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PL
The aim of this paper is to present the case of a 62-year-old man with a sphenoid sinus cyst with skull base destruction. He was admitted to hospital with severe headache, visual disturbance, left ear conductive hearing loss, and loss of weight. The complaints had been increasing over the last two years. The diagnosis of the sphenoid sinus cyst with the sella turcica destruction was established two years ago but the patient refused treatment. On admission, the CT revealed a pathological mass in the left sphenoid sinus (density of 48 HU, size of 33x25x25 mm), causing extensive destruction of its left and upper walls with penetration into the skull. MRI confirmed the presence of a 28x24-mm cyst which was adjacent to the bottom of the sella and did not penetrate to the brain. In addition, the studies revealed chronic sinusitis with polyps. The patient was treated by endoscopic sinus surgery under navigation system. Wide marsupialization of the frontal wall of the sphenoid sinus cyst and removal of the polypoid changes were carried out. Pain subsided after surgery. A control MRI revealed thickening of the mucous membranes of the ethmoid, sphenoid, and maxillary sinuses, and the left mastoid cells. Moreover, no evidence of invagination of the meninges within the operated area was stated.
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2020
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vol. 34
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issue 2
26-31
EN
Introduction Headaches are a common health issue. The second most common type of headache is the tension-type headache (migraine-type headache is the most common type). Tension-type headaches are often referred to as stress-related or psychogenic headaches. Tension-type headaches often correspond with feeling unwell, and with depression or anxiety. Often they are drug resistant. This means that the treatment process may require patients to consider lifestyle changes. Patients seek other treatment types than pharmacotherapy and consider more holistic approaches, for instance natural medicine, breathing exercises or traditional Chinese medicine. The literature presents relationships between craniosacral therapy and headaches of various etiology, yet relatively few studies have been conducted on this matter. This study provides an additional insight into this therapeutic method. The aim of this study was to establish whether craniosacral therapy can reduce pain. Material and methods the study involved 30 adult patients. There were 22 women (73.3%) and 8 male patients (26.7%). Their mean age was 30.13 ± 5.33 years. The treatment used the Upledger’s 10-step protocol and sessions were performed four times within a two-week period. Results Prior to the treatment, the mean HIT-6 scale pain intensity was 62.67 ± 4.65 points. After the treatment, pain intensity reduced to a statistically significant level of 48.43 ± 9.45 points. We found that pain reduction was greater in patients with higher BMI. The gender or age of patients did not affect the results. Conclusion Craniosacral therapy is an efficient pain reduction method in patients with tension-type headaches.
EN
Introduction: Migraine and allergies are common occurrences. The aim of this study was to investigate the relationship between respiratory allergy and cephalalgic migraine in childhood. Materials and Methods: We screened 800 children for headache and its characteristics. After that we investigated the presence of allergy performing prick tests, rhinoscopy, endoscopy, rhinomanometry, nasal cytology and mucociliary clearance tests. Results: Out of 800 children screened, 96 suffered from headache. Among these, 67 resulted to suffered from both headache and allergy. We found a significant correlation between allergy and headache onset in the morning and headache onset in the evening in non-allergic subjects. The average duration of the a headache attack was independent from the presence of allergy, as well as the frequency of the cephalalgy attacks, and the localization of the pain. Prodromal symptoms connected with headache were reported to be: dizziness, aurea, sparkling scotoma, nausea and vomiting, and they were associated with absence of allergy. We also found a relationship between female gender and headache onset, but in teen-agers only. Paracetamol or FANS were used in the majority of cases, but antihistaminic therapy and/or nasal topical sprays were also reported. Discussion: For an effective diagnostic and therapeutic approach to migraine, the pediatrician should take into account atopy and its related allergic manifestations requiring a consultation with an otolaryngologist or allergist, if necessary. Our findings also stress the potential role of medicines that are not usually utilized for migraine attacks, such as antihistamines or decongestionant nasal sprays.
EN
Introduction: Migraine and allergies are common occurrences. The aim of this study was to investigate the relationship between respiratory allergy and cephalalgic migraine in childhood. Materials and Methods: We screened 800 children for headache and its characteristics. After that we investigated the presence of allergy performing prick tests, rhinoscopy, endoscopy, rhinomanometry, nasal cytology and mucociliary clearance tests. Results: Out of 800 children screened, 96 suffered from headache. Among these, 67 resulted to suffered from both headache and allergy. We found a significant correlation between allergy and headache onset in the morning and headache onset in the evening in non-allergic subjects. The average duration of the a headache attack was independent from the presence of allergy, as well as the frequency of the cephalalgy attacks, and the localization of the pain. Prodromal symptoms connected with headache were reported to be: dizziness, aurea, sparkling scotoma, nausea and vomiting, and they were associated with absence of allergy. We also found a relationship between female gender and headache onset, but in teen-agers only. Paracetamol or FANS were used in the majority of cases, but antihistaminic therapy and/or nasal topical sprays were also reported. Discussion: For an effective diagnostic and therapeutic approach to migraine, the pediatrician should take into account atopy and its related allergic manifestations requiring a consultation with an otolaryngologist or allergist, if necessary. Our findings also stress the potential role of medicines that are not usually utilized for migraine attacks, such as antihistamines or decongestionant nasal sprays.
EN
Introduction. There is need for any healthcare setup to rapidly identify Sinus headache patients from other cases of Neurological and Primary headaches like Migraine and Chronic Tension type headache. Materials and Methods. 117 cases of confirmed sinusitis were evaluated and analysed for common traits which could help in rapid diagnosis of Sinusitis. Results. Unilateral, dull aching headache and facial pain, of changing intensity, lasting all day on an average of 4 to 6 hours with a previous short history of common cold in acute sinusitis is the most common pattern observed in this study. Discussion. Unilateral, dull aching headache and facial pain, of variable intensity, lasting all day on an average of 4 to 6 hours along with is highly sensitive criterion (91%) for diagnosis of acute sinusitis. This, along with a history of previous Upper Respiratory tract infection, is useful to rapidly screen patients for acute sinusitis (95% sensitive). Though a subset of other headache cases will also be included by the criteria, imaging or Endoscopy must be done in these positive cases to increase the specificity of the diagnostic criteria.
EN
The First Bite Syndrome is a rare late (1-2 months) post operation complication of surgery in the infratemporal fossa, parapharyngeal space and especially involving the deep lobe of parotid gland. Sometimes it can significantly worsen the patient's quality of life. Acute, sudden, short time pain in the parotid gland region with irradiation to the ear during the first bite a meal is a characteristic for this syndrome. The correct diagnosis and individual approach in choosing a treatment method is the key to success in treating this complication. The purpose of our article is to supplement scanty data on this complication in Polish literature.
EN
Migraine is one of the most common neurological disorders. In Poland, approximately 4 million individuals suffer from migraine headaches. A migraine headache may last 4-72 hours, is throbbing, moderate to severe in intensity, usually unilateral and is associated with nausea, vomiting, and hypersensitivity to light and sound. Lack of biological markers and inter-individual variations result in problems with correct diagnosis. Pathophysiological basis of migraine remains unclear, but recent research including neuroimaging and genetic studies, has significantly advanced our understanding of migraine pathophysiology. Since over 30 years, there is ongoing research on the role of melatonin – hormone enabling adaptation of the organism to cyclic changes in environmental conditions – in the pathophysiology of migraine. Experimental studies revealed manifold associations between secretion of melatonin and migraine, but this correlation has not been clearly determined. Several studies confirmed altered secretion of melatonin in patients with migraine. Available data assessing melatonin profile in persons with migraine depend on nature of headache (episodic or chronic) and temporal relationship of sampling to headache attack (ictal or interictal). Currently, there are only few reports concerning attempts at using melatonin in the treatment of migraine. Largescale, multicentre trials are necessary to define principles of use of melatonin in the treatment of migraine.
PL
Migrena jest jednym z najczęstszych schorzeń neurologicznych. W Polsce cierpi na nią około czterech milionów osób. Napad migreny zwykle trwa od 4 godzin do 72 godzin i charakteryzuje się wystąpieniem silnego, zazwyczaj połowiczego, pulsującego bólu głowy z towarzyszącymi nudnościami, wymiotami, nadwrażliwością na światło i dźwięki. Brak biologicznych markerów choroby oraz jej zmienny przebieg u różnych chorych powodują trudności w postawieniu właściwej diagnozy. Patofizjologia migreny pozostaje nadal niejasna, ale dzięki licznym badaniom, w tym neuroobrazowym i genetycznym, jesteśmy coraz bliżej pełnego jej poznania. Od ponad trzydziestu lat prowadzone są badania nad rolą melatoniny – hormonu umożliwiającego przystosowanie organizmu do cyklicznie zmieniających się warunków środowiska, w patofizjologii migreny. W badaniach doświadczalnych wykazano liczne powiązania pomiędzy sekrecją melatoniny a patofizjologią migreny, jednak zależność ta nie została jednoznacznie określona. Wiele innych badań dowodzi również zaburzeń sekrecji melatoniny u pacjentów z migreną. Wyniki dostępnych w piśmiennictwie badań oceniających profil melatoniny u pacjentów z migreną zależą od charakteru bólu głowy (epizodyczny czy przewlekły) oraz czasu wykonania pomiaru stężenia melatoniny (w trakcie napadu bólu głowy czy w okresie międzynapadowym). Aktualnie nieliczne są doniesienia dotyczące prób zastosowania melatoniny w terapii migreny. Przeprowadzenie zakrojonych na szeroką skalę, wieloośrodkowych badań jest niezbędne do ustalenia zasad stosowania melatoniny w leczeniu migreny.
EN
Dissection of the extracranial carotid and vertebral arteries is responsible for 2–3% of all strokes and for 20% of ischaemic events in the population of young people under the age of 45. Vertebral artery dissection is a very rare yet serious condition. The annual overall incidence of vertebral artery dissection is estimated at 1 to 1.5 per 100 000 persons. Its clinical manifestation is very nonspecific and diverse. The most typical clinical sign is sudden unilateral headache accompanied by neck pain. Other symptoms include systemic and non-systemic headaches as well as infarction or transient ischaemic attack in posterior circulation territorial area inn case where the intracranial vertebral artery dissection is associated with subarachnoid haemorrhage. The aetiology of dissection remains unclear and connected with multiple risk factors. Vertebral artery dissection can be caused by blunt force trauma of the head or neck or it can be spontaneous. The aetiology of spontaneous vertebral artery dissection includes vascular and genetic factors as well as structural defects of the arterial wall associated with connective tissue disorders. The diagnosis of vertebral artery dissection has to be established based on anamnesis, clinical features and imaging examination. Catheter cerebral angiography is the gold standard of diagnosis of arterial dissection, but also computed tomography angiography has been proven to have a very high sensitivity and specificity. In most cases extracranial vertebral artery dissection carries a good prognosis. The treatment of vertebral artery dissection is conservative and includes the use of anticoagulation and antiplatelet drugs. Surgical or endovascular treatment can be applied only for selected and small group of patients. Authors emphasize that clinical features can be very unspecific and vertebral dissection may be misdiagnosed especially in the first hours following the manifestation of symptoms. Vertebral artery dissection should be taken into consideration in the diagnosis of stroke in young persons despite unspecified symptoms and without traumatic history.
PL
Rozwarstwienie tętnic dogłowowych w odcinku zewnątrzczaszkowym odpowiada za 2–3% wszystkich udarów niedokrwiennych i 20% incydentów niedokrwiennych w populacji osób poniżej 45. roku życia. Rozwarstwienie tętnicy kręgowej występuje stosunkowo rzadko, z roczną częstością 1–1,5 na 100 tys. osób, ale wiąże się z poważnymi konsekwencjami. Obraz kliniczny jest bardzo niespecyficzny i zróżnicowany. Najczęstszy objaw to nagły, jednostronny ból głowy, któremu może towarzyszyć ból szyi. Wymienia się także zawroty głowy o charakterze układowym i nieukładowym oraz objawy wynikające z udaru bądź przejściowego niedokrwienia w tylnym obszarze unaczynienia mózgu, gdy rozwarstwienie dotyczy odcinka zewnątrzczaszkowego naczynia, lub krwotoku podpajęczynówkowego – w przypadku rozwarstwienia wewnątrzczaszkowego odcinka tętnicy kręgowej. Etiologia rozwarstwienia jest różnoraka, związana z wieloma czynnikami. Wyodrębnia się rozwarstwienie urazowe, spowodowane najczęściej tępym urazem głowy i/lub szyi, oraz rozwarstwienia spontaniczne (samoistne). W przypadku rozwarstwienia samoistnego bierze się pod uwagę czynniki naczyniowe i genetyczne oraz zaburzenia w budowie ściany naczynia związane z chorobami tkanki łącznej. W przypadku podejrzenia rozwarstwienia tętnicy kręgowej rozpoznanie ustala się na podstawie wywiadu, objawów klinicznych i badań obrazowych. Złotym standardem diagnostycznym pozostaje klasyczna angiografia naczyń dogłowowych, a wśród badań nieinwazyjnych angiografia tomografii komputerowej wykazuje 100-procentową swoistość i czułość. W większości przypadków rozwarstwienie tętnicy kręgowej w odcinku zewnątrzczaszkowym wiąże się z dobrym rokowaniem. Leczenie ma charakter zachowawczy i obejmuje terapię lekami przeciwzakrzepowymi lub przeciwpłytkowymi. Leczenie chirurgiczne i wewnątrznaczyniowe stosuje się w określonych grupach pacjentów. Co ważne, nietypowe objawy kliniczne w początkowym okresie rozwarstwienia naczynia utrudniają diagnozę. Rozwarstwienie tętnicy kręgowej powinno być brane pod uwagę w przypadku udaru mózgu u osoby młodej, mimo niecharakterystycznych objawów i braku urazowego wywiadu.
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