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By means of magnetic resonance imaging we investigated a total of 45 patients suffering from classic migraine; 25 patients had been treated in our department for classic migraine over the past 2 years (group A), and 20 other patients investigated between 1976 and 1984 were reexamined for this study (group B). Thirty-two age-and roughly sex-matched healthy volunteers underwent magnetic resonance imaging and served as controls (group C). There was a trend for patients with classic migraine to have more subcortical patchy lesions on T2 -weighted magnetic resonance imaging. In a comparison of our control subjects and patients with a history of >20 attacks of classic migraine taken from groups A and B, this difference in number of lesions was significant (/7=O.O2). The results suggest that patchy lesions in patients with classic migraine should be interpreted with particular caution before diagnosing a demyelinating disease since the lesions could be ischemic in origin. (Stroke 1991^2:1010-1014) D espite major efforts, the cause of migraine is still unknown. However, some important mechanisms involved in the pathophysiology of classic migraine have been elucidated. Investigations of cerebral blood flow (CBF) have demonstrated a "spreading oligemia" beginning at the occipital lobe and moving slowly anteriorly.

Background: The ability to repair tissue via percutaneous means may allow interventional pain physicians to manage a wide variety of diseases including peripheral joint injuries and osteoarthritis. This review will highlight the developments in cellular medicine that may soon permit interventional pain management physicians to treat a much wider variety of clinical conditions and highlight an interventional case study using these technologies Objective: To determine if isolated and expanded human autologous mesenchymal stem cells could effectively regenerate cartilage and meniscal tissue when percutaneously injected into knees. Design: Case Study Setting: Private Interventional Pain Management practice. Methods: An IRB approved study with a consenting volunteer in which mesenchymal stem cells were isolated and cultured ex-vivo from bone marrow aspiration of the iliac crest. The mesenchymal stem cells were then percutaneously injected into the subject’s knee with MRI proven degenerative joint disease. Preand post-treatment subjective visual analog pain scores, physical therapy assessments, and MRIs measured clinical and radiographic changes. Results: At 24 weeks post-injection, the patient had statistically significant cartilage and meniscus growth on MRI, as well as increased range of motion and decreased modified VAS pain scores. Conclusion: The described process of autologous mesenchymal stem cell culture and percutaneous injection into a knee with symptomatic and radiographic degenerative joint disease resulted in significant cartilage growth, decreased pain and increased joint mobility in this patient. This has significant future implications for minimally invasive treatment of osteoarthritis and meniscal injury. Key words: autologous mesenchymal stem cells, osteoarthritis, knee, cartilage