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Peretz AM, Woldeamanuel YW, Rapoport AM, Cowan RP. Spontaneous extracranial hemorrhagic phenomena in primary headache disorders: A systematic review of published cases. Cephalalgia 2016; 36:1257-1267. [PMID: 26611681 DOI: 10.1177/0333102415618951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Head pain is a cardinal feature of primary headache disorders (PHDs) and is often accompanied by autonomic and vasomotor symptoms and/or signs. Spontaneous extracranial hemorrhagic phenomena (SEHP), including epistaxis, ecchymosis, and hematohidrosis (a disorder of bleeding through sweat glands), are poorly characterized features of PHDs. Aim To critically appraise the association between SEHP and PHDs by systematically reviewing and pooling all reports of SEHP associated with headaches. Methods Advanced searches using the PubMed/MEDLINE, Web of Science, Cochrane Library, Google Scholar, and ResearchGate databases were carried out for clinical studies by combining the terms "headache AND ecchymosis", "headache AND epistaxis", and "headache AND hematohidrosis" spanning all medical literature prior to October 10, 2015. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were applied. Results A total of 105 cases of SEHP associated with PHDs (83% migraine and 17% trigeminal autonomic cephalgias) were identified (median age 27 years, male to female ratio 1:2.3); 63% had epistaxis, 33% ecchymosis, and 4% hematohidrosis. Eighty-three percent of studies applied the International Classification of Headache Disorders diagnostic criteria. Eighty percent of the reported headaches were episodic and 20% were chronic. Twenty-four percent of studies reported recurrent episodes of SEHP. Conclusions Our results suggest that SEHP may be rare features of PHDs. Future studies would benefit from the systematic characterization of these phenomena.
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Affiliation(s)
- Addie M Peretz
- 1 Stanford Headache and Facial Pain Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yohannes W Woldeamanuel
- 1 Stanford Headache and Facial Pain Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan M Rapoport
- 2 Department of Neurology, The David Geffen School of Medicine at UCLA in Los Angeles, USA
| | - Robert P Cowan
- 1 Stanford Headache and Facial Pain Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Byard RW. Lethal Epistaxis. J Forensic Sci 2016; 61:1244-9. [PMID: 27282512 DOI: 10.1111/1556-4029.13119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/24/2015] [Accepted: 11/15/2015] [Indexed: 12/18/2022]
Abstract
Epistaxis or nosebleed refers to bleeding from the nostrils, nasal cavity, or nasopharynx. Occasional cases may present with torrential lethal hemorrhage. Three cases are reported to demonstrate particular features: Case 1: A 51-year-old woman with lethal epistaxis with no obvious bleeding source; Case 2: A 77-year-old man with treated nasopharyngeal carcinoma who died from epistaxis arising from a markedly neovascularized tumor bed; Case 3: A 2-year-old boy with hemophilia B who died from epistaxis with airway obstruction in addition to gastrointestinal bleeding. Epistaxis may be associated with trauma, tumors, vascular malformations, bleeding diatheses, infections, pregnancy, endometriosis, and a variety of different drugs. Careful dissection of the nasal cavity is required to locate the site of hemorrhage and to identify any predisposing conditions. This may be guided by postmortem computerized tomographic angiography (PCTA). Despite careful dissection, however, a source of bleeding may never be identified.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA, 21 Divett Place, Adelaide, 5000, Australia. .,School of Medicine, Level 3 Medical School North Building, The University of Adelaide, Frome Rd, Adelaide, 5005, Australia.
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Iglesias Morales C, Duca Rezzulini F, Latre Saso C, Gonzalez Paniagua C, Iturri Clavero F, Martinez Ruiz A. Topiramate as concomitant antiepileptic treatment; an isolated perioperative hypofibrinogenaemia. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:240-242. [PMID: 26386515 DOI: 10.1016/j.redar.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/03/2015] [Accepted: 06/04/2015] [Indexed: 06/05/2023]
Abstract
A description of a case is presented of an isolated hypofibrinogenaemia acquired in relation to taking topiramate used as concomitant treatment of a drug resistant epilepsy. The hypofibrinogenaemia developed in the course of a month after the introduction of the drug, and was diagnosed in the perioperative period.
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Affiliation(s)
- C Iglesias Morales
- Anestesiología, Reanimación y Terapia del Dolor, Hospital de Cruces, Baracaldo, Vizcaya, España.
| | - F Duca Rezzulini
- Anestesiología, Reanimación y Terapia del Dolor, Hospital de Cruces, Baracaldo, Vizcaya, España
| | - C Latre Saso
- Anestesiología, Reanimación y Terapia del Dolor, Hospital de Cruces, Baracaldo, Vizcaya, España
| | - C Gonzalez Paniagua
- Anestesiología, Reanimación y Terapia del Dolor, Hospital de Cruces, Baracaldo, Vizcaya, España
| | - F Iturri Clavero
- Anestesiología, Reanimación y Terapia del Dolor, Hospital de Cruces, Baracaldo, Vizcaya, España
| | - A Martinez Ruiz
- Anestesiología, Reanimación y Terapia del Dolor, Hospital de Cruces, Baracaldo, Vizcaya, España
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Barros J, Damásio J, Tuna A, Pereira-Monteiro J. Migraine-induced epistaxis and sporadic hemiplegic migraine: unusual features in the same patient. Case Rep Neurol 2012; 4:116-9. [PMID: 22807908 PMCID: PMC3398094 DOI: 10.1159/000339824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Since the mid-19th century, epistaxis and migraine have been occasionally associated with each other. Nevertheless, we found only two cases in the contemporary medical literature. Sporadic hemiplegic migraine is a subtype of migraine with reversible motor deficits, without similar episodes in relatives. CASE We describe a 47-year-old male with a history of migraine with a scintillating scotoma starting at the age of 20. In some of the episodes, he developed epistaxis in the resolution phase of migraine. At the age of 35, he experienced a visual aura followed by transient aphasia, left crural weakness and headache. Contralateral similar episodes occurred in the subsequent months. Neurological examination and MRI were normal. Mutations in CACNA1A, ATP1A2, SCN1A and NOTCH3 were excluded. DISCUSSION Three distinct aspects deserve our consideration. This is the first report of migraine-induced epistaxis involving aura; the scarcity of similar reports may be due to the lack of a guided anamnesis. The complex aura presented had a peculiar topography, inconsistent with the classical analytical neurological semiology. This may suggest that the spreading depression affects the brain bilaterally but in an uneven and elective manner. Lastly, the present report conveys that the late appearance of complex auras requires improbable interactions between environmental and endogenous conditions in individuals with a genetic predisposition.
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Affiliation(s)
- José Barros
- Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
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Luszczki JJ, Trojnar MK, Trojnar MP, Kimber-Trojnar Z, Szostakiewicz B, Zadrozniak A, Borowicz KK, Czuczwar SJ. Effects of amlodipine, diltiazem, and verapamil on the anticonvulsant action of topiramate against maximal electroshock-induced seizures in micePresented in part at the 11th Congress of the European Federation of Neurological Societies, Brussels, Belgium, 25–28 August 2007. Can J Physiol Pharmacol 2008; 86:113-21. [DOI: 10.1139/y08-007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To assess the effect of 3 calcium channel antagonists (amlodipine, diltiazem, and verapamil) on the anticonvulsant action of topiramate (a new generation antiepileptic drug) in the mouse maximal electroshock seizure (MES) model. Amlodipine (20 mg/kg) significantly enhanced the anticonvulsant activity of topiramate in the MES test in mice, reducing its ED50 value from 54.83 to 33.10 mg/kg (p < 0.05). Similarly, diltiazem (5 and 10 mg/kg) markedly potentiated the antiseizure action of topiramate against MES, lowering its ED50 value from 54.83 to 32.48 mg/kg (p < 0.05) and 28.68 mg/kg (p < 0.01), respectively. In contrast, lower doses of amlodipine (5 and 10 mg/kg) and diltiazem (2.5 mg/kg) and all doses of verapamil (5, 10, and 20 mg/kg) had no significant impact on the antiseizure action of topiramate. Pharmacokinetic verification of the interaction of topiramate with amlodipine and diltiazem revealed that neither amlodipine nor diltiazem affected total brain topiramate concentration in experimental animals, and thus, the observed interactions were concluded to be pharmacodynamic in nature. The favorable combinations of topiramate with amlodipine or diltiazem deserve more attention from a clinical viewpoint because the enhanced antiseizure action of topiramate was not associated with any pharmacokinetic changes in total brain topiramate concentration.
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Affiliation(s)
- Jarogniew J. Luszczki
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, PL 20-950 Lublin, Poland
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, PL 20-081 Lublin, Poland
| | - Michal K. Trojnar
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, PL 20-950 Lublin, Poland
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, PL 20-081 Lublin, Poland
| | - Marcin P. Trojnar
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, PL 20-950 Lublin, Poland
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, PL 20-081 Lublin, Poland
| | - Zaneta Kimber-Trojnar
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, PL 20-950 Lublin, Poland
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, PL 20-081 Lublin, Poland
| | - Beata Szostakiewicz
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, PL 20-950 Lublin, Poland
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, PL 20-081 Lublin, Poland
| | - Anna Zadrozniak
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, PL 20-950 Lublin, Poland
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, PL 20-081 Lublin, Poland
| | - Kinga K. Borowicz
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, PL 20-950 Lublin, Poland
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, PL 20-081 Lublin, Poland
| | - Stanislaw J. Czuczwar
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, PL 20-950 Lublin, Poland
- Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, PL 20-090 Lublin, Poland
- Department of Internal Medicine, Medical University of Lublin, Staszica 16, PL 20-081 Lublin, Poland
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