¿Se abusa de las técnicas de neuroimagen en pacientes con migraña crónica? Estudio en un área de salud del Principado de Asturias

Introducción. Existe la creencia del abuso de las técnicas de neuroimagen en pacientes con cefalea en nuestro medio. Objetivo. Analizar el consumo de técnicas de neuroimagen, y fundamentalmente de la tomografía computarizada (TC), ya que es de acceso libre en nuestra área, en la práctica clínica habitual en pacientes con migraña crónica (MC). Pacientes y métodos. Se revisan las historias clínicas de una serie de mujeres consecutivas diagnosticadas en nuestra consulta de cefaleas de MC. Se recogieron datos acerca de la realización de técnicas de neuroimagen a todos niveles (urgencias, consultas y pacientes ingresados). Resultados. Se incluyeron 139 mujeres con MC. Un total de 106 pacientes (76%) tenía al menos una TC de cráneo y 28 (20%) dos o más estudios de TC de cráneo. En seis de estas pacientes (21%) existía justificación clínica para la repetición del estudio, pero no en las 22 (79%) restantes. Ya en nuestro servicio se solicitó resonancia magnética (RM) a 59 pacientes (42%). En 43 (73%), la RM fue normal; en nueve (15%) puso de manifiesto lesiones inespecíficas en la sustancia blanca; y en siete (11%) fue patológica, si bien en ninguno de estos casos había relación directa entre la lesión de la RM y la clínica de MC. En 15 pacientes con MC (11%) no se había solicitado ningún estudio de neuroimagen. Conclusiones. En contra de nuestra hipótesis inicial, no encontramos un abuso de las técnicas de neuroimagen en pacientes con MC en nuestra área de saludIntroduction: There is a general perception of neuroimaging procedures overuse, mainly of CT scan, in patients with headache in Spain. Aim: To analyze the use of neuroimaging techniques, mainly CT scan as it is of free access in our region, in routine clinical practice in patients with chronic migraine (CM). Patients and methods: We reviewed the medical records of a consecutive series of women diagnosed as CM in our headache clinic. The data on consumption of neuroimaging procedures were collected at all levels (emergency department, inpatient ward and neurologic outpatient consultation). Results: We included 139 women with CM. A total of 106 patients (76%) had at least one CT brain scan. Twenty-eight patients (20%) had 2 or more CT scans. In 6 of these patients (21%) there was a clinical reason for repeating the studies, while there was no reason in the remaining 22 (79%). MRI had been carried out in our headache clinic in 59 patients (42%). In 43 (73%) MRI was normal, in 9 (15%) the MRI showed nonspecific lesions in the white matter and in 7 patients (11%) MRI studies were abnormal. There was no direct relationship between MRI lesion and CM. There were 15 patients with CM (11%) without any neuroimaging study. Conclusions: We could not find a real overuse of neuroimaging techniques in patients with CM in our health are

Cardiogenic shock following administration of propofol and fentanyl in a healthy woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cardiogenic shock is very uncommon in healthy people. The differential diagnosis for patients with acute heart failure in previously healthy hearts includes acute myocardial infarction and myocarditis. However, many drugs can also depress myocardial function. Propofol and fentanyl are frequently used during different medical procedures. The cardiovascular depressive effect of both drugs has been well established, but the development of cardiogenic shock is very rare when these agents are used.</p> <p>Case presentation</p> <p>After a minor surgical intervention, a 32-year-old Caucasian woman with no significant medical history went into sudden hemodynamic deterioration due to acute heart failure. An urgent echocardiogram showed severe biventricular dysfunction and an estimated left ventricular ejection fraction of 20%. Extracorporeal life support and mechanical ventilation were required. Five days later her ventricular function had fully recovered, which allowed the progressive withdrawal of medical treatment. Prior to her hospital discharge, cardiac MRI showed neither edema nor pathological deposits on the delayed contrast enhancement sequences. At her six-month follow-up examination, the patient was asymptomatic and did not require treatment.</p> <p>Conclusion</p> <p>Although there are many causes of cardiogenic shock, the presence of abrupt hemodynamic deterioration and the absence of a clear cause could be related to the use of propofol and fentanyl.</p

Parkinsonism-hyperpyrexia, a rare consequence of deep brain stimulator malfunction in advanced Parkinson’s disease

Parkinsonism-hyperpyrexia syndrome (PHS) is a rare neurological emergency that shares clinical features with neuroleptic malignant syndrome. It is usually due to sudden deprivation of dopaminergic treatment, although there are cases related to failure of the deep brain stimulation system