Anna Baldrati

Mitochondrial Abnormalities in Migraine. Preliminary Findings.

SYNOPSIS

Ischemic stroke in young adults: the relevance of migrainous infarction

Sixty-one consecutive patients, £40 years old, were hospitalized for cerebral infarction between 1977 and 1985. Evaluation included computed tomographic brain scan, arteriography, echocardiography, and blood tests. A probable migrainous infarction was diagnosed in six patients (10%) (all women with a history of migraine) who survived the initial stroke and were followed-up for an average of four years. In five patients the stroke occurred during a common migraine attack and in one patient during a classic migraine attack. The site of infarction was invariably the occipital lobe. During the follow-up, no subject had a further stroke. All six women had a permanent hemianopic deficit.

Electroencephalogram and HIV infection: A prospective study in 100 patients

In order to study the correlation between central nervous system (CNS) involvement and EEG abnormalities in HIV infection we studied 100 consecutive HIV patients. Patients were divided into 4 groups; Group I: 42 neurologically asymptomatic subjects; Group II: 6 patients with peripheral neuropathies; Group III: 28 patients with AIDS Dementia Complex; Group IV: 24 patients with secondary CNS involvement. The results of this study emphasize that abnormal EEGs are correlated with CNS involvement. Neurologically asymptomatic patients showed no abnormal tracings, but the presence of borderline EEGs (33%) in asymptomatic patients should be evaluated prospectively.

Propranolol and acetylsalicylic acid in migraine prophylaxis

ABSTRACT‐ The aim of this double‐blind crossover study was to compare the prophylactic effect of acetylsalicylic acid (ASA) with that of propranolol (PRP) in the treatment of migraine. Plasma concentrations of the two drugs were measured in order to investigate a possible relationship to the clinical effect. Compared to the pretreatment period, PRP and ASA reduced migraine index, frequency, duration, severity of attacks and headache days. Due to the limited number of patients, our results should be cautiously interpreted, however relevant the clinical improvement seemed. Improvement of migraine index was not related to different plasma levels of the two drugs.

Flunarizine in common migraine: Italian cooperative trial. II. Long-term follow-up.

The effects of flunarizine administration (10 mg/day, at bed time) were studied in 120 common migraine patients who were followed for 24 months with quarterly controls. Besides headache index (HI) and analgesic use, other variables were monitored, such as arousal (Tolouse Pieron test), mood (Hamilton rating scale for depression), sleep/wake (hrs) and body weight. The study was open-type and after the 6th month control some responder (R) cases (HI reduction ≥ 60%) presenting HI scores ≤ 4 could continue the survey off-treatment. The percentage of R cases was 54.5% at the 3rd month, a figure that further increased up to 72% by the 9th month; relapses on treatment were not observed and rebound-headache occurred in 1/4 of R cases let off-treatment. Lower (p < 0.05) baseline HI values characterized non-responders. Side-effects not requiring withdrawal were drowsiness (42% within the 1st month) and weight gain (mean 7.9 ± 6.9 kg) in 54% of the cases, while a retarded type depression was the most frequent cause of drop-out from trial (7.5%). The results, while confirming the high prophylactic activity of flunarizine in common migraine, stress the importance of clinical long-term survey of side-effects using antimigraine drugs and suggest the need for further investigations about flunarizine effects on CNS.

Asystole induced by partial seizures: a rare cause of syncope.

The clinical distinction between cardiovascular and epileptic causes of loss of consciousness is sometimes difficult, but becomes challenging when a primary epileptic seizure secondarily causes an asystole. Epilepsy can be correlated to severe bradycardia or asystole. The syndrome is called the ictal bradycardia syndrome. Ictal bradycardia and asystole have been implicated in the etiology of sudden unexpected death in epileptic patients (SUDEP). We present a case of traumatic syncope during an epileptic disorder ab esordio and we discuss the related literature.

Transient abnormalities on magnetic resonance imaging after partial status epilepticus

We report two patients who developed focal abnormalities on MRI after partial status epilepticus.Maximum radiological modification occurred in the area of maximal epileptic discharge. Subsequent MRI failed to demonstrate persistent abnormalities.These transient abnormalities on MRI could be an expression of cerebral edema caused by focal epileptic status.SommarioRiportiamo due casi che hanno sviluppato anomalie transitorie alla RMN dopo stato di male parziale non convulsivo. La massima modificazione radiologica si è verificata in corrispondenza della zona di maggior attività critica. Le RMN eseguite successivamente sono risultate negative. La transitorietà delle alterazioni è probabilmente da interpretare sulla base di un edema critico. Alterazioni di neuroimaging possono essere quindi una conseguenza piuttosto che una lesione causale dello stato di male.

Cardiovascular Changes in Cluster Headache

SYNOPSIS

Status Epilepticus with Cognitive Symptomatology in a Patient with Partial Complex Epilepsy

A 16-year-old patient who had a history of complex partial seizures, had frequent episodes of status epilepticus with diffuse slow-wave discharges. The clinical manifestations were apparently insignificant due to the fact that vigilance, orientation and behaviour were unimpaired. Neuropsychological investigations showed that the cognitive processes were selectively impaired during such episodes. The electroclinical pattern was interrupted by break-off of contact concomitant with high-frequency spike discharges. Cognitive impairment is believed to represent the specific feature peculiar to this type of status epilepticus.

Long-Term Prognosis after Carotid Endarterectomy

This study analyzed 76 consecutive patients with carotid transient ischemic attacks (TIA) and carotid lesions appropriate to symptoms who underwent endarterectomy during the period 1975-1981. The mean age of the patients was 51.9 +/- 8 years at the time of surgery. Hypertension was present in 32.9%, diabetes mellitus in 13%, ischemic cardiopathy in 8.2% and peripheral vascular disease in 6.6%. Operative mortality was 1.3% and harder morbidity 4%. The average follow-up was 2.6 years (range 1-7 years). The observed 5-year survival rate was 85.2% compared to the expected rate of 92.4% in a normal population. During the follow-up 5 patients had a stroke: the cumulative stroke rate was 4.6% at 1 year and 7.9% at 3 years. 18 patients had further TIAs (13 carotid TIAs and 5 vertebro-basilar TIAs). 6 patients suffered myocardial infarction. The prognosis of TIA patients treated with endarterectomy is difficult to evaluate because the natural history of TIAs is still undefined.