ABSTRACT
BACKGROUND AND AIM: Protein-Energy Wasting and inflammation are the principal risk factors of haemodialysis complications. We evaluated the reliability of a simple and non expensive test, the Prognostic Inflammatory and Nutritional Index (PINI), for regular screening of maintenance haemodialysis (MHD) patients in order to detect early onset of inflammation and malnutrition. METHODS AND RESULTS: 121 adult patients on maintenance dialysis were followed up for 32 months and screened every 6 months for PINI, calculated as alpha1-Acid Glycoprotein (alpha1-AG)xC-Reactive Protein (CRP)/AlbuminxTransthyretin. PINI score < or =1 was considered normal. Patients were stratified according to their PINI score: 86 patients (71.66%) had a normal score, whereas 35 (28.33%) had PINI > or = 1. The latter also had higher CRP levels, despite no clinical evidence of inflammation at the time of enrolment. Survival in patients with normal PINI was similar to patients with normal CRP, while in patients with abnormal PINI it was significantly lower than in patients with low serum albumin (p<0.05) or elevated CRP (p<0.05). After follow-up, all surviving MHD patients with PINI > or = 1 had at least one cardiovascular event vs 2.5% of patients with PINI > or = 1. CONCLUSION: The assessment of PINI can reliably identify MHD patients at higher risk of mortality and morbidity even in the absence of overt Malnutrition-Inflammation Complex Syndrome (MICS). This simple test appears to be more sensitive and specific of the single components, and not expensive, so that it could be routinely used to identify patients with sub-clinical inflammation and/or malnutrition.
Subject(s)
Cardiovascular Diseases/etiology , Inflammation Mediators/blood , Inflammation/diagnosis , Nephelometry and Turbidimetry , Nutrition Assessment , Protein-Energy Malnutrition/diagnosis , Renal Dialysis/adverse effects , Adult , Aged , Biomarkers/blood , C-Reactive Protein/metabolism , Cardiovascular Diseases/blood , Cardiovascular Diseases/mortality , Case-Control Studies , Cost-Benefit Analysis , Female , Health Care Costs , Humans , Inflammation/blood , Inflammation/etiology , Inflammation/mortality , Kaplan-Meier Estimate , Male , Middle Aged , Nephelometry and Turbidimetry/economics , Orosomucoid/metabolism , Prealbumin/metabolism , Predictive Value of Tests , Protein-Energy Malnutrition/blood , Protein-Energy Malnutrition/etiology , Protein-Energy Malnutrition/mortality , ROC Curve , Renal Dialysis/economics , Renal Dialysis/mortality , Reproducibility of Results , Risk Assessment , Risk Factors , Serum Albumin/metabolismABSTRACT
In six Centers belonging to the Italian Movement Disorder Study Group, the efficacy of botulinum toxin treatment was evaluated in an open collaborative study in 251 patients with focal dystonia and hemifacial spasm. The percentage of functional improvement ranged from 66% to 81% in patients with blepharospasm, from 40% to 51% in patients with spasmodic torticollis and from 73% to 81% in those with hemifacial spasm. Good results were also obtained in patients with oromandibular dystonia, laryngeal dystonia and writer's cramp. Side effects were mild and transient. Local botulinum toxin injection is the first choice symptomatic treatment in focal dystonia and hemifacial spasm.
Subject(s)
Botulinum Toxins/therapeutic use , Dystonia/drug therapy , Facial Muscles , Spasm/drug therapy , Adult , Aged , Analysis of Variance , Blepharospasm/drug therapy , Botulinum Toxins/adverse effects , Dystonia/physiopathology , Humans , Middle Aged , Spasm/physiopathology , Torticollis/drug therapyABSTRACT
Investigation of vesico-urethral and sweating function was performed in twelve patients with classical idiopathic Parkinson's disease and ten patients with parkinsonism associated with features suggestive of more extensive involvement of the nervous system, as in the Shy-Drager syndrome. The urodynamic studies revealed detrusor hyperreflexia with reduction of maximal cystometric capacity in only one patient with Parkinson's disease (8%), but in nine patients with parkinsonism associated with other features (90%). Urethral sphincter electromyography did not indicate denervation in any patient of either group. Delayed or incomplete relaxation of the urethral sphincter during micturition was observed in seven patients with Parkinson's disease (58%) and in two patients of the other group (20%). Decreased sweating responses were found in both groups of patients when compared with control subjects. Hypohidrosis was more pronounced in parkinsonism associated with other features than in Parkinson's disease. Differences in sweating between the two sides of the body were observed in both groups of patients. Although there are differences in vesico-urethral and sweating function, they do not precisely differentiate between patients with classical Parkinson's disease and those with parkinsonism associated with features suggestive of more extensive involvement of the nervous system.
Subject(s)
Parkinson Disease/physiopathology , Sweating/physiology , Urethra/physiopathology , Urinary Bladder/physiopathology , Aged , Electromyography , Female , Humans , Male , Middle Aged , Shy-Drager Syndrome/physiopathology , Urodynamics/physiologyABSTRACT
The features of histamine-induced headache and its associated vascular responses were studied in 52 patients with different surgical lesions of the gasserian ganglion and in 12 control subjects. Certain features of headache (eg, intensity, type, and duration) were similar in patients and control subjects. However, the pain was absent on the side of the trigeminal lesion in 26 (50%) of the patients. This unilateral absence of pain was not related to the hypoesthesia that was caused by the operation, and it was associated with a decrease in vascular responses (histamine-induced facial flushing and increase in temperature) on the side operated on. These abnormalities were more prevalent in patients who had undergone thermocoagulation and presented with more severe damage of the trigeminal ganglion than in those who were subjected to trigeminal compression or glycerolization. The trigemino-vascular system seems to control headache of a vascular type and associated craniofacial vasodilatation in human subjects.
Subject(s)
Face/blood supply , Headache/physiopathology , Trigeminal Ganglion/physiology , Vasodilation/physiology , Aged , Body Temperature , Face/physiopathology , Female , Flushing/physiopathology , Histamine , Humans , Male , Middle Aged , Pain Measurement , Reference Values , Sensation , Skin/innervation , Trigeminal Ganglion/surgery , Trigeminal Neuralgia/physiopathology , Trigeminal Neuralgia/surgerySubject(s)
Corpus Striatum/physiopathology , Nerve Degeneration/physiology , Olivopontocerebellar Atrophies/diagnosis , Parkinson Disease/diagnosis , Shy-Drager Syndrome/diagnosis , Spinocerebellar Degenerations/diagnosis , Substantia Nigra/physiopathology , Urinary Bladder, Neurogenic/diagnosis , Urodynamics/physiology , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Neural Pathways/physiopathology , Olivopontocerebellar Atrophies/physiopathology , Parkinson Disease/physiopathology , Shy-Drager Syndrome/physiopathology , Spinocerebellar Degenerations/physiopathology , Urethra/innervation , Urinary Bladder/innervation , Urinary Bladder, Neurogenic/physiopathologyABSTRACT
One hundred patients with spontaneous subarachnoid hemorrhage due to aneurysm or presumed aneurysm consecutively admitted to a neurological clinic and subjected to CCT during the first 72 hours were examined retrospectively. The outcome after two months as defined by the Glasgow Outcome Scale (GOS) was relatively good: 23% of the patients suffered management mortality (GOS I) (postoperative lethality 8%), 3% showed GOS-Grade II, 14% grade III, 17% grade IV, and 43% grade V. The extent of intracranial hemorrhage correlated well with the initial Hunt-Hess Grade which, in turn, had a strong influence on case fatality and the degree of disability. Lethal factors were: 1. massive subarachnoid hemorrhage together with a massive ventricular hemorrhage (p < 0.001), 2. massive subarachnoid hemorrhage together with an intracerebral hematoma > 20 ml (p < 0.05). Case fatality was lower when angiography was negative. In our study rebleeding (12%) and delayed cerebral ischemia (DCI) (18%) were less frequent and the lethality due to acute hydrocephalus (5%) and delayed cerebral ischemia (5%) was less pronounced than in comparable studies. The degree of disability (GOS) was directly related to the amount of intracranial blood, to the development of acute or chronic hydrocephalus, delayed cerebral ischemia and rebleeding. DCI occurred in 60% of patients with marked hydrocephalus. Rebleeding was more frequent in patients with acute hydrocephalus. Hydrocephalus, DCI, and rebleeding were associated with a poorer initial grade on the Hunt and Hess Scale.
Subject(s)
Aneurysm, Ruptured/surgery , Intracranial Aneurysm/surgery , Postoperative Complications/mortality , Subarachnoid Hemorrhage/surgery , Adult , Aged , Aged, 80 and over , Aneurysm, Ruptured/diagnosis , Aneurysm, Ruptured/mortality , Female , Follow-Up Studies , Glasgow Coma Scale , Humans , Hydrocephalus/diagnosis , Hydrocephalus/mortality , Hydrocephalus/surgery , Intracranial Aneurysm/diagnosis , Intracranial Aneurysm/mortality , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/mortality , Ischemic Attack, Transient/surgery , Male , Middle Aged , Neurologic Examination , Postoperative Complications/diagnosis , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/mortality , Survival RateABSTRACT
The aim of this paper is to define the problems that arise in the clinical evaluation of drugs for the treatment of vertigo. Among these are the objective criteria used in defining vertigo and those used in evaluating efficacy of the drugs. The resulting protocol for a clinical study of vestibular drugs is a document that clarifies the debated points in the field, and above all furnishes guidelines for establishing uniformity in clinical studies. This, therefore, may become the reference protocol in Italy for clinical evaluations of drugs for the treatment of vertigo.
Subject(s)
Clinical Protocols , Vertigo/drug therapy , Humans , Italy , Vertigo/diagnosisABSTRACT
BACKGROUND AND PURPOSE: Our aim in this study was to compare headache-free and spontaneous migraine measurements of blood flow velocity and the pulsatility index in the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery. METHODS: Thirty-one patients (nine having experienced migraine with aura and 22 migraine without aura) were studied in headache-free periods and during spontaneous migraine attacks with transcranial Doppler ultrasonography. RESULTS: During attacks of migraine with aura, blood flow velocities (particularly the diastolic velocity [p = 0.05]) were reduced while the pulsatility index increased (p = 0.05), whereas a generalized increase in diastolic velocity (p less than 0.02) and a decrease in the pulsatility index (p = 0.05) were observed during attacks of migraine without aura. Significant variations of blood pressure and heart rate were never found. CONCLUSIONS: These findings are consistent with constriction of resistance vessels in migraine with aura and dilatation of the vessels in migraine without aura. This disparity could be due to a difference between the two migraine types or could be related to the fact that in this study the time interval between headache onset and transcranial Doppler was shorter in the migraine-with-aura group. The latter explanation would apply if, in fact, both types of migraine evolve from hypoperfusion to hyperperfusion during their time course, although perhaps with a difference in intensity.
Subject(s)
Cerebrovascular Circulation , Migraine Disorders/diagnostic imaging , Adult , Blood Flow Velocity , Female , Humans , Male , Migraine Disorders/complications , Nervous System Diseases/etiology , Reference Values , Sensation , Time Factors , UltrasonographyABSTRACT
Ten patients diagnosed as affected by primary degenerative dementia of the Alzheimer type, with a mild to moderate cognitive and behavioral impairment, were studied in a double blind design when taking for 60 days 5 mg twice a day of L-deprenyl or placebo. Cognitive functions and cerebral blood flow were assessed at the beginning and at the end of treatment by a wide array of memory, attention, and language efficiency measures and by SPECT-99TcHMPAO procedure. Reduced CBF on the parietal lobes was demonstrated in the patients at baseline together with a reduction of memory and cognitive efficiency. At the end of the treatment patients who received L-deprenyl showed an improvement in cognitive efficiency and no changes in CBF, while patients treated with placebo showed a worsening of cognitive efficiency and further reduction of parietal lobe CBF.
Subject(s)
Alzheimer Disease/drug therapy , Cerebrovascular Circulation/drug effects , Cognition/drug effects , Monoamine Oxidase Inhibitors/therapeutic use , Aged , Alzheimer Disease/physiopathology , Alzheimer Disease/psychology , Attention/drug effects , Double-Blind Method , Female , Humans , Magnetic Resonance Imaging , Male , Memory/drug effects , Selegiline/pharmacology , Selegiline/therapeutic use , Tomography, Emission-Computed, Single-PhotonABSTRACT
In six patients with Parkinson's disease exhibiting severe "on-off" phenomena, a 200-mg intravenous bolus of either L-DOPA or of its methyl ester were equally effective in reversing motor deficits, although the duration of action of the methyl ester was shorter. There were no marked differences in pharmacokinetic parameters for L-DOPA plasma levels after administration of L-DOPA and the methyl ester. In three patients, optimal infusion rates for the maintenance of mobility were established for L-DOPA and L-DOPA methyl ester. Both drugs were able to maintain patients "on" throughout a 12-h infusion period. However, on average the optimal infusion rate of L-DOPA methyl ester was 2.7 times greater than that for L-DOPA. There was no marked difference in the plasma levels of L-DOPA achieved, but 3-O-methyl DOPA levels increased more after infusion of L-DOPA methyl ester than after infusion of L-DOPA itself. The half-life of elimination and volume of distribution of L-DOPA formed from the methyl ester were markedly increased compared with values obtained after either an intravenous bolus of methyl ester or after an intravenous infusion of L-DOPA itself. An intravenous bolus of L-DOPA methyl ester produces an equivalent magnitude of clinical response to the same dose of L-DOPA. However, higher optimal infusion rates of methyl ester than L-DOPA are required to produce continuous effect. The pharmacokinetic handling of L-DOPA methyl ester given by intravenous infusion may differ from that of L-DOPA when given by the same route.
Subject(s)
Levodopa/analogs & derivatives , Levodopa/administration & dosage , Neurologic Examination/drug effects , Parkinson Disease/drug therapy , Aged , Double-Blind Method , Drug Administration Schedule , Female , Humans , Infusions, Intravenous , Levodopa/adverse effects , Levodopa/pharmacokinetics , Male , Middle Aged , Motor Skills/drug effects , Parkinson Disease/bloodABSTRACT
In a non-randomized retrospective study n = 36 prolactinoma patients (n = 7 micro- and n = 29 macroadenomas) were evaluated before (E0), 4 (E1) and 52 weeks (E2) after applying 3 different treatment modalities: A dopamine agonist (DA) therapy (n = 14), B surgery as initial procedure (n = 12) and oral DA therapy, C DA preinjection, subsequent surgery (n = 10) and oral DA medication. T0 outline the effect of the 3 regimens upon serum prolactin (PRL) and tumour size reduction, clinical signs and symptoms, anterior/posterior pituitary lobe function and MRI/CT findings were evaluated in each patient at E0, E1 and E2. In group A, PRL normalization was achieved in n = 10 patients (71%), although the frequency of an empty sella was only one out of 12 macroprolactinoma patients (less than 10%). Patients of group C showed the lowest PRLE2 levels (32 +/- 11 ng/ml, normalization rate 60%), although not statistically significant when compared with the other groups (A: 41 +/- 28 ng/ml, B: 114 +/- 33 ng/ml, normalization rate 31%). According to MRI studies in groups B and C total removal was achieved in 33% and 50% of macroprolactinomas, respectively. The most favourable ratio of the leading pre/posttreatment signs and symptoms was observed in patients of group C. It was concluded that no superiority of either treatment regimen exists for prolactinoma patients. Each mode of therapy has its own benefits which may be applied to the different biological behaviour of a prolactinoma in the respective patient.
Subject(s)
Bromocriptine/administration & dosage , Dopamine/administration & dosage , Hyperprolactinemia/surgery , Pituitary Neoplasms/surgery , Prolactinoma/surgery , Adolescent , Adult , Aged , Combined Modality Therapy , Female , Humans , Hyperprolactinemia/blood , Hyperprolactinemia/drug therapy , Hypophysectomy , Magnetic Resonance Imaging , Male , Middle Aged , Pituitary Hormones, Anterior/blood , Pituitary Neoplasms/blood , Pituitary Neoplasms/drug therapy , Postoperative Complications/blood , Postoperative Complications/etiology , Prolactin/blood , Prolactinoma/blood , Prolactinoma/drug therapy , Tomography, X-Ray ComputedABSTRACT
Seven patients, six suffering from amyotrophic lateral sclerosis (ALS) and one from Friedreich ataxia, were treated with a placebo i.v. infusion during the first day and with TRH-T i.v. infusion at a rate of 2 mg/h for 8 h daily (total daily dosage 16 mg) on the 2 consecutive days. Continuous blood pressure (BP) and EKG monitorings were performed during 3 days infusion. Blood samples were collected for endocrinological evaluations. The neurological evaluation after acute TRH-T treatment showed an objective improvement in 3 of the 8. We found significantly higher values of systolic (max. difference of 10.1 mm Hg) and diastolic (max. difference of 8.8 mm Hg) BP than during placebo, beginning from the 5th h of the infusion (p less than 0.05). A trend in progressive increase of the heart rate (HR) reached statistical significance (p less than 0.01) at the 8th h of the second TRH-T infusion. The cardiovascular changes during the i.v. continuous TRH-T infusions were clinically irrelevant and never required the interruption of the treatment.
Subject(s)
Amyotrophic Lateral Sclerosis/drug therapy , Friedreich Ataxia/drug therapy , Adult , Amyotrophic Lateral Sclerosis/physiopathology , Electrocardiography, Ambulatory/drug effects , Friedreich Ataxia/physiopathology , Humans , Infusions, Intravenous , Male , Middle Aged , Neurologic Examination/drug effects , Thyroid Hormones/blood , Thyrotropin-Releasing Hormone/administration & dosageABSTRACT
Motor fluctuations often complicate chronic levodopa treatment of Parkinson's disease. Pharmacologically, these phenomena are characterized by a progressive shortening of the duration of action of levodopa and a gradual narrowing of the range of "optimally effective" doses, able to improve parkinsonian akinesia without inducing abnormal involuntary movements. The effects of a continuous intravenous infusion of levodopa lasting 9 +/- 0.3 days on these clinical-pharmacological indices have been studied in 12 parkinsonian patients. Continuous infusion therapy gradually ameliorated motor fluctuations by more than 40%, and this improvement lasted for at least 6 days after resuming standard oral therapy. Moreover, levodopa duration of action was prolonged by about 30%, and the range of "optimally effective" dose was widened by about 50%. The above data suggest the possibility of plastic modifications of the pathogenetic mechanisms underlying motor fluctuations in Parkinson's disease, and a potential deleterious effect of intermittent oral therapy. Consequently, continuous dopaminergic stimulation, when used in the early stages of the disease, might theoretically have a prophylactic role on the development or worsening of motor fluctuations.
Subject(s)
Levodopa/therapeutic use , Parkinson Disease/drug therapy , Receptors, Dopamine/drug effects , Aged , Drug Tolerance , Female , Humans , Infusions, Intravenous , Levodopa/administration & dosage , Levodopa/adverse effects , Male , Middle Aged , Movement Disorders/etiology , Movement Disorders/prevention & control , Parkinson Disease/metabolism , Parkinson Disease/physiopathology , Receptors, Dopamine/physiologyABSTRACT
Nitroglycerin, a vasodilating agent, was administered sublingually in migraine without aura patients and in healthy volunteers. Systolic, diastolic and time-mean flow velocity and pulsatility index, were measured by transcranial Doppler sonography in the major intracranial arteries before and after nitroglycerin administration. Following nitroglycerin administration, a significant decrease in systolic and time-mean velocity and pulsatility index was observed in migraine patients, whereas in control subjects only time-mean velocity decreased significantly. Based on those findings we hypothesize a more marked responsiveness to nitroglycerin in migraine patients as compared to healthy subjects.
Subject(s)
Migraine Disorders/physiopathology , Nitroglycerin/pharmacology , Adult , Blood Flow Velocity/drug effects , Diastole/drug effects , Female , Humans , Male , Migraine Disorders/diagnostic imaging , Pulsatile Flow/drug effects , Pulse/drug effects , Systole/drug effects , UltrasonographyABSTRACT
The effects of the partial dopamine agonist terguride (9,10 transdihydrolisuride; THDL) on striatal dopamine receptors were studied by its i.v. administration to 13 patients with Parkinson's disease. Patients were maintained in a steadily mobile state with abnormal involuntary movements by a constant i.v. infusion of levodopa. Terguride showed dopamine antagonist properties in nine patients. In two of these nine patients, a decrease in dyskinesia score was observed without a concomitant worsening of parkinsonian symptoms, whereas in the remaining seven, full parkinsonian akinesia followed THDL administration. The subsequent i.v. injection of the dopamine agonist lisuride reversed THDL-induced akinesia in these seven patients. In the remaining four patients, no clinically significant motor effects were observed. These results show dopamine antagonist activity of terguride in patients with Parkinson's disease treated with Levodopa. Further studies using a wider dose titration are required to evaluate the possible role of dopamine partial agonists in the therapy of levodopa-induced dyskinesias.
Subject(s)
Dopamine Agents/therapeutic use , Lisuride/analogs & derivatives , Parkinson Disease/drug therapy , Adult , Aged , Dopamine Agents/administration & dosage , Humans , Levodopa/administration & dosage , Lisuride/administration & dosage , Lisuride/therapeutic use , Middle AgedSubject(s)
Hemangioma, Cavernous/diagnosis , Magnetic Resonance Imaging , Spinal Cord Neoplasms/diagnosis , Adolescent , Diagnosis, Differential , Hemangioma, Cavernous/pathology , Hemangioma, Cavernous/surgery , Humans , Male , Middle Aged , Spinal Cord/pathology , Spinal Cord/surgery , Spinal Cord Neoplasms/pathology , Spinal Cord Neoplasms/surgeryABSTRACT
Sweating and superficial vasodilator responses were studied in 22 patients suffering from Parkinson's disease in order to evaluate the thermoregulatory function. Sweating was evaluated on different areas of the body with a colorimetric method (Minor's method). The superficial vasodilatation at the level of the face was assessed after oral intake of nitroglycerin by means of telethermography. Sweating and superficial vasodilatation were reduced in parkinsonian patients compared with control subjects. Asymmetries in sweating and superficial vasodilator responses were also observed between the left and right sides of the body in the patients. The decreased heat elimination was more apparent on the symptomatic side in patients with hemiparkinsonism. No relationship was found between the alterations of the thermoregulation and the other clinical features of Parkinson's disease.
Subject(s)
Autonomic Nervous System Diseases/physiopathology , Body Temperature Regulation/physiology , Parkinson Disease/physiopathology , Aged , Autonomic Nervous System Diseases/diagnosis , Dominance, Cerebral/physiology , Female , Humans , Male , Middle Aged , Muscle, Smooth, Vascular/innervation , Neurologic Examination , Parkinson Disease/diagnosis , Skin/blood supply , Sweating/physiology , Vasodilation/physiologyABSTRACT
An EEG finding of temporo-occipital or temporo-parieto-occipital spike-wave complexes, suppressed by eye opening, coexisting with classical migraine, was observed in 14 children; in 13 of these patients, seizures were present. Classical migraine, visual phenomena and seizures coexisted in different clinical patterns.
Subject(s)
Electroencephalography , Epilepsy/physiopathology , Migraine Disorders/physiopathology , Occipital Lobe/physiology , Adolescent , Adult , Child , Epilepsy/complications , Female , Humans , Male , Migraine Disorders/complicationsABSTRACT
We compared the efficacy of a single dose of an oral solution of levodopa methyl ester (ME) to that of standard levodopa, in the form of a single dose of Madopar, in reversing afternoon "off" periods in 12 patients with Parkinson's disease (PD). The highly soluble ME solution led to a significantly more rapid reversal of "off" periods. This preparation may therefore convey a clinical advantage in patients experiencing motor fluctuations whilst taking multiple daily dosages of levodopa, particularly in those with long or highly variable latency to the next "on" period.
Subject(s)
Benserazide/administration & dosage , Levodopa/analogs & derivatives , Levodopa/administration & dosage , Parkinson Disease/drug therapy , Administration, Oral , Aged , Benserazide/therapeutic use , Drug Combinations , Humans , Levodopa/therapeutic use , Middle AgedABSTRACT
A study was carried out on headache after carotid endarterectomy. A specific type of headache, similar in its characteristics to "cluster headache", occurred on the operative side in 30% of 54 patients, whereas no such headache occurred after extra-intracranial bypass or peripheral vascular surgery. This postoperative headache was not spontaneously reported by 56% of patients unless they were specifically asked about it. Pharmacological pupillary testing performed in 37 patients revealed that a decreased oculosympathetic activity (with or without adrenoceptor supersensitivity) was constantly associated with post-endarterectomy headache. Although this same abnormality was also observed in 54% of the patients without headache, a statistically significant (p less than 0.01) higher prevalence of decreased oculosympathetic responses was found in the patients with headache. The results suggest that damage to the sympathetic plexus due to the surgical procedure is involved in the development of postoperative "cluster-like" headache.