Is conventional brain MRI useful for the diagnosis of cluster headache in patients who meet ICHD-3 criteria? Experience in three hospitals in Spain.

OBJECTIVE: To assess the frequency of symptomatic structural lesions and the diagnostic yield of conventional brain MRI in cluster headache (CH). BACKGROUND: In contrast to migraine, brain MRI is recommended in patients with CH to exclude potential mimics. The prevalence of symptomatic CH is not known. METHODS: We retrospectively analysed in detail the brain MRIs of patients diagnosed as CH in 3 Neurology Services in Spain and reviewed their clinical history. Clinical diagnoses were reassessed based on the ICHD-3 criteria. RESULTS: We included 130 patients: 113 (86.9%) were male; mean age at diagnosis being 41.4 years (range 7-82). Forty-nine (37.7%) showed some abnormal MRI finding. Only in two cases potential symptomatic lesions were found: one trigeminal schwannoma and one craneopharyngioma, but both presented atypical features (facial hypoesthesia on examination and episodes of prolonged duration that had progressed to continuous refractory pain without specific pattern, respectively) and therefore did not fulfil the ICHD-3 CH criteria. The remaining abnormal MRI findings were: white matter lesions (24 patients; 18.4%), sinus inflammatory changes (13; 10.0%), small arachnoid cysts (5; 3.8%), empty sella turca (3; 2.3%), and other unspecific findings (8; 6.2%). All of them were not symptomatic based on neuroimaging characteristics, clinical course and response to treatment. CONCLUSIONS: Brain MRI in patients who meet ICHD-3 CH criteria, with no atypical clinical features, does not show any clinically-relevant findings, suggesting that these criteria are highly predictive of its primary origin and that systematic MRI is not useful for the diagnosis of typical CH.

Angioplastia carotídea en estenosis tras radioterapia: revisión de 12 casos / Carotid angioplasty in stenosis following radiotherapy: a review of 12 cases

Introducción. La estenosis carotídea es una complicación de la radioterapia cervical. En estos casos, la angioplastia carotídea se ha planteado como el tratamiento de revascularización electivo. Sin embargo, la indicación de tratar es discutida, debido a la alta tasa de reestenosis y a los pocos estudios de evolución a largo plazo existentes. Objetivo. Presentar una serie de pacientes con estenosis carotídeas tras radioterapia tratadas mediante angioplastia con el fin de analizar su evolución a corto y largo plazo. Pacientes y métodos. De una serie de 426 pacientes con estenosis carotídeas tratadas endovascularmente, 12 pacientes (2,8%) habían recibido radioterapia previa en el cuello. Se realizó un seguimiento clínico y mediante imagen de todos ellos. Se recogió la tasa de complicaciones durante las primeras cuatro semanas y a largo plazo, y la tasa de reestenosis en el seguimiento. Resultados. El intervalo medio entre la radioterapia y la detección de estenosis fue de 14,7 años. Diez pacientes (83,3%) fueron sintomáticos. Durante las primeras cuatro semanas tras la angioplastia no se produjo ninguna complicación. El seguimiento medio fue de 45,09 meses: un 16,7% de pacientes presentó ictus, un 8,3% sufrió un infarto agudo de miocardio y un 33,3% falleció (16,6% a causa de cáncer). Al menos seis pacientes (50%) fueron diagnosticados de reestenosis; todas ellas fueron mayores o iguales al 50% y ninguna fue sintomática. Conclusiones. La angioplastia carotídea es una técnica segura y eficaz en la estenosis tras radioterapia, con escasas complicaciones a corto plazo. La tasa de restenosis carotídea es alta. La principal causa de fallecimiento es el cáncer(AU)

Introduction. Carotid stenosis is a complication of cervical radiotherapy. In these cases carotid angioplasty has been considered as the elective revascularisation treatment. Yet, the indication to treat is under discussion due to the high rate of restenosis and the scarcity of studies conducted on the long-term development. Aims. To report on a series of patients with carotid stenosis following radiotherapy who were treated by means of angioplasty, the aim being to analyse their long- and short-term development. Patients and methods. Of a series of 426 patients with carotid stenosis treated by endovascular means, 12 of them (2.8%) had previously received radiotherapy in the neck. All of them were submitted to a clinical and imaging follow-up. Data were collected concerning the rate of complications during the first four weeks and in the long term, as well as the rate of restenosis in the follow-up. Results. The mean interval between radiotherapy and the detection of stenosis was 14.7 years. Ten patients (83.3%) were symptomatic. No complications occurred during the first four weeks following the angioplasty. The mean follow-up time was 45.09 months: 16.7% of patients presented a stroke, 8.3% suffered acute myocardial infarction and 33.3% died (16.6% due to cancer). At least six patients (50%) were diagnosed with restenosis, all equal to or greater than 50% and none of them were symptomatic. Conclusions. Carotid angioplasty is a safe, effective technique in stenosis following radiotherapy, with few short-term complications. The rate of carotid restenosis is high. The main cause of death is cancer(AU)