Isso não está me cheirando bem! Cheiro desencadeando crises de migrânea que podem ser tratadas com aromaterapia? Hmm, something smells fishy! Smell triggering migraine attacks that can be treated with aromatherapy? .
Case report: Woman, 34 years old, with paresis that started four years ago during pregnancy, predominantly distal in the lower limbs and progression to the upper limbs. No involvement of cranial nerves and sensitivity. Initially considered a diagnosis of Myasthenia Gravis and clinical gain was observed with the use of pyridostigmine. After a few months, the patient’s symptoms recurred with asymmetric flaccid tetraparesis, predominantly in the lower limbs, associated with global areflexia and oral immunosuppressive therapy was initiated, with improvement. Electroneuromyography with normal sensory nerve conduction studies, but reductions in amplitudes in proximal compound muscle action potentials, with markedly reduced persistence in F-wave studies of the four limbs. Diffuse neurogenic changes were observed on exertion and activities such as positive sharp waves, fibrillation, fasciculations and myokymia at rest. Repetitive nerve stimulation at 3Hz without changes. A hypothesis of multifocal motor neuropathy (MMN) was then made. Treatment with intravenous immunoglobulin was performed, with significant recovery of symptoms. Discussion: MMN is a rare disease (prevalence of 0.6 per 100,000 individuals), with a predominance in men and a mean age of onset around 40 years. The differential diagnosis includes motor neuron disease and other demyelinating neuropathies. It is immune-mediated by antianglioside antibodies (anti-GM1), but they are not identified in all patients and may be present in other neuropathies. It is defined by muscle weakness predominantly distal, asymmetrical, predominantly in the upper limbs, slowly progressive, associated with reduced deep reflexes in the affected regions. The main electrophysiological characteristic is the presence of motor nerve conduction blocks (CB) outside the usual sites of compression. Conclusion: The finding that CB presents in patients with MMN suggests that nerve conduction should be extensively studied in every patient with a lowermotor-neuron syndrome to identify patients who might respond favorably to immunomodulating treatment.
Introduction: Posterior reversible leukoencephalopathy syndrome is an acute/subacute clinical-radiological syndrome characterized by headache, changes in consciousness, seizures, focal neurological deficits, visual deficits and that may be preceded by uncontrolled blood pressure in the day before. It does not commonly occur concomitantly with prolonged infectious conditions. The most typical imaging finding is white matter edema in the posterior cerebral hemispheres. Treatment is based on adequate control of blood pressure and epileptic seizures, as well as metabolic and electrolyte control. The prognosis in most cases is excellent with significant improvement and complete reversal over days to weeks. Case report: Female, 37-year-old, after one month of underwent an endoscopic retrograde cholangiopancreatography was hospitalized due to a perirenal abscess, and treatment with antibiotics was initiated. During this treatment, she developed a sudden onset of bilateral amaurosis, continuous horizontal nystagmus, mental confusion, right upper limb weakness and hyperreflexia, in addition to an epileptic seizure and fencing response posture requiring intravenous phenytoin. Brain tomography demonstrated hypodensity in the occipital hemispheres and magnetic resonance imaging identified signal alteration in the white matter diffuse without diffusion restriction compatible with posterior reversible leukoencephalopathy syndrome. She evolved with adequate control of blood pressure and epileptic seizures, progressive improvement in visual acuity and muscle strength, until he returned to normality 10 days after the onset of symptoms. The antiepileptic drug was suspended, and she was discharged with antihypertensive medication. Conclusion: Posterior reversible leukoencephalopathy syndrome is an important differential diagnosis in conditions of sudden deficits and seizures, especially in this infectious context, because it is a reversible clinical condition with a good prognosis.
The dark side of moon é um álbum do grupo inglês Pink Foyd, considerado um dos mais influentes discos do século XX. Neste artigo, realizamos uma análise cefaliátrica do álbum. As faixas são correlacionadas com a crise migranosa, desde os critérios diagnósticos (fotofobia, fonofobia, piora com exercício e aura) até a relação com o trabalho, gatilhos e síndromes raras como "Alice no País das Maravilhas".
As doenças ocupacionais estão diretamente ligadas à profissão do trabalhador, enquanto que as do trabalho estão ligadas ao ambiente de trabalho. No Brasil, estas entidades mórbidas são regidas pela Lei nº 8.213 de 24 de julho de 1991. As cefaleias ocupacionais foram, primeiramente, descritas por Bernardino Ramazzini, em 1700, em seu livro De morbis artificum diatriba. No entanto, até o momento, não foram inseridas na lista de doenças relacionadas ao trabalho, publicada pelo Ministério da Saúde, e adotada pelo Ministério da Previdência Social. A classificação de Schilling utilizada nas doenças ocupacionais em geral pode ser adaptada aos diagnósticos de cefaleia ocupacional. Para se chegar a esse diagnóstico, são necessários três elementos essenciais: anamnese ocupacional, diário de atividades e nexo causal.
BackgroundDuring the novel coronavirus - COVID-19 pandemic, health care systems are facing one of its greatest challenges.ResultsSecondary headaches may need urgent care at an emergency department. Primary headaches exacerbations may require intravenous infusion. Treatment optimization is key for a better outpatient management.ConclusionWe give recommendations on when a headache patient should go to the hospital despite the current limited resources, and primary headache management aspects during the outbreak.
Intracranial lipomas represent 0.1% to 0.5% of all intracranial tumors. Approximately half of the patients are asymptomatic. In symptomatic patients, headache is the most common symptom. We describe the case of a 71-year-old woman with history of generalized seizures and episodic migraine for about 30 years. In recent months, there has been a change in the characteristics of headache. She was admitted to the emergency room with muscle weakness in left hemibody and intense headache onset approximately four hours ago. Neuroimaging exams revealed a median frontal expansive lesion suggestive of intracranial lipoma.
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