Clinical Neuroscience

[Treatment of migraine in hypertension and ischemic heart disease]

FICZERE Andrea, CSIBA László

FEBRUARY 20, 2002

Clinical Neuroscience - 2002;55(01-02)

[Migraine is a common disorder with a prevalence of 9-10% in Hungary. Migraine can be accompanied by hypertension and/or ischemic heart disease sometimes in younger patients, but more frequently in the elderly, which is important for therapeutical considerations. The article reviews the literature with special focus on hypertension and coronary heart disease. In the second part, the authors summarize their experiences on headache patients.]

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[In the development of a cholesterol granuloma both cellular and vascular permeability factors have to be taken into consideration. It may arise as a special degradation product in a chronic cerebral infarct because of the partial insufficient activity of the macrophages. Consequently, the degradation of brain sphingolipids and other compounds does not follow the usual route of degradation and transportation by granular cells to the stage of neutral fat but the necrotic mass transforms into cholesterol esters. Cholesterol crystals produce an irritative effect to neighbouring tissues which may result in the formation of young fibroblasts with proliferative tendency in the vessel wall. Some of the fibroblasts take part in the proliferation of connective tissue, while the rest degenerate, producing more cholesterol or xanthomatous material. Inflammatory changes may also be associated with these lesions. The amount of cholesterol sometimes increases in the inner side of the thickening connective tissue layer. The final result may be an intracranial space occupying mass or it may end as a small cholesterol granuloma, as demonstrated in our incidental cases. By the time a granuloma has developed, the original vessel usually disappears completely, but sometimes remnants of vessels might prove the vascular origin. Other pathomechanisms should also be taken into consideration, such as a cholesterol embolus or anomalous vessel with a large cholesterol plaque in the wall. This also explains why trauma (hemorrhage, granulation), cholesterol embolus, inflammation, metabolic imbalance may predispose to the formation of a granuloma, as well as the hypercholesterolaemia. The nine cases demonstrate the significance of the intracranial granuloma from pathological, clinical and neurosurgical points of view. Such cases have not yet been reported in the national or international literature.]

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[A preclinical cadaver study was performed to test a transendoscopic sonographic probe for neurosurgery. In 25 fresh post-mortem adult human cadaver with a total of 39 endo-sonographic dissections in the ventricular system were carried out. A sonograph with an outer diameter of 6 F was used and radial sonograms were made by a realtime image technique. First results showed precise imaging, comparable to a CT in a neighbouring area of 3 cm. In this publication, the authors describe the endo-neurosonographic anatomy of the ventricular system. The sonographic probe was advanced through the working canal of a ventriculoscope, then the endoscopic and sonographic imaging were compared. Results were documented by paralell sonographic and endoscopic photo and video recordings. Based on the authors experience, it is revealed that the additional sonographic view could also be used as a navigation tool.]

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