ABSTRACT
El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)
Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)
Subject(s)
Chronic Pain/therapy , Hyperbaric Oxygenation/methods , Phantom Limb/therapy , Quality of Life , Reflex Sympathetic Dystrophy/therapy , Vascular Headaches/therapy , Brain Diseases/therapy , Facial Pain/therapy , Fibromyalgia/therapy , Causalgia/therapy , Diabetic Neuropathies/therapy , Edema/therapy , Neuralgia, Postherpetic/therapy , Chronic Pain/epidemiology , Cancer Pain/therapy , Hyperbaric Oxygenation/trends , Analgesia/methods , Inflammation/therapy , Neuralgia/therapyABSTRACT
Objective: To identify the most prevalent type of pain in postoperative craniotomy patients and evaluate the use of analgesic in this group of patients. Method: The case studies consisted of 55 patients undergoing craniotomy. Patients were evaluated from the first to the seventh postoperative day. Data were stored and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0. The variables analyzed were gender, demographic data, assessing the presence of pain, location of pain, severity of pain, use of analgesic, professionals who recorded the pain on the patients charts, and presence of insomnia. Results: The results show that headache, the main pain reported by the patients, is present from the first to the seventh postoperative day. It was observed that in some cases there was no prescription of analgesics and even in the group of patients who took analgesics, these drugs were not effective for the relief of headache. The final logistic regression model revealed that insomnia ( OR = 10.6, p = < 0.001 ), the pain recorded in the patients charts (OR = 2.38 , p = 0.016) and use of analgesic (OR = 2.03 , p = 0.014) adequately explained the outcome. Conclusion: Headache was the chief complaint of pain after postoperative craniotomy, and its intensity varied from mild to severe. The analgesic used was not effective for the control of postoperative headache. Proper handling of post-craniotomy headache by the multidisciplinary team can contribute to early neurological recovery of patients undergoing craniotomy, and should make the post-surgical care, with a view to early recovery and the humanization of care.
Subject(s)
Humans , Male , Adult , Female , Young Adult , Middle Aged , Craniotomy , Vascular Headaches/therapy , Pain, Postoperative/therapy , Pain Measurement , Surgical Procedures, Operative , Central Nervous System/pathologyABSTRACT
A ocorrência de sintomas neurológicos agudos em gestantes ou puérperas não é incomum. Podem ser causados tanto pela exacerbação de uma doença neurológica pré-existentes quanto por doenças relacionadas com a própria gravidez. O diagnóstico preciso é essencial para o tratamento adequado. Sendo assim, é recomentado acompanhamento multidisciplinar antes, durante e após a gravidez. O objetivo do presente estudo é realizar uma revisão da literatura sobre as principais síndromes neurológicas durante a gravidez, descrevê-las e elucidar como é feito o diagnóstico adequado. Para isso, foi realizada uma busca de artigos na base de dados do Medline, via Pubmed, sendo selecionados artigos publicados nos últimos 10 anos, nas línguas inglesa ou portuguesa. Desse modo, o presente estudo demonstra a importância de saber reconhecer e tratar adequadamente cada uma dessas síndromes, bem como de um acompanhamento em centro de referência, uma vez que as síndromes neurológicas estão relacionadas com morbidade e mortalidade materna.(AU)
The occurrence of acute neurological symptoms in pregnant women and during puerperium is not uncommon. This symptoms can be caused both by the exacerbation of a preexisting neurological disease and illnesses related to the pregnancy itself. The accurate diagnosis is essential for proper treatment. Therefore, it is recommended that a multidisciplinary monitoring before, during and after pregnancy. The aim of this study is to conduct a review of the literature on the main neurological syndromes during pregnancy, describe them and elucidate how is made the proper diagnosis. For this, a search for articles on Medline database, via Pubmed was performed, being selected articles published in the last 10 years, in English or Portuguese languages. Thus, the present study demonstrates the importance of knowing recognize and properly handle each of these syndromes, as well as a follow-up in tertiary centers, once the neurologicalsyndromes are related to maternal morbidity and mortality.(AU)
Subject(s)
Female , Pregnancy , Pregnancy Complications/diagnosis , Nervous System Diseases/diagnosis , Nervous System Diseases/diagnostic imaging , Neurologic Manifestations , Pre-Eclampsia , Sinus Thrombosis, Intracranial , Vascular Headaches , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Databases, Bibliographic , Eclampsia , Posterior Leukoencephalopathy Syndrome , HypertensionABSTRACT
Se comunican los casos de dos pacientes con síndrome de Bonnet, Wyburn-Mason en quienes existía un aneurisma cirsoide de la retina de diferente grado de desarrollo. En uno, el cuadro oftalmoscópico era obvio; en tanto que en el otro la manisfestación fundamental era una tortuosidad vascular acentuada y en quien solo la angiografía fluoresceínica del fondo ocular mostró sutiles cambios compatibles con una malformación arteriovenosa localizada. Otro elemento inusual en el comportamiento de este tipo de malformaciones fue la asociación a una coartación de la aorta torácica y multiples anomalías esqueléticas sencillas, así como la obstrucción de un segmento muy desarrollado de la malformación arteriovenosa con infarto hemorrágico retiniano e involución posterior de parte de ella
We communicate the cases of two patients with syndrome of Bonnet, Wyburn-Mason who had cirsoide aneurysms of the retina of differnt degrees of development. In one, the ophthalmoscopic picture was obvious, while on the other, The primary manifestation was a marked vascular tortuosity and in which only the ocular fundus fluorescein angiography showed subtle changes consistent with a located arteriovenous malformation. Another unusual element in the behavior of this type of malformations was a coarctation of the thoracic aorta and multiple skeletal anomalies simple associated, as well as the obstruction of a highly developed portion of the retinal arteriovenous malformation with hemorrhagic infarction and consecutive involution of part of it
Subject(s)
Humans , Male , Adolescent , Adult , Female , Aneurysm/pathology , Headache/ethnology , Seizures/diagnosis , von Hippel-Lindau Disease/pathology , Epistaxis/etiology , Exophthalmos/etiology , Fever/etiology , Arteriovenous Fistula/physiopathology , Unconsciousness/ethnology , Fluorescein Angiography/methods , Vascular Headaches/pathology , Fundus OculiABSTRACT
A Trombose Venosa Cerebral (TVC) é uma afecção rara, que resulta em obstrução parcial ou total dos seios venosos cerebrais.Possui diversas causas desencadeantes como infecção, trauma e distúrbios de coagulação, assim como diversas apresentaçõesclínicas. O trabalho relata o caso de TVC de um paciente jovem, do sexo masculino, que havia feito uso de Tamoxifeno, receitadona academia de musculação, para evitar crescimento das mamas pelo uso de suplementos de fórmula não conhecida. Foramdiscutidos também seu diagnóstico e abordagem escolhida.
Subject(s)
Male , Intracranial Thrombosis , Vascular HeadachesABSTRACT
Em Odontologia, o estudo da dor é muito importante, embora atue sobre uma área restrita. A sintomatologia dolorosa apresenta variações individuais e temporais, dificultando a sua caracterização e, consequentemente, sua avaliação. Tal avaliação é fundamental para acompanhar a evolução clínica do paciente, para então realizar os ajustes necessários ao tratamento. O objetivo deste estudo foi realizar uma revisão da literatura sobre as escalas subjetivas de dor, a fim de apresentar o seu uso mais comum e esclarecer suas características e formas de aplicação focando em estudos sobre a disfunção temporomandibular
Subject(s)
Pain , Temporomandibular Joint , Temporomandibular Joint Dysfunction Syndrome , Hyaluronic Acid , Placebos , Tension-Type Headache , Vascular HeadachesABSTRACT
This study describes the tensio-type headache with an update on mechanisms and treatment
Subject(s)
Humans , Headache Disorders , Pharmacology , Tension-Type Headache , Vascular HeadachesABSTRACT
A trombose venosa cerebral é uma doença vascular pouco freqüente, com múltiplas manifestações clínicas e distintas etiologias. Tem sido diagnosticada mais freqüentemente nas últimas décadas devido à melhora na qualidade dos exames de neuroimagem. O diagnóstico precoce é crucial e deve ser sempre considerado por clínicos e neurologistas. Relatamos o caso de uma jovem de 23 anos com quadro de cefaléia frontal, pulsátil, intensa, com irradiação holocraniana, associada à vômitos e sonolência, que teve seu diagnóstico firmado por investigação neurorradiológica. O presente relato discute aspectos relevantes da apresentação clínica, diagnóstico, tratamento, manejo clínico e prognóstico desta condição
Subject(s)
Adult , Female , Humans , Vascular Headaches/diagnosis , Vascular Headaches , Magnetic Resonance Spectroscopy , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial , Sinus Thrombosis, Intracranial/therapyABSTRACT
There are several reports suggesting a relation between migraine headaches and heart diseases. However, there is not enough persuading evidence implying that migraine headache is a potential risk factor for cardiovascular diseases. This study was conducted to determine the prevalence of migraine headaches in patients with myocardial infarction, concerning the common vascular etiology of both conditions. This is a hospital-based case-control study carried out in the summer and fall of 2001, at Nour, Alzahra, and Chamran hospitals, Isfahan, Iran. The case group consisted of 78 patients with acute MI, and a control group with equal numbers of patients without acute MI who were hospitalized at non-cardiac units, such as orthopedics, infectious diseases and general surgery wards. All patients were evaluated for migraine headaches. The data were analyzed by Chi Square and the multiple logistic regression tests using SPSS software package. 37% of patients were women, and 63% were men. The mean age of patients was 57.6 +/- 12 years, ranging from 37 to 90 years. 36% of patients with migraine headache were men, and 64% were women. The prevalence of migraine headaches was 16.5% and 5% in the case and control groups, respectively. Mean age of patients was 57.7 +/- 10.4 years in the case group, and 57.5 +/- 13.4 years in the control group. The onset age of migraine headaches was 25.4 +/- 11.4 years in the case group, and 24.9 +/- 8.6 years in the control group. Analysis of results demonstrated a meaningful difference between the case and control groups, as regards the relative prevalence of migraine headaches [P<0.05]. Multiple logistic regression analysis yielded an odds ratio [OR] of about 3.7. Given the high prevalence of migraine headaches in patients with acute myocardial infarction in the present study, and conformity of our results with those of previous studies, the strict control of other risk factors for coronary artery atherosclerosis is recommended
Subject(s)
Humans , Male , Female , Prevalence , Myocardial Infarction , Comorbidity , Vascular Headaches , Risk FactorsSubject(s)
Male , Female , Humans , Intracranial Hypertension , Stroke , Parkinson Disease , Vascular HeadachesABSTRACT
Este es el segundo de tres artículos que tienen como propósito presentar una revisión de la literatura de las condiciones que se han considerado para el establecimiento del diagnóstico diferencial del dolor orofacial. Los desórdenes neurovasculares (migrañas, cefaleas tipo cluster, paroxismo hemicraneano), vasculares (arteritis temporal, carotidinia) y musculoesqueléticos (cefaleas de tipo tensional, desórdenes temporomandibulares, dolor miofascial, fibromialgia, desórdenes espinocervicales) serán revisados
Subject(s)
Humans , Diagnosis, Differential , Facial Pain , Carotid Arteries/physiopathology , Cluster Headache/complications , Cluster Headache/diagnosis , Musculoskeletal Diseases/complications , Musculoskeletal Diseases/diagnosis , Facial Pain , Fibromyalgia , Giant Cell Arteritis , Migraine with Aura , Migraine without Aura/complications , Migraine without Aura/diagnosis , Myofascial Pain Syndromes , Neck Pain , Tension-Type Headache , Temporomandibular Joint Disorders/complications , Temporomandibular Joint Disorders/diagnosis , Vascular Diseases , Vascular HeadachesABSTRACT
O presente estudo apresenta a avaliação do efeito placebo no tratamento agudo da migrânea sem aura, migrânea com aura e cefaléia do tipo tensional episódica. Foram estudados pacientes que deram entrada entre 1 de março de 1997 a 31 de novembro de 1999 em dois pronto-socorros. Definiram-se três grupos, cada um com 30 pacientes: 1 - migrânea sem aura (MSA); 2 ó migrânea com aura (MCO); 3 ó cefaléia do tipo tensional episódica (CTTE). Os pacientes participavam de estudo randomizado para avaliar a eficácia de 4 drogas; aqueles randomizados para o placebo foram incluídos também. Os parâmetros avaliados foram: 1 ó dor; 2 - sintomas associados. Avaliados uma hora após a administração do placebo, 50 por cento dos pacientes do grupo MSA, 23,3 por cento dos pacientes do grupo MCA e 26,7 por cento dos pacientes do grupo CTTE apresentavam melhora da dor. A melhora, avaliada pela escala numérica da dor foi, em média, de 41,6 por cento, 23,1 por cento e 36 por cento, respectivamente. Houve também redução significativa de todos os sintomas associados. A utilização do placebo é, portanto, essencial na avaliação de drogas utilizadas no tratamento de cefaléias agudas.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Placebos/therapeutic use , Vascular Headaches/drug therapy , Acute Disease , Migraine with Aura/drug therapy , Migraine without Aura/drug therapy , Pain Measurement/methods , Tension-Type Headache/drug therapy , Treatment OutcomeABSTRACT
La migraña es un trastorno bastante frecuente en las mujeres, se presenta hasta en 18 por ciento, con mayor prevalencia entre los 20 y 50 años y los cambios hormonales la influencian a lo largo del ciclo reproductivo de la vida. Cuando durante el embarazo se presenta o se recrudece el médico tratante se preocupa acerca de la repercusión que la terapéutica misma pueda tener en el embarazo o bien en el producto. Objetivo. Hacer una breve revisión acerca de la definición, clasificación y teorías que hay para explicar la migraña, el efecto que tiene en el embarazo y finalmente presentar lineamientos de tratamiento tanto en el embarazo como en el periodo de lactancia. Existen dos teorías para explicar el origen de la migraña: la vascular y la neurogénica. Existe la observación de que el embarazo cambia los patrones de la migraña.
Subject(s)
Migraine Disorders , Pregnancy , Lactation , Vascular HeadachesABSTRACT
This study aimed to evaluate blood flow velocity [FV] and pulsatility index in patients with unilateral headache. Sixty-six patients were examined during headache-free period, three patients during attack of migraine and fourteen as control healthy volunteers who were migraine - free individuals and without cerebrovascular diseases. Mean flow velocity and pulsatility index was measured in the middle cerebral artery using transcranial Doppler. The sixty-six patients were divided into three subgroups as followed; 34 patients as non-dominant sided headache, 27 patients as dominant-sided headache and 5-patients with definite brain lesions. The FV mean of patients with definite brain lesion significantly increased on comparison with the control group, the non-dominant sided headache and the dominant sided headache. There was no significant difference between FV mean of the side of headache and the other side [non-painful side] in patients with dominant sided headache
Subject(s)
Humans , Male , Female , Diagnosis , Migraine Disorders/diagnostic imaging , Ultrasonography, Doppler, Transcranial , Blood Flow Velocity , Vascular HeadachesABSTRACT
El objetivo de este estudio prospectivo de cefalea en el niño fue conocer la prevalencia de consultas por cefalea en el policlínico de Neurología del Hospital Roberto del Río, las características clínicas, el tipo de cefalea y la utilidad en niños de la clasificación internacional de cefalea dadapor la Internacional Headache Society 1988. Entre enero y junio 1994, tuvimos 114 consultas por cefalea, de un total de 5 612, al policlínico de Neurología del Hospital de Niños Roberto del Río, lo que dio una prevalencia de 2 por ciento. Hubo 68 mujeres y 46 hombres, edades entre 3,5 y 14,8 años. Todos sufrían cefaleas recurrentes. La aplicación de la clasificación internacional nos permitió clasificar el 75 por ciento de los casos, con una distribución de 66 por ciento vascular, 8 por ciento tensional y 26 por ciento no definida
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Headache/epidemiology , Hospitals, Pediatric/statistics & numerical data , Headache/classification , Headache/diagnosis , International Classification of Diseases , Prevalence , Prospective Studies , Tension-Type Headache/epidemiology , Vascular Headaches/epidemiologyABSTRACT
Se presenta el caso clínico de una primigesta adolescente de 14 años, que asociado al inicio de su gestación, se le pesquisa una malformación vascular del tronco encéfalico complicada
Subject(s)
Humans , Female , Adolescent , Hemangioma, Cavernous/diagnosis , Intracranial Hemorrhages/complications , Pregnancy Complications, Cardiovascular/diagnosis , Hypertension/complications , Seizures/etiology , Vascular Headaches/etiologyABSTRACT
The intracranial blood vessels of the dura and the pia receive sensory afferent innervations from trigeminal nerve which has been believed to play a critical role in the mediation of vascular headache such as migraine. The purpose of this study was to discover the mechanism by which the interaction between trigeminal ganglion neurons and the function of cerebral blood vessels. Using electrophysiological recording, we studied the responses of trigeminal ganglion neurons to electrical stimulation of middle meningeal artery(MMA), superior sagittal sinus(SS) and transverse sinus(TS) in rats. Sumatriptan is a highly selective agonist for 5-HT1D receptor subtype which mediates vasoconstriction of cerebral blood vessels. We observed responses to electrical stimulation in trigeminal ganglion neurons and meningeal blood flow(MBF) after intravenous injection of sumatriptan. The results were as follows: 1) The presumed mean conduction velocities of the cells activated MMA, SS and TS by electrical stimulation were approximately 1.5, 2.9 and 2.9m/s, respectively. These were presumed to be nociceptive small myelinated or unmylinated sensory fibers. 2) The action potential discharges of trigeminal ganglion neurons on MMA, SS and TS in the experimental control groups were 671+/-39.49, 856+/-63.95 and 494+/-21.54microV, respectrely. The action potential discharges of sumatriptan groups on MMA, SS and TS(393+/-20.10, 562+/-32.26 and 262+/-18.94microV, respectively) were significantly decreased compared to that of the experimental control groups. 3) The mean MBF of normal control group was 63.29+/-7.54ml/100g/min. The mean MBF of the experimental control groups on MMA, SS and TS were 97.13+/-9.91, 104.28+/-12.54 and 91.82+/-6.41ml/100g/min, respectively(p<0.05). MBF of sumatriptan group before stimulation was significantly decreased(compared to normal: 37.17+/-4.76ml/100g /min vs 63.29+/-7.54ml/100g/min). The mean MBF of sumatriptan groups on MMA, SS and TS were 57.11+/-4.48, 66.56+/-6.23 and 56.07+/-5.00ml/100g/min, respectively. Compared to that of the experimental control groups, the MBF of the sumatriptan groups were significantly decreased. In conclusion, the activation of trigeminal sensory afferents by the electrical stimulation of the dural vessel may create vasodilatation and increase cerebral blood flow which may lead to vascular headaches via trigeminal ganglion to brain stem This pathway can be important for understanding the neural mechanism for the development of pharmacological and surgical approach to alleviate vascular headache.