Cardiovascular Autonomic Dysfunction in Migraine Attack

BACKGROUND: There has been proposing reports that the autonomic nervous system (ANS) is involved in the pathophysiological mechanism of migraine. However, previous reports suggesting ANS dysfunction during migraine attack was not consistent and were focused mainly on comparison between migraine patients in interictal period and normal controls. The current study is designed to evaluate quantitative evidence of ANS dysfunction by comparing patients in ictal period with those in interictal period. METHODS: We prospectively included 30 migraineurs in ictal period and 30 migraineurs in interictal period from August 2008 to August 2009. Sympathetic function was evaluated by blood pressure response to standing and isometric exercise. Parasympathetic function was evaluated by heart rate response to deep breathing, standing and the Valsalva maneuver. RESULTS: In orthostatic test, falling of systolic blood pressure (SBP) after standing was prominent in ictal group. Although both groups showed elevation of diastolic blood pressure (DBP) after standing, the change was smaller in ictal group than intercital group. Elevation of DBP after isometric exercise was lower in ictal group without statistical significance. Results of parasympathetic function test were not significantly different between ictal and interictal patients. CONCLUSIONS: This study suggests that subjects with migraine had sympathetic hypofunction during migraine attack.

A Case of Spontaneous Intracranial Hypotension with Subdural Hematoma Mimicking Meningitis / 대한뇌혈관외과학회지

Spontaneous intracranial hypotension (SIH) results from spontaneous cerebral spinal fluid leakage, of unknown etiology, at the level of the spine. Physicians' unfamiliarity with SIH and a its varied clinical and radiographic manifestations may contribute to a delayed or erroneous diagnosis. We report an SIH patient whose subdural hematoma (SDH) clinically mimicked meningitis, but who recovered 1 week later, without any neurologic deficit, after an epidural blood patch (EBP) treatment.

Preliminary Study About Effect of Continuous Positive Airway Pressure on Cardiac Autonomic Imbalance in Obstructive Sleep Apnea Syndrome

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with cardiac arrhythmia due to autonomic dysfunction. The aim of this study was to elucidate the effect of OSAS on the QT interval and the efficacy of continuous positive airway pressure (CPAP) treatment on a prolonged QT interval. METHODS: From March 2007 to January 2008, 13 patients diagnosed as OSAS received CPAP treatment. Ten age- and sex-matched healthy controls were enrolled, and nighttime polysomnography was performed. We analyzed the full-night electrocardiogram.which is one of the elements of nighttime polysomnography.in all patients and controls. RESULTS: In the patient group, the QTc interval was 0.380+/-0.45 ms (mean+/-SD) before CPAP treatment and 0.368+/-0.32 ms during CPAP treatment. In the control group, the QTc interval was 0.348+/-0.26 ms. The QTc interval did not differ between OSAS patients and controls (p=0.143), but it did significantly shorten between before and after CPAP treatment (p=0.047). CONCLUSIONS: This study suggests that CPAP treatment can improve QTc prolongation and thereby prevent future ventricular arrhythmia.

Parkinsonism Caused by Phenytoin Intoxication-A Case Report / 대한간질학회지

Parkinsonism is a very rare complication of phenytoin. The authors experienced a 71-year-old man who presented progressive cognitive decline, postural tremor, bradykinesia and gait disturbance. Laboratory test and brain imaging revealed no abnormality that commonly causes parkinsonism. The only abnormal finding was elevation of serum phenytoin above the therapeutic level. The patient showed marked improvement of symptoms by reduction of phenytoin dosage. Here we report a case of phenytoin induced parkinsonism.