Double dissociation between autonomic symptoms and pain in cluster headache.
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Autonomic Nervous System Diseases↗
Biomedical subjects
I P Martins
Publications and source records attributed to I P Martins.
Headaches associated with refractive errors: myth or reality?
INTRODUCTION: Headache and refractive errors are very common conditions in the general population, and those with headache often attribute their pain to a visual problem. The International Headache Society (IHS) criteria for the classification of headache includes an entity of headache associated with refractive errors (HARE), but indicates that its importance is widely overestimated. OBJECTIVES: To compare overall headache frequency and HARE frequency in healthy subjects with uncorrected or miscorrected refractive errors and a control group. METHODS: We interviewed 105 individuals with uncorrected refractive errors and a control group of 71 subjects (with properly corrected or without refractive errors) regarding their headache history. We compared the occurrence of headache and its diagnosis in both groups and assessed its relation to their habits of visual effort and type of refractive errors. RESULTS: Headache frequency was similar in both subjects and controls. Headache associated with refractive errors was the only headache type significantly more common in subjects with refractive errors than in controls (6.7% versus 0%). It was associated with hyperopia and was unrelated to visual effort or to the severity of visual error. With adequate correction, 72.5% of the subjects with headache and refractive error reported improvement in their headaches, and 38% had complete remission of headache. Regardless of the type of headache present, headache frequency was significantly reduced in these subjects (t = 2.34, P =.02). CONCLUSIONS: Headache associated with refractive errors was rarely identified in individuals with refractive errors. In those with chronic headache, proper correction of refractive errors significantly improved headache complaints and did so primarily by decreasing the frequency of headache episodes.
Adolescent↗
Hypnic headache and travel across time zones: a case report.
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Aged↗
Behavioral response to headache: a comparison between migraine and tension-type headache.
OBJECTIVE: To compare patients with migraine and tension-type headache in their behavior during the attacks and the maneuvers used to relieve the pain. BACKGROUND: Patients with headache often perform nonpharmacological measures to relieve the pain, but it is not known if these behaviors vary with the diagnosis, clinical features, and pathogenesis. METHODS: One hundred consecutive patients with either migraine (n = 72 ) or tension-type headache (n = 28) were questioned (including the use of a checklist) concerning their usual behavior during the attacks and nonpharmacological maneuvers performed to relieve the pain. The results of the two types of headache were compared. RESULTS: Patients with migraine tended to perform more maneuvers than individuals with tension-type headache (mean, 6.2 versus 3). These maneuvers included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet, and becoming immobile during the attacks. The only measure predominantly reported by patients with tension-type headache was scalp massage. However, the benefit derived from these measures was not significantly different between the two groups (except for a significantly better response to isolation, local pressure, local cold stimulation, and symptomatic medication in migraineurs). CONCLUSIONS: The behavior of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed to prevent its worsening or to improve associated symptoms. These behavioral differences may be due to the different pathogenesis of the attacks or to different styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.
Adolescent↗
Loss of topographic memory and prosopagnosia during migraine aura.
We report the case of a 28-year-old woman with a past history of acephalalgic migraine. She had a complex migraine aura with left-sided scintillating scotomas, hemianopia, left-sided paresthesias, a loss of topographic and procedural memory, and prosopagnosia. The rarity of right hemisphere cognitive dysfunction during the aura, its diagnostic difficulties, and differential diagnosis are discussed.
Adult↗
Acquired procedural dyscalculia associated to a left parietal lesion in a child.
We report the case of an 11-year-old boy who developed an anarithmetia in association with a left temporo-parietal tumor. His oral and written language were normal as well as his ability to judge magnitudes, process numbers, read operation signs and retrieve number facts. He had a specific difficulty in performing the procedures of subtraction, especially when it involved borrowing. These skills had been mastered before the present illness. This case shows that the components of calculation can be dissociated by brain lesions sustained during childhood, while arithmetic abilities are being acquired, thus reinforcing findings from developmental dyscalculias, that suggest a modular organisation of those skills during development.
Brain Neoplasms↗
Childhood aphasias.
The study of acquired childhood aphasia has shown that the aphasic syndromes found in adults are reproducible in children with identical lesion sites and that some brain areas are essential for aphasia recovery. Besides, language deficits and learning difficulties are very common in the long-term follow-up of those children. This suggests that the adult pattern of cerebral organization for speech is established early in life and alternative organizations have a lasting price. Yet in contradiction with this, children with focal lesions sustained pre- or perinatally do not show developmentally the aphasic syndromes observed in older children and adults. One possible explanation is that the areas responsible for learning a function are different from those subserving that function as a more mature stage of development. Concerning specific language impairment in children, there is a growing evidence that such syndromes are genetically determined, but there is still a missing link between this predisposition and the structural/functional defects underlying them. The finding that these children are often impaired in other areas of mental development indicates that there may be a more basic cognitive defect underlying their language disorders.
Adult↗
Aphasia following right hemisphere lesion in a woman with left hemisphere injury in childhood.
The case of a 56-year-old woman who became aphasic following a right temporoparietal lesion is reported. At the age of 2, this woman had an acute infantile hemiplegia on the right side of the body and it was reported by relatives that a deterioration of language was also noted. There was a slow recovery of these deficits and she was considered as having normal language only at age 7. Although it is difficult to be sure about the hand preference of the patient before the stroke at age 2, the relatives were quite positive saying, that she previously preferred the right hand and that she became left handed. The CT scan showed an old left frontal ischemic lesion and a recent right temporoparietal lesion. This case illustrates the ability of the right hemisphere to take over functions of the left when a left lesion occurs in early stages of language acquisition. Although this is an accepted model for recovery, this is the only case in the literature with a documented early focal lesion of the left hemisphere. Other evidence comes from studies performed in populations where severe epilepsy may contribute to particular functional organization.
Aphasia↗
EEG monitoring during endovascular embolization of cerebral arteriovenous malformations.
Arteriovenous malformations (AVMs) may have a bad prognosis. Endovascular embolization with cyanocrylate represents nowadays an important initial step in a staged treatment, that later may include surgery or radiotherapy. Embolization may induce significant changes in the dynamics of the cerebral circulation, some of which may provoke neurological sequelae. Therefore assessment of potential complications is usually done by using a superselective amytal test, during which small doses of amytal are injected directly in the pedicle that is going to be embolized. In spite of an extensive use of the EEG during endovascular embolization its evaluation in terms of benefits and limitations is not available. Such evaluation is therefore the aim of this work. EEG monitoring was performed during endovascular embolization of 19 patients; a large majority of patients presented large AVMs, with Spetzler indexes around IV or V. The main results were as follows: (1) EEG changes at baseline were significantly correlated with the AVM size and the Spetzler index but were unable to predict the difficulties in the embolization; (2) during amytal tests EEG positivity reached 35% and consisted mainly in ipsilateral slow focal activity; (3) in some cases embolization was performed in spite of transient EEG changes. It was found that focal or diffuse abnormalities in the lower frequency range, even when slight, could be followed by clinical hazards (3 out of 11 cases); (4) EEG monitoring was important in the prediction, evaluation and prognosis of clinical complications.
Adolescent↗
Atypical dominance for language in developmental dysphasia.
The authors report an association between developmental language disorder and acquired aphasia in a 13-year-old right-handed boy. Acquired aphasia was caused by a right-frontal abscess (crossed aphasia). It was non-fluent, with a disorder of auditory comprehension, an unusual feature of prerolandic lesions. This case shows that developmental language impairment can be associated not only with an atypical cerebral dominance, but also with unusual patterns of intrahemispheric specialization. The rapid and complete recovery of this boy's aphasia suggests that the cerebral plasticity for acquired lesions can be normal in such cases.
Adolescent↗
Extratrigeminal ice-pick status.
We describe six patients with an identical type of headache, consisting of short episodes (lasting around 1 week) of daily attacks of ice-pick-like pain, recurring every minute in the same points of the scalp. In all of them, the pain was felt outside the cutaneous area of the trigeminal nerve (retroauricular, parietal, and occipital regions). All patients were examined in the emergency department of a general hospital over a period of 7 years because of these acute headaches. None of them had a history of migraine. Although this pain is identical to idiopathic stabbing headache, it differs from it by its temporal profile (in "status"), its posterior (extratrigeminal) location, and its lack of association with migraine. While the bouts were usually severe and recurred in two patients, all had a self-limited benign course and responded promptly to indomethacin.
Adult↗
Raeder's syndrome. A case with an unusual localization.
We describe a patient with a Raeder's paratrigeminal neuralgia consisting of left-sided frontal and orbital pain, Horner syndrome (including anhydrosis of the forehead), and sensory loss in the territory of the first division of the trigeminal nerve. The involvement of the ophthalmic nerve is not consistent with the usual localization of this syndrome to the pericarotid sympathetic plexus. Oculosympathetic and sympathetic fibers supplying the sweat glands of the forehead join the ophthalmic nerve in the cavernous plexus localized in the cavernous sinus. Therefore, this seems to be the most likely site of the lesion when the ophthalmic nerve is involved.
Adult↗
Headaches during intracranial endovascular procedures: a possible model of vascular headache.
We report a series of 11 patients who developed headaches during intracranial endovascular procedures performed for the treatment of arteriovenous malformations (10 cases) or aneurysms (1 case). Headache was precipitated either by balloon inflation (3 cases) or by embolization (8 cases), and had a very constant pattern. In all cases the pain started suddenly, reaching maximum intensity at once. Headache was focal, unilateral, ipsilateral to the occluded artery, nonthrobbing and short-lasting (usually less than 10 minutes). It was not associated with gastrointestinal, autonomic, or aura-like symptoms. Headache localization depended upon the catheterized artery, being constant for each of the major vascular territories. Yet, in all patients pain was felt in the cutaneous territory of the ophthalmic division of the trigeminal nerve. The occurrence of headache was not associated with cortical deficit nor cortical irritation (assessed both clinically and by the EEG) and therefore seems to be directly related to the stimulation of the arterial wall. This type of pain can be used as a model of pure vascular headache. Its study can contribute not only to understand the pattern of intracranial vascular innervation but also to understand or to refute the vascular components of migraine.
Adolescent↗
Atypical facial pain, ectasia of the basilar artery, and baclofen: a case report.
Atypical facial pain is a clinical syndrome of facial pain that has been related to depression but whose pathogenesis is not known. We describe a 72-year-old woman with a chronic facial pain, and ectasia and left sided deviation of the basilar artery, that responded dramatically to baclofen. This case suggests that vascular compression of the trigeminal nerve may be one of the mechanisms producing this syndrome and in these cases it might respond to baclofen.
Aged↗
Acquired crossed aphasia in a child.
A case is reported of acquired aphasia in a 15-year-old right-handed boy, secondary to a right occipitotemporal tumour. He had aphasia, alexia, agraphia and visuospatial disturbances, which persisted after partial removal of the neoplasm. 15 days after surgery he had an episode of left focal seizures, after which the aphasia worsened. One month later he developed severe (global) aphasia associated with rostral extension of the tumour. Although crossed aphasia was previously considered common in children, there are few reports with anatomical confirmation. In the authors' own series of 31 children with acquired aphasia this is the only case of crossed aphasia, an incidence similar to that found in adult cases.
Adolescent↗
Acquired conduction aphasia in a child.
An 11-year old girl is described who acquired conduction aphasia after head trauma. Detailed study of her repetition defect showed that it was because of impaired short-term verbal memory. CT scan showed two hypodense areas in the left hemisphere, which included the supramarginal gyrus and Wernicke's area. This case is similar to adults with conduction aphasia, indicating the early intrahemispheric specialisation for verbal functions, in this case auditory verbal short-term memory.
Aphasia↗
Neglect in children.
Three children developed neglect following right-hemispheric lesions. In the first, computed tomography (CT) demonstrated a striatoinsular infarction. In the second, CT revealed a large meningioma compressing the right hemisphere, and in the third, CT revealed two intracerebral hemorrhages in the right posterior parietal and occipital lobes. Neglect in these children produced a clinical picture comparable to that occurring in adults, but there was a rapid and complete recovery. The paucity of reports of neglect in children may be a function of the rapid recovery, the phenomenon being missed if not looked for in the acute stage. We conclude that, at least for children aged 6 years or more, the right hemisphere is dominant for directed selective attention.
Attention↗
CT scan correlates of gesture recognition.
The ability to recognise gestures was studied in 65 left-hemispheric stroke patients whose lesions were located by CT scan. In the acute stage (first month) frontal lobe and basal ganglia were frequently involved in patients showing inability to recognise gestures. In the later (third to fourth month) and chronic stages (greater than 6 months) parietal lobe involvement was important; lesions causing gesture recognition impairment were larger, had more extensive and frequent parietal involvement and produced less temporal lobe damage than those causing aural comprehension defects. These findings are discussed in the light of recent models of cerebral localisation of complex functions.
Aged↗