The impact of exposure to tobacco smoking and maternal trauma in fetal life on risk of migraine.

Introduction: Prenatal period is the key time in human development. Many prenatal factors are well-known and increase the risk of developing diseases' after birth. Few studies indicated the link between the prenatal period and the prevalence of migraine in childhood and adolescence so far. We decided to broaden current knowledge and investigate whether the prenatal factors influence the prevalence of migraine in adulthood. The objective of this study is to provide evidence of relationship between in utero environment and risk of migraine. Methods: In total 266 females (136 in the migraine group, 130 in the control group) and 80 males (35 in the migraine group, 45 in the control group), aged 18-65 participated in the study. The quality of prenatal environment was characterized on the basis of mother's and father's education, tobacco smoke exposure, alcohol consumption, and traumatic event during pregnancy, which are considered as prenatal factors and affect on fetal development. Results: Migraine occurrence in adulthood was significantly associated with maternal tobacco smoking during pregnancy (OR 3.42, 95% CI 1.54-7.61, p = 0.036) and traumatic event during pregnancy (OR 2.27, 95% CI 1.24-4.13, p = 0.020). Discussion: Our study suggests that the fetal programming effect of tobacco smoking exposure and maternal trauma is not limited to prenatal life and is suggested as having a role in adulthood. Our findings support evidence that migraine adulthood can be partly influenced by early life conditions.

Clinical Characteristics of Patients with Vertebral Artery Hypoplasia.

Vertebral artery hypoplasia (VAH) belongs to the relatively frequent Doppler ultrasonography (US) findings. However, its clinical significance remains controversial. This was a retrospective study analyzing clinical data of patients undergoing US because of cerebrovascular disease in a single academic neurology center. In the dataset of 2500 US examinations, 80 individuals with VAH (VA diameter < 2.0 mm) were identified (3.2% of all patients). Patients with significant vertebral artery asymmetry (SVAA, difference in VA diameters > 1.0 mm) (n = 80) and patients with normal VA diameter (n = 80) were also recruited. Clinical parameters including clinical signs and symptoms, concomitant diseases, imaging findings and the hospitalization outcome were compared between groups. The frequency of vertigo was highest in VAH group. Ischemic lesions of the cerebellum were found in 10% of VAH patients, 16% of SVAA patients and 5% of control subjects. Neurological deficits improved in over 60% of patients in each group, whereas ca. 30% of patients remained in a stable neurological status. The percentage of patients who deteriorated did not exceed 5% in any of the groups. The results of our study support a relatively high frequency of VAH. Our observations suggest coexistence of VAH with a higher frequency of neurological presentations associated with posterior arterial circulation of the central nervous system.

Risk of Migraine in Europeans with Low Melanin Levels-A Population Based Case-Control Study.

Populations with a relatively low concentration of melanin, e.g., inhabitants of Europe, North America, and Australia, are the most vulnerable to the harmful effects of UV radiation. Individuals with fair phototype are at greatest risk of developing skin cancer. Several neurological studies present that light skin may modify the risk of Alzheimer's and Parkinson's diseases. However, the relationship between migraine and skin pigmentation has not been investigated yet. The objective of this study is to provide evidence of the relationship between skin pigmentation and migraine prevalence in adults. We examined a group of 148 adults (33 men, 115 women) with migraine and a control group of 107 adults (43 men, 64 women). Parameters of skin pigmentation (melanin index, erythema index, CIElab, and RGB scales) were measured using a DSM II Cortex Technology dermospectrophotometer. Risk of migraine in lightly pigmented adults was elevated. Individuals with a low melanin index had over 3-fold increased risk of migraine (women: OR 3.53, men: OR 3.73). Fair phototype, which results from lightly pigmented skin, was associated with migraine prevalence. Migraineurs should take extra care to protect their skin from the negative effects of solar radiation.

A Loop That Matters-An Unusual Case of Bow Hunter's Syndrome.

Bow Hunter's syndrome (BHS), also known as rotational vertebral artery occlusion (VAO), is a rare entity in which vertebral artery is reversibly compressed due to rotation or extension of the head, causing vertebrobasilar insufficiency. Because of VAO, BHS should be considered as a possible life-threatening condition. Diverse aetiologies of BHS may trigger a broad spectrum of non-specific symptoms and may result in frequent misdiagnosis of this disorder in daily clinical practice. Herein, we present a case of BHS caused by previously non-described vascular aetiology.

First case of ischemic stroke which happened during continuous intravenous infusion of rt-PA.

Catheter-directed thrombolysis (CDT) is one of the methods in the treatment of patients with acute lower limb ischemia. It is based on intrathrombus infusion of one of the thrombolytic agents. The most common complication of CDT is bleeding. We present a patient with left lower limb ischemia, treated by CDT, in which symptoms of stroke, proved to have ischemic etiology, started during continuous intra-arterial infusion of rt-PA. As the patient presented with the history of atrial fibrillation, the most probable mechanism of stroke was related to detachment of possible intra-atrial thrombus. Ischemic stroke which happened during intra-arterial thrombolysis with rt-PA has never been mentioned in literature yet and the case stands for the statement that very effective causative treatment of ischemic stroke with rt-PA is not sufficient to "prevent" ischemic stroke if used in very small doses.

Brain metastases of mouse mammary adenocarcinoma is increased by acute stress.

Brain metastases from mammary adenocarcinoma constitute the chief cause of morbidity and mortality. Some evidence suggests that stress may contribute to disease progression and metastases. Here we show that acute restraint stress (30 min) induces statistically significant increase in brain metastases of systemically administered luciferase-tagged 4T1-BR-3P mouse mammary adenocarcinoma cells as evidenced by the total brain-associated photons from 5.6 × 10(7) photons in unstressed controls to 1.7 × 10(8) photons in C57BL/6 (p = 0.0018) and from 7.6 × 10(7) to 2.1 × 10(7) photons in BALB/c (p = 0.004) mice. Acute stress may increase metastases by disrupting the blood-brain-barrier (BBB), through release of corticotropin-releasing-hormone (CRH) activating perivascular brain mast cells.

Impact of stress and mast cells on brain metastases.

Metastases continue to be the chief cause of morbidity and mortality for many tumors, including brain metastases of lung and mammary adenocarcinoma. Stress appears to increase metastases, but the mechanism is not understood. Recent evidence suggests that local inflammation is conducive for cancer growth and a unique immune cell, the mast cell, accumulates in the stroma surrounding tumors and is critically located at the blood-brain-barrier (BBB). Mast cells express receptors for and can be stimulated by corticotropin-releasing hormone (CRH), secreted under stress, to release mediators such as histamine, IL-8, tryptase and vascular endothelial growth factor (VEGF), which disrupt the BBB permitting metastases. Stress and mast cells could serve as new targets for drug development to prevent brain metastases, especially since CRH receptor antagonists and brain mast cell inhibitors have recently been developed.

[Triptans in migraine--here and now (15 years after they were implemented in therapy)]. / Tryptany w migrenie--tu i teraz (15 lat od wprowadzenia do terapii).

Migraine is one of the most common primary/idiopathic headaches as well as one of the most frequent complaints in the society. For the last 15 years there has been a significant change in the acute treatment of migraine attacks. It was a result of an extensive research on serotonin receptors, primarily their 5-HT(1B) and 5-HT(1D) subtypes, and on the pathological mechanisms underlying migraine headache. New drugs acting selectively, triptans, are not only more effective than traditional medicaments, common pain-killers (NSAID) and ergotamine, but are also much safer than non-selective and high affinity pharmaceuticals and ergotamine, which binds for a long time the 5-HT receptors, predominantly in the coronary arteries. The review shows main differences between particular triptans and discusses the principles of therapy, including contraindications.