Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Evaluation of the Relationship between Silent Cerebral Lesions and Triglyceride/HDL-Cholesterol in Patients with First Stroke Attack

im: Triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio is defined as theserum atherogenicity index. High TG/HDL-C ratio is related with vascular diseases, insulinresistance and metabolic syndrome. The TG/HDL-C ratio in cerebrovascular diseases,especially in silent cerebral lesions hasn’t been well studied. The aim of this study was toevaluate the frequency of silent cerebral ischemia (SCI) and leukoaraiosis (LA), and itsrelationship with TG/HDL-C ratio in patients admitted with the first ischemic stroke attack.Material and Methods: We retrospectively evaluated 200 patients who admitted to BulentEcevit University Faculty of Medicine, Department of Neurology with the diagnosis of acutefirst ischemic stroke. Silent cerebral lesions were defined as LA and SCI with magneticresonance imaging. TG/HDL-C ratio was calculated by dividing TG levels by HDL-C levels.Results: Silent cerebral lesions were detected 124 (83.2%) of 149 patients. LA severity wasevaluated according to Fazekas score, 22 (14.8%) of patients were grade 0, 49 (32.9%) of themwere grade 1, and 78 (52.3%) of them were advanced periventricular white matterhyperintensity (adv-PWMH) group. TG/HDL-C ratio in SCI group was higher than the groupwithout SCI, but it wasn’t statistically significant (p=0.091). A significant increase wasobserved in the TG/HDL-C ratio, as LA severity increased. TG/HDL-C ratio was significantlyhigher in adv-PWMH group (p=0.050).Conclusion: High serum atherogenicity index is associated with atherosclerosis and vascularendothelial dysfunction. With this simple, inexpensive and effective test method, high-riskgroup of LA and SCI could be identified

Transient Gyral Enhancement After Epileptic Seizure in a Patient with CREST Syndrome

Sınırlı skleroderma; otoimmün bağ dokusu hastalığı olan sklerodermanın bir formudur ve CREST sendromu (kalsinozis kutis, Raynaud fenomeni, özefageal dismotilite, sklerodaktili ve telenjiektazi) olarak da adlandırılır. Sklerodermada nörolojik tutulum diğer sistem tutulumlarına göre daha az görülür. Epileptik nöbet ise nadir görülen nörolojik komplikasyonlardandır. Hastalıkta giral kontrastlanma beklenen bir bulgu değildir. Giral kontrastlanma, beyin parankiminin yüzeyel kontrast tutulumudur ve genellikle vasküler, enflamatuvar, enfeksiyöz ve neoplastik süreçler sonucu ortaya çıkar. Üç yıldır CREST sendromu tanısı olan 67 yaşında kadın hasta hastanemize başvurdu. Üç gün önce epileptik nöbet geçirmişti ve nöbet sonrasında davranış değişiklikleri mevcuttu. Özgeçmişinde epileptik nöbet hikayesi yoktu. Nörolojik muayenesinde; apatikti ve kooperasyonu kısıtlı idi. Derin tendon refleksleri yaygın olarak artmıştı, sağda Hoffman ve Babinski refleksleri pozitifti. Laboratuvar incelemelerinde anti-nükleer antikor pozitifti (1/1000) ve anti-sentromer antikor pozitifti. Kontrastlı kraniyal manyetik rezonans görüntülemede (MRG) sol paryeto-oksipital bölgede giral kontrast tutulumu izlendi. Beyin omurilik sıvısı tetkikleri normal sınırlarda idi. Çekilen elektroensefalografide; diffüz serebral disfonksiyon gözlendi. Yatışında hastaya antiepileptik tedavi başlandı. Takipte hastanın apatisi ve kooperasyon kısıtlılığı düzeldi. Nöbeti tekrarlamadı. On gün sonra çekilen kontrol kontrastlı kraniyal MRG'de giral kontrastlanmanın büyük ölçüde azaldığı gözlendi. CREST sendromunda nörolojik tutulum nadirdir ve hastalık seyrinde epileptik nöbet gözlenmesi literatürde sınırlı sayıda yer almıştır. Giral kontrastlanma vasküler ve enflamatuvar süreçlere ikincil olarak ortaya çıkabilmektedir fakat epileptik nöbet sonrası geçici olarak gözlenebildiği de akılda tutulmalıdırLimited scleroderma, also termed CREST syndrome (calcinosis cutis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia), is a form of scleroderma which is an autoimmune connective tissue disease. Neurological involvement is less common than other system involvements in scleroderma. Epileptic seizure is a rare neurological complication. Gyral enhancement is not an expected finding during disease. Gyral enhancement is contrast enhancement of superficial brain parenchyma and it usually occurs as a result of vascular, inflammatory, infectious and neoplastic processes. A-sixty-seven-year old female patient, who was diagnosed as CREST syndrome for three years was admitted to our hospital. She had an epileptic seizure three days ago and behavioral changes after the seizure. There was not epilepsy diagnosis in her medical history. In neurological examination; she was apathic and deep tendon reflexes were hyperactive, Hoffman’s and Babinski reflexes were positive on the right side of her body. In laboratory studies; anti-nuclear antibody was positive at 1/1000 and anti-centromere antibody was positive. On contrast-enhanced cranial magnetic resonance imaging (MRI); gyral enhancement was observed in the left parieto-occipital region. Cerebrospinal fluid tests were within normal limits. Electroencephalography demonstrated diffuse cerebral dysfunction. We administrated antiepileptic drug to the patient during hospitalization. On the follow up, apathy and restriction of the cooperation were improved. Epileptic seizure did not recur. After ten days, in the control cranial MRI, gyral enhancement was reduced significantly. Neurological involvement in CREST syndrome is rare and epileptic seizures have been appeared in a limited number in the literature. Inflammatory and vascular processes can cause gyral enhancement, but also it must be kept in mind that gyral enhancement can be observed transiently after epileptic seizur

Evaluation of the Relationship between Silent Cerebral Lesions and Triglyceride/HDL-Cholesterol in Patients with First Stroke Attack

im: Triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio is defined as theserum atherogenicity index. High TG/HDL-C ratio is related with vascular diseases, insulinresistance and metabolic syndrome. The TG/HDL-C ratio in cerebrovascular diseases,especially in silent cerebral lesions hasn’t been well studied. The aim of this study was toevaluate the frequency of silent cerebral ischemia (SCI) and leukoaraiosis (LA), and itsrelationship with TG/HDL-C ratio in patients admitted with the first ischemic stroke attack.Material and Methods: We retrospectively evaluated 200 patients who admitted to BulentEcevit University Faculty of Medicine, Department of Neurology with the diagnosis of acutefirst ischemic stroke. Silent cerebral lesions were defined as LA and SCI with magneticresonance imaging. TG/HDL-C ratio was calculated by dividing TG levels by HDL-C levels.Results: Silent cerebral lesions were detected 124 (83.2%) of 149 patients. LA severity wasevaluated according to Fazekas score, 22 (14.8%) of patients were grade 0, 49 (32.9%) of themwere grade 1, and 78 (52.3%) of them were advanced periventricular white matterhyperintensity (adv-PWMH) group. TG/HDL-C ratio in SCI group was higher than the groupwithout SCI, but it wasn’t statistically significant (p=0.091). A significant increase wasobserved in the TG/HDL-C ratio, as LA severity increased. TG/HDL-C ratio was significantlyhigher in adv-PWMH group (p=0.050).Conclusion: High serum atherogenicity index is associated with atherosclerosis and vascularendothelial dysfunction. With this simple, inexpensive and effective test method, high-riskgroup of LA and SCI could be identified