The Visual Aura Rating Scale as an Outcome Predictor for Persistent Visual Aura Without Infarction

Cephalalgia ◽  
2008 ◽  
Vol 28 (12) ◽  
pp. 1298-1304 ◽  
Author(s):  
Y-F Wang ◽  
J-L Fuh ◽  
W-T Chen ◽  
S-J Wang
Keyword(s):  
Complete Resolution ◽  
Rating Scale ◽  
Present Report ◽  
Visual Aura ◽  
Systematic Analysis ◽  
Treatment Regimens ◽  
Symptom Profiles ◽  
Duration Of Illness ◽  
Specific Agent ◽  
Visual Disturbances

Persistent visual aura without infarction is rare. Its pathogenic mechanism is unknown, and the response to migraine prophylactic agents varies. A systematic analysis of 29 patients (23 from the literature and six in the present report; 6M/23F, mean age 37.6 years) was carried out in terms of demographics, headache and visual symptom profiles, treatment regimens and outcomes. Patterns of visual disturbances (VDs) were re-assessed with the Visual Aura Rating Scale (VARS, score 0-10). Even though the majority of patients had headache improvement, only eight (27.6±) had complete resolution of persistent VD, without definite relevance to any specific agent. Patients with complete resolution of VD tended to have scotoma (50.0± vs. 0±; P = 0.003), unilateral/homonymous involvement (62.5± vs. 9.5±; P = 0.008), higher VARS scores (1.88 ± 1.73 vs. 0.10 ± 0.30; P< 0.001) and shorter duration of illness (10.0 ± 12.9 vs. 60.2 ± 90.9 months, P = 0.008) compared with those without. These findings remained even when the six current patients were not included for analyses. In conclusion, the prognosis of persistent VD was poor, and higher VARS scores, i.e. more typical of migraine visual aura, predicted a better outcome. For those with a potential for complete resolution, improvement would occur early in the course.

scholarly journals Transient Visual Disturbance is Associated with Disability and Suicidal Risk in Patients with Migraine Without Aura

2021 ◽  
Author(s):  
Yu Chien Tsao ◽  
Yen-Feng Wang ◽  
Jong-Ling Fuh ◽  
Wei-Ta Chen ◽  
Kuan-Lin Lai ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Migraine Without Aura ◽  
Rating Scale ◽  
Depression Scale ◽  
Visual Disturbance ◽  
Visual Aura ◽  
Visual Phenomenon ◽  
Headache Clinic ◽  
Headache Impact ◽  
Visual Disturbances

Abstract Background: Patients with migraine without aura frequently report transient visual disturbances (TVD) other than typical visual aura, but the clinical correlates are not determined. Method: Patients with migraine without aura (MO) that attended the headache clinic were enrolled. Structured questionnaires were self-administered by the patients including headache profiles, comorbidities, lifetime suicidal ideation and attempts, six-item Headache Impact Test, Migraine Photophobia Score, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, Beck Depression Inventory, and Pittsburgh Sleep Quality Index. A semi-structured visual phenomenon questionnaire was also used to assess the characteristics of TVDs. TVD is defined as any zigzag flashes, flickering dots/lines, or blurred/foggy vision associated with headache and with a Visual Aura Rating Scale < 4. Headache specialists interviewed with the participants for the ascertainment of diagnosis and verified of the questionnaires.Result: MO patients (n = 7,200, female/male = 3.56, mean age: 40.1 ± 13.4 years) were divided into 2 subgroups based on the presence (n=2,488) or absence of TVDs (n= 4,712). Patients with TVD had higher headache-related disability, more psychiatric comorbidities and were more likely to be photophobic. Suicidal ideation and attempts were more common in patients with TVD than in those without (ideation: 31.9% vs. 18.1%, OR = 1.92 [95% CI: 1.71−2.15], p < 0.001; attempt: 8.2% vs. 3.5%, OR = 2.23 [95% CI: 1.80−2.75], p < 0.001). The associations remained after adjustment of confounding factors.Conclusion: Presence of transient visual disturbance may suggest a higher migraine-related disability, higher level of photophobia and higher suicidal ideation/attempts in MO patients.

The Visual Aura Rating Scale (VARS) for Migraine Aura Diagnosis

Cephalalgia ◽  
2005 ◽  
Vol 25 (10) ◽  
pp. 801-810 ◽  
Author(s):  
MK Eriksen ◽  
LL Thomsen ◽  
J Olesen
Keyword(s):  
Rating Scale ◽  
Evidence Based ◽  
Validation Sample ◽  
Semistructured Interview ◽  
Migraine Aura ◽  
Visual Symptom ◽  
Visual Aura ◽  
Maximum Score ◽  
Cardinal Characteristics ◽  
Visual Disturbances

To supplement the traditional ICHD-2 diagnosis for migraine with aura (MA) we developed a diagnostic scale for migraine aura that quantifies the importance of the cardinal characteristics of MA. Since more than 99% of MA patients have visual aura, we developed for simplicity a Visual Aura Rating Scale (VARS). In total 427 patients with MA (ICHD-2) or nonaura visual disturbances were diagnosed in a validated semistructured interview by a trained physician. The patients were separated into a derivation sample and a validation sample. By regression analysis we identified the visual aura characteristics associated with MA in the derivation sample. Based on the identified characteristics we developed VARS and derived a predictive VARS score which was tested in the validation sample. The VARS score is the weighted sum of the presence of five visual symptom characteristics: duration 5-60 min (3 points), develops gradually ≤5 min (2 points), scotoma (2 points), zig-zag lines (2 points), and unilateral (1 point). The maximum score is 10 points. A VARS score of 5 or more diagnosed MA with a sensitivity of 96% (95% CI 92-99%) and a specificity of 98%(95% CI 95-100%) in the derivation sample, and a sensitivity of 91% (95% CI 86-95%) and a specificity of 96% (95% CI 91-100%) in the validation sample. VARS adds evidence based weights to a number of clearly specified characteristics; it is easy to learn, apply and teach and may therefore be a valuable addition to traditional ICHD-2 diagnosis.

scholarly journals Framework for patient-ventilator asynchrony during long-term non-invasive ventilation

Thorax ◽  
2019 ◽  
Vol 74 (7) ◽  
pp. 715-717 ◽  
Author(s):  
Jesus Gonzalez-Bermejo ◽  
Jean-Paul Janssens ◽  
Claudio Rabec ◽  
Christophe Perrin ◽  
Frédéric Lofaso ◽  
...  
Keyword(s):  
Present Report ◽  
Time Windows ◽  
Clinical Impact ◽  
Positive Pressure ◽  
Systematic Analysis ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Polygraphic Recordings ◽  
Bench Testing

Episodes of patient-ventilator asynchrony (PVA) occur during acute and chronic non-invasive positive pressure ventilation (NIV). In long-term NIV, description and quantification of PVA is not standardised, thus limiting assessment of its clinical impact. The present report provides a framework for a systematic analysis of polygraphic recordings of patients under NIV for the detection and classification of PVA validated by bench testing. The algorithm described uses two different time windows: rate asynchrony and intracycle asynchrony. This approach should facilitate further studies on prevalence and clinical impact of PVA in long-term NIV.

scholarly journals Factors Related to Anxiety Events in Parkinson's Patients in Dr. M Djamil Padang

2021 ◽  
Vol 7 (2) ◽  
pp. 242-246
Author(s):  
Yoga Setia Kurniawan ◽  
Yuliarni Syafrita ◽  
Restu Susanti
Keyword(s):  
Marital Status ◽  
Significant Relationship ◽  
Rating Scale ◽  
Univariate Analysis ◽  
P Value ◽  
Research Subjects ◽  
Duration Of Illness ◽  
Hamilton Anxiety Rating Scale ◽  
Age And Sex ◽  
Hamilton Anxiety

Introduction : Anxiety is one of the most non-motorized symptoms in patients with Parkinson's which greatly affects the quality of life, but in clinical practice it is often neglected. Anxiety in patients with Parkinson's can accelerate motor deterioration / disability and also increase mortality. Methods: This cross-sectional study was conducted at the Neurology polyclinic Dr. M Djamil Padang from July to December 2020 in patients who had been diagnosed with Parkinson's Disease (PD) by excluding secondary Parkinson's and a history of stroke. Anxiety was measured using the Hamilton Anxiety Rating Scale (HARS). The research subjects were 60 people. Univariate analysis to present baseline characteristics and bivariate tests assessed factors associated with anxiety and the relationship between variables. A p value <0.05 was considered statistically significant. Results: Most of the subjects were male (55%) with a mean age of 58.05 ± 9.7 years and disease duration of 6.35 ± 5.29 years. By examining the Hamilton Anxiety Rating Scale (HARS), it was obtained 38.3% of Parkinson's sufferers with anxiety. There is a significant relationship between marital status, duration of illness and degree of disease with the incidence of anxiety (p <0.05) and there is no significant relationship between age and sex with the incidence of anxiety in patients with Parkinson's. Conclusion: There is a significant relationship between marital status, duration of illness and degree of disease with the incidence of anxiety in patients with Parkinson's and there is no relationship between age and sex with the incidence of anxiety in patients with Parkinson's.

scholarly journals Characteristics and treatment effectiveness of the nummular headache: a systematic review and analysis of 110 cases

2020 ◽  
Vol 2 (1) ◽  
pp. e000049
Author(s):  
Urvish K Patel ◽  
Sidra Saleem ◽  
Arsalan Anwar ◽  
Preeti Malik ◽  
Bindi Chauhan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complete Resolution ◽  
Rating Scale ◽  
Botulinum Toxin Type A ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Primary Headache ◽  
Tricyclic Antidepressant ◽  
Nummular Headache ◽  
Pubmed Database

Background/objectiveNummular headache (NH) is a primary headache disorder characterised by intermittent or continuous scalp pain, affecting a small circumscribed area of the scalp. As there are limited data in the literature on NH, we conducted this review to evaluate demographic characteristics and factors associated with complete resolution of the headache, and effectiveness of treatment options.MethodsWe performed a systematic review of cases reported through PubMed database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and ‘nummular headache’, ‘coin-shaped headache’ and ‘coin-shaped cephalalgia’ keywords. Analysis was performed by using χ2 test and Wilcoxon rank-sum test. For individual interventions, the response rate (RR%) of the treatment was calculated.ResultsWe analysed a total of 110 NH cases, with median age 47 years and age of pain onset 42 years. Median duration to make correct diagnosis was 18 months after first attack. The median intensity of each attack was 5/10 on verbal rating scale over 4 cm diameter with duration of attack <30 min. Patients with NH had median three attacks per day with frequency of 9.5 days per month. 40 (57.97%) patients had complete resolution of the headache after treatment. Patients with complete resolution were younger, more likely to be female, and were more likely to have diagnosis within year. Patients with complete resolution more likely to have received treatment with onabotulinum toxin A (botulinum toxin type A (BoNT-A)), and gabapentin compared with patients without complete resolution. Most effective interventions were gabapentin (n=34; RR=67.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (n=32; RR=65.6%), BoNT-A (n=12; RR=100%) and tricyclic antidepressant (n=9; RR=44.4%).ConclusionYounger patients, female sex and early diagnosis were associated with complete resolution. NSAIDs, gabapentin and BoNT-A were most commonly used medications, with significant RRs.

scholarly journals A 21-Year-Old Man with Systemic-Onset Juvenile Rheumatoid Arthritis, Cough and Progressive Dyspnea

2010 ◽  
Vol 17 (3) ◽  
pp. e42-e44 ◽  
Author(s):  
A Leber ◽  
S Carette ◽  
KR Chapman ◽  
DM Hwang ◽  
LG Singer ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Juvenile Rheumatoid Arthritis ◽  
Present Report ◽  
Systemic Disease ◽  
Lipoid Pneumonia ◽  
Multiple Treatment ◽  
Treatment Regimens ◽  
Progressive Dyspnea ◽  
Definitive Management ◽  
Systemic Onset

Primary or nonobstructive, endogenous lipoid pneumonia is a rare clinical entity usually associated with an underlying systemic disease. The present report describes a case involving a 21-year-old man with systemic-onset juvenile rheumatoid arthritis who developed primary endogenous lipoid pneumonia. Multiple treatment regimens were attempted; however, definitive management was only achieved through double-lung transplantation.

scholarly journals Recurrent Pituicytoma in a Pediatric Patient: A Case Report

2018 ◽  
Vol 37 (02) ◽  
pp. 119-122
Author(s):  
Miguel Maldonado-Morán ◽  
Jeisson Ospina ◽  
Juan Vega ◽  
Claudia Restrepo ◽  
Daniela Rico ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Pediatric Patient ◽  
Glial Cells ◽  
Clinical Presentation ◽  
Present Report ◽  
Rare Tumor ◽  
Radiological Features ◽  
Long Time ◽  
Visual Disturbances

AbstractPituicytoma is a rare tumor that arises from the glial cells of the neurohypophysis. For a long time, it was believed that pituicytomas only appeared in adults. Currently, at least three cases of this entity occurring in children have been reported in the literature. The aim of the present report is to describe the case of a 5-year-old girl who presented to the emergency department with visual disturbances, and the diagnosis was a recurrent pituicytoma. Therefore, the clinical presentation, the radiological features of the tumor, and the corresponding surgical management are described. Additionally, a brief review of the management of this unusual entity was performed.

A Randomised Dose De-Escalation Safety Study of Oral Fludarabine, ±Oral Cyclophosphamide and Intravenous Rituximab (OFOCIR) As First-Line Therapy of Fit Patients with Chronic Lymphocytic Leukaemia (CLL) Aged ≥65 Years – End of Recruitment Analysis of Response and Toxicity of the Australasian Leukaemia and Lymphoma Group (ALLG) and CLL Australian Research Consortium (CLLARC) CLL5 Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 436-436 ◽  
Author(s):  
Stephen P Mulligan ◽  
Devinder S Gill ◽  
Paul Turner ◽  
William E. P. Renwick ◽  
Rosemary Harrup ◽  
...  
Keyword(s):  
Dose Reduction ◽  
Research Funding ◽  
Rating Scale ◽  
Therapy Response ◽  
Patient Choice ◽  
First Line ◽  
Patient Cohort ◽  
Treatment Regimens ◽  
First Line Therapy ◽  
Grade 3

Abstract Abstract 436 Background: Combination immunochemotherapy with fludarabine (F), cyclophosphamide (C) and rituximab (R) gave superior progression free and overall survival compared to FC in the CLL8 Study. The median age in CLL8 was 61 years compared to a median age for overall CLL patients of 72 years. There is ongoing debate regarding the tolerability and safety of FCR in elderly patients, and what are the most appropriate criteria for selection of therapy. Methods: Previously untreated patients with progressive CLL aged ≥65 were randomised to one of three treatment regimens FR5, FCR3 and FCR5 as follows: (i) F 24mg/m2 po D1-5 + R (375 mg/m2 C1, 500mg/m2 C2-6) iv D1 (FR5), (ii) F 24mg/m2 po and C 150mg/m2 po D1-3 + R iv D1 (FCR3) or (iii) F 24mg/m2 po + C 150mg/m2po D1-5 + R iv D1 (FCR5), all given at 4 weekly intervals for an intended 6 cycles. The dosage of FCR5 is equivalent to standard 3 day IV FCR in the CLL8 Study. Patients were administered their therapy arm with no dose reduction but fludarabine dose was reduced if the eGFR was 50–69ml/min. Therapy was delayed up to 2 weeks if there was grade 3 or 4 toxicity, and if unresolved after 2 weeks, patients were taken off study. If toxicity resolved to grade 2 or less, therapy proceeded. Results: Recruitment of all 120 randomised patients was completed in July 2012. An analysis was performed with a cut-off date of 5 May, 2012 at which time there were 117 of 120 recruited from 29 centres in Australia and New Zealand. Median age was 71.7 (range 65–83) years. Binet stage at registration was progressive A – 20 (17.1%), B – 55 (47.0%) and C – 42 (35.9%). Response data are shown in table 1 for the total patient cohort - no analysis has been performed to date by treatment arm. Analysis of grade 3 and 4 toxicity events by Cumulative Illness Rating Scale (CIRS) score and age are shown in Tables 2 and 3 with data available at the cut-off date. Conclusions: Oral F(C)R therapy appears generally safe and well tolerated in CLL patients aged ≥65 years requiring first-line treatment according to data available at end of recruitment. Using stringent stopping criteria with delay of 2 weeks for recovery of grade 3 or 4 toxicity but no dose reduction, ∼40% of patients stop early due to toxicity, intercurrent illness or patient choice. Based on the 66 patients with completed Final Pathological Staging 2 months after end of therapy, response rates appear high with an overall response rate (ORR) of 92.3%. For this relatively fit elderly patient cohort, neither a CIRS score of 0 to 6, nor age predicted for grade 3 and 4 toxicity. Disclosures: Mulligan: Roche: Consultancy, Research Funding, Speakers Bureau; Genzyme: Consultancy, Research Funding, Speakers Bureau.

Does depression conciliate in marital adjustment?

2016 ◽  
Vol 33 (S1) ◽  
pp. S399-S399
Author(s):  
A. Channa
Keyword(s):  
Marital Satisfaction ◽  
Rating Scale ◽  
Marital Adjustment ◽  
Medical Condition ◽  
Satisfaction Scale ◽  
General Medical Condition ◽  
Duration Of Illness ◽  
Severity Of Depression ◽  
Marital Dissatisfaction ◽  
Competing Interest

Marriage is one of the principal facets when it comes to interpersonal context of depression. There is evidence supporting bidirectional casual effect between depression and marital satisfaction. However the phenomenon of marital adjustment and its related variable has not been given much attention in the Pakistan.ObjectiveTo determine the frequency of marital adjustment in patients with depression.MethodDepressed patients, who were aged between 15–65 were included. Patients who had documented co morbid of substance use or any unstable serious general medical condition were excluded. The severity of depression was evaluated by using Urdu validated Hamilton Depression Rating Scale. Marital adjustment is determined by using Urdu validated version of Kansas Marital Satisfaction Scale.ResultOnly 8.6% were well adjusted in their marital life, and all were females. The association of marital adjustment and severity of depression and difference in both genders on KANSAS was insignificant. The longer duration of illness was positively interrelated to the marital adjustment with odd ratio of 7.6. Being employed and above 30 years of age were inversely related to marital satisfaction with odd ratio of 6.1 and 5.4 respectively. However, the correlation between other independent variables and marital adjustment were insignificant in both genders.ConclusionThis study confirms the presence of high frequency i.e. 91.4% of marital dissatisfaction in depression in both male and females, irrespective of their severity of depression.Disclosure of interestThe author has not supplied their declaration of competing interest.

scholarly journals Biomarkers of Oxidative Stress in Major Depressive Disorder

2020 ◽  
Vol 8 (B) ◽  
pp. 501-506
Author(s):  
Rania A. Hamed ◽  
Heba A. Elmalt ◽  
Abeer A. Salama ◽  
Sarah Y. Abozaid ◽  
Amani S. Ahmed
Keyword(s):  
Oxidative Stress ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Patient Group ◽  
Rating Scale ◽  
Control Group ◽  
Related Factor ◽  
Major Depressive ◽  
Duration Of Illness ◽  
Number Of Patients

BACKGROUND: Many data support that oxidative stress and inflammation represent a pathway to pathology in a number of depressed patients. Therefore, investigating this pathway presents an area for developing potential therapeutic strategies for depression. AIM: This study compares the serum level of malondialdehyde (MDA), superoxide dismutase (SOD), and nuclear factor erythroid 2-related factor 2 (Nrf2) in depressed and non-depressed subjects and correlate between their levels with severity of disorder, socio-demographic characteristics, previous hospitalization, and number of episodes. METHODS: A total of 60 patients diagnosed with major depressive disorder (MDD) from the Psychiatric Outpatient Clinic in Al-Zahra University Hospital, Cairo, Egypt, during the period from July 1, 2018, to December 31, 2018. A cross-matched control group of 60 subjects was selected from employers working in the hospital, complete psychiatric history, Hamilton Depression rating scale was done and serum levels of MDA, Nrf2, and SOD were estimated. RESULTS: No statistical difference between patient and control group was observed regarding age, sex, education, and marital status. The number of patients with mild depression was 28 (46.7%), moderate depression 18 (30%), and severe depression 14 (23.3%). The mean duration of illness in years was 6.13, and mean number of episodes was 3.66. MDA level was significantly elevated in the patient group than the control one. Meanwhile, SOD and Nrf2 were significantly lower in the patient group than the control. There was significant relationship between duration of illness and number of episodes and MDA, Nrf2, and SOD levels. CONCLUSION: Our results indicate that oxidative stress can attribute to the occurrence of MDD.

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