C Zanferrari

Università degli studi di Parma, Parma, Emilia-Romagna, Italy

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Publications (25)72.72 Total impact

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    ABSTRACT: We report a case of reversible cerebral vasoconstriction, possibly secondary to the use of indomethacin to relieve pain during a migraine with aura attack. Non-steroidal anti-inflammatory drugs are not reported among substances precipitating secondary forms of reversible cerebral vasoconstriction. A transcranial Doppler sonography study, performed during the phase with headache and the other neurological deficits, suggested the presence of distal cerebral vasospasm, which normalized when all symptoms regressed completely (<24 hours). We speculated that indomethacin might represent the trigger factor of these particular phenomena, by acting either directly on distal cerebral vessels, or under certain predisposing conditions, such as migraine with aura attacks.
    No preview · Article · May 2011 · Headache The Journal of Head and Face Pain
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    ABSTRACT: The objective of the study was to compare the cerebral distribution of white matter lesions (WMLs) between migraine patients with different aura symptoms. Migraine with aura (MA) patients were consecutively enrolled as part of the Shunt-Associated Migraine (SAM) study. According to clinical symptoms, aura was classified as motor, aphasic, sensory, visual or vertebrobasilar. Standard and FLAIR (fluid attenuated inversion recovery) T(2)-weighted MRI sequences were inspected for WMLs by three independent raters blinded to clinical data. WMLs were assessed in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Schelten's scale. Interobserver agreement was good to excellent (k = 0.64 to 0.96, p < .0001). One hundred and eighty-five patients (77% women) were included. Aura symptoms were classified as visual in 172 (99%) patients, sensory in 76 (42%), aphasic in 54 (30%), motor in 39 (21%) and vertebrobasilar in 17 (9%) patients. One hundred and four patients (57%) exhibited more than one type of aura. D-WMLs were mainly detected in the frontal lobes (86%). There was no association between type of aura and the presence of WMLs in any cerebral location. Aura symptoms do not influence the cerebral distribution of WMLs associated with migraine disease.
    No preview · Article · Jul 2010 · Cephalalgia
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    ABSTRACT: Platypnea-orthodeoxia is a syndrome characterized by dyspnea and hypoxemia in orthostatism relieved by supine position. This phenomenon is frequently associated with interatrial communication, mainly patent foramen ovale. The association of platypnea-orthodeoxia syndrome with recurrent stroke and patent foramen ovale is extremely uncommon. A 73-year-old woman experienced recurrent attacks of dyspnea after an ischemic stroke. Arterial blood gas analysis changes in upright and supine position confirmed the diagnosis of platypnea-orthodeoxia syndrome. Contrast-enhanced transthoracic echocardiography showed patent foramen ovale with atrial septal aneurysm and right-to-left shunt. Percutaneous closure of patent foramen ovale led to stabilization of blood oxygen saturation and resolution of dyspnea. Platypnea-orthodeoxia syndrome should be considered in patients with stroke and unexplained dyspnea. The diagnosis could lead to correction of an unknown cardiac defect and of potential risk factor for stroke.
    No preview · Article · Oct 2009 · Neurological Sciences
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    ABSTRACT: White matter lesions (WMLs) are commonly found on brain MRI of migraine patients. Migraine with aura (MA+) is associated with an increased frequency of right-to-left shunt (RLS) mostly due to patent foramen ovale. The relationship between WML load and RLS in MA+ is currently unknown. MA+ patients were consecutively enrolled as part of the Shunt Associated Migraine (SAM) study. Patients underwent a standardized headache and vascular risk factors questionnaire, contrast-enhanced transcranial Doppler, blood coagulation tests, and brain MRI. RLS was categorized into four grades: no shunt, <10 microbubbles (mb), >10 mb single spikes pattern, and >10 mb shower/curtain pattern. Standard and fluid-attenuated inversion recovery T2-weighted MRI sequences were inspected for WMLs by three independent raters blinded to RLS grade. WML load was scored in the periventricular areas (PV-WMLs) with the Fazekas scale and in the deep white matter (D-WMLs) with the Scheltens scale. Interobserver agreement was good to excellent (kappa = 0.64 to 0.96, p < 0.0001). WML load was then correlated between patients with and without RLS. One hundred eighty-five patients (77% women) were included. PV-WML load was similar between patients with and without RLS. D-WML load decreased in patients with RLS (p = 0.045). On logistic regression analysis, only age was associated with WMLs (p < 0.001). The presence of right-to-left shunt does not increase white matter lesion load in patients who have migraine with aura.
    Full-text · Article · Aug 2008 · Neurology
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    ABSTRACT: Migraine with aura (MA) is associated with the persistence of patent foramen ovale (PFO) in about 50% of cases, and migraineurs tend to have larger shunts than controls, suggesting that right-to-left shunt (RILES) determined by PFO could play a role in triggering migraine attacks. Moreover, some preliminary reports have suggested that PFO closure may give relief to both migraine and aura attacks. The aim of this study was to clarify if shunt-associated migraine (SAM) has clinical features that allow a distinction from shunt-unrelated migraine (SUM), in a prospective, multicentre, observational study (SAM study). We enrolled consecutive MA patients, who underwent a structured, standardized questionnaire for family and personal history and for detailed migraine features. All were systematically screened for RILES with transcranial Doppler, and for coagulation disorders. Overall, 460 patients were included; the SUM and SAM classes comprised 58% and 42% of patients, respectively. SAM patients were significantly younger (34.1 +/- 10 vs. 37.1 +/- 11 years), had a more frequent family history of migraine (76% vs. 66%) and a higher frequency of sensory symptoms of aura (51% vs. 41%); by contrast, there was a lesser association of SAM with other cardiac abnormalities and with coagulation disorders. The SAM study suggests that the effect of RILES on migraine features is not relevant. The higher family history of migraine in SAM suggests a possible genetic linkage between migraine and RILES.
    Full-text · Article · May 2008 · Cephalalgia

  • No preview · Conference Paper · Feb 2007
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    ABSTRACT: Because of the presumed non-atherosclerotic pathogenesis, the potential link between spontaneous cervical artery dissection (sCAD) and common risk factors for atherosclerosis has never been investigated systematically. Therefore, this prospective, multicentre, case-control study compared the frequency of tobacco use, hypertension, diabetes mellitus, and hypercholesterolaemia among a group of consecutive patients with sCAD (n = 153), a group of patients with ischaemic stroke, not related to CAD (non-CAD), and a group of controls. As opposed to the other variables, a trend towards a significant association was seen when the prevalence of hypertension was compared among patients with sCAD and controls (26.8% v 17.0%; odds ratio (OR) 1.79; 95% confidence interval (CI), 0.98 to 3.27; p = 0.058). Hypertension was also significantly associated with the subgroup of patients with sCAD and cerebral infarction (OR, 1.94; 95% CI, 1.01 to 3.70; p = 0.045), particularly when involving the vertebral arteries (OR, 2.69; 95% CI, 1.20 to 6.04; p = 0.017). These findings might help define the spectrum of pathogenic conditions predisposing to sCAD and provide information to help investigate the combined effect of such susceptibility factors in future studies.
    Full-text · Article · Feb 2006 · Journal of Neurology Neurosurgery & Psychiatry
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    ABSTRACT: The presence of epidemiological data that demonstrate the coexistence of migraine with aura (MA) and ischemic stroke has led to the research of common underlying etiopathogenetic factors. Many observation studies, both retrospective and prospective, have identified the patent foramen ovale (PFO) associated to the right-left shunt, as one of the possible link mechanisms between the two pathologies. The association of PFO and MA could not be a simple coincidence: in fact, a right-left shut could play a very important role in the outbreak of the aura and, in some cases, it could lead to the stroke. The evidences collected until now suggest that a right-left shunt condition can be accidentally related to a number of patients suffering of migraine and that can explain, at least partly, the increase of the stroke risk connected to migraine (1). The purpose of this study is to evaluate the presence of PFO in patients with migraine with aura, to compare the clinical characteristics of patients with MA positive for PFO to those of patients with MA negative for PFO and identify a possible subtypes of MA related to the presence of right-left shunt.
    No preview · Article · Jan 2006
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    ABSTRACT: The pathophysiology of spontaneous cervical artery dissection (sCAD) is largely unknown. An association with migraine has been suggested, but not definitively proven. In the setting of a hospital-based prospective case-control study we assessed personal and family history of migraine in 72 patients with sCAD, 72 patients with cerebral infarct unrelated to a CAD (non-CAD) and 72 control subjects. Personal history of migraine was significantly associated to sCAD compared to non-CAD (59.7% vs. 30.6%; OR 3.14; 95% CI 1.41-7.01) and controls (18.1%; OR 7.41; 95% CI 3.11-17.64). As opposed to migraine with aura, migraine without aura was significantly more frequent among sCAD than among non-CAD (56.9% vs. 25.0%; OR 3.91; 95% CI 1.71-8.90) and controls (12.5%; OR 9.84; 95% CI 3.85-25.16). Similar results were observed when the frequencies of family history of migraine were compared. These findings are consistent with the hypothesis that migraine may represent a predisposing condition for sCAD.
    Full-text · Article · Sep 2005 · Cephalalgia
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    ABSTRACT: Spontaneous supraaortic arterial dissection represents a rare pathology; it ranges from 2,6 to 2,9 per 100.000 per year for the carotid arteries and from 1,3 to 1,5 per 100.000 per year for the vertebral arteries. Spontaneous dissection represents the cause of 20 % of the stroke in patients under the age of 30 and 10 % in patients under the age of 40. Etiology include neck trauma, different connective tissue disorders and anomalies of the vascular wall and probably involves a combination of genetic and environmental factors. Typical presentation of spontaneous internal artery dissection is an ipsilateral pain in neck and face with Horner's syndrome and contralateral deficit; lower cranial nerve palsy have been reported in association with dissection. Therapy includes anticoagulation becouse is supported by the demonstration of emboli as the most common cause of stroke in these patients; percutaneous angioplasty and stent deployment may be also indicated. Surgical treatment of dissections, consisting of an interposition graft or extracranial-intracranial bypass, is indicated only for those patients who are not candidates for endovascular treatment. The aim of this review is to present our multicentric clinical experience.
    No preview · Article · Jan 2001

  • No preview · Article · Jan 2001
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    ABSTRACT: This multicenter, double-blind, clinical study was designed to compare the efficacy and safety of alpha-dihydroergocryptine and flunarizine in the prophylaxis of migraine without aura. One hundred thirty-five patients fulfilling the diagnostic criteria of the International Headache Society were enrolled at five neurologic centers. The study design included a 1-month pretreatment phase with placebo; a 6-month, double-blind, double-dummy treatment phase with alpha-dihydroergocryptine (10 mg twice daily) or flunarizine (5 mg once daily); a further 3-month follow-up phase without treatment. Efficacy was assessed using the patient's diary. Laboratory tests, vital signs, and adverse events were monitored. Analysis of covariance for repeated measures was performed on the intent-to-treat sample. Both treatments led to a significant reduction in the frequency of migraine, days with headache, and use of relief medication. Overall, 51% of those treated with alpha-dihydroergocryptine and 49% of those treated with flunarizine were responders (50% or greater reduction in attack frequency), the average percentage of reduction being 64% with alpha-dihydroergocryptine and 51% with flunarizine. There was no significant difference between the two groups in terms of incidence of adverse events; dizziness and weight gain were the most frequent observed adverse events with alpha-dihydroergocryptine and flunarizine, respectively. Based on the overall improvement in migraine parameters, alpha-dihydroergocryptine can be recommended for use in migraine prophylaxis.
    No preview · Article · Jul 1999 · Headache The Journal of Head and Face Pain
  • L Bettoni · E Bortone · M Chiusi · R Tortorella · C Zanferrari · D Mancia
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    ABSTRACT: Continuous rhythmic lingual myoclonus is a rare disorder, usually described in association with palatal myoclonus. Isolated lingual myoclonus is exceptionally reported [1–6]. We recently observed a case of transient rhythmic myoclonus of the tongue, in which there was no evidence of pathology.
    No preview · Article · Feb 1999 · European Neurology
  • L. Bettoni · E. Bortone · R. Tortorella · M. Chiusi · C. Zanferrari · Mancia
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    ABSTRACT: Linguai myocionus nas been rarely described in association with palatal myocionus. Isolated myocionus of the tongue is exceptionally reported in the coxirse of neurological disorders (Araold-Chiari malformation; head traumas). An healthy 35 years-old woman presented a sudden, subcontinuos, isolated, rythmtcal myocionus of the tongue. Family and personal hystory were unrevealing for head injuries, movement disorders or seizures.Apart from lingual jerks, the neurological examination was normal. EEG, BAEPs and SEPs where normal. By surface EMG low frequency (2-4 Hz) short duration bursts (<40 ms) of muscle activity were recorded from genioglossal and myloioideus muscles bilaterally, but more costant on the right side of the tongue. MRI didn't show any lesion; focalized scans didn't reveal olive alterations. Treatment with clobazam (20 mg/die) completely stopped off lingual jerks. In our opinion this case represents a primary clinical entity, but neuroradiological, neurophysiological and clinical follow up would contribute to clarify some features of this very rare focal hyperkinesia.
    No preview · Article · Jan 1997
  • G C Manzoni · F Granella · G Sandrini · A Cavallini · C Zanferrari · G Nappi
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    ABSTRACT: We conducted a retrospective study of 150 patients with chronic daily headache (CDH) to determine how to categorize their headache according to the classification of the International Headache Society (IHS). All patients were first evaluated at Parma and Pavia Headache Centres (from January 1992 to March 1993) and had had headache for at least 15 days a month during the previous 6 months. Four patients were thereafter excluded due to poor reliability. The 146 patients who met our CDH criteria (92 with and 54 without clear-cut migraine attacks) could be classified into four groups: (i) chronic tension-type headache (CTTH)--27 patients; (ii) coexisting migraine plus CTTH--65 patients; (iii) unclassifiable daily headache--27 patients; and (iv) migraine and an unclassifiable interval headache--27 patients. Seventy-two percent of patients with CDH had migraine as the initial form of their headache. We therefore propose to revise the IHS classification for migraine, taking into account its evolution, and add two subcategories, migraine with interparoxysmal headache and chronic migraine.
    No preview · Article · Mar 1995 · Cephalalgia
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    ABSTRACT: We assessed interobserver reliability of the International Headache Society (IHS) classification for diagnosis of primary headaches. The study was performed on 103 patients consecutively seen at two Headache Centres. Each patient was given a structured interview recorded on videotape. Four experienced clinicians then reviewed the interviews separately and made a diagnosis of headache according to IHS criteria at the one- and two-digit levels. At both the one- and the two-digit level the agreement was substantial (Kappa = 0.74 and 0.65, respectively). The analysis of reliability for each of nine items necessary for diagnosis showed an agreement ranging from substantial (Kappa = 0.69) to almost perfect (Kappa = 0.89). Our results indicate that the IHS classification has a good reliability for the diagnosis of primary headaches at the one- and two-digit levels.
    No preview · Article · Mar 1994 · Cephalalgia
  • G Sandrini · G C Manzoni · C Zanferrari · G Nappi
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    ABSTRACT: Chronic daily headache (CDH), a heterogeneous group of headaches, includes different forms that occur daily, or almost daily, over a prolonged period of time. The nosography of this group is still a matter of debate, and in the most recent classification of the IHS (1988) only a few types of CDH are included: chronic tension-type headache, coexisting migraine. This study is an epidemiological approach to identifying the clinical features of CDH and the possible factors involved in changing episodic headache in CDH. Ninety CDH outpatients were investigated using a computerized record chart. The main observed forms were: (a) chronic tension-type headache--migraine with interparoxysmal headache, an evolved form of migraine in which a constant low severity headache develops between attacks; (b) transformed migraine, an evolved form of migraine with progressive worsening of the disease which reaches the level of continuous pain with the disappearance of typical migraine attacks. Interval headaches in migraine with interparoxysmal headache partly fulfil the IHS criteria for chronic tension-type headache. Analgesic drug abuse plays a prominent role in inducing CDH and in determining its clinical features.
    No preview · Article · May 1993 · Cephalalgia
  • G C Manzoni · F Granella · G Sandrini · F Antonaci · C Zanferrari · G Nappi
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    ABSTRACT: A comprehensive record chart for the study of chronic daily headache (CDH) is presented. The record chart contains 11 parts (232 items) concerning: sociodemographic data, physiological history, female reproductive life history, family history, pathological history, drug abuse, headache history, headache clinical features, prophylactic therapy, instrumental investigations, and physical and neurological examination. Furthermore, three attached special charts are illustrated which concern, respectively, the cervical spine examination, oromandibular function examination and the assessment of analgesic use.
    No preview · Article · Jan 1993 · Functional neurology
  • F Granella · G Sances · C Zanferrari · A Costa · E Martignoni · G C Manzoni
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    ABSTRACT: A retrospective study was conducted on 1300 women suffering from migraine without aura referred to the Headache Centers of Parma and Pavia from 1984 to 1990. All the data concerning their reproductive life, and the modifications induced by it on the course of headache were obtained from record-charts. Migraine frequently started at menarche (10.7%); in 60% of cases the migraine attacks occurred mostly or exclusively in the perimenstrual period, in 67% of cases disappeared during pregnancy, and in 24.1% significantly (P < 0.0001) worsened with "pill" intake. This study also designated a migraine subgroup which is more influenced by changes in sexual hormones, i.e. migraine with onset at menarche. This form of migraine shows more frequently a menstrual periodicity, and usually improves during pregnancy. Furthermore, menstrual migraine patients show social and cultural characteristics with distinguish them from other women.
    No preview · Article · Nov 1992 · Headache The Journal of Head and Face Pain
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    ABSTRACT: Two-hundred-and-fifty-one consecutive cluster headache (CH) patients referred to the Pavia and Parma Headache Centers were evaluated in order to verify the presence and recurrence of one or more autonomic symptoms. Data obtained show that in 2.8% of patients cluster attacks were not accompanied by localized autonomic symptoms, thus confirming the report of Ekbom. We observed a high prevalence of photophobia, nausea and vomiting. The IHS diagnostic criteria for CH may need to be modified. The high frequency of "general" autonomic symptoms seems to suggest a component of "central" drive in the physiopathology of cluster headache.
    No preview · Article · Jul 1992 · Cephalalgia

Publication Stats

686 Citations
72.72 Total Impact Points


  • 1992-2011
    • Università degli studi di Parma
      • Department of Neurosciences
      Parma, Emilia-Romagna, Italy
  • 2008
    • University of Padova
      • Department of Neurosciences
      Padua, Veneto, Italy
  • 2007
    • University of Verona
      Verona, Veneto, Italy
  • 2005
    • Università degli Studi di Brescia
      • Department of Medicine and Surgery
      Brescia, Lombardy, Italy
  • 1991-1992
    • University of Pavia
      • Department of Public Health, Neuroscience, Experimental and Forensic Medicine
      Ticinum, Lombardy, Italy