Migraine-like headache in cerebral venous sinus thrombosis

A 20-year-old female, university student presented with severe, throbbing, unilateral headache, nausea and vomiting that started 2 days ago. The pain was aggravated with physical activity and she had photophobia. She had been taking contraceptive pills due to polycystic ovary for 3 months. Cranial computed tomography was uninformative and she was considered to have the first attack of migraine. She did not benefit from triptan treatment and as the duration of pain exceeded 72h further imaging was done. Cranial MRI and MR venography revealed a central filling defect and lack of flow in the left sigmoid sinus caused by venous sinus thrombosis. In search for precipitating factors besides the use of contraceptive pills, plasma protein C activity was found to be depressed (42%, normal 70–140%), homocystein was minimally elevated (12.7μmol/L, normal 0–12μmol/L) and anti-cardiolipin IgM antibody was close to the upper limit

Post-thymectomy, seronegative myasthenia gravis

Kansu, Tulay/0000-0002-1986-4680; Kansu, Tulay/0000-0002-1986-4680WOS: 000253089500003Patients with thymoma associated myasthenia gravis (MG) usually present with severe disease unresponsive to usual treatment and almost all have antibodies against acetylcholine receptors (AChR). We like to present a case of post-thymectomy, seronegative MG. A 55-year-old man was referred with horizontal diplopia and abduction deficit in the right eye two years after he had thymectomy for a thymoma. Single-fiber electromyography was diagnostic for MG and AChR titer was undetectable. Ocular signs did not response to pyridostigmine, prednisolone and immunoglobulin treatments and the patient also suffered from proximal weakness and pain in the extremities. Cyclosporine-A was started and the initial response was favorable with a decrease in general weakness

Bilateral Optic Neuritis After Influenza Vaccination

Kansu, Tulay/0000-0002-1986-4680; Kansu, Tulay/0000-0002-1986-4680WOS: 000283294800010Optic neuritis is a rare complication of vaccination. We report a 55-year-old woman who presented with bilateral optic neuritis following influenza vaccination. The patient has typical features of acute optic neuritis with acute visual loss, periocular pain, visual defects, full recovery of vision after 6 months, and the absence of deterioration after withdrawal of corticosteroids. Considering the absence of oligoclonal bands in the cerebrospinal fluid analysis and the nonexistence of lesions resembling multiple sclerosis (MS) in cranial magnetic resonance imaging, the case at present does not appear to be associated with MS

Retinal nerve fiber layer analysis in idiopathic intracranial hypertension

WOS: 000239211900011PubMed: 16804262Background: The chronic nature of idiopathic intracranial hypertension (IIH) represents a risk factor for progressive optic nerve damage and structural abnormalities of the retina. Aim: We measured the retinal nerve fiber layer (RNFL) thickness in patients followed with the diagnosis of IIH who had no or mild visual impairment to search for possible structural alterations in the retina for diagnostic and prognostic purposes. Settings and Design: Case-control prospective study. Materials and Methods: The study group consisted of 12 women followed and treated with the diagnosis of IIH in our clinic. The selection criteria were the, normal optic nerve, normal visual fields or mild visual field defects (Grade 1-3) by Humphrey perimeter. Randomly assigned, age-matched 12 healthy women were taken as the control group. Retinal nerve fiber layer thickness was evaluated with scanning laser polarimetry and both eyes were studied for each case in both groups. Statistical Analysis Used: Mann-Whitney U test. Results: The mean ages of the patient and the control groups were 34.58 +/- 4.2 and 34.42 +/- 5.7 years respectively (P=0.87). The mean duration of disease was 5.5 +/- 3 years. Some parameters related to RNFL thickness were found to differ significantly between patients with IIH and control subjects. Namely superior ratio (P=0.007), inferior ratio (P=0.039), superior-nasal ratio (P=0.025), maximum modulation (P=0.01) and symmetry (P=0.006) were lower in the patient group than controls. Conclusion: Scanning laser polarimetry might be a good adjunct for determining possible structural affects of IIH on the retina in patients with no or mild visual impairment

Bilateral non-arteritic anterior ischemic optic neuropathy following second-trimester spontaneous abortion-related haemorrhage

WOS: 000309640500026PubMed: 22898194Bilateral anterior ischemic optic neuropathy is a rare complication of massive haemorrhage and related hypotension and anaemia in young individuals. We report a 34-year-old woman with bilateral non-arteritic ischemic optic neuropathy (NAION) after a massive spontaneous abortion-related haemorrhage who presented with sudden painless visual loss in her left eye. Visual acuity was 20/20 in the right eye with only hand motion discernible in the left eye. There was a left relative afferent papillary defect (RAPD). Fundus examination revealed bilateral swollen, hyperaemic optic discs and nerve fiber layer haemorrhages. Brain MRI and magnetic resonance venography were normal. The diagnosis of bilateral NAION was made and intravenous pulse corticosteroid therapy (1000 mg/day) was administered for three days. On the sixth clay, optic disc oedema regressed bilaterally and on the third week, the visual acuity improved to 20/80 in the left eye. The visual field showed only a small spared area in the nasal region, and persistent RAPD was present. After two months, fundus examination showed a small and crowded optic disc on the right and a pale optic disc on the left. Severe acute haemorrhage is an important risk factor for NAION in healthy young individuals. In addition to correction of hypotension and anaemia, intravenous high dose corticosteroid might be beneficial for treatment. (C) 2012 Elsevier Ltd. All rights reserved

Migraine-like headache in cerebral venous sinus thrombosis

WOS: 000349735500015PubMed: 25666780A 20-year-old female, university student presented with severe, throbbing, unilateral headache, nausea and vomiting that started 2 days ago. The pain was aggravated with physical activity and she had photophobia. She had been taking contraceptive pills due to polycystic ovary for 3 months. Cranial computed tomography was uninformative and she was considered to have the first attack of migraine. She did not benefit from triptan treatment and as the duration of pain exceeded 72 h further imaging was done. Cranial MRI and MR venography revealed a central filling defect and lack of flow in the left sigmoid sinus caused by venous sinus thrombosis. In search for precipitating factors besides the use of contraceptive pills, plasma protein C activity was found to be depressed (42%, normal 70-140%), homocystein was minimally elevated (12.7 mu mol/L, normal 0-12 mu mol/L) and anti-cardiolipin IgM antibody was close to the upper limit. (C) 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved

Migren ve gerilim tipi başağrısında depresyon ve anksiyete

Amaç: Başağrısı olan olgularda psikiyatrik komorbidite riskinin belirlenmesi olguların yaşam kalitesi ve prognostik açıdan büyük önem taşımaktadır. Bu çalışmada migren ve gerilim tipi başağnsı (GTBA) olan hastalarda psikiyatrik bozukluklar araştırılmıştır. Hastalar ve Yöntem: Kırıkkale Üniversitesi Tıp Fakültesi Nöroloji Ana-bilim dalında ayrıntılı anamnez ve nörolojik muayene sonunda uluslararası başağnsı kriterlerine göre migren ve gerilim tipi başağnsı tanısı alan 75 kadın, 20 erkek toplam 95 hasta çalışmaya alındı. Tüm hastalara DSM-IV'de depresyon ve anksiyete bozuklukları tanı kriterleri temel alınarak hazırlanmış kırk bir soruluk bir semptom sorgulama formu verildi. Bununla birlikte hastalara Beck depresyon ölçeği (BDÖ)ve durumluluk ve sürekli anksiyete ölçeği(STAI-t ve STAI-s) (Stait and trait) uygulandı. Formların tamamlanmasını takiben olgulara psikiyatrik değerlendirme yapıldı. Bulgular: Çalışma grubunu oluşturan olguların 51 'inde (%53.7) migren ve 44'ünde (%46.3) GTBA mevcut olup ortalama yaşlan sırasıyla 32.77D7.8 ve 30.32D9.4 yıl bulundu (p0.11.). Her iki grupta semptomların şiddeti genel olarak benzer olmasına karşın migrcnli olgularda libido azalması (p0.02), yavaşlık (p0.04) ve bulantı'nın (p0.003) daha ağır olduğu görüldü. Gruplar arasında fark olmamakla beraber hem migren hem GTBA'lı olgularda BDÖ, STAI-t ve STAI-s skorlarının patolojik derecede yüksek olduğu belirlendi. Psikiyatrik değerlendirme sonrasında migrenli olguların %37.3'ünde depresyon, %15.7'sinde anksiyete, %9.8'inde depresyonanksiyete birlikte saptanırken GTBA olguların %43.2'sinde depresyon, %9.1'inde ankziyete, %6.8'inde depresyonanksiyete birlikte bulunuyordu (p0.92) Sonuç: Bu çalışmada hem migren hem GTBA'sinda yüksek oranda ve benzer şiddetle depresyon ve anksiyete komorbiditesi olduğu sonucuna varılmıştır.Purpose: The identification of headache patients who are at risk for psychiatric comorbidity is an important quality of life and prognostic issue. The purpose of this study was to assess psychiatric comorbidity in TTH and migraine patients. Materials and Methods: The study group included 95 (75 female, 20 male) patients diagnosed with either migraine or TTH. All patients were requested to fill out a 44-item symptom list constructed according to DSM-1.V diagnostic criteria for depression and anxiety disorders and to complete the Beck Depression Inventory (BDI) and Spielberger State-trait Anxiety Inventory (STA1). After that all patients were evaluated for the presence of psychiatric disorders according to DSM-IV criteria. Results: Fifty-one (53.7%) patients had migraine while 44 (46.3%) had TTH and their mean ages were 32.777.8 and 30.32±9.4 years, respectively (p0.11). The overall intensity levels of symptoms related to depression and anxiety were similar in both migraine and TTH patients. However, reduced libido (p0.02), slowness (p0.04) and nausea (p0.003) were more intense in migraine patients. The mean BDI, SAI and TAI scores were elevated to the pathologic range in both migraine and TTH patients despite the absence of a significant difference between the groups. The incidences of depression, anxiety and depressionanxiety were 37.3%, 15.7% and 9.8%, respectively, in migraine patients and 43.2%, 9.1% and 6.8%, respectively, in TTH patients (p0.92). Conclusion: Depression and anxiety disorders are common and generally similar in extent and distribution in migraine and TTH patients

Gabapentin treatment in notalgia paresthetica: a preliminary report

WOS: 000491995200001PubMed: 31646616