Headache as the sole clinical manifestation of acute myocardial infarction: one case with cardiac cephalalgia and literature review.

OBJECTIVE: Cardiac cephalalgia, once seen as a rare symptom of coronary artery disease, is now more recognized. It often comes with chest discomfort and autonomic dysfunction, worsened by physical activity. However, not all cases have chest symptoms or are activity induced. This report presents a case of cardiac cephalalgia and reviews 46 previous cases. METHOD: We discuss a unique case where a patient had headache attacks without chest symptoms, autonomic dysfunction, or triggers. We reviewed English case reports of cardiac cephalalgia from 1982 to 2022 using PubMed (http://www.ncbi.nlm.nih.gov/pubmed). RESULTS: A 69-year-old man presented with a sudden headache without triggers or typical symptoms. Coronary computed tomography angiography (CTA) showed diffuse stenosis in the left anterior descending and the first diagonal branch arteries. His headache improved after percutaneous coronary intervention. Cardiac cephalalgia is usually marked by severe headaches, autonomic signs, and often affects the occipital region. Electrocardiogram (ECG) might not always show abnormalities, and chest pain is not always present. In such cases, elevated cardiac enzymes can be crucial for diagnosis. CONCLUSION: When a headache is the sole symptom of an acute coronary event, consider moderate to severe intensity, older age at onset, occipital localization, and autonomic signs. ECG, cardiac enzymes, and coronary CTA are valuable for accurate diagnosis and treatment.

Decreased AQP4 Expression Aggravates ɑ-Synuclein Pathology in Parkinson's Disease Mice, Possibly via Impaired Glymphatic Clearance.

The pathological hallmarks of Parkinson's disease (PD), a neurodegenerative disorder, are the selective loss of dopamine neurons in the substantia nigra pars compacta (SNpc) and the presence of α-synuclein (α-syn) aggregates in the form of Lewy bodies/Lewy neurites (LBs/LNs) in neurons. Recent studies have indicated that aquaporin 4 (AQP4), as a predominant water channel protein in the brain, is involved in the progression of Parkinson's disease (PD). However, it remains unclear whether AQP4 expression affects α-syn pathology in Parkinson's disease. In this study, we established a progressive PD model by subjecting AQP4 null (AQP4+/-) mice to bilateral intrastriatal injection of α-syn preformed fibrils (PFFs) and investigated the effect of decreased AQP4 expression on the development of PD. We found that decreased expression of AQP4 accelerated pathologic deposition of α-syn and facilitated the loss of dopamine neurons and behavioral disorders. Draining of macromolecules from the brain via the glymphatic pathway was slowed due to decreased AQP4 expression. Taken together, these findings indicate that decreased AQP4 expression may aggravate PD-like pathology, possibly via impairment of the glymphatic pathway.

Endovascular stent-graft treatment of thoracic aortic dissection.

Endovascular stent-graft implantation technique is a newly developed, effective and less invasive method in treating thoracic aortic dissection (TAD). Our study was designed to further verify the feasibility, the efficacy, and safety of this technique. We present a 4-year follow-up report of endovascular stent-graft treatment over 36 cases of acute TAD patients and 40 cases of chronic TAD patients. The mortality and comorbidity rates were evaluated thoroughly. In our study, the deployment of the stent-grafts was successfully performed in 75 cases. The hospital cumulative 30-day mortality rate was 1.3%. The instant endoleak rate was 15.8% (12 patients). All endoleaks were successfully treated with a second stent. All patients in local anesthesia were transported to the general ward after the intervention and were discharged from hospital within 1 week. Our preliminary results showed endovascular stent-graft implantation technique offered good peri-operative morbidity and mortality rates. Stent-graft placement over TAD produced a low incidence of spinal cord ischemia, cardiac and pulmonary complications, less hospital stay, less blood transfusion and became the first choice of TAD patients in our department.