Migraine aura or transient ischemic attacks? A five-year follow-up case-control study of women with transient central nervous system disorders in pregnancy.

BACKGROUND: Migraine aura may be difficult to differentiate from transient ischemic attacks and other transient neurological disorders in pregnant women. The aims of the present study were to investigate and diagnose all pregnant women with transient neurological disorders of suspected central nervous system origin, and to compare this group with a control group of pregnant women with regard to vascular risk factors and prognosis. METHODS: During a 28 month period, 41 patients were detected with transient neurological symptoms during pregnancy. These were studied in detail with thorough clinical and laboratory investigations in order to make a certain diagnosis and to evaluate whether the episodes might be of a vascular nature. For comparison, the same investigations were performed in 41 pregnant controls. To assess the prognosis, both patients and controls were followed with questionnaires every year for five years. RESULTS: Migraine with aura was the most common cause of symptoms during pregnancy, occurring in 34 patients, while 2 were diagnosed with stroke, 2 with carpal tunnel syndrome, 1 with partial epilepsy, 1 with multiple sclerosis and 1 with presyncope. Patients had more headache before pregnancy than controls, but the average levels of vascular risk factors were similar. None of the patients or the controls reported cerebrovascular episodes during the five-year follow-up. CONCLUSION: The diagnosis of migraine aura was difficult because for many patients it was their first ever attack and headache tended to be absent or of non-migraineous type. The aura features were more complex, with several aura symptoms and a higher prevalence of sensory and dysphasic aura than usual. Gradually developing aura symptoms, or different aura symptoms occurring in succession as described in the International Classification of Headache Disorders, seem to be useful for differentiating aura from other transient disorders. A meticulous history and clinical neurological examination are more useful than routine supplementary investigations for cerebrovascular disease. The five-year follow-up clearly indicates that migraine with aura in pregnancy usually has a good prognosis with regard to cerebrovascular events.

[Cerebral venous thrombosis--diagnosis and treatment]. / Cerebral venetrombose--diagnostikk og behandling.

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare cause of stroke, and an important differential diagnosis for a number of neurological complaints. This review article concerns the aetiology, pathology, diagnostic work-up and treatment of the condition. MATERIAL AND METHODS: This article is based on a review of relevant literature and on the authors' personal experience. RESULTS AND INTERPRETATION: CVT is thought to be responsible for about 0.5-1.0% of all strokes. Headache is the initial symptom in 70-90% of the cases. Apart from this, symptoms vary considerably. CVT was previously assumed to be a rare condition with a high mortality, as the diagnosis could in effect only be made post mortem. Conditions with a benign course can now be diagnosed with modern neuroradiological examinations. All patients should be assessed carefully; particular attention should be given to possible congenital or acquired forms of thrombophilia. Scepsis about the use of anticoagulants in CVT has long prevailed, especially in connection with haemorrhagic infarcts. During the last 10-15 years, several studies indicate that anticoagulation with heparin, or low-molecular heparin, should be the initial treatment of choice. Catheter-based endovascular thrombolytic treatment should be considered in serious cases where anticoagulant treatment is unsuccessful. Mortality is about 10%.

[Surgical treatment of carotid stenosis in Norway]. / Kirurgisk behandling ved carotisstenose i Norge.

BACKGROUND: Our purpose was to explore indications, preoperative investigation and operative technique for carotid endarterectomy in Norway. MATERIAL AND METHODS: A questionnaire was sent to 22 departments performing vascular surgery. Questions included an evaluation of the volume of carotid surgery, indications, preoperative examination, surgical technique and postoperative follow up. We requested the number of carotid endarterectomies performed in 2002, and whether the hospital also performed endovascular treatment for carotid artery stenosis. RESULTS: Carotid endarterectomy was performed in 19 hospitals, with an average of 16 operations per department. Among the surgeons, 18 stated that the number of carotid endarterectomies in Norway was too low. Endovascular treatment was performed in three hospitals. There was agreement on the indications for carotid endarterectomy for symptomatic stenosis, while the practice for asymptomatic stenosis varied widely. Patients who had undergone a minor stroke, were offered surgery after more than 4 weeks in 10 cases. In 11 departments a neurologist always examined the patient preoperatively. Duplex ultrasound examination of the carotid arteries was usually done by a neurologist; only 6 departments did preoperative conventional angiography in all cases. More than half of the surgeons always used a shunt during the operation, while only a few used intraoperative monitoring. Nine out of 20 surgeons closed the arteriotomy with a patch. INTERPRETATION: Consensus regarding the indications for carotid endarterectomy should be sought and more patients probably be offered surgery soon after the occurrence of symptoms.