Premonitory Symptoms Research Articles

Maternal and Perinatal Outcome of Posterior Reversible Encephalopathy Syndrome (PRES) in Patients with Eclampsia at Tertiary Health Care Centre.

Posterior reversible encephalopathy syndrome (PRES) and the related term reversible posterior leukoencephalopathy syndrome (RPLS) denote a constellation of clinical symptoms paired with key radiological findings. Eclampsia associated with PRES is a rare condition and remains a challenging diagnosis to make. There are only a few studies regarding PRES syndrome with a limited sample size. Our institution is a tertiary referral centre; hence, a good sample size of patients with eclampsia complicated with PRES syndrome is seen in our study. The objective was to identify the maternal and neonatal outcomes in PRES with eclampsia. This study is a prospective observational study done in Government Medical College, Aurangabad, India from October 2018 to September 2020. In the present study, we have enrolled 63 cases, who satisfied inclusion and exclusion criteria during two years. All women admitted in the labour room of tertiary health care centre diagnosed with eclampsia with neurological symptoms during the study period were studied. Relevant data were obtained from the case file and compiled by common proforma. Analysis was done by SPSS (Statistical package for social sciences) Version 25th. In patients with a confirmed diagnosis of PRES with eclampsia(n = 63), the mean age of the patient was 20.74 ± 2.04years, 23 (36.5%) patients had headache as premonitory symptoms, whereas 13(20.6%)patients had visual disturbances as the premonitory symptom. The mean gestational age at presentation was 34.4 ± 2weeks. 40(63.5%) patients were showing parieto-occipital region changes, and 24(38.1%) subjects were showing only occipital region involvement in CT brain. 12 (19.04%) subjects were diagnosed with HELLP syndrome as a maternal complication, 07 (11.1%) subjects had Abruptio placentae. 26(41.3%) babies needed NICU admission, and 4 (6.3%) babies had neonatal death. In pregnant patients presenting with seizure and neurological symptoms, a possibility of PRES should be considered. Proper diagnosis requires careful attention to clinical and radiographic presentation. In eclampsia with PRES patients, a timely intervention with anti-hypertensive, anti-cerebral oedema measures as well as management of other associated symptoms are required. The online version contains supplementary material available at 10.1007/s13224-021-01585-9.

Premonitory and Accompanying Symptoms in Childhood Migraine.

To review the literature on the clinical characteristics of the symptoms other than headache that occurs during a migraine attack in childhood and adolescence. Premonitory symptoms (42-67%) and postdrome phase (82%) are frequent. The most frequent auras were visual. There was no association between age or sex and the occurrence of auras. Cranial autonomic symptoms are also frequent (40-70%) and are most often bilateral. Most studies suggest that age is not associated with the frequency of nausea, vomiting, photophobia, and phonophobia. Cephalic cutaneous allodynia (15-37%) and osmophobia (20-53%) are common symptoms in children with migraine. Osmophobia has low sensitivity and high specificity for the diagnosis of migraine and is associated with the severity of the migraine. Migraine is a complex disease, and although headache is its best-known symptom, other symptoms also occur frequently during migraine attacks in children and adolescents.

Distinct Perspective of Uterine Prolapse with special reference to its Etiological Factor and Treatment

Uterine prolapse (UP), also known as pelvic organ prolapse (POP) and genital prolapse, describes the descent of the uterus from its normal anatomical confines to positions within or outside the vaginal introitus. Etiological factors for prolapse vary from study to study but those reported consistently are increasing age, parity and obesity. Other possible causes include smoking, chronic increase in intra-abdominal pressure, estrogen deficiency; connective tissue disorders, low socioeconomic status, ethnicity and family history.This article is a case study which represents, raised internal abdominal pressure due to YOGactivities like Kapalbhatias a causative factor of uterine prolapse and accordingly the treatment plan. At present people are practicing Yog, Pranayam& Asana. But it is important to remember that the activities appropriate for some women may not be suited to others depending on individual risk factors for pelvic floor injury. In Ayurved, treatment plan changes from person to person depending upon NIDANPANCHAK (Diagnostics) that is 1. Etiological factors 2. Premonitory Symptoms 3. Signs & Symptoms 4. Pacifying & Aggravating factors 5. Individualized pathogenesis of disease. Thus, it is not sufficient to treat such cases with disease specific treatment, but investigating etiological factor and planning of treatment accordingly is worthwhile.

Possibility of migraine prevention by propranolol treatment during premonitory symptoms

Possibility of migraine prevention by propranolol treatment during premonitory symptoms

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

The importance of HbA1C test in prediabetes with special reference to Purvarupavastha of Prameha-A literary review

Diabetes mellitus is a metabolic disorder causing hyperglycaemia with defect in metabolism of carbohydrates, fats, and proteins due to defect in insulin secretion, or its utilization or both. Prediabetes is a condition in which the blood glucose levels do not meet the criteria for diabetes or too high to be considered normal (ADA). It is an early stage of DM. So it is important to diagnose Diabetes Mellitus type 2 in the previous stage that is prediabetes. It is already in practice to diagnose it with laboratory blood tests. But additionally, we can also take help of Prameha purvarupas as premonitory symptoms in patients prediabetes. HbA1C is a useful parameter to diagnose prediabetes. There is mild or no symptoms mentioned for prediabetes. Purvarupas of Prameha mentioned in Ayurvedic samhitas can be useful to know early stage of Diabetes mellitus type 2, clinically. The purpose of this article is to highlight the importance of Purvarupa of Prameha to diagnose prediabetes. So, the need of hour is to focus on screening and diagnosing pre-Diabetes earlier, by spreading knowledge and awareness among society which will play a key role to reduce the conversion of pre-diabetes to diabetes mellitus.

Sodium Chloride, Migraine and Salt Withdrawal: Controversy and Insights.

This paper examines evidence implicating migraine headache as a withdrawal symptom of excessive sodium chloride intake. Emerging research in food addiction posits that food and drug addictions share common features, such as withdrawal symptoms. Salt (sodium chloride) meets the criteria for the diagnosis of substance dependence, including withdrawal in which the substance is used to relieve withdrawal symptoms. The premonitory symptoms of migraine include food cravings for salty foods, which can alleviate migraine pain. Edema, possibly related to large amounts of salt consumed in binge eating, can cause approximately four pounds of retained fluid. This amount of fluid is similar to the fluid retained before the onset of migraine headache, which may be accompanied by polyuria. This paper proposes that inhibited withdrawal from highly processed food intake, rich in salt, mediates an association between increased sodium chloride intake and relief from migraine headache pain. The relief from withdrawal symptoms could also be a mediating factor that explains the controversial findings inversely associating dietary sodium intake with migraine history. Moreover, the withdrawal of retained sodium and edema related to the use of nonsteroidal anti-inflammatory drugs may elucidate a potential mechanism in medication overuse headache. Further research is needed to investigate the pain experienced from sodium chloride withdrawal in migraine headache.

Bench to bedside understanding of migraine pathophysiology

Migraine is a common, complex brain disorder whose pathophysiology is being unravelled by bench to bedside and back iterative advances [ [1] Goadsby P.J. Holland P.R. Martins-Oliveira M. Hoffmann J. Schankin C. Akerman S. Pathophysiology of Migraine- A disorder of sensory processing. Physiol. Rev. 2017; 97: 553-622 Google Scholar ]. Migraine consists of overlapping, parallel “phases” that offer insights into brain areas for laboratory exploration. Pain in migraine involves the activation, or perception of activation, of the pain-producing innervation of intracranial structures, notably the dura mater. The first, ophthalmic division, can be activated by direct stimulation in experimental animals to activate pathways of potential interest. Second order activation occurs in the trigemiinocervical complex that projects, with decussation, in the quintothalamic tract to the neurons of the ventroposteromedial thalamus. Triptans, serotonin 5-HT1B/1D receptor agonists, gepants, calcitonin gene-related peptide (CGRP) receptor antagonists, and ditans, 5-HT1F receptor agonists, each reduce nociceptive signalling in this pathway, and are effective in the acute treatment of migraine. Blockade of the pathway with monoclonal antibodies directed at the peptide, or its canonical receptor, are effective in the preventive treatment of migraine. Remarkably, gepants can have both acute attack effects and preventive effects in migraine. Brain imaging has demonstrated activations in the region of the hypothalamus in migraineurs in the premonitory phase in nitrogylcerin-triggered attacks or in spontaneous attacks. Given premonitory symptoms such as somnolence, yawning, thirst and polyuria, diencephalic structures offer a target for further bench-based studies. Understanding migraine neurobiology has generated new therapies and is likely to continue to do.

Migraine pathophysiology, clinical correlates

Migraine is well known by the headache itself, however there are many other signals and symptoms that can occur during an attack. Some symptoms, called premonitory symptoms, such as yawning and feeling tired, occur in 72–84% of patients. About 20% of migraineurs present aura. The most common aura is visual disturbances, following by sensitive symptoms. The headache of migraine is characterized by pulsatile unilateral pain, of moderate to severe intensity, that worsen by routine physical activities, associated with photo/phonofobia, nausea and vomiting. About 68–80% of migraine patients present the last phase called postdrome or resolution, in which the most common symptoms are tiredness and cognitive difficulties. This lecture will discuss the pathophysiological aspects of the main signals and symptoms of a migraine attack.

Can migraine still be considered a pathology of the central nervous system?

Although peripheral contributions are present, migraine is primarily a disease of the brain. Numerous migraine symptoms that occur during different phases of the migraine attack localize to the brain. Amongst others, this includes common premonitory symptoms, hypersensitivities to visual and auditory stimuli, extracephalic cutaneous allodynia, and cognitive dysfunction. Aberrant multisensory integration in the brain likely contributes to how exposure to sensory stimuli in one domain can exacerbate symptoms within another, such as exposure to light leading to increased cutaneous sensitivity.

Epidemiology and fetomaternal outcomes in cases of imminent eclampsia and eclampsia- retrospective study

The most common complication in pregnancy is Hypertension complicating 12-22% of all pregnancies. Among these pre-eclampsia is the leading cause constituting 10% of all pregnancies worldwide. In hospital practice in India, the incidence of pre-eclampsia varies from 5% to 15% and of eclampsia about 1.5%. According to WHO report 2008, eclampsia constitutes for 12% of all maternal deaths in developing countries. Thus it is important to study its Epidemiology and Management strategies. Retrospective descriptive data based study. The data is collected after reviewing the medical records of all gravid women with hypertensive disorder of pregnancy who presented between July 2010–July 2014. Data was collected on predesigned, standardised proforma of National Eclampsia Registry. Statistical analysis was performed using SPSS version 22. Data was expressed as Mean, percentages, proportions. Chi-square test was used to find association between various categorical variables. p-value <0.05 was considered to be statistically significant. During the study period there were 22,591 deliveries. There were 1468 mild and severe pre-eclampsia cases and 309 imminent eclampsia and eclampsia cases. The proportion of Pregnancy Induced Hypertension (PIH) cases was found to be 7.85% and that of eclampsia 1.36%. 74.34% of the patients belonged to age group between 20-30 years. 69.11% patients were primigravidas with significant corelation to parity (p value <.00). 68.4% cases were unbooked with p value <.00. 84.3% cases presented between 29-36 weeks. 56.96% patients had headache and 28.48% had headache with vomiting as premonitory symptoms. 74.4% patients had antepartum, 9.14% intra partum and 16.46% postpartum eclampsia. Increasing proteinuria was significantly related to no. of convulsions (p <.05). Maternal complications were seen in 21.68% cases. Maternal deaths during study period due to eclampsia complications were 1.3%. Perinatal complications were seen in 19.41% babies; prematurity being most common (40%). Low birth weight was seen in 68.09% babies which was statistically significant (p value <0.00). There was no significant change in the incidence of eclampsia over four years. Present study highlights various risk factors for pre-eclampsia. Unbooked, young primigravida with significant proteinuria are at increased risk for pre-eclampsia-related morbidity and mortality. As doctor to patient ratio is below par, the role of ASHA workers is important. Government efforts to track all pregnancies will ensure adequate antenatal care especially to the socio-economically deprived and rural population. Doctors working in peripheral hospitals should have periodic training in the management of preeclampsia and eclampsia to avoid missed opportunities as well as better transport facilities to handle obstetric emergencies. As no change in incidence of eclampsia over years, ASHA workers to be trained to identify warning signs. Doctors working in peripheral hospitals should have periodic training in the management of preeclampsia and eclampsia to avoid missed opportunities.

Reliability Assessment in Wireless Apparatus Using LoRa and Sigfox in Catch Basin

The importance of preventing damage from pluvial flooding has been increasing under global climate change. The discovery of premonitory symptoms of pluvial flooding enables effective evacuation and inundation prevention activities. However, apparatuses that automatically detect this in real time are not widespread. There are difficulties in the cost of installing them and the agreements made by the parties concerned, especially in cities. To solve this problem, we devised an apparatus to be installed inside a catch basin that detects its water level. The water level in the catch basin may indicate a sign of pluvial flooding, and the number of people involved in operating the catch basin is smaller than that of facilities on the ground. In order to reduce the cost of installation and operation, we adopted Low Power Wide Area (LPWA), which is a communication method that enables wireless transmission of detected information over long distances for a long time using batteries. So far, for catch basins, a wireless transmission experiment was conducted using LoRa, which is part of LPWA. However, Sigfox, which uses the same frequency as LoRa but has a different wireless system, has not been verified. In this study, the reliability of wireless communication was assessed by apparatuses using LoRa and Sigfox side by side in each catch basin in two places in a densely populated city. The number of experiment days and transmissions differed depending on the apparatus, with the number of days ranging from 97–151 and the number of transmissions from 2328–3748. The reliability in the experiment ranged from 99.97–99.53%. The experimental results showed that wireless transmission was possible with high reliability using either the LoRa or Sigfox system from inside these catch basins. This study expands the options for communication infrastructure that can be used for apparatuses that detect premonitory symptoms of pluvial flooding. This will enable a reduction in installation costs and will expand the range of areas of potential installation.

A CRITICAL REVIEW OF JWARAHARA YOGAS OF AYURVEDIC CLASSICS: A PARADIGM TO REVERSE PHARMACOLOGY

Jwara is the first and foremost among all somatic diseases. Although an independent disease, it is also seen manifested in the form of premonitory symptom, symptom and causative factor of various disorders. 2019-20 has witnessed a new pandemic identified as Corona virus (COVID-19) with adverse health issues. In proportion to the wide variety of diseases, viral vaccines are very few, that too with adverse effects. Hence there is an urgent need of most promising Indigenous drugs with antipyretic and anti-viral activity in the current scenario. A critical analysis is made to explore the Jwarahara Yogas of classics to unfold the Antiviral, Antipyretic, Antioxidant and Immunomodulatory potential of phytochemicals in formulations. An attempt has been made to explore the antiviral and antipyretic potential of Amrutotharam Kashayam, one of the most popular and widely used Jwarahara yoga in classics. The review will definitely give new insights on the synergistic actions of phytochemicals in formulations to revalidate the clinical evidences and will throw lime light on repurposing of the documented novel drugs and combinations in classics to offer unique preventive strategies and therapeutic solutions to the present pandemic and emerging viral infections.

Premonitory symptoms in migraine from China: A multi-clinic study of 4821 patients.

To observe the prevalence and characteristics of premonitory symptoms in Chinese migraineurs and explore their associations with migraine-related factors. Migraineurs who visited a tertiary headache clinic and one of nine neurology clinics between May 2014 and November 2019 were studied. Among the 4821 patients meeting the migraine criteria (International Classification of Headache Disorders, 3rd edition), 1038 (21.5%) patients experienced at least one premonitory symptom. The most common premonitory symptoms were neck stiffness, dizziness, yawning and drowsiness. The logistic regression analysis demonstrated that aura, photophobia, aggravation by routine physical activity, triggers, family history, depression, coffee consumption and physical exercise were associated with an increased probability of experiencing premonitory symptoms (p ≤ 0.001). The premonitory symptoms of migraine with and without aura differ in prevalence and most common symptoms. The cluster analysis revealed pairwise clustering of the following premonitory symptoms: Photophobia/phonophobia, concentration change/dysesthesia, loquacity/overactivity, yawning/drowsiness, fatigue/dizziness, and mood change/irritability. The correlation analysis of triggers and premonitory symptoms revealed that temperature change, environment change, sleep disorder, activity and stress were related to multiple premonitory symptoms, and that food, light, menstruation, alcohol and odor were related to special premonitory symptoms (p ≤ 0.001). The prevalence of premonitory symptoms among migraineurs in China is 21.5%. Some factors influence the probability of experiencing premonitory symptoms. Paired premonitory symptoms in the clustering analysis may share similar origins. Certain triggers associated with multiple premonitory symptoms may induce brain dysfunction; however, other triggers that overlap with corresponding special premonitory symptoms may be premonitory symptoms or a form of premonitory symptom.

Influential factors and predictors of anti-N-methyl-D-aspartate receptor encephalitis associated with severity at admission

We aimed to study the clinical characteristics and biological indicators of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis with different severity levels to explore factors predicting disease severity at admission. Using the modified Rankin scale (mRS), patients were divided into mild-to-moderate group (mRS ≤ 3) and severe group (mRS > 3) on admission based on severity of illness. General information, previous history, premonitory symptoms, clinical manifestations before admission, imaging findings and biochemical tests were compared to explore the clinical manifestations and biological indicators related to the severity of illness at admission. In the severe group, the incidences of fever, anti-infective therapy, generalized seizures, consciousness disorder, blood white blood cell, neutrophils, and neutrophil–lymphocyte ratio (NLR) were higher than those in mild-to-moderate group (P < 0.001, P = 0.001, P = 0.020, P < 0.001, P = 0.002, P < 0.001, P < 0.001, respectively); blood lymphocyte counts was lower than those in mild-to-moderate group (P < 0.001). There was the strongest significant positive correlation between the NLR and disease severity at admission (rs = 0.684, P < 0.001). In multivariate logistic regression, fever, generalized seizures, consciousness disorder, and elevated NLR were independent risk factors for disease severity; the area under the receiver operating characteristic curve was 0.896 (95%CI: 0.840–0.952, P < 0.001). Fever, generalized seizures, consciousness disorder, and elevated NLR were independent risk factors for disease severity. NLR is a good predictor of the severity of illness at admission.

Timely diagnosis of multiple endocrine neoplasia 2B by identification of intestinal ganglioneuromatosis: a case series

BackgroundMedullary thyroid carcinoma (MTC) in childhood is rare and has an unfavorable prognosis. To improve outcome, early diagnosis is essential. In patients with multiple endocrine neoplasia type 2B (MEN2B), MTC can occur already before the age of 1 year. Recognition of non-endocrine features of MEN2B may lead to timely diagnosis.PurposeTo describe how early recognition of non-endocrine features can lead to a timely diagnosis of MEN2B as well as the effect of recognition of premonitory symptoms on prognosis.MethodsA retrospective case series from the University Medical Center Utrecht/Wilhelmina Children’s Hospital, a Dutch national expertise center for MEN patients. All eight MEN2B patients in follow-up between 1976 and 2020 were included and medical records reviewed.ResultsIntestinal ganglioneuromatosis (IGN) as the cause of gastrointestinal (GI) symptoms was detected in seven patients. In three of them within months after birth. This led to early diagnosis of MEN2B, which allowed subsequent curative thyroid surgery. On the contrary, a MEN2B diagnosis later in childhood—in three patients (also) triggered by oral neuromas/neurofibromas—led to recurrent, persistent, and/or progressive MTC in five patients.ConclusionsNeonatal GI manifestations offer the most important window of opportunity for early detection of MEN2B. By accurate evaluation of rectal biopsies in patients with early onset severe constipation, IGN can be timely detected, while ruling out Hirschsprung’s disease. MEN2B gene analysis should follow detection of IGN and—when confirmed—should prompt possibly still curative thyroid surgery.

Prevalence of pre-cluster symptoms in episodic cluster headache: Is it possible to predict an upcoming bout?

Early symptoms prior to a cluster headache bout have been reported to occur days or weeks before the actual beginning of the cluster headache bouts. This study aimed to describe the prevalence of pre-cluster (premonitory) symptoms and examine the predictability of an upcoming cluster headache bout. 100 patients with episodic cluster headache were included in this retrospective cross-sectional study. All patients underwent a semi-structured interview including 25 questions concerning pre-cluster symptoms. Pre-cluster symptoms were reported by 86% of patients with a mean of 6.8 days (interquartile range 3-14) preceding the bout. An ability to predict an upcoming bout was reported by 57% with a mean 4.6 days (interquartile range 2-7) before the bout. Occurrence of shadow attacks was associated with increased predictability (odds ratio: 3.06, confidence interval: 1.19-7.88, p-value = 0.020). In remission periods, 58% of patients reported mild cluster headache symptoms and 53% reported occurrence of single shadow attacks. The majority of episodic cluster headache patients experienced pre-cluster symptoms, and more than half could predict an upcoming bout, suggesting the significant potential of early intervention. Furthermore, the experience of mild cluster headache symptoms and infrequent shadow attacks in remission periods is common and suggest an underlying pathophysiology extending beyond the cluster headache bouts.

Are some patient-perceived migraine triggers simply early manifestations of the attack?

ObjectiveTo study the agreement between self-reported trigger factors and early premonitory symptoms amongst a group of migraineurs in both spontaneous and pharmacologically provoked attacks.MethodsFifty-three subjects with migraine with and without aura, with ≤ 22 headache days/month, with spontaneous premonitory symptoms associated with migraine attacks were recruited nationally. A detailed history was taken by a study investigator to confirm diagnosis and extended phenotyping was performed to identify patient-reported triggers for migraine attacks, premonitory symptom phenotype and headache characteristics, using a standardised physician-administered questionnaire. The same subjects were exposed to a 0.5 mcg/kg/min nitroglycerin infusion over 20 min, to determine if similar migraine symptoms could be triggered. The triggered attacks were phenotyped in the same way as spontaneous ones. Percentage agreement and Cohen’s kappa measure of agreement were used to identify concordance between patient-reported triggers and the corresponding spontaneous and triggered premonitory symptoms. Percentage agreement of > 60% and/or a kappa value > 0.3 with P < 0.05 were considered significant.ResultsThere was statistically significant agreement between perception of light as a migraine trigger and spontaneous premonitory photophobia; perception of sound as a trigger and triggered premonitory phonophobia; skipping meals as a trigger and spontaneous premonitory food cravings; and food triggers and spontaneous premonitory food cravings. There was good agreement between stress and premonitory triggered mood change.ConclusionsAt least some patient-reported triggers, such as light, sound, foods and skipping meals, may represent early brain manifestations of the premonitory phase of the migraine attack.

Cortical glutamate and gamma-aminobutyric acid over the course of a provoked migraine attack, a 7 Tesla magnetic resonance spectroscopy study

Enhanced activity of the glutamatergic system has been linked to migraine pathophysiology. The present study aimed to assess the involvement of the glutamatergic system in the onset of attacks. We provoked attacks by infusion of glyceryl trinitrate (GTN; 0.5 µg/kg/min over 20 min) in 24 female episodic migraineurs without aura and 13 female age-matched healthy controls. Over the course of a single day participants were scanned three times at fixed time slots (baseline before GTN infusion, 90 min and 270 min after start of GTN infusion). Single-volume proton magnetic resonance spectra (1H–MRS) were acquired at 7 Tesla from a volume of interest (VOI, 2x2x3 cm) in the visual cortex. We assessed the concentrations of glutamate, its major precursor glutamine, and its product gamma-aminobutyric acid (GABA) over the course of a provoked attack. The preictal state was defined as the period after GTN infusion until the migraine-like headache started, independent of possible experienced premonitory symptoms, and the ictal state was defined as the period with provoked migraine-like headache. Data were analyzed using a linear mixed-effect model for repeated measures. Glutamate and glutamine levels did not change from interictal to the preictal and ictal state. GABA levels increased from interictal towards the preictal state for migraine patients compared with healthy controls. We conclude that high resolution 7T MRS is able to show changes in the glutamatergic system towards a triggered migraine attack, by revealing an increased GABA concentration associated with the onset of a migraine attack.

Electroclinical features and outcome of ANKRD11-related KBG syndrome: A novel report and literature review

Electroclinical features and outcome of ANKRD11-related KBG syndrome: A novel report and literature review