Headache during airplane travel ("airplane headache"): first case in Greece.

Headache related to airplane flights is rare. We describe a 37-year-old female patient with multiple intense, jabbing headache episodes over the last 3 years that occur exclusively during airplane flights. The pain manifests during take-off and landing, and is located always in the left retro-orbital and frontotemporal area. It is occasionally accompanied by dizziness, but no additional symptoms occur. Pain intensity diminishes and disappears after 15-20 min. Apart from occasional dizziness, no other symptoms occur. The patient has a history of tension-type headache and polycystic ovaries. Blood tests and imaging revealed no abnormalities. Here, we present the first case in Greece. We review the current literature on this rare syndrome and discuss on possible pathophysiology and the investigation of possible co-factors such as anxiety and depression.

Sacral meningocele in a military pilot, presenting during flight.

This study describes an unusual case of a military pilot with sacral meningocele that contained cerebrospinal fluid and presented as episodes of gluteal neuralgia during flight. The patient, a 38-yr-old male pilot, had complained of a dull and mild low lumbar pain over the previous 10 mo. These pains were exacerbated and radiated to the left gluteal region during flight. The patient's history, clinical examination, imaging findings, and treatment are reported. CT and MRI imaging revealed an unusual case of sacral meningocele (2.2 cm x 3.6 cm X 5.8 cm). These lesions can progress steadily in size, leading to worsening symptoms and potentially requiring surgical management. However, surgery is not indicated for stable and asymptomatic lesions not associated with tumors. In our case, tactical monitoring was suggested, since no other symptoms appeared. There are currently no other reported cases involving pilots, so an individual approach to treatment should be taken in accordance with their military health service, the potential, risk factors, and depending on the level of acceleration experienced. We discuss the pathogenesis, the clinical and radiological findings of this rare condition, and note that a spinal cyst is of special interest when occurring in pilots since they are exposed to intense accelerations and spinal strain.

Unusual cases of multiple symmetrical lipomatosis with neurological disorders.

Multiple symmetrical lipomatosis (MSL) is a rare disorder of unknown etiology defined as the presence of multiple and symmetrical fatty accumulations, usually involving the upper trunk, neck and head. Frequently associated findings include diabetes mellitus, hyperlipidemia, liver disease, hypothyroidism and polyneuropathy of unknown origin, but nevertheless, there are published reports of cognitive disorders in patients with MSL. We describe two unusual cases (38-year-old and 45-year-old Greek men) of MSL who presented with polyneuropathy and memory disorders. This is the first description of memory disorders in patients with MSL. We propose that Mini-Mental State Examination and assessment of cognitive functions should be performed for all patients with MSL. The underlying mechanism in our patients remains unknown, and this question should be the subject of a future study.

Headache as a first manifestation of Vogt-Koyanagi-Harada disease.

OBJECTIVES: To describe headache as an initial presentation of Vogt-Koyanagi-Harada (VKH) disease. CLINICAL PRESENTATION AND INTERVENTION: A 56-year-old man initially presented with a 6-month duration of a continuous, diffuse headache of mild to moderate and sometimes of severe intensity. A CT of the brain was normal. Neurological examination was normal, including absence of symptoms and signs of meningismus. During the last 2 months, an intermittent eye pain, redness, and gradual loss of vision in both eyes was detected and subsequently he had tinnitus, malaise, nausea and mild meningismus. He was diagnosed as having VKH disease. Ophthalmologic examination revealed high intraocular pressure, requiring trabeculectomy with surgical iridectomy. The patient is now being treated with systemic steroids. CONCLUSION: VKH disease may initially present as sustained headache, without specific ophthalmologic symptoms and it should be considered in the differential diagnosis in patients with atypical but relentless headache.