prevalence of magnetic resonance imaging hyperintensity in migraine patients and its association with migraine headache characteristics and cardiovascular risk factors

To determine the frequency of hyperintense foci in migraine patients and the relationship with migraine headache characteristics and cardiovascular risk factors. Ninety patients with migraine headache [70 without aura and 20 with aura] were enrolled and interviewed. Information on their headache [severity, frequency, and mean disease duration] and other related data was obtained by completing a clinical checklist. Subsequently, brain magnetic resonance imaging [MRI] was performed and each patient was then evaluated for hyperintense lesions. Of the 90 patients, 29 [32%] had silent hyperintense lesions on their MRI. The mean age of the patients with hyperintense foci was 41 years while those with no lesions was 33 years [p<0.010]. Supratentorial hyperintense lesions represented the majority of lesions in the patients [n=46, 63%]. Moreover, 56.3% of the lesions [n=41] were located within the right hemisphere. Cardiovascular risk factors such as smoking, serum cholesterol, oral contraceptive pills use, and body mass index [BMI] were not significantly different in these two groups [p>0.050]. The lesions were found significantly more frequently in the patients who experienced chronic migraine [p=0.032]. Our study adds weight to the theory that disease duration has a key role in the formation of hyperintense brain lesions. Certain cardiovascular risk factors such as sex, smoking, serum cholesterol, and BMI, do not affect the presence or absence of such lesions, suggesting that the relationship between migraine and these lesions may be directly due to the effects of migraine itself

Isolated vertigo and possibility of brain Ischemia

In cases of isolated vertigo, physicians are unable to definitely distinguish between central and peripheral vertigo by history and physical examination. Some central causes of isolated vertigo such as cerebellar stroke can be life-threatening and require intervention. On the other hand, brain infarction can be detected shortly after the onset of clinical symptoms by using diffusion-weighted MRI [DWI]. We have conducted this study to perform DWI in isolated vertigo patients with a higher probability of brain infarction. We enrolled 55 consecutive patients with isolated vertigo who had at least one cardiovascular risk factor. A questionnaire that consisted of cardiovascular risk factors was completed and DWI performed for each patient. We analyzed the association of cardiovascular risk factors with infarction as identified by DWI. Using DWI, 5 [9.1%] patients had an acute ischemic stroke. Among cardiovascular risk factors, analysis showed a significant relationship between diabetes mellitus [DM] and infarction. Isolated vertigo may occur due to the occlusion of a small artery in the area of brain circulated by the posterior inferior cerebellar artery. According to our results, DWI may be used in diabetic patients with isolated vertigo to locate a probable infarction

[Greater occipital nerve block by bupivacaine/methyl prednisolone vs. bupivacaine/normal saline in medication overuse headache]

Medication overuse headaches [MOH] include headaches that last more than 15 days a month and usually occur after long-term use of analgesic. Most methods of medical treatment are ineffective. In some studies, great occipital nerve block is used to treat the headaches. This double-blind experimental study was performed in adult patients with MOH who attended Sina Hospital in Tehran from June 2009 to June 2011. Greater occipital nerve [GON] block was done in the two groups of patients by administering a combination of 3 ml of 0.5% bupivacaine and 2 ml of 5% saline or 3 ml of 0.5% bupivacaine and 80 mg of methyl prednisolone. We evaluated headache severity by Visual analog scale [VAS] and recorded days without headache. If patients were taking pain medications, preventive medications were given as usual before and after the injection. Student's t-test was performed for statistical analysis and a P<0.05 was considered significant. Overall, 13 male and 19 female patients with a mean age of 39.88 +/- 8.76 years participated in the study. The mean reduction in headache severity one hour after injection was 5.56 +/- 1.03 and 4.63 +/- 1.92 in the first and second groups, respectively. Average days without headache one month after injection were 8.75 and 4.75 days in the first and second groups, respectively. There were no significant differences between the two groups. Both methods seem to be effective in medication overuse headaches treatment. This finding is important as non-responders to conventional methods will otherwise have a decreased quality of life

[Transient ischemic attacks and presence of an acute brain lesion in diffusion-weighted MRI: study of 50 patients]

Finding an acute brain lesion by diffusion-weighted [DW] MRI upon an episode of transient ischemic attack [TIA] is a predictor of imminent stroke in the near future. Therefore, exploring risk factors associated with lesions in DW-MRI of the brain is important in adopting an approach to TIA management. In the current study, we tried to determine the risk factors associated with lesions in DW-MRI of the brain in patients experiencing TIA episodes. Fifty patients with TIA were recruited consecutively in Sina Hospital, Tehran, Iran, over a 6-month period between July 2008 and January 2009. All of the patients underwent a complete neurological examination and laboratory tests. Brain DW-MRIs were performed for all the patients within 72 hours of a TIA episode. DW-MRI revealed an acute lesion in 16% of the participants. There was a significant correlation between presence of an acute lesion in DW-MRI and TIA duration, history of diabetes mellitus and presence of unilateral facial palsy [P=0.0003, P=0.02 and P=0.008, respectively]. Other variables such as age, hypertension, hyperlipidemia, past history of TIA, headache, vertigo, and sensory or visual disturbances had no significant relation with the presence of an acute lesion in DW-MRI. Duration of TIA, presence of diabetes mellitus and unilateral facial palsy are risk factors for an acute lesion in DW-MRI, meaning that patients with such risk factors are at risk for stroke in the near future