Background: Migraine, tension type headache (TTH), and hypothyroidism are clinical problems that affect patient daily activities and quality of life. Objectives: The purpose of this study was to investigate the potential association between hypothyroidism in patients with migraine and TTH. Patients and methods: Two hundred and twelve patients with migraine and TTH and one hundred control subjects underwent clinical evaluation, assessment of thyroid hormones, and thyroid ultrasound. Results: Subclinical and overt hypothyroidism were significantly higher in patients with migraine and TTH (P = 0.001) than control subjects. Patients with migraine and TTH showed significantly more abnormal thyroid gland morphology than healthy control (P = 0.027). Hypothyroidism is significantly expressed in chronic TTH more than TTH with infrequent or frequent TTH (P = 0.009). Conclusions: Patients having migraine and TTH more prone to develop hypothyroidism when compared with control group. Also patients with chronic TTH are susceptible to develop hypothyroidism (either subclinical or overt) when compared with patients having frequent or infrequent TTH.
Introduction Traditionally, non-invasive and invasive techniques were used for the treatment of cervicogenic headache (CH). Greater occipital nerve block is the most frequent peripheral nerve block invasive technique used for the management of cervicogenic headache. The purpose of this prospective, double-blinded study was to compare the efficacy of two different techniques: multifidus cervicis plane block and greater occipital nerve block in the treatment of refractory cervicogenic headache by using ultrasound. Methods Sixty patients with cervicogenic headache were recruited and diagnosed according to the ICHD-III beta version. The patients were divided into two groups, one group was for greater occipital nerve block and the other group was for multifidus cervicis plane block with ultrasound-guided. Results Visual analog scale (VAS) was 2.09% in the multifidus cervicis plane block (MCPB) group and was 2.22% in the greater occipital nerve block (GONB) group with a median reduction of − 4.33 and − 3.048, respectively, at 2-week visits with a statistically significant difference better in the MCPB group (P < 0.001). At 4 weeks visits, VAS scale was better in the MCPB group than in the GONB group (3.79 and 4.44, respectively) with a median reduction in VAS scale (− 3.27 and − 3.095, respectively) and statistically significant differences between both groups (P = 0.020). Conclusion Both the ultrasound-guided multifidus cervicis plane block and greater occipital nerve block are effective as intervention techniques in the treatment of refractory cervicogenic headache. These techniques are simple, safe, more reliable with less side effects, and often reduce the requirements of analgesic drugs.
Background: The annual incidence of Bell's palsy (BP) is 15 to 20 per 100,000 with 40,000 new cases each year, and the lifetime risk is 1 in 60. For decades, clinicians have searched the prognostic tests of sufficient accuracy for acute facial paralysis. Objective: The present study was designed to verify in BP which clinical or electrophysiological parameters could be considered as predictive of the degree of recovery of normal facial muscle function. Methods: Sixty-three patients with BP were initially assessed according to the House and Brackmann facial function scoring system "HB system". All patients were followed for 3 months, the functional recovery then reassessed according to HB system. Nerve conduction studies were measured on the affected side via a bipolar surface stimulator placed over the stylomastoid foramen. Results: We could not find statistically significant differences between BP with good and poor prognosis as regard age, sex, onset, diabetes, hypertension, dyslipidemia, or the initial HB Score. Compound motor action potential amplitude (CMAP) detected during the initial electroneurography (ENoG) was statistically significant between BP with good and poor prognosis. Conclusions: The initial ENoG is more predictive of recovery of Bell's palsy than the initial clinical grading using the HB system. Age, sex, hypertension, diabetes, and dyslipidemia do not seem to correlate with the degree of recovery in Bell's palsy.
Objectives We aimed to predict cerebral vasospasm in acute aneurysmal subarachnoid hemorrhage and to determine the cut-off values of the mean flow velocity by the use of transcranial Doppler. Methods A total of 40 patients with acute aneurysmal subarachnoid hemorrhage were included in this study and classified into two groups. The first group was 26 patients (65%) with cerebral vasospasm and the second group was 14 patients (35%) without vasospasm. Initial evaluation using the Glasgow Coma Scale and the severity of aneurysmal subarachnoid hemorrhage was detected by using both the clinical Hunt and Hess and radiological Fisher grading scales. All patients underwent transcranial Doppler evaluations five times in 10 days measuring the mean flow velocities (MFV) of cerebral arteries. Results Patients with cerebral vasospasm were associated with significantly higher mean Glasgow Coma Scale score ( p = 0.03), significantly higher mean Hunt and Hess scale grades ( p = 0.04), with significantly higher mean diabetes mellitus ( p = 0.03), significantly higher mean systolic blood pressure and diastolic blood pressure ( p = 0.02 and p = 0.005 respectively) and significantly higher MFVs measured within the first 10 days. Logistic regression analysis demonstrated that MFV ≥81 cm/s in the middle cerebral artery is accompanied by an almost five-fold increased risk of vasospasm (OR 4.92, p < 0.01), while MFV ≥63 cm/s in the anterior cerebral artery is accompanied by a three-fold increased risk of vasospasm (OR 3.12, p < 0.01), and MFV ≥42 cm/s in the posterior cerebral artery is accompanied by a two-fold increased risk of vasospasm (OR 2.11, p < 0.05). Conclusion Transcranial Doppler is a useful tool for early detection, monitoring, and prediction of post subarachnoid vasospasm and valuable for early therapeutic intervention before irreversible ischemic neurological deficits take place.
Background: Montreal Cognitive Assessment test (MoCA) is a brief, sensitive test that has been recommended as a reliable tool to detect mild cognitive impairment. Associations between brain imaging measures and cognitive functioning have been observed in patients with multiple sclerosis (MS). Objectives: To evaluate cognitive dysfunction and physical disability in MS patients by making correlation between magnetic resonance imaging (MRI), MoCA test, and Expanded Disability Status Scale (EDSS). Methods: Fifty MS patients and 25 controls underwent clinical evaluation and assessment of cognitive functions using the MoCA test. In addition, all MS patients underwent conventional MRI brain and Expanded Disability Status Scale (EDSS). Results: The scores for trail making test, memory, attention, serial seven subtractions, fluency, naming, and orientation in MS patients were significantly different from control (p < 0.05). There was significant inverse correlation between number of MS plaques in the temporal lobe and abstraction (p < 0.001, r = − 0.52). Less inverse correlation was found between total number of MRI plaques and concentration, total number of MRI plaques and abstraction, and infratentorial lesions and clock drawing test. No correlations were found between the number of MS plaques in frontal, parietal, occipital, corpus callosum, and neuropsychological tests. Conclusion: Although conventional MRI techniques are crucial in the MS diagnostic workup, their accuracy in evaluating and predicting cognitive dysfunction is less relevant. The MoCA test would provide a brief screen for cognitive dysfunction in MS.
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