RESUMO
INTRODUCTION: Primary headaches are characterised by their high rates of prevalence and incidence among the general population. DEVELOPMENT: The main types of primary headaches that produce a significant social and economic impact as well as an important effect on the health system are migraine and tension-type headaches. Migraine is a condition that gives rise to a high percentage of visits to different health professionals and leads to a large number of prescriptions for medication, which in turn produces an increase in costs. Moreover, general practitioners and other specialists -even from the field of neurology- very often have scant knowledge about primary headaches, especially as regards topics concerning new therapies, the use of the International Headache Society's diagnostic criteria, epidemiology and comorbidities. Furthermore, many of these professionals seldom attend accredited courses in education in headaches and this means that the follow-up of the patients is often inadequate. CONCLUSIONS: The appearance of new pharmaceuticals for the abortive and preventive treatment of headaches, together with the creation of specialised headache centres, has allowed improvements to be made in the treatment of patients with lower overall costs for the health system. At the same time, occupational and personal productivity and quality of life have also been enhanced. Nevertheless, because the number of specialised headache centres is low and their implementation is more complex, there is a need for the creation and dissemination of programmes to educate general practitioners and other health care specialists in matters concerning headaches. Some of these programmes currently being run have obtained statistically significant positive results (p < 0.0001).
Assuntos
Efeitos Psicossociais da Doença , Cefaleia , Custos de Cuidados de Saúde , Transtornos de Enxaqueca , Atividades Cotidianas , Instituições de Assistência Ambulatorial , Analgésicos/economia , Analgésicos/uso terapêutico , Cefaleia/economia , Cefaleia/epidemiologia , Cefaleia/fisiopatologia , Cefaleia/terapia , Serviços de Saúde/economia , Humanos , Transtornos de Enxaqueca/economia , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/fisiopatologia , Transtornos de Enxaqueca/terapia , Triptaminas/economia , Triptaminas/uso terapêuticoRESUMO
INTRODUCTION: Different patterns of headache have been reported in idiopathic intracranial hypertension. PATIENTS AND METHODS: We conducted a retrospective study to evaluate patients in a Columbian hospital who satisfied Friedman and Jacobson criteria for idiopathic intracranial hypertension. Two groups of patients, with throbbing headaches (TH) and heaviness/oppressive headaches (HOH), were correlated with International Headache Society classification criteria. RESULTS: We found 16 patients, 14 of whom were females (87.5%), with a mean age of 27 years. Patients had a history of two months or more (43.7%), 1-2 months (25%) and 2 weeks (18.7%). Six patients were found to be suffering from TH and nine had HOH. In the TH group, headaches were hemicranial (50%), frontal (33.3%), moderate (33.3%), severe (66.6%), got worse with activity (100%), with sickness/vomiting (83.3%), and photophobia (33.3%). All of them had clinical parameters similar to those of migraine. In the HOH group headaches were global (33.3%), hemicranial (22.2%), frontal and occipital (22.2%), moderate (66.6%), severe (33.3%), and with sickness/vomiting (55.5%). 66.6% of them had clinical parameters similar to those of de novo chronic daily headache (NCDH). On carrying out a physical examination in all the patients, paresis of the abducent nerve was found in 31.2% and papilloedema in 93.7%. The average opening pressure was 27 cmH2O. Computerised axial tomography scanning revealed unspecific anomalies in 18.7% and they were also observed with magnetic resonance imaging in 31.2%. Associated pathologies were found in six patients (37%). Pharmacological treatment was effective in 93.8%. There were no relapses or sequelae. CONCLUSIONS: Idiopathic intracranial hypertension is a malady affecting young people, mainly females, with subacute headaches and symptoms similar to those of migraine and NCDH. A neurological abnormality suggestive of intracranial hypertension was found in 31.2-93.7% of patients.
Assuntos
Cefaleia/etiologia , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/fisiopatologia , Adolescente , Adulto , Colômbia , Feminino , Cefaleia/classificação , Cefaleia/tratamento farmacológico , Cefaleia/fisiopatologia , Humanos , Hipertensão Intracraniana/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCTION: The prevalence of epilepsy in the population is between 15 and 18 per 1000. About 60 to 80% of the people affected are considered to have an appropriate long term prognosis (from 5 to 10 years), while between 20 and 40% respond partially to pharmacological therapy. Temporal lobe epilepsy (TLE) is the main cause of refractory epilepsies and is associated to atrophy and sclerosis of the hippocampus. Aims. To determine the physiopathology, clinical characteristics, modes of therapy and prognosis of TLE through a survey of the literature. DEVELOPMENT: The physiopathology of this disease is unknown but early brain injury, with ensuing neuronal death and loss, triggered by mechanisms of excitotoxicity has been put forward as an explanation. TLE presents a clinical picture, which is heterogeneous in childhood and homogeneous in adulthood, that is characterised by the presence of simple partial seizures and complex partial seizures. These seizures can become generalised. Diagnosis is based on the results from the electroencephalogram and from the cranial magnetic resonance, which is currently considered to be the standard diagnostic method. The pharmacological treatment of TLE only achieves complete control over the seizures in less than 20% of patients. Surgical methods, such as anterior temporal lobectomy and amygdalohippocampectomy, reach control rates in 67 85% of patients, with low morbidity and mortality rates. Although prognosis depends on a number of factors, surgical treatment improves the quality of life of these patients.
Assuntos
Epilepsia do Lobo Temporal , Adulto , Tonsila do Cerebelo/cirurgia , Lobectomia Temporal Anterior , Anticonvulsivantes/uso terapêutico , Atrofia , Criança , Terapia Combinada , Resistência a Medicamentos , Eletroencefalografia , Epilepsia Parcial Complexa/diagnóstico , Epilepsia Parcial Complexa/epidemiologia , Epilepsia Parcial Complexa/fisiopatologia , Epilepsia Parcial Complexa/terapia , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/epidemiologia , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/terapia , Hipocampo/patologia , Hipocampo/cirurgia , Humanos , Imageamento por Ressonância Magnética , Prognóstico , Esclerose , Lobo Temporal/fisiopatologiaRESUMO
INTRODUCTION: Thrombosis of the cerebral venous sinuses (TCVS) is an infrequent entity that still represents a challenge in health care. PATIENTS AND METHODS: A descriptive study involving the evaluation of the medical records of patients that met the following criteria: over 18 years of age with a diagnosis of TCVS confirmed by CAT scan or cranial MRI, the absence of a history of intracranial surgery in the previous six months and absence of a history of intracranial infection. RESULTS: A total of 15 patients (14 females and one male) were found with an average age of 28.6 years. The time required for the development of the most frequent symptoms was 1 10 days (60%). The usual presentation was a syndrome of intracranial hypertension with focalisation and encephalopathy. Risk factors were identified in 13 patients (87%). TCVS was diagnosed by cranial MRI in the case of 14 patients (93%), by CAT scanning in one (7%) and this was also used to orient diagnosis in 12 cases (80%). The most frequently affected sinuses were the superior longitudinal and transverse, in 10 cases each (66%), and venous infarctions were also detected in 10 patients (66%). In the patients in whom we were able to evaluate clotting disorders, it was found that the only individual who displayed activated protein C resistance was positive, three out of four patients had a protein C deficiency and four out of six had an antithrombin III deficiency. CONCLUSION: TCVS presents as an intracranial hypertension syndrome and it is possible to find risk factors in as many as 85% of the cases.