A comparative ID migraine screener study in ophthalmology, ENT and neurology out-patient clinics

Migraine is more likely to be misdiagnosed in patients with comorbid diseases. Not only primary care physicians, but also specialists might misdiagnose it due to the lack of diagnostic criteria awareness. The ID migraine test is a reliable screening instrument that may facilitate and accelerate migraine recognition. This study aimed to compare the prevalence and characteristics of migraine in a large sample of patients admitted to clinics of ophthalmology (OC), ear, nose and throat diseases (ENTC) and neurology (NC), as well as to validate the use of the ID migraine test in OC and ENTC settings. This was a multicentre (11 cites) study of out-patients admitting either to NC, ENTC or OC of the study sites during five consecutive working days within 1 week. From each of the clinics, 100 patients were planned to be recruited. All recruited patients were interviewed and those having a headache complaint received an ID migraine test and were examined for headache diagnosis by a neurologist, blinded to the ID migraine test result. A total of 2625 subjects were recruited. Only 1.3% of OC patients and 5.4% of ENTC patients have been admitted with a primary complaint of headache, whereas the percentage of NC patients suffering from headache was 37.6%. Whereas 138 patients (19.3%) in OC, 154 (17.3%) in ENTC and 347 (34%) in NC were found to be ID migraine test positive, 149 patients (20.8%) in OC, 142 (16%) in ENTC and 338 (33.1%) in NC were diagnosed with migraine. The sensitivity, specificity, and positive and negative predictive ratios of the ID migraine test were found to be similar in all clinics. An important fraction of the patients admitted to NC, as well as to OC and ENTC, for headache and/or other complaints were found out to have migraine by means of a simple screening test. This study validated the ID migraine test as a sensitive and specific tool in OC and ENTC, encouraging its use as a screening instrument.Pfizer-Türkiy

Brainstem Lesions in Herpes Encephalitis

Herpes simplex encephalitis typically involves the medial temporal and inferior frontal lobes; brainstem lesions are very unusual. We present a 42-year-old woman admitted with delirium and diagnosed as herpes simplex encephalitis. The patient had gadolinium-enhancing inferior frontal and pontine lesions on magnetic resonance imagings. The patient was successfully treated without any neurologic sequelae, though contrast-enhancement was still present. This case report emphasizes that herpes simplex encephalitis should be investigated in the differential diagnosis of brainstem lesions. Moreover, contrast-enhancement may persist for some months even after clinical improvement

Neurosarcoidosis and Partial Motor Seizure

Bilimsel zemin: Sarkoidoz pek çok sistemi etkileyen enflamatuvar bir hastalıktır. Nörolojik tutulum, klinik kriterlere göre sarkoidoz olgularının %5-9’unda belirlenmekteyken, otopsi serilerinde bu oran %25’e kadar yükselmektedir, bununla beraber sistemik tutulum olmadan gelişen nörosarkoidoz olgularına nadir rastlanmaktadır. OLGU: Özgeçmişinde 1 yıl önce başlayan basit parsiyel nöbetler dışında bilinen hastalık olmayan 48 yaşında kadın hasta kliniğimize baş ağrısı şikâyeti nedeniyle başvurdu. Başvuru sırasındaki nörolojik muayenede özellik yoktu, kraniyal görüntülemede sağ pariyeto-oksipital bölgede talamusa ulaşan, kontrast tutan lezyon ve mezensefalonda ödem bulgusu saptandı. Seyri sırasında cilt lezyonları ve solunum sistemiyle ilgili belirtiler gelişmesi nedeniyle olası nörosarkoidoz tanısı kondu. Yüksek doz parenteral metilprednizolon tedavisi ile tüm bulgularda belirgin gerileme gözlendi. YORUM: Baş ağrısı nörosarkoidozda en sık görülen belirtidir ve sıklıkla ilk bulgu olarak ortaya çıkmaktadır, nöbetlerin ise ilk belirti olarak %10 ve hastalığın seyri süresince %15 oranında görüldüğü bildirilmiştir. Olgumuzda sistemik hastalık belirtileri olmadan nörolojik tutulum saptanmış, sistemik belirtiler ortaya çıktıktan sonra biyopsi ile tanı konulabilmişti. Nörosarkoidoz olgularında spontan düzelme gözlenebildiği gibi, hastaların %30’unda progresif nörolojik hastalık gelişmektedir. Hastamızın oral kortikosteroid tedavisine cevabı minimal iken, yüksek doz kortikosteroid kullanımı ile klinik ve kraniyal görüntüleme bulguları üstüne belirgin derecede etkili olunabilmiştir. Ayrıca söz konusu tedavinin hasta tarafından iyi derecede tolere edildiği gözlenmişti

Occipital Neuralgia With Atypic Symptoms: A Case Report

Cranial neuralgia is a rare form of headache disorders characterized with transient and unilateral attacks. Inflamatuar diseases and cervical compression are amongst the most common etiological factors even so idiopathic forms might be observed. International Classification of Headache Disorders (ICHD-2)made the classification of cranial neuralgias in 18 different groups. Occipital neuralgia, being a subgroup of cranial neuralgies, is a headache that involves anatomically at major, minor or third occipital nerve areas sometimes accompanying with sensory deficits or dysesthesia. Occipital neuralgia includes aching burning or throbbing headache that is often unilateral and continuous with intermittent shocking and shooting pain on the occipital nerve area. Patients with occipital neuralgia can be divided into those with structural causes and those with idiopathic causes. Structural lesions are cervical disc diseases, trauma, compression of the cervical discs. Tumors rarely metastasize to the paravertebral region and compression of the cervical nerve roots may result in occipital neuralgia. Our aim is to present a case with late onset medical refractory occipital neuralgia due to metastatic prostate cancer, emphasizing that relevant medical history should alert clinicans to the possibility of metastasis causing occipital neuralgia

Cerebrovascular Diseases and Early Seizure

OBJECTIVE: Cerebrovascular disease is one of the important causes of seizures and epilepsy among the advanced age group. Seziures are found to be associated with lesion localization and size in previous studies. METHODS: Here, we aimed to detect prevelance of seizure, relation of seizure and lesion localization, and observed seizure types. RESULTS: Three hundred seventy eight patients with ischemic cerebrovascular disease or intraparenchymal hemorrhage who were followed in Cerrahpasa IVIedical School clinic were studied retrospectively and probability of seizure occurence within 1 month after stroke was evaluated. CONCLUSION: Among 378 patients hospitalized by acute stroke, 339 were diagnosed as ischemic cerebrovascular disease and 39 (10.3%) had primary intraparenchymal hematoma. Seizures were observed in 16 patients (4.2%), 2 (%5.1) in intraparenchymal hematoma group and 14 (%4.1) in ischemic cerebrovascular disease. Early seizures were detected in 33% of patients with anterior cerebral artery, in 6.8% of posterior cerebral artery and in 3.3% of middle cerebral artery infarcts and in three patients out of 12 who were known to have epilepsy. Seizure types were secondarily generalised tonic-clonic seizure in nine cases (57%). Among whole group status epilepticus was observed in four patients (1.1%). Conclusion: Early seizure rates are found to be high among patients with anterior cerebral artery infarct and known epileps

Comorbidity: Guidelines Of Turkish Society Of Cerebrovascular Diseases – 2015

In this section, updated information and recommendation about stroke-related comorbidities including migraine, respiratory impairments and sleep disorders will be offered