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Introduction: After the European Headache Federation (EHF) Congress, renowned Spanish neurologists specialised in migraine presented the most significant latest developments in research in this field at the Post-EHF Meeting., Development: The main data presented concerning the treatment of chronic and episodic migraine were addressed, with attention paid more specifically to those related to preventive treatments and real-life experience in the management of the disease. An important review was carried out of the new therapeutic targets and the possibilities they offer in terms of understanding the pathophysiology of migraine and its treatment. An update was also presented of the latest developments in the treatment of migraine with fremanezumab, a monoclonal antibody recently authorised by the European Medicines Agency. Participants were also given an update on the latest developments in basic research on the pathology, as well as an overview of the symptoms of migraine and COVID-19. Finally, the repercussions of migraine in terms of its burden on the care and economic resources of the health system were addressed, along with its impact on society., Conclusions: The meeting summarised the content presented at the 14th EHF Congress, which took place in late June/early July 2020. more...

Introduction: About half of the patients with chronic migraine do not respond or do not tolerate the different migraine preventatives., Aim: To analyse the efficacy and tolerability of zonisamide in the treatment of migraine in patients who had not responded or tolerated topiramate, the current drug of choice for the treatment of this condition., Patients and Methods: Those patients with no response or intolerance to topiramate received zonisamide. This drug was increased 25 mg per week up to a maximum of 200 mg/day. The efficacy of this drug was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment., Results: Our series comprises a total of 34 patients, most of them middle-aged women. All met chronic migraine criteria. Zonisamide showed efficacy (response) in 19 patients (56%), response being excellent in 6 (18%). Nine patients (26%) did not show response, whereas 6 (18%) did not tolerate the drug., Conclusions: The results, obtained in patients refractory to other preventatives and particularly to topiramate, suggest that zonisamide can be useful in the prevention of chronic migraine. Of course, controlled clinical trials are necessary to confirm these preliminary results. more...

Introduction: T2*-weighted gradient echo MRI sequences (T2*-MRI) have made it possible to detect cerebral microhemorrhages (MH) that have been considered as subclinical but whose clinical significance is largely unknown., Objective: To establish the frequency of MH in a sample of consecutive symptomatic cerebrovascular disease (SCD) patients, analyzing its associations with different vascular risk factors (VRF) and its clinical significance., Methods: A total of 198 patients with SCD were consecutively examined using T2*-MRI. Preferential location of MH and associations between MH presence and MH number with VRF, previous antithrombotic treatment and SCD subtypes were analyzed., Results: A total of 52.5% of our patients had MH. The highest frequency of MH was found in hemorrhagic strokes (72.2%), Transitory ischemic attack (TIA) (42.9%) being the group with the lowest frequency. According to the bivariate analysis, the factors associated with the presence of MH were elderly age (72.4+/-10.5 vs 67.7+/-12.7; p 0.004), hypertension (65.4 vs 51.1%; p 0.041), diabetes (35.6 vs 22.3 %; p 0.041) and being under antithrombotic treatment (45.2 vs 28.7 %; p 0.017). According to the multivariate analysis, elderly age (p 0.019; OR: 1.03 [1.01- 1.06]), hypertension (p 0.032; OR: 1.97 [1.06-3.65]), use of antithrombotic treatment (p 0.038; OR: 1.95 [1.04-3.65]) and having a hemorrhagic stroke (p 0.028; OR: 3.63 [1.15- 11.46]) were predictors of MH presence., Conclusions: The presence of MH is frequent among patients with SCD, this being especially elevated in patients with hemorrhagic stroke. Cerebral MHs are classically associated with VRF classically related with small vessel disease and previously taking antithrombotic treatment. more...

Introduction: The uveo-meningitic syndrome, or the combination of chronic or recurrent meningitis and acute uveitis, has a specific differential diagnosis. This syndrome can be the clinical debut of systemic disorders, vasculophathies, connective tissue disorders and inmuno-mediated diseases. In patients with AIDS, the syndrome often appears in relation with an opportunist concomitant infection of the central nervous system (CNS)., Case Report: We present one case of subacute uveo-meningitic syndrome as symptomatic presentation of a early infection of HIV. The patient was a man, 37 years-old. He was inmunocompetent and did not know his seropositivity for HIV type 1. We relate the results of the neurologic examination and complementary tests. Only serologic test for HIV type 1 and detection of IgG anti-HIV in cerebrospinal fluid were positives., Conclusions: In patients HIV-positive the ocular infection, usually a posterior uveitis, appears together with systemic disorders or central nervous infections. In other hand, the cause of meningitic infection depends on grade of immunocompromise. Aseptic meningitis, for early stages of the disease, is usually no symptomatic. After, opportunist infections or neoplasic infiltration of CNS can be cause of meningoencephalitis. In this patient, the early infection of HIV causes an subacute uveomeningoencephalitis. Early infection of HIV increases the possibilities of aetiological diagnosis of uveomeningitic syndrome. more...

Posttraumatic headache (PTHA) is, usually, one of several symptoms of the posttraumatic syndrome and therefore may be accompanied by somatic, psychological or cognitive disturbances. The aetiology of these symptoms in individuals with mild traumatic brain injury or whiplash injury has been a subject of some controversy with explanations ranging from neural damage to malingering. PTHA can resemble a tension-type headache, migrainous or cervicogenic headaches. Post-whiplash headache habitually is a pain radiating from the neck to the forehead, with moderate intensity and benign, but prolonged course. The pathogenesis of PTHA is still not well-known but might share some common headache pathways with primary headaches. In this chapter, we review recent investigations in the pathophysiology of PTHA, review recognised risk factors for a poor outcome and give some recommendations of management. We also discuss the new diagnostic criteria of IHS Classification, 2004, for PTHA and Headache attributed to whiplash. more...

Introduction: The objective of our study is to know the efficacy and safety of endovascular treatment in our setting., Patients and Methods: a) prospective evaluation of patients with aneurysmal subarachnoid hemorrhage (SAH) or incidental aneurysm (Dec 1999-Dec 2002), and b) neurological, angiographic and evolutive evaluation of the endovascularly operated patients., Results: A total of 79 patients were evaluated: 75 with SAH, 4 with incidental aneurysm. Arteriographies were performed in 74 (93.6%), detecting 58 aneurysms in 52 patients, 15 of the anterior communicating artery (25%) and 14 of the posterior communicating artery (24%). Fifty-two aneurysms were treated with Guglielmi Detachable Coiling (GDC) (89.6 %). Total occlusion (100 %) was obtained in 48 (82.7%) and partial occlusion in 4. Technique failure occurred in six cases. The earlier complications, after endovascular procedure (< 24 h), were one rebleeding, four angiographic spasms and ischemia and one coil displacement. During the first month, there were other cases of rebleeding and two cases of spasm and ischemia. Morbidity rate was 11.5 %. Death rate was 5.7 %. Follow-up period ranges between 6 and 42 months. After endovascular treatment 40 patients had a favourable outcome (Ranking 1-2) and 9 suffered moderate-severe incapacity (Ranking 3-5). We prescribed angiographic controls one year after the hemorrhagic event and there was only one case of aneurysmal recurrence., Discussion: In our experience endovascular treatment is useful to treat ruptured and unruptured aneurysms, with similar surgical occlusion, morbidity and death rates. more...

The reoperation of patients with recurrence of cerebral glioma is a technique offering survival with a good quality of life. The accepted criteria are a Karnofski index until reoperation greater than or equal to 70, young age, and a favourable histologic grade of tumor. NMR offers better sensitivity than other neuroimaging techniques for the detection of tumoral extension, local and at a distance, and allows a good tumoral resection. We report a patient with recurrence of a cerebral astrocytoma grade II with the criteria for reoperation, but when we performed NMR a dissemination of the tumor to the posterior fossa was seen, and reoperation was consequently counter-indicated. We discuss the mechanism of the extension of cerebral gliomas, the value of neuroimaging techniques and the role of reoperation in this context. We consider it necessary to perform NMR prior to reoperation in this special group of patients with a cerebral glioma recurrence. more...