Acta neurologica Belgica
-
Acta neurologica Belgica · Mar 2019
Review Case ReportsDevelopment of a delayed acute epidural hematoma following contralateral epidural hematoma evacuation: case report and review of literature.
The formation of a post-traumatic delayed epidural hematoma (DEDH) is a rare but well-described complication in the literature. It is defined as an extradural bleeding not evident at the first computed tomography (CT) scan performed after trauma, but evidenced by further radiological evaluations. The most supported hypothesis about the mechanism responsible for the formation of a DEDH concerns above all the loss of a tamponade effect given by the reduction of intracranial pressure with medical or surgical treatment. ⋯ The timing of postoperative radiological examinations after EDH removal has to consider possible complications and has to be balanced on the basis of patient's clinical condition and neuroradiological data, such as skull fractures or intraoperative anomalies. The development of a DEDH after the surgical removal of an EDH is a rare event, characterized by a high mortality rate. DEDH develops preferentially on the contralateral side and with a concomitant skull fracture.
-
Acta neurologica Belgica · Jun 2016
ReviewSpontaneous intracranial hypotension: diagnosis to management.
Spontaneous Intracranial Hypotension typically occurs from spontaneous CSF leak. CSF volume depletion rather than decrease in CSF pressure is thought to be the main causative feature for intracranial hypotension. More and more cases of intracranial hypotension are getting diagnosed with the advances in the imaging. ⋯ To localize the location of the CSF leak-CT myelography is the modality of choice. CSF cysternography may provide additional confirmation in uncertain cases and also MRI spine imaging may be of significant help in some cases. Spontaneous intracranial hypotension continues to be a diagnostic dilemma and our effort was to consolidate available information on the clinical features, diagnostics, and management for a practicing neurologist for a "15-20 min quick update of the topic".
-
Acta neurologica Belgica · Mar 2012
Review Case ReportsTo control or not? A motivational perspective on coping with pain.
Pain relief is often the primordial treatment objective in pain patients. However, an exclusive focus upon pain relief may have costs. Evidence is accumulating that persistent attempts to gain control over pain may, paradoxically, hinder successful adaptation to pain and increase frustration and limitations due to pain. ⋯ A clinical implication is that cautiousness is warranted in promoting strategies exclusively aimed at pain relief. Beyond standard medical care, interventions should also be aimed at the improvement of functioning despite pain. Certainly those patients for whom there is no definite or sound cure to pain and who increasingly experience emotional and physical problems due to pain might benefit from paramedical help by psychologists and/or physiotherapists.
-
Acta neurologica Belgica · Jun 2011
ReviewThe role of magnetic resonance imaging in the study of multiple sclerosis: diagnosis, prognosis and understanding disease pathophysiology.
Magnetic resonance imaging (MRI) has become an established tool to diagnose multiple sclerosis (MS) and to monitor its evolution. In patients at presentation with clinically isolated syndromes suggestive of MS, MRI criteria for MS diagnosis have been proposed and are updated on a regular basis. In addition, MRI "red flags" useful for the differential diagnosis from other neurological conditions which can mimic MS have been identified. ⋯ The use of these techniques has allowed to grade in vivo the heterogeneity of MS pathology not only in focal lesions, but also in the normal-appearing white matter and grey matter. Combined with the use of functional MRI, this is ameliorating progressively our understanding of the factors associated to MS evolution. This review summarizes how MRI has improved our ability to diagnose MS and to predict its course, as well as how it is changing our understanding of the factors associated with the accumulation of irreversible disability in this condition.
-
Acta neurologica Belgica · Dec 2009
ReviewCGRP antagonists: hope for a new era in acute migraine treatment.
Calcitonin gene-related peptide (CGRP) has a widespread distribution throughout the trigeminovascular system and other brain areas involved in migraine pathogenesis. Serum levels of CGRP are elevated during the migraine attack and return to normal with alleviation of pain. Intravenous injection of CGRP in migraineurs results in delayed headache similar to migraine. ⋯ Intravenous BIBN4096BS (olcegepant) and oral MK-0974 (telcagepant), two CGRP-receptor antagonists, were safe and effective in the treatment of migraine attacks in Phase I and II trials. In a Phase III clinical trial, the efficacy of telcagepant 300 mg was comparable to that of zolmitriptan 5 mg. We intend to review the rationale for the use of CGRP-receptor antagonists, and to outline current developments and future perspectives.