Haemodialysis-related headache

Dialysis may induce severe headache as a result of a large amount of water and electrolyte shifts. It is important to recognize it because it can be a great problem to the patient and changing dialysis parameters or methods can prevent it. In this study we investigated the frequency and clinical characteristics of headaches occurring during haemodialysis (HD). Thirty female and 33 male patients with chronic renal failure on regular dialysis for at least 6 months in the HD unit of the Internal Medicine Department from 1996 to 2000 participated in the study. The dialysis solution contained acetate in 35 patients and bicarbonate in 28 patients. In all patients capillary dialysers and Cuprophan membranes were used and every session of dialysis lasted 4 h. All patients received the same questionnaire and they were visited randomly. Dialysis headache (DH) diagnosis was made according to the criteria of the International Headache Society. Patients with primary headache and under drug treatment during HD, which can cause headache, were excluded from the study. The frequency of DH, its relation to gender, age, dialysis technique and parameters and its features were investigated. DH was detected in 48% (n=30) of the study group. Compared with dialysis solutions, no difference was found between patients with and without DH. The difference in the pre- and post-dialysis value of urea in patients with DH was statistically significant (P<0.05). Patients with DH showed significantly higher mean systolic and diastolic blood pressure predialysis values in comparison with patients without DH (systolic, P<0.001; diastolic, P<0.01), whereas post-treatment values did not differ between the two groups. Fronto-temporal location, moderate severity, throbbing quality and short duration (<4 h) were the most prevalent features of DH in patients

Hepatitis B vaccine related-myelitis?

We present four incidental cases that developed partial myelitis following the administration of hepatitis B vaccine in 1998. The first two cases, a 33-year-old man and a 42-year-old woman developed progressive sensory symptoms without motor involvement within 4 weeks following the vaccination. Their magnetic resonance imaging (MRI) disclosed similar lesions consistent with myelitis at their cervical spinal cord. A comparable inflammatory lesion was seen at the T9-T10 levels of the spinal cord in the third case, who was a 40-year-old woman presenting with numbness in her legs and urinary retention following the vaccination. The fourth case who was a 42-year-old woman, presented with sensory symptoms in her left extremities, which developed 3 months after the vaccination. Her MRI showed a hyperintense lesion at C6. She also had two tiny lesions in her cranial MRI. In all cases, there was no history of preceding infections and no clinical evidence suggestive of any other disorders that may cause myelopathy. All patients recovered completely within 3 months with the exception of the third patient who developed new neurological symptoms after 12 months. Similar clinical and imaging presentation of myelitis following hepatitis B vaccination within a 1 year period with no other demonstrable clinical and laboratory evidence for any other disorder raise the probability of a causal link between these two events

Seizure-related headache in patients with epilepsy

We investigated the type and frequency of interictal primary headache and peri-ictal headache in 109 patients with partial-onset and 26 patients with generalized onset seizures in this study. Interictal headaches were present in 50 (40.7%) of 135 patients. Comparing the interictal headache on the basis of seizure type, we couldn't find any significant difference between the seizure groups. Seventy-nine (58.51%) patients had peri-ictal headache. Eleven of these patients had pre-ictal headache (PriH), three of all had ictal headache and, 56 of these had post-ictal headache (PoiH). PriH and PoiH were more frequently encountered before and after secondary generalized tonic-clonic seizures (GTCS) compared to other seizure groups. The type of pain in PoiH was 'throbbing' in complex partial seizures and 'steady' in GTCS. (C) 2001 BEA Trading Ltd