The aim of this study was to explore the association between different types of headache (HA) and the clinical features of multiple sclerosis (MS). The relationship between HA and MS-specific therapies was also analysed. A total of 102 MS patients were recruited at the MS Centre of S. Andrea Hospital in Rome. According to International Headache Society criteria, the lifetime prevalence of primary HA was 61.8%. Migraine was observed more often in young relapsing-remitting MS patients, whilst tension-type HA was associated with older age, male gender and a secondary progressive course. Sixty-four patients had a history of ongoing or past interferon beta (IFNb) exposure. Of these, 17 subjects did not have a history of HA, while 24 complained of an increase in frequency of migraine attacks and 7 reported an IFNb-induced HA. Investigating and treating HA in MS patients starting IFNb therapy may improve MS-specific medication compliance.

Our experience in this small series indicates that endovascular treatment of S-AVFs with Onyx is rapid, safe, and highly effective.

S pontaneous intracerebral hemorrhage (ICH) accounts for 8% to 15% of all strokes 1 and is the most fatal form of stroke, with a mortality rate of ≈50% within the first month, and 80% rate of dependency at 6 months from onset. 2 The incidence of spontaneous ICH has not changed in the past 3 decades, 3 and remains without a proven specific treatment. Several factors have been implicated as predictors of morbidity and mortality, including baseline hematoma volume, Glasgow Coma Scale score, presence of intraventricular hemorrhage, and age. [4][5][6] Independent of these factors, hematoma expansion has been described as a determinant of both mortality and functional outcome, 6,7 making attenuation of growth an attractive and potentially modifiable therapeutic target.A trial of recombinant activated factor VII (rFVIIa) generated optimism by demonstrating reduction in hematoma expansion; however, it failed to show improvement in clinical outcome and raised questions about the safety of rFVIIa given the thromboembolic complications. 8 The discrepant results may have been because of inclusion of a large number of subjects that did not expand and were therefore not likely to benefit from hemostatic therapy.Recently, the computed tomography angiography (CTA) spot sign has been validated in several studies as an imaging biomarker for hematoma expansion and poor outcome. [9][10][11][12][13][14][15] CTA spot sign has various descriptions and the outcome variables and definitions of hematoma expansion are not constant across studies, 16 the results are consistent irrespective of definition, spot sign presence reliably predicts expansion. The largest prospective study, Prediction of Haematoma Growth and Outcome in Patients With Intracerebral Haemorrhage Using the Background and Purpose-The computed tomography angiography (CTA) spot sign is a validated biomarker for poor outcome and hematoma expansion in intracerebral hemorrhage. The spot sign has proven to be a dynamic entity, with multimodal imaging proving to be of additional value. We investigated whether the addition of a 90-second delayed CTA acquisition would capture additional intracerebral hemorrhage patients with the spot sign and increase the sensitivity of the spot sign. Methods-We prospectively enrolled consecutive intracerebral hemorrhage patients undergoing first pass and 90-second delayed CTA for 18 months at a single academic center. Univariate and multivariate logistic regression were performed to assess clinical and neuroimaging covariates for relationship with hematoma expansion and mortality. Results-Sensitivity of the spot sign for hematoma expansion on first pass CTA was 55%, which increased to 64% if the spot sign was present on either CTA acquisition. In multivariate analysis the spot sign presence was associated with significant hematoma expansion: odds ratio, 17.7 (95% confidence interval, 3.7-84.2; P=0.0004), 8.3 (95% confidence interval, 2.0-33.4; P=0.004), and 12.0 (95% confidence interval, 2.9-50.5; P=0.0008) if present on first pass, delayed, or ...

Background and Purpose-Significant stenosis of the internal carotid artery (ICA) is an established stroke risk factor.Recent evidence suggests that features within the atherosclerotic plaque also have prognostic value. The purpose of this study was to correlate the enhancement of the vasa vasorum (VV) overlying the carotid artery plaque with acute neurological symptoms in patients with 50% to 70% ICA stenosis. Methods-We conducted a 4-year retrospective computerized tomographic angiographic review to identify patients with 50% to 70% stenosis of the ICA. Three types of plaques were identified: enhancing VV, calcified, and nonenhancingnoncalcified. Medical records were reviewed for cardiovascular risk factors and neurological status, and imaging was reviewed for signs of a recent stroke. Results-We identified a total of 428 patients with 50% to 70% ICA stenosis: 103 (24.1%) had enhancing VV, 202 (47.2%) calcified, and 123 (28.7%) nonenhancing-noncalcified arteries; 97 were symptomatic and 331 asymptomatic. Thirty-three (34%) symptomatic subjects demonstrated enhancing VV, 42 (20%) had calcified arterial plaques, and 22 (17%) had nonenhancing-noncalcified arterial plaques. Fisher exact tests revealed that the proportion of symptomatic individuals with enhancing VV plaque was double that of the other groups combined (P=0.015; odds ratio, 1.92; 95% confidence interval, 1.17-3.16). Regression analyses confirmed this association as independent from other known cardiovascular risk factors. Conclusions-In patients with 50% to 70% ICA stenosis, VV enhancement recognized on computed tomographic angiography is strongly associated with acute neurological symptoms compared with calcified and nonenhancingnoncalcified arterial plaques. This finding may aid in the identification of patients at increased risk for ischemic stroke within populations with the same degree of stenosis. [13][14][15][16] Several studies have demonstrated the correlation of carotid wall enhancement on micro-computerized tomography (CT) and MRI with VV neovascularization in histological specimens. 13,17 In patients with ≥70% carotid stenosis, enhancement of the VV on CT angiography (CTA) is associated with acute neurological symptoms. 18 The purpose of this study was to determine whether a significant relationship exists between acute neurological symptoms and enhancement of the VV in patients with moderate (50%-70%) ICA stenosis. Materials and MethodsWe obtained approval from our institutional review board to perform this study. A waiver of consent was granted. Research activities were in full accordance with all applicable federal and state regulations, including the Health Insurance Portability and Accountability Act privacy rule. Patient SelectionThrough our neuroimaging database, all neck CTAs performed at our institution during a 4-year period were selected; all patients with ICA atheromatous stenosis between 50% and 70% were included in our study. The strokes were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) ...