Cranial nerve blocks (CNBs) have been used for the acute and preventive treatment of a variety of headaches, including migraine. The effectiveness of CNBs in migraine is usually observed beyond the duration of the nerve block, possibly due to central pain modulation. The most used target is the greater occipital nerve. Other commonly targeted nerves are the lesser occipital nerve and various branches of the trigeminal nerve, including the supratrochlear, supraorbital, and auriculotemporal nerves. CNBs are generally safe and well-tolerated procedures that can be performed in either emergency or outpatient settings. There is currently no guideline standardizing CNBs in migraine. In clinical practice, as well as the few published studies, the results are encouraging, justifying further studies in the area. In the present study we critically review the literature about the safety and efficacy of CNBs in the treatment of migraine attacks and in the preventive treatment of migraine.
Context: In the literature, there are few cases of Guillain Barré syndrome (GBS) in association with systemic lupus erythematosus (SLE). There is description of 19 neuropsychiatric syndromes associated with SLE, 12 of the central nervous system (CNS) and 7 of the peripheral nervous system (PNS). 10% of the patients with SLE and neurological manifestations have PNS complications. SLE is considered to have a late onset when it starts above 50 years of age and it consists in, on average, 26% of the total of individuals with SLE, however, in contrast to juvenile lupus, the number of studies is scarce. Case report: A patient diagnosed with late onset SLE who came to the emergency department due to seizure crisis and during the management, the patient developed an atypical form of GBS (motor, facial and bulbar), requiring mechanical ventilation and gastrostomy. The patient obtained a favorable outcome after pulse therapy and plasmapheresis. Conclusion: The atypical form of GBS is a very rare complication in patients with SLE, more studies need to be done for a standardized approach.
Introduction: Cerebral collateral circulation has become increasingly important in recent years. It is a physiological vascular protection circuit, designed to preserve cerebral irrigation in a failure context of the primary pathways. Methods: This retrospective, descriptive and analytical study aims to analyze the predictive factors for the collateral circulation presence in patients with acute ischemic stroke, seen in the emergency room of the Santa Casa de Misericórdia Hospital in São Paulo, with large vessels occlusion on angiotomography. Results: 21 patients were analysed between january 2018 and april 2020, 10 men and 11 women, with a median age of 71 years. The median NIHSS score was 16 and intravenous thrombolysis was performed in 71.4% of the patients. We identified the presence of hyperglycemia, cervical obstruction and female gender as factors independently associated with an unsatisfactory leptomeningeal collateral state. Systemic arterial hypertension, smoking, alcoholism and a history of stroke had no association with poor collateral status, as well as the previous use of sinvastatin does not improve the combined score. Conclusion: Knowing the risk factors and comorbidities associated with the rarefaction of cerebral collateral circulation is of great importance in assessing the ischemic stroke acute phase, contributing to improvement in treatment and primary and secondary prevention.
Introduction: The performance of Cranial nerve blocks (CNBs) in migraine has been increasingly used. CNBs are generally safe and well-tolerated procedures that can be performed in either emergency or outpatient settings. There is currently no guideline standardizing CNBs in migraine. In clinical practice, as well as the few published studies, the results are encouraging, justifying further studies in the area. Objectives: Evaluate the clinical response, safety and tolerability to the CNBs performed in patients with diagnostic criteria for migraine accompanying in the headache clinic in a reference hospital, and evaluate the response through objective scales (HIT 6 and EVA) evaluating comparatively pre and after application in a time interval of 60 days. Methods: Cross-sectional and retrospective observational clinical study in a convenience sample, in which the response to the CNBs performed in patients with migraine diagnostic criteria who accompany the headache clinic in a reference hospital, through the application of objective scales (HIT 6 and EVA) comparatively evaluating pre and after application in a time interval of 60 days, in the period from January 2021 to July 2022. Results: There were 15 patients included in the present study. The evaluation of the averages from EVA and HIT 6 pre and after application was statistically significant with P < 0.001. Only 6.66% (1) complained of some adverse effect such as initial insomnia. 93.33% (14) denied any post-application adverse effect. Unilateral and bilateral application, type of drug used in nerve block and prophylaxis concomitant also showed statistical relevance in the variation of the VAS scale. Conclusion: Despite the limitations and the reduced sample size, restricting to a more conclusive interpretation, the findings point to a potential therapeutic benefit and for the safety of the CNBs, justifying the performance of more studies in the area in order to create a protocol for the practice of CNBs.
Introduction: Acetazolamide is commonly used to treat idiopathic intracranial hypertension (IIH). The Idiopathic Intracranial Hypertension Treatment Trial showed a modest improvement in visual field function in patients using acetazolamide with a low-sodium weight-reduction diet compared with diet alone. There is still insufficient data to establish its use. Objectives: To describe acetazolamide effect in improving headache, visual acuity and papilloedema in patients with HII and assess patient’s tolerance to it Design. Retrospective analysis of 37 patients with IIH taking acetazolamide in a headache clinic of a tertiary medical center in São Paulo, Brazil. Results: The population analyzed was mostly female, with a mean age of 34.32 years, obese with a mean body mass index of 34.16, and were referred to the headache clinic from the emergency department. All 37 patients complained of headache and had increased cerebrospinal fluid opening pressure initially (mean 42.05). Improvement of headache was reported by 25 (67.56%) patients. Fundoscopy was described in the initial and last visit in 24 patients: 15 had papilloedema initially and 9 had a normal exam. At the last visit 9 patients improved (60%), 6 maintained papilloedema and 1 patient developed it. Visual acuity was described in the initial and last visit in 20 patients: 5 had normal visual acuity, 14 had low visual acuity and one patient was amaurotic. Of those with low visual acuity 2 (14.28%) got completely recovered, 5 (35.71%) recovered partially and 7 (50%) got worse. Two patients with the initial normal exam got worse during follow-up. Adverse effects were reported by 5 (13.51%) patients and led to discontinuation of acetazolamide — 3 of 5 reported paresthesias. Conclusion: Acetazolamide reduced headache in 67.56%, improved visual acuity in 50% and papilloedema in 60%, and was well tolerated by 86.48% of patients.
Osmotic demyelination syndrome is a rare disease, clinically presented as a global reduction in strength, tetraparesis, variations in the level of consciousness, and its content, and comatose status, associated with rapid variances in serum sodium levels (whether hyponatremia or hypernatremia). The neuroimaging findings are mainly in the pontine region, but currently the number of reports of extrapontine involvement has increased, typically with lesions in the topography of the thalamus, cerebellum, midbrain (substantia nigra), corpus callosum and hypothalamus. We display a rare case of pontine and extra-pontine involvement, even after the sodium replacement protocols of the current guidelines.
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