European Organization for Research and Treatment of Cancer

Spontaneous occlusion of the circle of willis : moyamoya disease

Headache is a common complaint in the emergency department (ED). In order to examine headache work-ups and diagnoses across the USA, we queried a representative sample of adult ED visits (the National Hospital Ambulatory Medical Care Survey) for the years 1992-2001. Headache accounted for 2.1 million ED visits per year (2.2% of visits). Of the 14% of patients who underwent neuroimaging, 5.5% received a pathological diagnosis. Of the 2% of patients who underwent lumbar puncture, 11% received a pathological diagnosis. On multivariable analysis, a decreased rate of imaging was noted for patients without private insurance [odds ratio (OR) 0.61, confidence interval (CI) 0.44, 0.86] and for those presenting off-hours (OR 0.55, CI 0.39, 0.77). Patients over 50 were more likely to receive a pathological diagnosis (OR 3.3, CI 1.2, 9.3). In conclusion, clinicians should ensure that appropriate work-ups are performed regardless of presentation time or insurance status, and be vigilant in the evaluation of older patients.

Headache in United States Emergency Departments: demographics, work‐up and frequency of pathological diagnoses

https://www.annemergmed.com/article/S0196-0644(07)00079-0/pdf

Oligoanalgesia in the Emergency Department: Short-Term Beneficial Effects of an Education Program on Acute Pain

Objective.—When patients present to an emergency department because of nontraumatic headache, they often present a diagnostic challenge. This study aimed to examine the utility of clinical features in detecting serious underlying causes of nontraumatic headache in adult patients presenting to an emergency department.



Methods.—A prospective observational study of alert adult patients presenting to 1 UK emergency department over a period of 14 months was conducted. Patients were excluded if their headache was related to trauma or they had been previously recruited into the study. A standardized data collection form was used to record details of the history and examination findings. Investigation and management were conducted according to the existing departmental protocols. Patients were followed up for 3 months following their initial presentation. Each factor in the history and examination was examined for its ability to predict a serious underlying cause of headache.



Results.—Five hundred and eighty-nine patients were included in the study with complete follow-up details obtained on 558 (94.7%) patients. Seventy-five (13.4%) patients were found to have a serious pathological cause of their headache. Four features were found to be significant independent predictors of serious pathology, these were age >50 years (likelihood ratio (LR) = 2.34), sudden onset, (LR = 1.74), any abnormality on neurological examination (LR = 3.56), and presentation due to associated features (LR = 2.27). Taken in combination, the presence of any 1 of the first 3 features has a sensitivity of 98.6% and specificity of 34.4% (Positive LR = 1.50, Negative LR = 0.04).



Conclusion.—Three features, age greater than 50, sudden onset, and an abnormal neurological examination, are identified as significant independent predictors of serious pathology, which, in combination, can exclude the presence of such pathology in adult patients presenting with nontraumatic headache.

The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department.

Objective: To provide to emergency department (ED) physicians with guidelines for diagnosis of patients with nontraumatic headaches. Background: Many patients present to an ED with the chief complaint of headache. Causes of nontraumatic headache include life-threatening illnesses, and distinguishing patients with such ominous headaches from those with a primary headache disorder can be challenging for the ED physician. Conclusion: We present a consensus statement aimed to be a useful tool for ED doctors in making evidence-based diagnostic decisions in the management of adult patients with nontraumatic headache. Methods: A multidisciplinary work performed an extensive review of the medical literature and applied the information obtained to commonly encountered scenarios in the ED.

Evidence-Based Diagnosis of Nontraumatic Headache in the Emergency Department: A Consensus Statement on Four Clinical Scenarios

Background
After a brain biopsy, the genetic analysis can fail because of insufficient material, extensive tumor necrosis, and formalin fixation under conditions that adversely affected the quality of the DNA or because the assay result was indeterminant. The freezing of fresh tumor tissue at surgery could greatly improve the success of DNA extraction and methyl guanine methyl transferase (MGMT) promoter methylation testing. The concentration of the DNA samples can also be improved from a withdrawal in an area with a high probability of neoplastic cells.

Analysis of MGMT promoter methylation status on intraoperative fresh tissue section from frameless neuronavigation needle biopsy: a preliminary study of ten patients

Introduction
Percutaneous vertebroplasty, i.e. the consolidation of a vertebral body with polymethylmethacrylate, is a safe and effective image-guided technique increasingly used as a treatment option for different pathologic conditions, mainly vertebral body fractures secondary to osteoporosis, hemangiomas and metastasis. The procedure, although minimally invasive, could be painful and is better tolerated if a conscious sedation regimen is added to local anesthesia. An anesthesiologist usually performs the sedo/analgesia, but frequently, he is not available in our angiography unit, so we have begun to perform the sedo/analgesia ourselves following an analogous situation that physicians of the Digestive Endoscopic Unit of our institution experienced some years ago.

Administration of conscious sedation by a neuroradiology team during percutaneous vertebroplasty and spinal biopsy procedures

Objective.—To provide to emergency department (ED) physicians with guidelines for diagnosis of patients with nontraumatic headaches. Background.—Many patients present to an ED with the chief complaint of headache. Causes of nontraumatic headache include life-threatening illnesses, and distinguishing patients with such ominous headaches from those with a primary headache disorder can be challenging for the ED physician. Conclusion.—We present a consensus statement aimed to be a useful tool for ED doctors in making evidencebased diagnostic decisions in the management of adult patients with nontraumatic headache. Methods.—A multidisciplinary work performed an extensive review of the medical literature and applied the information obtained to commonly encountered scenarios in the ED.

Gianni De Berti

Papers

Evidence-Based Diagnosis of Nontraumatic Headache in the Emergency Department: A Consensus Statement on Four Clinical Scenarios

Analysis of MGMT promoter methylation status on intraoperative fresh tissue section from frameless neuronavigation needle biopsy: a preliminary study of ten patients

Administration of conscious sedation by a neuroradiology team during percutaneous vertebroplasty and spinal biopsy procedures

Views and Perspectives Evidence-Based Diagnosis of Nontraumatic Headache in the Emergency Department: A Consensus Statement on Four Clinical Scenarios

Virtual Navigator study: Subset of preliminary data about cerebral venous circulation