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1.
Epilepsy Behav ; 116: 107712, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33460988

RESUMO

OBJECTIVE: To examine the lateralizing value of unilateral peri-ictal and interictal headaches in patients with drug-resistant focal epilepsy (DRFE). METHODS: Four-hundred consecutive patients undergoing presurgical evaluation for DRFE were interviewed. Patients with headache were broadly divided into two groups: peri-ictal and interictal headache. The lateralizing value of unilateral headache was compared in each group between three diagnoses: temporal lobe epilepsy (TLE), extratemporal lobe epilepsy (ETLE), and temporal-plus epilepsy (TEMP+ epilepsy). RESULTS: Out of 400 patients, 169 (42.25%) had headaches. Peri-ictal headaches were experienced in 106 patients (26.5%) and interictal headaches were experienced in 63 (15.75%). In the peri-ictal group, unilateral headaches were present in 48 out of 60 patients (80%) with TLE; they were ipsilateral to the seizure focus in 45 out of 48 patients (93.75%). Unilateral headaches in patients with ETLE were present in 20 out of 31 patients (64.5%) and were ipsilateral to the seizure focus in 14 out of 20 patients (70%). In patients with TEMP + epilepsy, unilateral peri-ictal headaches were present in 9 out of 15 patients (60%); they were ipsilateral to the seizure focus in all 9 patients (100%). In the interictal headache group, unilateral headaches were ipsilateral the seizure focus in 9 out of 10 patients (90%) with TLE and 5 out of 6 patients (83.3%) with ETLE. None of the TEMP + epilepsy patients had a unilateral interictal headache. CONCLUSION: Headache is a frequently encountered symptom in patients with DRFE. When occurring in a unilateral fashion, it has a high lateralizing value in temporal and extratemporal lobe epilepsies. This has been demonstrated to be true for both peri-ictal and interictal headaches. In the vast majority of patients with DRFE, unilateral headache occurs ipsilateral to the seizure focus.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsias Parciais , Epilepsia do Lobo Temporal , Preparações Farmacêuticas , Epilepsia Resistente a Medicamentos/complicações , Eletroencefalografia , Epilepsias Parciais/complicações , Epilepsia do Lobo Temporal/complicações , Lateralidade Funcional , Cefaleia/complicações , Humanos
2.
J Neurovirol ; 27(1): 86-93, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33417193

RESUMO

The COVID-19 pandemic has infected more than 22 million people worldwide. Although much has been learned about COVID-19, we do not know much about its neurological features and their outcome. This observational study was conducted on the patients of Imam Hossein Hospital, and 361 adult patients (214 males) with confirmed diagnosis of COVID-19 from March 5, 2020 to April 3, 2020, were enrolled. Data was gathered on age, sex, comorbidities, initial symptoms, symptoms during the disease course, neurological symptoms, and outcome. The mean age of the patients was 61.90 ± 16.76 years. The most common initial symptoms were cough, fever, and dyspnea. In 21 patients (5.8%), the initial symptom was neurological. History of dementia was associated with severe COVID-19 disease (odds ratio = 1.28). During the course of the disease, 186 patients (51.52%) had at least one neurological symptom, the most common being headache (109 [30.2%]), followed by anosmia/ageusia (69, [19.1%]), and dizziness (54, [15%]). Also, 31 patients had neurological complications (8.58%). Anosmia, ageusia, dizziness, and headache were associated with favorable outcome (P < 0.001), while altered mental status and hemiparesis were associated with poor outcome. The mortality rate of patients who had neurological complications was more than twice than that of patients without neurological complication (P = 0.008). Almost half of the patients experienced at least one neurological symptom, which may be the initial presentation of COVID-19. Dementia appears to be associated with severe COVID-19. Mortality was higher in patients with neurological complications, and these patients needed more intensive care.


Assuntos
/complicações , Demência/complicações , Dispneia/complicações , Cefaleia/complicações , Paresia/complicações , /patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Ageusia/complicações , Ageusia/diagnóstico , Ageusia/mortalidade , Ageusia/virologia , /diagnóstico , /virologia , /mortalidade , Tosse/complicações , Tosse/diagnóstico , Tosse/mortalidade , Tosse/virologia , Demência/diagnóstico , Demência/mortalidade , Demência/virologia , Dispneia/diagnóstico , Dispneia/mortalidade , Dispneia/virologia , Feminino , Febre/complicações , Febre/diagnóstico , Febre/mortalidade , Febre/virologia , Cefaleia/diagnóstico , Cefaleia/mortalidade , Cefaleia/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/mortalidade , Paresia/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
3.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 261-267, nov.-dic. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-197920

RESUMO

INTRODUCCIÓN: El abordaje suboccipital lateral es de práctica habitual en neurocirugía para exponer la región del ángulo pontocerebeloso. El dolor poscraniectomía (DPC) es una de las complicaciones más frecuentes que disminuyen la calidad de vida de los pacientes. OBJETIVO: Comparar el DPC en pacientes operados de neurinomas vestibulares por un abordaje suboccipital lateral mediante 2 incisiones distintas. MATERIAL Y MÉTODOS: Estudio de investigación prospectivo aleatorizado. Se realizó seguimiento de un grupo de pacientes operados por neurinomas vestibulares entre julio de 2017 y mayo de 2019 (n=40) por un mismo cirujano. Un grupo recibió la incisión lineal clásica (n=20) y otro grupo la incisión alternativa en «U» invertida o «Dandy modificada» (n=20). La intensidad del dolor fue evaluada mediante escala numérica. Se realizó un seguimiento mínimo de 3 meses. El impacto en la calidad de vida se objetivó mediante cuestionario SF-36 versión corta tanto pre- como posquirúrgico. RESULTADOS: La edad promedio fue 46,1 años. El índice global de DPC fue del 27,5% (n=11) de los pacientes. La incidencia de cefalea en el grupo que recibió la incisión clásica (A) fue del 20% (n=4), en el grupo B fue del 35% (n=7). CONCLUSIÓN: Encontramos un mayor índice de DPC en los pacientes que recibieron una incisión tipo «Dandy modificada». Estos son datos preliminares de un estudio que continúa y esperamos obtener datos más representativos en el futuro. Recomendamos el seguimiento interdisciplinario para el tratamiento integral del DPC


BACKGROUND: Suboccipital lateral approach is a common practice in neurosurgery to expose the region of the cerebellopontine angle. Postcraniectomy headache (PCH) is one of the most frequent complications that diminish the quality of life of patients. OBJECTIVE: To compare postcraniectomy pain in patients operated on for vestibular neurinomas by a suboccipital lateral approach by 2 different incisions. MATERIAL AND METHODS: Prospective randomized research study. Follow-up of patients operated for vestibular neurinomas between July 2017 and May 2019 (n=40) by the same surgeon. One group received the classical linear incision (n=20) and another group the alternative incision in an inverted "U" (modified Dandy) (n=20). Pain intensity was evaluated by numerical scale. A minimum follow-up of 3 months was carried out. The impact on quality of life was measured by the SF-36 questionnaire short version both before and after surgery. RESULTS: The average age was 46.1 years. The overall PCH index was 27.5% (n=11) of the patients. The incidence of pain in the group that received the classical incision (A) was 20% (n=4) and in group B was 35% (n=7). CONCLUSIONS: We found a higher rate of post-craniectomy headache in patients who underwent a "modified Dandy" incision. These are preliminary data of an undergoing study and we hope to obtain more representative information in the future. We recommend interdisciplinary follow up for the integral treatment of PCH


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Craniotomia/efeitos adversos , Cefaleia/complicações , Procedimentos Neurocirúrgicos/efeitos adversos , Neurilemoma/complicações , Seguimentos , Craniotomia/métodos , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Cefaleia/etiologia , Método Duplo-Cego , Complicações Pós-Operatórias/etiologia
5.
Neurologia ; 35(9): 628-632, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32896463

RESUMO

INTRODUCTION: In recent months, doubts have arisen among patients, general practitioners, and neurologists as to whether some drugs commonly used in patients with headaches and neuralgia may favour or complicate the disease caused by SARS-CoV-2. MATERIAL AND METHODS: We collected information on the opinions of scientific societies and medicines agencies (American, European, and Spanish) to clarify doubts regarding the use of drugs such as lisinopril, candesartan, ibuprofen, corticosteroids, carbamazepine, and monoclonal antibodies targeting the calcitonin gene-related peptide in the context of the COVID-19 pandemic. RESULTS: We make recommendations about the use of standard headache treatments in the context of the COVID-19 pandemic, based on the current scientific evidence. CONCLUSIONS: At present, there is no robust scientific argument to formally contraindicate any of the standard treatments employed for headaches and neuralgias.


Assuntos
Analgésicos/efeitos adversos , Infecções por Coronavirus/complicações , Cefaleia/tratamento farmacológico , Neuralgia/tratamento farmacológico , Pneumonia Viral/complicações , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Antivirais/farmacologia , Benzimidazóis/efeitos adversos , Benzimidazóis/uso terapêutico , Betacoronavirus , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/efeitos adversos , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Carbamazepina/efeitos adversos , Carbamazepina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Suscetibilidade a Doenças/induzido quimicamente , Interações Medicamentosas , Indução Enzimática/efeitos dos fármacos , Cefaleia/complicações , Cefaleia/prevenção & controle , Humanos , Ibuprofeno/efeitos adversos , Ibuprofeno/farmacologia , Ibuprofeno/uso terapêutico , Lisinopril/efeitos adversos , Lisinopril/uso terapêutico , Neuralgia/complicações , Pandemias , Peptidil Dipeptidase A/biossíntese , Peptidil Dipeptidase A/genética , Receptores Virais/biossíntese , Receptores Virais/genética , Fatores de Risco , Tetrazóis/efeitos adversos , Tetrazóis/uso terapêutico
6.
J Neurovirol ; 26(5): 619-630, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32839951

RESUMO

The recent pandemic outbreak of coronavirus is pathogenic and a highly transmittable viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). In this time of ongoing pandemic, many emerging reports suggested that the SARS-CoV-2 has inimical effects on neurological functions, and even causes serious neurological damage. The neurological symptoms associated with COVID-19 include headache, dizziness, depression, anosmia, encephalitis, stroke, epileptic seizures, and Guillain-Barre syndrome along with many others. The involvement of the CNS may be related with poor prognosis and disease worsening. Here, we review the evidence of nervous system involvement and currently known neurological manifestations in COVID-19 infections caused by SARS-CoV-2. We prioritize the 332 human targets of SARS-CoV-2 according to their association with brain-related disease and identified 73 candidate genes. We prioritize these 73 genes according to their spatio-temporal expression in the different regions of brain and also through evolutionary intolerance analysis. The prioritized genes could be considered potential indicators of COVID-19-associated neurological symptoms and thus act as a possible therapeutic target for the prevention and treatment of CNS manifestations associated with COVID-19 patients.


Assuntos
Betacoronavirus/patogenicidade , Encéfalo/metabolismo , Infecções por Coronavirus/genética , Interações Hospedeiro-Patógeno/genética , Proteínas do Tecido Nervoso/genética , Pneumonia Viral/genética , Proteínas Virais/genética , Encéfalo/patologia , Encéfalo/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Depressão , Tontura/complicações , Tontura/genética , Tontura/patologia , Tontura/virologia , Encefalite/complicações , Encefalite/genética , Encefalite/patologia , Encefalite/virologia , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/genética , Síndrome de Guillain-Barré/patologia , Síndrome de Guillain-Barré/virologia , Cefaleia/complicações , Cefaleia/genética , Cefaleia/patologia , Cefaleia/virologia , Humanos , Proteínas do Tecido Nervoso/classificação , Proteínas do Tecido Nervoso/metabolismo , Transtornos do Olfato/complicações , Transtornos do Olfato/genética , Transtornos do Olfato/patologia , Transtornos do Olfato/virologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Mapeamento de Interação de Proteínas , Convulsões/complicações , Convulsões/genética , Convulsões/patologia , Convulsões/virologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/virologia , Proteínas Virais/metabolismo
7.
J Neurovirol ; 26(5): 785-789, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32666422

RESUMO

Over the course of the pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), multiple new clinical manifestations, as the consequence of the tropism of the virus, have been recognized. That includes now the neurological manifestations and conditions, such as headache, encephalitis, as well as olfactory and taste disorders. We present a series of ten cases of RT-PCR-confirmed SARS-CoV-2-infected patients diagnosed with viral-associated olfactory and taste loss from four different countries.


Assuntos
Ageusia/complicações , Betacoronavirus/patogenicidade , Encefalopatias/complicações , Infecções por Coronavirus/complicações , Cefaleia/complicações , Transtornos do Olfato/complicações , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Ageusia/imunologia , Ageusia/patologia , Ageusia/virologia , Encéfalo/patologia , Encéfalo/virologia , Encefalopatias/imunologia , Encefalopatias/patologia , Encefalopatias/virologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Europa (Continente) , Feminino , Cefaleia/imunologia , Cefaleia/patologia , Cefaleia/virologia , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte , Transtornos do Olfato/imunologia , Transtornos do Olfato/patologia , Transtornos do Olfato/virologia , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , América do Sul , Fatores de Tempo
8.
Neurol Sci ; 41(7): 1667-1671, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32483687

RESUMO

RESULTS: Various neurological manifestations have been reported in the literature associated with COVID-19, which in the current study are classified into Central Nervous System (CNS) related manifestations including headache, dizziness, impaired consciousness, acute cerebrovascular disease, epilepsy, and Peripheral Nervous System (PNS) related manifestations such as hyposmia/anosmia, hypogeusia/ageusia, muscle pain, and Guillain-Barre syndrome. CONCLUSION: During the current context of COVID-19 pandemic, physicians should be aware of wide spectrum of neurological COVID-19 sign and symptoms for early diagnosis and isolation of patients. In this regard, COVID-19 has been associated with many neurological manifestations such as confusion, anosmia, and ageusia. Also, various evidences support the possible CNS roles in the COVID-19 pathophysiology. In this regard, further investigation of CNS involvement of SARS-COV-2 is suggested.


Assuntos
Betacoronavirus , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Doenças do Sistema Nervoso/virologia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/virologia , Infecções por Coronavirus/complicações , Cefaleia/complicações , Cefaleia/virologia , Humanos , Doenças do Sistema Nervoso/epidemiologia , Pandemias , Pneumonia Viral/complicações
9.
J Oral Pathol Med ; 49(6): 547-554, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32531859

RESUMO

BACKGROUND: Adenosine triphosphate (ATP) and glutamate are associated with some headache conditions, and purinergic (P2X) and glutamatergic N-methyl-D-aspartate (NMDA) receptor-related processes in the medulla can modulate the effects of trigeminal nociceptive afferent inputs into the brainstem on craniofacial sensorimotor circuits. This study aimed to test whether neck muscle activity can be induced in rats by noxious stimulation of the frontal dura or superior sagittal sinus that involves P2X or NMDA receptor-dependent mechanisms. METHODS: While electromyographic activities of neck and craniofacial muscles were being recorded in anesthetized rats (n = 46), the inflammatory irritant mustard oil (0.2 µL, 20% MO) or vehicle (mineral oil) was topically applied to the dura or sinus, preceded by 10 µL of the ATP antagonist 2',3'-O-(2,4,6- trinitrophenyl) adenosine 5'-triphosphate (TNP-ATP, 0.1 mmol/L; n = 8) or 2-amino-5-phosphonopentanoic acid (APV, 0.05 mmol/L; n = 7) or phosphate-buffered saline (PBS as vehicle control; n = 10). RESULTS: Application of MO but not vehicle to the frontal dura significantly increased (P < .05) neck electromyographic activity whereas MO application to the superior sagittal sinus did not significantly increase neck electromyographic activity unless MO had previously been applied to the dura. Pre-treatment (i.t.) with TNP-ATP or APV but not vehicle control significantly reduced neck electromyographic activity evoked by MO application to the dura. CONCLUSIONS: These data suggest that noxious stimulation of the frontal dura (but not superior sagittal sinus) may enhance neck muscle activity that is P2X and NMDA receptor-dependent. These effects may contribute to neck muscle stiffness that occurs in some headache conditions.


Assuntos
Cefaleia , N-Metilaspartato , Músculos do Pescoço , Trifosfato de Adenosina , Animais , Dura-Máter , Cefaleia/complicações , N-Metilaspartato/fisiologia , Músculos do Pescoço/fisiopatologia , Ratos , Ratos Sprague-Dawley , Receptores de N-Metil-D-Aspartato
10.
BMC Neurol ; 20(1): 162, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349710

RESUMO

BACKGROUND: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. METHODS: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. Targeted epidural patches with fibrin sealant were performed. Treatment response at return visit (3 months post-patch) was documented. RESULTS: Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Mean age at the time of headache onset was 39 years old, and a range from 32 to 50 years old. Mean time to targeted epidural patches with fibrin sealant was 4.5 years. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. All patients had significant improvement in their headache intensity. CONCLUSION: Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension; 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension; and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site.


Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Vazamento de Líquido Cefalorraquidiano/complicações , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Gadolínio , Cefaleia/complicações , Cefaleia/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mielografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/tratamento farmacológico , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Ideggyogy Sz ; 73(3-4): 135-139, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32364341

RESUMO

The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare entity. This disease has been related to migrainous headaches. It is a benign, self-limited disorder, which is characterized by fluctuating neurological symptoms and cerebrospinal fluid lymphocytosis. We describe a case of a 47 years old man with acute onset of headache and aphasia. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis (25 cells/µl, 100% lymphocytes). Electroencephalogram showed moderate slow rhythm in the left hemisphere, with temporoparietal predominance, and without epileptiform activity. His blood tests as well as magnetic resonance imaging (MRI) results were normal. With the diagnosis of HaNDL syndrome the patient was accepted in the Department of Neurology and discharged with full recovery.


Assuntos
Encéfalo/patologia , Líquido Cefalorraquidiano/química , Cefaleia/diagnóstico , Linfocitose/líquido cefalorraquidiano , Doenças do Sistema Nervoso/diagnóstico , Afasia , Eletroencefalografia , Cefaleia/líquido cefalorraquidiano , Cefaleia/complicações , Humanos , Linfocitose/diagnóstico , Masculino , Pessoa de Meia-Idade , Síndrome
12.
J Neurovirol ; 26(2): 143-148, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32447630

RESUMO

A pandemic due to novel coronavirus arose in mid-December 2019 in Wuhan, China, and in 3 months' time swept the world. The disease has been referred to as COVID-19, and the causative agent has been labelled SARS-CoV-2 due to its genetic similarities to the virus (SARS-CoV-1) responsible for the severe acute respiratory syndrome (SARS) epidemic nearly 20 years earlier. The spike proteins of both viruses dictate tissue tropism using the angiotensin-converting enzyme type 2 (ACE-2) receptor to bind to cells. The ACE-2 receptor can be found in nervous system tissue and endothelial cells among the tissues of many other organs.Neurological complications have been observed with COVID-19. Myalgia and headache are relatively common, but serious neurological disease appears to be rare. No part of the neuraxis is spared. The neurological disorders occurring with COVID-19 may have many pathophysiological underpinnings. Some appear to be the consequence of direct viral invasion of the nervous system tissue, others arise as a postviral autoimmune process, and still others are the result of metabolic and systemic complications due to the associated critical illness. This review addresses the preliminary observations regarding the neurological disorders reported with COVID-19 to date and describes some of the disorders that are anticipated from prior experience with similar coronaviruses.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Encefalite Viral/epidemiologia , Meningite/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Betacoronavirus/genética , Betacoronavirus/metabolismo , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Encefalite Viral/complicações , Encefalite Viral/diagnóstico , Encefalite Viral/virologia , Cefaleia/complicações , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Cefaleia/virologia , Interações Hospedeiro-Patógeno/genética , Humanos , Meningite/complicações , Meningite/diagnóstico , Meningite/virologia , Mialgia/complicações , Mialgia/diagnóstico , Mialgia/epidemiologia , Mialgia/virologia , Miosite/complicações , Miosite/diagnóstico , Miosite/epidemiologia , Miosite/virologia , Sistema Nervoso/patologia , Sistema Nervoso/virologia , Peptidil Dipeptidase A/genética , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Ligação Proteica , Receptores Virais/genética , Receptores Virais/metabolismo , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/metabolismo , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/virologia , Internalização do Vírus
13.
Clin Nucl Med ; 45(10): e427-e429, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32404707

RESUMO

Sphenoid sinus metastasis is extremely rare. Herein, we report a case of occult hepatocellular carcinoma with initial symptoms of decreased vision and headache, which were caused by sphenoid sinus metastasis. A 44-year-old man recently complained of bilateral decreased vision and headache. Head MRI showed a soft tissue mass in the sphenoid sinus. Pathological examination of the resected sphenoid sinus mass indicated metastatic carcinoma. Subsequently, F-FDG PET/CT and immunohistochemical analysis of the sphenoid sinus mass confirmed the hepatic origin of the primary lesion.


Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/fisiopatologia , Cefaleia/complicações , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/fisiopatologia , Visão Ocular , Adulto , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Seio Esfenoidal/diagnóstico por imagem
14.
Am J Med Sci ; 359(6): 372-377, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32317167

RESUMO

Tuberculosis is a global burden with an unacceptably high mortality rate, especially in low- and middle-income countries. We reported the case of 34-year-old Somali female with no significant risk factors who initially presented with headache and blurred vision. The patient subsequently developed altered mental status and significant vision changes. Initial lumbar puncture showed lymphocytic pleocytosis with negative gram stain, acid-fast bacilli stain, and culture. Initial polymerase chain reaction for tuberculosis was negative. The patient worsened despite receiving broad-spectrum antibiotics. The patient had a prolonged hospital course and eventually required lumbar drain placement for hydrocephalus. Repeated polymerase chain reactions for Mycobacterium tuberculosis from the lumbar drain samples was positive, and the diagnosis of tuberculous meningitis was confirmed. The patient improved after lumbar drain placement and treatment with isoniazid, rifampin, pyrazinamide, ethambutol and steroid tapering. This case illustrated the challenge of diagnosing tuberculous meningitis.


Assuntos
Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/tratamento farmacológico , Adulto , Antituberculosos/administração & dosagem , Asma/complicações , Etambutol/administração & dosagem , Feminino , Cefaleia/complicações , Hospitalização , Humanos , Hidrocefalia/complicações , Hidrocefalia/cirurgia , Isoniazida/administração & dosagem , Leucocitose , Imagem por Ressonância Magnética , Reação em Cadeia da Polimerase , Pirazinamida/administração & dosagem , Rifampina/administração & dosagem , Somália , Punção Espinal , Tuberculose Meníngea/complicações , Estados Unidos , Transtornos da Visão/complicações
16.
J Clin Neurosci ; 75: 30-34, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32223975

RESUMO

The incidence of postdural puncture headache (PDPH) in relation to pre-existing chronic headache (CH) was assessed, as was the clinical course of CH, at one, three, and six months after PDPH. The study was conducted as a single center cohort prospective study that included 252 patients (105 men and 147 women), average age of 47.3 ± 15.0 years, on whom lumbar puncture (LP) was performed. PDPH was reported in 133 (52.8%) patients; CH was reported in 82 (32.5%) patients. Patients with CH were more likely to have PDPH (p = 0.003). The individual clinical type of CH did not have an effect on the incidence of PDPH (p = 0.128). Patients with PDPH had a clinical deterioration of CH three and six months after LP (p = 0.047, p = 0.027, respectively) in terms of increased headache days per month and/or incomplete efficacy of performed therapy in relation to baseline values. Six months after LP, the worsening of CH was more common in women with PDPH (OR 5,687 [95% CI: 1526-21,200], p = 0.010) and patients with a longer history of CH (OR 1064 [95% CI: 1007-1124], p = 0.027). Multivariate analysis confirmed the direct association of female sex and duration of CH and its worsening six months after PDPH (OR 4478 [95% CI: 1149-17,452], p = 0.031; OR 1448 [95% CI: 1292-1808], p = 0.022). The presented results could be significant for the prediction/differential diagnosis of PDPH in patients with CH and for the prediction/prevention of CH clinical worsening after PDPH.


Assuntos
Cefaleia/complicações , Cefaleia Pós-Punção Dural/epidemiologia , Exacerbação dos Sintomas , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punção Espinal/efeitos adversos
17.
Braz Oral Res ; 34: e019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187305

RESUMO

The aim of this study was to verify the oral habits, symptoms, and characteristics of some children aged 8 to 10 years that could be associated with possible sleep bruxism. A cross-sectional study was performed. Questionnaires were sent to parents to obtain information on sex, age, school shift, sleep quality, parents' perception of children's behavior, and children's oral habits (nail biting, object biting, and lip biting), and symptoms such as headache or earache. In addition, parents reported the frequency of sleep bruxism (no day to 7 days a week). Descriptive analysis and multinomial logistic regression were performed and the level of significance was set at 5%. A total of 1,554 parents of children aged 8 to 10 years participated in this study. Possible sleep bruxism was reported as mild for 65.7%, moderate for 25.3%, and severe for 9% of the children. In the adjusted multinomial logistic regression, boys were 79% more likely to have sleep bruxism (OR: 1.79; 95%CI 1.23-2.60) and were 2.06 more times at risk of being in the habit of lip biting (OR: 2.06; 95%CI 1.26-3.37). Children with possible severe sleep bruxism were 61% more likely to develop object biting (OR: 1.61; 95%CI 1.09-2.39), 52% more likely to have headaches (OR: 1.52; 95%CI 1.01-2.28), and 3.29 more times at risk of poor sleep quality (OR: 3.29; 95%CI 2.25-4.82). Based on the report, boys with lip and object biting habits, headaches, and poor sleep quality presented a higher chance of possible severe sleep bruxism.


Assuntos
Hábitos , Bruxismo do Sono/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Cefaleia/complicações , Cefaleia/epidemiologia , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Bruxismo do Sono/etiologia , Transtornos do Sono-Vigília/complicações , Inquéritos e Questionários
18.
Int J Med Sci ; 17(2): 153-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038098

RESUMO

Aims: Systemic Lupus Erythematosus (SLE) is a connective tissue disease characterized by a wide range of pleomorphic pictures, including mucocutaneous, renal, musculoskeletal and neurological symptoms. It involves oral tissues, with hyposalivation, tooth decay, gingivitis, angular cheilitis, ulcers and glossitis. Temporomandibular disorders represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in SLE patients (Lp) compared with a control group. Methods: Fifty-five patients (9 men and 46 women) with diagnosed Lupus were recruited in the study group. A randomly selected group of 55 patients, matched by sex and age, served as control group. The examination for TMD symptoms and signs was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. Results: Lupus patients complained more frequently (95.8%) of oral and TMJ symptoms (dysgeusia, stomatodynia, masticatory muscle pain during function, neck and shoulder muscles pain and presence of tinnitus) but only xerostomia (χ2=4,1548 p=0,0415), temple headache (χ2=4,4542 p=0,035) and the sensation of a stuck jaw (Mid-p-test p=0,043) were significant. About signs, cheilitis (p=0,0284) oral ulcers (χ2=4,0104 p=0,045) and fissured tongue are significantly more frequent in study group. The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001). As regard to the oral kinematics, restricted movements (RM) in protrusion and left lateral movement were significantly different between study group and controls. In particular, 85,2% of Lp showed limited protrusion versus 56,4% of controls (χ2= 10,91 p<0,001); 59,3% of Lp had also a limitation during left lateral movement versus 47,3% of controls (T=2,225 p=0,0282). About bruxism, only the indentations on the lateral edges of the tongue were found in Lp group (72,7%), with a significant difference respect to controls (χ2=7,37 p=0,007). Conclusions: While masticatory muscles have an overlapping behavior in both groups, the findings collected show a more severe TMJ kinematic impairment in Lp than in controls, with protrusion and left lateral movements significantly different. In addition, a remarkable reduction of salivary flow has been detected in Lp compared to controls. In conclusion, this autoimmune disease seems to play a role in oral manifestations and TMJ disorders, causing an increase in orofacial pain and an altered chewing function.


Assuntos
Bruxismo/fisiopatologia , Dor Facial/fisiopatologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto , Bruxismo/complicações , Bruxismo/diagnóstico , Dor Facial/complicações , Dor Facial/diagnóstico , Feminino , Cefaleia/complicações , Cefaleia/fisiopatologia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Mastigação , Músculos da Mastigação/fisiopatologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Inquéritos e Questionários , Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico , Doenças Dentárias/complicações , Doenças Dentárias/diagnóstico , Doenças Dentárias/fisiopatologia , Xerostomia/complicações , Xerostomia/diagnóstico , Xerostomia/fisiopatologia
19.
Artigo em Russo | MEDLINE | ID: mdl-32105274

RESUMO

AIM: To study the compliance of neurologists and headache specialists to chronic headache and chronic migraine (CM) diagnosis and treatment guidelines. MATERIAL AND METHODS: The survey included 634 neurologists from all regions of the Russian Federation. Mean age of respondents was 40.7±8.5 years, mean years of experience 14.2±7.8 years. RESULTS: Most doctors work in outpatient or hospital settings (49% and 24%, respectively), 7% were headache specialists. Tension-type headache (TTH) was diagnosed in 30% and CM in 17% of patients while 44% of patients were presumed to have a mixed headache disorder (TTH+CM). Only 10% of physicians do not use instrumental diagnostic methods in chronic headache. This study has shown sufficient attention to comorbid conditions and frequent prescription of headache preventative treatment. Botox prescription data is equivocal: 35% of physicians recommend such treatment, 27% do not, while other doctors prescribe it for off-label indications. CONCLUSION: To overcome clinical inertia, further education in chronic headaches and their optimal treatment is warranted.


Assuntos
Cefaleia/diagnóstico , Cefaleia/terapia , Pesquisas sobre Serviços de Saúde , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Neurologistas/educação , Adulto , Doença Crônica/prevenção & controle , Doença Crônica/terapia , Cefaleia/complicações , Cefaleia/prevenção & controle , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/prevenção & controle , Federação Russa , Cefaleia do Tipo Tensional/complicações , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/prevenção & controle , Cefaleia do Tipo Tensional/terapia
20.
Adv Exp Med Biol ; 1251: 49-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31792808

RESUMO

The aim of the study was to determine the course and outcome of bacterial meningitis (BM) in patients with cancer. We retrospectively reviewed files of patients with community-acquired BM, hospitalized in a single neuroinfection center between January 2010 and December 2017. There were 209 patients included in the analysis: 28 had cancer (9 women, 19 men; median age 76, IQR 67-80 years) and 181 were cancer-free (76 women, 105 men; median age 52, IQR 33-65 years) and constituted the control group. Cancer patients, compared with controls, were more likely to present with seizures (25% vs. 8%, p = 0.019), scored higher on the Sequential Organ Failure Assessment, and had a higher mortality rate (32% vs. 13%, p = 0.025). Further, cancer patients were less likely (64% vs. 83%, p = 0.033) to present with two or more out of four clinical manifestations of BM (pyrexia, neck stiffness, altered mental status, and headache) and had a lower white blood cell (WBC) count than non-cancer controls. In multiple regression analysis, the presence of bacterial meningitis in cancer patients was independently associated only with older age (p = 0.001) and lower WBC count (p = 0.007), while mortality was associated with lower Glasgow Coma Score (p = 0.003). In conclusion, bacterial meningitis in cancer patients is characterized by atypical symptoms and high mortality, which requires physicians' vigilance and a prompt investigation of cerebrospinal fluid in suspected cases. However, multiple regression analysis suggests that differences in clinical presentation and outcomes of bacterial meningitis between cancer and cancer-free patients may also be attributable to other factors, such as age differences.


Assuntos
Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/tratamento farmacológico , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Neoplasias/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Febre/complicações , Cefaleia/complicações , Humanos , Masculino , Estudos Retrospectivos , Convulsões/complicações , Resultado do Tratamento
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