In order to make the correct diagnosis and to choose the appropriate therapy, it is important to be aware of this rare presentation and its association with Nevus of Ota.

Immediately after a neck dissection, just a few patients showed diaphragmatic immobility, and there was a transient decrease in inspiratory strength in all individuals. Such findings can increase the risk of postoperative complications in patients with previous lung disease.

BACKGROUND AND OBJECTIVES: Neuropathic pain is defined as pain induced by injury or disease involving the somatosensory system. Dysfunctions in anatomic regions responsible for the processing of pain may involve peripheral and central nervous system components. A careful history and clinical evaluation with special attention to neurologic propaedeutics are critical for the syndromic, anatomic and etiologic diagnosis of neuropathic pain. However, diagnosis is not always simple and often depends on additional tests. This chapter aimed at reviewing most commonly used additional tests in the clinical practice to help diagnosing neuropathic pain. CONTENTS: Electroneuromyography is primarily indicated for topographic, etiologic and prognostic diagnosis of peripheral nervous system diseases and for the differential diagnosis between neurogenic, myopathic and neuromuscular junction diseases. It gives real time information on what is going on in the nerve and the muscle, being fundamentally important for differential neuromuscular disease diagnosis. Some imaging methods, such as computerized tomography and magnetic resonance, for their spatial resolution, give details of anatomic structures. Other methods, such as positron emission tomography scan and functional magnetic resonance, in addition to anatomic details, also provide data on metabolic and functional measurements. In addition, imaging techniques such as spectroscopy and diffusion tensor magnetic resonance, allow the study of brain biochemical changes and conectivities with different temporal and spatial resolutions. Other additional tests, such as sensory quantification test and microneurography are seldom used in the clinical practice. CONCLUSION: Additional tests, together with careful history and neurological evaluation focused on neurologic propaedeutics, may provide important data for the diagnosis of neuropathic pain and are often used in the clinical practice.

In everyday clinical practice, neurologists frequently encounter complex clinical cases in which a full analysis of several variants are essential to reach the right diagnosis. The resolution of a doubtful case may rely on the recognition of a very specific diagnostic clue. The objective of this report was to describe a case in which the prompt recognition of a very subtle imaging feature in the emergency room could have precluded further extensive diagnostic investigations. case rePorTA 34-year-old woman came into the Emergency department with a worsening headache. The symptoms had begun two weeks earlier, with a holocranial pulsatile headache that gradually worsened and became unbearable in the preceding three days. In association with the pain, she complained of nausea, vomiting and intolerance to movement, light and sound. As relevant medical history, she had dyslipidemia and was taking anphepramona for obesity. She had suffered occasional headaches in the past, but never of that intensity. She had already used several over the counter analgesics and nonsteroidal anti-inflammatory drugs with no relief.Neurologic examination disclosed left eye ptosis, which she claimed to be preexisting (Fig A), confirmed on an old photograph. Cerebrospinal fluid analysis was normal. A magnetic resonance angiogram (MRA) of the internal carotid artery (ICA) demonstrated no signal within left ICA (Fig B) absTracT At times in clinical neurology, the identification of a subtle clinical or radiological sign can lead to prompt diagnosis of a very rare or difficult case. We report on a patient who presented with untreatable headache and unilateral ptosis. Computed tomography (CT) scan of the head did not reveal any structural cause. Magnetic resonance angiogram showed absence of left internal carotid artery, which was eventually confirmed by a catheter angiography. Reviewing the case, it emerged that a feature on the initial CT scan "bone window" would have confirmed the diagnosis, had it been searched for: the underdeveloped carotid canal, which is a consequence and a marker of internal carotid artery agenesis.Key words: carotid artery agenesis, Horner syndrome, carotid canal underdevelopment, computed tomography. resumo Em algumas circunstâncias, o reconhecimento de um sinal clínico ou radiológico sutil pode tornar simples o diagnóstico de um caso raro ou muito difícil em neurologia clínica. Relatamos o caso de uma paciente que apresentava cefaleia intratável e ptose palpebral unilateral. A tomografia computadorizada (TC) de crânio não permitiu identificar nenhuma causa estrutural. A ressonância magnética evidenciou ausência da artéria carótida interna esquerda, posteriormente confirmada por arteriografia convencional. Retrospectivamente, descobriu-se que um dado da janela óssea da primeira TC de crânio teria confirmado o diagnóstico, tivesse ele sido pesquisado: o hipodesenvolvimento do canal carotídeo, que é uma consequência e um marcador de agenesia da artéria carótida interna.Palavras-Chave: agenesia da artéria carótida, sínd...

ObjectiveThe objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN).Methods and findingsA prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA–B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056–0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040–0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062–0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013–0.96; p = 0.046) survival.ConclusionsThese results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes.