Correlation of transcranial doppler examination of cerebral arteries and clinical features of episodic primary headaches

Uvod: Promene u cerebralnoj hemodinamici, funkcionalna rezerva arteriola mozga i emboligeni potencijal, inicijalno kao primarni, a zatim kao sekundarni fenomeni, kada su u pitanju primarne glavobolje, istraživani su do sada uglavnom kod osoba sa migrenom. Povezanost kliničke prezentacije i promena u cerebralnom protoku nije dovoljno ispitana ni kada je u pitanju migrena, kao ni kada su u pitanju drugi tipovi primarnih glavobolja. Metodologija: Kliničkim ispitivanjem glavobolje je obuhvaćeno 485 bolesnika lečenih u desetogodišnjem periodu, od početka 2006. do kraja 2015. godine, u okviru Centra za glavobolje Klinike za neurologiju KCS. Ispitivani su bolesnici sa tri najčešća tipa epizodičnih primarnih glavobolja, migrena sa aurom - 153 bolesnika, migrena bez aure - 116 bolesnika, glavobolja tenzionog tipa - 61 bolesnik, klaster glavobolja - 155 bolesnika. Primenom TCD-a, kod bolesnika je procenjivana cerebralna hemodinamika, funkcionalna rezerva mozga i emboligeni potencijal, a zatim poređena sa elementima kliničke slike. Rezultati: Elementi kliničke slike ispitivanih pacijenata sa glavoboljom odgovaraju dijagnostičkim kriterijumima Međunarodne klasifikacije glavobolja. Migrenski fenomeni javljaju se kod četvrtine pacijenata sa klaster glavoboljom, pri čemu osnovne kliničke razlike između migrene i klaster glavobolje, kao što su trajanje napada, lateralizacija bola i priroda udruženih fenomena, ostaju korisni pokazatelji u postavljanju ispravne dijagnoze. Interiktalne vrednosti hemodinamskih parametara SBP i IP, merene nad svim arterijama Vilisovog poligona, za sva tri tipa ispitivanih epizodičnih glavobolja su u okvirima referentnih vrednosti za zdravu populaciju. Kod osoba sa migrenom, sa i bez aure, interiktalno se održava relativno povećanje obima protoka u ACP, a relativno povećanje protoka u ACA korelira sa zastupljenošću udruženih migrenskih fenomena. Postoji povezanost učestalosti napada glavobolja i rezistencije arteriola i to tako što kod osoba sa migrenom, sa povećanjem učestalosti napada opada relativno povećana rezistencija arteriola, a kod osoba sa GTT sa povećanjem učestalosti glavobolje rezistencija arteriola raste. Sa dužim trajanjem klaster perioda, promene cerebralnog protoka se održavaju i potenciraju, tako da se izvestan poremećaj distribucije cerebralnog protoka u vidu relativne vazodilatacije sa posledičnim padom SBP, održava i van bolnog perioda. Nalaz povećanog BHI kod osoba sa MA u odnosu na osobe sa epizodičnim formama MO, GTT i KG, kao i u odnosu na zdrave kontrole ukazuje na to da je funkcionalna rezerva kod epizodičnih formi primarnih glavobolja očuvana, pa čak i povećana kod osoba sa MA...Background: Cerebral blood flow changes, vasomotor reactivity and cerebral microembolisation, as primary phenomena, and afterwards as a epiphenomena, had been studied mainly in migraine patients. The correlation between clinical presentation of headache and cerebral blood flow changes for other types of primary headaches, as well as for the migraine, remains unclear. Methods: Clinical examination had been performed in 485 patients treated in ten years period, from the begining of 2006. till the end of 2015., in the Headache Center of the Nerololgy Clinic CCS. We have examined patients with migraine with aura - 153 patients, migraine without aura - 116 patients, tension type headache – 61 patient, cluster headache - 155 patients. Using the TCD, we have examined cerebral blood flow, vasomotor reactivity and cerebral microembolisation, in correlation with clinical features of headache. Results: Clinical features of headache in examined patients matched with diagnostic criteria given in International Classification of Headache Disorders. Migraine phenomena are present in one quater of cluster patients, still, main clinical differencies between migraine and cluster headache, attack duration, pain lateralization and accompaning features, remain valuable tools for establishing correct diagnosis. Interictal values of hemodynamic parameters, MV and PI, measured for all arteries of circle of Willis, for all three types of episodic primary headaches are normal. In patients with migraine, with and without aure, we observed interictal relativ increase of volume of cerebral blood flow in ACP, while the such increase in ACA was in correlation with representation of migraine phenomena. There is correlation between attack frequency and the resistence of arterioles in the way that, in migraine patients that correlation is negative, and in patients with tension type headache is positive. In patients with cluster headache the cerebral blood flow changes are in relation to the cluster period duration. Increased BHI in patients with migraine with aura, comparing to patients with other types of primary headaches and comparing to healty controls, suggests that functional reserve of cerebral vessels is preserved, even increased, and, it is in correlation with intensity of pain. Emboligenic potential in patients with migraine with aura is increased comparing to patients with other types of primary headaches. The presense of right-to-left shunt was in relation to exacerbation by physical exertion, in patients with migraine with aura, and with attack frequency and pulsating quality of pain in patients with migraine without aura..

Correlation of transcranial doppler examination of cerebral arteries and clinical features of episodic primary headaches

Uvod: Promene u cerebralnoj hemodinamici, funkcionalna rezerva arteriola mozga i emboligeni potencijal, inicijalno kao primarni, a zatim kao sekundarni fenomeni, kada su u pitanju primarne glavobolje, istraživani su do sada uglavnom kod osoba sa migrenom. Povezanost kliničke prezentacije i promena u cerebralnom protoku nije dovoljno ispitana ni kada je u pitanju migrena, kao ni kada su u pitanju drugi tipovi primarnih glavobolja. Metodologija: Kliničkim ispitivanjem glavobolje je obuhvaćeno 485 bolesnika lečenih u desetogodišnjem periodu, od početka 2006. do kraja 2015. godine, u okviru Centra za glavobolje Klinike za neurologiju KCS. Ispitivani su bolesnici sa tri najčešća tipa epizodičnih primarnih glavobolja, migrena sa aurom - 153 bolesnika, migrena bez aure - 116 bolesnika, glavobolja tenzionog tipa - 61 bolesnik, klaster glavobolja - 155 bolesnika. Primenom TCD-a, kod bolesnika je procenjivana cerebralna hemodinamika, funkcionalna rezerva mozga i emboligeni potencijal, a zatim poređena sa elementima kliničke slike. Rezultati: Elementi kliničke slike ispitivanih pacijenata sa glavoboljom odgovaraju dijagnostičkim kriterijumima Međunarodne klasifikacije glavobolja. Migrenski fenomeni javljaju se kod četvrtine pacijenata sa klaster glavoboljom, pri čemu osnovne kliničke razlike između migrene i klaster glavobolje, kao što su trajanje napada, lateralizacija bola i priroda udruženih fenomena, ostaju korisni pokazatelji u postavljanju ispravne dijagnoze. Interiktalne vrednosti hemodinamskih parametara SBP i IP, merene nad svim arterijama Vilisovog poligona, za sva tri tipa ispitivanih epizodičnih glavobolja su u okvirima referentnih vrednosti za zdravu populaciju. Kod osoba sa migrenom, sa i bez aure, interiktalno se održava relativno povećanje obima protoka u ACP, a relativno povećanje protoka u ACA korelira sa zastupljenošću udruženih migrenskih fenomena. Postoji povezanost učestalosti napada glavobolja i rezistencije arteriola i to tako što kod osoba sa migrenom, sa povećanjem učestalosti napada opada relativno povećana rezistencija arteriola, a kod osoba sa GTT sa povećanjem učestalosti glavobolje rezistencija arteriola raste. Sa dužim trajanjem klaster perioda, promene cerebralnog protoka se održavaju i potenciraju, tako da se izvestan poremećaj distribucije cerebralnog protoka u vidu relativne vazodilatacije sa posledičnim padom SBP, održava i van bolnog perioda. Nalaz povećanog BHI kod osoba sa MA u odnosu na osobe sa epizodičnim formama MO, GTT i KG, kao i u odnosu na zdrave kontrole ukazuje na to da je funkcionalna rezerva kod epizodičnih formi primarnih glavobolja očuvana, pa čak i povećana kod osoba sa MA...Background: Cerebral blood flow changes, vasomotor reactivity and cerebral microembolisation, as primary phenomena, and afterwards as a epiphenomena, had been studied mainly in migraine patients. The correlation between clinical presentation of headache and cerebral blood flow changes for other types of primary headaches, as well as for the migraine, remains unclear. Methods: Clinical examination had been performed in 485 patients treated in ten years period, from the begining of 2006. till the end of 2015., in the Headache Center of the Nerololgy Clinic CCS. We have examined patients with migraine with aura - 153 patients, migraine without aura - 116 patients, tension type headache – 61 patient, cluster headache - 155 patients. Using the TCD, we have examined cerebral blood flow, vasomotor reactivity and cerebral microembolisation, in correlation with clinical features of headache. Results: Clinical features of headache in examined patients matched with diagnostic criteria given in International Classification of Headache Disorders. Migraine phenomena are present in one quater of cluster patients, still, main clinical differencies between migraine and cluster headache, attack duration, pain lateralization and accompaning features, remain valuable tools for establishing correct diagnosis. Interictal values of hemodynamic parameters, MV and PI, measured for all arteries of circle of Willis, for all three types of episodic primary headaches are normal. In patients with migraine, with and without aure, we observed interictal relativ increase of volume of cerebral blood flow in ACP, while the such increase in ACA was in correlation with representation of migraine phenomena. There is correlation between attack frequency and the resistence of arterioles in the way that, in migraine patients that correlation is negative, and in patients with tension type headache is positive. In patients with cluster headache the cerebral blood flow changes are in relation to the cluster period duration. Increased BHI in patients with migraine with aura, comparing to patients with other types of primary headaches and comparing to healty controls, suggests that functional reserve of cerebral vessels is preserved, even increased, and, it is in correlation with intensity of pain. Emboligenic potential in patients with migraine with aura is increased comparing to patients with other types of primary headaches. The presense of right-to-left shunt was in relation to exacerbation by physical exertion, in patients with migraine with aura, and with attack frequency and pulsating quality of pain in patients with migraine without aura..

Correlation of transcranial doppler examination of cerebral arteries and clinical features of episodic primary headaches

Uvod: Promene u cerebralnoj hemodinamici, funkcionalna rezerva arteriola mozga i emboligeni potencijal, inicijalno kao primarni, a zatim kao sekundarni fenomeni, kada su u pitanju primarne glavobolje, istraživani su do sada uglavnom kod osoba sa migrenom. Povezanost kliničke prezentacije i promena u cerebralnom protoku nije dovoljno ispitana ni kada je u pitanju migrena, kao ni kada su u pitanju drugi tipovi primarnih glavobolja. Metodologija: Kliničkim ispitivanjem glavobolje je obuhvaćeno 485 bolesnika lečenih u desetogodišnjem periodu, od početka 2006. do kraja 2015. godine, u okviru Centra za glavobolje Klinike za neurologiju KCS. Ispitivani su bolesnici sa tri najčešća tipa epizodičnih primarnih glavobolja, migrena sa aurom - 153 bolesnika, migrena bez aure - 116 bolesnika, glavobolja tenzionog tipa - 61 bolesnik, klaster glavobolja - 155 bolesnika. Primenom TCD-a, kod bolesnika je procenjivana cerebralna hemodinamika, funkcionalna rezerva mozga i emboligeni potencijal, a zatim poređena sa elementima kliničke slike. Rezultati: Elementi kliničke slike ispitivanih pacijenata sa glavoboljom odgovaraju dijagnostičkim kriterijumima Međunarodne klasifikacije glavobolja. Migrenski fenomeni javljaju se kod četvrtine pacijenata sa klaster glavoboljom, pri čemu osnovne kliničke razlike između migrene i klaster glavobolje, kao što su trajanje napada, lateralizacija bola i priroda udruženih fenomena, ostaju korisni pokazatelji u postavljanju ispravne dijagnoze. Interiktalne vrednosti hemodinamskih parametara SBP i IP, merene nad svim arterijama Vilisovog poligona, za sva tri tipa ispitivanih epizodičnih glavobolja su u okvirima referentnih vrednosti za zdravu populaciju. Kod osoba sa migrenom, sa i bez aure, interiktalno se održava relativno povećanje obima protoka u ACP, a relativno povećanje protoka u ACA korelira sa zastupljenošću udruženih migrenskih fenomena. Postoji povezanost učestalosti napada glavobolja i rezistencije arteriola i to tako što kod osoba sa migrenom, sa povećanjem učestalosti napada opada relativno povećana rezistencija arteriola, a kod osoba sa GTT sa povećanjem učestalosti glavobolje rezistencija arteriola raste. Sa dužim trajanjem klaster perioda, promene cerebralnog protoka se održavaju i potenciraju, tako da se izvestan poremećaj distribucije cerebralnog protoka u vidu relativne vazodilatacije sa posledičnim padom SBP, održava i van bolnog perioda. Nalaz povećanog BHI kod osoba sa MA u odnosu na osobe sa epizodičnim formama MO, GTT i KG, kao i u odnosu na zdrave kontrole ukazuje na to da je funkcionalna rezerva kod epizodičnih formi primarnih glavobolja očuvana, pa čak i povećana kod osoba sa MA...Background: Cerebral blood flow changes, vasomotor reactivity and cerebral microembolisation, as primary phenomena, and afterwards as a epiphenomena, had been studied mainly in migraine patients. The correlation between clinical presentation of headache and cerebral blood flow changes for other types of primary headaches, as well as for the migraine, remains unclear. Methods: Clinical examination had been performed in 485 patients treated in ten years period, from the begining of 2006. till the end of 2015., in the Headache Center of the Nerololgy Clinic CCS. We have examined patients with migraine with aura - 153 patients, migraine without aura - 116 patients, tension type headache – 61 patient, cluster headache - 155 patients. Using the TCD, we have examined cerebral blood flow, vasomotor reactivity and cerebral microembolisation, in correlation with clinical features of headache. Results: Clinical features of headache in examined patients matched with diagnostic criteria given in International Classification of Headache Disorders. Migraine phenomena are present in one quater of cluster patients, still, main clinical differencies between migraine and cluster headache, attack duration, pain lateralization and accompaning features, remain valuable tools for establishing correct diagnosis. Interictal values of hemodynamic parameters, MV and PI, measured for all arteries of circle of Willis, for all three types of episodic primary headaches are normal. In patients with migraine, with and without aure, we observed interictal relativ increase of volume of cerebral blood flow in ACP, while the such increase in ACA was in correlation with representation of migraine phenomena. There is correlation between attack frequency and the resistence of arterioles in the way that, in migraine patients that correlation is negative, and in patients with tension type headache is positive. In patients with cluster headache the cerebral blood flow changes are in relation to the cluster period duration. Increased BHI in patients with migraine with aura, comparing to patients with other types of primary headaches and comparing to healty controls, suggests that functional reserve of cerebral vessels is preserved, even increased, and, it is in correlation with intensity of pain. Emboligenic potential in patients with migraine with aura is increased comparing to patients with other types of primary headaches. The presense of right-to-left shunt was in relation to exacerbation by physical exertion, in patients with migraine with aura, and with attack frequency and pulsating quality of pain in patients with migraine without aura..

Tolosa-Hunt syndrome: is it really necessary to show granuloma? - The report of eight cases

Introduction. Tolosa–Hunt syndrome (THS) is a rare entity, characterized by unilateral orbital pain associated with paresis of one or more of the oculomotor cranial nerves and caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. The low prevalence of THS with a broad spectrum of other disorders that could cause painful ophtalmoplegia resulted in a stricter diagnostic criteria of THS in the latest edition of the International Classification of Headache Disorders. Current criteria require demonstration of granuloma by magnetic resonance imaging or biopsy. The diagnosis could be difficult and the initiation of treatment delayed due to a high variablity of clinical presentation of TSH. Reducing the number of patients that, based on clinical presentation, could be classified as having THS, but do not fullfil all diagnostic criteria further complicates establishing of correct diagnosis. Case report. Hereby we presented eight patients diagnosed with and treated for THS. Inspite the exclusion of other causes of painful ophtalmoplegia, granuloma could not be demonstrated in a half of patients. Clinical presentation of THS in patients with and without shown granuloma, did not significantly differ concerning headache characteristics (localization, intensity, quality, duration preceding cranial nerve palsy, response to steroids), the affected cranial nerve, disease course and response to the treatment, as well as types of diagnostic procedures that were performed in ruling out other diseases from the extensive differential diagnosis of painful ophthalmoplegia. Conclusion. There is no significant difference between the THS patients with and without demonstrated granuloma

Determinants of quality of life among individuals seeking mental health care after termination of state of emergency due to the coronavirus disease 2019 pandemic

Prompted by the need to measure the impact of the coronavirus disease 2019 on main areas of quality of life related to mental health (MH), the COV-19-impact on quality of life (COV19-QoL) scale has been developed recently. We measured how patients seeking face-to-face MH care perceived the coronavirus disease 2019 impact on QoL and how socio-demographic factors, stress, and personality contributed to QoL in this diagnostically diverse population. Patients aged 18 to 65 years (n = 251) who came for the first time to the outpatient units during the 6-week index-period (May 21-July 1, 2020) were included. The cross-sectional assessment involved sociodemographic variables, working diagnosis, personality traits (7-dimension model, including HEXACO and DELTA), stress (list of threatening experiences and proximity to virus), and COV19-QoL. The perceived impact of the pandemic on QoL was above the theoretical mean of a 5-point scale (COV19-Qol = 3.1 +/- 1.2). No association between total COV19-QoL score, sociodemographic parameters, and working diagnoses was found in the present sample. After testing whether positional (threatening experiences), or dispositional (personality) factors were predominant in the perceived impact of COV-19 on QoL, significant predictors of the outcome were personality traits Disintegration (B = 0.52; P lt .01) and Emotionality (B = 0.18; P lt .05). It seems that pervasiveness and uncertainty of the pandemic threat triggers-especially in those high on Disintegration trait-a chain of mental events with the decrease of QoL as a final result. Present findings could be used to establish a profile of MH help seeking population in relation to this biological disaster, and to further explore QoL and personality in different contexts

Additional file 3: of Headache service quality: evaluation of quality indicators in 14 specialist-care centres

SQE implementation questionnaire nurse or other HCP. (PDF 251 kb