Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Review Case Reports
Symptomatic cluster-like headache triggered by forehead lipoma: a case report and review of the literature.
We describe the case of a patient with symptomatic strictly unilateral paroxysmal headache mimicking cluster headache related to an ipsilateral forehead lipoma. Interestingly, immediately after the surgical excision of the lipoma pain attacks disappeared with no recurrence during a follow-up period of 18 months. ⋯ To our knowledge, this is the first well-described cluster-like headache case secondary to an extracerebral lipoma. This case offered the opportunity to discuss the possible pathophysiological mechanisms underlying probable TACs and the relationship with peripheral extracerebral activation of the trigeminal-autonomic reflex.
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Case Reports
Recovery from acute paraplegia due to spontaneous spinal, epidural hematoma under minimal-dose acetyl-salicylic acid.
Spontaneous spinal epidural hematoma (SEH) has not been reported under anti-thrombotic therapy with acetyl-salicylic acid (ASA) in a dosage of 50 mg/d. ⋯ This case shows that SEH occurs under a minimal dose of ASA and that such patients rapidly recover upon immediate surgical decompression and evacuation of the hematoma.
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The modern treatment of spontaneous intracranial hemorrhages requires a multidisciplinary approach including neurosurgery, interventional neuroredicology, vascular neurology and radiosurgery to determine the best management strategy.
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Primary intracerebral hemorrhage is the least treatable form of stroke and is associated with high mortality rates. In the thrombolytic era, the attention has bee driven on the first hours of onset, when the hematoma is still growing. ⋯ Even if recombinant activated factor VII administered within 4 h of symptom onset did not improve outcome in a recent phase 3 trial, it reduced hematoma growth. Therefore, the rational for ultra-early hemostatic therapy it is still valid and another trial on hemostatic treatment is warranted.
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Intracerebral hemorrhage (ICH) accounts for between 10% to 30% of first-ever strokes; outcomes are significantly worse than with ischemic stroke with a 30-day mortality rate up to 50%, furthermore, half of the deaths occur in the acute phase. Intracerebral hemorrhage (ICH) is classified as primary or secondary according to the underlying etiology. Primary ICH (about 80%) comes from the spontaneous rupture of small vessels more often in relation to long-standing or uncontrolled arterial hypertension and is generally located in the basal ganglia and internal capsula. ⋯ Rapid recognition and diagnosis of ICH as well as identification of early prognostic indicators are essential for planning the level of care and avoiding acute rapid progression during the first hours. Hematoma size has been identified as one of the most important predictors of 30-day mortality and its expansion is highly predictive of neurological deterioration. Blood pressure management remains, although controversial, the first-line medical approach along with possible new and effective treatments coming from the numerous between pilot and larger randomized medical trials for ICH completed in the past decade.