A 38-year-old woman with a history of migraine presented with two tonic-clonic seizures confined to the left size of the body, which occurred one hour apart. The second seizure was followed by severe headache and hemiplegia ipsilateral to the seizures, which persisted for 24 hours, reversing completely thereafter. Brain MRI and a 21-channel EEG were normal. A lumbar puncture revealed CSF under normal opening pressure, discrete lymphocyte pleocytosis, and normal glucose and protein levels. This patient meets the diagnostic criteria for HaNDL syndrome, a rare condition of unknown cause, whose prognosis is usually favorable, with complete reversal of symptoms within a few weeks. Its diagnosis must be taken into account to avoid the practice of invasive tests or complex treatments that are not devoid of adverse effects.
headache
Crisis focales como síntoma de presentación del síndrome HaNDL (cefalea transitoria y déficits neurológicos con pleocitosis linfocitaria). Focal seizures revealing HaNDL syndrome (Transient headache and neurological deficits with lymphocytic pleocytosis).
Mixoma de aurícula derecha como probable causa de migraña. Right atrial myxoma as a probable cause of migraine.
Introduction: Cardiac myxoma is a benign tumor known as the “great imitator” because it can manifest clinically in a very diverse manner and/or with nonspecific findings that create a lot of confusion and make diagnosis difficult. It is associated with neurological manifestations, typically secondary to embolic complications affecting the nervous system, such as ischemic strokes, which can cause dizziness, headaches, loss of consciousness, and/or vision and speech disturbances.
Clinical Case: A 16-year-old female patient with a six-month history of headaches and no other neurological history. She was hospitalized for diagnostic evaluation by the neurology department, where her condition was interpreted as primary migraine-type headaches without aura. Among the tests performed during her hospitalization, an intracardiac mass in the right atrium was detected, compatible with cardiac myxoma, confirmed by postoperative histopathological analysis. She evolved favorably without presenting neurological symptoms again.
Conclusion: The occurrence of migraines in patients with cardiac myxomas is rarely reported, and this condition has only been associated with myxomas located in the left heart chambers. Describing the different published pathophysiological mechanisms that can lead to this neurological condition, and due to the unusual nature of the case reported, given the location of the neoplasm in the right heart chambers, it is considered possible that the migraine may have originated from the synthesis and release of vasoactive intestinal polypeptide by the myxomatous tumor.
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Profilaxis en la Migraña: Descripción de la Prescripción en un Primer Nivel de Colombia. Migraine Prophylaxis: Description Of The Prescription In A First Level Of Colombia
Introduction: Migraine is a prevalent disease, crisis can be prevented with medication for not less than 6 months.
Objective: To identify the drugs used for the prophylactic treatment of migraine, inappropriate prescriptions and associated variables.
Materials and methods. Cross-sectional study, in patients of legal age, diagnosed with migraine and prescribed with prophylactic medications. Sociodemographic, comedication, comorbidities and drugs variables were included. Univariate, bivariate and binary logistic regression analysis was performed. Inappropriate prescription was defined by the formulation of drugs without evidence of effectiveness for prophylaxis or by the use of drugs at doses or subtherapeutic times.
Results: 241 patients were included, 87.1% were women. 87.6% of patients received effective drugs, 10.8% probably effective, 2.5% possibly effective and 10.4% drugs without evidence. Propranolol was the most commonly used drug for prophylaxis, on average for 69.1±57.2 days, followed by valproic acid (53.2±55.3 days) and amitriptyline (45.7±39.6 days). 99.6% of patients presented an inappropriate prescription.
Conclusions: A high inadequate prescription of medications for the prophylactic treatment of migraine was identified due to not complying with the recommended dose and duration, as well as an important use of drugs without evidence.
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Trombosis Venosa Cerebral en una paciente con Linfoma no Hodgkin en remisión.
Introduction: Cerebral venous thrombosis is an unusual complication, scarcely reported in patients with non-Hodgkin lymphoma with indolent and not too aggressive type.
Case report: We describe the clinical picture of a woman with low degree non-Hodgkin lymphoma with an evolution of one year remission post treatment, who developed a sinus rectus thrombosis without relationship with intracranial extension nor treatment induced hypercoagulability state. The first manifestation was isolated migraine.
Conclusion: In patients with non-Hodgkin lymphoma and isolated migraine is important to perform neuroimaging studies in order to exclude a cerebral venous thrombosis.
