The objectives of this study were to investigate the efficacy of bromocriptine (BR) combined with speech therapy (ST) to improve a late recovery in non-fluent aphasic stroke patients. We performed a double-blind study with high dosage of BR, prescribed according to a dose-escalating protocol, comprehensive of clinical data, relatives' impression, and language evaluations. The study was divided into the following phases: t-0, inclusion; t-30, language re-test to evaluate the stability of aphasia; t-90, placebo (PL) and ST; t-150, BR and ST; t-210, BR; t-270, wash-out. With respect to the baseline assessment, a significant improvement was observed in the following tests: dictation (F, 4.8; p < .004), reading-comprehension (F, 8.1; p < .0003), repetition (F, 3.8; p < .01) and verbal latency (F, 4.9; p < .01). High dosage of BR promoted a late recovery in stable chronic non-fluent aphasia and this improvement was enhanced by combination with ST.

PrevalenceHeadache is one of the most common reported complaints in the general adult population and it accounts for between 1% and 3% of admissions to emergency departments (ED) [1,2]. Despite the fact that this symptom is very widespread and is a costly medical condition, the diagnosis of headache and its epidemiological impact in the ED has still not been completely considered. This is because most of the data collected in this field are obtained with retrospective studies. From this point of view it has been shown that the incidence of primary headache (PH) diagnosis is lower in the ED than in the general population [1][2][3][4][5][6][7][8][9].In a multicentre retrospective Italian study [3] done to evaluate the prevalence of primary headache in the ED, it accounted for 0.6% of all attendances. In an observational three-month pilot study, executed by our team in 2002, we found a prevalence of 1.2% of headache complaints in the ED (unpublished data).An unexpected aspect of the data obtained in our study was the equal prevalence of secondary (52%) and primary (48%) headache in this population.Out of PH, migraine headache is a common presenting complaint to the ED. The prevalence of migraine diagnosis at discharge from emergency is very variable, ranging from 15 to 32% [3,8,9]. The majority of patients were discharged with a diagnosis of cephalalgia or headache not otherwise specified (NOS) [3,8,9]. J Headache Pain (2005) Abstract Headache is one of the most common reported complaints in the general adult population and it accounts for between 1% and 3% of admissions to an Emergency Department (ED). The overwhelming majority of patients who present to an ED with acute primary headache (PH) have migraine and very few of them receive a specific diagnosis and then an appropriate treatment. This is due, in part, to a low likelihood of emergency physicians diagnosing the type of PH, in turn due to lack of knowledge of the IHS criteria, and also the clinical condition of the patients (pain, border type of headache, etc.) In agreement with the literature, another interesting aspect of data emerging from our experience is that few of the ED PH patients are referred to headache clinics for diagnosis and treatment, especially if they present with high levels of disability. This attitude promotes the high-cost phenomenon of repeater patients that have already been admitted to the ED for the same reason in the past. This is statistically important because it involves about 10% of the population with PH.6:287-289 DOI 10.1007/s10194-005-0210-1 Primary headache in Emergency Department: prevalence, clinical features and therapeutical approach

We report a case of Tolosa-Hunt syndrome (THS) in a patient with systemic lupus erythematosus studied with MRI. Magnetic resonance showed enlargement of the cavernous sinus and compression of the carotid syphon by enhancing tissue. In particular, fat-suppressed T1-weighted images before and after contrast agent injection and MR angiography showed extension of the abnormal tissue to the apex of the orbit and narrowing of the internal carotid artery. A presumptive diagnosis of THS was made and steroid treatment was started with rapid relief of symptoms. Follow-up MR study after steroid therapy demonstrated sub-total resolution of the neuroradiological findings. Neuroradiological findings in THS are quite typical but they may be subtle; furthermore, the presence of a systemic disease may suggest secondary involvement of the cavernous sinus. Utilization of the appropriate MR techniques and follow-up exams may contribute to the diagnosis of THS even in the presence of other systemic diseases.

IntroductionCluster headache (CH) is characterised by attacks of severe unilateral pain in the orbital, supraorbital and/or temporal areas, lasting from 15 up to 180 min, recurring up to 8 times daily and accompanied by ipsilateral autonomic symptoms. In the episodic form, headache attacks usually occur in bouts (cluster periods) lasting from one week to 1 year, separated by pain-free periods of at least 1 month. In the chronic form these pain-free periods are absent or last less than a month [1].Although effective acute treatments are available for CH attacks, e.g., subcutaneous sumatriptan injections, most patients need, in addition, preventative therapy. Several drugs, such as verapamil, methysergide and lithium carbonate, have proven efficacious in the prevention of CH attacks and shortening of bouts. Oral steroids are probably the most effective short-term preventative treatment [2], but patients may become steroid-dependent and develop serious steroid-related adverse effects within a few months.Anthony [3] shows that suboccipital injections of a local anaesthetic alone have neither a beneficial nor a J Headache Pain (2006) -006-0283-5 Great occipital nerve blockade for cluster headache in the emergency department: case report Abstract A 44-year-old man with a past medical history of episodic cluster headache presented in our ED with complaints of multiple daily cluster headache attacks, with cervico-occipital spreading of pain from May to September 2004. The neurological examination showed no abnormalities as well as brain and spine MRI. Great Occipital Nerve (GON) blockade, with Lidocaine 2% (5 ml) and betamethasone (2 mg), were performed in the right occipital region (ipsilaterally to cluster headache), during attack. GON blockade was effective immediately for the attack and the cluster period resolved after the injection. We suppose that the action of GON blockade may involve the trigemino-cervical complex and we moreover strongly suggest to use GON blockade in emergency departments for cluster headache with cervico-occipital spreading as attack abortive therapy, especially in oxygen and sumatriptan resistant cluster headache attacks, in patients who complaints sumatriptan side-effects or have contraindications to use triptans.7:98-100 DOI 10.1007/s10194

It has recently been suggested that the trigeminocervical complex plays a crucial role in the pathophysiology of neck discomfort that accompanies migraine attacks. Clinical and neurophysiological data have shown that pain within the occipital area may be transmitted by the first trigeminal branch, which supports an anatomical and functional link between cervical and trigeminal modulation of peripheral afferents. We describe a patient with an acute symptomatic migraine attack and chronic occipital neuralgia, both due to bleeding of a bulbocervical cavernoma. The clinical presentation is also discussed and related to recent scientific data on the role of the trigeminocervical complex in both the clinical picture and underlying pathophysiological mechanisms of cervical and head pain.