IntroductionThe patent foramen ovale (PFO) is a residue of foetal circulation and is found to be patent in approximately 20%− 30% of the adult population. In these subjects there is an interatrial right-to-left (R-L) shunting when right atrial pressure exceeds the pressure present in the left atrium. The association between PFO and stroke and other neurological diseases has been well documented by both perspective and historical studies [1,2].Transoesophageal sonography represents the gold standard for the diagnosis and follow-up of patients suffering from neurological diseases possibly due to J Headache Pain (2005) 6:71-76 DOI 10.1007 High prevalence of patent foramen ovale in migraine with aura Abstract In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour-coded sonography (c-TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c-TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c-TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.
A 65-year-old man with Tangier disease (analphalipoproteinemia) had had a progressive sensorimotor distal neuropathy with sensory ataxia for 1 year. Muscle biopsy demonstrated excess lipid vacuoles on histochemical and electron-microscopic techniques. Sural nerve biopsy showed a marked loss of large fibers and an increase in small myelinated fibers, with presence of remyelinating fibers and clusters of regeneration; a few aspects of active demyelination and some onion-like formations were also present. Lipid accumulation chiefly affected the Schwann cells of unmyelinated fibers and, to a lesser degree, of myelinated fibers, endoneurial fibroblast, and vasa nervorum. Teased fibers showed prevalent aspects of de-/remyelination and, often in association, marked myelin wrinkling suggesting axonal atrophy. This Tangier patient differs from known cases for the presence of a distal symmetrical sensorimotor polyneuropathy (not previously reported in Tangier disease) and because of the morphological findings of de-/remyelination coexisting with aspects of axonal atrophy and previous degeneration, and of lipid accumulation within striated muscle and vasa nervorum. This latter finding contrasts with the assumption that in Tangier disease vessel walls are not a site of lipid storage: probably the vasa nervorum are different, in this respect, from other vessels, because of the intense lipid metabolism of the nervous tissue. Thus we suggest that involvement of vasa nervorum in Tangier disease may be more important than previously suspected, possibly playing a role in the causation of neuropathy.
We report 31 cases of herpes zoster (HZ) with neurological complications: 14 with cranial nerve deficits, 1 with cranial nerve deficit associated with segmental motor disorder, 3 with segmental motor deficits, 2 with meningoencephalitis, 2 with meningoencephalitis associated with cranial neuropathy or myelitis, 2 with meningitis, 2 with hemiplegia contralateral to the ophthalmic HZ. 1 with hemiplegia and motor deficit and finally 1 with hemiplegia and a cranial neuropathy. Smoking was the putative risk factor in 53% of our patients together with diabetes, which has already been mentioned in the literature. We frequently observed more than one complication in succession (19.3%) that could not easily be related to the cutaneous distribution. Acyclovir had no demonstrable positive effects on neurological complication in our patients.
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