M L Cuadrado

Hospital Clínico San Carlos, Madrid, Madrid, Spain

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Publications (89)255.03 Total impact

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    ABSTRACT: The infratrochlear nerve supplies the medial aspect of the upper eyelid, the superolateral aspect of the nose and the lacrimal caruncle. This nerve may contribute to the pain stemming from the trochlea, but infratrochlear neuralgia has not been identified as a specific cause of pain. Over a 10-year period we have been recruiting patients with pain in the internal angle of the orbit that did not show features of trochlear pain. Seven patients (six female, one male; mean age, 46.1 ± 18.9) presented with pain in the territory of the infratrochlear nerve. The pain appeared in the internal angle of the orbit and upper eyelid (n = 3), the superolateral aspect of the nose (n = 3), or the lacrimal caruncle (n = 1). All patients had a paroxysmal pain, with the attacks lasting five to 30 seconds. Pain attacks were mostly spontaneous, but two patients had triggers. Between attacks, all patients had local allodynia. Pain did not increase with vertical eye movements. Six patients were treated with gabapentin with complete response, and one patient experienced long-lasting relief with an anesthetic blockade of the infratrochlear nerve. Infratrochlear neuralgia should be considered as a possible cause of pain in the internal angle of the orbit. © International Headache Society 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    Cephalalgia 03/2015; DOI:10.1177/0333102415578429 · 4.12 Impact Factor
  • Pain Medicine 02/2015; DOI:10.1111/pme.12698 · 2.24 Impact Factor
  • Pain Practice 01/2015; 15(1). DOI:10.1111/papr.12261 · 2.18 Impact Factor
  • María‐Luz Cuadrado, Ángel Aledo‐Serrano
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    ABSTRACT: IntroductionLacrimal neuralgia has only recently been described in 3 cases. None of them had an underlying lesion or any precipitating event, so they were considered primary. Here, we report a symptomatic case due to surgical trauma.Case reportA 73-year-old woman started having a circumscribed pain at age 66 after left cataract surgery. The pain was located in a small area of her left temple next to the lateral canthus. Pain attacks lasted 1-2 minutes, and were associated with allodynia. The attacks were precipitated by light touch on the eyelid or the temple, and were also evoked by palpation of the superoexternal angle of the orbit. An anesthetic blockade performed at the emergence of the lacrimal nerve resulted in complete and long-lasting pain relief.Conclusion Lacrimal neuralgia may be due to local trauma. This new case not only reinforces the existence of a specific neuralgia of the lacrimal nerve, but also introduces a classification into primary and secondary forms based on the etiology.
    Headache The Journal of Head and Face Pain 11/2014; 55(2). DOI:10.1111/head.12467 · 2.94 Impact Factor
  • Journal of the American Medical Directors Association 10/2014; DOI:10.1016/j.jamda.2014.09.015 · 4.78 Impact Factor
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    ABSTRACT: Objectives To assess and compare the prevalence of migraine in patients with restless legs syndrome (RLS) and matched controls.Background Recent studies have suggested an association between migraine and RLS. Our work is the first case–control study on this subject performed in an RLS population.MethodsA case–control study was conducted in 47 RLS patients (27 women and 20 men aged between 18 and 65 years) and 47 age- and sex-matched controls. Validated questionnaires were used to investigate the presence of migraine, anxiety, and depression (Zung Self-Rating Anxiety and Depression scales), sleep quality (Pittsburgh Sleep Quality Index), and RLS severity (International RLS scale).ResultsRLS patients had higher lifetime prevalence of migraine than non-RLS controls (53.2% vs 25.5%, P = .005; matched-OR 1.3 [P = .019]; adjusted odds ratio (OR) 3.8 [P = .03]). No significant associations were found between RLS and active migraine with aura or inactive migraine (no episodes in the previous year). However, active migraine without aura was significantly more prevalent in patients with RLS than in controls (40.4% vs 12.8%, P = .001; matched OR 1.5 [P = .001]; adjusted OR 2.7 [P = .04]). Within the RLS group, patients with migraine had poorer sleep quality than those without migraine (Pittsburgh Sleep Quality Index >5:100 vs 80.9%, P = .038) but did not differ in terms of RLS severity, anxiety and depression, use of dopaminergic agonists, and body mass index.Conclusion There appears to be a relationship between RLS and migraine, in particular for active migraine without aura.
    Headache The Journal of Head and Face Pain 06/2014; 54(8). DOI:10.1111/head.12382 · 2.94 Impact Factor
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    ABSTRACT: IntroductionNummular headache, considered a primary headache in the 3rd edition of the International Classification of Headache Disorders, has nonetheless been attributed in several occasions to underlying epicranial anomalies.Case reportsVascular imaging of the head in 2 patients with nummular headache revealed fusiform aneurysms of the scalp vessel in close relation to the painful area. One of the patients underwent surgical resection of the aneurysm with excellent response. A response to triptans was noted in both.DiscussionIn selected patients with nummular headache, vascular imaging of the scalp may reveal anomalies amenable to surgical treatment or triptan administration, sometimes resulting in disappearance of the pain.
    Headache The Journal of Head and Face Pain 06/2014; 54(7). DOI:10.1111/head.12398 · 2.94 Impact Factor
  • Neurologia (Barcelona, Spain) 05/2014; · 1.35 Impact Factor
  • Neurologia (Barcelona, Spain) 05/2014; DOI:10.1016/j.nrl.2014.04.006 · 1.35 Impact Factor
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    ABSTRACT: Body mass index (BMI) is used worldwide as an indirect measure of nutritional status and has been shown to be associated with mortality. Controversy exists over the cut points associated with lowest mortality, particularly in older populations. In patients suffering from dementia, information on BMI and mortality could improve decisions about patient care. The objective was to explore the association between BMI and mortality risk in an incident dementia cohort. Cohort study based on SveDem, the Swedish Quality Dementia Registry; 2008-2011. Specialist memory clinics, Sweden. A total of 11,398 patients with incident dementia with data on BMI (28,190 person-years at risk for death). Hazard ratios and 95% confidence intervals for mortality associated with BMI were calculated, controlling for age, sex, dementia type, results from Mini-Mental State Examination, and number of medications. BMI categories and linear splines were used. Higher BMI was associated with decreased mortality risk, with all higher BMI categories showing reduced risk relative to patients with BMI of 18.5 to 22.9 kg/m(2), whereas underweight patients (BMI <18.5 kg/m(2)) displayed excess risk. When explored as splines, increasing BMI was associated with decreased mortality risk up to BMI of 30.0 kg/m(2). Each point increase in BMI resulted in an 11% mortality risk reduction in patients with BMI less than 22.0 kg/m(2), 5% reduction when BMI was 22.0 to 24.9 kg/m(2), and 3% risk reduction among overweight patients. Results were not significant in the obese weight range. Separate examination by sex revealed a reduction in mortality with increased BMI up to BMI 29.9 kg/m(2) for men and 24.9 kg/m(2) for women. Higher BMI at the time of dementia diagnosis was associated with a reduction in mortality risk up to and including the overweight category for the whole cohort and for men, and up to the normal weight category for women.
    Journal of the American Medical Directors Association 04/2014; 15(6). DOI:10.1016/j.jamda.2014.03.001 · 5.30 Impact Factor
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    ABSTRACT: Background: Knowledge on survival in dementia is crucial for patients and public health planning. Most studies comparing mortality risk included few different dementia diagnoses. Objectives: To compare mortality risk in the most frequent dementia disorders in a large cohort of patients with an incident diagnosis, adjusting for potential confounding factors. Methods: 15,209 patients with dementia from the national quality database, Swedish Dementia Registry (SveDem), diagnosed in memory clinics from 2008 to 2011, were included in this study. The impact of age, gender, dementia diagnosis, baseline Mini-Mental State Examination (MMSE), institutionalization, coresidency, and medication on survival after diagnosis were examined using adjusted hazard ratios (HR) with 95% confidence intervals (CI). Results: During a mean follow-up of 2.5 years, 4,287 deaths occurred, with 114 (95% CI 111-117) deaths/1,000 person-years. Adjusted HR of death for men was 1.56 (95% CI 1.46-1.66) compared to women. Low MMSE, institutionalization, and higher number of medications were associated with higher HR of death. All dementia diagnoses demonstrated higher HR compared to Alzheimer's disease, with vascular dementia presenting the highest crude HR. After adjusting, frontotemporal dementia had the highest risk with a HR of 1.91 (95% CI 1.52-2.39), followed by Lewy body dementia (HR 1.64; 95% CI 1.39-1.95), vascular dementia (HR 1.55; 95% CI 1.42-1.69), Parkinson's disease dementia (HR 1.47; 95% CI 1.17-1.84), and mixed Alzheimer's disease and vascular dementia (HR 1.32; 95% CI 1.22-1.44). Conclusion: Worse cognition, male gender, higher number of medications, institutionalization, and age were associated with increased death risk after dementia diagnosis. Adjusted risk was lowest in Alzheimer's disease patients and highest in frontotemporal dementia subjects.
    Journal of Alzheimer's disease: JAD 03/2014; 41(2). DOI:10.3233/JAD-131856 · 3.61 Impact Factor
  • Pain Medicine 12/2013; DOI:10.1111/pme.12324 · 2.24 Impact Factor
  • César Fernández-de-Las-Peñas, María L Cuadrado
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    ABSTRACT: The term cervicogenic headache (CeH) describes a syndrome originating from the cervical spine. There are a variety of therapeutic approaches used for the management of CeH, but scientific evidence of their effectiveness is scarce. No medication drug has proven to be effective. The evidence for greater occipital nerve blocks, cervical nerve blockades, facet joint injections and surgical procedures is limited. Several physical therapy interventions are proposed for CeH, with spinal manipulation and soft tissue interventions being the most commonly used. However, the lack of solid evidence of positive effects and risks of serious complications for spinal manipulation should be considered in favor of other physical therapy interventions associated with less risk. The inconsistent results in the literature can be related to the fact that maybe not all therapeutic interventions are appropriate for all patients with CeH or maybe not all patients with CeH will benefit from particular interventions.
    Expert Review of Neurotherapeutics 12/2013; DOI:10.1586/14737175.2014.863710 · 2.96 Impact Factor
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    ABSTRACT: INTRODUCTION: Intermittent fever has been occasionally related to migraine, either as a migraine equivalent or as a migraine accompaniment. We present a case of recurrent increase in body temperature consistently associated with migraine headaches. METHODS: A 15-year-old girl reported a 3-year lasting history of migraine without aura, with a feeling of warmth occurring in each episode. Ancillary tests did not show any evidence of secondary headaches or any systemic disease. A 2-month headache diary was obtained, with daily records of headache intensity (0, no headache; 1, mild pain; 2, moderate pain; 3, severe pain) and simultaneous measurements of axillary temperature. Both parameters were registered in the evening, at 6:00 pm every day. The distribution of headache intensity and body temperature as well as the relationship between both variables over time were analyzed with nonparametric tests. RESULTS: The number of days without pain was 28 (45.2%); a mild headache was present on 13 days (21%), a moderate headache on 15 days (24.2%), and a severe headache on 6 days (9.7%). Headache days were associated with higher body temperature than headache-free days (median values: 37.3°C vs 36.6°C; Mann-Whitney U-test, P < 0.001). Moreover, a positive correlation was found between headache intensity and body temperature (Spearman's rho coefficient: 0.83, P < 0.001). CONCLUSIONS: Recurrent increase in body temperature may be another manifestation of the complex clinical spectrum of migraine. This symptom is probably related to hypothalamic involvement.
    Pain Medicine 05/2013; 14(8). DOI:10.1111/pme.12145 · 2.24 Impact Factor
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    ABSTRACT: OBJECTIVE: Epicrania fugax (EF) is a primary headache of recent description. We aimed to report 19 new cases of EF, and thus contribute to the characterization of this emerging headache. BACKGROUND: EF is characterized by painful paroxysms starting in a particular area of the head, and rapidly radiating forwards or backwards through the territories of different nerves. The pain is felt in quick motion along a lineal or zigzag trajectory. To date, 47 cases have been published, 34 with forward EF and 13 with backward EF. METHODS: We performed a descriptive study of all EF cases attending our Headache Unit from April 2010 to December 2012. Demographic and clinical data were recorded with a structured questionnaire. RESULTS: Overall, there were 12 women and 7 men. Mean age at onset was 51.7 ± 16.2. Fourteen patients had forward EF, while 5 patients had backward EF. Painful paroxysms lasted 1-4 seconds. Pain intensity was usually moderate or severe, and pain quality was mostly electric. Four patients had ocular autonomic accompaniments. Pain frequency was extremely variable, and 7 patients identified some triggers. Between attacks, 13 patients had some pain or tenderness in the stemming area. Thirteen patients required therapy for their pain. Neuromodulators, indomethacin, anesthetic blockades, and steroid injections were used in different cases, with partial or complete response. CONCLUSION: EF appears as a distinct headache syndrome and could be eventually included in future editions of the International Classification of Headache Disorders.
    Headache The Journal of Head and Face Pain 04/2013; 53(5). DOI:10.1111/head.12094 · 2.94 Impact Factor
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    ABSTRACT: IntroductionHallucinations are frequent in clinical practice, with an incidence of up to 38.7% in the general population. We aim to determine the prevalence of hallucinations among healthy young adults in our environment.Subjects and methodsWe designed an observational study, using as subjects 3rd to 6th year medical students at the Universidad Complutense de Madrid who complete clinical rotations in the Hospital Clínico San Carlos. After a screening questionnaire, an individual interview was conducted via telephone or e-mail to those students who reported hallucinations. We obtained clinical and epidemiological data through a semi-structured clinical interview performed by a third year neurology resident.ResultsN = 134 (average age was 22.1 years; 77.6% were women). 74 respondents answered affirmatively to one or more screening questions, and 54 completed the follow-up interview. 22.2% described visual phenomena and 64.8%, auditory. The majority reported sleep-related experiences and auditory perceptions related to hyper vigilance, such as hearing the telephone or the doorbell ring when in fact it had not (38.8%). All subjects had good insight into their experiences and none had psychotic symptoms. Two cases were associated with substance abuse.Conclusions Hallucinations are frequent among the general population. Traditionally, auditory phenomena have been associated with psychotic pathology, and other studies show a low population incidence (0.6%). However, in our sample, short auditory perceptions with immediate analysis were frequent and not pathological.
    Neurologia (Barcelona, Spain) 01/2013; 28(1):19–23. DOI:10.1016/j.nrl.2012.02.004 · 1.35 Impact Factor
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    ABSTRACT: OBJECTIVES.: Epicrania fugax (EF) is a novel syndrome presenting with brief pain paroxysms that always start in a particular area of the head to spread immediately either forward or backward. Paroxysms stem from a focal area, in which a well-shaped continuous pain reminiscent of the symptomatic area described in nummular headache (NH) can be present. We aimed to analyze the association of these two epicranial headaches in eight patients. METHODS.: We prospectively assessed all patients with EF attending an outpatient headache office from March 2008, when EF was first described, to June 2012. Among them, we selected those patients with a well-circumscribed continuous pain at the stemming point fulfilling the research diagnostic criteria for NH of the International Classification of Headache Disorders II Edition (ICHD-II) appendix. We considered the demographic and clinical features of the selected patients. RESULTS.: Eight patients (five females, three males) were diagnosed with both EF and NH. Mean age of onset was 44.2 ± 12 (range: 23-60). Regarding NH, the diameter of the painful area was 4.4 ± 1 centimeters (range: 3-6) and pain intensity was 4.2 ± 0.7 (range: 3-5) on a 10-point verbal analogical scale (VAS). As for the EF, the radiating paroxysms always started in the NH painful area and lasted 6.6 ± 4.5 seconds (range: 2-15), with a pain intensity of 7.9 ± 1.6 (range 5-10) on the VAS. Five cases had forward radiation, while three cases had backward EF. Four cases had ipsilateral autonomic accompaniments. Six patients required a preventive, and lamotrigine achieved complete response in three of them. CONCLUSION.: Although the etiology of NH and EF remains uncertain, both syndromes seem to share a peripheral source. Their association in a number of patients is probably reflecting a pathophysiological connection. Lamotrigine might be a good therapeutic option for those patients presenting with both disorders.
    Pain Medicine 12/2012; 14(3). DOI:10.1111/pme.12022 · 2.24 Impact Factor
  • Neurologia 08/2012; 29(1). DOI:10.1016/j.nrl.2012.06.005
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    ABSTRACT: INTRODUCTION: Hallucinations are frequent in clinical practice, with an incidence of up to 38.7% in the general population. We aim to determine the prevalence of hallucinations among healthy young adults in our environment. SUBJECTS AND METHODS: We designed an observational study, using as subjects, 3rd to 6th year medical students of the Universidad Complutense de Madrid who complete clinical rotations in the Hospital Clínico San Carlos. After a screening questionnaire, an individual interview was conducted via telephone or e-mail to those students who reported hallucinations. We obtained clinical and epidemiological data through a semi-structured clinical interview performed by a third year Neurology resident. RESULTS: N=134 (average age was 22.1 years; 77.6% were women). 74 respondents answered affirmatively to one or more screening questions, and 54 completed the follow-up interview. 22.2% described visual phenomena and 64.8%, auditory. The majority reported sleep-related experiences and auditory perceptions related to hyper vigilance, such as hearing the telephone or the doorbell ring when in fact it had not (38.8%). All subjects had good insight and none had psychotic symptoms. Two cases were associated with substance abuse. CONCLUSIONS: Hallucinations are frequent among the general population. Traditionally, auditory phenomena have been associated with psychotic pathology, and other studies show a low population incidence (0.6%). However, in our sample, short auditory perceptions with immediate insight were frequent and not pathological.
    Neurologia 05/2012;

Publication Stats

1k Citations
255.03 Total Impact Points

Institutions

  • 1999–2015
    • Hospital Clínico San Carlos
      • Servicio de Neurología
      Madrid, Madrid, Spain
  • 2009–2014
    • Complutense University of Madrid
      • Department of Medicine
      Madrid, Madrid, Spain
  • 2011
    • Hospital Clínico Universitario de Valladolid
      • Department of Neurology
      Valladolid, Castille and León, Spain
  • 1999–2010
    • King Juan Carlos University
      • • Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine
      • • Facultad de Ciencias de la Salud
      Madrid, Spain
  • 2008
    • Hospital Universitario Fundacion Alcorcon
      • Departamento de Neurología
      Madrid, Madrid, Spain
  • 2005–2008
    • Hospital Rey Juan Carlos - Madrid
      Madrid, Madrid, Spain
    • Universidad Politécnica de Madrid
      Madrid, Madrid, Spain