing this way, the marathon of suffering and doubtful approaches, that these patients are usually submitted.

[Chronic post-traumatic headache after mild head injuries]. / Cefaléia pós-traumática crônica em traumatismos crânio-encefálicos leves.

Current evidence indicates that chronic post-traumatic headache (cPTH) has organic causes. Nevertheless, these patients are considered as neurotics or malingering by health professionals, mainly if the headache originates from mild head injuries (MHI). Our aim was to identify the features of cPTH after MHI. We studied 27 consecutive patients fulfilling the criteria established for cPTH and MHI. Headache began on the same day of the trauma in 51.8% of patients. The clinical features allowed the following diagnosis: migraine (70.3%); tension type headache (51.8%); cervicogenic headache (11.1%). Concomitance of migraine and tension type headache was found in 29.6%. Thirty three percent of employees, 40% of housewives and 50% of students in our series referred prejudice in their productive activities. However, only three patients (11.1%) were claiming for compensation. The lack of potential gain and the uniformity of the clinical presentation are suggestive that the cPTH has an organic cause.

[Primary chronic daily headache: clinical factors]. / Cefaléia crônica diária primária. Características clínicas.

Under the denomination primary chronic daily headache (CDH) there are different types of headache which present daily or near-daily, during long spells. This concept refers to temporality and not to a specific kind of headache. It is important to know the CDH and its natural history, as well as some factors that possibly turn it into chronic. They are critically reviewed here.

[Primary chronic daily headache: a report on 52 cases]. / Cefaléia crônica diária primária. A propósito de 52 casos.

Fifty-two patients (48 women, 4 men, ages varying between 13 and 71 years) that fulfilled the criteria by Silberstein et al. (1994) for chronic daily headache (CDH) were studied. The main clinical characteristics allowed three diagnostic types of CDH: transformed migraine (n = 39; 75%); chronic tension-type headache (n = 11; 21.1%); and new daily persistent headache (n = 2; 3.9%). Thirty-four patient used to take symptomatic medication in excess and were considered as having drug-induced headache. The treatment included increasing doses of amitriptyline alone or associated with propranolol besides the interruption of the symptomatic medication. This scheme was effective to lower the frequency of headache in most CDH patients and its beneficial effects had lasted even six months after the beginning of the follow-up. In the few patients in which the treatment was unsuccessful, the persistence of abusive use of symptomatic drugs was statistically significant.

[Electroretinography by reversal pattern in patients with migraine without aura]. / Eletrorretinografia por padrão reverso em pacientes com enxaqueca sem aura.

Seventeen patients with migraine without aura were investigated: the age was between 16 and 39 years, 6 were men and 11 women. The diagnosis of migraine was made according to the classification proposed by the International Headache Society. The method of electroretinogram was performed with pattern reversal (PERG), with monocular stimulation. The stimulation was performed with pattern reversal with 4 x 4 cm black and white squared screen placed one meter from nasion at stimulus frequency 1/s; 512 individual trials were analysed. The PERG did not show a significant increase in the value of the P50 and N95 latency in our cases. Specifically in one of our cases no wave was detected in the left eye.

Pattern reversal visual evoked potentials in migraine subjects without aura.

Twenty seven patients with migraine without aura were investigated. The age was between 12 and 54 years; 5 were men and 22 women. The diagnosis of migraine was made according to the classification proposed by the International Headache Society. The method of visual evoked potential was performed with pattern reversal (VEP-PR), with monocular stimulation. The stimulation was performed with pattern reversal with 4x4 cm black and white and red and green squared screen placed 1 meter from the nasion at stimulus frequency 1/s; 128 individual trials were analysed. The VEP-PR with black/white and red/green study showed a significant increase of value of the P-100 latency in 10 migraine patients. In 8 cases the LP100 in VEP-PR black/white was normal but in VEP-PR red/green the LP100 showed increase. Specifically in 1 of our cases, LP100 were normal in VEP-PR black/white but in the red/green there were no reproductive waves. On basis of these observations we consider that the method of VEP-PR is an useful instrument for investigation of migraine patients without aura.

[Electroencephalographic findings in post-anoxic myoclonic encephalopathy]. / Achados eletrencefalográficos na encefalopatia mioclônica pós anóxica.

The electroencephalographic (EEG) findings observed in nine patients with post-anoxic myoclonic encephalopathy are reported. The tracings showed typical myoclonus potential in some, and characteristic diffuse brain injury in others. In two of our cases the spike and wave complex was faster than in the others. Our EEG tracings are similar to those studied by Gastaut and Rémond in 1952.

[Post-anoxic hemi-myoclonic encephalopathy: report of a case]. / Encefalopatia hemi-mioclônica pós anóxica: registro de um caso.

A case of a young man with myoclonus in his right side after cerebral hypoxia is reported. This patient had cerebral hypoxia caused by injury in his left common carotid artery. After a few hours he had generalized convulsive seizures of tonic-clonic type and also a septic shock. As consciousness was regained, he developed action and intention myoclonus in his right-side. The EEG showed diffuse typical myoclonus potentials. Clonazepan 8 mg daily was used with good results. This is the first reference in the medical literature of the unilateral localization in the Lance-Adams syndrome. The authors think that in this case two abnormalities contributed to the cerebral anoxia: the common carotid artery injury and the septic shock.

[Necrotizing myelopathy and neoplasms: clinico-pathological report of 2 cases]. / Mielopatia necrotizante e neoplasias: registro clínico-patológico de dois casos.

Two clinico-pathological cases of necrotic myelopathies with a distant malignancy are presented. The first patient had histiocytic medullary reticulosis and the second one had a renal cell carcinoma. The authors referred to other similar cases found in the literature. In both patients the pathological features in the spinal cord were similar to the other cases reported, but in their first case they found an intense inflammatory reaction and hyperplasia of astrocytes into bizarre giant forms. The cause of necrotizing myelopathy associated with neoplasms remain unknown. The authors think that the presence of inflammatory reaction and the changes in the astrocytes in their first case are consistent with the effects of a virus.

Mielopatia necrotizante e neoplasias.Registro clinico-patologico de dois casos. / Necrotizing myelopathy and neoplasms: clinico-pathological report of 2 cases

Sao relatados dois casos de mielopatia transversa subaguda associada a tumores malignos. O primeiro paciente apresentava neoplasia de celulas reticulares histiocitarias e o segundo, carcinoma renal.Os autores fazem revisao dos casos similares descritos na literatura. As alteracoes anatomo-patologicas medulares encontradas foram semelhantes as descritas nos relatos previos, sendo que no primeiro caso havia tambem intenso infiltrado inflamatorio perivascular e a presenca de astrocitos bizarros. Tais alteracoes encontradas sugerem ser esta afeccao de natureza viral

[Post-anoxic myoclonic encephalopathy (Lance-Adams syndrome): anatomopathological study of 2 cases]. / Encefalopatia mioclônica pós-anóxica (síndrome de Lance-Adams): estudo anatomopatológico de dois casos.

Two cases of Lance-Adams syndrome with anatomopathologic study are reported. There were evidences of diffuse neuronal degeneration in the brain. These changes were most seen in the neurones of the cortical layers, thalamus and subthalamic nuclei. The cells changes were similar to those seen in ischaemic disease. Some neurones showed intracytoplasmatic inclusions staining with the P.A.S. method. These inclusions were readily distinguished from the Lafora bodies.

Encefalopatia mioclonica pos-anoxica (sindrome de Lance-Adams): estudo anatomopatologico de dois casos. / Post-anoxic myoclonic encephalopathy (Lance-Adams syndrome): anatomopathological study of 2 cases

Foram feitos estudos neuropatologicos em dois casos de pacientes que apresentaram encefalopatia mioclonica pos-anoxica (sindrome de Lance-Adams). O encefalo mostrou lesoes neuronais difusas, comprometendo principalmente o cortice, talamo e estruturas sub-talamicas, desde lesoes discretas caracterizadas pela presenca de vacuolos intracitoplasmaticos (primeira alteracao vista na anoxia) ate neuronios totalmente degenerados, notando-se varios neuronios com lesoes classicas de isquemia. A presenca de material de inclusao anfofilica discretamente PAS positiva observado no citoplasma neuronal foi diferente das inclusoes verificadas nos casos de epilepsia mioclonica com corpusculos de Lafora.Nao conseguimos identificar a constituicao destas inclusoes, apesar de serem feitos diferentes metodos de coloracao. Nao encontramos tambem, na literatura, referencia a tal tipo de inclusao. Foram tambem encontradas alteracoes vasculares, consistindo de vasos proliferados com celulas endoteliais tumefeitas. Tais celulas apresentaram-se com disposicao anarquica, provavelmente devidas a anoxia isquemica.A diferenca dos achados anatomopatologicos, entre os casos 1 e 2,sao provavelmente decorrentes do mecanismo diverso da instalacao da anoxia

[Infiltration of central nervous system and meninges in lymphomas with leukemic conversion]. / Infiltração do sistema nervoso central e das meninges nos linfomas com representação leucémica.

The cases of four patients with lymphoma with leukemic conversion, who exhibited neoplastic infiltration of the central nervous system and of the meninges are reported. The anatomo-pathologic study showed the presence of small nodules of leukemic cells, in two patients. The other two patients had clinical improvement after the use of metotrexate by spinal route so that the anatomopathologic study of their CNS and meninges showed no abnormality.

[Post-anoxic myoclonic encephalopathy (Lance-Adams syndrome): report of 6 cases]. / Encefalopatia mioclônica pós-anóxica (síndrome de Lance-Adams): registro de seis casos]

Six patients are studied (five females and one male) in which disorders of consciousness varying from stupor to coma have occurred following variable periods of cerebral hypoxia caused either by cardiorespiratory standstill (five cases) or acute pulmonary injury. After a few hours they had generalized convulsive crisis of tonic-clonic type. As consciousness was regained they developed generalized myoclonic trembling of great intensity. Hence post-anoxic myoclonic encephalopathy is characterized. It is also called the Lance-Adams syndrome, in honor of the authors that described it in 1963. Five patients underwent electroencephalographic examination; the tracing showed typical myoclonus potentials in some, and characteristic diffuse brain injury in others. Electromyography was carried out in one patient, and cerebral computerized tomography in two others. The latter revealed an accentuated widening of sylvian cleft at the base in one them, specially on the right side, which explain his dementia-like picture. The biochemical analysis of the spinal fluid was normal in five cases.

[Guillain-Barré syndrome as a manifestation of systemic lupus erythematosus. Report of a case]. / Síndrome de Guillain-Barré como manifestacao do lupus eritematoso sistêmico. Registro de um caso.

The case of a young female patient with acute symmetrical ascending polyneuropathy as a manifestation of systemic lupus erythematosus is reported. There was involvement of several cranial nerves and the cerebrospinal fluid showed albuminocytologic dissociation. Pathologic examination of the sural nerve showed degeneration of myelinated fibers, fibrosis of the perineurium and endoneurium, and overgrowth of the medial layer of the vasa-nervorum. The authors call attention to the uncommon involvement of the peripheral nervous system in S.L.E. They believe that a abnormal autoimmune reaction could be responsible for the nerve fiber degeneration.

[Mucolipidosis type II. Report of 2 suggestive cases]. / Mucolipidose do tipo II. Registro de dois casos sugestivos.

The clinical and laboratorial study of two brothers with gargoylism is reported. The examination of the urine showed normal findings of mucopolysaccharides. The authors made differential diagnoses with others mucolipidoses and concluded that mucolipidose type II should be considered in any patient with gargoylism.

[Internal carotid artery thrombosis in the course of rheumatic disease. Report of a case]. / Trombose da artéria carótida interna no curso de doença reumática. Registro de um caso.

The case of a 21 years old man with hemiplegia and hyperthermia of sudden onset is reported. The angiographic study showed thrombosis of the distal portion of the internal carotid artery. Laboratorial studies revealed positive rheumatic tests. The authors think that the rheumatic arteritis may be responsible for this ischemic cerebral accident. Differential diagnosis with the embolic accidents caused by the rheumatic disease is discussed.