High prevalence of patent foramen ovale in migraine with aura

In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour–coded sonography (c–TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c–TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c–TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis

Post-traumatic aseptic necrosis of the mandible: A case report and review of the literature

Aseptic necrosis of the mandible after a traumatic fracture is a rare occurrence. However, other causes such as bisphosphonate- associated osteonecrosis have been widely reported in the literature. We present a rare case of a patient who developed a post-traumatic necrosis of the mandible. The aim of this article is to raise the awareness of clinicians in relation to the timing, technique employed and approach to fixation in traumatic osteonecrosis at the first stage. In fact, given the close relationship between the first portion of the maxillary artery and the mandible, it is not surprising that tears of the artery can occur, leading to muscle and bone necrosis