Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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In the past, cerebral venous thrombosis (CVT) was considered a rare, devastating disease. The widespread use of angiography, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) over the years has made early diagnosis of CVT possible and has completely changed the perception of this condition. CVT is much more common than previously thought. ⋯ Our retrospective study, confirmed by preliminary results in the prospective multicentric study, showed that headache in CVT is as often acute as subacute, and that it is more frequently localised than diffuse. Finally, both studies showed a significant correlation between headache of acute onset and severe intensity and CVT. We then conclude that these headache features, especially in the presence of underlying prothrombotic conditions, should lead clinicians to consider the diagnosis of CVT and to require appropriate neuroimaging examinations.
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Headache can be either a late or early symptom of a brain tumour, depending on the location of the tumour. A constant, progressively increasing pain, or a change in the character of headache pain, may alert the physician to this occurrence. Fortunately most people with headache, even persistent or severe headaches, do not have a tumour. In this work we review the literature about prevalence of headache as an isolated/early symptom of brain tumour and report our experience.
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Multicenter Study
Does headache represent a clinical marker in early diagnosis of cerebral venous thrombosis? A prospective multicentric study.
The main aim of this study is to look for early clinical markers of cerebral venous thrombosis (CVT). As headache represents the major clinical manifestation at presentation we focused our attention on this symptom. We present the preliminary results of a prospective multicentric study that includes cases diagnosed as CVT in the participating centres. ⋯ The onset of pain was mostly acute-subacute (38.5%-50.0%) and the intensity moderate-severe (37.0%-51.9%). On univariate analysis, we found a positive correlation between CVT, acute headache onset (p=0.001) and severe headache (p=0.004). These preliminary results seem in accordance with our previous findings in the retrospective study, suggesting that CVT is more often associated with acute-onset headache of severe intensity.
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Headache is one of the most common symptoms that leads patients to the emergency room (ER) and is often related to diseases requiring prompt diagnosis and immediate treatment. This consideration brought us to consider the importance of the neurologist in improving the management of patients arriving in the ER with headache. We carried out a study for testing the degree of agreement between ER physician and neurologist using patient evaluation at headache centre (HC) as the gold standard. ⋯ There was no significant difference in the agreement of the three evaluators in patients with impairment of daily living activities or aged over 40. The agreement between the ER physician and the neurologist was lower (Kappa=0.58), especially in patients with their first headache episode. Based on our results, patients seen at the ER for a headache episode can be fairly successfully managed by the ER physician, except those who present a first attack, for whom neurological consultation is needed.
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We investigated if, in patients with vascular lesions, the variable that best discriminated demented from non-demented patients was the severity of the vascular pathology or the degree of hippocampal atrophy. A total of 39 patients multiple subcortical infarcts, who could be considered as possible vascular dementia with small vessel pathology, with underwent a neuropsychological study and brain magnetic resonance imaging (MRI) DSM IV criteria supported by neuropsychological data were used to distinguish demented from non-demented patients. ⋯ The distribution of lesions and a factor analysis showed that hippocampal atrophy is a better predictor of dementia than the number of brain infarcts. Multiple subcortical infarcts alone are probably not able to cause clinical dementia but the presence of vascular lesions increases the expression of concomitant Alzheimer's disease.