Enxaqueca complicada: a propósito de três casos

Sanvito, Wilson Luiz; Monzillo, Paulo Hélio

doi:10.1590/S0004-282X1986000100005

Resumos

Três casos de enxaqueca complicada são relatados, de acordo com critérios previamente estabelecidos. A expressão enxaqueca complicada deve ser reservada para os casos em que sintomas neurológicos focais ultrapassam a crise enxaquecosa por mais de 24 horas ou quando déficit neurológico permanente se desenvolve em virtude de infarto cerebral. Outro critério para firmar o diagnóstico é a presença de infarto na tomografia computadorizada, mesmo na ausência dos critérios clínicos mencionados. O papel da agregação plaquetária, do espasmo vascular e da hipercoagulabilidade do sangue é considerado na causa do infarto. Todos os doentes, do presente relato, apresentaram déficit neurológico prolongado e infarto ao exame tomográfico.

After brief considerations about complicated migraine, three cases are reported. The diagnosis was made by the clinical features and by computed tomography. The term complicated migraine must be reserved for those cases in which the neurological symptoms and signs outlast migraine attack for more than 24 hours or in which permanent deficit develops because of cerebral or brainstem infarction. Other criteria for diagnosis is the presence of infarction in CT scanning, although prolonged or permanent deficit are absent. The possible role of platelet aggregation, vascular spasm and increased coagulability of the blood, as the cause of infarction, is discussed. All the patients in this report showed prolonged neurological deficit and infarction in CT scanning.

Wilson Luiz Sanvito; Paulo Hélio Monzillo

Neurologista - Trabalho da Disciplina de Neurologia do Departamento de Medicina da Santa Casa de São Paulo

RESUMO

Três casos de enxaqueca complicada são relatados, de acordo com critérios previamente estabelecidos. A expressão enxaqueca complicada deve ser reservada para os casos em que sintomas neurológicos focais ultrapassam a crise enxaquecosa por mais de 24 horas ou quando déficit neurológico permanente se desenvolve em virtude de infarto cerebral. Outro critério para firmar o diagnóstico é a presença de infarto na tomografia computadorizada, mesmo na ausência dos critérios clínicos mencionados. O papel da agregação plaquetária, do espasmo vascular e da hipercoagulabilidade do sangue é considerado na causa do infarto. Todos os doentes, do presente relato, apresentaram déficit neurológico prolongado e infarto ao exame tomográfico.

SUMMARY

After brief considerations about complicated migraine, three cases are reported. The diagnosis was made by the clinical features and by computed tomography. The term complicated migraine must be reserved for those cases in which the neurological symptoms and signs outlast migraine attack for more than 24 hours or in which permanent deficit develops because of cerebral or brainstem infarction. Other criteria for diagnosis is the presence of infarction in CT scanning, although prolonged or permanent deficit are absent. The possible role of platelet aggregation, vascular spasm and increased coagulability of the blood, as the cause of infarction, is discussed. All the patients in this report showed prolonged neurological deficit and infarction in CT scanning.

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Disciplina de Neurologia, Departamento de Medicina da Santa Casa - Rua Dr. Cesário Motta, Jr., 112 - 01221 - São Paulo, SP - Brasil.

1. BOISEN, E. - Strokes in migraine: report on seven strokes associated with severe migraine attacks. Dan. med. Bull. 22:100, 1975.
2. BOUSSER, M.G.; BARON, J.C.; IBA-ZIZEN, M.T.; COMAR, D.; CANABIS, E. & CASTAIGNE, P. - Migrainous cerebral infarction: a tomographic study of cerebral blood flow and oxygen extraction fraction with the oxygen-15 inhalation tecnique. Stroke 11:145. 1980,
3. CASTALDO, J.E.; ANDERSON, M. & REEVES, A.G. - Middle cerebral artery occlusion with migraine. Stroke 13:308, 1982.
4. COHEN, R.J. & TAYLOR, J.R. - Persistent neurologic sequelae of migraine: a case report. Neurology 29:1175, 1979.
5. DORFMAN, L.J.; MARSHALL, W.H. & ENZMANN, D.R. - Cerebral infarction and migraine: clinical and radiologic correlations. Neurology 29:317, 1979.
6. FISCHER, CM. - Late-life migraine accomppaniments as a cause of unexplained transient ischemic attacks. J. Can. S. Neurol. 7:9, 1980.
7. GUEST, I.A. & WOLF, A.L. - Fatal infarction of brain in migraine. Brit. med. J. 1:225, 1964.
8. HART, R.G. & MILLER, V.T. - Cerebral infarction in young adults: a practical approach. Stroke 14:110, 1982.
9. HUNGERFORD, G.D.; BOULAY, G.H. & ZILKHA, K.J. - Computorized axial tomography in patients with severe migraine: a preliminary report. J. Neurol. Neurosurg. Psychiat. 39:990, 1976.
10. KALENDOVSKY, Z. & AUSTIN, J.H. - "Complicated migraine" its association with increased platelet aggregability and abnormal plasma coagulation factors. Headache 4:18, 1975.
11. MATHEN, N.T.; MEYER, J.S.; WELCH, K.M.A. & NEBLETT, C.R. - Abnormal CT-scans in migraine. Headache 16:272, 1977.
12. McDONALD, W.I. & SANDERS, M.D. - Migraine complicated by ischemic pappillopathy. Lancet 4:521, 1971.
13. MOOREHEAD II, M.T.; MOVIUS, H.J.; MOOREHEAD, J.R.; JACKSON, M.H. & JACKSON, J.G. - Classic migraine with cerebral cortical infarction causing permanent hemianopsia. Southern med. J. 2:821, 1979.
14. OSUNTOKUN, B.O. & OSUNTOKUN, O. - Coomplicated migraine and haemoglobin AS in Nigerians. Brit. med. J. 2:621, 1972.
15. PEARCE, J. - Migraña complicada. In J. Pearce: Conceptos Actuales en la Migraña. Marin, Barcelona, 1977, pg. 39.
16. SERRATRICE, G. - Saber Interpretar uma Enxaqueca. Andrei, São Paulo, 1982.

Enxaqueca complicada: a propósito de três casos

Complicated migraine: report of three cases

Datas de Publicação

Publicação nesta coleção
29 Jun 2011
Data do Fascículo
Mar 1986

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BOISEN, E. - Strokes in migraine: report on seven strokes associated with severe migraine attacks. Dan. med. Bull. 22:100, 1975.

[2] 2. BOUSSER, M.G.; BARON, J.C.; IBA-ZIZEN, M.T.; COMAR, D.; CANABIS, E. & CASTAIGNE, P. - Migrainous cerebral infarction: a tomographic study of cerebral blood flow and oxygen extraction fraction with the oxygen-15 inhalation tecnique. Stroke 11:145. 1980,

[3] 3. CASTALDO, J.E.; ANDERSON, M. & REEVES, A.G. - Middle cerebral artery occlusion with migraine. Stroke 13:308, 1982.

[4] 4. COHEN, R.J. & TAYLOR, J.R. - Persistent neurologic sequelae of migraine: a case report. Neurology 29:1175, 1979.

[5] 5. DORFMAN, L.J.; MARSHALL, W.H. & ENZMANN, D.R. - Cerebral infarction and migraine: clinical and radiologic correlations. Neurology 29:317, 1979.

[6] 6. FISCHER, CM. - Late-life migraine accomppaniments as a cause of unexplained transient ischemic attacks. J. Can. S. Neurol. 7:9, 1980.

[7] 7. GUEST, I.A. & WOLF, A.L. - Fatal infarction of brain in migraine. Brit. med. J. 1:225, 1964.

[8] 8. HART, R.G. & MILLER, V.T. - Cerebral infarction in young adults: a practical approach. Stroke 14:110, 1982.

[9] 9. HUNGERFORD, G.D.; BOULAY, G.H. & ZILKHA, K.J. - Computorized axial tomography in patients with severe migraine: a preliminary report. J. Neurol. Neurosurg. Psychiat. 39:990, 1976.

[10] 10. KALENDOVSKY, Z. & AUSTIN, J.H. - "Complicated migraine" its association with increased platelet aggregability and abnormal plasma coagulation factors. Headache 4:18, 1975.

[11] 11. MATHEN, N.T.; MEYER, J.S.; WELCH, K.M.A. & NEBLETT, C.R. - Abnormal CT-scans in migraine. Headache 16:272, 1977.

[12] 12. McDONALD, W.I. & SANDERS, M.D. - Migraine complicated by ischemic pappillopathy. Lancet 4:521, 1971.

[13] 13. MOOREHEAD II, M.T.; MOVIUS, H.J.; MOOREHEAD, J.R.; JACKSON, M.H. & JACKSON, J.G. - Classic migraine with cerebral cortical infarction causing permanent hemianopsia. Southern med. J. 2:821, 1979.

[14] 14. OSUNTOKUN, B.O. & OSUNTOKUN, O. - Coomplicated migraine and haemoglobin AS in Nigerians. Brit. med. J. 2:621, 1972.

[15] 15. PEARCE, J. - Migraña complicada. In J. Pearce: Conceptos Actuales en la Migraña. Marin, Barcelona, 1977, pg. 39.

[16] 16. SERRATRICE, G. - Saber Interpretar uma Enxaqueca. Andrei, São Paulo, 1982.