The management of headaches in the emergency department: critical issues.

Typical cases of the most common kinds of headache can be diagnosed and treated by general practitioners (GPs). Non-traumatic patients with de novo acute sudden-onset disabling headaches as well as significant worsening of pre-existing headaches seek care at emergency departments (EDs) and represent a diagnostic challenge for the consultant neurologist, who is the specialist of reference for the entire diagnostic process. Explicit diagnostic criteria for the classification of headache disorders (ICHD-II) are fundamental for verifying the final diagnosis, but in the emergency setting diagnostic and therapeutic guidelines and recommendations, coupled with lists of diagnostic alarms and warnings, may further contribute to the preliminary identification of secondary headaches.

Relapsing-remitting painful ophthalmoplegia due to orbital myositis.

We describe a woman with a long history of relapsing-remitting painful ophthalmoplegia in a seasonal pattern, due to an isolated orbital myositis that was--at our observation--classified in the context of the so-called SAPHO syndrome. She had been previously treated with corticosteroid therapy, but the association with immunosuppressive drugs produced a more prompt resolution of both the headache and ophthalmoplegia, and of the magnetic resonance imaging pictures of isolated myositis as well.

Brain protection with intracarotid filter in angioplasty and stenting of the cervical carotid bifurcation. Preliminary experience in five cases.

SUMMARY: We report our preliminary experience in five cases of carotid stenting and angioplasty performed under cerebral protection with new filter devices allowing carotid flow maintenance during the procedure. In four out of five cases solid material was found inside the filters after balloon inflation for angioplasty. The technical aspects are discussed with correlation to carotid plaque embolic behavior and to functional factors.

Percutaneous cervical diskectomy: preliminary experience.

We assessed the feasibility of percutaneous treatment of a cervical herniated disc. In the lumbar region, the surgical instrument for percutaneous diskectomy passes only through the paravertebral muscles, while in the cervical region there is considerable risk of nervous, parenchymal and vascular lesions. Moreover, open surgery for cervical herniated nucleus pulposus is a well-established, low-risk procedure, with little risk of epidural fibrosis, the main complication of lumbar open surgery; a percutaneous procedure should therefore have a low morbidity rate. A safe percutaneous approach to cervical discs could be useful for biopsy and for treatment of high-risk patients for general anaesthesia. We treated 15 patients with cervical herniated nucleus pulposus; all gave informed consent and refused or were not eligible for open surgery. We used the Nucleotome described for treatment of lumbar herniated discs; except for the first three cases, we used colour Doppler sonography to detect hazardous structures in the path of the probe. We had one complication, a cervical haematoma due to damage to the inferior thyroid artery, prior to the use of ultrasound.

[A comparative evaluation of the centering precision performed with 2 different stereotaxic instruments in nonpalpable breast lesions]. / Valutazione comparativa della precisione nella centratura di lesioni mammarie non palpabili eseguita con due differenti apparecchi stereotassici.

Two different instruments for nonpalpable breast lesion localization, with different patient position (prone and sitting), were evaluated in precision performances by measuring the mean needle deviation on X and Y axes in 150 and 100 examinations, respectively. Both instruments yielded precise information: some drawbacks were observed with the stereotaxic instrument fitted to the plain mammographic unit, due to imperfect fixation in the sitting position of the patient. The development of special seats could obviate the problem, thus allowing a further improvement in the performance of this kind of instruments.

[Arthrographic semeiotics of traumatic capsular and ligamentous pathology of the tibiotarsal articulation]. / Semeiotica artrografica nella patologia traumatica capsulare e legamentosa della articolazione tibio-tarsica.

One-hundred and fifty-five patients with recent trauma were submitted to arthrography of the ankle joint in order to evaluate the actual diagnostic value of the methodology. Arthrography clearly demonstrated the single ligaments (anterior talo-fibular, calcaneal-fibular, posterior talo-fibular, and deltoid) and the capsular damage or rupture. The technical factors affecting the quality of the examinations are discussed. Arthrographic accuracy was 94.2%, with 92.7% sensitivity and 100% specificity. Arthrography of the ankle joint proved to be a quick and low-cost method providing good diagnostic results and no complications, thus allowing better preoperative planning in capsular and ligament injuries.