The Syndrome of Acute Bilateral Basal Ganglia Lesions in a Patient with Diabetes Mellitus and Uremia

WOS: 000487708100058PubMed ID: 31512672

Airplane headache: An atypical case with autonomic symptoms and long duration

WOS:000616431700026Airplane Headache (AH) which is classified under headache attributed to disorder of homeostasis in International Classification of Headache Disorders (ICHD)-3 is a severe, unilateral, orbitofrontal headache that occurs during and caused by airplane travel. It remits after landing. AH cases with autonomic symptoms had rarely been reported. We present a 35-year-old male complained of five attacks of right-sided, unilateral, orbitofrontal headache accompanied with lacrimation, conjunctival injection and eye redness ipsilaterally, starting 20-30 minutes prior to landing. The headache duration varied between 30-90 minutes. AH diagnosis was made in the light of anamnesis and neurological examination. The secondary causes and primary headaches with autonomic symptoms were ruled out. As far as we know this is the first reported longer duration AH case with autonomic symptoms in the literature. AH is an underdiagnosed headache. We report this atypical AH case to call attention to this rare but treatable headache

Propuesta de reducción del retraso de productos terminados en el área de producción de una empresa metalmecánica mediante la Teoría de las Restricciones y herramientas Lean

La siguiente tesis está conformada por cuatro capítulos, donde el primero presenta el marco teórico investigado en fuentes académicas respaldadas por autores especializados en metodologías de administración de producción y manufactura. En el segundo capítulo se muestra el análisis y diagnóstico realizado a una empresa metalmecánica nacional donde explica su entorno, sus procesos y el problema que enfrenta. En el capítulo 3 se muestra la propuesta de solución en función al diagnóstico realizado y el marco teórico investigado, se aterrizará al entorno de la empresa las diferentes metodologías explicadas en el capítulo 1, además se presentará una análisis económico justificando la rentabilidad de la implementación de la solución. Para finalizar en el capítulo 4 brinda las principales conclusiones a partir de la propuesta de solución y recomendaciones futuras para la empresa en estudio.Tesi

Comparison of clinical features in patients with vestibular migraine and migraine

Vestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p 0.001) when all other associated symptoms were more frequent in patients with MwoV (p 0.001) as well as attack triggers (p 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM

Can vestibular migraine development be predicted in patients with new onset migraine headaches?

Objective: This study aims to determine the clinical features associated with the development of vestibular migraine (VM) in patients with migraine headaches. Methods: A cross-sectional, multicenter study was performed in nine tertiary neurology clinics. Patients with migraine without vestibular symptoms were classified as having migraine only (MO) and compared with patients with VM to determine any differences in clinical features, associated disorders, past medical history, and family history of migraine headaches. Moreover, we investigated the features that might predict the development of VM. Results: Two hundred forty-four patients with MO and 461 patients with VM were included. The age of onset of headache attacks was later in life for patients with VM (p0.001). Migraine without aura (MwoA) was significantly more common than migraine with aura (MwA) in patients with VM (p=0.016). All associated features of migraine headaches were significantly more frequent in patients with MO than patients with VM (p0.005). The same was true for all triggers, including fasting, sleep disturbances, menstruation, stress, flickering lights, and smartphones/computer games (p0.005). A family history of migraine headaches was more common in MO patients (p=0.002). However, a previous history of motion sickness was significantly more common in patients with VM (p0.001), as was aural fullness/tinnitus accompanying attacks (p0.001). Logistic regression analysis indicated that aural fullness/tinnitus accompanying attacks and a previous history of motion sickness were risk factors for the development of VM. Conclusion: Patients with migraine reporting aural symptoms accompanying attacks and motion sickness in their past medical history are at increased risk of vestibular attacks fulfilling the diagnosis of VM later in life

Factors determining the response to treatment in patients with vestibular migraine

Purpose To find out clinical features associated with poor response to treatment in vestibular migraine (VM) Methods VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. >= 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. Results The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 +/- 12.2 years (range: 17-74 years), were analyzed. Conclusion Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives

Can vestibular migraine development be predicted in patients with new onset migraine headaches?

Objective: This study aims to determine the clinical features associated with the development of vestibular migraine (VM) in patients with migraine headaches. Methods: A cross-sectional, multicenter study was performed in nine tertiary neurology clinics. Patients with migraine without vestibular symptoms were classified as having migraine only (MO) and compared with patients with VM to determine any differences in clinical features, associated disorders, past medical history, and family history of migraine headaches. Moreover, we investigated the features that might predict the development of VM. Results: Two hundred forty-four patients with MO and 461 patients with VM were included. The age of onset of headache attacks was later in life for patients with VM (p<0.001). Migraine without aura (MwoA) was significantly more common than migraine with aura (MwA) in patients with VM (p=0.016). All associated features of migraine headaches were significantly more frequent in patients with MO than patients with VM (p<0.005). The same was true for all triggers, including fasting, sleep disturbances, menstruation, stress, flickering lights, and smartphones/computer games (p<0.005). A family history of migraine headaches was more common in MO patients (p=0.002). However, a previous history of motion sickness was significantly more common in patients with VM (p<0.001), as was aural fullness/tinnitus accompanying attacks (p<0.001). Logistic regression analysis indicated that aural fullness/tinnitus accompanying attacks and a previous history of motion sickness were risk factors for the development of VM. Conclusion: Patients with migraine reporting aural symptoms accompanying attacks and motion sickness in their past medical history are at increased risk of vestibular attacks fulfilling the diagnosis of VM later in life