Lost diagnoses in not otherwise specified headache in Emergency Department

The diagnosis of Not Otherwise Specified (NOS) headaches in the Emergency Department (ED) is frequent despite many specialist visits performed. The aim of the study was to examine specialist visits carried out in the patients discharged from ED with diagnosis of NOS headache to evaluate discrepancies between specialist and ED diagnosis at discharge. We retrospectively (1.6.2018–31.12.2018) analyzed all the patients admitted with non-traumatic headache to the ED of the tertiary-care University Hospital of Trieste. We evaluated the patients discharged from ED with a final diagnosis of NOS headache and who underwent at least one specialist examination. Demographic data, specialist and ED diagnosis were analyzed. One hundred twenty-four patients (93 F, 31 M, mean age 44 ± 15 years) were included. 71.8% of patients were examined only by a neurologist, 12.9% by non-neurologists, 15.3% by both neurologist and non-neurologist. Only 37% of the patients received a precise diagnosis. Neurologist made a diagnosis slightly more frequently than the other consultants (40.5% vs 37.5%). Neurologists diagnosed primary headaches, headaches secondary to neurological diseases, and facial neuralgia, instead non-neurologists diagnosed only headaches secondary to non-neurological diseases. Primary headaches were diagnosed in 25.7% of cases, migraine being the most frequent. Physicians did not report any specialist diagnoses in the ED discharge sheet. Specialist consultants made specific diagnoses in about one-third of patients that were not reported as final in the discharge records by the ED physician. This leads to a loss of diagnoses and to an overestimation of NOS headache.

Frank Hartley and his Contribution to Surgery

Although Frank Hartley (1856-1913) was mostly known as the deviser of the method of bisecting the ganglion of the trigeminal nerve within the skull for the relief of facial neuralgia, it should be noted that he had also done very important work in the surgical treatment of goiter which was neglected at his times but later followed by his successors. Furthermore, he also had interest in the surgical treatment of clubfoot and the exstrophy of the bladder.

Enfoque diagnóstico del paciente con dolor facial: revisión de la literatura.

El objetivo del estudio es revisar y describir la principal evidencia disponible relacionada con el enfoque diagnóstico del dolor facial, especialmente en el entorno de atención primaria, y brindar una herramienta que sintetice los hallazgos. Se realizó una revisión de la literatura, mediante una búsqueda en bases de datos como PubMed, SciELO, LILACS, Google Académico, y Scopus. Se usaron como palabras clave “facial pain”, “facial neuralgia”, “trigeminal nerve disease”, y “diagnosis”. Se encontró que el dolor facial se debe enfocar de forma sindromática y etiológica, identificando aspectos del dolor sugestivos de alteración neurológica central o periférica, y realizando un estudio completo clínico y paraclínico que permita identificar la etiología. Concluimos que el dolor facial requiere un abordaje integral y debe ser un tópico central en los programas de enseñanza en medicina y odontología

Bilateral Atypical Facial Pain Caused by Eagle’s Syndrome

Recurrent throat pain, “foreign body” sensation, difficulty in swallowing, or vague facial pain is many times caused by the presence of an elongated styloid process. Many times, this condition is misdiagnosed and the patient is treated for facial neuralgia. But once Eagle’s syndrome is confirmed by clinical and radiological examination, the treatment is always surgical resection. The approach maybe intraoral or extraoral. In this paper, we present a case of Eagle’s syndrome caused by bilateral elongation of the styloid process and where surgical resection of the same gave instant permanent relief for the patient.

Neuralgia do trigêmeo periférica tratada com alcoolização: relato de caso

Os casos de neuralgia do trigêmeo no âmbito da Odontologia merecem, ainda, maior atenção devido ao difícil e criterioso diagnóstico desta condição que, muitas vezes, acaba confundida com outras patologias associadas às dores orofaciais. Este trabalho visa relatar o caso de uma paciente idosa edêntula com quadros de dor em topografia de nervo mentual direito, com sensibilização em mucosa gengival e lábio inferior à direita, compatível com neuralgia trigeminal, a qual foi tratada com indução à neurólise do nervo mentual direito por necrose asséptica estimulada por solução alcoólica. A paciente encontra-se com dois anos de acompanhamento e sem os episódios de dor. Mesmo o processo de diagnóstico sendo extenso e exigindo muito critério, foi possível diagnosticar a nevralgia da paciente e empregar o passo-a-passo do tratamento, chegando a melhor opção para este caso, que foi a alcoolização do nervo mentual.Descritores: Neuralgia Facial; Neuralgia; Neuralgia do Trigêmeo; Bloqueio Nervoso.ReferênciasSiqueira SRDT, Siqueira JTT. Neuralgia do trigêmeo: diagnóstico diferencial com odontalgias. APCD. 2003.Leocádio JCM, Santos LC, Sousa MCA, Gonçalves NJC, Campos IC. Neuralgia do trigêmeo: uma revisão de literatura. Braz J Surg Clin Res. 2014;7(2):33-7.Headache Classification Subcommitte of the International Headache Society. The International Classification of Headache Disorders. 2nd ed. Cephalalgia. 2004;24(Suppl):9-160.Quesada GAT, Baptista CE, Pedroso DS, Flores DL. Neuralgia trigeminal: do diagnóstico ao tratamento. Rev Dentíst Online. 2005;5(11):46-54.Bertoli FMP, Koczicki VC, Meneses MS. A neuralgia do trigêmeo: um enfoque odontológico. JBA. 2003;3(10):125-29.Classificação Internacional de Cefaleias. 3. ed. 2014. Disponível em: https://www.ichd-3.org/wp-content/uploads/2016/08/2087_ichd-3-beta-versao-pt-portuguese.pdf. Acesso em 04 out 2018.Domingues RB, Kuster GW, Aquino CCH. Treatment of trigeminal neuralgia with low doses of topiramate. Arq Neuropsiquiatr. 2007;65(3B):792-94.Borbolato RM, Ambiel CR. Neuralgia do trigêmeo: aspectos importantes na clínica odontológica. Saúde e Pesquisa. 2009;2(2):201-8.Mattos JMB, Bueno FV, Mattos LR. Neuralgia do trigêmeo: um novo protocolo de tratamento clínico. Rev Dor. 2005;6(4):652-56.Kitt CA, Gruber K, Davis M, Woolf CJ, Levine JD. Trigeminal neuralgia: opportunities for research and treatment. Pain. 2000;85(1-2):3-7.Frizzo HM, Hasse PN, Veronese RM. Neuralgia do trigêmeo: revisão bibliográfica analítica. Rev Cir Traumatol Buco-Maxilo-Facial. 2004;4(4):212-17.Alves TCA, Azevedo GS, Carvalho ES. Tratamento farmacológico da neuralgia do trigêmeo: revisão sistemática e metanálise. Rev Bras Anestesiol. 2004;54(6):836-49.Felix F, Olivaes MCD, Gismondi RAOC, Belmont H, Felix JAP. Tratamento conservador da síndrome de Gradenigo. Rev Bras Otorrinol. 2003;69(2):256-59.Okeson JP. Dores bucofaciais de Bell: tratamento clínico da dor bucofacial. 6. ed. São Paulo: Quintessence, 2006.Poluha RL, Silva RS. Neuralgia do trigêmeo – V3: relato de caso. Rev Uningá. 2015;45(1):40-2.