Basak Karakurum

Personality, depression, and anxiety as risk factors for chronic migraine.

This article evaluated risk factors such as personality, depression, and anxiety in relation to migraine transformation in Turkish patients. Thirty-seven patients with chronic migraine and 50 patients with episodic migraine were investigated. The scores for hysteria, hypochondriasis, psychasthenia, depression, and social introversion were all significantly higher in the chronic-migraine group than the episodic-migraine group. Seventy-four percent of the chronic-migraine group and 26% of the episodic-migraine group had depression. Eighty percent of the chronic-migraine group and 36% of the episodic-migraine group had anxiety. The results suggest that depression, anxiety, and personality characteristics such as hysteria, hypochondriasis, psychasthenia, depression, and social introversion may be associated with chronic migraine in Turkish patients.

Magnetic resonance imaging of patients with cervicogenic headache

Cervicogenic headache (CH) is a syndrome which is postulated to originate from nociceptive structures in the neck or head. The anatomical neck or head structures that are responsible for the pain in CH have not been clearly identified, but the pain in these patients probably originates from the structures of the cervical spine. In this study, cervical MRI were studied in 22 patients with cervicogenic headache and 20 control patients who did not have any disease which may effect the bone and muscle structures of cervical region. MRI imaging of cervical vertebra showed a disc bulging in 10 (45.4%) out of 22 patients with CH and in 9 (45.0%) of 20 controls (P > 0.05). The distribution of pathological lesions in patients and controls were not significantly different (P > 0.05). As a result, MRI may not be an adequate method to detect pathological findings underlying the aetiology of CH such as nerve roots, intervertebral joints and periosteum.

Greater occipital nerve blockade in migraine, tension-type headache and cervicogenic headache

Abstract The blockade of the greater occipital nerve (GON) has been used in the treatment of migraine without aura (MWOA), tension-type headache (TTH) and cervicogenic headache (CH). There have been only a few reports about the effectiveness of the GON blockade in patients with MWOA and TTH and it has not yet been clarified whether or not it is a diagnostic tool for CH. In this study, we therefore investigated the diagnostic value of GON blockade in patients with CH, MWOA and TTH. Sixty patients who were affected by TTH, MWOA and CH participated in the study. They were divided into three main groups, each of which consisted of 20 patients with TTH, MWOA and CH respectively. Each group was then divided into two sub-groups with 10 patients, ten of whom were injected with 1 ml 2% prilocaine, and the other ten with 1 ml physiological saline (PS). Our results showed that GON blockade reduced pain in the orbitofrontal (OF) and orbitonuchal (ON) areas in patients with CH. In MWOA and TTH patients, GON blockade reduced pain only in the ON area. In the light of these findings, we may conclude that GON blockade is a diagnostic tool if it is effective in the ON and OF areas.

Gender influences headache characteristics with increasing age in migraine patients.

Background and aims Migraine headache is one of the most common primary headache disorders and is three times more prevalent in women than in men, especially during the reproductive ages. The neurobiological basis of the female dominance has been partly established. The present study aimed to investigate the effect of gender on the headache manifestations in migraine patients. Methods The study group consisted of 2082 adult patients from five different hospitals’ tertiary care-based headache clinics. The relationship between headache characteristics and gender was evaluated in migraine with aura (MwA) and migraine without aura (MwoA). The duration, severity, frequency of headache and associated symptoms were evaluated in both genders and age-dependent variations and analyzed in two subgroups. Results Women with migraine were prone to significantly longer duration and intensity of headache attacks. Nausea, phonophobia and photophobia were more prevalent in women. Median headache duration was also longer in women than in men in MwA (p = 0.013) and MwoA (p < 0.001). Median headache intensity was higher in women than in men in MwA (p = 0.010) and MwoA (p = 0.009). The frequency of nausea was significantly higher in women than in men in MwA (p = 0.049). Throbbing headache quality and associated features (nausea, photophobia, and phonophobia) were significantly more frequent in women than in men in MwoA. The gender impact varied across age groups and significant changes were seen in female migraineurs after age 30. No age-dependent variation was observed in male migraineurs. Conclusion Gender has an influence on the characteristics of the headache as well as on the associated symptoms in migraine patients, and this impact varies across the age groups, particularly in women.

Partial recovery from cortical blindness following carbon monoxide intoxication.

Patients with carbon monoxide (CO) intoxication may show neurological signs such as headache, seizures, extrapyramidal findings, and coma. However, cortical blindness is rare in these cases. This study describes a woman exhibiting confusion and axial rigidity after CO intoxication. Ten days after intoxication, her pupils were isonormocoric and reactive to light. A fundoscopic examination was normal, but visual acuity was light-perception in both eyes. There were diffuse EEG slow waves. Magnetic resonance imaging (MRI) demonstrated bilateral hyperintensity in the basal ganglia. The P100 latencies of visual evoked potentials (VEP) were increased and dispersed. One year later, the patients visual acuity was almost normal and VEPs showed mild dispersion in P100 latencies. The authors found this case of interest because cortical blindness due to CO intoxication is only rarely seen with a relatively good outcome.

Silent cerebral infarct in patients with mitral valve prolapse.

It is still not clear whether mitral valve prolapse (MVP) is a risk factor for ischemic stroke. The aim of this study was to evaluate whether uncomplicated MVP is a risk factor for silent cerebral ischemic events. Fifty-two patients with uncomplicated MVP and 46 control subjects without MVP were included in the study. All subjects were evaluated for silent cerebral infarct (SCI) with a magnetic resonance imaging. Five (9.6%) of the patients who had MVP but no other risk factors for ischemic cerebral events had SCI. The results suggest that uncomplicated MVP is a risk factor for SCI, and that patients with MVP should receive anti-platelet-aggregating drugs.

A CASE OF PARINAUD'S SYNDROME DUE TO THE REMOTE EFFECT OF SMALL CELL CARCINOMA

In a case with small cell carcinoma of lung, typical features of Parinauds syndrome were seen. MRI and EEG revealed no involvement of central nervous system. Tests for specific infections and connective tissue diseases did not indicate abnormal findings. No electrophysiological findings suggesting the involvement of the peripheral and neuromuscular systems were seen using EMG-NCV measurements and repetitive electrical stimulations. Although no immunological studies were carried out, Parinauds syndrome in this case can be attributed to a remote effect of the lung cancer

Risperidone as an alternative treatment for paroxysmal kinesigenic dyskinesia

Paroxysmal kinesigenic dyskinesia (PKD) describes a group of paroxysmal movement disorders characterized by choreoathetosis, dystonia, or ballistic movements triggered by action [1]. Although most cases are familial with autosomal dominant inheritance, idiopathic and secondary cases also occur [1, 2]. Besides familial cases, there have also been acquired cases due to lesions of putamen, thalamus, caudate nucleus and rostral brainstem that are due to cerebrovascular disease, head injury, multiple sclerosis, thyrotoxicosis and hypoparathyroidism [1–3]. A 49-year-old woman presented to our department with a 4-year history of sudden involuntary movements of the left upper and lower extremities. The problem occurred during voluntary activity. The motions caused her limbs to turn inwards, and were preventing her from accomplishing her daily tasks. She had had hypertension for 18 years, and had suffered a cerebrovascular accident (intracerebral hemorrhage) 5 years prior to presentation. Findings on general physical examination were unremarkable. Neurological examination revealed minimal left hemiparesis, a brisk deep tendon reflex, and an extensor plantar response on the left side. There were no involuntary movements while the patient was resting, but when she moved or raised her upper or lower extremities, choreoathetoic and dystonic movements commenced. As the attack developed, the left leg and arm extended, the distal part of extremity inverted and flexed. The attacks were provoked by voluntary movements. The motions caused gait impairment. There were no premonitory symptoms. Consciousness and sphincter control were never lost. The frequency of attacks was 7–8 per day. Attacks lasted about 5–10 minutes. The laboratory test results were unremarkable. Cranial magnetic resonance imaging showed an 11x5 mm2 chronic hematoma in the right thalamus that spread through subthalamus. The lesion was hypointense on T1weighted images and hyperintense on T2-weighted images, and was surrounded by a rim of hemosiderin. The patient was initially treated with 2 mg/day clonazepam, but because of the sedative effect of this drug it was stopped. After that we tried 1200 mg/day carbamazepine. Initially the severity and frequency of attacks decreased to 2–3 per day, but after three months her complaints repeated. After that, we tried haloperidol. Because of an allergic adverse effect, it was stopped. On trying 2 mg/day risperidone, we observed significant beneficial effect in frequency and severity. After 3–4 days of risperidone treatment, the frequency of attacks was 2–3 per day and the attacks lasted about 4–5 minutes Although the pathophysiology of PKD is not fully understood, it is generally believed that the cause is gamma aminobutyric acid dysregulation or abnormal dopamine meNeurol Sci (2003) 24:92–93

Menstrual migraine and SPECT

Abstract Menstrual migraine (MM) pathogenesis has not yet been clarified, even though several hypotheses have been formulated. In the present research, we investigated cerebral blood flow in 15 patients with MM. Brain SPECT was performed in the middle of the menstrual cycle and during an MM attack. Although some modifications in cerebral blood flow were observed in both periods, no statistically significant differences were found.