Stress at work in migraine patients: differences in attack frequency.

INTRODUCTION: Migraine is a common and prevalent disease that contributes to health expenditure and interferes with quality of life. Our goal was to analyse the level of stress at work in a sample of migraine and its possible association with the chronicity of the process MATERIAL AND METHODS: We applied the Maslach Burnout Inventory, consisting of 22 items grouped into blocks that assess emotional exhaustion (EE), personal accomplishment (PA), depersonalisation at work (DP)] and positive influence (PI), to 94 consecutive subjects recruited in the outpatient clinic. Differences were compared between clinical groups (chronic migraine [CM]: > 15 days/month with headache over a 3-month period vs episodic migraine [EM]: < 15 days/month with headache) using the general linear model adjusted for age and MIDAS score RESULTS: The mean age was higher in the CM group. Mean MIDAS scores were 51 ± 4.1 in CM, and 17.7 ± 15 in EM (P=.001). Adjusted means for EE were 24.6 ± 2.6 in CM patients, 16.2 ± 2.6 in EM patients, and 13.4 ± 2.3 (P=.03) in the healthy group. MIDAS scale scores were inversely correlated to PA (P<.05) DISCUSSION: Our results suggest that the level of EE at work is higher in EM than in CM patients, while PA levels decrease as impact on the MIDAS scale increases. The Maslach scale is a potentially useful tool for studying migraine impact. Surprisingly, EE is higher in patients with fewer episodes; this tendency could be related to stress adaptation mechanisms present in patients with chronic illness.

[Metronidazole-induced encephalopathy: description of a case with radiological and anatomopathological findings]. / Encefalopatia inducida por metronidazol: descripcion de un caso con hallazgos radiologicos y anatomopatologicos.

INTRODUCTION: Metronidazole is a widely known and used antibiotic. In exceptional cases, an encephalopathy with characteristic lesions on magnetic resonance imaging (MRI), usually located in the cerebellum and splenium of the corpus callosum, may be an adverse effect. The incidence and pathogenesis are unknown. The suspension of the treatment usually resolves the symptoms and normalizes the MRI in a few weeks. Due to the usual good prognosis, the anatomopathological findings are exceptional. We present a clinical case with the radiological findings suggestive of metronidazole-induced encephalopathy and, exceptionally, we provide the anatomopathological findings. CASE REPORT: A 72 years-old woman with severe Crohn's disease who, months after starting treatment with metronidazole, presented a slowly progressing bradypsychia and difficulty walking until she came to coma. In MRI it showed hyperintense images in T2 in the corpus callosum, red and dentate nuclei. He improved by stopping metronidazole but later developed sepsis and died. At autopsy, softening of the red nucleus was observed and, microscopically, cell necrosis and demyelination. CONCLUSION: With the publication of the clinical, radiological and anatomopathological information of our case we intend to promote the knowledge of this infrequent treatable cause of subacute encephalopathy and provide data that help to clarify its pathogenesis.

TITLE: Encefalopatia inducida por metronidazol: descripcion de un caso con hallazgos radiologicos y anatomopatologicos.Introduccion. El metronidazol es un antibiotico ampliamente conocido y utilizado. En casos excepcionales puede producir como efecto adverso un cuadro de encefalopatia con unas lesiones caracteristicas en la resonancia magnetica, localizadas generalmente en el cerebelo y el esplenio del cuerpo calloso. La incidencia y la patogenia se desconocen. La suspension del tratamiento habitualmente resuelve los sintomas y normaliza la resonancia magnetica en pocas semanas. Debido al habitual buen pronostico, los hallazgos anatomopatologicos son excepcionales. Se presenta un caso clinico con los hallazgos radiologicos sugestivos de la encefalopatia inducida por metronidazol y, de forma excepcional, se aportan los hallazgos anatomopatologicos. Caso clinico. Mujer de 72 años, con enfermedad de Crohn grave, que meses mas tarde de iniciar tratamiento con metronidazol presento de forma lentamente progresiva bradipsiquia y dificultad para caminar hasta llegar al coma. En la resonancia magnetica mostraba caracteristicas imagenes hiperintensas en T2 en el cuerpo calloso, y los nucleos rojos y dentados. Mejoro al suspender el metronidazol, pero posteriormente desarrollo una sepsis y fallecio. En la autopsia se observo reblandecimiento del nucleo rojo y, microscopicamente, necrosis celular y desmielinizacion. Conclusion. Con la publicacion de la informacion clinica, radiologica y anatomopatologica de este caso se pretende fomentar el conocimiento de esta infrecuente causa tratable de encefalopatia subaguda y aportar datos que ayuden a aclarar su patogenia.