https://repositorio.fleni.org.ar/xmlui/handle/123456789/15 2026-10-04T05:55:34Z 2026-10-04T05:55:34Z Portes Souza, Marcio Nattan Uribe, Bernardo Zavala, Lucía Lopez, Reydmar Nagel, Vanesa Calderaro, Marcelo Edelmuth, Diogo Guilherme https://repositorio.fleni.org.ar/xmlui/handle/123456789/1608 2026-09-30T14:29:49Z 2026-04-20T00:00:00Z

Update on spontaneous intracranial hypotension Portes Souza, Marcio Nattan; Uribe, Bernardo; Zavala, Lucía; Lopez, Reydmar; Nagel, Vanesa; Calderaro, Marcelo; Edelmuth, Diogo Guilherme Background Spontaneous intracranial hypotension (SIH) is a secondary headache disorder caused by spontaneous cerebrospinal fluid (CSF) leakage, typically from dural tears, meningeal diverticula, or CSF venous fistulas, in the absence of preceding trauma or procedures. Although increasingly recognized, SIH remains underdiagnosed and frequently mistaken for primary headache syndromes. Methods This narrative review synthesizes current evidence on the epidemiology, pathophysiology, clinical manifestations, neuroimaging features, complications, and management of SIH. Recent literature and expert consensus were analyzed to integrate advances in imaging-based diagnosis and leak type specific therapeutic strategies. Results SIH arises from low CSF volume rather than true hypotension, leading to brain descent, venous engorgement, and the characteristic MRI features summarized by the SEEPS mnemonic: subdural collections, pachymeningeal enhancement, venous engorgement, pituitary enlargement, and brain sagging. Orthostatic headache is the hallmark symptom, though up to 15% of patients lack clear positional features. Associated symptoms include vestibulocochlear disturbances, neck or interscapular pain, cranial nerve palsies, and cognitive or motor dysfunction. Brain and whole spine MRI are first line diagnostic tools. MR myelography distinguishes SLEC positive (types 1 and 2) from SLEC negative (type 3) leaks, guiding targeted myelography with dynamic CT or digital subtraction techniques for leak localization. Treatment should be tailored to leak type and site: epidural blood or fibrin patching for dural and diverticular leaks, and transvenous embolization for CSF venous fistulas. Surgical repair is reserved for refractory or anatomically complex cases. Reported complications include subdural hematoma, cerebral venous thrombosis, superficial siderosis, and bibrachial amyotrophy. Conclusions SIH represents a heterogeneous spinal disorder with intracranial manifestations. Early recognition, standardized imaging algorithms, and multidisciplinary management are crucial to improving outcomes. Ongoing research into imaging biomarkers, predictors of response, and consensus based care pathways will help advance precision medicine in SIH.

2026-04-20T00:00:00Z Martinelli, Daniele De Icco, Roberto Al-Khazali, Haidar M. Ashina, Sait Diener, Hans-Christoph Dodd-Glover, Freda Goicochea, María Teresa Jenkins, Bronwyn MaassenVanDenBrink, Antoinette Lee, Mi Ji Özge, Aynur Prieto Peres, Mario Fernando Pozo Rosich, Patricia Puledda, Francesca Sacco, Simona Schwedt, Todd J. Terwindt, Gisela M. Tassorelli, Cristina https://repositorio.fleni.org.ar/xmlui/handle/123456789/1565 2026-08-10T19:28:46Z 2026-03-01T00:00:00Z

Advances in migraine prevention Martinelli, Daniele; De Icco, Roberto; Al-Khazali, Haidar M.; Ashina, Sait; Diener, Hans-Christoph; Dodd-Glover, Freda; Goicochea, María Teresa; Jenkins, Bronwyn; MaassenVanDenBrink, Antoinette; Lee, Mi Ji; Özge, Aynur; Prieto Peres, Mario Fernando; Pozo Rosich, Patricia; Puledda, Francesca; Sacco, Simona; Schwedt, Todd J.; Terwindt, Gisela M.; Tassorelli, Cristina Migraine imposes a heavy burden on patients and societies. Preventive treatments aimed at reducing the occurrence of migraine attacks and their intensity have been largely underused, leaving a multitude of people with migraine to rely exclusively on acute treatments, which, when used in excess, might even worsen the clinical situation. Large, randomised trials have established the tolerability and efficacy of calcitonin gene-related peptide (CGRP)-targeting drugs, a new class of migraine-specific treatment. The increased adherence to longer treatment cycles with migraine-specific preventive drugs, such as CGRP-targeting therapies, compared with non-migraine specific treatments has the potential to improve control of the disease. These migraine-specific drugs also provide benefits to individuals with migraine who previously did not benefit from non-specific migraine preventive medications. Increased reliance on preventive treatment with migraine-specific options is progressively optimising the management of migraine for mounting numbers of patients disabled by the disease, thereby improving disease control and their quality of life.

2026-03-01T00:00:00Z Bohórquez-Valderrama, Stephania Santillán, María Elena Corzo, Matías Sebastián Buonanotte, Carlos Federico Bonamico, Lucas Héctor https://repositorio.fleni.org.ar/xmlui/handle/123456789/1551 2026-08-04T13:48:43Z 2025-12-31T00:00:00Z

Trigeminal neuralgia Bohórquez-Valderrama, Stephania; Santillán, María Elena; Corzo, Matías Sebastián; Buonanotte, Carlos Federico; Bonamico, Lucas Héctor Background Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder characterized by recurrent, severe, unilateral facial pain in the distribution of one or more branches of the trigeminal nerve. Discussion Although its prevalence is relatively low, TN remains one of the most debilitating pain syndromes due to its intensity and unpredictable nature. This review aims to summarize current knowledge on the pathophysiology, diagnostic criteria, and management of trigeminal neuralgia, including both pharmacological and surgical options. Conclusions Trigeminal neuralgia remains a challenging condition requiring an individualized, multidisciplinary approach.

2025-12-31T00:00:00Z Larripa, Natalia Grandinetti, Mariela Calvo, Daniela Nagel, Vanesa Goicochea, María Teresa https://repositorio.fleni.org.ar/xmlui/handle/123456789/1550 2026-09-18T20:31:41Z 2026-01-01T00:00:00Z

Toxina botulínica tipo A en el tratamiento preventivo de la migraña crónica : experiencia en un servicio de cefaleas de Argentina Larripa, Natalia; Grandinetti, Mariela; Calvo, Daniela; Nagel, Vanesa; Goicochea, María Teresa Introducción: La migraña crónica (MC) es una de las enfermedades neurológicas más discapacitantes, con un marcado impacto en la calidad de vida y en la utilización de recursos sanitarios. En Argentina, no existen datos publicados de vida real sobre el uso de toxina botulíni ca tipo A; onabotulinumtoxinA (onabotA), en migraña crónica. El objetivo fue describir los resultados clínicos de pacientes con MC tratados con onabotA en un centro especializado en cefaleas de Argentina. Materiales y métodos: Se realizó un estudio observa cional retrospectivo mediante revisión de historias clíni cas digitales de pacientes con MC tratados con onabotA en el servicio de cefaleas de la institución, entre enero y diciembre de 2021. Se registraron datos epidemiológi cos, sobreuso de analgésicos, duración del tratamiento, respuesta clínica y eventos adversos. Resultados: Se analizaron 394 pacientes (91% muje res, edad media 46 años). El 66% presentaba sobreuso de analgésicos y el 40% refirió deterioro de fin de dosis. Entre quienes completaron el diario de cefaleas (n=162), el 65% alcanzó una reducción ≥50% en los días de cefalea mensuales y el 34% revirtió el sobreuso de analgésicos. Los eventos adversos fueron poco frecuentes (4%) y no motivaron la discontinuación del tratamiento. Conclusión: Nuestros resultados respaldan la efica cia y seguridad de onabotA en la prevención de la MC en la práctica clínica, en concordancia con los ensayos pivotales y estudios internacionales de vida real. Este trabajo constituye el primer reporte de experiencia local en Argentina.

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