Elaboración de criterios diagnósticos del vértigo y la migraña

Introducción: El vértigo recurrente asociado a la migraña es una causa de vértigo en los pacientes con migraña. Aunque es una entidad controvertida cada vez más autores defienden esta entidad y publican sobre el tema. Con una fisiopatología posiblemente relacionada a la migraña los pacientes presentan crisis recurrentes de vértigo que pueden durar de horas a varios días, Típicamente no suelen ser posicionales y no se acompañan de otros síntomas neurootológicos. Dentro del diagnóstico diferencial se deben incluir las causas más habituales de vértigo recurrente, como la enfermedad de Ménière, la vestibulopatía autoinmune o el vértigo recurrente asociado a la migraña. Responde habitualmente a los mismos tratamientos de la migraña, de tal manera que las crisis pueden mejorar con triptanes y el vértigo con fármacos preventivos de la migraña. Objetivos: Elaborar y validar unos criterios diagnósticos para el vértigo recurrente asociado a la migraña fiables, válidos y con confiabilidad. Validar su uso en la consulta y evaluación telefónica. Determinar la frecuencia que aparecen el vértigo recurrente asociado a la migraña en los pacientes con migraña y estimar la prevalencia en la población general..

Infiltración con onabotulinumtoxinA y bloqueos en el paciente con cefalea y neuralgia: recomendaciones de seguridad frente a la infección por SARS-CoV-2

Introducción La infección por SARS-CoV-2 y la situación de pandemia hacen necesario un cambio en nuestra práctica clínica, en relación con la adopción de nuevas estrategias que permitan la asistencia integral de los pacientes con cefalea y neuralgia. Material y métodos Ante la elevada capacidad de transmisión del virus, determinados procedimientos, como la infiltración de onabotulinumtoxinA y la realización de bloqueos anestésicos, deben realizarse adoptando medidas que garanticen un nivel adecuado de seguridad. Resultados Nuestro objetivo es presentar una serie de recomendaciones basadas en las medidas establecidas por nuestro sistema sanitario para evitar el contagio. Diferenciaremos entre aquellas medidas relacionadas con el paciente y el facultativo, con la técnica, con la infraestructura (sala de espera y consulta) y con la gestión asistencial. Introduction: The COVID-19 pandemic has given rise to the need for changes in clinical practice, with new strategies to enable integrated care for patients with headache and neuralgia. Material and methods: Given the high spreadability of SARS-CoV-2, new safety measures are required in such procedures as onabotulinumtoxinA infiltration and nerve blocks. Results: We present a series of recommendations based on the measures implemented to prevent infection in our healthcare system. We differentiate between measures related to patients and physicians, to technique, to infrastructure (waiting room and consultation), and to healthcare management

A rare midbrain infarction presenting with plus-minus lid syndrome with ataxia: a case report

<p>Abstract</p> <p>Introduction</p> <p>We present the case of a patient with midbrain infarction with an unusual clinical presentation, where clinical diagnosis and anatomical localization were valuable tools in deciding treatment.</p> <p>Case presentation</p> <p>Our patient was a 59-year-old, right-handed Caucasian man with hypertension who presented to our facility with acute diplopia that persisted until he developed complete right-sided ptosis. He also had difficulty walking and coordinating movements of his upper extremities bilaterally, but this was worse on his left side.</p> <p>Conclusions</p> <p>Plus-minus lid syndrome with ataxia is a rare presentation of midbrain infarction with a unique localization and anatomical description. This case highlights the importance of clinical skills for making a diagnosis in the absence of imaging to confirm the findings.</p

Acute monocular oligemia in a patient with migraine with aura demonstrated using OCT-angiography: A case report.

Introduction: Migraine is one of the most common causes of transient visual loss. Optical coherence tomography angiography (OCTA) provides fast and non-invasive imaging of the retinal vessels. We report one case of monocular retinal oligemia demonstrated using OCTA during a migraine attack with aura. Case description: A 27-year-old man with a previous history of migraine with visual aura was seen in the emergency room due to acute left hemicranial pain with positive visual symptoms in his right eye. The patient reported a blue stain in his right eye. Optical coherence tomography angiography (OCT-A) showed an extensive area of hypoperfusion in the macular region of his right eye. Forty-eight hours later visual symptoms had improved and the OCT-A showed a significant reduction in the area of hypoperfusion. Seven days later the patient was asymptomatic and retinal perfusion had returned to normal values. Conclusion: Monocular involvement suggests that these retinal vascular changes are independent from cerebral vascular changes, supporting the hypothesis of selective retinal ganglion cell layer spreading depression as the possible cause of some cases of retinal migraine.pre-print515 K

Neuroimaging in the evaluation of patients with non-acute headache

Available studies offer only limited guidance on neuroimaging of non-acute headache patients. The aim of this study was to estimate the frequency of significant intracranial lesions in patients with headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. All patients aged ≥l 15 years attending the Neurology Clinic with non-acute headache were included in the study and followed prospectively. Every patient was investigated by neuroimaging studies, either computed tomography or magnetic resonance imaging. Neuroimaging results were classified as ‘significant abnormalities’, ‘nonsignificant abnormalities’ or ‘normal’. Significant abnormalities included neoplastic disease, hydrocephalus, vascular malformations, Chiari malformation, large arachnoid cysts, intracranial haemorrhage, and acute cerebral infarcts. Consecutive patients (n = 1876; 1243 women and 633 men) were included. Their mean age was 38 years (range 15-95 years). Neuroimaging studies detected significant lesions in 22 patients [1.2%, 95% confidence interval (CI) 0.7, 1.8]. The rate of significant intracranial abnormalities in patients with headache and normal neurological examination was 0.9% (95% CI 0.5, 1.4). The only clinical variable associated with a higher probability of intracranial abnormalities was neurological examination. The proportion of patients with headache and intracranial lesions is relatively small, but neither neurological examination nor the features in the clinical history permit us to rule out such abnormalitie

Editorial: Consequences of the COVID-19 Pandemic on Care for Neurological Conditions

The coronavirus disease 2019 (COVID-19) pandemic has caused a wide range of unprecedentedconsequences, including social, economic, and health disruptions. From the point of view ofhealthcare assistance, COVID-19 has deeply impacted usual practice at all levels since the beginningof 2020. In this setting, neurological assistance has adapted to the circumstances of the pandemic. Infact, because COVID-19 involves neurological symptoms, affected patients require the attention ofneurologists, and the high demand for clinical care entailed the recruitment ofmany neurologists tofrontline assistance (1). In addition, the pandemic has impacted the management of patients withneurological disorders, with changes in the management of relapses, usual follow-up, diagnosticprocedures, implementation or generalization of telemedicine, etc. Lockdown and social isolationwere also very harmful in patients with neurological disorders (2). Furthermore, the treatment ofneurological emergencies, such as stroke, was also compromised because of resource re-allocationduring the emergency, and the fear of patients to attend the hospital.The neurological community needed to share experiences about how to face this globalchallenge. Accordingly, this Research Topic was launched in April 2020 to address these issues.Over 117 manuscripts were submitted, and 76 papers have been published, including originals,reviews, and case reports. Studies have covered the main areas of neurological care, includinggeneral neurological care, stroke, epilepsy, multiple sclerosis, movement disorders, cognitiveneurology, neuromuscular disorders, headache, and neuropediatricsFil: Matias Guiu, Jordi A.. Universidad Complutense de Madrid; EspañaFil: Sung, Sheng Feng. No especifíca;Fil: Hsieh, Cheng Yang. No especifíca;Fil: Nezu, Tomohisa. No especifíca;Fil: Porta Etessam, Jesús. Universidad Complutense de Madrid; EspañaFil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Wallenberg’s syndrome and symptomatic trigeminal neuralgia

Symptomatic trigeminal neuralgia due to a brainstem infarction is said to be rare. However, facial pain is not uncommon in Wallenberg’s syndrome. Facial pain related to a Wallenberg’s syndrome may be either persistent of intermittent, and occasionally occurs in brief attacks. Here, we report a patient with a right lateral medullary infarction who started having first division trigeminal neuralgia 1 month after the stroke. The pain paroxysms were suppressed with gabapentin

Deep Phenotyping of Headache in Hospitalized COVID-19 Patients via Principal Component Analysis

Producción CientíficaObjectives: Headache is a common symptom in systemic infections, and one of the symptoms of the novel coronavirus disease 2019 (COVID-19). The objective of this study was to characterize the phenotype of COVID-19 headache via machine learning. Methods: We performed a cross-sectional study nested in a retrospective cohort. Hospitalized patients with COVID-19 confirmed diagnosis who described headache were included in the study. Generalized Linear Models and Principal Component Analysis were employed to detect associations between intensity and self-reported disability caused by headache, quality and topography of headache, migraine features, COVID-19 symptoms, and results from laboratory tests. Results: One hundred and six patients were included in the study, with a mean age of 56.6 ± 11.2, including 68 (64.2%) females. Higher intensity and/or disability caused by headache were associated with female sex, fever, abnormal platelet count and leukocytosis, as well as migraine symptoms such as aggravation by physical activity, pulsating pain, and simultaneous photophobia and phonophobia. Pain in the frontal area (83.0% of the sample), pulsating quality, higher intensity of pain, and presence of nausea were related to lymphopenia. Pressing pain and lack of aggravation by routine physical activity were linked to low C-reactive protein and procalcitonin levels. Conclusion: Intensity and disability caused by headache attributed to COVID-19 are associated with the disease state and symptoms. Two distinct headache phenotypes were observed in relation with COVID-19 status. One phenotype seems to associate migraine symptoms with hematologic and inflammatory biomarkers of severe COVID-19; while another phenotype would link tension-type headache symptoms to milder COVID-19.Grant 07.04.467804.74011.0 - Institute of Health Carlos III (ISCIII

Factors Associated with the Differences in Migraine Prevalence Rates between Spanish Regions

We have analyzed the relation of prevalence rates in Spanish regions with a series of human, environmental, and ecological factors. We find that the variability in migraine rates found between Spanish regions may be explained by interregional differences in the percentage of daily smokers, percentage of alcohol consumers, percentage of population presenting physical and/or psychological life-limiting conditions, percentage of population engaging in physical exercise, minimum absolute temperatures per year, number of days under 0°C per year, and altitude

Prevalence and clinical characteristics of Charles Bonnet syndrome in Madrid, Spain

Purpose: Charles Bonnet syndrome (CBS) is a condition characterized by development of visual hallucinations in patients with no cognitive impairment and significant loss of vision mainly caused by age-related macular degeneration (AMD) or glaucoma. Methods: This was a study of prevalence and characteristics of CBS diagnosed at the Neuroophthalmic Unit within the Ophthalmology Department of Hospital Clínico San Carlos (HCSC), Madrid, Spain. Results: The CBS prevalence in patients from HCSC Madrid is 0.47%, rising to 15% in patients with low vision. Women over 80 years of age comprised 58.3% of the patients, who mainly had AMD (58.3%). Main characteristics of hallucinations included animals (50%), color (58.3%), moving (75%), 6- to 12-month evolution (50%), three times a day frequency (75%), and 3- to 5-minute duration (50%). Conclusions: Charles Bonnet syndrome is a complex process that must be treated jointly by ophthalmologists, neurologists, and psychiatrists in order to ensure accurate diagnosis and adequate management. New studies are needed in order to improve awareness of clinical manifestation of this condition, the incidence of which is underestimated due to patients' fear of being branded mentally ill, as well as physicians' lack of knowledge about CBS