Search

Resumen La cefalea es uno de los motivos mas frecuentes de consulta en nuestros centros de salud, algo que no nos debe extranar si tenemos en cuenta que es uno de los sintomas que con mas frecuencia padece la poblacion. La mayor preocupacion del medico de familia, y del medico de urgencias, es llegar a un diagnostico correcto mediante una adecuada historia clinica y una exploracion neurologica basica y adaptada al tiempo y los medios de que dispone. En caso de dudas diagnosticas o sospecha de una cefalea secundaria el medico de atencion primaria o del servicio de urgencias tendran que derivar al paciente para que sea estudiado y/o tratado en los servicios de Neurologia correspondientes, dicha derivacion se hara con mayor o menor urgencia en funcion de la presencia, o no, de los sintomas o los signos de alarma. Un grupo de trabajo constituido por neurologos de la Sociedad Andaluza de Neurologia (SAN) que prestan sus servicios en diferentes hospitales de Andalucia y por Medicos de Familia representantes de la Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) y de la Sociedad Espanola de Medicos de Atencion Primaria (SEMERGEN Andalucia), han elaborado una «Guia rapida» de cefaleas, en la que se abordan los aspectos mas practicos, para el diagnostico, tratamiento y seguimiento del paciente con cefalea. Presentamos en este articulo el capitulo que se ocupa de los criterios de alarma y derivacion.

This is the first large series, comprising 50 patients who suffered a total of 164 episodes, of pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (PMP syndrome). Onset of PMP was between the ages of 14 and 39 years and was most frequent in males (68%). Eight males (24%) and five females (31%) had a personal history of migraine. One-quarter had had a viral-like illness up to 3 weeks prior to the onset of the syndrome. The clinical picture consisted of one to 12 episodes of changing variable neurological deficits accompanied by moderate-to-severe headache and occasionally fever. The headaches were described as predominantly throbbing and bilateral with variable duration (mean, 19 h). The mean duration of the transient neurological deficits was 5 h. Sensory symptoms were most common (78% of episodes), followed by aphasic (66%) and motor (56%) symptoms. Visual symptoms appeared in only 12% of episodes. The most frequent combinations were motor aphasia plus sensory and motor right hemibody symptoms (19% of episodes), motor aphasia plus right sensory symptoms (10%) and isolated right (9%) or left (9%) sensory symptoms. All patients were asymptomatic between episodes and following the symptomatic period (maximum duration 49 days). Lymphocytic pleocytosis ranged from 10 to 760 lymphocytic cells/mm3 CSF (mean, 199). In CSF, protein was increased in 96% of patients, IgG was normal in 80% of cases and oligoclonal bands were not found. Adensoine deaminase values were slightly above normal in two out of 16 patients tested. Extensive microbiological determinations, including viral HIV and borrelia serologies, were negative. Brain CT and MRI were always within normal limits, while EEG frequently showed focal slowing. Conventional cranial angiography was performed on 12 patients. In only one were there abnormalities suggestive of localized vascular inflammation, coincident with the focal neurological symptoms. Two patients developed PMP symptoms immediately after angiography. SPECT, performed on only three patients in the symptomatic period, revealed focal areas of decreased uptake consistent with the clinical symptoms. PMP aetiology remains a mystery; chronic arachnoiditis, viral meningoencephalitis or migraine are not plausible aetiological explanations. Because a number of patients had had a prodromic viral-like illness, we hypothesize here that such a viral infection could activate the immune system, thereby producing antibodies that would induce an aseptic inflammation of the leptomeningeal vasculature, possibly accounting for this clinical picture.

Headache is one of the most frequent reasons for consultation in our health centers, something which should not be surprising if we consider that is one of the most common symptoms experienced by the population. The main concern of the family physician and emergency physician is to reach a correct diagnosis by clinical history and a basic neurological examination and adapted to the time and means at its disposal. In case of diagnostic doubts or suspected secondary headache, the primary care physician or emergency medical have to refer the patient to be studied and/or treated for Neurology services, such referral shall be made with varying degrees of urgency depending on the presence, or not, of symptoms or signs of alarm. A working group consisting of Neurologists of Sociedad Andaluza de Neurología (SAN) to provide services in different hospitals in Andalucía and Family Physicians representatives of the Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFyC) and the Sociedad Española de Médicos de Atención Primaria (SEMERGEN Andalucía), has developed a Quick Guide headache, which addresses the more practical aspects for the diagnosis, treatment and monitoring of patients with headache. We show you in this paper, the chapter that deals the alarm criteria and referral.

Sneddon's syndrome is the association between livedo reticularis and stroke. Hemorrhagic strokes in Sneddon's syndrome are exceptional.A 39-year-old woman who had had a livedo reticularis for about 14 years attended the Emergency Unit complaining of sudden, severe headache and numbness and weakness in her left extremities. Physical examination revealed left supranuclear facial palsy and left crural hemiparesis and hemihypoalgesia. Cranial CT showed a right parieto-occipital lobar haemorrhage. Immunological studies, including antiphospholipid antibodies, were negative. A cerebral angiography showed anomalies in most distal branches of intracranial arteries. Biopsies of the skin and digital arteries yielded non conclusive results.The association between livedo reticularis and stroke, together with the angiographic findings led us to the diagnosis of Sneddon's syndrome. When comparing our case with similar ones, we must point out to its onset with a hemorrhagic stroke and to the lobar location of the bleeding.

Since its first description in 1980, pseudomigraine syndrome with transient neurologic deficits and lymphocytic pleocytosis, or migraine with pleocytosis, has given rise to conflicting opinions regarding its possible etiology and place in the classification of headache. We describe the clinical profile of migraine with pleocytosis and its possible etiopathogenesis, with a broad survey of both Spanish cases and those reported in the English literature.