Idiopathic hypertrophic pachymeningitis mimicking hemicrania continua: An unusual clinical case

Background Hemicrania continua (HC) is a primary headache syndrome characterized by a unilateral, moderate, continuous headache with exacerbations marked by migrainous and cranial autonomic symptoms. However, clinical phenotypes similar to primary HC may be subtended by several disorders. Case report We report the case of a 62-year-old man experiencing, over the previous year, a headache completely consistent with HC and its absolute responsiveness to indomethacin therapy. Later, the patient developed diplopia caused by sixth cranial nerve palsy ipsilateral to headache. In this frame, clinical, laboratory and neuroimaging characteristics supported the diagnosis of idiopathic hypertrophic pachymeningitis (IHP). Conclusions IHP is a rare fibrosing inflammatory disorder leading to a localized or diffuse dura mater thickening. IHP clinical manifestations are a progressively worsening headache and signs related to cranial nerves involvement and venous sinus thrombosis. Here, we report, for the first time, a HC phenotype subtended by IHP.

Download Full-text

COVID-19 and cerebrovascular diseases: a comprehensive overview

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420978004 ◽

2020 ◽

Vol 13 ◽

pp. 175628642097800

Author(s):

Georgios Tsivgoulis ◽

Lina Palaiodimou ◽

Ramin Zand ◽

Vasileios Arsenios Lioutas ◽

Christos Krogias ◽

...

Keyword(s):

Cerebrovascular Disease ◽

Clinical Laboratory ◽

Sinus Thrombosis ◽

Case Reports ◽

Cardiac Injury ◽

Clinical Manifestations ◽

Relevant Information ◽

Cerebral Venous Sinus Thrombosis ◽

Stroke Patients ◽

Comprehensive Overview

Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.

Download Full-text

A case of remitting hemicrania continua with seasonal variation and clustering: a diagnostic confusion with cluster headache

BMJ Case Reports ◽

10.1136/bcr-2019-229650 ◽

2019 ◽

Vol 12 (5) ◽

pp. e229650

Author(s):

Sanjay Prakash ◽

Kalu Singh Rawat

Keyword(s):

Discrete Series ◽

Primary Headache ◽

Complete Response ◽

Hemicrania Continua ◽

Therapeutic Trial ◽

Cranial Autonomic Symptoms ◽

Unilateral Headache ◽

Continuous Background ◽

Diagnostic Confusion ◽

History Of

Hemicrania continua (HC) is an indomethacin responsive primary headache that is characterised by a continuous strictly unilateral headache with periodic exacerbations. About 15% may have a remitting subtype of HC. Herein, we are reporting a 36-year-old man who had a 5-year history of episodic right-sided headaches. The headaches used to occur in a discrete series lasting 4–6 weeks, separated by pain-free remissions of 10–11 months. In each relapse, he had continuous background pain with superimposed exacerbations. The superimposed exacerbations were 1–2 attacks per day, lasting for 2–5 hours, and were associated with ipsilateral cranial autonomic symptoms. However, the patient did not respond to usual therapies of custer headache (CH). He had a complete response to indomethacin. We suggest that remitting subtype of HC may mimic CH. A therapeutic trial of indomethacin should be done in all strictly unilateral headaches who are not responding to other drugs.

Download Full-text

Phenotypic and treatment outcome data on SUNCT and SUNA, including a randomised placebo-controlled trial

Cephalalgia ◽

10.1177/0333102417739304 ◽

2017 ◽

Vol 38 (9) ◽

pp. 1554-1563 ◽

Cited By ~ 25

Author(s):

Hsing-Yu Weng ◽

Anna S Cohen ◽

Christoph Schankin ◽

Peter J Goadsby

Keyword(s):

Controlled Trial ◽

Clinical Manifestations ◽

Primary Headache ◽

Outcome Data ◽

Short Term ◽

Autonomic Symptoms ◽

Primary Headache Disorders ◽

Cranial Autonomic Symptoms ◽

History Of

Background Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are two rare headache syndromes classified broadly as Trigeminal Autonomic Cephalalgias (TACs). Methods Here, 65 SUNCT (37 males) and 37 SUNA (18 males) patients were studied to describe their clinical manifestations and responses to treatment. Results Pain was almost always unilateral and side-locked. There were three types of attack: Single stabs, stab groups, and a saw-tooth pattern, with some patients experiencing a mixture of two types. As to cranial autonomic symptoms, SUNA patients mainly had lacrimation (41%) and ptosis (40%). Most cases of the two syndromes had attack triggers, and the most common triggers were touching, chewing, or eating for SUNCT, and chewing/eating and touching for SUNA. More than half of each group had a personal or family history of migraine that resulted in more likely photophobia, phonophobia and persistent pain between attacks. For short-term prevention, both syndromes were highly responsive to intravenous lidocaine by infusion; for long-term prevention, lamotrigine and topiramate were effective for SUNCT, and lamotrigine and gabapentin were efficacious in preventing SUNA attacks. A randomized placebo-controlled cross-over trial of topiramate in SUNCT using an N-of-1 design demonstrated it to be an effective treatment in line with clinical experience. Conclusions SUNCT and SUNA are rare primary headache disorders that are distinct and very often tractable to medical therapy.

Download Full-text

Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes

Neurology ◽

10.1212/wnl.0000000000008124 ◽

2019 ◽

Vol 93 (12) ◽

pp. e1138-e1147 ◽

Cited By ~ 9

Author(s):

Christian Ziegeler ◽

Arne May

Keyword(s):

Facial Pain ◽

Care Center ◽

Tertiary Care ◽

Primary Headache ◽

Hemicrania Continua ◽

Paroxysmal Hemicrania ◽

Primary Headaches ◽

Cranial Autonomic Symptoms ◽

Pain Syndromes ◽

The Face

ObjectiveTo assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center.MethodsBetween 2010 and 2018, we routinely assessed the prevalence of facial pain presentations of all patients with primary headaches.ResultsOf 2,912 patient datasets, 291 patients reported facial pain either as an independent or as an additional symptom. Among patients with migraine, 2.3% (44 of 1,935) reported a facial involvement, most commonly in V2. Of these, 18 patients (40.9%) experienced the pain predominantly in the face. In patients with cluster headache, 14.8% (42 of 283) reported a facial involvement, of which 31.0% perceived the pain predominantly in the face. A facial involvement was seen in 45.0% of patients with paroxysmal hemicrania (9 of 20), 21.4% of patients with hemicrania continua (9 of 42), and 20.0% of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (3 of 15). In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day.ConclusionOur data suggest that a facial involvement in primary headaches is infrequent but not uncommon. A sole facial presentation of primary headache symptomatology seems to be exceptionally rare. We describe 3 different types of facial pain involvement and, in this context, distinguish patients with paroxysmal orofacial pain syndromes that have not been previously described. These patients may represent a new entity that could tentatively be called constant unilateral facial pain with added attacks.

Download Full-text

Hemicrania Continua Associated with Classic Scintillating Scotoma

Case Reports in Neurology ◽

10.1159/000487881 ◽

2018 ◽

Vol 10 (1) ◽

pp. 83-87 ◽

Cited By ~ 1

Author(s):

Eva Auffenberg ◽

Friedemann Bender ◽

Tobias Freilinger

Keyword(s):

Primary Headache ◽

Headache Disorder ◽

Complete Response ◽

Hemicrania Continua ◽

Response To Treatment ◽

Visual Aura ◽

Primary Headache Disorder ◽

Cranial Autonomic Symptoms ◽

Potential Link ◽

Scintillating Scotoma

Hemicrania continua (HC) is a rare primary headache disorder, characterized by persistent unilateral pain associated with cranial autonomic symptoms and prompt response to indomethacin. While migrainous features (including aura) have been recognized in cluster headache, there have been only single reports of HC with aura. Here, we report the case of a 53-year-old man with constant right-sided headache and superimposed exacerbations to severe pain lasting for several hours. Secondary etiologies were excluded, and a diagnosis of HC was established after prompt and complete response to treatment with indomethacin. During an episode of pain exacerbation, for the first time the patient experienced an episode of transient visual disturbances compatible with scintillating scotoma. We propose a potential link between HC and visual aura, which parallels similar observations in other trigeminal autonomic cephalalgias and more specifically confirms previous observational data on aura in HC, thus highlighting potentially shared pathophysiological mechanisms.

Download Full-text

CEREBROVASCULAR COMPLICATIONS OF COVID-19

Eastern Ukrainian Medical Journal ◽

10.21272/eumj.2021;9(3):219-227 ◽

2021 ◽

Vol 9 (3) ◽

Author(s):

Volodymyr Lychko ◽

Mykola Burtyka

Keyword(s):

Cerebrovascular Disease ◽

Clinical Laboratory ◽

Sinus Thrombosis ◽

Case Reports ◽

Clinical Manifestations ◽

Relevant Information ◽

Neurological Complications ◽

Cerebral Venous Sinus Thrombosis ◽

Systemic Review ◽

Stroke Patients

The systematic online search of articles utilizing the search terms ”Coronavirus, SARS-COV-2 and Neurological complications”, published between January 2019 and September 2021, was performed. Neurological manifestations are prevalent during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is a clear association between cerebrovascular disease and coronavirus disease 2019 (COVID-19). But today, whether this association is causal or incidental is still unknown. This systemic review presents the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describes the most often neurological complications and their prognosis, discusses several clinical and laboratory characteristics. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune storm with inflammation, coagulopathy, complications due to critical illness and prolonged hospitalization can all contribute as potential etiological and pathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral haemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients, with a prevalence ranging between 0.5 % and 5.0 %. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients. Understanding of the specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ in recognizing COVID-19-related acute neurological complications.

Download Full-text

THE CLINICAL, LABORATORY MANIFESTATIONS AND HISTOPATHOLOGY IN NEPHROTIC PATIENTS WITH LUPUS NEPHRITIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.2.9 ◽

2018 ◽

pp. 52-58

Author(s):

Le Thuan Nguyen ◽

Bui Bao Hoang

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Lupus Erythematosus ◽

Clinical Laboratory ◽

Activity Index ◽

Clinical Manifestations ◽

Systemic Lupus ◽

Cross Sectional ◽

Organ Systems ◽

Tubulointerstitial Lesions

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organ systems. The kidney appears to be the most commonly affected organ, especially nephrotic is a serious kidney injury. The clinical, laboratory manifestations and histopathology are very useful for diagnosis, provide the means of predicting prognosis and guiding therapy in nephrotic patients with lupus nephritis. Methods: Descriptive cross-sectional study of nephrotic patients with lupus treated in the Department of Nephrology Trung Vuong Hospital and Cho Ray Hospital between May/2014 and May/2017. Renal histopathological lesions were classified according to International Society of Nephrology/Renal Pathology Society - ISN/RPS ’s 2003. The clinical, laboratory manifestations and histopathological features were described. Results: Of 32 LN with nephritic range proteinuria cases studied, 93.7% were women. The 3 most common clinical manifestations were edema (93.8%), hypertension (96.8%) and pallor (68.9%), musculoskeletal manifestions (46.9%), malar rash (40.6%). There was significant rise in laboratory and immunological manifestions with hematuria (78.1%), Hb < 12g/dL (93.5%), increased Cholesterol (100%), and Triglycerid (87.5%), Creatinine > 1.4 mg/dL (87.5%), increased BUN 71.9%, ANA (+) 93.8%, Anti Ds DNA(+) 96.9%, low C3: 96.9%, low C4: 84.4%. The most various and severe features were noted in class IV with active tubulointerstitial lesions and high activity index. Conclusion: Lupus nephritis with nephrotic range proteinuria has the more severity of histopathological feature and the more severity of the more systemic organ involvements and laboratory disorders were noted. Key words: Systemic lupus, erythematosus (SLE) lupus nepphritis, clinical

Download Full-text

Influence of the Acetylation Type on the Incidence of Isoniazid-Induced Hepatotoxicity in Patients with Newly Diagnosed Pulmonary Tuberculosis

Antibiotics and Chemotherapy ◽

10.37489/0235-2990-2020-65-7-8-31-36 ◽

2020 ◽

Vol 65 (7-8) ◽

pp. 31-36

Author(s):

N. M. Krasnova ◽

N. E. Evdokimova ◽

A. A. Egorova ◽

O. I. Filippova ◽

E. A. Alekseeva ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Clinical Laboratory ◽

Clinical Manifestations ◽

Normal Activity ◽

Slow Acetylators ◽

Nucleotide Polymorphisms ◽

Newly Diagnosed ◽

Single Nucleotide ◽

Tuberculosis Chemotherapy ◽

Genetically Determined

Introduction. Liver damage can be a dangerous side effect of using isoniazid. Individual susceptibility to isoniazid in humans is dependent on the presence of N-acetyltransferase 2 allelic variants in genome. It was imperative to assess the effect of genetically determined isoniazid acetylation rate in terms of risk of developing isoniazid-induced hepatotoxicity, as well as prevention of potential hepatopathy, and improvement of tuberculosis chemotherapy safety. Aim. To study the effect of acetylation type on the incidence of isoniazid hepatotoxicity in residents of the Sakha Republic (Yakutia) with newly diagnosed pulmonary tuberculosis. Methods. The study included 112 patients with newly diagnosed pulmonary tuberculosis. Genotyping was performed using real-time polymerase chain reaction. The following single nucleotide polymorphisms were studied: rs1801280, rs1799930, rs1799931, rs1799929, rs1208, rs1041983. Hepatotoxicity was determined based on the results of clinical laboratory monitoring and using the criteria developed by the European Association for the Study of the Liver (2019). Results. Hepatotoxic reactions developed more often in slow acetylators (43.2%), compared to fast acetylators (20.7%) and intermediate acetylators (10.9%); p=0.002. Serum alanine aminotransferase activity was 5 or more times above the upper limit of normal activity in 37.8% of slow acetylators, and in 8.7% of intermediate acetylators; p=0.001. Clinical manifestations of isoniazid hepatotoxicity were observed more often in slow acetylators (29.7%), than in fast acetylators (3.4%); p=0.000. Conclusion. Slow acetylation type ought to be considered an important risk factor for developing isoniazid hepatotoxicity in patients with pulmonary tuberculosis.

Download Full-text

Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure

Journal of Clinical Medicine ◽

10.3390/jcm10081599 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1599

Author(s):

Marc E. Wolf ◽

Beate Luz ◽

Ludwig Niehaus ◽

Pervinder Bhogal ◽

Hansjörg Bäzner ◽

...

Keyword(s):

Sinus Thrombosis ◽

Clinical Manifestations ◽

Venous Sinus ◽

European Medicines Agency ◽

Coagulation Disorder ◽

Platelet Factor ◽

Venous Sinus Thrombosis ◽

Antiplatelet Antibodies ◽

Imaging Results ◽

Venous Thromboembolic Events

Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Covishield). While the vaccine prevents severe course of and death from COVID-19, the observation of pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objective: To describe the clinical manifestations and the concerning management of patients with cranial venous sinus thrombosis following first exposure to the “COVID-19 vaccine AstraZeneca”. Methods: Patient files, laboratory findings, and diagnostic imaging results, and endovascular interventions of three concerning patients were evaluated in retrospect. Results: Three women with intracranial venous sinus thrombosis after their first vaccination with “COVID-19 vaccine AstraZeneca” were encountered. Patient #1 was 22 years old and developed headaches four days after the vaccination. On day 7, she experienced a generalized epileptic seizure. Patient #2 was 46 years old. She presented with severe headaches, hemianopia to the right, and mild aphasia 13 days after the vaccination. MRI showed a left occipital intracerebral hemorrhage. Patient #3 was 36 years old and presented 17 days after the vaccination with acute somnolence and right-hand hemiparesis. The three patients were diagnosed with extensive venous sinus thrombosis. They were managed by heparinization and endovascular recanalization of their venous sinuses. They shared similar findings: elevated levels of D-dimers, platelet factor 4 antiplatelet antibodies, corona spike protein antibodies, combined with thrombocytopenia. Under treatment with low-molecular-weight heparin, platelet counts normalized within several days. Conclusion: Early observations insinuate that the exposure to the “COVID-19 vaccine AstraZeneca” might trigger the expression of antiplatelet antibodies, resulting in a condition with thrombocytopenia and venous thrombotic events (e.g., intracranial venous sinus thrombosis). These patients’ treatment should address the thrombo-embolic manifestations, the coagulation disorder, and the underlying immunological phenomena.

Download Full-text

Relative Frequency and Risk Factors of COVID-19 Related Headache in a Sample of Egyptian Population: A Hospital-Based Study

Pain Medicine ◽

10.1093/pm/pnab020 ◽

2021 ◽

Author(s):

Mona Hussein ◽

Wael Fathy ◽

Ragaey A Eid ◽

Hoda M Abdel-Hamid ◽

Ahmed Yehia ◽

...

Keyword(s):

Multivariate Analysis ◽

Platelet Count ◽

Relative Frequency ◽

Clinical Laboratory ◽

Primary Headache ◽

Female Gender ◽

Imaging Data ◽

Laboratory Findings ◽

Neutrophil Lymphocyte Ratio ◽

The Impact

Abstract Objectives Headache is considered one of the most frequent neurological manifestations of coronavirus disease 2019 (COVID-19). This work aimed to identify the relative frequency of COVID-19-related headache and to clarify the impact of clinical, laboratory findings of COVID-19 infection on headache occurrence and its response to analgesics. Design Cross-sectional study. Setting Recovered COVID-19 patients. Subjects In total, 782 patients with a confirmed diagnosis of COVID-19 infection. Methods Clinical, laboratory, and imaging data were obtained from the hospital medical records. Regarding patients who developed COVID-19 related headache, a trained neurologist performed an analysis of headache and its response to analgesics. Results The relative frequency of COVID-19 related headache among our sample was 55.1% with 95% confidence interval (CI) (.516–.586) for the estimated population prevalence. Female gender, malignancy, primary headache, fever, dehydration, lower levels of hemoglobin and platelets and higher levels of neutrophil/lymphocyte ratio (NLR) and CRP were significantly associated with COVID-19 related headache. Multivariate analysis revealed that female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count were independent predictors of headache occurrence. By evaluating headache response to analgesics, old age, diabetes, hypertension, primary headache, severe COVID-19, steroid intake, higher CRP and ferritin and lower hemoglobin levels were associated with poor response to analgesics. Multivariate analysis revealed that primary headache, steroids intake, moderate and severe COVID-19 were independent predictors of non-response to analgesics. Discussion Headache occurs in 55.1% of patients with COVID-19. Female gender, fever, dehydration, primary headache, high NLR, and decreased platelet count are considered independent predictors of COVID-19 related headache.

Download Full-text