Background Headache is the most common COVID-19-related neurological symptom. We aimed to reveal diagnostic clues of headache for COVID-19 infection and to investigate the course of primary headaches during the pandemic. Methods We developed a detailed web-based questionnaire screening the characteristics and course of headaches besides clinical COVID-19 features. The participants were grouped according to being diagnosed with COVID-19 infection or not, and having previous or new-onset headaches. The COVID-19 related headache features and their associations with other clinical features were investigated. A binary logistic regression model was performed to differentiate the characteristics of headache related to COVID-19. Findings A total of 3458 participants (2341 females;67.7%, 1495 healthcare workers;43.2%) with a mean age of 43.21 ± 11.2 years contributed to the survey. Among them, 262 participants had COVID-19 diagnosis and 126 (48.1%) were male. The rate of males in the group without COVID-19 was 31% (991 out of 3196 participants) showing significant gender difference between groups (p < 0.000). COVID-19 related headaches were more closely associated with anosmia/ageusia and gastrointestinal complaints (p < 0.000 and p < 0.000), and showed different characteristics like pulsating, pressing, and even stabbing quality. Logistic regression analyses showed that bilateral headache, duration over 72 h, analgesic resistance and having male gender were significant variables to differentiate COVID-19 positive patients from those without COVID-19 (p = 0.04 for long duration and p < 0.000 for others). A worsening of previous primary headaches due to the pandemic-related problems was not reported in the majority of patients. Interpretation Bilateral, long-lasting headaches, resistance to analgesics and having male gender were more frequent in people with COVID-19 in conjunction with anosmia/ageusia and gastrointestinal complaints. These features may be helpful for diagnosing the headache related to COVID-19 during the pandemic.

BackgroundHeadache is the most common COVID-19-related neurological symptom. But, diagnostic clues of headache for COVID-19 infection are not well known. MethodsWe developed a detailed web-based questionnaire screening the characteristics and course of headaches besides clinical COVID-19 features. The participants were grouped according to being diagnosed with COVID-19 infection or not, and having previous or new-onset headaches. The COVID-19 related headache features and their associations with other clinical features were investigated. A binary logistic regression model was performed to differentiate the characteristics of headache related to COVID-19. Findings 3458 participants (2341 females;67.7%, 1495 healthcare workers;43.2%) with a mean age of 43.21±11.2 years experiencing headache during pandemic contributed to the survey. Among them, 262 participants had COVID-19 and 126(48.1%) were male. The rate of males in the group without COVID-19 was 31% (991 out of 3196 participants) showing significant gender difference between groups (p<0.000). COVID-19 related headaches were more closely associated with anosmia/ageusia and gastrointestinal complaints (RR=3.7 and RR=1.33, respectively), showed different characteristics like pulsating, pressing, and even stabbing quality. Logistic regression analyses showed that bilateral headache, duration over 72 hours, analgesic resistance and having male gender were significant variables to differentiate COVID-19 positive patients from those without COVID-19 (p<0.000 for all variables). A worsening of previous primary headaches due to the pandemic-related problems was not the rule in majority of patients.Interpretation Bilateral, long-lasting headaches, resistance to analgesics and having male gender were more frequent in people with COVID-19 in conjunction with the anosmia/ageusia and gastrointestinal complaints. These features may be helpful for COVID-19 diagnosis in the clinical evaluation of headache patients during the pandemic.Funding: This study was funded by Scientific Research Projects Coordination Unit of Istanbul University with a project number of GAP-36802.

Subacute sclerosing panencephalitis (SSPE) is a well-known childhood disease; however, the adult onset of SSPE cases are also widely recognized where the oldest case reported is 52 years old. We report a 61-year-old woman patient presenting with atypical clinical and EEG features, diagnosed with SSPE. Measles and SSPE have decreased dramatically owing to worldwide immunization programs; however, there are still reasons to consider SSPE in differential diagnosis even in patients presenting with atypical clinical findings and older ages. First, there is a generation who missed the immunization era, constituting a latent disease pool. Second, antivaccination movements have led to a decline in MMR (measles, mumps, rubella) vaccination worldwide, leading to measles outbreaks and potential future SSPE cases. Third, most of the vaccination programs start measles immunization at the age of 12 months, leading to a shift in the incidence below the age of 1 year, when the risk of developing SSPE in adult life is higher. Finally, disruption in vaccination programs, in which fast disease transmission due to close contact living, unhygienic conditions of refugee camps, and limited access to health care in displaced populations have also led to measles outbreaks. In conclusion, we believe that neurologists for adults should consider SSPE in differential diagnosis, even in older patients with atypical presentations.

BackgroundHeadache is the most common COVID-19-related neurological symptom. We aimed to reveal diagnostic clues of headache for COVID-19 infection and to investigate the course of primary headaches during the pandemic. MethodsWe developed a detailed web-based questionnaire screening the characteristics and course of headaches besides clinical COVID-19 features. The participants were grouped according to being diagnosed with COVID-19 infection or not, and having previous or new-onset headaches. The COVID-19 related headache features and their associations with other clinical features were investigated. A binary logistic regression model was performed to differentiate the characteristics of headache related to COVID-19. Findings A total of 3458 participants (2341 females;67.7%, 1495 healthcare workers;43.2%) with a mean age of 43.21±11.2 years contributed to the survey. Among them, 262 participants had COVID-19 diagnosis and 126 (48.1%) were male. The rate of males in the group without COVID-19 was 31% (991 out of 3196 participants) showing significant gender difference between groups (p<0.000). COVID-19 related headaches were more closely associated with anosmia/ageusia and gastrointestinal complaints (p<0.000 and p<0.000), and showed different characteristics like pulsating, pressing, and even stabbing quality. Logistic regression analyses showed that bilateral headache, duration over 72 hours, analgesic resistance and having male gender were significant variables to differentiate COVID-19 positive patients from those without COVID-19 (p=0.04 for long duration and p<0.000 for others). A worsening of previous primary headaches due to the pandemic-related problems was not reported in the majority of patients.Interpretation Bilateral, long-lasting headaches, resistance to analgesics and having male gender were more frequent in people with COVID-19 in conjunction with anosmia/ageusia and gastrointestinal complaints. These features may be helpful for diagnosing the headache related to COVID-19 during the pandemic.

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The effects of ionized radiation on the fetus during pregnancy have become remarkable because imaging modalities are frequently used today. The clinical approach is to use the least amount of radiation, and as much as possible, to use imaging methods that do not contain radiation [e.g., ultrasonography, magnetic resonance imaging (MRI)].Although MRI seems safe especially in the second and third trimesters, it is thought that radiofrequency waves and high acoustic media may negatively affect fetal tissues in the first trimester, and especially in the organogenesis period. The effectiveness of MRI increases with gadolinium. However, it is known that gadolinium is transmitted to fetal blood with maternal serum, excreted to amniotic fluid from the fetal circulation, and then recirculated. The risk for fetal nephrogenic systemic fibrosis is believed to increase secondary to this situation. Therefore, physicians must be aware that contrast agent should not be given and more attention should be paid when MRI is performed in pregnancy.In a retrospective study conducted in Ontario between April 2003 and March 2015 (1), two groups were created with pregnant women aged over 16 years and under 50 years who had completed the 20 th gestational week, using the first child in multipara pregnancies. The mothers and babies were healthy.Pregnant women who were exposed to MRI in the first trimester of gestation (2 to 14 weeks' gestation) were included in the first group, and patients who were exposed to contrastenhanced MRI in any period from the second gestational week to the second prenatal day were included in the study. Potential results for the first group were listed as congenital anomalies without accompanying chromosomal anomalies, neoplasms, loss of vision, and loss of hearing. The relevant conditions were determined as rheumatic, inflammatory, infiltrative diseases (arthritis, vasculitis, bone diseases, dermatitis, connective tissue calcification) and every type of condition related with stillbirth/abortion.A total rate of 19/1,000 stillbirths/abortions was seen in the first group, which was not different from the normal population. The most common conditions occurring in the first trimester included anomalies associated with the circulatory system, digestive system, and musculoskeletal system, and this situation was not correlated with the time of exposure to MRI or the anatomic location from which the MRI was taken. Although neoplasm, congenital anomalies, and loss of hearing were not significant in the first 5-10 th gestational weeks, loss of vision was slightly higher (HR: 2.28, RR: 2.7/1000). A rate of stillbirth/abortion of 7/1,000 was found in the second group with nephrogenic systemic fibrosis being more significant Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Özge Uygun MD,

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