Klasterowy ból głowy – objaw czy choroba samoistna? Opis przypadku

Headache with severe, strictly one-sided unilateral attacks of pain in orbital, supraorbital, temporal localisation lasting 15-180 minutes occurring from once every two days to 8 times daily, typically with one or more autonomic symptoms, is recognized as cluster headache (CH). Headache with normal neurological examination and abnormal neuroimaging studies, mimicking cluster headache, is reported by several authors. We present an elderly woman with a cluster-like headache probably associated with other comorbidities. We differentiate between primary, but ‘atypical’ CH and symptomatic cluster headache due to frontal sinusitis, pontine venous angioma or vascular compression of the trigeminal nerve root. This headache is not so rare in the general population and its secondary causes must be ruled out before the diagnosis of a primary headache as cluster headache is made.Klasterowy ból głowy jest bardzo silnym, jednostronnym bólem zlokalizowanym w okolicy oka, nadoczodołowej i skroniowej. Napad klasterowego bólu głowy trwa 15–180 minut, a liczba napadów wynosi od 1 do 8 dziennie. Dodatkowo bólowi towarzyszą bardzo charakterystyczne objawy autonomiczne. W każdym przypadku klasterowego bólu głowy badanie neurologiczne oraz badania neuroobrazowe powinny być prawidłowe. Każde odchylenie w badaniu przedmiotowym i laboratoryjnym sugeruje objawowe tło choroby. Przypadki bólu głowy przypominające ból klasterowy są stosunkowo często opisywane w piśmiennictwie. W pracy przedstawiono przypadek starszej kobiety, u której rozpoznano klasteropodobny ból głowy związany prawdopodobnie z innymi chorobami. W trakcie przeprowadzania diagnostyki różnicowej rozważano atypowy klasterowy ból głowy i objawowy ból głowy spowodowany zapaleniem zatok obocznych nosa, naczyniakiem żylnym lub uciskiem naczynia na korzenie nerwu trójdzielnego. Ten rodzaj bólu głowy nie jest bardzo rzadki w populacji ogólnej, a w każdym przypadku rozpoznania samoistnego bólu klasterowego, szczególnie o nietypowym przebiegu, należy wykluczyć objawową przyczynę dolegliwości

SGLT-2 inhibitors as adjunctive to insulin therapy in type 1 diabetes

The absolute insulin deficiency that occurs in type 1 diabetes mellitus (T1DM) is associated with the need for intensive functional insulin therapy as the only appropriate treatment model. In the recent years, introduction of new classes of glucose-lowering drugs has led to an increasing interest in adjunct therapies for T1DM. These therapies are designed to support exogenous insulin therapy in achieving the therapeutic goal while reducing the risk of hypoglycaemia and exerting a beneficial effect on body weight. One potential therapeutic option are sodium-glucose co-transporter 2 (SGLT-2) inhibitors. In the present paper, we reviewed the current clinical research on SGLT-2 inhibitors as add-on therapy to insulin in patients with T1DM. This therapy modification contributes to an improvement in metabolic control without increasing the risk of severe hypoglycaemia and with a beneficial effect on body weight, translating to improved compliance, quality of life, and patient satisfaction with treatment. However, due to possible adverse effects including euglycaemic diabetic ketoacidosis, the decision to use SGLT-2 inhibitors in patients with T1DM should be made with caution, and patients require proper education regarding the prevention and treatment of acidosis

Idiopatyczna czuciowa neuropatia trójdzielna. Opis przypadku

Idiopathic trigeminal sensory neuropathy is a rare clinical condition characterized by sensory disturbances on the face. Its symptoms may be permanent or temporary and a wide variety of diagnostic procedures is usually required to establish the diagnosis. Frequently, it is the first manifestation of a systemic disorder. In the majority of cases causal treatment is not possible, even though patients with trigeminal sensory neuropathy should be carefully monitored by physicians.Idiopatyczna czuciowa neuropatia trójdzielna to rzadka choroba dotycząca zaburzeń czucia w obrębie twarzy. Zjawisko to może mieć charakter przejściowy lub stały, diagnostyka zaś wymaga zazwyczaj wykonania wielu różnych badań. Często neuropatia trójdzielna jest pierwszym objawem choroby układowej. Najczęściej leczenie przyczynowe nie jest możliwe, jednak pacjenci z idiopatyczną neuropatią trójdzielną powinni być pod stałą opieką medyczną

Hypoglossal nerve palsy as an isolated syndrome of internal carotid artery dissection: A review of the literature and a case report

A review of literature on the dissection of internal carotid artery was presented with apresentation of a rare case of patient with transient left hypoglossal nerve palsy caused bymechanic compression from intramural hematoma in higher extracranial portion of dissected carotid artery confirmed in MRI and CT scans. The clinical presentation and management are discussed

Validation of exophthalmos magnetic resonance imaging measurements in patients with Graves’ orbitopathy, compared to ophthalmometry results

Purpose: Although assessment of the orbital structures using magnetic resonance imaging (MRI) is well described in the literature, there is no consensus as to which measurement method is the most useful in exophthalmos assessment. The aim of the study was to correlate 2 MRI methods of exophthalmos measurement with exophthalmometry results and to determine a proper technique of exophthalmos measurement. Material and methods: Fifty-four patients (108 orbits) with exophthalmos in the course of Graves’ orbitopathy were enrolled in the study. Two measurements on axial T2W orbital MRI images were performed by 2 independent radiologists: the distance from the interzygomatic line to the anterior surface of the globe (AD) and the distance from the interzygomatic line to the posterior sclera (PD). Within 4 weeks, an exophthalmometry was performed by an ophthalmologist using a Hertel exophthalmometer. The inter-observer variation was assessed using the Pearson correlation coefficient. Values were presented as mean and standard deviation, and the differences in values were explored with Student’s t-test. Results: The mean AD measured on MRI by the first observer was 20.6 ± 3 mm, and 20.6 ± 2.9 mm by the second observer. PD values were 2.9 ± 2.8 mm and 3.4 ± 2.8 mm, respectively. The mean exophthalmometry result was 21 ± 3.3 mm. The correlation was very high between observers for AD measurements (r = 0.98, p = 0.01) and high for PD measurements (r = 0.95, p = 0.01). AD measurements on MRI and exophthalmometry results were strongly correlated (r = 0.9, p = 0.01). Conclusions: The AD measurement has better reproducibility and is directly correlated with Hertel exophthalmometry. This method could be sufficient in routine practice

The impact of studying on the hippocampal volume in medical students and its correlation with the results of the Final Medical Examination : a single-centre, prospective observational cohort study

Purpose: The hippocampus forms part of the limbic system and is involved in the learning process; it is responsible for transferring information from short-term to long-term memory. The aim of our study was to assess the effect of intensive studying on hippocampal volume and whether this correlates with exam results. Material and methods: The analysis included volunteer final-year medical students who underwent 2 volumetric 3D T1 magnetic resonance imaging scans with an interval of 20 weeks: 19 weeks before and one week after the Final Medical Examination. FreeSurfer software was used to compare the volumes of the whole hippocampus and its subfields between the 2 measurements. We assessed correlations between changes in hippocampal volume and the time students spent studying, between changes in hippocampal volume and the results of the exam, and between time spent studying and exam results. Results: Forty participants (25 women and 15 men; mean age 25 years) were included in the analysis. The right hippocampus presubiculum area increased significantly over the study period (p = 0.029), whereas the volume of the left hippocampus remained unchanged. An increase in the volume of the right hippocampus correlated with longer study time (r = 0.371 in percentage and r = 0.397 in mm3) and better LEK exam results (r = 0.441 in percentage and r = 0.456 in mm3). Conclusions: Our research confirms the role of the hippocampus, particularly the subicular complex, in the process of learning and remembering, and suggest that the plastic abilities of the hippocampus depend on the intensity of learning and translate into better skills

The role of MR cholangiography in the detection of biliary complications after orthotopic liver transplantation

Background: To assess the usefulness of magnetic resonance cholangiography (MRC) in the diagnostics of biliary complications after liver transplantation. Material/Methods: In 40 patients (17 men, 23 women) 51 MRC examinations were performed, from 1 to 58 months (mean-12) after liver transplantation. Studies were performed with 1.5 T unit. The imaging protocol consisted of tree hydrographic TSE sequences: 2D, 3D and single-slice technique. The results were compared with ERCP (n=10), percutaneous cholangiography (n=4), T-tube cholangiography (n=1), T-tube cholangiography and percutaneous cholangiography (n=1), T-tube cholangiography and ERCP (n=1), fistulography (n=2) and histopathology (n=3). In remaining patients other imaging studies (US, CT), laboratory liver functions tests and clinical status were evaluated. Results: In 46 cases (90%) abnormalities of biliary tract were depicted. Following biliary complications were diagnosed: dilatation of biliary tree (n=29), biliary strictures located beside anastomosis site (n=19), anastomotic biliary strictures (n=17), intrahepatic strictures (n=7), biliary obstruction (n=2), biliary stones/sludge (n=14), bile leak (n=12). In 5 cases (10%) MRC was normal. In 50 cases (98%) there was concordance between MRC results and the standard of reference, 1 remaining case (2%) of bile duct ischemia was not confirmed by other studies. Conclusions: MRC is a noninvasive modality, providing accurate assessment of biliary complications in patients after liver transplantation

Role of DTI-MRI parameters in diagnosis of ALS: useful biomarkers for daily practice? Tertiary centre experience and literature review

Introduction. Despite the rapid development of neuroimaging techniques, the diagnosis of amyotrophic lateral sclerosis (ALS) remains a significant challenge. Magnetic resonance imaging (MRI) is important for ruling out ALS mimickers, while Diffusion Tensor Imaging (DTI) is a useful tool for the identification of cortical tract damage. The aim of this study was to identify the optimal set of DTI parameters to support the diagnosis of ALS that could be applied to everyday MRI and be used as a disease biomarker in daily practice. Material and methods. Forty-seven ALS patients and 55 age- and gender-matched healthy individuals underwent MRI using a 1.5-Tesla scanner including a DTI sequence with 30 spatial directions and a b-value 0/1,000 s/mm2. Two independent researchers measured the DTI parameters: fractional anisotropy (FA), TRACE and apparent diffusion coefficient (ADC) using freehand regions of interest (ROIs) placed along both corticospinal tracts (CSTs), starting at the level of the internal capsule and ending at the medulla. Results. Statistical significance was only achieved for fractional anisotropy (FA) (ALS vs controls, p < 0.001). The highest sensitivity was found in the brainstem (cerebral peduncles, pons and pyramids) where it ranged from 72.3% to 80.9%, whereas the highest specificity was observed at the level of the internal capsule (94.6%). The combined highest sensitivity and specificity was obtained in the pons (72.3% and 72.7%, respectively). Classifier based positive predictive values for Youden index cut-off scores varied between 60.7% and 69.4%. Conclusions. Fractional anisotropy (FA) measured at the level of the brainstem was shown to be the single most relevant parameter in differentiating patients with ALS from healthy subjects. This has the potential to become an ALS-specific biomarker for patient identification in daily practice

Predictors of Class I epilepsy surgery outcome in tumour-related chronic temporal lobe epilepsy in adults

Objective. Temporal lobe tumours, especially low-grade gliomas and glioneuronal tumours, are common causes of seizures in patients referred for epilepsy surgery. We here present our experience of surgical treatment of patients with intractable chronic epilepsy associated with temporal lobe tumours, focusing on the long-term surgical outcomes and the features associated with better seizure control.Methods. In this study, we retrospectively analysed 44 consecutive patients from a total of 182 with refractory temporal lobe epilepsy presenting with long-term intractable epilepsy due to a temporal lobe tumour who were surgically treated at our institution between 2005 and 2015 with post-surgical follow-up of at least two years. All patients underwent a standard pre-surgical evaluation that included: history and physical examination with a description of the seizure semiology, serial scalp EEG recording, brain MR imaging, and a detailed neuropsychological evaluation. Our surgical strategy comprised tumour resection, and combined mesial temporal and neocortical resection in most cases.Results. No patient died during surgery or the postoperative course. Seven patients had postoperative complications, of whom two had permanent hemiparesis due to ischaemic stroke. At the final follow-up, a favourable seizure outcome (Engel Class I) was found in 37 patients (84%), including 31 (70.5%) in Engel Class IA (excellent result). Two (4.5%) patients presented with an Engel Class II outcome (unfavourable outcome). Five patients (11.5%) were in Engel Classes III or IV (surgical failure). We found that completeresection of the hippocampus along with tumour and temporal pole removal was strongly associated with seizure freedom (p = 0.015). Pathological diagnosis was also a significant prognostic indicator of tumour-related seizure freedom. Patients with a diagnosis of a glioneuronal tumour benefited from more seizure freedom after resection compared to those who had a low-grade glioma (p = 0.024).Conclusion. The most appropriate management of tumour-related chronic temporal lobe epilepsy in adults appears to be tai-lored temporal lobe resection including tumour and hippocampal complex removal. Surgical treatment of tumoural temporal lobe epilepsy demonstrates excellent results in terms of seizure improvement, especially in patients with glioneuronal tumours

The role of MR cholangiography in the detection of biliary complications after orthotopic liver transplantation

Background: To assess the usefulness of magnetic resonance cholangiography (MRC) in the diagnostics of biliary complications after liver transplantation. Material/Methods: In 40 patients (17 men, 23 women) 51 MRC examinations were performed, from 1 to 58 months (mean-12) after liver transplantation. Studies were performed with 1.5 T unit. The imaging protocol consisted of tree hydrographic TSE sequences: 2D, 3D and single-slice technique. The results were compared with ERCP (n=10), percutaneous cholangiography (n=4), T-tube cholangiography (n=1), T-tube cholangiography and percutaneous cholangiography (n=1), T-tube cholangiography and ERCP (n=1), fistulography (n=2) and histopathology (n=3). In remaining patients other imaging studies (US, CT), laboratory liver functions tests and clinical status were evaluated. Results: In 46 cases (90%) abnormalities of biliary tract were depicted. Following biliary complications were diagnosed: dilatation of biliary tree (n=29), biliary strictures located beside anastomosis site (n=19), anastomotic biliary strictures (n=17), intrahepatic strictures (n=7), biliary obstruction (n=2), biliary stones/sludge (n=14), bile leak (n=12). In 5 cases (10%) MRC was normal. In 50 cases (98%) there was concordance between MRC results and the standard of reference, 1 remaining case (2%) of bile duct ischemia was not confirmed by other studies. Conclusions: MRC is a noninvasive modality, providing accurate assessment of biliary complications in patients after liver transplantation