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1.
Schmerz ; 35(2): 139-149, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33725180

RESUMO

Post-dural puncture headache belongs to the group of secondary headache disorders and is a typical complication of intended or unintended dural puncture. The main symptom is orthostatic headache, which can be accompanied by neurological symptoms such as diplopia depending on the extent of the cerebrospinal fluid leak. The course of this headache is predominantly benign, showing spontaneous improvement over a couple of days, although severe cases are described in the literature. The following article provides an overview of the current knowledge about the headache's pathophysiology, diagnostic work-up and therapy.


Assuntos
Cefaleia Pós-Punção Dural , Placa de Sangue Epidural , Vazamento de Líquido Cefalorraquidiano , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Cefaleia Pós-Punção Dural/tratamento farmacológico , Cefaleia Pós-Punção Dural/terapia
3.
Medicine (Baltimore) ; 100(10): e25075, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725898

RESUMO

RATIONALE: Pituitary tumor apoplexy (PTA) is a rare clinical syndrome which requires urgent diagnosis and treatment due to its life-threatening consequences. Management of undiagnosed pituitary tumor before pregnancy is a problem during pregnancy. PATIENT CONCERNS: We reported a case with PTA which was not diagnosed before pregnancy presenting with vomiting associated with hyponatremia during the third trimester. After supplying the sodium the patient presented with dysarthria and hemiplegia. DIAGNOSES: MRI examination showed PTA accompanied with extrapontine myelinolysis (EPM). INTERVENTIONS: The patient was given hydrocortisone according to the symptoms gradually to taper off dose, at the same times oral levothyroxine therapy (25µg/day) was given. OUTCOMES: The patient delivered a healthy baby via cesarean section at hospital at 38 + 1 week of gestation. We performed MRI examination regularly and the tumor regressed significantly 8 months postpartum. LESSONS: We reported a case as PTA associated with EPM. Headache during pregnancy is often nonspecific, so careful medical history inquiry is very important.


Assuntos
Mielinólise Central da Ponte/diagnóstico , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Cesárea , Quimioterapia Combinada , Disartria/etiologia , Feminino , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Hemiplegia/tratamento farmacológico , Hemiplegia/etiologia , Humanos , Hidrocortisona/administração & dosagem , Hiponatremia/diagnóstico , Hiponatremia/tratamento farmacológico , Hiponatremia/etiologia , Imagem por Ressonância Magnética , Mielinólise Central da Ponte/tratamento farmacológico , Mielinólise Central da Ponte/etiologia , Apoplexia Hipofisária/sangue , Apoplexia Hipofisária/tratamento farmacológico , Apoplexia Hipofisária/etiologia , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Gravidez , Terceiro Trimestre da Gravidez , Sódio/administração & dosagem , Tiroxina/administração & dosagem , Resultado do Tratamento , Vômito/tratamento farmacológico , Vômito/etiologia , Adulto Jovem
4.
BMJ Case Rep ; 14(3)2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33674294

RESUMO

A woman in her 70s presented to the emergency department with fever, fluctuating cognition and headache. A detailed examination revealed neurological weakness to the lower limbs with atonia and areflexia, leading to a diagnosis of bacterial meningitis, alongside a concurrent COVID-19 infection. The patient required critical care escalation for respiratory support. After stepdown to a rehabilitation ward, she had difficulties communicating due to new aphonia, hearing loss and left third nerve palsy. The team used written communication with the patient, and with this the patient was able to signal neurological deterioration. Another neurological examination noted a different pattern of weakness to the lower limbs, along with new urinary retention, and spinal arachnoiditis was identified. After more than 10 weeks in the hospital, the patient was discharged. Throughout this case, there were multiple handovers between teams and specialties, all of which were underpinned by good communication and examination to achieve the best care.


Assuntos
/complicações , Meningite devida a Escherichia coli/complicações , Idoso , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , /terapia , Ceftriaxona/uso terapêutico , Coinfecção , Terapia Combinada , Comunicação , Confusão/etiologia , Cuidados Críticos , Diagnóstico Diferencial , Feminino , Febre/etiologia , Cefaleia/etiologia , Humanos , Meningite devida a Escherichia coli/diagnóstico por imagem , Meningite devida a Escherichia coli/tratamento farmacológico , Equipe de Assistência ao Paciente , Modalidades de Fisioterapia , Relações Médico-Paciente , Respiração Artificial , Resultado do Tratamento
5.
Praxis (Bern 1994) ; 110(4): 201-206, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33726510

RESUMO

COVID-19 and Headaches Abstract. Headaches are a common symptom of COVID-19 infections. Patients generally describe them as bilateral, predominantly frontal, squeezing and of moderate or severe intensity. Searching for "Red Flags" often allows distinction from primary headaches - usually fever, cough, and elevated inflammatory markers accompany COVID-19-associated headaches. Prospective studies did not confirm caveats against the use of ibuprofen as symptomatic treatment. While carrying facial masks often caused headaches, probably by compressing sensory nerves, many patients' migraine frequencies dropped during lockdown. Treatment of patients with primary headaches was complicated by quarantine and many centres offered online consultations.


Assuntos
Controle de Doenças Transmissíveis , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Estudos Prospectivos
6.
Artigo em Russo | MEDLINE | ID: mdl-33728860

RESUMO

Headache is a common symptom of acute and chronic cerebrovascular diseases. Headache can be symptomatic in patients with various forms of vascular pathology of the brain but primary headaches are much more common. Secondary headaches in acute cerebrovascular accidents may be the first symptom, and in some cases, a risk factor or complication of stroke. In chronic cerebrovascular diseases, headache may be the predominant symptom in the early stages and resolve in the later stages of the disease. At the same time, the severity, nature and course of headache cannot be considered as reliable signs of cerebrovascular disease. Meanwhile, the verification of the headache form is important from the point of view of determining the priorities of diagnosis and therapy.


Assuntos
Transtornos Cerebrovasculares , Acidente Vascular Cerebral , Transtornos Cerebrovasculares/complicações , Doença Crônica , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
7.
Artigo em Russo | MEDLINE | ID: mdl-33728862

RESUMO

Anxiety and related sleep disorders are a problem in modern society. Sleep disorders cover more than 45% of the world's population and have become a global health problem in recent decades. Numerous studies have shown an association of sleep disorders with pain, depression, and anxiety, as well as a causal relationship between chronic pain and sleep deficits. Patients with headaches are at a higher risk of mood and anxiety disorders than people in the general population; these results are particularly noticeable for patients with chronic daily headache as well as medication overuse headache. This interaction between mood/anxiety problems and medication overuse may be an important factor in chronification of episodic headache. Detection and treatment of comorbid diseases will not only provide better results, but also improve the quality of life of patients. In the treatment of this category of patients, it is possible to use noofen, which improves sleep, cognitive functions, and reduces headache.


Assuntos
Transtornos da Cefaleia , Transtornos do Sono-Vigília , Transtornos de Ansiedade/epidemiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia/etiologia , Humanos , Qualidade de Vida , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia
9.
Cochrane Database Syst Rev ; 2: CD013665, 2021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33620086

RESUMO

BACKGROUND: The clinical implications of SARS-CoV-2 infection are highly variable. Some people with SARS-CoV-2 infection remain asymptomatic, whilst the infection can cause mild to moderate COVID-19 and COVID-19 pneumonia in others. This can lead to some people requiring intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever, cough, or loss of smell or taste, and signs such as oxygen saturation are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19, or select patients for further testing. This is an update of this review, the first version of which published in July 2020. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19. SEARCH METHODS: For this review iteration we undertook electronic searches up to 15 July 2020 in the Cochrane COVID-19 Study Register and the University of Bern living search database. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included patients with clinically suspected COVID-19, or if they recruited known cases with COVID-19 and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies in hospitalised patients were only included if symptoms and signs were recorded on admission or at presentation. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2) checklist. We presented sensitivity and specificity in paired forest plots, in receiver operating characteristic space and in dumbbell plots. We estimated summary parameters using a bivariate random-effects meta-analysis whenever five or more primary studies were available, and whenever heterogeneity across studies was deemed acceptable. MAIN RESULTS: We identified 44 studies including 26,884 participants in total. Prevalence of COVID-19 varied from 3% to 71% with a median of 21%. There were three studies from primary care settings (1824 participants), nine studies from outpatient testing centres (10,717 participants), 12 studies performed in hospital outpatient wards (5061 participants), seven studies in hospitalised patients (1048 participants), 10 studies in the emergency department (3173 participants), and three studies in which the setting was not specified (5061 participants). The studies did not clearly distinguish mild from severe COVID-19, so we present the results for all disease severities together. Fifteen studies had a high risk of bias for selection of participants because inclusion in the studies depended on the applicable testing and referral protocols, which included many of the signs and symptoms under study in this review. This may have especially influenced the sensitivity of those features used in referral protocols, such as fever and cough. Five studies only included participants with pneumonia on imaging, suggesting that this is a highly selected population. In an additional 12 studies, we were unable to assess the risk for selection bias. This makes it very difficult to judge the validity of the diagnostic accuracy of the signs and symptoms from these included studies. The applicability of the results of this review update improved in comparison with the original review. A greater proportion of studies included participants who presented to outpatient settings, which is where the majority of clinical assessments for COVID-19 take place. However, still none of the studies presented any data on children separately, and only one focused specifically on older adults. We found data on 84 signs and symptoms. Results were highly variable across studies. Most had very low sensitivity and high specificity. Only cough (25 studies) and fever (7 studies) had a pooled sensitivity of at least 50% but specificities were moderate to low. Cough had a sensitivity of 67.4% (95% confidence interval (CI) 59.8% to 74.1%) and specificity of 35.0% (95% CI 28.7% to 41.9%). Fever had a sensitivity of 53.8% (95% CI 35.0% to 71.7%) and a specificity of 67.4% (95% CI 53.3% to 78.9%). The pooled positive likelihood ratio of cough was only 1.04 (95% CI 0.97 to 1.11) and that of fever 1.65 (95% CI 1.41 to 1.93). Anosmia alone (11 studies), ageusia alone (6 studies), and anosmia or ageusia (6 studies) had sensitivities below 50% but specificities over 90%. Anosmia had a pooled sensitivity of 28.0% (95% CI 17.7% to 41.3%) and a specificity of 93.4% (95% CI 88.3% to 96.4%). Ageusia had a pooled sensitivity of 24.8% (95% CI 12.4% to 43.5%) and a specificity of 91.4% (95% CI 81.3% to 96.3%). Anosmia or ageusia had a pooled sensitivity of 41.0% (95% CI 27.0% to 56.6%) and a specificity of 90.5% (95% CI 81.2% to 95.4%). The pooled positive likelihood ratios of anosmia alone and anosmia or ageusia were 4.25 (95% CI 3.17 to 5.71) and 4.31 (95% CI 3.00 to 6.18) respectively, which is just below our arbitrary definition of a 'red flag', that is, a positive likelihood ratio of at least 5. The pooled positive likelihood ratio of ageusia alone was only 2.88 (95% CI 2.02 to 4.09). Only two studies assessed combinations of different signs and symptoms, mostly combining fever and cough with other symptoms. These combinations had a specificity above 80%, but at the cost of very low sensitivity (< 30%). AUTHORS' CONCLUSIONS: The majority of individual signs and symptoms included in this review appear to have very poor diagnostic accuracy, although this should be interpreted in the context of selection bias and heterogeneity between studies. Based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out COVID-19. The presence of anosmia or ageusia may be useful as a red flag for COVID-19. The presence of fever or cough, given their high sensitivities, may also be useful to identify people for further testing. Prospective studies in an unselected population presenting to primary care or hospital outpatient settings, examining combinations of signs and symptoms to evaluate the syndromic presentation of COVID-19, are still urgently needed. Results from such studies could inform subsequent management decisions.


Assuntos
Assistência Ambulatorial , Atenção Primária à Saúde , Avaliação de Sintomas , Ageusia/diagnóstico , Ageusia/etiologia , /etiologia , Artralgia/diagnóstico , Artralgia/etiologia , Viés , /epidemiologia , Tosse/diagnóstico , Tosse/etiologia , Diarreia/diagnóstico , Diarreia/etiologia , Dispneia/diagnóstico , Dispneia/etiologia , Fadiga/diagnóstico , Fadiga/etiologia , Febre/diagnóstico , Febre/etiologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Mialgia/diagnóstico , Mialgia/etiologia , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias , Exame Físico , Viés de Seleção , Avaliação de Sintomas/classificação , Avaliação de Sintomas/estatística & dados numéricos
10.
Am J Forensic Med Pathol ; 42(1): 77-80, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33555675

RESUMO

ABSTRACT: Mass lesions in the brain encompass a wide range neoplastic and nonneoplastic entities. These can present as a diagnostic pitfall, with nonspecific, overlapping symptoms and similar appearances on radiology. They may cause death through varied mechanisms, either specific to the underlying pathophysiology or due to the space-occupying effect of the lesion. We report a case of fatal hemorrhagic cerebral pseudocyst, a rare mass lesion, associated with a cerebral varix, causing death in a morbidly obese individual. To the best of our knowledge, there is no previous documentation in the postmortem literature of this entity as a cause of death. This case aims to document this rare entity in the differential diagnosis of a tumor-like lesion in the brain, highlight the clinical difficulty in its assessment, and demonstrate an uncommon mechanism of death, of a mass lesion acting as a focus causing seizures, with resulting hypoxia due to effects of morbid obesity and heart failure.


Assuntos
Neoplasias Encefálicas/patologia , Cistos do Sistema Nervoso Central/patologia , Hemorragia Cerebral/patologia , Adulto , Encéfalo/irrigação sanguínea , Hemorragia Cerebral/etiologia , Feminino , Cefaleia/etiologia , Parada Cardíaca/etiologia , Humanos , Obesidade Mórbida/complicações , Lobo Parietal/patologia , Convulsões/etiologia , Varizes/patologia
11.
FP Essent ; 501: 17-23, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33595264

RESUMO

Temporomandibular disorders (TMDs) is a collective term for a group of heterogeneous musculoskeletal and neuromuscular conditions involving the temporomandibular joint (TMJ) complex, masticatory muscles, and surrounding osseous structures. TMDs affect 5% to 12% of the US population, with a peak incidence at ages 45 to 65 years. Common clinical manifestations include facial pain, ear pain, headache, TMJ discomfort, and adventitious sounds. The etiologies of TMDs are multifactorial and include behavioral, social, emotional, and occlusive factors. Common causes of TMDs are myofascial pain and dysfunction, articular disk displacement, and degenerative joint conditions. In most cases, the diagnosis can be made based on the history and physical examination. In the absence of trauma, imaging typically is reserved for patients with chronic TMDs. Initial management includes education, self-management, behavioral therapy, and physical therapy. Occlusal devices are recommended for management of sleep bruxism or diurnal clenching. Adjunctive pharmacotherapies include nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, antidepressants, and anticonvulsants. (This is an off-label use of some NSAIDs and an off-label use of benzodiazepines, antidepressants, and anticonvulsants.) Intra-articular injections have been used alone or with arthrocentesis. Patients who do not benefit from these therapies should be referred to an oral and maxillofacial surgeon.


Assuntos
Transtornos da Articulação Temporomandibular , Idoso , Dor Facial/diagnóstico , Dor Facial/etiologia , Dor Facial/terapia , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Injeções Intra-Articulares , Pessoa de Meia-Idade , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Transtornos da Articulação Temporomandibular/terapia
12.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542005

RESUMO

Acute cerebellar ataxia is a rare primary manifestation of neuropsychiatric systemic lupus erythematosus (NPSLE). We report a case of a 22-year-old woman who presented with gait instability, behavioural changes and new-onset seizures. The tempo of disease progression was explained by an autoimmune cause, eventually fulfilling the criteria for systemic lupus erythematosus. The patient's neurological symptoms improved markedly following administration of steroids and immunomodulators. A review of literature on cerebellar ataxia in NPSLE and a summary of all reported cases to date are also presented.


Assuntos
Anti-Inflamatórios/uso terapêutico , Ataxia Cerebelar/etiologia , Vasculite Associada ao Lúpus do Sistema Nervoso Central/diagnóstico , Vasculite Associada ao Lúpus do Sistema Nervoso Central/tratamento farmacológico , Prednisona/uso terapêutico , Adulto , Antimaláricos/uso terapêutico , Feminino , Análise da Marcha , Cefaleia/etiologia , Humanos , Hidroxicloroquina/uso terapêutico , Vasculite Associada ao Lúpus do Sistema Nervoso Central/complicações , Convulsões/etiologia
13.
J Med Case Rep ; 15(1): 76, 2021 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-33593422

RESUMO

BACKGROUND: Myeloproliferative neoplasms (MPNs) such as polycythemia Vera (PV) and Essential Thrombocythemia (ET) can be associated with a high risk of both venous and arterial thrombosis. However, the co-existence between these two complications is very rare and has never been described before, especially in young adults with no known history of MPNs. CASE PRESENTATION: We report the case of a 39 year-old Caucasian Moroccan male patient without cardiovascular risk factors (CVRF), who presented with acute chest pain. He also suffered from a severe headache since 2 weeks. Electrocardiogram (ECG) showed ST segment elevation myocardial infarction in the posterolateral leads. Cerebral Computed Tomography (CT) scan revealed subarachnoid hemorrhage (SAH), and cerebral Magnetic Resonance Angiography (MRA) found a Superior Sagittal Sinus Thrombosis (SSST). Routine blood tests showed raised hemoglobin and hematocrit in addition to leukocytosis and thrombocythemia. His coronary angiography revealed a thrombus in the ostial left circumflex artery (LCX). Further testing revealed positive Janus kinase 2 (JAK2) V617F mutation and low erythropoietin level, confirming the diagnosis of PV according to the 2008 World Health Organization (WHO) criteria. Antithrombotic and anti-ischemic treatments, in addition to myelosuppressive therapy with hydroxyurea, were initiated with a good clinical and biological evolution. CONCLUSION: This case shows that MPNs are an important cause of thrombosis, especially in young patients with no other risk factors. Early diagnosis and appropriate management are fundamental before the occurrence of life-threatening complications that can sometimes present in unusual forms associating arterial and venous thrombotic events.


Assuntos
Policitemia Vera/complicações , Policitemia Vera/diagnóstico , Trombose Venosa/etiologia , Adulto , Dor no Peito/etiologia , Vasos Coronários , Eritropoetina/sangue , Cefaleia/etiologia , Humanos , Janus Quinase 2/genética , Masculino , Mutação , Seio Sagital Superior , Trombose Venosa/diagnóstico por imagem
14.
Orv Hetil ; 162(7): 246-251, 2021 02 14.
Artigo em Húngaro | MEDLINE | ID: mdl-33582651

RESUMO

Összefoglaló. A klasszikus esetben ortosztatikus fejfájást okozó, spontán intracranialis hypotensiót az esetek túlnyomó többségében a gerinccsatornában, annak nyaki-háti átmenetében, illetve a háti szakaszán található liquorszivárgás okozza. Meglévo kötoszöveti betegség, degeneratív gerincbetegségek, illetve kisebb traumák szerepet játszhatnak a szivárgás kialakulásában. Az ortosztatikus fejfájás létrejöttében szerepet játszhat a meningealis szerkezetek, érzoidegek és hídvénák vongálódása. A klasszikus pozicionális, ortosztatikus fejfájásban szenvedo betegek körében gondolni kell a spontán intracranialis hypotensio lehetoségére, és az agykoponya, illetve a gerinc kontrasztanyaggal végzett mágneses rezonanciás vizsgálata (MRI) javasolt. A kontrasztanyaggal végzett koponya-MRI-vel klasszikus esetben diffúz, nem nodularis, intenzív, vaskos pachymeningealis kontrasztanyag-halmozás, kitágult vénássinus-rendszer, subduralis effusiók és az agytörzs caudalis diszlokációja ("slumping") látható. Fontos azonban szem elott tartani, hogy az esetek 20%-ában ezen eltérések nem detektálhatók. Jó minoségu, randomizált, kontrollált vizsgálatok nem történtek, a kezelés hagyományokon alapul. Kezdetben általában konzervatív terápiát alkalmaznak (ágynyugalom, koffein- és folyadékbevitel), ennek hatástalansága esetén epiduralis sajátvér-injekció, epiduralis fibrinragasztó-injektálás, illetve sebészi terápia jöhet szóba. Orv Hetil. 2021; 162(7): 246-251. Summary. Spontaneous intracranial hypotension, the classic feature of which is orthostatic headache, is most commonly caused by a cerebrospinal fluid leakage at the level of the spinal canal, in most cases at the thoracic level or cervicothoracic junction. Underlying connective tissue disorders, minor trauma, degenerative spinal diseases may play a role in the development of cerebrospinal fluid leaks. Traction on pain-sensitive intracranial and meningeal structures, particularly sensory nerves and bridging veins, may play a role in the development of orthostatic headache. In the case of patients with classic orthostatic headache, the possibility of spontaneous intracranial hypotension should be considered, and if suspected, brain magnetic resonance imaging (MRI) with gadolinium and additional spine MRI are recommended. Diffuse, non-nodular, intense, thick dural enhancement, subdural effusions, engorgement of cerebral venous sinuses, sagging of the brain are typical features on brain MRI, which, however, remain normal in up to 20 percent of patients with spontaneous intracranial hypotension. Unfortunately, no randomized clinical trials have evaluated the effectiveness of the various treatment strategies and no definitive treatment protocols have been established. In clinical practice, the first-line treatment of spontaneous intracranial hypotension is conservative (bed rest, caffeine and fluid intake). If conservative therapy is not effective, epidural blood patch, epidural fibrin glue, or surgical repair should be considered. Orv Hetil. 2021; 162(7): 246-251.


Assuntos
Encéfalo/diagnóstico por imagem , Hipotensão Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Cefaleia/etiologia , Humanos
15.
J Neurol Sci ; 423: 117283, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33636661

RESUMO

OBJECTIVE: We report the findings from the Spanish Society of Neurology's NeuroCOVID-19 Registry. METHODS: We performed a multicentre study of patients with neurological manifestations of COVID-19. Participating physicians reported demographic, clinical, and paraclinical data and judged the involvement of COVID-19 in causing neurological symptoms. RESULTS: A total of 233 cases were submitted, including 74 different combinations of manifestations. The most frequently reported were stroke (27%), neuromuscular symptoms (23.6%), altered mental status (23.6%), anosmia (17.6%), headache (12.9%), and seizures (11.6%). The mean age of patients was 61.1 years, with 42.1% being women; a higher proportion of women was recorded among patients with altered mental status, anosmia, and headache. The onset of symptoms differed within categories. Onset of anosmia occurred a mean (standard deviation) of 2.9 (2.5) days after the first general symptom, whereas neuromuscular symptoms appeared after 13.9 (10.1) days. Neurological symptoms were persistent in 33% of patients. General symptoms were present in 97.7% of patients, and results from general laboratory studies were abnormal in 99.4% of patients. Cerebrospinal fluid analysis findings were abnormal in 62.7% of the cases in which this test was performed (n = 51), but positive results for SARS-CoV-2 were only found in one case. CONCLUSIONS: The neurological manifestations of COVID-19 are diverse. Anosmia, myalgia, and headache occur earlier in the course of the disease. Altered mental status, neuromuscular symptoms, and stroke are associated with greater severity. COVID-19 must be incorporated into most clinical and radiological differential diagnoses. COVID-19 may cause persistent and disabling neurological symptoms.


Assuntos
/complicações , Doenças do Sistema Nervoso/etiologia , Adulto , Idoso , /etiologia , /epidemiologia , Doenças Cardiovasculares/epidemiologia , Causalidade , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Mialgia/epidemiologia , Mialgia/etiologia , Doenças do Sistema Nervoso/líquido cefalorraquidiano , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/epidemiologia , Neuroimagem , Exame Neurológico , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/etiologia , Sistema de Registros , Espanha/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Virulência
16.
Neurol Sci ; 42(4): 1267-1276, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33502666

RESUMO

BACKGROUND: SARS-CoV-2 is a novel infectious agent causing coronavirus disease 2019, which has been declared as pandemic in March 2020. Personal protective equipment has been mandatory for healthcare workers in order to contain the outbreak of pandemic disease. Mild neurological disturbances such as headache have been related to the extensive utilization of facemask. This study aims to examine headache variations related to the intensive utilization of facemask among a cohort of healthcare professionals in a setting of low-medium risk of exposure to SARS-CoV-2. METHODS: This is a cross-sectional study among healthcare providers from different hospital and clinics in Italy. Each participant completed a specifically designed self-administered questionnaire. Headache features and outcome measures' change from baseline were evaluated over a 4-month period, in which wearing facemask has become mandatory for Italian healthcare workers. RESULTS: A total of 400 healthcare providers completed the questionnaire, 383 of them met the inclusion criteria. The majority were doctors, with a mean age of 33.4 ± 9.2 years old. Among 166/383 subjects, who were headache free at baseline, 44 (26.5%) developed de novo headache. Furthermore, 217/383 reported a previous diagnosis of primary headache disorder: 137 were affected by migraine and 80 had tension-type headache. A proportion (31.3%) of these primary headache sufferers experienced worsening of their pre-existing headache disorder, mainly for migraine frequency and attack mean duration. CONCLUSIONS: Our data showed the appearance of de novo associated facemask headache in previous headache-free subjects and an exacerbation of pre-existing primary headache disorders, mostly experienced by people with migraine disease.


Assuntos
Cefaleia/etiologia , Pessoal de Saúde , Máscaras/efeitos adversos , Pandemias , Equipamento de Proteção Individual/efeitos adversos , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Cefaleia/epidemiologia , Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia/etiologia , Humanos , Hiperalgesia/epidemiologia , Hiperalgesia/etiologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/etiologia , Médicos , Inquéritos e Questionários
18.
West Afr J Med ; 38(1): 54-58, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33463708

RESUMO

BACKGROUND: The SARS-CoV-2 infection continues to ravage the global community since it was declared a pandemic. The socio-demographic and clinical characteristics defining the disease are mainly from Europe and Asia. The disease symptomatology is similar to the prevalent diseases in our environment, this could result in the delay in prompt identification and appropriate management of suspected cases toward combating community transmission. This study evaluates the prevalence, socio-demographic and clinical characteristics of positive cases of COVID -19. METHODS: This was a retrospective cohort study. Data on the socio-demographic, clinical characteristics and the results of the SARS-CoV-2 test of participants at the Nigerian Institute of Medical Research [NIMR] Modified Drive-through Centre for COVID-19 test sample collection over two months [24th February 2020- 27th April 2020] were retrieved from the electronic medical records (EMR). Data obtained were analyzed using SPSS version 22.0. RESULTS: A total number of 481 clients were evaluated in this review. The prevalence of SARS-CoV-2 infection in the population was 14.6%. The mean age of the positive cases was 42.2 [±15.9] years. The common symptoms reported by the positive cases were fever (40.0%), cough (32.9%), sore throat (17.1%) and running nose (15.7%). Fever depicted statistical significance with positive cases with the majority being of mild to moderate clinical severity. CONCLUSION: The prevalence of SARS-CoV-2 infection among this cohort was 14.6% with a male preponderance. Fever and sore throat were the variables that predicted SARS CoV-2 infection among our cohort.


Assuntos
/epidemiologia , Pandemias , Adolescente , Tosse/epidemiologia , Tosse/etiologia , Fadiga/epidemiologia , Fadiga/etiologia , Febre/epidemiologia , Febre/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Masculino , Nigéria/epidemiologia , Faringite/epidemiologia , Faringite/etiologia , Prevalência , Estudos Retrospectivos
19.
BMJ Open ; 11(1): e042745, 2021 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436471

RESUMO

BACKGROUND: Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. METHODS: The Corona São Caetano programme is a primary care initiative providing care to all residents with COVID-19 in São Caetano do Sul, Brazil. It was designed to capture standardised clinical data on community COVID-19 cases. After triage of potentially severe cases, consecutive patients presenting to a multimedia screening platform between 13 April and 13 May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days with phone calls every 2 days. RT-PCR-negative patients were offered additional SARS-CoV-2 serology testing to establish their infection status. We describe the clinical, virological and natural history features of this prospective population-based cohort. FINDINGS: Of 2073 suspected COVID-19 cases, 1583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95% CI 25.9 to 30.3) were positive; 604/1136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of confirmed COVID-19 were cough, fatigue, myalgia and headache; whereas self-reported fever (OR 3.0, 95% CI 2.4 to 3.9), anosmia (OR 3.3, 95% CI 2.6 to 4.4) and ageusia (OR 2.9, 95% CI 2.3 to 3.8) were most strongly associated with a positive COVID-19 diagnosis by RT-PCR or serology. RT-PCR cycle thresholds were lower in men, older patients, those with fever and arthralgia and closer to symptom onset. The rates of hospitalisation and death among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age and obesity more frequent in the hospitalised group. CONCLUSION: COVID-19 presents in a similar way to other mild community-acquired respiratory diseases, but the presence of fever, anosmia and ageusia can assist the specific diagnosis. Most patients recovered without requiring hospitalisation with a low fatality rate compared with other hospital-based studies.


Assuntos
/diagnóstico , Atenção Primária à Saúde/métodos , Adolescente , Adulto , Fatores Etários , Brasil , Criança , Estudos de Coortes , Tosse/etiologia , Tosse/fisiopatologia , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Febre/etiologia , Febre/fisiopatologia , Cefaleia/etiologia , Cefaleia/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Fatores Sexuais , Adulto Jovem
20.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504528

RESUMO

Fungal infections involving the pituitary gland are rare and can be life threatening. A 75-year-old man with hypertension and diabetes mellitus presented with headache and hyponatraemia. Imaging study showed right upper lung mass, and mass resection showed aspergilloma without tissue invasion on histology. The patient developed visual impairment a few weeks later, and MRI of the brain revealed bilateral sphenoid sinusitis and pituitary invasion. The trans-sphenoidal biopsy confirmed invasive Aspergillus infection. His sphenoidal sinuses were endoscopically debrided, and he was treated with oral voriconazole. Pituitary aspergillosis should be considered in the differential diagnosis in patients with lung aspergilloma with headache and sinusitis. Prompt biopsy and antifungal treatment are important due to the high mortality rate of the infection.


Assuntos
Síndrome de Secreção Inadequada de HAD/diagnóstico , Neuroaspergilose/diagnóstico , Doenças da Hipófise/diagnóstico , Aspergilose Pulmonar/diagnóstico por imagem , Idoso , Antifúngicos/uso terapêutico , Complicações do Diabetes , Diabetes Mellitus , Endoscopia , Cefaleia/etiologia , Hemoptise/etiologia , Humanos , Hipertensão , Hiponatremia/etiologia , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Hipopituitarismo/metabolismo , Síndrome de Secreção Inadequada de HAD/etiologia , Síndrome de Secreção Inadequada de HAD/metabolismo , Imagem por Ressonância Magnética , Masculino , Neuroaspergilose/complicações , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/metabolismo , Doenças da Hipófise/complicações , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/metabolismo , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/cirurgia , Insuficiência Renal Crônica , Sinusite Esfenoidal/complicações , Sinusite Esfenoidal/diagnóstico , Sinusite Esfenoidal/terapia , Cirurgia Torácica Vídeoassistida , Voriconazol/uso terapêutico
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