Vestibular Migraine

The consensus diagnostic criteria for vestibular migraine (VM) are used to specifically describe episodic vestibular symptoms associated with migraine. Because of an incomplete understanding of the etiology, a variety of clinical manifestations, and overlap with other vestibular disorders, the precise prevalence of VM is unknown. Clinical examination during vestibular episodes and vestibular laboratory tests interictally are more commonly abnormal in patients with VM than in controls, but none of the findings are specific for the diagnosis. The majority of information about VM treatment originates from case studies and retrospective reviews. In this chapter, the current epidemiology data, pathophysiology, significance of clinical and laboratory findings, and possible therapeutic approaches with existing and new medications or devices will be discussed

Risk factors for development of personal protective equipment induced headache : e-survey of medical staff in Baltic states

Funding Information: The authors received no financial support for the research, authorship, and publication of this article. We would like to thank all the medical personnel who participated in this study. Publisher Copyright: © 2022, The Author(s).Background: The COVID-19 pandemic led to an unprecedented increase in the use of personal protective equipment (PPE) among medical personnel. The goal of this study was to determine the risk factors and frequency of PPE-induced headache during the COVID-19 pandemic. Methods: From January 25 to March 1, 2021, an anonymous online survey was undertaken in the Baltic states. Results: In total, 2132 individuals participated. 52.3% experienced a PPE-induced headache. Usual onset time was between 2–3 h, lasting up to 1 h after PPE removal. The most common localization was in temporal and frontal regions. Headache usually occurred 2 to 3 days per week with an average pain score of 5.04 ± 1.80 points. Higher risk was associated with discomfort/pressure OR = 11.55, heat stress OR = 2.228, skin conditions OR = 1.784, long PPE use (duration 10-12 h) OR = 2,18, headache history prior PPE use OR = 1.207. Out of 52.3% respondents with PPE-induced headache, 45.5% developed de novo headache, whereas 54.5% had headache history. Statistically significant differences of PPE-induced headache between respective groups included severity (4.73 vs 5.29), duration (≥ 6 h 6.7% vs 8.2%), accompanying symptoms (nausea (19.3% vs 25.7%), photophobia (19.1% vs 25.7%), phonophobia (15.8% vs 23.5%), osmophobia (5.3% vs 12.0%)) and painkiller use (43.0% vs 61.7%). Conclusions: Over half of the medical personnel reported headache while using PPE. The risk was higher in individuals with headache history, increased duration of PPE use and discomfort while using PPE. Predisposed individuals reported PPE-induced headache which persisted longer, was more intense and debilitating than in the respondents with de novo headache.publishersversionPeer reviewe

Infectious encephalitis diagnosis and treatment in immunosupressed patients: a case report and review of literature

Infectious encephalitis in immunosuppressed patients is a common and urgent condition that requires rapid diagnosis and early treatment. The disease can lead to severe neurological deficit and eventually result in the death of the patient. Usually infectious encephalitis presents with fever, headache, focal neurological deficits, and altered state of consciousness. Immunosuppressed patients pose a great differential diagnostic challenge since clinical symptoms, laboratory findings, and imaging tests are often attenuated and may imitate stroke or other non-infectious diseases. Therefore, infectious meningoencephalitis should be suspected in all immunosuppressed patients with acute focal neurological symptoms, even in the absence of fever and meningeal signs. Accordingly, physician should thoroughly evaluate patient’s history, perform detailed physical examination, and carefully interpret test results. Early diagnosis and initiation of appropriate treatment of bacterial meningoencephalitis correlates with better prognosis for the patient. This article describes an atypical clinical case of a bacterial meningoencephalitis with stroke-like symptoms in a patient with multiple myeloma. In addition, the article reviews clinical presentation, diagnostic and treatment recommendations of infectious encephalitis in immunosuppressed patients

Testing for Thrombophilia in Young Cryptogenic Stroke Patients: Does the Presence of Patent Foramen Ovale Make a Difference?

Background and Objectives: The diagnostic value of thrombophilia remains unknown in young patients with patent foramen ovale (PFO) and stroke. In this study we hypothesized that inherited thrombophilias that lead to venous thrombosis are more prevalent in patients with PFO. Materials and Methods: The study included patients of the tertiary center Vilnius University Hospital Santaros Klinikos who had a cryptogenic ischemic stroke between the ages of 18 and 50 between the years 2008 and 2021. Transient ischemic attacks were excluded. Contrast-enhanced transcranial Doppler ultrasound and extensive laboratory testing were performed. Results: The study included 161 cryptogenic stroke patients (mean age 39.2 ± 7.6 years; 54% female), and a right-to-left shunt was found in 112 (69.6%). The mean time between stroke and thrombophilia testing was 210 days (median 98 days). In total, 61 (39.8%) patients were diagnosed with thrombophilia. The most common finding was hyperhomocysteinemia (26.7%), 14.3% of which were genetically confirmed. Two patients (1.2%) were diagnosed with factor V Leiden mutation, three patients (1.9%) with prothrombin G20210A mutation, one patient (0.6%) had a protein C mutation and one patient (0.6%) had a protein S mutation. No antithrombin mutations were diagnosed in our study population. A total of 45.5% of patients with inherited thrombophilia had a right-to-left shunt, while 54.5% did not, p = 0.092. Personal thrombosis anamnesis was positive significantly more often in patients with antiphospholipid syndrome. Conclusions: The hypothesis of the study was rejected since inherited venous thrombophilia was not significantly more common in patients with PFO. Due to the rarity of thrombophilias in general, more research with a larger sample size is required to further verify our findings

Accuracy of migraine diagnosis and treatment by neurologists in the Baltic states: e-survey with clinical case challenge

Abstract Background Underdiagnosis of migraine causes a significant health burden, including lower quality of life, excessive medication use, and a delay in effective treatment. The purpose of this study was to evaluate migraine diagnosis accuracy and to review the treatment approaches used by neurologists in the Baltic states. Methods The research was conducted as an anonymous e-survey with four cases in March and April 2021. Results 119 practicing adult neurologists have participated. The migraine diagnostic accuracy was 63.2%. The most commonly used diagnostic criteria were moderate/severe pain, unilateral pain, and disruption of daily activities. Diagnostic accuracy did not differ significantly between neurologists who always use ICHD-3 criteria and those who don’t (68.4% vs. 58.5%, p = 0.167). It was higher in neurologists who were working in headache centers (91.7% vs. 60.9%, p = 0.012), and was related to a higher percentage of migraine diagnoses in all consulted headache patients (R 2 = 0.202, adjusted R 2 = 0.195, p < 0.001), prophylaxis with onabotulinumtoxin A [OR = 4.332, 95% Cl (1.588–11.814)], and anti-CGRP monoclonal antibodies [OR = 2.862, 95% Cl (1.186–6.907)]. Conclusions Migraine diagnostic accuracy is improved through practical patient counseling and modern treatment prescription. Although the neurologists in the Baltic states follow current European guidelines, there is room for improvement in diagnostic accuracy to reduce migraine burden