39 research outputs found
Principles of Pharmacological Treatment of Migraine Based on Scientific Evidence
LijeÄenje migrene prilagoÄeno je individualnim potrebama bolesnika. Kako bi se izbjegao nasumiÄan izbor lijekova, treba odabrati lijek koji ima pouzdanu uÄinkovitost u zaustavljanju glavobolje i popratnih simptoma, koji je dobro podnoÅ”ljiv i ne utjeÄe na komorbiditete. FarmakoloÅ”ko lijeÄenje može biti usmjereno samo na abortivnu akutnu terapiju ako se migrena rijetko javlja, nema teži kliniÄki oblik i ne uzrokuje znaÄajne poremeÄaje dnevnih životnih aktivnosti. Ako je onesposobljenost blaga, prvi lijek izbora može biti nesteroidni antireumatik, jednostavni ili kombinirani analgetik. U sluÄaju jaÄe onesposobljenosti može se odmah dati specifiÄni analgetik iz razreda triptana, koji se takoÄer daju u sluÄaju neuspjeha prve linije akutnog lijeÄenja migrene blažeg intenziteta. ProfilaktiÄko lijeÄenje migrene treba zapoÄeti kod uÄestalih epizodnih i kroniÄnih oblika migrene i neuspjeha akutne terapije koji se dokumentiraju praÄenjem u dnevniku glavobolje. Prva linija lijeÄenja prema dostupnosti lijekova u Hrvatskoj su oralni nespecifiÄni profilaktici iz razreda betablokatora (propranolol i metoprolol) i antiepileptika (topiramat), a u drugoj liniji tricikliÄki antidepresiv (amitriptilin). Ako je terapija neuspjeÅ”na nakon dva pokuÅ”aja lijeÄenja s dva razliÄita oralna profilaktika u bolesnika koji imaju najmanje 4 dana migrene mjeseÄno, prema struÄnim smjernicama treba propisati specifiÄnu profilaktiÄku terapiju ā monoklonska antitijela na kalcitonin genpovezani peptid (CGRP) (fremanezumab ili galkanezumab) ili na receptor CGRP (erenumab). SpecifiÄni profilaktici za migrenu imaju prednost u odnosu na nespecifiÄne: jednostavnu uporabu, brzi poÄetak djelovanja, postojanu uÄinkovitost, bolju podnoÅ”ljivost i sigurnosni profil.Migraine treatment is tailored to the individual needs of the patient. To avoid random drug selection, a drug that has reliable efficacy in stopping headaches and accompanying symptoms, that is well tolerated and does not affect comorbidities, should be selected. Pharmacological treatment can be directed only to abortive acute therapy if the migraine is rare, has no more severe clinical features and does not cause significant disturbances of daily life activities. If the disability is mild, the first drug of choice may be a nonsteroidal antirheumatic, simple or combined analgesic. In case of severe disability, a specific analgesic from the triptan class can be given immediately, which is also given in case of the first line failure of acute treatment in milder migraine. Prophylactic treatment of migraine should be initiated with frequent episodic and chronic forms of migraine and failure of acute therapy documented by the headache diary. The first line of treatment according to the availability of drugs in Croatia are oral nonspecific prophylactics: beta-blockers (propranolol and metoprolol) and anticonvulsant (topiramate), and in the second line tricyclic antidepressant (amitriptyline). If therapy fails after two attempts at treatment with two different oral prophylactics in patients with at least 4 days of migraine per month, specific prophylactic therapy should be prescribed according to professional guidelines - monoclonal antibodies to calcitonin gene-related peptide (CGRP) (fremanezumab or galcanezumab) / CGRP receptor (erenumab). Specific migraine prophylactics have an advantage over non-specific ones: easy to use, fast onset of action, consistent efficacy, better tolerability and safety profile
Diagnostic and Therapeutic Approach to Headaches
Glavobolja nije samo simptom organskog ili psihiÄkog poremeÄaja nego je i zaseban kliniÄki entitet. DijagnostiÄki kriteriji za sve glavobolje standardizirani su u MeÄunarodnoj klasifikaciji glavobolja, a temelje se na kliniÄkim obilježjima glavobolje i popratnih simptoma, dok su druge dijagnostiÄke pretrage u funkciji iskljuÄivanja ili dokazivanja patomorfoloÅ”kog supstrata. Primarne glavobolje (migrena, glavobolja tenzijskog tipa, trigeminalne autonomne cefalalgije) uzrokovane su poremeÄajem u antinociceptivnomu mehanizmu srediÅ”njega živÄanog sustava koji se ne može detektirati makromorfoloÅ”kim supstratom s pomoÄu uobiÄajenih metoda oslikavanja, za razliku od sekundarnih glavobolja. Terapija glavobolja temelji se na postavljenoj dijagnozi. Usmjerena je k akutnom lijeÄenju napadaja boli i popratnih simptoma i na sprjeÄavanje ponavljanja napadaja glavobolje. LijeÄenje glavobolja može biti farmakoloÅ”ko ili nefarmakoloÅ”ko. Izbor analgetika zasnovan je na kliniÄkim dokazima i smjernicama za lijeÄenje prema vrsti glavobolje. Postoje opÄi analgetici koji su primjenjivi u svim kliniÄkim oblicima glavobolja i specifiÄni lijekovi za pojedine vrste glavobolja (triptani, kortikosteroidi, indometacin). Farmakoprofilaksa glavobolje provodi se specifiÄnim lijekovima pri Äestim ponavljanim ili kroniÄnim glavoboljama u bolesnika koji slabo reagiraju na akutnu terapiju ili ih glavobolje onesposobljavaju u svakodnevnom životu. NefarmakoloÅ”ko lijeÄenje obuhvaÄa razliÄite invazivne i neinvazivne metode lijeÄenja usmjerene na kupiranje boli ili na profilaksu glavobolje.Headache is not just a symptom of an organic or psychological disorder, but also a distinct clinical entity. The standard diagnostic criteria for all headache disorders are established according to the International Classification of Headache Disorders and are based mainly on clinical features of headache disorders and their accompanying symptoms, while other diagnostic procedures are used to either exclude or demonstrate a pathomorphological substrate. Primary headaches (migraine, tension-type headache and trigeminal autonomic cephalalgias) are caused by a dysfunctional antinociceptive mechanism in the central nervous system that cannot be detected by a macromorphological substrate using conventional neuroimaging techniques, as opposed to secondary headaches. Treatment of headache varies, depending on the diagnosis. The treatment focuses on acute pain and its concomitant symptoms, as well as on the prevention of recurrent headache episodes. Either pharmacological or non-pharmacological management option may be used for the treatment of headache. The choice of analgesic drug is based on evidence of clinical efficacy and on guidelines for specific headache treatment. There are general analgesics that are used in all clinical forms of headache, as well as drugs specifically designed for certain types of headache disorders (triptans, corticosteroids, indomethacin). Pharmacoprophylaxis of headache with specific drugs is indicated in frequent episodic or chronic headaches in patients who poorly respond to acute therapy or have a reduced quality of life due to headaches. Non-pharmacological treatment includes various invasive and non-invasive methods of treatment focused on pain alleviation or headache prophylaxis
Uvodnik: Migrena
Migrena je primarna glavobolja koja je, prema globalnome epidemioloÅ”kom istraživanju, drugi najveÄi uzrok onesposobljenosti u svijetu kada se mjeri godinama izgubljenog života zbog invaliditeta jer znaÄajno ometa profesionalne, obrazovne, kuÄanske, obiteljske i socijalne aktivnosti te drugi po veliÄini Äimbenik koji doprinosi optereÄenju od neuroloÅ”kih bolesti, nakon moždanog udara.
Migrena nije obiÄna glavobolja koja se lako može izlijeÄiti ili izbjeÄi bez uporabe posebnih lijekova i drugih metoda lijeÄenja koje provode medicinski struÄnjaci.
U lijeÄenju migrene sudjeluje tim struÄnjaka razliÄitih profila (lijeÄnici obiteljske medicine i razliÄitih drugih specijalnosti, neuroznanstvenici, psiholozi, fizikalni i radni terapeuti, medicinski tehniÄari, ljekarnici), ali prvenstveno se njome bave neurolozi. Oni Äe u interakciji s bolesnicima pronaÄi najbolji naÄin lijeÄenja migrene koji je temeljen na znanstvenim osnovama i struÄnom iskustvu te prilagoÄen individualnim potrebama bolesnika
Principles of Pharmacological Treatment of Migraine Based on Scientific Evidence
LijeÄenje migrene prilagoÄeno je individualnim potrebama bolesnika. Kako bi se izbjegao nasumiÄan izbor lijekova, treba odabrati lijek koji ima pouzdanu uÄinkovitost u zaustavljanju glavobolje i popratnih simptoma, koji je dobro podnoÅ”ljiv i ne utjeÄe na komorbiditete. FarmakoloÅ”ko lijeÄenje može biti usmjereno samo na abortivnu akutnu terapiju ako se migrena rijetko javlja, nema teži kliniÄki oblik i ne uzrokuje znaÄajne poremeÄaje dnevnih životnih aktivnosti. Ako je onesposobljenost blaga, prvi lijek izbora može biti nesteroidni antireumatik, jednostavni ili kombinirani analgetik. U sluÄaju jaÄe onesposobljenosti može se odmah dati specifiÄni analgetik iz razreda triptana, koji se takoÄer daju u sluÄaju neuspjeha prve linije akutnog lijeÄenja migrene blažeg intenziteta. ProfilaktiÄko lijeÄenje migrene treba zapoÄeti kod uÄestalih epizodnih i kroniÄnih oblika migrene i neuspjeha akutne terapije koji se dokumentiraju praÄenjem u dnevniku glavobolje. Prva linija lijeÄenja prema dostupnosti lijekova u Hrvatskoj su oralni nespecifiÄni profilaktici iz razreda betablokatora (propranolol i metoprolol) i antiepileptika (topiramat), a u drugoj liniji tricikliÄki antidepresiv (amitriptilin). Ako je terapija neuspjeÅ”na nakon dva pokuÅ”aja lijeÄenja s dva razliÄita oralna profilaktika u bolesnika koji imaju najmanje 4 dana migrene mjeseÄno, prema struÄnim smjernicama treba propisati specifiÄnu profilaktiÄku terapiju ā monoklonska antitijela na kalcitonin genpovezani peptid (CGRP) (fremanezumab ili galkanezumab) ili na receptor CGRP (erenumab). SpecifiÄni profilaktici za migrenu imaju prednost u odnosu na nespecifiÄne: jednostavnu uporabu, brzi poÄetak djelovanja, postojanu uÄinkovitost, bolju podnoÅ”ljivost i sigurnosni profil.Migraine treatment is tailored to the individual needs of the patient. To avoid random drug selection, a drug that has reliable efficacy in stopping headaches and accompanying symptoms, that is well tolerated and does not affect comorbidities, should be selected. Pharmacological treatment can be directed only to abortive acute therapy if the migraine is rare, has no more severe clinical features and does not cause significant disturbances of daily life activities. If the disability is mild, the first drug of choice may be a nonsteroidal antirheumatic, simple or combined analgesic. In case of severe disability, a specific analgesic from the triptan class can be given immediately, which is also given in case of the first line failure of acute treatment in milder migraine. Prophylactic treatment of migraine should be initiated with frequent episodic and chronic forms of migraine and failure of acute therapy documented by the headache diary. The first line of treatment according to the availability of drugs in Croatia are oral nonspecific prophylactics: beta-blockers (propranolol and metoprolol) and anticonvulsant (topiramate), and in the second line tricyclic antidepressant (amitriptyline). If therapy fails after two attempts at treatment with two different oral prophylactics in patients with at least 4 days of migraine per month, specific prophylactic therapy should be prescribed according to professional guidelines - monoclonal antibodies to calcitonin gene-related peptide (CGRP) (fremanezumab or galcanezumab) / CGRP receptor (erenumab). Specific migraine prophylactics have an advantage over non-specific ones: easy to use, fast onset of action, consistent efficacy, better tolerability and safety profile
NEUROPATHIC PAIN IN HEADACHES
VeÄina neuropatija u podruÄju glave javljaju se kao orofacijalne neuralgije, dakle boli u podruÄju lica i usne Å”upljine, a manjim dijelom u dijelu glave gdje se inaÄe pojavljuju glavobolje. Trigeminalna neuralgija rijetko se javlja u podruÄju glave supraorbitalno (u oko 4 %). Bol se u trigeminalnoj neuralgiji lijeÄi farmakoloÅ”ki primarno antikonvulzivima (karbamazepinom, okskarbazepinom), miorelaksansom baklofenom, a iznimno neuroleptikom pimozidom. U farmakorezistentnim sluÄajevima indicirane su kirurÅ”ke i radiokirurÅ”ke metode. Diferencijalno-dijagnostiÄki idiopatsku i klasiÄnu trigeminalnu neuralgiju treba razlikovati od simptomskih neuralgija (postherpetiÄna ) i neuropatija u podruÄju Äela i orbita (posttraumatska, oftalmoplegiÄna) te od primarne idiopatske probadajuÄe glavobolje i numularne glavobolje. Neke primarne glavobolje mogu se javljati istovremeno s trigeminalnom neuralgijom (cluster-tic sindrom, paroksizmalna hemikranija-tic sindrom i hemicrania continua-tic sindrom). U primarnim glavoboljama, kao Å”to su migrena i glavobolja tenzijskog tipa uz klasiÄnu nociceptivnu i specifi Änu neurogenu bol može nastati neuropatska bol zbog centralne senzitizacije koja se kliniÄki oÄituje alodinijom i hiperalgezijom. Rana primjena triptana u migrenskom napadaju sprjeÄava pojavu centralne senzitizacije i omoguÄuje izbjegavanje alodinije. Centralno uzrokovana neuropatska bol u podruÄju glave nastaje kao posljedica bolesti i oÅ”teÄenja u srediÅ”njem živÄanom sustavu ( najÄeÅ”Äe moždani udar ili multipla skleroza).The most common origin of neuropathic pain in the head are orofacial neuralgias; they appear mostly in the lower facial parts of the head and in the oral cavity, rarely in the upper part of the head as the main location of pain in headache disorders. Only a small proportion (4%) of patients with trigeminal neuralgia have symptoms in the supraorbital region. The fi rst choice of drugs to treat pain in trigeminal neuralgia are anticonvulsants (carbamazepine and oxcarbazepine), followed by muscle relaxants (baclofen) and pimozide (a neuroleptic drug) in most severe cases. In drug resistant cases, either conventional surgery or gamma-knife surgery may be indicated to treat pain. Differential diagnosis has to be made to distinguish both idiopathic and classical trigeminal neuralgia from symptomatic neuralgias (post-herpetic), fronto-orbital neuropathies (post-traumatic, ophthalmoplegic) and primary headaches (idiopathic stabbing headache, nummular headache). In some cases, trigeminal neuralgia may co-occur with primary headaches (syndromes labeled as cluster-tic syndrome, paroxysmal hemicrania-tic syndrome, and hemicrania continua-tic syndrome). Neuropathic pain may be evoked by central sensitization in primary headaches like migraine and tension-type headache causing allodynia and hyperalgesia along with the usual clinical presentation of classical nociceptive and specifi c neurogenic pain. Early intervention with triptans at the beginning of migraine attack is the best way to prevent central sensitization and avoid allodynia. Central neuropathic pain occurring in the head region is caused by a lesion or dysfunction in the central nervous system (stroke, multiple sclerosis)
Uvodnik: Migrena
Migrena je primarna glavobolja koja je, prema globalnome epidemioloÅ”kom istraživanju, drugi najveÄi uzrok onesposobljenosti u svijetu kada se mjeri godinama izgubljenog života zbog invaliditeta jer znaÄajno ometa profesionalne, obrazovne, kuÄanske, obiteljske i socijalne aktivnosti te drugi po veliÄini Äimbenik koji doprinosi optereÄenju od neuroloÅ”kih bolesti, nakon moždanog udara.
Migrena nije obiÄna glavobolja koja se lako može izlijeÄiti ili izbjeÄi bez uporabe posebnih lijekova i drugih metoda lijeÄenja koje provode medicinski struÄnjaci.
U lijeÄenju migrene sudjeluje tim struÄnjaka razliÄitih profila (lijeÄnici obiteljske medicine i razliÄitih drugih specijalnosti, neuroznanstvenici, psiholozi, fizikalni i radni terapeuti, medicinski tehniÄari, ljekarnici), ali prvenstveno se njome bave neurolozi. Oni Äe u interakciji s bolesnicima pronaÄi najbolji naÄin lijeÄenja migrene koji je temeljen na znanstvenim osnovama i struÄnom iskustvu te prilagoÄen individualnim potrebama bolesnika
A case of death caused by the intake of saliduretics for the purpose of weight reduction
Prikazan je sluÄaj mlaÄe ženske osobe, koja je tokom niza godina povremeno uzimala salidiuretike u svrhu Ā»estetskogĀ« smanjenja tjelesne težine. Bolesnica je u nekoliko navrata pregledavana u ambulanti opÄe medicine gdje je navodila da uzima diuretike radi mrÅ”avljenja. U medicinskoj dokumentaciji nije navedeno da li su joj ambulantno ordinirana diuretika i najvjerojatnije ih je nabavljala bez recepta. Prema tragovima ozljeda po tijelu može se zakljuĀ Äiti da je bolesnica nekoliko dana prije smrti pokazivala simptome hipokalijemije. EpidemioloÅ”kom i kriminoloÅ”kom metodom, te obdukcijom tijela umrle i histoloÅ”kim pretragama, nepobitno je utvrÄeno da se radilo o oÅ”teÄenju bubrega i miokarda nastalog uslijed dugotrajne hipokalijemije. Smrt predstavlja primjer nesretnog sluÄaja.The paper deals with a case of death of a young women, who has been taking salidiuretics at times for several years for the purpose of an Ā»esteticĀ« reduction of body weight. The patient was examined in surgeries several times and she stated the intake of diuretics in order to lose weight. Her medical record does not state that diuretics were prescribed to her; she was probably getting them without prescriptions. The lesions found on her body led to the conclusion that the patient had shown the symptoms of hypokalaemia a few days before she died. Epidemiological and criminological analysis as well as the obduction and histological examinations undoubtedly revealed kidney and myocardial lesions caused by a protracted hypokalaemia. This is an example of accidental death
Migraine and Stroke
Glavobolja je Äest simptom moždanog udara, a primarne glavobolje javljaju se kao Äest komorbiditet. Migrena je primarna glavobolja od koje pate uglavnom mlaÄe žene i Äija se prevalencija poveÄava do 50. godine života. Vjerojatnost razvoja ishemijskoga moždanog udara veÄa je u mlaÄih žena koje boluju od migrena s aurom. Genetika igra bitnu ulogu u patofiziologiji migrene i ishemijskoga moždanog udara (IMU), prvenstveno kodirajuÄi proteine koji reguliraju funkciju endotela krvnih žila i produkciju Äimbenika zgruÅ”avanja krvi. Od riziÄnih Äimbenika valja spomenuti pretilost, hiperlipidemiju, hiperglikemiju i puÅ”enje, kao i primjenu oralnih kontraceptiva. Neki kardijalni Äimbenici, kao Å”to je perzistentni foramen ovale, poveÄavaju rizik za razvoj migrene s aurom i ishemijskoga moždanog udara. Kako svi ovi nabrojani Äimbenici utjeÄu na samu patofiziologiju migrene i IMU, joÅ” je predmet istraživanja. Od ostalih vrsta cerebrovaskularnih bolesti postoje naznake da je i hemoragijski cerebrovaskularni inzult ÄeÅ”Äi u mlaÄih žena s migrenom, iako su istraživanja joÅ” uvijek kontradiktorna. Ono Å”to je ipak vidljivo je da žene koje imaju migrenu s aurom, te dobiju neki oblik hemoragijskoga cerebrovaskularnog inzulta, imaju i veÄu vjerojatnost loÅ”ijeg ishoda u vidu smrtnosti ili znaÄajne invalidnosti. Migrene su ÄeÅ”Äe i u nekim drugim cerebrovaskularnim bolestima, kao Å”to su disekcija cervikalnih arterija, te u bolestima malih krvnih žila mozga, gdje presudan utjecaj imaju genetske promjene. Prisutnost vaskularne bolesti ograniÄava primjenu akutne i profilaktiÄke terapije migrene zbog vazokonstrikcijskog uÄinka. Mjere za sprjeÄavanje moždanog udara u bolesnika s migrenom usmjerene su na kontroliranje Äimbenika rizika.Headache is a common symptom of stroke, and primary headaches occur as a common comorbidity. Migraine is a primary headache that mainly affects younger women and whose prevalence increases up until the age of 50. The likelihood of developing an ischemic stroke is higher in younger women who suffer from migraines with aura. Genetics also plays an important role in the pathophysiology of migraine and stroke, primarily encoding proteins that regulate vascular endothelial function and the production of blood clotting factors. Risk factors include obesity, hyperlipidemia, hyperglycemia and smoking, as well as the use of oral contraceptives. Some cardiac factors, such as persistent foramen ovale, increase the risk of developing migraine with aura and cerebrovascular disease. How all these factors affect the very pathophysiology of migraine and cerebrovascular disease is still the subject of research. There are indications that hemorrhagic stroke is also more common in younger women with migraine, although research is still contradictory. What is evident, however, is that women who have a migraine with aura, and suffer a form of hemorrhagic stroke, are also more likely to have a worse outcome in terms of mortality or significant disability. Migraines are more common in some other cerebrovascular diseases such as dissection of the cervical arteries, and in cerebral small blood vessel diseases, where genetic changes are of major influence. The presence of vascular disease limits the use of acute and prophylactic migraine therapy due to its vasoconstrictive effect. Measures to prevent stroke in migraine patients are aimed at controlling risk factors
Migraine and Stroke
Glavobolja je Äest simptom moždanog udara, a primarne glavobolje javljaju se kao Äest komorbiditet. Migrena je primarna glavobolja od koje pate uglavnom mlaÄe žene i Äija se prevalencija poveÄava do 50. godine života. Vjerojatnost razvoja ishemijskoga moždanog udara veÄa je u mlaÄih žena koje boluju od migrena s aurom. Genetika igra bitnu ulogu u patofiziologiji migrene i ishemijskoga moždanog udara (IMU), prvenstveno kodirajuÄi proteine koji reguliraju funkciju endotela krvnih žila i produkciju Äimbenika zgruÅ”avanja krvi. Od riziÄnih Äimbenika valja spomenuti pretilost, hiperlipidemiju, hiperglikemiju i puÅ”enje, kao i primjenu oralnih kontraceptiva. Neki kardijalni Äimbenici, kao Å”to je perzistentni foramen ovale, poveÄavaju rizik za razvoj migrene s aurom i ishemijskoga moždanog udara. Kako svi ovi nabrojani Äimbenici utjeÄu na samu patofiziologiju migrene i IMU, joÅ” je predmet istraživanja. Od ostalih vrsta cerebrovaskularnih bolesti postoje naznake da je i hemoragijski cerebrovaskularni inzult ÄeÅ”Äi u mlaÄih žena s migrenom, iako su istraživanja joÅ” uvijek kontradiktorna. Ono Å”to je ipak vidljivo je da žene koje imaju migrenu s aurom, te dobiju neki oblik hemoragijskoga cerebrovaskularnog inzulta, imaju i veÄu vjerojatnost loÅ”ijeg ishoda u vidu smrtnosti ili znaÄajne invalidnosti. Migrene su ÄeÅ”Äe i u nekim drugim cerebrovaskularnim bolestima, kao Å”to su disekcija cervikalnih arterija, te u bolestima malih krvnih žila mozga, gdje presudan utjecaj imaju genetske promjene. Prisutnost vaskularne bolesti ograniÄava primjenu akutne i profilaktiÄke terapije migrene zbog vazokonstrikcijskog uÄinka. Mjere za sprjeÄavanje moždanog udara u bolesnika s migrenom usmjerene su na kontroliranje Äimbenika rizika.Headache is a common symptom of stroke, and primary headaches occur as a common comorbidity. Migraine is a primary headache that mainly affects younger women and whose prevalence increases up until the age of 50. The likelihood of developing an ischemic stroke is higher in younger women who suffer from migraines with aura. Genetics also plays an important role in the pathophysiology of migraine and stroke, primarily encoding proteins that regulate vascular endothelial function and the production of blood clotting factors. Risk factors include obesity, hyperlipidemia, hyperglycemia and smoking, as well as the use of oral contraceptives. Some cardiac factors, such as persistent foramen ovale, increase the risk of developing migraine with aura and cerebrovascular disease. How all these factors affect the very pathophysiology of migraine and cerebrovascular disease is still the subject of research. There are indications that hemorrhagic stroke is also more common in younger women with migraine, although research is still contradictory. What is evident, however, is that women who have a migraine with aura, and suffer a form of hemorrhagic stroke, are also more likely to have a worse outcome in terms of mortality or significant disability. Migraines are more common in some other cerebrovascular diseases such as dissection of the cervical arteries, and in cerebral small blood vessel diseases, where genetic changes are of major influence. The presence of vascular disease limits the use of acute and prophylactic migraine therapy due to its vasoconstrictive effect. Measures to prevent stroke in migraine patients are aimed at controlling risk factors
Brain Tissue Adaptability to Slow-Growing Tumors: Case Report of Clivus Meningioma
A 46-year-old female patient with a large slow-growing craniocervical junction tumor is presented. Her complaints began 6 months before with sensory and painful sensations, sphincter impairment, and motor events (spastic tetra- paresis, more pronounced on the left extremities). Magnetic resonance of the head revealed a rounded tumor of 2.5 cm in diameter, by its characteristics corresponding to meningioma, at the level of C1 vertebra and craniocervical junction, with the base at spinal canal anterior wall, occupying most of the craniocervical junction, compressing spinal cord and medulla oblongata. Intracerebral computed tomography angiography showed spared lumen and a satisfactory image of vertebral arteries bypassing the expansive growth at the occipital foramen, confirming slow tumor growth. Antiedema- tous therapy led to transient improvement in extremity strength and partial recovery of neurologic deficit, which resolved completely upon neurosurgical operation and rehabilitation. This case report exemplifies brain adaptability to slowly growing expansive neoplasms, based on its volume reduction up to the moment when further adaptation is not possible anymore, i.e. breaking of the mechanism of adaptation. Because of brain adaptability, such slowly growing tumors may stay asymptomatic for a long time. Brain plasticity also includes adaptation and autoregulation of the circulation, thus ensuring stable blood flow