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Viana M, Khaliq F, Zecca C, Figuerola MDL, Sances G, Di Piero V, Petolicchio B, Alessiani M, Geppetti P, Lupi C, Benemei S, Iannacchero R, Maggioni F, Jurno ME, Odobescu S, Chiriac E, Marfil A, Brighina F, Barrientos Uribe N, Pérez Lago C, Bordini C, Lucchese F, Maffey V, Nappi G, Sandrini G, Tassorelli C. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol 2019; 27:536-541. [PMID: 31574197 DOI: 10.1111/ene.14098] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. METHODS This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. RESULTS In all, 1161 patients completed the study. Twenty-eight per cent of participants were aware that they suffered from migraine. Sixty-four per cent called their migraine 'headache'; less commonly they used terms such as 'cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty-eight per cent of patients had received symptomatic migraine-specific medications and 29% at least one migraine preventive medication. CONCLUSIONS Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.
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Affiliation(s)
- M Viana
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Headache Center, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.,Headache Group, Department of Basic and Clinical Neurosciences, King's College London, London, UK
| | - F Khaliq
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Scunthorpe General Hospital, North Lincolnshire, UK
| | - C Zecca
- Headache Center, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - M D L Figuerola
- Hospital de Clínicas José San Martín, Buenos Aires, Argentina.,Hospital Alemán, Buenos Aires, Argentina
| | - G Sances
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - V Di Piero
- Sapienza University of Rome, Rome, Italy
| | | | | | - P Geppetti
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Lupi
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Benemei
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | | | | | - M E Jurno
- FAME/FUNJOB and FHEMIG, Barbacena, Brazil
| | - S Odobescu
- National Headache Center, Institute of Neurology and Neurosurgery of Chisinau City, Chisinau, Moldova
| | - E Chiriac
- National Headache Center, Institute of Neurology and Neurosurgery of Chisinau City, Chisinau, Moldova
| | - A Marfil
- Hospital Universitario, Monterrey, Mexico
| | - F Brighina
- Headache Center, Department BIONEC, University of Palermo, Palermo, Italy
| | | | | | - C Bordini
- Clínica Neurológica Batatais, Batatais, Brazil
| | - F Lucchese
- Sapienza University of Rome, Rome, Italy
| | - V Maffey
- Sapienza University of Rome, Rome, Italy
| | - G Nappi
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sandrini
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Martinez HR, Rangel-Guerra R, Arredondo-Estrada JH, Marfil A, Onofre J. Medical and surgical treatment in neurocysticercosis a magnetic resonance study of 161 cases. J Neurol Sci 1995; 130:25-34. [PMID: 7650528 DOI: 10.1016/0022-510x(94)00278-v] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a prospective non-controlled study we have treated 161 consecutive cases of Active Neurocysticercosis (NCC) diagnosed by Magnetic Resonance (MR). Active NCC was classified in: (1) brain parenchymal cysts (85 cases); (2) ventricular cysts (24 cases); (3) subarachnoid cysts (46 cases); and (4) cysticercus racemose (6 cases). All patients had MR follow up 1 month after treatment. Twenty five patients had MR with gadopentetate dimeglumine (Gd) contrast enhancement. Cine MR was performed in one patient. Medical treatment with albendazole (ABZ) or Praziquantel (PZQ) was applied in 136 cases. Drug efficacy, assessed by disappearance of the lesion on MR, was 92.5% with ABZ and 60% with PZQ. Thirty patients were treated by surgery. Five patients of group I were treated surgically due either to refractory seizures or persistent abnormalities on MR. Ventricular cysts were removed in 20 cases; 4 cases with cysticercus racemose and one with subarachnoid spinal cyst were also treated by surgery. Two patients with 4th ventricle cysts received ABZ and ventricular shunt only. Two cases with intraventricular cysts (lateral ventricles) and two with racemose cysts were successfully treated with ABZ. The Gd infusion showed enhancement in cysts with adjacent inflammatory reaction or edema and in cases with meningeal inflammation. Cine MR was useful in the differential diagnosis with congenital arachnoid cyst. We conclude that (1) MR is sensitive in the diagnosis of active NCC and may be useful in evaluating degenerative changes in the parasite; (2) ABZ is highly effective in the treatment of parenchymal and subarachnoidal NCC; (3) Parenchymal lesions which remain with abnormal appearance on MR (Degenerative cysticerci or gliosis) and refractory seizures should be treated by surgery; (4) Cysticercus racemose without intracranial hypertension may be treated with ABZ; (5) Ventricular cysts are treated by surgical removal, however, ABZ and ventricular peritoneal shunt may also be an alternative approach.
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Affiliation(s)
- H R Martinez
- Internal Medicine Department, Hospital Universitario U.A.N.L., Monterrey, Mexico
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Rangel-Guerra RA, Martínez HR, Marfil A, Bosques Padilla F, Cavazos R. [Reye's syndrome in an adult. Review of pathogenic mechanisms]. Rev Invest Clin 1994; 46:417-20. [PMID: 7839023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Reye's syndrome is considered a disease of the pediatric age. It is characterized by a prodrome of viral illness followed by vomiting and encephalopathy with associated hepatic dysfunction. This syndrome is potentially life-threatening with high morbidity and mortality rates. There are 27 other cases of adult onset Reye's syndrome reported in the literature. We describe a 18-year-old woman who developed varicella and four days later started with vomiting, delirium and in the following day she became comatose. Laboratory tests of liver function and pathology of a liver biopsy proved the diagnosis. The patient survived. A review of the proposed pathogenic mechanisms are presented. Our patient represents case the number 28 in world literature and the first in the mexican literature.
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