[Low-pressure] variant of idiopathic intracranial hypertension: a unique subtype of chronic daily headache

Headache, papilledema and elevated CSF pressure above 200 mm H2O [250 mm H2O in obese patients] in a patient with normal neurological examination and neuro-imaging meet the international headache society [IHS] diagnostic criteria for idiopathic intracranial hypertension [IIH]. However variants of the classic syndrome have been reported i.e apapilledimic [without papilledema] and pure ophthalmic [without headache]. The aim of this study was to investigate a series of patients with refractory chronic daily headache [CDH] without papilledema, and with borderline CSF pressure [160-200 mm H2O in non-obese patients; 160-250 mm H2O in obese patients] to highlight their clinical, and neuroimaging findings. Twenty five cases with refractory chronic daily headache [CDH] who presented at the neurosurgery and neurology outpatient clinics were included in the study. All patients were evaluated clinically and radiologically and CSF manometry was recorded. All patients had unclassified chronic daily headache, visual field defects, a partial empty sella on imaging studies and borderline CSF pressure [160-200 mm H20 in non-obese patients; 160-250 mm H2O in obese patients]-. The majority of patients showed headache improvement after treatment with medications that lower intracranial pressure in combination with their conventional headache therapy regimens. The constellation of chronic daily headache, field defects, a partial empty sella and borderline CSF pressure in a patient with normal neurologic examination may constitute a [low-pressure] variant of idiopathic intracranial hypertension

Immunohistochemical Detection of HCV in nerves and muscles of patients with HCV associated Peripheral Neuropathy and Myositis

Background: Chronic hepatitis C Virus [HCV] infection may be associated with numerous extrahepatic manifestations, such as mixed cryoglobulinaemia, membranoproliferative glomerulonephritis, sicca syndrome. Cryoglobulinaemia [CG] is a condition characterized by the presence of serum proteins that reversibly precipitate in the cold. The objective of the present work was to study the histopathological changes in neuromuscular biopsies in patients with HCV associated peripheral neuropathy, or myopathy; with and without cryoglobulinemia, and to assess the presence of HCV in nerve and muscle tissues of those patients which might clarify some pathogenetic mechanisms for neuropathy, and myopathy associated with HCV

Methods: The study was conducted on 17 cases of HCV infected patients with peripheral neuropathy and myositis. All patients were subjected to thorough laboratory investigations, neurological examination, electrophysiologic studies including nerve conduction, and needle EMG studies

Results: Histopathological examination of nerve biopsies showed features of vascultis in 2/10 cases, interstitial inflammatory infiltrates in 5/10. Muscle biopsies showed intense inflammatory reaction, degenerative changes in the muscles of 3/10 cases diagnosed as myositis. Immunohistochemical results, showed in nerve biopsies, 7/10 cases with positive reaction for HCV with nuclear and perinuclear staining.. Two patients showed positive reaction in the epineural, and endoneural blood vessels and a negative reaction in nerve bundles, while in five patients, reaction was only positive in the nerve bundles. In muscle biopsies, 7/10 cases showed positive reaction for HCV in the nuclei of the muscle fibers, including the cases presented with myositis

Conclusion: The presence of HCV particles in nerve and muscle biopsies of patients with peripheral neuropathy suggests a virus triggered immune mediated mechanism

Immunohistochemical detection of HCV in nerves and muscles of patients with HCV associated peripheral neuropathy and myositis

Chronic hepatitis C Virus [HCV] infection may be associated with numerous extrahepatic manifestations, such as mixed cryoglobulinaemia, membranoproliferative glomerulonephritis, sicca syndrome, Cryoglobulinaemia [CG] is a condition characterized by the presence of serum proteins that reversibiy precipitate in the cold. The objective of the present work was to study the histopathological changes in neuromuscular biopsies in patients with HCV associated peripheral neuropathy, or myopathy; with and without cryoglobulinemia, and to assess the presence of HCV in nerve and muscle tissues of those patients which might clarify some pathogenetic mechanisms for neuropathy, and myopathy associated with HCV. The study was conducted on 17 cases of HCV infected patients with peripheral neuropathy and myositis. All patients were subjected to thorough laboratory investigations, neurological examination, electrophysiologic studies including nerve conduction, and needle EMG studies. Histopathological examination of nerve biopsies showed features of vascultis in 2/10 cases, interstitial inflammatory infiltrates in 5/10. Muscle biopsies showed intense inflammatory reaction, degenerative changes in the muscles of 3/10 cases diagnosed as myositis. Immunohistochemical results, showed in nerve biopsies, 7/10 cases with positive reaction for HCV with nuclear and perinuclear staining. Two patients showed positive reaction in the epineural, and endoneural blood vessels and a negative reaction in nerve bundles, while in five patients, reaction was only positive in the nerve bundles. In muscle biopsies, 7/10 cases showed positive reaction for HCV in the nuclei of the muscle fibers, including the cases presented with myositis. The presence of HCV particles in nerve and muscle biopsies of patients with peripheral neuropathy suggests a virus triggered immune mediated mechanism

Chronicity in migraine

Rarely migraine may turn from episodic attacks to continuous form of headache with intermittent attacks. The present study investigated most of the clinical variables, which might play a role in such transformation. Three clinical variables appeared to be associated with chronic outcome: Duration of illness more than 10 years, heavy smoking, and hypertension. All of them were statistically significant from control cases