Acute treatment of menstrual migraine (MM) attacks is often incomplete and unsatisfactory, and perimenstrual prophylaxis with triptans, oestrogen supplementation or naproxen sodium may be needed for decreasing frequency and severity of the attack. In this pilot, open-label, non-randomised, parallel group study we evaluated, in 38 women with a

We report 2 very unusual cases of thunderclap headache complicating minimally invasive medical procedures. In the first case headache developed as the consequence of a pneumocephalus caused by an inadvertent intrathecal puncture during oxygen-ozone therapy for lumbar disk herniation. The second case involved intracranial hypotension, caused by the persistence of the needle, used for epidural anesthesia, and then penetrated in the subarachnoid space.

In daily hospital activity a frequent observation is that of patients in conditions of acute global suffering of the central nervous system due to a primary cause or symptomatic of other diseases. This condition shows an alteration of the state of consciousness, which involves three possible semeiologic manifestations: delirium (acute confusional state), acute confusional state associated with psychomotor underactivity and coma. The possible causes of an acute encephalopathy (AE) are: metabolic, iatrogenic and toxic, infective, primary neurologic, surgery-related and others. Diagnostic-therapeutic routes to be followed by emergency room doctors and neurologists dealing with AE are defined.

IntroductionBRCA tumour testing is a crucial tool for personalised therapy of patients with ovarian cancer. Since different next-generation sequencing (NGS) platforms and BRCA panels are available, the NGS Italian Network proposed to assess the robustness of different technologies.MethodsSix centres, using four different technologies, provided raw data of 284 cases, including 75 cases with pathogenic/likely pathogenic variants, for a revision blindly performed by an external bioinformatic platform.ResultsThe third-party revision assessed that all the 284 raw data reached good quality parameters. The variant calling analysis confirmed all the 75 pathogenic/likely pathogenic variants, including challenging variants, achieving a concordance rate of 100% regardless of the panel, instrument and bioinformatic pipeline adopted. No additional variants were identified in the reanalysis of a subset of 41 cases.ConclusionsBRCA tumour testing performed with different technologies in different centres, may achieve the realibility and reproducibility required for clinical diagnostic procedures.

Chronic short-lasting headaches, in which trigeminal autonomic cephalalgias (TACs) are included, are relatively rare syndromes and not always well recognised. We present a case highly suggestive of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and we try to affirm essential points to distinguish the diagnosis from other TACs and chronic short-lasting headaches. We conclude that the qualifying points for differential diagnosis are number and duration of attacks in a day, presence of autonomic features and lack of indomethacin effect. Keywords SUNCT • TACs Case reportA 47-year-old man was admitted to our Headache Centre for unilateral attacks of severe orbital headache, sometimes with temporal stabbing, extremely frequent (30-50 episodes in a day), lasting 15-30 s, associated with evident conjunctival injection and lacrimation, nasal congestion, rhinorrhoea and eyelid oedema. The pain quality was described as burning and throbbing. He was totally pain-free between attacks.NMR of brain did not showed any pathologic condition. The patient had presented this clinical condition for two weeks before arriving and he had experienced similar symptoms 1 and 4 years before, for about one month each time. In both events the clinical picture remitted spontaneously, and on these occasions the symptoms did not respond to therapy with subcutaneous sumatriptan, or to indomethacin.No trigger zones were documented. Sometimes neck movements elicited the attacks.The diagnosis we made was a short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) case, with respect to diagnostic criteria of the revised IHS classification. Particularly, we think that the attacks' duration and frequency, the important autonomic concomitant features and the lack of indomethacin effect represented the qualifying points for diagnosis. DiscussionSUNCT is one of the rarest trigeminal autonomic cephalalgias (TACs) and it shows a dramatic picture for the number of crises that create a condition of important disability. The worst characteristic is not the intensity of the crises, described as medium or severe, but never extremely severe like other chronic paroxystic cephalalgias, but the number of them and the intense autonomic involvement of the involved eye.The syndrome was described first in 1978 [1] and afterwards characterised [2] for the extreme shortness of crises that last only a few seconds and the total absence of symptoms in the intercritical periods. The most intensive pain occurs in the orbital and peri-orbital regions and can irradiate ipsilaterally in the frontal, temporal and nasal zones, and to cheek and palate. The quality of pain is described as burning, stabbing or throbbing, and more rarely as an electric current. Paroxysms start and finish acutely, reaching the highest level in 2.3 s. Single cases described the pain for longer times also, but the revised criteria of the International Headache Society indicate a duration between 10 and 120 s for ...

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Cerebral venous thrombosis (CVT) may represent the clinical onset of malignancies or complicate their course, also in phase of quiescence. In literature, there are several case reports on the association between CVT and tumors, but there are few articles on its clinical characteristics in cancer patients (Pts). Our aim was to analyze the clinical characteristics of CVT associated with extracranial tumors. We identified nine cases of CVT in adults affected by extracranial tumors in 6 years from six hospitals. The median age was 40 years; eight Pts were female. Associated tumors were: lymphoma (4/9); breast (2/9), rhinopharynges (1/9) and gastric (1/9) carcinomas. One patient presented a kidney tumor and a melanoma at the same time. Multiple sinuses were affected in seven Pts. MRI showed parenchymal lesions in most cases (7/9). Clinical manifestations were: focal deficits (7/9), headache (6/9), early seizures (4/9) and consciousness disorders (3/9). Headache was the onset symptom in six Pts. In four of these Pts, headache preceded the onset of the focal deficit and/or seizures than 2-15 days. The characteristics of the headache were variable in intensity, location and type but all the Pts agreed in saying that it was an unusual headache, unresponsive to common pain medications. Five of the six Pts complaining of headache in the course of CVT presented focal deficits and parenchymal lesions at admission to the emergency room. All nine Pts were anticoagulated without further haemorrhagic complications. At discharge, the Pts presented a complete recovery in four cases, mild sequelae in four and moderate sequelae in one. In conclusion, we would like to underline the importance of particular care to cancer Pts complaining of headache, since the early diagnosis and the appropriate anticoagulant treatment could prevent the appearance of parenchymal lesions and the consequent neurological deficits. Also in the cases of normal brain CT, a brain MRI/MR venography should be performed in emergency setting if CVT is suspected.

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