RESUMO
A sellar spine is a rare midline osseous spur, which arises from the dorsum sellae and projects into the pituitary fossa. It can be found incidentally on imaging or may present with symptoms related to optic chiasm compression or hormonal disturbances.Herein, we present the case of an incidentally detected sellar spine in a patient presenting with sudden onset headaches.
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Sela Túrcica , Humanos , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologia , Sela Túrcica/anormalidades , Imageamento por Ressonância Magnética , Osteófito/diagnóstico por imagem , Osteófito/complicações , Cefaleia/etiologia , Masculino , Achados Incidentais , Feminino , Tomografia Computadorizada por Raios X , Pessoa de Meia-IdadeRESUMO
Chikungunya patients may develop chronic joint pain that can persist for months to years. This study aimed to determine the factors associated with Chikungunya chronicity. This case-control study involved data from patients with laboratory-confirmed Chikungunya reported from March 2016 to December 2020 in Vitória, Espírito Santo state, Brazil. The data were accessed from compulsory notification databases (SINAN and eSUS VS) and electronic medical reports (Rede Bem-Estar). For each patient who developed chronic symptoms, we included a control patient who did not develop chronic symptoms by random sampling. A total of 183 chronic and 183 non-chronic patients were included in the study. Most of them were female (73.2%), with a median age of 49.5 years (interquartile range = 37-61), and presented fever (89.6%), myalgia (89.6%), arthralgia (89.3%), and headache (82.0%). Chronic patients were older (median = 53; interquartile range = 41-61) than non-chronic cases (median = 46; interquartile age = 31-61) (OR = 0.979, 95% CI = 0.968-0.991) and more frequently presented nausea (58.5% vs. 40.4%; OR = 2.109, 95% CI = 1.374-3.238), and leukopenia (20.2% vs. 10.9%; OR = 2.060, 95% CI = 1.122-3.779). Therefore, these characteristics should be monitored for the better clinical management of cases prone to chronicity.
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Febre de Chikungunya , Humanos , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/complicações , Brasil/epidemiologia , Feminino , Pessoa de Meia-Idade , Masculino , Adulto , Estudos de Casos e Controles , Doença Crônica , Artralgia/virologia , Vírus Chikungunya , Fatores de Risco , Idoso , Febre/virologia , Mialgia/epidemiologia , Mialgia/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologiaRESUMO
BACKGROUND: Patients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with associated comorbidities. However, few studies have assessed the safety of the COVID-19 vaccine in patients with RA. OBJECTIVE: To evaluate the safety of vaccines against SARS-CoV-2 in patients with RA. METHODS: This data are from the study "Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases," a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 (Oxford/AstraZeneca) or CoronaVac (Sinovac/Butantan). Stratification of postvaccination AEs was performed using a diary, filled out daily and returned at the end of 28 days for each dose. RESULTS: A total of 188 patients with RA were include, 90% female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed, mainly after the first dose. The most common AEs after the first dose were pain at the injection (46,7%), headache (39,4%), arthralgia (39,4%), myalgia (30,5%) and fatigue (26,6%), and ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0.001) arthralgia (62% vs 22%, p < 0.001) and myalgia (45% vs 20%, p < 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection (37%), arthralgia (31%), myalgia (23%), headache (21%) and fatigue (18%). Arthralgia (41,4% vs 25%, p = 0.02) and pain at injection (51,4% vs 27%, p = 0.001) were more common with ChAdOx1. No serious AEs were related. With Regard to RA activity level, no significant difference was observed between the three time periods for both COVID-19 vaccines. CONCLUSION: In the comparison between the two immunizers in patients with RA, local reactions and musculoskeletal symptoms were more frequent with ChAdOx1 than with CoronaVac, especially after the first dose. In summary, the AE occurred mainly after the first dose, and were mild, like previous data from others immunizing agents in patients with rheumatoid arthritis. Vaccination did not worsen the degree of disease activity.
Assuntos
Artrite Reumatoide , Vacinas contra COVID-19 , COVID-19 , ChAdOx1 nCoV-19 , Humanos , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/complicações , Feminino , Masculino , Brasil/epidemiologia , Pessoa de Meia-Idade , COVID-19/prevenção & controle , COVID-19/complicações , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/administração & dosagem , ChAdOx1 nCoV-19/efeitos adversos , Estudos Prospectivos , Adulto , SARS-CoV-2/imunologia , Idoso , Cefaleia/induzido quimicamente , Cefaleia/etiologia , Mialgia/induzido quimicamente , Mialgia/etiologia , Artralgia/etiologia , Vacinas de Produtos InativadosRESUMO
OBJECTIVE: The purpose of this study was to describe the factors related to dizziness in workers with noise-induced hearing loss in Brazil. METHOD: A cross-sectional study was carried out with a sample from noise-induced hearing loss reports (2007-2019). The dependent variable in this study was dizziness, and the independent variables were sociodemographic characteristics, comorbidities, symptoms, and noise characteristics in the work environment. Logistic regression analysis was performed. RESULTS: A total of 3,824 individuals with noise-induced hearing loss in Brazil were analyzed. The prevalence of dizziness was 23.4% in the sample. Factors associated with dizziness were women (odds ratio [OR]: 2.10; 95% confidence interval [CI] [1.64, 2.69]), hypertension (OR: 1.68; 95% CI [1.38, 2.06]), headache (OR: 6.31; 95% CI [5.26, 7.57]), tinnitus (OR: 3.46; 95% CI [2.82, 4.25]), and continuous noise at the work environment (OR: 1.54; 95% CI [1.22, 1.94]). CONCLUSIONS: The factors associated with the outcome-dizziness-were gender (female), systemic arterial hypertension, headache, tinnitus, and continuous exposure to workplace noise. Such findings demonstrate the importance of promoting a multifactorial approach to understanding dizziness among workers exposed to occupational noise.
Assuntos
Tontura , Perda Auditiva Provocada por Ruído , Ruído Ocupacional , Zumbido , Humanos , Feminino , Masculino , Brasil/epidemiologia , Tontura/epidemiologia , Perda Auditiva Provocada por Ruído/epidemiologia , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Ruído Ocupacional/efeitos adversos , Prevalência , Zumbido/epidemiologia , Fatores de Risco , Doenças Profissionais/epidemiologia , Fatores Sexuais , Hipertensão/epidemiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricosRESUMO
OBJETIVE: this study was to determine the relationship between acute febrile illness and bacterial pathogens with zoonotic potential that cause emerging and re-emerging diseases in a central-eastern region of Peru. RESULTS: Out of the 279 samples analyzed, 23 (8.2%) tested positive for infection by Rickettsia spp., while a total of 15 (5.4%) tested positive for Leptospira spp. Women had a higher frequency of infection by Rickettsia spp., with 13 cases (53.3%), while men had a higher frequency of infection by Leptospira spp., with 10 cases (66.7%). The most frequently reported general symptom was headache, with 100.0% (n = 23) of patients with Rickettsia (+) and 86.7% (n = 13) of patients with Leptospira (+) experiencing it. Arthralgia was the second most frequent symptom, reported by 95.6% (n = 22) and 60% (n = 9) of patients with Rickettsia (+) and Leptospira (+), respectively. Myalgia was reported by 91.3% (n = 21) and 66.7% (n = 10) of patients with Rickettsia (+) and Leptospira (+), respectively. Retroocular pain, low back pain, and skin rash were also present, but less frequently. Among the positives, no manifestation of bleeding was recorded, although only one positive case for Leptospira spp. presented a decrease in the number of platelets.
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Leptospira , Leptospirose , Infecções por Rickettsia , Rickettsia , Humanos , Peru/epidemiologia , Rickettsia/isolamento & purificação , Feminino , Masculino , Leptospira/isolamento & purificação , Leptospira/patogenicidade , Leptospirose/epidemiologia , Leptospirose/microbiologia , Leptospirose/complicações , Leptospirose/diagnóstico , Infecções por Rickettsia/epidemiologia , Infecções por Rickettsia/microbiologia , Infecções por Rickettsia/diagnóstico , Adulto , Animais , Febre/microbiologia , Zoonoses/microbiologia , Zoonoses/diagnóstico , Zoonoses/epidemiologia , Mialgia/microbiologia , Mialgia/epidemiologia , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Cefaleia/microbiologia , Cefaleia/etiologia , Cefaleia/epidemiologia , Artralgia/microbiologia , Artralgia/etiologiaRESUMO
OBJECTIVES: Only a small proportion of patients presenting to an ED with headache have a serious cause. The SNNOOP10 criteria, which incorporates red and orange flags for serious causes, has been proposed but not well studied. This project aims to compare the proportion of patients with 10 commonly accepted red flag criteria (singly and in combination) between patients with and without a diagnosis of serious secondary headache in a large, multinational cohort of ED patients presenting with headache. METHODS: Secondary analysis of data obtained in the HEAD and HEAD-Colombia studies. The outcome of interest was serious secondary headache. The predictive performance of 10 red flag criteria from the SNNOOP10 criteria list was estimated individually and in combination. RESULTS: 5293 patients were included, of whom 6.1% (95% CI 5.5% to 6.8%) had a defined serious cause identified. New neurological deficit, history of neoplasm, older age (>50 years) and recent head trauma (2-7 days prior) were independent predictors of a serious secondary headache diagnosis. After adjusting for other predictors, sudden onset, onset during exertion, pregnancy and immune suppression were not associated with a serious headache diagnosis. The combined sensitivity of the red flag criteria overall was 96.5% (95% CI 93.2% to 98.3%) but specificity was low, 5.1% (95% CI 4.3% to 6.0%). Positive predictive value was 9.3% (95% CI 8.2% to 10.5%) with negative predictive value of 93.5% (95% CI 87.6% to 96.8%). CONCLUSION: The sensitivity and specificity of the red flag criteria in this study were lower than previously reported. Regarding clinical practice, this suggests that red flag criteria may be useful to identify patients at higher risk of a serious secondary headache cause, but their low specificity could result in increased rates of CT scanning. TRIAL REGISTRATION NUMBER: ANZCTR376695.
Assuntos
Serviço Hospitalar de Emergência , Cefaleia , Valor Preditivo dos Testes , Humanos , Feminino , Serviço Hospitalar de Emergência/organização & administração , Masculino , Pessoa de Meia-Idade , Adulto , Cefaleia/etiologia , Cefaleia/diagnóstico , Sensibilidade e Especificidade , IdosoRESUMO
OBJECTIVE: To assess the incidence, characteristics, and risk factors for developing persistent headache attributed to past ischemic stroke. BACKGROUND: Although the most recent International Classification of Headache Disorders has recognized the existence of persistent headache attributed to past ischemic stroke, there has been limited research in this area. METHODS: This was a prospective cohort study. We initially assessed patients hospitalized with ischemic stroke admitted within 72 h of symptom onset. All patients underwent diffusion-weighted magnetic resonance imaging. These patients were re-interviewed by telephone 1 year after the stroke. Semi-structured questionnaires, the National Institutes of Health Stroke Scale (NIHSS), and six-item Headache Impact Test were used. RESULTS: A total of 119 participants answered the interview conducted 1 year after the stroke. The mean (standard deviation) age was 64 (13.1) years, 82/119 (68.9%) were female, and the median (interquartile range) NIHSS score was 2 (1.0-4.0). The incidence rate of persistent headache attributed to past ischemic stroke was 12/119 (10.1%; 95% confidence interval [CI] 5.3-17.0%). The most frequent pattern presented was a migraine-like pattern in seven of the 12 (58.3%) patients, which had a substantial/severe impact on five of the 12 (41.7%). For most patients this headache continued, although it began to improve. Previous migraine (odds ratio 7.1, 95% CI 1.06-50.0; p = 0.043) and headache intensity in the acute phase of stroke (odds ratio 1.75, 95% CI 1.13-2.7; p = 0.012) were associated with the occurrence of persistent headache attributed to past ischemic stroke. CONCLUSION: Persistent headache attributed to past ischemic stroke is a frequent complication after stroke. It often has a significant impact on patients' lives and presents a migraine-like pattern as its most frequent phenotype.
Assuntos
AVC Isquêmico , Transtornos de Enxaqueca , Acidente Vascular Cerebral , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , AVC Isquêmico/complicações , Estudos Prospectivos , Cefaleia/etiologia , Cefaleia/complicações , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologiaRESUMO
A scoping review was carried out with the aim of mapping the existing literature on the association between sleep/awake bruxism and primary headache (migraine and tension headache) in children and adolescents. This scoping review followed the method proposed by Arksey & O'Malley and the Joanna Briggs Institute Manual for Evidence Synthesis and was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR). The methods were registered in the Open Science Framework (
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Bruxismo , Bruxismo do Sono , Humanos , Bruxismo do Sono/complicações , Criança , Adolescente , Bruxismo/complicações , Cefaleia do Tipo Tensional/etiologia , Transtornos de Enxaqueca/complicações , Feminino , Cefaleia/etiologia , Vigília/fisiologia , MasculinoRESUMO
BACKGROUND: Persistent headache is a frequent symptom after coronavirus disease 2019 (COVID-19) and there is currently limited knowledge about its clinical spectrum and predisposing factors. A subset of patients may be experiencing new daily persistent headache (NDPH) after COVID-19, which is among the most treatment-refractory primary headache syndromes. METHODS: We conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants' responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student's t and Mann-Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson's chi-square and Fisher's exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH. RESULTS: Four hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH. CONCLUSION: This is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.
Assuntos
COVID-19 , Transtornos da Cefaleia , Humanos , Feminino , Adulto , Adolescente , Masculino , COVID-19/complicações , COVID-19/epidemiologia , Estudos Transversais , América Latina/epidemiologia , SARS-CoV-2 , Vacinas contra COVID-19 , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologiaRESUMO
Background: There are severe neurological conditions in patients with COVID-19, such as: cerebrovascular disease, Guillain-Barré syndrome, encephalitis, acute hemorrhagic necrotizing encephalopathy and myelitis. Objective: We describe that the patient with SARS-CoV 2 with respiratory symptoms has subtle or subclinical neurological manifestations. Material and methods: Observational, cross-sectional, analytical study, which included patients aged 18-65 years with respiratory symptoms and a confirmed diagnosis of COVID-19. Intubated patients with chronic neurodegenerative diseases or pre-existing neurological compromise were excluded. Semiology of the headache and neurological examination were performed; Serum levels of glucose, protein, electrolytes, lactate, C-reactive protein, lactic dehydrogenase, and D-dimer were measured. Cerebrospinal fluid (CSF) analysis and electroencephalogram (EEG) were also performed in patients who accepted the risks. Results: A high prevalence of subtle neurological manifestations was found in patients with COVID-19 with only a respiratory clinical picture. Headache, anosmia, dysgeusia, and hypopalesthesia predominated in the early stages, with frequent abnormal findings in the CSF (>70%) and less frequently in the EEG (<20%). Conclusions: Headache, anosmia, dysgeusia and hypoesthesia were frequent at the beginning of the infection, together with abnormal findings in CSF and EEG, without other neurological symptoms or neurological disease.
Introducción: existen condiciones neurológicas severas en pacientes con COVID-19, como: enfermedad cerebrovascular, síndrome de Guillain-Barré, encefalitis, encefalopatía necrotizante hemorrágica aguda y mielitis. Objetivo: describimos que el paciente con SARS-CoV-2 con síntomas respiratorios tiene manifestaciones neurológicas sutiles o subclínicas. Material y métodos: estudio observacional, transversal, analítico, que incluyó pacientes de 18-65 años con síntomas respiratorios y diagnóstico de COVID-19 confirmado. Se excluyeron pacientes intubados, con enfermedades neurodegenerativas crónicas o compromiso neurológico preexistente. Se realizó semiología de la cefalea y exploración neurológica; Se midieron los niveles séricos de glucosa, proteínas, electrolitos, lactato, proteína C reactiva, deshidrogenasa láctica y dímero D. También se realizaron análisis de líquido cefalorraquídeo (LCR) y un electroencefalograma (EEG) en los pacientes que aceptaron los riesgos. Resultados: se encontró alta prevalencia de manifestaciones neurológicas sutiles en pacientes con COVID-19 con solo cuadro clínico respiratorio. Cefalea, anosmia, disgeusia e hipopalestesia predominaron en las primeras etapas, con hallazgos anormales frecuentes en el LCR (>70%) y con menos frecuencia en el EEG (<20%). Conclusiones: la cefalea, anosmia, disgeusia e hipoestesia fueron frecuentes al inicio de la infección, junto con hallazgos anormales en LCR y EEG, sin otros síntomas neurológicos ni enfermedad neurológica.
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COVID-19 , Doenças do Sistema Nervoso , Humanos , SARS-CoV-2 , COVID-19/complicações , COVID-19/diagnóstico , Disgeusia , Anosmia , Estudos Transversais , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/diagnóstico , Cefaleia/etiologia , Cefaleia/epidemiologiaRESUMO
BACKGROUND: Headache represents the most common neurologic symptom in children. In this study, we investigated the relationship between watching television, listening to music with headphones, smartphone, tablet, and computer use, and primary headaches in children. We aimed to determine whether primary headache in children is associated with excessive use of digital display devices and headphones and whether reducing the use of digital display devices and headphones affects primary headache. METHODS: The study included 69 children with primary headaches and 64 with no headaches as a control group. All subjects were evaluated for demographic and headache characteristics and the use of digital display devices and headphones. Our recommendation for patients and families was to decrease the use of digital display devices and headphones, and the headache burden was re-evaluated after one month. RESULTS: Headache frequency was more common in patients who watched television and used smartphones or tablets for more than 6 hours per day. Using a smartphone or tablet for more than 3 hours daily was more common in the study group than the control group. Headache frequency decreased in all patients one month after the digital imaging device and headphones were restricted. CONCLUSIONS: Watching television and using a smartphone or tablet strongly associates with primary headaches during childhood.
INTRODUCCIÓN: La cefalea representa el síntoma neurológico más común en los niños. En este estudio se investigó la relación entre ver televisión, escuchar música con auriculares, el uso del teléfono inteligente o tableta y computadora y el dolor de cabeza primario en niños. Nuestro objetivo fue determinar la asociación entre la cefalea primaria en niños y el uso excesivo de dispositivos de visualización digital y auriculares, y el efecto de la disminución del uso de dispositivos de visualización digital y auriculares sobre la cefalea primaria. MÉTODOS: El estudio incluyó a 69 niños con cefaleas primarias y 64 niños sin cefaleas como grupo control. Se evaluaron las características demográficas y de dolor de cabeza y uso de dispositivos de visualización digital y auriculares de los participantes. Se aconsejó a los pacientes y familiares que disminuyeran el uso del dispositivo de pantalla digital y los auriculares y se volvió a evaluar la carga de dolor de cabeza después de 1 mes. RESULTADOS: La frecuencia de la cefalea fue más frecuente en los pacientes que veían televisión y utilizaban un teléfono inteligente o una tableta más de 6 horas al día. El uso de más de 3 horas al día fue más común en el grupo de estudio que en el grupo control. La frecuencia del dolor de cabeza disminuyó en todos los pacientes 1 mes después de la restricción del dispositivo de imagen digital y los auriculares. CONCLUSIONES: Ver la televisión y el uso de un teléfono inteligente o tableta se asocian estrechamente con el dolor de cabeza primario en la infancia.
Assuntos
Cefaleia , Smartphone , Humanos , Criança , Cefaleia/epidemiologia , Cefaleia/etiologiaRESUMO
INTRODUCTION: Ingesting some foods can trigger headache attacks in migraine patients. Diet-sourced citrulline activates the
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Citrullus , Transtornos de Enxaqueca , Adulto , Humanos , Adulto Jovem , Arginina , Citrullus/efeitos adversos , Ingestão de Alimentos , Cefaleia/etiologia , Transtornos de Enxaqueca/etiologia , Óxido Nítrico , Nitritos/sangueRESUMO
BACKGROUND: Despite previous studies indicating a moderate/high incidence of angiography headache (AH), there is still limited data about the risk factors associated with its occurrence. OBJECTIVE: The present study aimed to assess the associations among demographic, clinical, and technical characteristics of cerebral digital subtraction angiography (DSA) and the occurrence of AH. METHODS: Cross-sectional analytical observational study with a sample comprised of individuals with a recommendation for elective DSA. Clinical interviews were conducted to assess the occurrence of AH, using a standardized questionnaire. RESULTS: Among 114 subjects, the mean age was 52.8 (±13.8) years old, 75.4% (86/114) were women, 29.8% (34/114) had a history of migraines, and 10.5% (12/114) had chronic headaches. The overall frequency of AH was 45.6% (52/114). Of those, 88.4% (46/52) underwent 3D angiography, 7.7% (4/52) underwent aortography, and 1.9% (1/52) underwent both procedures. There was a statistically significant association between AH and previous history of migraine (odds ratio [OR]: 4.9; 95% confidence interval [CI] 1.62-14.7; p = 0.005) and 3D angiography (OR 6.62; 95%CI: 2.04-21.5; p = 0.002). CONCLUSIONS: 3D angiography is strongly associated with the occurrence of AH, which has never been reported before. The association between a previous history of migraine and AH confirms the results of previous studies.
ANTECEDENTES: Apesar de estudos prévios indicarem uma incidência moderada/alta de cefaleia da angiografia (CA), os dados sobre os fatores de risco associados à sua ocorrência ainda são relativamente escassos. OBJETIVO: O presente estudo teve como objetivo avaliar as associações entre as características demográficas, clínicas e técnicas da angiografia cerebral por subtração digital (ACSD) e a ocorrência de CA. MéTODOS: Estudo observacional analítico transversal com uma amostra composta por indivíduos com indicação de ACSD em caráter eletivo. Entrevistas clínicas foram realizadas utilizando um questionário padronizado para acessar a ocorrência de CA. RESULTADOS: Entre os 114 indivíduos, a idade média foi de 52,8 (±13,8) anos, 75,4% (86/114) eram mulheres, 29,8% (34/114) tinham histórico de enxaqueca e 10,5% (12/114) tinham cefaleia crônica. A frequência geral de CA foi de 45,6% (52/114). Desses, 88,4% (46/52) foram submetidos à angiografia 3D, 7,7% (4/52), à aortografia e 1,9% (1/52), aos dois procedimentos. Houve associação estatisticamente significativa entre CA e histórico prévio de enxaqueca (odds ratio [OR] 4,9; intervalo de confiança [IC] 95%: 1,6214,7; p = 0,005) e angiografia 3D (OR 6,62; IC95%: 2,0421,5; p = 0,002). CONCLUSõES: A angiografia 3D está fortemente associada à ocorrência de CA, o que é inédito na literatura. A associação entre um histórico de enxaqueca e a CA confirma os resultados de estudos anteriores.
Assuntos
Cefaleia , Transtornos de Enxaqueca , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Angiografia Cerebral , Estudos Transversais , Cefaleia/diagnóstico por imagem , Cefaleia/epidemiologia , Cefaleia/etiologia , Fatores de Risco , Transtornos de Enxaqueca/diagnóstico por imagemRESUMO
BACKGROUND: It is estimated that headache attributed to ischemic stroke occurs in 7.4% to 34% of the cases. Despite its frequency, this headache has been little studied in terms of its risk factors and characteristics. OBJECTIVE: To assess the frequency and clinical characteristics of headache attributed to ischemic stroke and the factors associated with its occurrence. METHODS: The present was a cross-sectional study which included patients consecutively admitted within 72 hours of the onset of ischemic stroke. A semi-structured questionnaire was used. The patients underwent magnetic resonance imaging. RESULTS: A total of 221 patients were included, 68.2% of whom were male, and the mean age was of 68.2 ± 13.8 years. The frequency of headache attributed to ischemic stroke was of 24.9% (95% confidence interval [95%CI]: 19.6-31.1%). The headache had a median duration of 21 hours and most frequently began at the same time as the focal deficit (45.3%), with a gradual onset (83%). It was of moderate intensity, pulsatile (45.3%), bilateral (54.6%), and presented a similar pattern to that of tension-type headache (53.6%). Headache attributed to stroke was significantly associated with previous tension-type headache, and previous migraine with and without aura (logistic regression). CONCLUSION: Headache attributed to stroke is common, with a pattern similar to that of tension-type headache, and it is associated with a history of tension-type and migraine headaches.
ANTECEDENTES: A cefaleia atribuída ao acidente vascular cerebral isquêmico (AVCi) tem uma frequência de 7,4% a 34% dos casos. Apesar de ser considerada frequente, esta cefaleia ainda é pouco estudada em termos de seus fatores de risco e características. OBJETIVO: Avaliar a frequência e as características clínicas da cefaleia atribuída ao AVCi e os fatores associados com a sua ocorrência. MéTODOS: Este foi um estudo transversal que incluiu pacientes admitidos consecutivamente com até 72 horas do início do AVCi. Foi utilizado um questionário semiestruturado. Os pacientes realizaram ressonância magnética. RESULTADOS: Foram incluídos 221 pacientes, 68,2% dos quais eram do sexo masculino, e com idade média de 68,2 ± 13,8 anos. A frequência da cefaleia atribuída ao AVCi foi de 24,9% (intervalo de confiança de 95% [IC95%]: 19,631,1%). A duração mediana da cefaleia foi de 21 horas, e ela se iniciou com mais frequência ao mesmo tempo em que o déficit focal (45,3%), teve instalação gradual (83%), foi de moderada intensidade, pulsátil (45,3%), bilateral (54,6%) e teve um padrão semelhante ao da cefaleia de tipo tensional (53,6%). A cefaleia atribuída ao AVCi esteve significativamente associada à cefaleia de tipo tensional prévia, e à migrânea com e sem aura prévias (regressão logística). CONCLUSãO: A cefaleia atribuída ao AVCi é frequente, tem padrão mais habitual semelhante ao da cefaleia de tipo tensional, e está associada aos antecedentes de cefaleia de tipo tensional e migrânea.
Assuntos
AVC Isquêmico , Transtornos de Enxaqueca , Acidente Vascular Cerebral , Cefaleia do Tipo Tensional , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Cefaleia do Tipo Tensional/complicações , AVC Isquêmico/complicações , Estudos Transversais , Cefaleia/etiologia , Cefaleia/epidemiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Transtornos de Enxaqueca/complicaçõesRESUMO
OBJECTIVE: To review the epidemiology, the differential diagnosis, and the clinical and laboratory factors associated with the care management of headaches in patients with systemic lupus erythematosus (SLE). BACKGROUND: SLE is a chronic autoimmune disease and in 12%-95% of patients, the nervous system is involved. Headache is a frequently reported, although nonspecific, symptom that may potentially represent serious underlying diagnoses. Primary headaches may also occur in these patients, thereby causing a negative and significant impact on their quality of life. METHODS: This is a narrative review. A literature review was conducted on the PubMed platform using the following terms: (1) headache and (2) lupus. All articles considered relevant were included. No limitations were imposed for the publication date. RESULTS: Headache is a frequent symptom in patients with SLE. Although its prevalence is similar to the general population, headaches nonetheless tend to have a greater negative impact on these patients. Patients with SLE are more likely to experience headache due to vascular diseases such as cerebral venous sinus thrombosis, stroke, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and vasculitis. Aseptic meningitis, neuroinfections, intracranial neoplasms, and intracranial hypertension or hypotension may also be a cause of headache in these patients. Although used in disease activity scores, the concept of lupus headache is controversial. CONCLUSIONS: Headache is a frequent symptom in patients with SLE. An appropriate approach enables the potentially serious conditions, which are the causes of secondary headaches, to be recognized and treated, together with an appropriate diagnosis and treatment of primary headaches.
Assuntos
Lúpus Eritematoso Sistêmico , Síndrome da Leucoencefalopatia Posterior , Humanos , Qualidade de Vida , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Cefaleia/epidemiologia , Cefaleia/etiologia , Cefaleia/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Diagnóstico DiferencialRESUMO
The coronavirus disease 2019 (COVID-19) pandemic has changed the course of human history and killed millions of people worldwide. Its long-term consequences remain uncertain. This study aimed to describe the short- and long-term symptoms of COVID-19 among individuals in Goiás, central Brazil, who experienced acute mild or non-symptomatic SARS-CoV-2 infection during the first wave of the pandemic. This prospective cohort study included 110 healthcare workers, 18 safety workers, and 19 administrative support workers, who were followed up for 12 months after the onset of COVID-19. Most participants were healthy adult female healthcare professionals. At the onset of infection, the major symptoms were headache, myalgia, nasal congestion, cough, coryza, anosmia, ageusia, sore throat, fatigue, diarrhea, and dyspnea. Furthermore, 20.3% of the participants had three or more COVID-19 symptoms that persisted for at least 12 months. These included coryza, congestion, hair loss, sore throat, headache, myalgia, cough, memory loss, anosmia, and fatigue. This study revealed a high prevalence of persistent symptoms of COVID-19 in healthy individuals from central Brazil, which may present an additional burden on healthcare services. Further studies are required to investigate the sequelae of COVID-19 over periods greater than 12 months.
Assuntos
COVID-19 , Faringite , Adulto , Humanos , Feminino , COVID-19/epidemiologia , SARS-CoV-2 , Mialgia , Anosmia , Tosse/epidemiologia , Estudos Prospectivos , Cefaleia/epidemiologia , Cefaleia/etiologia , Faringite/epidemiologia , Pessoal de Saúde , Fadiga/epidemiologia , Fadiga/etiologia , Atenção à SaúdeRESUMO
Abstract Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.
Assuntos
Humanos , Feminino , Gravidez , Cefaleia Pós-Punção Dural/terapia , Punção Espinal/efeitos adversos , Placa de Sangue Epidural/métodos , Período Pós-Parto , Anestesiologistas , Cefaleia/etiologiaRESUMO
Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.
Assuntos
Cefaleia Pós-Punção Dural , Humanos , Gravidez , Feminino , Cefaleia Pós-Punção Dural/terapia , Anestesiologistas , Cefaleia/etiologia , Placa de Sangue Epidural/métodos , Período Pós-Parto , Punção Espinal/efeitos adversosRESUMO
BACKGROUND AND PURPOSE: Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease with a wide spectrum of clinical manifestations. The aim of this study is to assess the presence of subarachnoid hemorrhage (SAH) in the context of CVST and to present its epidemiological, clinical and radiological/laboratory aspects. METHODS: Between October 2012 and October 2019, 43 patients with CVST were reviewed. Eleven (25.58%) cases presented SAH. RESULTS: A quarter of the patients evaluated with CVST had SAH. There were 9 women (81.82%) and 2 men, with a mean age at presentation of 37.7 years (range 28-49). The most common risk factor was the use of oral contraceptives and the most prevalent symptom was headache. Both sinuses, the superior sagittal sinus and the transverse sinus, were the most affected. There was no isolated involvement of the cortical vein. The SAH was limited to some sulci of cerebral convexity in 8 cases (72.73%). In one case, the location of SAH was in the cerebellum and in two cases in the Sylvian fissure. In two cases, there was an evolution to venous infarction; and in three cases, intraparenchymal hemorrhage was present. Seven patients (63.64%) improved considerably with anticoagulation after 6 months of treatment. CONCLUSIONS: This series found that 25.58% of patients with CVST had SAH. It is the highest incidence described in the literature so far. Findings of SAH located in the cerebral convexities, without affecting the base cisterns, should always lead to the suspicion of CVST.