History Of Headache Research Articles

Effect of correction of refractive error and threshold estimation in ocular headache patients in a tertiary eye care center

Purpose: Headache is one of the most common symptoms in patients with refractive error. Our study aimed to find the effect of refractive error correction and estimate the threshold of refractive error in patients with ocular headaches in a tertiary eye care center. Methods: We enrolled patients who came with complaints of headaches. It was a prospective, interventional study. All the patients underwent comprehensive ocular examination that included a detailed headache history, objective and subjective refraction, cycloplegic refraction, Humphrey visual fields test (30-2), cover test, and dilated fundus examination. We excluded uveitis, glaucoma, optic atrophy, papilledema, sinusitis, migraine, dental cavities, and neuropathy patients. We prescribed glasses after the post-mydriatic test. We surveyed via phone call regarding the compliance of spectacle wear and relief of headaches. Results: Out of the 98 enrolled patients, 67 were female and 31 were male in the age group of 16 to 35. The patients had simple astigmatism (57.14%), simple myopia (15.30%), simple myopic astigmatism (23.46%), and hyperopia (9.18%). The threshold value of dioptric power was −1.25 D, −1.00 D, −0.75 DS/−0.75 DC, and +1.00 D for simple astigmatism, simple myopia, simple myopic astigmatism, and hyperopia, respectively. 86.73% recovered with glasses. Simple astigmatism had the highest recovery rate. Headaches frequently occurred in the frontal (44.89%), followed by temporal (32.65%), parietal (16.32%), occipital, and parietal (11.22%). Conclusion: Lower degrees of refractive error caused the headache. We reported the threshold values of the refractive error that caused the ocular headache. Correcting the refractive error relieved the headache

Genetic Risk Loci and Familial Associations in Migraine: A Genome-Wide Association Study in the Han Chinese Population of Taiwan.

Migraine is a condition that is often observed to run in families, but its complex genetic background remains unclear. This study aimed to identify the genetic factors influencing migraines and their potential association with the family medical history. We performed a comprehensive genome-wide association study of a cohort of 1,561 outpatients with migraine and 473 individuals without migraine in Taiwan, including Han Chinese individuals with or without a family history of migraine. By analyzing the detailed headache history of the patients and their relatives we aimed to isolate potential genetic markers associated with migraine while considering factors such as sex, episodic vs. chronic migraine, and the presence of aura. We revealed novel genetic risk loci, including rs2287637 in DEAD-Box helicase 1 and long intergenic non-protein coding RNA 1804 and rs12055943 in engulfment and cell motility 1, that were correlated with the family history of migraine. We also found a genetic location downstream of mesoderm posterior BHLH transcription factor 2 associated with episodic migraine, whereas loci within the ubiquitin-specific peptidase 26 exonic region, dual specificity phosphatase 9 and pregnancy-upregulated non-ubiquitous CaM kinase intergenic regions, and poly (ADP-ribose) polymerase 1 and STUM were linked to chronic migraine. We additionally identified genetic regionsassociated with the presence or absence of aura. A locus between LINC02561 and urocortin 3 was predominantly observed in female patients. Moreover, three different single-nucleotide polymorphisms were associated with the family history of migraine in the control group. This study has identified new genetic locations associated with migraine and its family history in a Han Chinese population, reinforcing the genetic background of migraine. The findings point to potential candidate genes that should be investigated further.

Factors influencing the headaches and their impact on daily life of medical students

Background and Objective: 
 Medical students are considered high risk for headaches due to various triggers in their daily routine. The objective of this study was to assess the factors influencing headaches and their impact on the daily life of medical students.
 Methods:
 This cross-sectional study utilized a sample of 242 participants who were selected through a convenient method of sampling. Data was collected from medical students of Liaquat National Medical College for a period of six months (January to June 2021). Data was gathered using pre-designed questionnaires that assessed demographic information, lifestyle factors (such as consumption of tea, coffee, and soft drinks), sleep patterns, meal habits, stress levels, and headache characteristics (including frequency, duration, intensity, associated symptoms, aura symptoms, and triggers). An analysis using a chi-square test was conducted to investigate the potential relationships between these factors and the occurrence of headaches.
 Results:
 Age and gender were not significant predictors of headaches in this particular sample. Instead, factors such as missed days due to headaches (p=0.020) and problems staying asleep (p=0.044) were more closely linked to headache occurrence. Headaches lead to a minor reduction in the ability to function for a large proportion of individuals (58.1%). A high percentage of participants had a family history of headaches (41%).
 
 Conclusion:
 These findings highlight the importance of addressing sleep quality as a potential avenue for mitigating the burden of headaches in individuals. However, further research is necessary to establish causation and generalizability of these results to broader populations.

Impact of Playing Surface on Concussion Symptoms in Young American Football Players.

It has been suggested that sport-related concussion (SRC) occurs more commonly on natural grass compared with artificial turf in contact sports. As playing surface is a potentially modifiable risk factor, this study sought to identify differences in symptoms following SRC on these 2 surfaces in a sample of young American football players. Prospective. Part of the multi-institutional North Texas Concussion Registry (ConTex) research project. Ten-year-old to 24-year-old male American football players (n = 62) who had sustained a helmet-to-ground SRC and presented to a specialty concussion clinic within 14 days of injury. Helmeted impact with grass (n = 33) or artificial turf (n = 29). Severity and number of symptoms endorsed on the Sport Concussion Assessment Tool 5th Edition (SCAT5) Symptom Evaluation at the time of initial clinical evaluation. Both groups were similar in mean time since injury, concussion history, and history of headache, but the artificial turf group was slightly older, with a mean age of 14.6 versus 13.6 years ( P = 0.039). Athletes who sustained a SRC on grass reported significantly higher mean total symptom severity scores (26.6 vs 11.6, P = 0.005) and total number of symptoms (10.3 vs 5.9, P = 0.006) compared with those who were injured on artificial turf. This may be the first study to examine postconcussive symptoms after SRC as they relate to playing surface. This small sample of young American football players reported higher symptom severity scores and higher total number of symptoms after SRC on natural grass compared with artificial turf.

Hyalinizing Clear Cell Carcinoma in the Sphenoid Sinus.

A 39-year-old man presented with a 1-month history of headaches. Imaging revealed a mass with extensive destruction. T2-weighted imaging displayed mixture of low and sponge-like high intensities and also dark area, with FDG PET/CT showing uneven but intense accumulation. Biopsy confirmed EWSR1 rearrangement, and hyalinizing clear cell carcinoma (HCCC) was diagnosed. HCCC, recently renamed from clear cell carcinoma in the fifth edition of the World Health Organization Classification of Head and Neck Tumors, is a rare tumor. This case describes the features of T2-weighted imaging and FDG PET patterns in HCCC, possibly contributing to their consideration in the differential diagnosis.

Ruptured Intracranial Vascular Aneurysm with Subarachnoid Haemorrhage: Autopsy Case Series and Literature Review

Background: Subarachnoid haemorrhage (SAH) is a severe condition where bleeding occurs in the subarachnoid space surrounding the brain. SAH can be caused by a ruptured aneurysm or head injury leading to a stroke (with associated disability or death). Common symptoms include severe (thunderclap) headache, neck pain, nausea, vomiting, and sensitivity to light. Case Presentations: Firstly, a 58-year-old man presented with a history of severe headaches and inability to use the left side of his body, with a possible hemorrhagic right-sided hemispheric stroke diagnosis. Following death, an autopsy revealed a ruptured intracranial Charcot Bouchard aneurysm, with SAH as the cause. Secondly, a 35-year-old woman presented with a sudden loss of consciousness and three episodes of generalised tonic-clonic convulsion during a coital activity at a guest house. Following death, an autopsy revealed a ruptured middle cerebral artery’s saccular (berry) aneurysm, causing SAH with bilateral tonsillar herniation as the cause. These case series highlight the importance of autopsy in diagnosing SAH.

Comparison of pupil size in patients of migraine with photophobia versus normal subjects and correlation of the pupil size to severity of headache.

To compare the pupil size of patients having migraine with photophobia versus normal subjects and to correlate the pupil size to the severity of headache. This was a prospective case-control study. One hundred eyes of 50 patients who had migraine with photophobia were compared with same number of control subjects who had no history of headache. Pupil size was measured using the IOL Master 700 in all cases. Severity of headache was evaluated by the Migraine Disability Assessment (MIDAS) test questionnaire, and MIDAS grades from 1 to 4 ranging from minimal disability to severe disability were obtained in all cases. The pupil sizes in all grades were compared. The mean pupil size was 4.89 ± 0.9 mm (95% confidence interval [CI]) in patients of migraine with photophobia compared to 3.8 ± 0.49 mm (95% CI) in normal subjects, with a P value of <0.0001, which was statistically significant. Among the 50 patients with migraine, according to MIDAS grades, 20 had Grade 4 or severe disability, 15 had Grade 3 or moderate disability, 10 had Grade 2 or mild disability, and five had Grade 1 or minimal disability. Pupil size in Grade 4 category was the largest with a mean value of 5.6 ± 0.79 mm (95% CI). The pupil size in patients of migraine with photophobia is larger than in normal subjects and could be a trigger for the migraine attacks. The larger the pupil size, the more severe is the migraine disability.

New daily persistent headache after SARS-CoV-2 infection in Latin America: a cross-sectional study

BackgroundPersistent headache is a frequent symptom after coronavirus disease 2019 (COVID-19) and there is currently limited knowledge about its clinical spectrum and predisposing factors. A subset of patients may be experiencing new daily persistent headache (NDPH) after COVID-19, which is among the most treatment-refractory primary headache syndromes.MethodsWe conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants’ responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student’s t and Mann–Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson’s chi-square and Fisher’s exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH.ResultsFour hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH.ConclusionThis is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.

Case Report: Tolosa-Hunt syndrome, a neuroinflammatory origin of painful ophthalmoplegia

Background Tolosa-Hunt syndrome is a rare neuroinflammatory disease that affects the cavernous sinus and superior orbital fissure, resulting in symptoms of neuropathy. Case presentation We report a case of a 35-year-old male patient with no past medical history who presented to the emergency department (ED) complaining of a four-day history of progressively increasing headaches associated with right eye pain and double vision. A physical examination showed findings suggestive of abducens nerve palsy. A computed tomography (CT) scan showed subtle asymmetric thickening of the right cavernous sinus, which prompted further investigation by magnetic resonance imaging (MRI) scan. The MRI scan showed intensely enhanced soft tissue thickening in the right cavernous sinus region, slightly extending to the right orbital apex, which caused enlargement of the cavernous sinus and appeared isointense to the adjacent muscles on T1 and T2. The diagnosis of Tolosa-Hunt syndrome was made after the exclusion of all other possible pathologies. The patient received prednisolone therapy; his symptoms improved, and he was discharged after three days. Two weeks later, the patient presented again to the ED with the same symptoms and was treated symptomatically. Conclusions This case highlights a very rare etiology for painful ophthalmoplegia, which is Tolosa-Hunt syndrome. Thickening of the cavernous sinus on MRI images with a background history of painful ophthalmoplegia and headache should raise clinician’s suspicion towards the disease. In addition, exclusion of other possible causes is very important, as Tolosa-Hunt syndrome is a diagnosis of exclusion.

Clinical course of multiple sclerosis with comorbid endometriosis: A matched cohort study

BackgroundEndometriosis (EMS) is pain syndrome in which endometrial tissue grows outside the uterus. EMS is associated with an increased risk of multiple sclerosis (MS), a demyelinating disease of the central nervous system. ObjectiveTo characterize clinical phenotypes of a cohort of patients with both EMS and MS compared to a cohort of matched controls with only MS. MethodsWe retrospectively identified patients with EMS and MS at Beth Israel Deaconess Medical Center (BIDMC). We collected data on EMS treatments and analyzed differences in histories of gynecological cancer, smoking, fatigue, anxiety, depression, headache, and neuropathic pain compared to matched controls. We used Wilcoxon signed rank tests for paired samples to compare Expanded Disability Status Scores (EDSS) and timed 25-foot walk values (T25FW). ResultsUsing a case-control methodology, we found significantly increased EDSS (p < 0.001) and T25FW (p = 0.01) in the EMS-MS group compared to the MS group. More patients in the EMS-MS group had histories of smoking, anxiety, depression, and headaches, while more patients in the MS group had histories of fatigue and neuropathic pain. ConclusionWhen controlling for age, race, and MS therapy, those with EMS-MS experience more MS disability than controls, suggesting this population requires more monitoring and efficacious treatment.

Severe bilateral papilledema after sigmoid sinus constriction surgery: a case report

BackgroundPapilledema is a common sign of various diseases in the eye. It could result from any conditions of increased intracranial pressure (ICP). Underlying the etiology of papilledema and appropriate treatment in time is essential.Case reportWe present a case of severe bilateral papilledema after sigmoid sinus constriction surgery. A 25-year-old female presented with a 1-month history of bilateral blurred vision, headache, and vomiting. The patient had a history of right-side sigmoid sinus constriction surgery for pulsatile tinnitus (PT) one month before in another hospital. Fundus examination showed severe bilateral papilledema. Lumbar puncture showed an elevated cerebrospinal fluid (CSF) opening pressure of 29 cm H2O. Neuroimaging examination demonstrated the right sigmoid sinus filling defect as changes after surgery. We referred the patient to the initial surgeon, who repaired the sigmoid sinus on the right side by removing the implanted gelatin sponge, as diuretic treatment could not be effective. Intracranial hypertension symptoms and signs improved soon after eliminating sigmoid sinus stenosis. Neuroimaging showed resolved right sigmoid sinus stenosis after the second surgery. CSF opening pressure was 14.5 cm H2O at the 1-month follow-up. Fundus examination showed entirely resolved papilledema. Three years of follow-up showed no recurrence.ConclusionsThis is the first clinical report of intracranial hypertension associated with sigmoid sinus constriction surgery. Although rare, rapid detection and adequate etiology management could lead to a good prognosis. It highlights the need for ophthalmologists to be aware of the diagnostic approach to papilledema and enhance cooperation with multidisciplinary departments. The most likely cause of the intracranial hypertension was dominant sinus surgical constriction by mechanical external compression, as confirmed by the complete clinical remission following the second operation to remove the implanted gelatin sponge. Thus, this case also highlights the importance of selecting the appropriate therapeutic option for PT. Surgical sinus constriction should no longer be considered a viable option for PT treatment.

Time to recovery and determinant factors of COVID-19 patients under treatment in Sidama region, Ethiopia: A retrospective cohort study

IntroductionEvidence from several studies shows that the median recovery time among COVID-19 patients varies in different settings, and why that difference occurs is questionable. The current study was aimed to estimate the time to recovery and to identify determinant factors among COVID-19 patients admitted to treatment centers in the Sidama region, Ethiopia. MethodsThe secondary data was extracted from the Sidama Public Health Institute (SPHI), data management unit. A total of 1038 COVID-19 patients who were under treatment from 1, June 2020, to 30, June 2022, at different treatment centers in the region were included in the study. The Log-Logistic Accelerated Failure Time (AFT) model was employed to estimate the effects size of different covariates on recovery time of COVID-19 patients under treatment. ResultsAmong the total number of patients in the study, 704 (67.82 %) were recovered, while 334(32.18 %) were censored. The median recovery time was 14 days (IQR: 10–18 days). Patients who were above 65 years old had nearly 1.17 times more prolonged recovery time as compared to patients who were below 25 years old, (OR = 1.168, p-value = 0.032, CI = 0.013,0.298). The log odds of recovery for patients who were in critical severity status at admission was 1.279 times more decelerated as compared to asymptomatic patients (P-value = 0.005, CI = 0.076, 0.417). The log odds of recovery for patients who had no history of headache was 1.107 times more accelerated as compared to patients who had a history of headache (OR = 1.107, p-value = 0.027, CI = 0.011, 0.192). The log odds of recovery for non-diabetic patients was 1.244 times more accelerated as compared to patients who were diabetic (OR = 1,244, p-value = 0.002, CI = 0.077, 0.360), holding other covariates constant in the model. ConclusionAge, critical severity status of infection, having symptoms of infection, having a history of headaches, and being diabetic had statistically significant effects on time to recovery among COVID-19 patients admitted to the treatment centers in the Sidama region.

Examining the Impact of Puberty on Primary Headache Disorders in Female Schoolchildren: A Cross-Sectional Study.

Introduction and aim Headaches are one of the most prevalent childhood disorders. Primary and secondary headaches are the two types of headaches affecting kids and teenagers. The three most typical primary headache forms are tension-type headaches (TTH), migraine, and cluster headaches. This study sought to determine the relationship between puberty and types of headaches. Methods This cross-sectional study was conducted from May 18 to July 31, among female schoolchildren aged between eight and 15 years in the Eastern Province of Saudi Arabia. Respondents were recruited through face-to-face interviews. A self-administered questionnaire was utilized, mainly consisting of demographic data and questions related to diagnosing and managing the impact of puberty in girls on the prevalence of primary headache disorder. Results In total, 481 female schoolchildren were interviewed, mostly between 13 and 15 years old (65.9%). Last year prevalence of headaches was 65.5%, with a significant difference among those who lived in Dhahran (p=0.001) and those with a family history of headaches (p<0.001). The most common type of headache was frequent TTH (16.4%) and chronic TTH (16%). Chronic TTH (p<0.001), frequent TTH (p<0.001), and migraine without aura (p=0.005) were significantly more common among the older age groups. Conclusion There was a high prevalence of headaches among female schoolchildren, with frequent TTH and chronicTTH being the most common. Furthermore, increasing age was associated with an increasing risk for chronic TTH, frequent TTH, and migraine headaches without aura. More epidemiological studies are necessary to determine the underlying causes of headaches among schoolchildren.

TUMOR FIBROSO SOLITARIO CEREBRAL: A PROPÓSITO DE UN CASO

Introduction: Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms that, although typically develop in the visceral pleura, occasionally occur in the intracranial cavity. Furthermore, they are characterized by high rates of metastasis and recurrence. Case Report: We present the case of a 59-year-old male patient with a 3-month history of headache and bradyphrenia. Computed tomography revealed a neoformative tumor infiltrating the nasal cavity, ethmoid sinuses, and anterior cranial fossa, involving the left frontal lobe. The patient underwent two exploratory craniectomies, during which diagnoses suggestive of high-grade glial neoplasia and SFT were made. For precise diagnosis, immunohistochemistry was performed, which was consistent with solitary fibrous tumor. The case is analyzed, focusing particularly on histopathological aspects, the unusual location of this tumor, and its variable clinical manifestations.

Giant cell tumor of the clivus misdiagnosed as calcifying fibrous tumor

Abstract Introduction/Objective Giant cell tumors of bone (GCTs) are generally benign, locally aggressive lesions accounting for approximately 4% of primary bone tumors. GCTs of the skull are rare and constitute &amp;lt;1% of all reported GCTs as they typically occur in the epiphysis of long bones. Specifically, in the clivus location, these tumors are exceedingly rare with fewer than 10 articles in English literature. The purpose of this report is to describe a case of GCT in this unusual location that was misdiagnosed as giant cell reparative granuloma on biopsy and subsequently calcifying fibrous tumor on resection. Methods/Case Report A 34-year-old male presented with history of headache, visual disturbance, epistaxis, and nausea. MRI demonstrated a large soft tissue mass eroding the clivus. A biopsy was interpreted at an outside institution as giant cell reparative granuloma. The patient was treated with denosumab and subsequently underwent resection of the mass due to worsening symptoms. Post-treatment pathology was interpreted as calcifying fibrous tumor. The patient presented to our institution for further management and outside pathology was reviewed. Histologically, the initial tumor was composed of a bland spindle cell proliferation with admixed osteoclast-type giant cells. In this location, the differential diagnosis includes Brown tumor, giant cell reparative granuloma, and, rarely, GCT. HG34W immunostain was positive in the tumor cells confirming the diagnosis of GCT. The post-therapy specimen showed abundant woven bone formation and a lack of giant cells. Post-denosumab GCT are known to show these features. Follow up imaging showed a slow growing moderately enhancing mass at the resection site. Patient is alive with disease 36 months after initial diagnosis. Results (if a Case Study enter NA) NA Conclusion With rare exceptions, bone tumors frequently follow generalized patterns of involvement. Pathologists need to be aware of these exceptions. Appropriate panel of immunohistochemical stains help clinching the right diagnosis, especially in unusual clinical settings.

A Pterygopalatine Fossa Abscess Caused by Streptococcus Constellatus With Ptosis as Initial Presentation: Case Report.

Pterygopalatine fossa (PPF) abscess is an exceedingly rare occurrence. Typically, it has been reported in association with odontogenic infections or hematogenous dissemination. In this report, we present the first case of PPF abscess where no obvious underlying cause or primary infection was evident. The patient initially presented with a 2-week history of left ptosis and persistent headaches, which were subsequently accompanied by fever and limited mouth opening. Based on elevated inflammatory markers and imaging findings, the diagnosis of a PPF abscess was established. Successful treatment was achieved through surgical drainage using an external cervical approach. Cultures from the aspirated pus identified Streptococcus constellatus as the causative agent. This case highlights the importance of considering PPF abscess in patients presenting with ptosis as an initial symptom. When diagnosed, surgical drainage should be considered as a viable therapeutic option.

Case Report: A rare case of multicentric angiosarcomas of bone mimicking multiple myeloma on 18F-FDG PET/CT

BackgroundAngiosarcoma, a rare endothelial-origin tumor, can develop throughout the body, with the head and neck skin being the most commonly affected areas. It can also originate in other sites such as the breast, iliac artery, and visceral organs including the liver, spleen, and kidneys. Angiosarcoma of the bone is remarkably rare, presenting as either unifocal or multifocal bone lesions and often leading to a grim prognosis. Diagnosing bone angiosarcoma poses a significant challenge. 18F-FDG PET/CT serves as a reliable and indispensable imaging modality for evaluating distant metastases and clinically staging angiosarcomas.Case reportA 57-year-old woman presented with a 10-day history of dizziness and headaches. Cranial CT scan revealed bone destruction of the parietal bone, accompanied by soft tissue lesions, protruding into the epidural space. MRI examination demonstrated lesions with slightly elevated signal intensity on T2FLAIR, showing moderate enhancement. Furthermore, multiple foci were observed within the T12, L1-5, and S1-2 vertebrae, as well as in the bilateral iliac bones. For staging, 18F-FDG PET/CT was performed. The MIP PET showed multifocal FDG-avid lesions in the sternum, bilateral clavicles, bilateral scapulae, multiple ribs, and pelvic bones. Heterogeneous FDG uptake was observed in multiple bone lesions, including intracranial (SUVmax = 11.3), right transverse process of the T10 vertebra (SUVmax = 5.8), ilium (SUVmax = 3.3), and pubis (SUVmax = 4.7). The patient underwent surgical resection of the cranial lesion. The pathological diagnosis was made with a highly differentiated angiosarcoma.ConclusionAngiosarcoma of bone on FDG PET/CT scans is characterized by abnormal FDG uptake along with osteolytic destruction. This case highlights that angiosarcoma of bone can manifest as multicentric FDG uptake, resembling the pattern seen in multiple myeloma. FDG PET/CT can be a useful tool for staging this rare malignant tumor, offering the potential to guide biopsy procedures toward the most metabolically active site. And it should be considered in the differential diagnosis of multiple osteolytic lesions, including metastatic carcinoma, multiple myeloma, and lymphoma of bone.

Spontaneous Cerebrospinal Fluid Leak in a Patient with Asymptomatic Idiopathic Intracranial Hypertension

BackgroundSpontaneous cerebrospinal fluid (CSF) leaks occur when there is a tear in the dura mater. Spontaneous CSF leaks are rare, and often associated with conditions like intracranial hypertension, connective tissue disorders, or congenital defects in the dura mater. Case ReportThe patient was a 66-year-old woman who presented to the Emergency Department with clear, positional nasal discharge from her left nostril for 1 week. She had a history of chronic headaches, which seemed to have been relieved around the time of onset of her rhinorrhea. Diagnostic imaging, including computed tomography and magnetic resonance imaging scans, confirmed the presence of a CSF leak and a left temporal meningoencephalocele. The patient subsequently underwent surgical repair of the leak and ventriculoperitoneal shunt placement, and was discharged home in stable condition. Why Should an Emergency Physician Be Aware of This?Early detection of CSF leaks require a thorough history and physical examination, and is crucial in preventing potentially life-threatening complications such as meningitis and intracranial abscesses.

Transmissibility and severity of COVID-19 in a humanitarian setting: First few X investigation of cases and contacts in Juba, South Sudan, 2020.

The first few 'X' (FFX) studies provide evidence to guide public health decision-making and resource allocation. The adapted WHO Unity FFX protocol for COVID-19 was implemented to gain an understanding of the clinical, epidemiological, virological and household transmission dynamics of the first cases of COVID-19 infection detected in Juba, South Sudan. Laboratory-confirmed COVID-19 cases were identified through the national surveillance system, and an initial visit was conducted with eligible cases to identify all close contacts. Consenting cases and close contacts were enrolled between June 2020 and December 2020. Demographic, clinical information and biological samples were taken at enrollment and 14-21 days post-enrollment for all participants. Twenty-nine primary cases and 82 contacts were included in the analyses. Most primary cases (n= 23/29, 79.3%) and contacts (n= 61/82, 74.4%) were male. Many primary cases (n= 18/29, 62.1%) and contacts (n= 51/82, 62.2%) were seropositive for SARS-CoV-2 at baseline. The secondary attack rate among susceptible contacts was 12.9% (4/31; 95% CI: 4.9%-29.7%). All secondary cases and most (72%) primary cases were asymptomatic. Reported symptoms included coughing (n= 6/29, 20.7%), fever or history of fever (n= 4/29, 13.8%), headache (n= 3/29, 10.3%) and shortness of breath (n= 3/29, 10.3%). Of 38 cases, two were hospitalised (5.3%) and one died (2.6%). These findings were used to develop the South Sudanese Ministry of Health surveillance and contract tracing protocols, informing local COVID-19 case definitions, follow-up protocols and data management systems. This investigation demonstrates that rapid FFX implementation is critical in understanding the emerging disease and informing response priorities.

Bilateral Abducens Nerve Palsy and Nystagmus Resolved Upon Intravenous Dextrose Administration in Hypoglycemic Young Female: A Case Report and Review of the Literature

Hypoglycemia can cause a variety of neurological symptoms ranging from mild confusion to seizures and coma. The brain depends heavily on glucose as its main energetic resource, and a decrease in glucose levels can lead to impaired cerebral function. A 38-year-old female presented to the Emergency department with a history of headache, dizziness and asymmetric reactive pupils in addition to bilateral medial strabismus, nystagmus and photophobia. A non-contrast brain Computed Tomography scan was performed showed no significant radiological findings. Laboratory tests were within normal ranges except for a clinically significant hypoglycemia (level II). Intravenous dextrose was administered and strabismus gradually resolved, and headache subsided gradually within an hour. Hypoglycemic state should be investigated first in any patient with sudden neurological deficit.