Search

Spontaneous intracranial hypotension is a rare condition, but due to increased awareness and better diagnostics it is more frequently reported. This is a case report of a 52-year-old male with sudden onset of vertigo and orthostatic headache. Initial workup was negative, but over the following six months symptoms progressed and bilateral hygromas were identified. Complete recovery was noted after two autologous blood patches. The importance of clinical presentation and differential diagnoses of spontaneous intracranial hypotension is emphasized.

Idiopathic intracranial hypertension (IIH) is characterised by intractable headache, papilloedema, visual symptoms, pulsatile tinnitus and elevated intracranial pressure (ICP). The incidence has increased, most likely due to the simultaneous increase in obesity. This review finds that imaging is centered on ruling out structural causes of elevated ICP as well as visualising classical signs of IIH. Surgery is only indicated for patients at risk of acute vision loss and first line treatment in Denmark is optic nerve sheath fenestration, liquor drainage followed by endovascular treatment.

Idiopathic intracranial hypertension (IIH) is a challenging disease characterized by an increase in intracranial pressure which occurs without any known cause. The disease is mainly seen in obese females of child-bearing age. While originally described as rare, the incidence is increasing in parallel with pandemic obesity, and clinicians in all fields are increasingly likely to meet patients with IIH. The condition causes major morbidity due to chronic headache and visual loss if untreated. In the past ten years new diagnostic criteria and guidelines for management have been published.

Medication-overuse headache (MOH) is a disabling, costly and often overlooked disorder. The prevalence in Denmark is 1.8% equivalent to 80.000-100.000 adults. The aim is to increase awareness of clinical presentation and treatment options for patients with MOH when encountered in primary care setting, exemplified by three representative cases. Clinical presentation of MOH and three treatment approaches are discussed. MOH is a chronic disorder which is preventable and treatable.

Idiopathic intracranial hypertension (IIH) is a disease of unknown aetiology. IIH typically affects young obese females. The majority of the cases are complicated by papilloedema, visual loss and significant headache. Weight loss is, in addition to medical therapy, the mainstay of IIH management. Medical therapy is currently solely based on clinical experience. Malignant cases with rapid visual deterioration may require immediate surgical treatment in order to prevent irreversible visual loss. Early identification is essential, and increased awareness of IIH is important.

Intensive care contributes to a substantial part of health care expenses. Admission to intensive care units is associated with a high mortality rate and a high risk of long-term disability. Data from several studies suggest that suboptimal standards of intensive care are relatively common. Lack of knowledge regarding the use of intensive care and long-term outcome as well as the effectiveness and adverse effects of intensive care impede a systematic and evidence-based development and quality improvement. An initiative to establish a Danish national clinical database for intensive care has been launched.

A cluster headache is an attack of half-sided very strong pain in or behind an eye, lasting for up to a few hours with tearing and rhinorrhea and sometimes Horner's syndrome. The attacks occur in clusters of weeks' to some months' duration. A cluster headache is a neurovascular primary headache which seems to involve the hypothalamus. The clinical picture, diagnosis and investigations are reviewed. The attack can be treated with oxygen or subcutaneous sumatriptan, and verapamil, ergotamine and prednisolone can be successfully used for prophylaxis. Early diagnosis and specific treatment are emphazised.

Headache is the most frequent pain disorder, and 31% of the adult Danish population has sought medical assistance due to headache. In addition, the socio-economic costs of headache are substantial, and a national treatment strategy is therefore important. With respect to treatment of migraine, considerable scientific progress has been made, whereas the scientific interest in and treatment of the highly prevalent tension-type headache are insufficient. The most frequent primary headache disorders, their differential diagnosis and the current treatment strategy are briefly reviewed.

Frequent use of symptomatic headache drugs may induce medication overuse headache. In primary care settings, medication overuse headache is the third common diagnosis of headache, next to migraine and tension-type headache. The pathophysiologic mechanisms are unknown. It is a severely disabling condition that has a huge economic impact on society. Treatment includes complete drug withdrawal, and the prognosis is good. Preventive measures and providing information to the patients are very important.

Headache is extremely prevalent and experienced by almost everyone. A clinical test for the diagnosis of headache is still lacking, and a detailed clinical description is therefore essential for a precise diagnosis. The second edition of the International Headache Classification is presented, along with a translation into Danish. The major changes from the first edition are a detailed description of several subtypes of migraine, three subdivisions of tension-type headache according to frequency of headache and a major extension of the chapter concerning secondary headaches due to medication overuse. General knowledge of the major subforms of primary and secondary headaches is a very important tool for diagnosis and treatment.

Percutaneous dilatational tracheostomy (PDT) was performed on a 64 year-old female multitraumatised patient. Because of difficulties during the procedure, fiberoptic tracheoscopy was carried out and revealed perforation and dilatation of the endotracheal tube. The error was corrected with little loss of time, and no complications were observed after finishing the procedure. We recommend the use of routine fiberoptic tracheoscopy during and after percutaneous dilatational tracheostomy as suggested by Ciaglia et al (2).

Fifteen patients electively selected for percutaneous dilatational tracheostomy as performed with the Ciaglia Percutaneous Tracheostomy Introducer Set are reported in this preliminary study. The median time for insertion of the tracheostomy tube was 13.1 min. Complications were cuff puncture of the translaryngeal tube at an early stage of the procedure in one case, and minor bleeding controllable by the compressible effect of the dilatational procedure in three cases. During the posttracheostomy period complications included one case of minor bleeding controllable by digital compression and one case of minor infection, i.e. cellulitis in a few millimetres around the stoma without purulent secretion. Our preliminary results indicate that the technique as performed with the Ciaglia Introducer Set is effective and safe with only minor complications. Furthermore, we now use it as a bed-side procedure in the ICU, thus avoiding the transportation of critically ill patients to the operating theatre. A conclusion on the superiority of percutaneous tracheostomy to dissectional tracheostomy has to await clinical randomized studies including more patients.