ICHD-3 is significantly more specific than ICHD-3 beta for diagnosis of migraine with aura and with typical aura

Abstract Background In the emergency room, distinguishing between a migraine with aura and a transient ischemic attack (TIA) is often not straightforward and mistakes can be harmful to both the patient and to society. To account for this difficulty, the third edition of the International Classification of Headache disorders (ICHD-3) changed the diagnostic criteria of migraine with aura. Methods One hundred twenty-eight patients referred to the emergency room at the University Hospital of Lübeck, Germany with a suspected TIA were prospectively interviewed about their symptoms leading to admission shortly after initial presentation. The diagnosis that resulted from applying the ICHD-3 and ICHD-3 beta diagnostic criteria was compared to the diagnosis made independently by the treating physicians performing the usual diagnostic work-up. Results The new ICHD-3 diagnostic criteria for migraine with aura and migraine with typical aura display an excellent specificity (96 and 98% respectively), and are significantly more specific than the previous ICHD-3 beta classification system when it comes to diagnosing a first single attack (probable migraine with aura and probable migraine with typical aura). Conclusions The ICHD-3 is a highly useful tool for the clinical neurologist in order to distinguish between a migraine with aura and a TIA, already at the first point of patient contact, such as in the emergency department or a TIA clinic.

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Prospective testing of ICHD-3 beta diagnostic criteria for migraine with aura and migraine with typical aura in patients with transient ischemic attacks

Cephalalgia ◽

10.1177/0333102417702121 ◽

2017 ◽

Vol 38 (3) ◽

pp. 561-567 ◽

Cited By ~ 10

Author(s):

Elena R Lebedeva ◽

Natalia M Gurary ◽

Denis V Gilev ◽

Jes Olesen

Keyword(s):

Diagnostic Criteria ◽

Migraine With Aura ◽

Field Test ◽

Structured Interview ◽

International Classification ◽

Main Body ◽

Transient Ischemic Attacks ◽

Headache Disorders ◽

Better Than

Introduction The International Classification of Headache Disorders 3rd edition beta (ICHD-3 beta) gave alternative diagnostic criteria for 1.2 migraine with aura (MA) and 1.2.1 migraine with typical aura (MTA) in the appendix. The latter were presumed to better differentiate transient ischemic attacks (TIA) from MA. The aim of the present study was to field test that. Methods Soon after admission, a neurologist interviewed 120 consecutive patients diagnosed with TIA after MRI or CT. Semi-structured interview forms addressed all details of the TIA episode and all information necessary to apply the ICHD-3beta diagnostic criteria for 1.2, 1.2.1, A1.2 and A1.2.1. Results Requiring at least one identical previous attack, the main body and the appendix criteria performed almost equally well. But requiring only one attack, more than a quarter of TIA patients also fulfilled the main body criteria for 1.2. Specificity was as follows for one attack: 1.2: 0.73, A1.2: 0.91, 1.2.1: 0.88 and A1.2.1: 1.0. Sensitivity when tested against ICHD-2 criteria were 100% for the main body criteria (because they were unchanged), 96% for A1.2 and 94% for A1.2.1. Conclusion The appendix criteria performed much better than the main body criteria for 1.2 MA and 1.2.1 MTA when diagnosing one attack (probable MA). We recommend that the appendix criteria should replace the main body criteria in the ICHD-3.

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Adrenal venous sampling in the diagnostic workup of primary aldosteronism

British Journal of Radiology ◽

10.1259/bjr.20210311 ◽

2021 ◽

Author(s):

Matthias Johannes Betz ◽

Christoph Johannes Zech

Keyword(s):

Primary Aldosteronism ◽

Adrenal Adenoma ◽

Secondary Hypertension ◽

University Hospital ◽

Bilateral Disease ◽

Bilateral Adrenal Hyperplasia ◽

Diagnostic Work ◽

The University ◽

Work Up ◽

Current Guidelines

Primary aldosteronism (PA) is the primary cause of secondary hypertension. The prevalence of PA has probably been underestimated in the past and recent studies suggest that PA could be present in up to 10% of patients suffering from hypertension. Aldosterone excess in PA can be caused by unilateral adrenal disease, usually adrenal adenoma, or bilateral adrenal hyperplasia. Differentiation between unilateral and bilateral disease is clinically important as the former can effectively be treated by removal of the affected adrenal. CT or MRI cannot reliably distinguish unilateral from bilateral disease. Therefore, adrenal vein sampling (AVS) is an important step of the diagnostic work-up in patients with PA. Current guidelines recommend PA in virtually all patients with biochemically diagnosed PA who would undergo adrenal surgery if unilateral PA was diagnosed. In this narrative review, we give an overview of the current technique used for AVS with a focus on the experience with this technique at the University Hospital Basel, Switzerland.

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Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

Journal of Clinical Medicine ◽

10.3390/jcm8030345 ◽

2019 ◽

Vol 8 (3) ◽

pp. 345 ◽

Cited By ~ 5

Author(s):

Tobias Kuster ◽

Christian Nickel ◽

Mirjam Jenny ◽

Lana Blaschke ◽

Roland Bingisser

Keyword(s):

Time Course ◽

Predictive Power ◽

Secondary Analysis ◽

Clinical Work ◽

Adverse Outcomes ◽

University Hospital ◽

Chief Complaints ◽

The University ◽

Work Up ◽

Inclusion Period

The predictive power of certain symptoms, such as dyspnoea, is well known. However, research is limited to the investigation of single chief complaints. This is in contrast to patients in the emergency department (ED) presenting usually more than one symptom. We aimed to identify the most common combinations of symptoms and to report their related outcomes: hospitalisation, admission to intensive care units, and mortality. This is a secondary analysis of a consecutive sample of all patients presenting to the ED of the University Hospital Basel over a total time course of 6 weeks. The presence of 35 predefined symptoms was systematically assessed upon presentation. A total of 3960 emergency patients (median age 51, 51.7% male) were included. Over 130 combinations of two, 80 combinations of three, and 10 combinations of four symptoms occurred 42 times or more during a total inclusion period of 42 days. Two combinations of two symptoms were predictive for in-hospital mortality: weakness and fatigue (Odds ratio (OR) = 2.45), and weakness and headache (OR = 3.01). Combinations of symptoms were frequent. Nonspecific complaints (NSCs), such as weakness and fatigue, are among the most frequently reported combinations of symptoms, and are associated with adverse outcomes. Systematically assessing symptoms may add valuable information for prognosis and may therefore influence triage, clinical work-up, and disposition.

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The University Hospital Zurich Offers a Medical Online Consultation Service for Men With Intimate Health Problems

American Journal of Men s Health ◽

10.1177/1557988315614890 ◽

2015 ◽

Vol 11 (3) ◽

pp. 518-524 ◽

Cited By ~ 1

Author(s):

Sabine Schmidt-Weitmann ◽

Urs Schulz ◽

Daniel Max Schmid ◽

Christiane Brockes

Keyword(s):

International Classification Of Diseases ◽

Health Problems ◽

Medical Advice ◽

International Classification ◽

University Hospital ◽

Health Issue ◽

Consultation Service ◽

Online Consultation ◽

The University

The University Hospital of Zurich offers a text-based, Medical Online Consultation Service to the public since 1999. Users asked health questions anonymously to tele-doctors. This study focused on the characteristics of male enquirers with intimate health problems, the content of their questions, the medical advice given by tele-doctors and the rating of the service to prove the benefit of an online service for medical laymen. This retrospective study included 5.1% of 3,305 enquiries from 2008 to 2010 using the International Classification of Diseases-10 and International Classification of Primary Care codes relevant for intimate and sexual health problems in men. A professional text analysis program (MAXQDA) supported the content analysis, which is based on the procedure of inductive category development described by Mayring. The average age was 40 years, 63.1% enquirers had no comorbidity, in 62.5% it was the first time they consulted a doctor, and 70.2% asked for a specific, single, intimate health issue. In 64.3%, the most important organ of concern was the penis. Overall, 30.4% asked about sexually transmitted diseases. In 74.4% a doctor visit was recommended to clarify the health issue. The rating of the problem solving was very good. The service was mainly used by younger men without comorbidity and no previous contact with a doctor with regard to an intimate health problem. The anonymous setting of the teleconsultation provided men individual, professional medical advice and decision support. Teleconsultation is suggested to empower patients by developing more health literacy.

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Surgery in autoimmune pancreatitis

Digestive Surgery ◽

10.1159/000521490 ◽

2021 ◽

Author(s):

Sara Nikolic ◽

Poya Ghorbani ◽

Raffaella Pozzi Mucelli ◽

Sam Ghazi ◽

Francisco Baldaque- Silva ◽

...

Keyword(s):

Autoimmune Pancreatitis ◽

University Hospital ◽

Premalignant Lesions ◽

Single Centre ◽

Age At Surgery ◽

Diagnostic Work ◽

Work Up

Introduction: Autoimmune pancreatitis (AIP) is a disease that may mimic malignant pancreatic lesions both in terms of symptomatology and imaging appearance. The aim of the present study is to analyse experiences of surgery in patients with AIP in one of the largest European cohorts. Methods: We performed a single-centre retrospective study of patients diagnosed with AIP at the Department of Abdominal Diseases at Karolinska University Hospital in Stockholm, Sweden, between January 2001 and October 2020. Results: There were 159 patients diagnosed with AIP, and among them 35 (22.0%) patients had surgery: 20 (57.1%) males and 15 (42.9%) females; average age at surgery was 59 years (range 37-81). Follow-up period after surgery was 67 months (range 1-235). AIP type 1 was diagnosed in 28 (80%) patients and AIP type 2 in 7 (20%) patients. Malignant and premalignant lesions were diagnosed in 8 (22.9%) patients for whom AIP was not the primary differential diagnosis but, in all cases, it was described as a simultaneous finding and recorded in retrospective analysis in histological reports of surgical specimens. Conclusions: Diagnosis of AIP is not always straightforward, and, in some cases, it is not easy to differentiate it from the malignancy. Surgery is generally not indicated for AIP but might be considered in patients when suspicion of malignant/premalignant lesions cannot be excluded after complete diagnostic work-up.

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A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

Cephalalgia ◽

10.1177/0333102419877661 ◽

2019 ◽

Vol 40 (4) ◽

pp. 337-346 ◽

Cited By ~ 3

Author(s):

Alberto Terrin ◽

Federico Mainardi ◽

Carlo Lisotto ◽

Edoardo Mampreso ◽

Matteo Fuccaro ◽

...

Keyword(s):

Prospective Study ◽

Diagnostic Criteria ◽

Migraine Without Aura ◽

Tension Type Headache ◽

Headache Disorders ◽

Headache Attack ◽

Accompanying Symptoms ◽

Type Headache ◽

A Prospective Study

Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

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Causes of brain dysfunction in acute coma: a cohort study of 1027 patients in the emergency department

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-019-0669-4 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 2

Author(s):

Wolf Ulrich Schmidt ◽

Christoph J. Ploner ◽

Maximilian Lutz ◽

Martin Möckel ◽

Tobias Lindner ◽

...

Keyword(s):

Hospital Mortality ◽

Clinical Laboratory ◽

Brain Dysfunction ◽

University Hospital ◽

Unknown Etiology ◽

Efficient Management ◽

Observational Study Design ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

Abstract Background Coma of unknown etiology (CUE) is a major challenge in emergency medicine. CUE is caused by a wide variety of pathologies that require immediate and targeted treatment. However, there is little empirical data guiding rational and efficient management of CUE. We present a detailed investigation on the causes of CUE in patients presenting to the ED of a university hospital. Methods One thousand twenty-seven consecutive ED patients with CUE were enrolled. Applying a retrospective observational study design, we analyzed all clinical, laboratory and imaging findings resulting from a standardized emergency work-up of each patient. Following a predefined protocol, we identified main and accessory coma-explaining pathologies and related these with (i.a.) GCS and in-hospital mortality. Results On admission, 854 of the 1027 patients presented with persistent CUE. Their main diagnoses were classified into acute primary brain lesions (39%), primary brain pathologies without acute lesions (25%) and pathologies that affected the brain secondarily (36%). In-hospital mortality associated with persistent CUE amounted to 25%. 33% of patients with persistent CUE presented with more than one coma-explaining pathology. In 173 of the 1027 patients, CUE had already resolved on admission. However, these patients showed a spectrum of main diagnoses similar to persistent CUE and a significant in-hospital mortality of 5%. Conclusion The data from our cohort show that the spectrum of conditions underlying CUE is broad and may include a surprisingly high number of coincidences of multiple coma-explaining pathologies. This finding has not been reported so far. Thus, significant pathologies may be masked by initial findings and only appear at the end of the diagnostic work-up. Furthermore, even transient CUE showed a significant mortality, thus rendering GCS cutoffs for selection of high- and low-risk patients questionable. Taken together, our data advocate for a standardized diagnostic work-up that should be triggered by the emergency symptom CUE and not by any suspected diagnosis. This standardized routine should always be completed - even when initial coma-explaining diagnoses may seem evident.

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Double Vision Is a Major Manifestation in Moderate to Severe Graves' Orbitopathy, but It Correlates Negatively With Inflammatory Signs and Proptosis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-4557 ◽

2015 ◽

Vol 100 (5) ◽

pp. 2098-2105 ◽

Cited By ~ 4

Author(s):

Peter Laurberg ◽

Dalia C. Berman ◽

Inge Bülow Pedersen ◽

Stig Andersen ◽

Allan Carlé

Keyword(s):

Outcome Measures ◽

University Hospital ◽

Double Vision ◽

Binocular Fusion ◽

Binocular Field ◽

Physiological Properties ◽

Patient Variables ◽

Graves Orbitopathy ◽

The University

Abstract Context: Double vision (diplopia) is a major determinant of work disability in patients with Graves' orbitopathy (GO), but is not part of the classification NOSPECS classification of GO. Objective: The objectives of the study were to quantitate diplopia in patients with moderate to severe GO and to study associations with other disease and patient variables. Design: This was a single-center prospective study of consecutive patients at the time of referral. Setting: The study was conducted at the University Hospital Thyroid-Eye Clinic. Patients: Patients included 216 patients diagnosed with moderate to severe and active GO. Main Outcome Measures: Binocular diplopia in field of gaze and monocular fields of motility were prospectively recorded on diagrams and measured by planimetry. Fields of diplopia were correlated to other disease and patient variables. Results: Six patients had only one functional eye and were excluded. Among the remaining 210 patients, diplopia was present in 75.2%. In patients with diplopia, this ranged from 5% to 100% (observed in 11.4% of patients) of binocular field of gaze. The field of diplopia correlated positively with eye motility restriction and with asymmetrical affection of orbits but negatively with signs of inflammation and proptosis that often are the main outcome measures in clinical studies of GO therapy. Conclusion: Diplopia is very common in moderate to severe GO and a major cause for active therapy. In moderate to severe GO, the field of diplopia correlates negatively with some other indicators of disease activity, which may be explained by the physiological properties of binocular fusion.

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Serial testing of the ICHD-3 beta diagnostic criteria for probable reversible cerebral vasoconstriction syndrome: A prospective validation study

Cephalalgia ◽

10.1177/0333102417744361 ◽

2017 ◽

Vol 38 (10) ◽

pp. 1665-1671 ◽

Cited By ~ 2

Author(s):

Mi Ji Lee ◽

Hyun Ah Choi ◽

Hanna Choi ◽

Chin-Sang Chung

Keyword(s):

Medical Center ◽

Final Diagnosis ◽

Acute Stage ◽

Thunderclap Headache ◽

Reversible Cerebral Vasoconstriction Syndrome ◽

Cerebral Vasoconstriction ◽

Diagnostic Work ◽

Work Up ◽

Beta Version

Objectives To serially test the International Classification of Headache Disorders (ICHD) 3rd edition beta version criteria for 6.7.3.1 probable reversible cerebral vasoconstriction syndrome (probable RCVS) in patients with thunderclap headache. Methods We prospectively screened consecutive patients with thunderclap headache who visited the Samsung Medical Center between October 2015 and March 2017. Patients were included in the analysis if they a) visited our hospital within 1 month after onset, b) completed a diagnostic work-up, and c) had no secondary causes other than RCVS. The ICHD-3 beta 6.7.3.1 criteria were evaluated serially during the first visit (visit 1), 2 weeks after the first visit (visit 2), and 1–3 months after onset (visit 3). Results A total of 99 patients completed this study. Based on the first clinical and radiological evaluation, 63 (63.6%) were diagnosed with angiogram-proven RCVS, whilst 36 (36.4%) showed normal neuroimaging. The ICHD-3 beta 6.7.3.1 criteria were fulfilled in 76.2% of patients with angiogram-proven RCVS. In patients with normal angiograms, the ICHD diagnosis of probable RCVS changed over time: 25.0%, 47.2%, and 38.9% at visits 1, 2, and 3, respectively. The sensitivity and specificity of the criteria at visit 1 were 72.4% and 95.5%, respectively, for the prediction of a final diagnosis of overall (angiogram-proven + probable) RCVS. Conclusions The ICHD-3 beta criteria for probable RCVS are applicable for patients with thunderclap headaches at the acute stage, with the exception of criterion C3. Criteria C1 and C2 are less reliable when applied at the first visit. Repeated evaluation is necessary to enhance diagnostic sensitivity.

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International Classification of Headache Disorders - ICHD-4. Will medication-overuse headache survive?

Headache Medicine ◽

10.48208/headachemed.2021.16 ◽

2021 ◽

pp. 72-74

Author(s):

Mario Fernando Prieto Peres ◽

Thaiza Agostini Córdoba de Lima ◽

Marcelo Moraes Valença

Keyword(s):

Clinical Practice ◽

Diagnostic Criteria ◽

Critical Analysis ◽

Medication Overuse ◽

Medication Overuse Headache ◽

International Classification ◽

Headache Disorders ◽

Critical View

The article is a critical analysis of the diagnostic criteria for medication-overuse headache. This is an important discussion to improve the criteria in the next update, as well as providing a critical view for neurologists when applying the criteria to their clinical practice.

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