A Study on Headache Disorder in Kingdom Of Saudi Arabia Review (October 2013)

Headache is the most common central nervous systemdisorders & one of commonest health problem (1).It has psychological, social & economic effect on the patients &their surrounding populations. Although many epidemiologicalstudies about headache disorders are performed yearly; they areonly partially documented. Those studies are performed mainlyin the developed countries & only few numbers of studies wasperformed in the developing countries because of the limitedresources & funding and the present of difficult to be reachedcites or villages.ObjectivesThe aim of our study is to define the problem of headacheworldwide & to compare the world wide studies & experienceswith studies published in Arabian Gulf countries & Kingdom ofSaudi Arabia (KSA); to gain better understanding of the burdenof headache & situation of headache care in our country; if it issatisfying the patient and if the health resources are well utilizedto decrease their suffering. Worldwide experience should be usedto put helpful solutions & to make the management of headachedisorders in our country more effective & efficient.MethodsReview of most relevant worldwide studies related tointernational headache epidemiology including Arabian Gulfcountries & burden of headache worldwide. We searched studiespublished on PubMed & Google scholar for the most relevant &updated studies.An electronic survey that was performed will be discussed to,those surveys were spread through social websites to get someideas about general populations & physicians opinions on recentstatus of headache care provided to headache patients & the ideaof initiating a specialized headache clinic in Kingdom of SaudiArabia.ResultsIn KSA; prevalence of headache was measured throughsmall number of studies; 1-year prevalence of all headache was63% & it is accounted for 13% of all neurological outpatients.More than one-third of school students were absent from schooldue to headache. Mean headache-attributed lost work-days perperson/year was 24.0 days for migraine, 6.6 days for Tension typeheadache (TTH ) & 53.4 days for medication overuse headache .The results of our 3 questionnaires show that; almost half ofour samples have monthly attacks of headache & around 10-15%have daily headache attacks. More than one third of theresponders mentioned that headache prevent them fromperforming their daily activity , it causes social isolation in morethan 20 % of them , in almost equal percentage it is affect theirrelations & it is affect the school or work attendance in 8.33-9.3% of them.Almost all of our responders agree that there is a need formore organization in management of headache cases & moreeducation for headache patients in KSA.ConclusionEpidemiological studies worldwide show that headache has ahigh prevalence & burden; most of the developed country initiateheadache organizations, programs that is aiming for physicianeducations & specialized headache clinic. Studies in KSA showthat headache is affecting people life & most of the patients donot know where to go to manage their headaches. Moreorganized headache care is needed & a Saudi headache societyshould be built to perform more studies & provide optimal carefor headache patients

Paraneoplastic limbic encephalitis associated with testicular mixed germ cell tumor

Paraneoplastic limbic encephalitis (PLE) is a rare immunopathological syndrome, reported in association with certain types of malignancies. Patients present with cognitive and memory impairments, disordered perception, mood and behavioral changes, sleep disturbances, and seizures. Despite the growing number of cases being reported, it still poses a diagnostic challenge. We encountered a patient with a myriad of neuropsychiatric symptoms who exhibited a highly variable response to therapy. A 36-year-old male presented with memory impairment, excessive sleepiness, and slurred speech. Brain magnetic resonance imaging revealed hyperintensities in the temporal lobes and hypothalamus, all suggestive of limbic encephalitis. He was found to have a mixed germ cell testicular teratoma. Screening for commonly associated antibodies did not yield positive results, which emphasizes that sero-negative PLE can be missed in patients with malignancies. In reporting this case, we urge neurologists to consider PLE as part of the differential diagnosis in similar ambiguous clinical scenarios