Association between neurovascular contact and clinical characteristics in classical trigeminal neuralgia: A prospective clinical study using 3.0 Tesla MRI

Cephalalgia ◽  
2015 ◽  
Vol 35 (12) ◽  
pp. 1077-1084 ◽  
Author(s):  
Stine Maarbjerg ◽  
Frauke Wolfram ◽  
Aydin Gozalov ◽  
Jes Olesen ◽  
Lars Bendtsen
Keyword(s):  
Trigeminal Neuralgia ◽  
Clinical Characteristics ◽  
Cross Sectional Study ◽  
Prospective Clinical Study ◽  
Structured Interviews ◽  
3.0 Tesla ◽  
Cross Sectional ◽  
Classical Trigeminal Neuralgia ◽  
Duration Of Disease ◽  
Symptomatic Side

Background Previous studies demonstrated that a severe neurovascular contact (NVC) causing displacement or atrophy of the trigeminal nerve is highly associated with classical trigeminal neuralgia (TN). There are no studies describing the association between the clinical characteristics of TN and severe NVC. Methods Clinical characteristics were prospectively collected from consecutive TN patients using semi-structured interviews in a cross-sectional study design. We evaluated 3.0 Tesla MRI blinded to the symptomatic side. Results We included 135 TN patients. Severe NVC was more prevalent in men (75%) compared to women (38%) ( p < 0.001), and the odds in favor of severe NVC on the symptomatic side were 5.1 times higher in men compared to women (95% CI 2.3–10.9, p < 0.001). There was no difference between patients with and without severe NVC in age (≥60 years vs. <60) (OR 1.6 95% CI (0.8–3.4), p = 0.199) or duration of disease ( p = 0.101). Conclusions Severe NVC was much more prevalent in men than in women, who may more often have other disease etiologies causing or contributing to TN. Severe NVC was not associated with age or with duration of disease.

Neurovascular contact plays no role in trigeminal neuralgia secondary to multiple sclerosis

Cephalalgia ◽  
2020 ◽  
pp. 033310242097435
Author(s):  
Navid Noory ◽  
Emil Andonov Smilkov ◽  
Jette Lautrup Frederiksen ◽  
Tone Bruvik Heinskou ◽  
Anne Sofie Schott Andersen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Odds Ratio ◽  
Morphological Changes ◽  
3.0 Tesla ◽  
Classical Trigeminal Neuralgia ◽  
Mri Scans ◽  
Low Prevalence ◽  
Headache Center ◽  
Symptomatic Side

Introduction A demyelinating plaque and neurovascular contact with morphological changes have both been suggested to contribute to the etiology of trigeminal neuralgia secondary to multiple sclerosis (TN-MS). The aim of this study was to confirm or refute whether neurovascular contact with morphological changes is involved in the etiology of TN-MS. Methods We prospectively enrolled consecutive TN-MS patients from the Danish Headache Center. Clinical characteristics were collected systematically. MRI scans were done using a 3.0 Tesla imager and were evaluated by the same experienced blinded neuroradiologist. Results Sixty-three patients were included. Fifty-four patients were included in the MRI analysis. There was a low prevalence of neurovascular contact with morphological changes on both the symptomatic side (6 (14%)) and the asymptomatic side (4 (9%)), p = 0.157. Demyelinating brainstem plaques along the trigeminal afferents were more prevalent on the symptomatic side compared to the asymptomatic side (31 (58%) vs. 12 (22%), p < 0.001). A demyelinating plaque was highly associated with the symptomatic side (odds ratio = 10.6, p = 0.002). Conclusion The primary cause of TN-MS is demyelination along the intrapontine trigeminal afferents. As opposed to classical trigeminal neuralgia, neurovascular contact does not play a role in the etiology of TN-MS. Microvascular decompression should generally not be offered to patients with TN-MS. The study was registered at ClinicalTrials.gov (number NCT04371575)

Trigeminal neuralgia (part I): Revisiting the clinical phenotype

Cephalalgia ◽  
2015 ◽  
Vol 36 (8) ◽  
pp. 730-746 ◽  
Author(s):  
Y Haviv ◽  
J Khan ◽  
A Zini ◽  
G Almoznino ◽  
Y Sharav ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Clinical Phenotype ◽  
Cross Sectional Study ◽  
Study Cohort ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Pain Attack ◽  
Classical Trigeminal Neuralgia ◽  
Background Pain

Aims We conducted a cross-sectional study to re-examine the clinical profile of patients with a clinical diagnosis of classical trigeminal neuralgia (CTN). Methods Inclusion criteria consisted of the International Headache Society’s published classification of CTN. For the specific purposes of the study, features such as autonomic signs, persistent background pain, attack durations of >2 minutes and reports of pain-related awakening were included. The demographic and clinical phenotype of each patient were carefully recorded for analysis. Results The study cohort consisted of 81 patients and based on reported attack duration these were divided into short (≤ 2 minutes, n = 61) and long (> 2 minutes, n = 20) groups for further analysis. The group with short attack duration neatly fit most of the criteria for CTN while the long attack group presents a more challenging diagnosis. There were no significant differences in pain severity, quality and location between the short and long attack groups. The frequency of persistent background pain was significantly higher in the long (70%) compared to the short attack group (29.5%, p = 0.001). There were significantly more reports of pain-related awakenings in the long (55%) than in the short attack groups (29.5%, p = 0.04). There were no significant differences in the frequency of autonomic signs between the short (21.3%) and long attack groups (40%, p = 0.1). In the short attack group, the presence of autonomic signs was significantly associated with longer disease duration, increased pain-related awakenings, and a reduced prognosis. Conclusion There are clear diagnostic criteria for CTN but often patients present with features, such as long pain attacks, that challenge such accepted criteria. In our cohort the clinical phenotype of trigeminal, neuralgiform pain with or without autonomic signs and background pain was observed across both short and long attack groups and the clinical implications of this are discussed.

scholarly journals Clinical Characteristics of Ulcerative Colitis in Nepalese Population: Experience from a Tertiary Care Center TUTH, Kathmandu, Nepal

2015 ◽  
Vol 4 (1) ◽  
pp. 1-6
Author(s):  
Shaneel Harsh ◽  
Ananya Adhikari ◽  
Rahul Pathak ◽  
Prem K Khadga ◽  
Sashi Sharma
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Cross Sectional Study ◽  
Western World ◽  
Asian Countries ◽  
Cross Sectional ◽  
Duration Of Disease

Background and Aim: Rising incidence and prevalence of ulcerative colitis (UC) had been observed in Asian countries. We conducted a study in our center, aiming to describe the demographic and clinical characteristics of UC in Nepalese population.Method: This is a cross sectional study of patients with diagnosis of UC in our hospital from Feb 2014 to Jan 2015. The diagnosis of UC has to satisfy the internationally accepted criteria. All patients were Nepalese and Clinical and epidemiological data were obtained and analysed through SPSS version 20.Results: 60 patients were included in the study. Mean age at diagnosis was 34.6 years. Male had slight preponderance with M:F (1.06:1). Mean duration of disease at diagnosis was 3.7 years. 83% had rectal bleed, Diarrhoea was seen in 77.3%, Tenesmus and Urgency in 70%, Mucus in stool was found in 65%, abdominal pain in 55%. 16.7% had weight loss and extraintestinal manifestations whereas fever was seen in 8.3%. In our patients 38.3% had ulcerative proctitis and 50% had left-sided UC, whereas 11.7% had extensive UC at presentation. The majority presented with mild (53.3%) or moderate (38.3%) disease activity, only 8.3% with severe disease.Conclusions: The peak age of UC was similar to other Western and Asian countries but second peak reported in western countries have not been seen in this study. This finding is similar to reports from East Asia. Similarly the proportion of patients with extra intestinal manifestations was low in our study as compared to studies reported from western world. Our study also showed that it takes longer to diagnose UC in Nepal. This might be related to the unawareness of the patients’ and lack of availability of the diagnostic resources.Journal of Nobel College of Medicine Vol.4(1) 2015: 1-5

Field-testing of the ICHD-3 beta diagnostic criteria for classical trigeminal neuralgia

Cephalalgia ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 291-300 ◽  
Author(s):  
Stine Maarbjerg ◽  
Morten Togo Sørensen ◽  
Aydin Gozalov ◽  
Lars Bendtsen ◽  
Jes Olesen
Keyword(s):  
Trigeminal Neuralgia ◽  
Diagnostic Criteria ◽  
False Negative ◽  
Field Testing ◽  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
International Classification ◽  
Cross Sectional ◽  
Classical Trigeminal Neuralgia

Introduction We aimed to field-test the beta version of the third edition of the International Classification of Headache Disorders (ICHD-3 beta) diagnostic criteria for classical trigeminal neuralgia (TN). The proposed beta draft of the 11th version of the International Classification of Diseases (ICD-11 beta) is almost exclusively based on the ICHD-3 beta classification structure although slightly abbreviated. We compared sensitivity and specificity to ICHD-2 criteria, and evaluated the needs for revision. Methods Clinical characteristics were systematically and prospectively collected from 206 consecutive TN patients and from 37 consecutive patients with persistent idiopathic facial pain in a cross-sectional study design. Results: The specificity of ICHD-3 beta was similar to ICHD-2 (97.3% vs. 89.2%, p = 0.248) and the sensitivity was unchanged (76.2% vs. 74.3%, p = 0.134). The majority of false-negative diagnoses in TN patients were due to sensory abnormalities at clinical examination. With a proposed modified version of ICHD-3 beta it was possible to increase sensitivity to 96.1% ( p < 0.001 compared to ICHD-3 beta) while maintaining specificity at 83.8% ( p = 0.074 compared to ICHD-3 beta). Conclusion ICHD-3 beta was not significantly different from ICHD-2 and both lacked sensitivity. A modification of the criteria improved the sensitivity greatly and is proposed for inclusion in the forthcoming ICHD-3.

Abstract P354: Circulating Interleukin 17 A In Patients With Acute And Chronic Coronary Syndrome

2021 ◽  
Vol 129 (Suppl_1) ◽  
Author(s):  
Dinaldo C Oliveira ◽  
Edivaldo Mendes Filho ◽  
Mariana Barros ◽  
Carolina Oliveira ◽  
Joao Vitor Cabral ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Healthy Volunteers ◽  
Clinical Characteristics ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Interleukin 17 ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Artery Disease

Introduction: Interleukin L-17 is produced by Th 17 cells and other cells. There is a debate if IL 17 is atherogenic or atheroprotective. The true role of this interleukin during the development and progression of the coronary artery disease is not known. Objective: To evaluate if there are differences between the IL17 A serum levels according to clinical presentation of the coronary artery disease. Methods: This is a cross sectional study which enrolled 101 patients with acute coronary syndrome (ACS), 100 patients with chronic coronary syndrome (CCS) and 100 healthy volunteers. Blood samples were taken from patients ( at admission) and controls to analysis the level of IL17A. Clinical characteristics were collected through questionnaires. This research was approved by ethical committee. Results: Comparisons of the clinical characteristics between patients with ACS and CCS revealed: mean age ( 62 ± 12.4 vs 63.3 ± 9.8, p = 0.4 ), male (63.4% vs 58%, p = 0.4) hypertension (85.1% vs 79%, p = 0.1) , disyipidemia (48% vs 31%, p =0.01), Diabetes Mellitus (47.5% vs 41%, p = 0.3), previous myocardial infarction (57.4% vs 40%, p = 0,01), smoking (29.7% vs 38%, p = 1). The peripheral concentrations of IL17A according to ACS, CCS and controls were: 5.36 ± 8.83 vs 6.69 ± 17.92 vs 6.26 ± 11.13, p = 0.6. Besides, the comparison between ACS and CCS showed: 5.36 ± 8.83 vs 6.69 ± 17.92, p = 0.3. Conclusion: The main finding os this study was that the circulating IL 17 concentrations were similar in patients with ACS, CCS and healthy volunteers). Besides, there was no difference between patients with ACS and CCS. Therefore, our hypothesis is that in patients with ACS and CCS the circulating IL 17 A concentrations are low or undetectable.

scholarly journals Use of psychotropic medications by caregivers of elderly patients with dementia: is this a sign of caregiver burden?

2012 ◽  
Vol 70 (3) ◽  
pp. 169-174 ◽  
Author(s):  
Einstein Francisco Camargos ◽  
Andrea Brígida Souza ◽  
Aline Silva Nascimento ◽  
Alessandra Cicari Morais-e-Silva ◽  
Juliana Lima Quintas ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Caregiver Burden ◽  
Psychotropic Drugs ◽  
Cross Sectional Study ◽  
Psychotropic Medications ◽  
Sectional Study ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Sleeping Pills

This study evaluated the consumption of psychotropic medications by caregivers of elderly patients with or without dementia. This was a cross-sectional study conducted at all geriatric units in Brasília, Brazil, during a two-month period. Structured interviews were performed with 311 caregivers of people with or without dementia and they completed questionnaires. Among the caregivers, 196 (63%) were caregivers of patients with dementia and 115 (37%) were caregivers of patients without dementia. Forty-four caregivers (14.1%) were taking psychotropic drugs (benzodiazepines or antidepressants), and this usage was more frequent among caregivers of patients with dementia (p<0.01). Twenty-two caregivers of patients with dementia (11.4%) had used sleeping pills after beginning care, compared with only five (4.3%) caregivers of patients without dementia (p<0.01). In conclusion, this study found that caregivers of patients with dementia took psychotropic drugs (benzodiazepines and antidepressants) more frequently than the ones of patients without dementia.

scholarly journals Clinical Characteristics of Pigment Dispersion Syndrome and Pigmentary Glaucoma Patients: A Cross-sectional Study

2020 ◽  
Author(s):  
Vijay Pratap Singh Tomar ◽  
Sandeep Sharma ◽  
Rahul Bhardwaj ◽  
Sindhuja Singh ◽  
Virendra Kumar Pal ◽  
...  
Keyword(s):  
Visual Field ◽  
Optic Disc ◽  
Clinical Characteristics ◽  
Cross Sectional Study ◽  
Pigment Dispersion ◽  
Pigmentary Glaucoma ◽  
Spherical Equivalent ◽  
Sectional Study ◽  
Cross Sectional ◽  
Pigment Dispersion Syndrome

Introduction: Pigmentary Glaucoma (PG) and Pigment Dispersion Syndrome (PDS) are two different spectrums of a single disease. Since the disease is seen in younger population and is rapidly progressive blinding disease, therefore early diagnosis and treatment will reduce the burden of the disease and improve the quality of life. Aim: To evaluate clinical characteristics of PDS and PG patients in eastern part of Uttar Pradesh. Materials and Methods: This was a two years (1st January 2018 to 31st December 2019) hospital‑based retrospective cross‑sectional study of patients who attended the glaucoma clinic. Diagnosis of PDS was made when they had normal optic disc, normal visual field {with or without increased Intra Ocular Pressure (IOP)} and at least two of the following three signs were found clinically: Krukenberg spindle, homogenous moderate‑to‑heavy (≥Spaeth 2+) Trabecular Meshwork (TM) pigmentation, and any degree of zonular and/or lenticular pigment granule dusting. Patients with PDS were diagnosed with PG, if they had two or more of the following findings: initial IOP >21 mmHg, glaucomatous optic nerve damage or glaucomatous visual field loss. Various parameters such as influence of demographics, IOP, Best‑Corrected Visual Acuity (BCVA), Central Corneal Thickness (CCT), Mean Deviation (MD), Visual Field Index (VFI %), spherical equivalent and clinical finding of anterior segment of study patients were analysed. Mean, standard deviation and percentage were calculated using GraphPad Instat version 3.0. Results: Among 40 patients, nine eyes of the six patients had myopia of ‑0.5D or greater, with mean refractive error of ‑3.55±4.72 spherical equivalent. The average baseline IOP in study patients (PDS+PG), was 30.21±11.42 mmHg. Twenty four (60%) patients, either in one or both eyes had glaucoma, secondary to PDS at the initial diagnosis. Thirty three (82.5%) patients had Krukenberg spindles. Homogeneous TM pigmentation was seen in all patients. Typical spoke‑like radial Iris Transillumination Defects (ITDs) were not observed in any of the patients except in one patient, who had isolated short slit‑like trans‑illumination defects in iris crypts. Conclusion: PDS patients with normal optic disc and visual field and raised IOP, should be started prophylactic treatment and needs to be monitored more closely. Thus, the finding of PDS in Indians should alert the ophthalmologist to look for glaucoma during the initial examination.

scholarly journals Clinical characteristics and outcome of vasculitides

2016 ◽  
Vol 3 (2) ◽  
pp. 3-9
Author(s):  
Buddhi Prasad Paudyal ◽  
Anjana Education Rajbhandari
Keyword(s):  
Medical Records ◽  
Clinical Characteristics ◽  
Cross Sectional Study ◽  
Health Sciences ◽  
Small Vessel ◽  
Small Vessel Vasculitis ◽  
Cross Sectional ◽  
The Mean ◽  
Schonlein Purpura ◽  
Overall Mortality

 Introductions: Vasculitides can cause significant morbidity and mortality if not treated on time. There is lack of data locally. This study aims to define the pattern, clinical characteristics, and outcome of vasculitides.Methods: This was a cross sectional study between January 2011 and December 2015 at Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. The medical records of patients diagnosed with vasculitides in adults rheumatology service of the hospital were reviewed.Results: Ninety six patients were diagnosed with vasculitides during the study period. The mean age was 42.2 years. Sixty nine (71.8%) patient had small vessel, 20 (20.8%) large vessel and five (5.2%) had variable vessel vasculitides. Seventy five patients (78.1%) had primary and 21 (21.8%) secondary vasculitides. Cutaneous leucocytoclasticangitis was seen in 27 (28.1%), Takayasu arteritis in 17 (17.7), Henoch-Schonlein purpura in 11 (11.4%) and Rheumatoid arthritis associated vasculitis in nine patients. Purpura was present in all 96 (100%). The overall mortality was 9 (9.3%).Conclusions: Primary vasculitides were more common than secondary forms. Small vessel vasculitis was the most common. Cutaneous symptoms were predominant features. The mortality was attributed to active disease, sepsis, and complications of the primary disease. Journal of Patan Academy of Health  Sciences. 2016 Dec;3(2):3-9

Sign in / Sign up

Export Citation Format

Share Document