The PRIAMO study: age- and sex-related relationship between prodromal constipation and disease phenotype in early Parkinson's disease.

OBJECTIVES: To explore the impact of sex and age on relationship between prodromal constipation and disease phenotype in Parkinson's disease at early stages. METHODS: A total of 385 Parkinson's disease patients from the PRIAMO study were classified according to the presence of prodromal constipation and followed for 24 months. Multivariable mixed-effect models were applied. All analyses were performed separately for sex (64.1% men) and median age (different by sex: 67 years-old in men and 68 years-old in women). RESULTS: As for sex, prodromal constipation was associated with greater odds of attention/memory complaints and apathy symptoms in women only. As for age, prodromal constipation was associated with lower cognitive and higher apathy scores in older patients only. CONCLUSIONS: Prodromal constipation anticipates lower cognitive performances and more severe apathy since the earliest stages in women and older patients. Sex- and age-related heterogeneity of prodromal markers of Parkinson's disease may impact disease phenotype

Hypnic headache secondary to a growth hormone-secreting pituitary tumour

Hypnic headache (HH) is a rare, benign, chronic headache disorder, usually affecting aged people and characterized by a close relation to sleep. It was first described by Raskin in 1988 (1). Diagnostic criteria for HH have been established, and HH is included in the recent International Headache Society (IHS) classification as a primary form of headache (IHS classification 4.5) (2). At the time of writing, > 100 cases have been reported in the literature (for review see (3)). Furthermore, several patients with this disorder have been described in Italy (4–12). The pathophysiology of HH remains unclear (13). In most instances, even extensive neurological and neuroradiological examinations will be normal (14). However, symptomatic HH has been reported in relation to obstructive sleep apnoea syndrome (15), arterial hypertension (3), pontine stroke (16) and posterior fossa meningioma (17). We report a case of HH in an acromegalic patient with an intrasellar pituitary adenoma

Adult aqueductal stenosis presenting as a thunderclap headache: a case report.

Thunderclap headache is well known to be a presenting feature of a variety of causal events. Indeed, a primary form is considered in the International Classification of Headache Disorders-II, but such diagnosis must be made only after exclusion of a possible secondary cause. We report a case of late-onset idiopathic aqueductal stenosis presenting with thunderclap headache, in the absence of abnormal neurological findings or indirect signs of raised intracranial pressure. The patient recovered completely after endoscopic third ventriculostomy. This case indicates primary aqueduct stenosis as a possible, never previously reported, cause of thunderclap headache

Headache attributed to intracranial tumors: a prospective cohort study.

Between January 2007 and March 2008, we prospectively studied all patients operated on for intracranial tumours in our Department of Neurosurgery. Preoperatively, all patients were interviewed by a neurologist to collect headache characteristics. Measurements of tumour and oedema volume were made using dedicated software for magnetic resonance imaging studies. Tumour histopathology was established by histological examination postoperatively. If headache improved postoperatively, a diagnosis of 'headache attributed to intracranial neoplasm' was made, according to the 2004 International Classification of Headache Disorders (ICHD-II). A multivariate logistic regression model was used to evaluate the association of headache with potential risk factors. We studied 206 subjects. The prevalence of tumour headache was 47.6%. Intracranial tumour headache was non-specific and in most cases could not be classified by current ICHD-II diagnostic criteria for primary headache syndromes. Its prevalence varied depending on volume, location and type of tumour, as well as on the patient's previous headache history

Clinical outcome of deep brain stimulation for dystonia: constant-current or constant-voltage stimulation? A non-randomized study

Background and purposeBilateral globus pallidus deep brain stimulation (GPi-DBS) represents an effective and relatively safe therapy for different forms of refractory dystonia. The aim of this study was to assess, retrospectively, the effect of two different stimulation settings during GPi-DBS in 22 patients affected by primary generalized or multi-segmental dystonia. MethodsThirteen patients were stimulated using a voltage-controlled setting whilst in the other nine patients a current-controlled setting was used. Clinical features were evaluated for each patient at baseline, 6months and 12months after surgery by means of the Burke-Fahn-Marsden Dystonia Rating Scale. ResultsGlobus pallidus deep brain stimulation was effective in all patients. However, comparing constant-current and constant-voltage stimulation, a better outcome was found in the current-controlled group during the last 6 months of follow-up. ConclusionsCurrent-controlled stimulation is effective during GPi-DBS for primary dystonia and it could be a better choice than voltage-controlled stimulation over long-term follow-up