高压氧治疗血管性偏头痛临床疗效及机理分析

目的:探讨高压氧(HBO)对血管性偏头痛的临床疗效及其治疗机理。方法:研究对象为93例血管性偏头痛患者,分成常规治疗(B组)45例和加用HBO治疗(A组)48例,疗程结束后观察1年按临床疗效标准进行评定和统计。结果:B组总有效率为62.22%,A组分别加用2￣5个疗程HBO治疗后,总有效率达93.75%,比B组增加31.53%。两组之间总有效率差异有非常显著性(P<0.01)。结论:HBO治疗血管性偏头痛疗效显著,其机理主要是通过增加脑组织血氧含量,提高血氧分压,加大组织中氧气的有效弥散距离,从而改善脑组织缺氧状态;同时低降二氧化碳分压,阻止血管扩张,减轻组织水种,并通过HBO作用于5-HT系统和影响周围神经肽含量,从而缓解和消除头痛。     

补中益气汤临床新用

补中益气汤在临床应用范围广泛,涉及病种多,例举该方在痿证、头痛、气短、发热、尿浊5个不同疾病治疗经验,认为该5病案辨病虽无类同之处,而辨证都可归属“脾气虚弱证”,均可用补中益气汤加减治疗。阐明方证对应是重要前提,辨证论治的优势不容置疑。     

Does post dural puncture headache exist in idiopathic intracranial hypertension? A pilot study

Background/ObjectiveOccurrence of post-dural puncture headache (PDPH) after diagnostic lumbar puncture (LP) for idiopathic intracranial hypertension (IIH) may seem very unlikely in clinical practice. Nevertheless, it has been suggested by several studies, mainly in sub-group analyses. We aimed to evaluate the prevalence of PDPH in an IIH population and determine any eventual predictive factors of PDPH occurrence.MethodsWe conducted a retrospective multiple-center observational study. All newly diagnosed IIH patients who met the International Classification of Headache Disorders (ICHD-3) or the Dandy modified criteria were included from three different French hospitals. They all underwent LP following the same process with the same type of needle. We recorded PDPH occurring within five days after LP, as defined by ICHD-3 criteria.ResultsSeventy-four IIH patients were recruited, of whom 23 (31%) presented with PDPH. Neither classical risk factors for PDPH such as body mass index, age or gender, nor cerebrospinal fluid opening pressure, or specific IIH features were associated with occurrence of PDPH.ConclusionPDPH can occur after LP in IIH patients. Clinicians should be aware of this possible event during the IIH diagnosis assessment and should not automatically reconsider IIH diagnosis. PDPH prevention using an atraumatic needle and dedicated PDPH treatment seem relevant in IIH patients.     

Accuracy of Electrode Position in Sphenopalatine Ganglion Stimulation in Correlation With Clinical Efficacy

IntroductionSphenopalatine ganglion (SPG) stimulation is an efficient treatment for cluster headache. The target for the SPG microstimulator in the pterygopalatine fossa lies between the vidian canal and foramen rotundum, ideally two contacts should be placed in this area. However, placement according to the manufacturers recommendations is frequently not possible. It is not known whether a suboptimal electrode placement interferes with postoperative outcomes.Materials and MethodsSPG stimulation was performed in 13 patients between 2015 and 2018 in a single center. Lead location was determined by intraoperative computed tomography scan and correlated with the planned lead position as well as clinical data and stimulation parameters. Patients with a reduction of 50% or more in pain intensity or frequency were considered responsive.ResultsEleven patients (84.6%) responded to SPG stimulation with eight being frequency responders (61.5%). In seven cases, there were less than two electrodes between vidian canal and foramen rotundum, there was no significant correlation with negative stimulation results (p = 0.91). The mean distance of lead location between pre- and postoperative images did not correlate with clinical outcomes (p = 0.84) and was even bigger in responders (4.91 mm vs. 4.53 mm). The closest electrode contact to the vidian canal was in the stimulation area in all but one patient, regardless of its overall distance to canal. The distance of the closest electrode to the vidian canal was, however, not significantly correlated to the percentage of frequency (p = 0.68) or intensity reduction (p = 0.61).ConclusionThere was no significant correlation regarding aberrations of lead position from the planned position with clinical outcome. However, this study might be underpowered to detect such a correlation. The closest electrode contact to the vidian canal was in the stimulation area in all but one patient in the final programming. This indicates that, overall, the lead location does play a crucial role in SPG stimulation for cluster headache.