Ante Jurjević

Migraine and tension-type headache in Croatia : A population-based survey of precipitating factors

The careful monitoring of the trigger factors of headache could be an important step in treatment, because their avoidance may lessen the frequency and severity of attacks. Furthermore, they may provide a clue to the aetiology of headache. The aim of the present study was to estimate the prevalence of tension-type headache (TTH) and to establish the frequency of precipitating factors in subjects with migraine and TTH in the adult population of Bakar, County of the Coast and Gorski Kotar, Croatia. Another important purpose of the study was to examine the relationship of the precipitating factors with migraine and TTH, and with migraine subtypes: migraine with aura (MA) and migraine without aura (MO). We performed a population-based survey using a ‘face-to-face door-to-door’ interview method. The surveyed population consisted of 5173 residents aged between 15 and 65 years. The 3794 participants (73.3%) were screened for headache history according to the International Headache Society (IHS) criteria. Headache screen-positive responders, 2475 (65.2%), were interviewed by trained medical students with a structured detailed interview focused on the precipitating factors. The following precipitating factors in lifetime migraineurs and tension-type headachers have been assessed: stress, sleep disturbances, eating habits, menstrual cycle, oral contraceptives, food items, afferent stimulation, changes in weather conditions and temperature, frequent travelling and physical activity. A total of 720 lifetime migraineurs and 1319 tension-type headachers have been identified. The most common precipitants for both migraine and TTH were stress and frequent travelling. Stress (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.17, 1.69) was associated with migraine, whereas physical activity (OR 0.72, 95% CI 0.59, 0.87) was related to TTH. Considering MA and MO, frequent travelling (OR 2.2, 95% CI 1.59, 2.99), food items (OR 2.2, 95% CI 1.35, 3.51) and changes in weather conditions and temperature (OR 1.75, 95% CI 1.27, 2.41) exhibited a significant positive association with MA. The present study demonstrated that precipitant-dependent attacks are frequent among both migraineurs and tensiontype headachers. Lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headachers. MA was more frequently associated with precipitating factors than MO. We suggest that some triggering factors may contribute to the higher occurrence of precipitant-dependent headache attacks in susceptible individuals.

The use of standardized incidence and prevalence rates in epidemiological studies on multiple sclerosis. A meta-analysis study.

Objective: To demonstrate whether or not the age and sex adjustment of incidence and prevalence rates in multiple sclerosis (MS) could allow more reliable comparison between epidemiological studies performed in different areas of the world and to establish if the latitude gradient theory could be confirmed after the standardization for age and sex distribution. Methods: A meta-analysis of population-based incidence and prevalence studies on MS from 1980 through 1998 using the terms ‘multiple sclerosis’, ‘prevalence’ and ‘incidence’ in the bibliographic databases MEDLINE and EMBASE was performed. We included studies that reported the diagnostic criteria, number of cases and the population studied, the date of the study, the latitude, and the age- and sex-specific crude incidence and prevalence rates. According to the inclusion criteria, 69 of 127 papers on prevalence and 22 of 70 papers on incidence were considered for age adjustment and 27 prevalence and 8 incidence studies for sex adjustment. The mean incidence and prevalencerates and the 95% confidence intervals age- and sex-adjusted to the World and the European standard populations were calculated. Results: The Spearman rank correlation and the multiple regression analyses indicated that age adjustment to standard populations could overcome the limitations in comparing the crude prevalence and incidence rates of different epidemiological studies on MS. When the mean crude and age- and sex-adjusted prevalence and age-adjusted incidence rates were stratified by latitude (from south to north), the latitudinal gradient, which was highly significant for the crude rates, became less remarkable for the age- and sex-adjusted prevalence rates and not significant for the age-adjusted incidence rates. Conclusions: The crude incidence and prevalence rates in epidemiological studies on MS should be age- and sex-adjusted to a common standard population to permit a more reliable comparison among studies performed in different countries. Our findings support the opinion that the latitude does not play a key role in determining the onset of MS. Whenever possible, the crude incidence and prevalence rates should be adjusted to the ethnic origin and migration characteristics.

Prevalence of migraine in Croatia: a population-based survey.

Objectives.—The aim of the present study was to estimate the prevalence of migraine among Croatian adults. This is the first epidemiological study of migraine in Croatia in which the operational diagnostic criteria of the International Headache Society have been applied.

Incidence and Prevalence of Myasthenia gravis in the County of the Coast and Gorski kotar, Croatia, 1976 through 19961

For the period 1976 through 1996, we carried out an incidence and prevalence study of myasthenia gravis in the County of the Coast and Gorski kotar, Croatia. This was the first epidemiological study of myasthenia gravis in Croatia. A total of 43 incident cases were identified. Overall the average crude annual incidence rate was 6.52 per 1,000,000 person-years; 5.59 per 1,000,000 person-years for men and 7.41 per 1,000,000 person-years for women. The incidence rate was 6.30 (95% confidence intervals 4.56–8.51), age-adjusted to the European population and 5.17 (95% confidence intervals 3.74–6.98), age-adjusted to the world population. On 31 December 1996, there were 32 prevalent cases. The crude prevalence was 99 per 1,000,000 population (95% confidence intervals 67.7–139.6). The prevalence adjusted to the European and world populations was 101.9 (95% confidence intervals 69.7–143.7) and 75.9 (95% confidence intervals 51.9–107) per 1,000,000 population, respectively. Our incidence findings are similar to those reported in North-East Italy but lower than those in the United States. Our prevalence findings were generally higher than those in Northern European Countries but lower than those in the United States. Standardization of rates to the European or world population could facilitate comparison between different populations.

Intraventricular thrombolysis with rt-PA in patients with intraventricular hemorrhage

Dunatov S, Antoncic I, Bralic M, Jurjevic A. Intraventricular thrombolysis with rt‐PA in patients with intraventricular hemorrhage. 
Acta Neurol Scand: 2011: 124: 343–348. 
© 2011 John Wiley & Sons A/S.

Recurrent Transient Global Amnesia at High Altitude

We report the case of a 57-year-old man who experienced recurrent episodes of memory loss that resemble transient global amnesia (TGA). The first episode lasted 20 minutes, and the second was 8 hours long.

A case with giant arachnoid cysts manifested as migraine.

A 69-year-old female with a diagnosis of essential hypertension presented with a sudden onset severe headache. For the last 15 years she had been suffering from headache that was diagnosed as migraine and treated accordingly. On admission except from headache described as pulsing, localized in occipital and temporal region, followed by nausea and vomiting, vital signs and neurological examination were normal. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed giant arachnoid cysts in the temporal lobe and on the convexity of frontal lobe, 10x12x5.5 cm in dimension on the right side, and 8x7x5.5 cm on the left. Brain mass was hourglass-shaped. Temporal lobes were almost completely erased and parietal lobes reduced. Only occipital lobes were fully developed (Figs. 1, 2 and 3). Though surgery was advocated to her, she strongly refused it. At follow-up examination 3 years later she was doing fine and neurological examination showed no deficits. Arachnoid cysts are cavities with content similar to cerebrospinal fluid. They are often found incidentally, in 0.1% to 0.4% in the general population and they make up approximately 1% of all intracranial space-occupying lesions. Arachnoid cysts are the result of developmental abnormalities, but a small number of them are acquired, such as those in association with neoplasm or those that are due to adhesions following leptomeningitis, hemorrhage, or surgery. Neurological symptoms depend on location, although intracranial hypertension is the most frequent. They include headache, seizures, hearing and visual disturbances, vertigo, hemiparesis, ataxia and behavioral changes. Symptoms usually develop at an early age and are rarely seen in the elderly. Treatment is symptomatic. When symptoms warrant, the surgical placement of a shunt may be required to decompress the cyst. No general survey has yet been conducted regarding surgical treatment in elderly patients, since the result after surgery is rather unpredictable in these patients. Thus, minimally invasive fenestration techniques are available to offer low-risk surgical treatment in selected cases.

Incidence and prevalence of motor neuron disease in Coastal and Mountainous Regions, Croatia, 1984–1993. A preliminary survey

In the period 1984–1993, we carried out an incidence and prevalence study of motor neuron disease in Coastal and Mountainous Regions, Croatia. This was the first epidemiological study on motor neuron disease in Croatia. A total of 22 incident cases were identified. The crude annual incidence rate was 0.68 (95% confidence interval 0.43‐1.03) per 100,000 person‐years; 0.95 (95% confidence interval 0.60‐1.43) per 100,000 person‐years for men and 0.42 (95% confidence interval 0.26‐0.63) per 100,000 person‐years for women. The rate adjusted to the European population was 0.63 (95% confidence interval 0.39‐0.95) per 100,000 person‐years. The age‐adjusted incidence in our population is similar to the rates, standardized to the European population, observed in Italy, but lower than recent rates in the US and northern European studies. On 31st December 1993, there were 18 prevalent cases. The prevalence adjusted to the European population was 5.24 (95% confidence interval 3.10‐8.28) per 100,000 population.