Hemodialysis‐related headache (HRH) is a well‐known clinical event. It is considered as one of the most commonly reported neurological symptoms among hemodialysis patients. Its epidemiological, physiological, clinical, and therapeutic data remain scarce and are poorly studied. Our aim was to determine the frequency of HRH in the region of Casablanca, Morocco, to describe its clinical characteristics and to explore the hypothesis that renal replacement techniques, such as conventional versus online hemodiafiltration may have an association on clinical adverse effects like HRH. A descriptive, cross‐sectional, and multicentric study was carried out among 100 chronic hemodialysis patients for at least 6 months. HRH was defined according to criteria published by the International Classification of Headache Disorder third edition beta version (ICHD3β) [1]. Two different HD‐modalities (standard HD and OL‐HDF) have been investigated in order to explore their impact on HRH. Headache was reported by 60% of the patients including 41.6% of hemodialysis‐related headache. HRH had on average a duration of 7.4 hours, pulsatile among 38% of interviewed patients and of moderate intensity in 48% of cases. In total, 51.3% of patients undergoing conventional hemodialysis modality reported HRH compared to 12.5% undergoing online hemodiafiltration technique (OL‐HDF) (P = .008). Hemodialysis‐related headache remains a poorly studied clinical event despite its high prevalence. Its diagnosis, management, and especially its prevention remain a challenge for the neurologist and the nephrologist. Our results suggest that OL‐HDF is a promising therapeutic and preventive tool to reduce the incidence of HRH.
Coronavirus disease 2019 (COVID-19) has been described as being primarily responsible for respiratory symptoms. Although several case reports have shown the importance of neurological manifestations, only a few have reported non-convulsive status epilepticus (NCSE) as the first manifestation of COVID-19 infection. Here, we report the case of a 30-year-old male patient with no past medical history who was admitted with altered consciousness. On examination, the patient had a Glasgow Coma Scale (GCS) of 13/15. Vital signs were within normal range. Computed tomography scan of the and magnetic resonance imaging of the brain were normal. Biochemical assessments showed a mild hyponatremia (134 mEq/L) and high levels of D-dimer and lactate dehydrogenase. Urine drug screening did not find any abnormality and a lumbar puncture showed an increased cerebrospinal fluid protein. The result of the reverse transcription polymerase chain reaction test in the nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electroencephalogram (EEG) showed a generalized epileptiform activity. Upon undergoing antiepileptic treatment, patient's GCS improved to 15 gradually. A repeated EEG confirmed complete resolution of epileptic abnormalities four days later. This case report shows that SARS-CoV-2 infection can directly involve the central nervous system and can be manifested with isolated NCSE without any other neurological manifestations.
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