Asunto(s)
Adenoma/fisiopatología , Blefaroptosis/etiología , Diplopía/etiología , Apoplejia Hipofisaria/diagnóstico , Neoplasias Hipofisarias/fisiopatología , Adenoma/cirugía , Anciano , Parálisis Facial/etiología , Parálisis Facial/fisiopatología , Cefalea/etiología , Cefalea/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Náusea/etiología , Enfermedades del Nervio Oculomotor/etiología , Enfermedades del Nervio Oculomotor/fisiopatología , Apoplejia Hipofisaria/etiología , Apoplejia Hipofisaria/fisiopatología , Apoplejia Hipofisaria/cirugía , Neoplasias Hipofisarias/cirugía , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vómitos/etiologíaRESUMEN
In the present study we describe the cases of two patients with cluster-like headache related to intracranial carotid artery aneurysm. One of these patients responded to verapamil prescription with headache resolution. In both cases the surgical clipping of the aneurysm resolved the cluster pain. These findings strongly suggest a pathophysiological link between the two conditions. The authors discuss the potential pathophysiological mechanisms underlying cluster-like headache due to intracranial carotid artery aneurysm.
Asunto(s)
Cefalalgia Histamínica/diagnóstico , Cefalalgia Histamínica/etiología , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico , Enfermedades del Nervio Oculomotor/etiología , Hemorragia Subaracnoidea/etiología , Vías Aferentes , Bloqueadores de los Canales de Calcio/uso terapéutico , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Arteria Carótida Interna/cirugía , Angiografía Cerebral , Cefalalgia Histamínica/fisiopatología , Diagnóstico Diferencial , Humanos , Aneurisma Intracraneal/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Midriasis/etiología , Procedimientos Neuroquirúrgicos , Enfermedades del Nervio Oculomotor/diagnóstico , Enfermedades del Nervio Oculomotor/fisiopatología , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/cirugía , Instrumentos Quirúrgicos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares , Verapamilo/uso terapéuticoRESUMEN
BACKGROUND: To review the preoperative signs of bilateral superior oblique paresis and to analyze their presence. METHODS: The proposed preoperative signs of bilateral superior oblique (SO) muscle paresis were separated into "certain signs" and "suspicious signs." The signs were analyzed for accuracy using case examples and statistics. RESULTS: A strong preoperative sign of bilateral SO muscle paresis was reversal of the hypertropia in the ipsilateral (and/or ipsi-supralateral) position and/or in the contralateral head tilt position. In such cases, the addition of a light contralateral weakening procedure to the operation aimed at the elimination of the hypertropia caused by the more affected SO muscle prevented development of the clinical picture of a contralateral SO muscle paresis. A suggestive preoperative sign of bilateral SO muscle weakness was marked reduction of the hypertropia in the ipsilateral (and ipsi-supralateral) position, as well as in the contralateral head tilt position. In these cases, a contralateral inferior oblique muscle weakening was deferred until after motility could be reassessed postoperatively. An additional sign of possible bilateral SO muscle weakness was the presence of a large V pattern. CONCLUSIONS: When planning surgery for apparent unilateral SO muscle paresis, the surgeon should be aware of the often subtle preoperative signs of bilateral SO muscle paresis. Early diagnosis allows the surgeon to avoid the reversal of the clinical picture or to advise the patient of the possibility of a bilateral problem.