Headache Symptoms Research Articles

Poisoned in their homes - Red blood cell abnormalities in lead-exposed residents of a Pakistani Industrial Zone.

The present study investigated the clinical and hematological effects of chronic lead exposure in the population residing in Shadi Pura, a small industrial zone in Lahore, Pakistan. A cross-sectional analysis of 149 participants recruited through health camps was conducted to explore the hematological manifestations of environmental lead exposure, focusing on various red blood cell (RBC) indices and morphology. Moreover, the study examined the differences in the impact of lead exposure on RBC indices and morphology between men, women, and children. Participants exhibited symptoms of lead poisoning, including fatigue, muscle pain, and headache, with a significant percentage of women (44%) reporting miscarriages. Iron deficiency anemia was highly prevalent among all sub-groups of the study population, with adult females showing a significantly higher prevalence than adult males. Male children were the most affected subgroup, with 93% displaying anemia. The RBC count in children remained unchanged, while 31% of male and 7% of female participants displayed elevated RBC counts. RBC indices, mainly mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH), were below normal levels, with children being more affected than adults and adult males being the least affected group. Furthermore, RBC morphology was severely affected, with a considerable proportion of females and children displaying hypochromic microcytic morphology. Our results highlight variations in the hematological impacts of lead exposure in different sex and age cohorts. Overall, our findings underscore the urgency of addressing the issue of environmental lead exposure in similar industrial zones. It is critical to implement appropriate measures to reduce lead exposure and enhance the infrastructure for safe drinking water and waste disposal to protect the health of populations in such areas.

Migraine diagnosis in patients with sinus headache symptoms: a cross-sectional study at Khartoum ENT Hospital

Migraine diagnosis in patients with sinus headache symptoms: a cross-sectional study at Khartoum ENT Hospital

Central Nervous System Involvement in Pediatric Juvenile Idiopathic Arthritis: A Case Report of Cerebellitis and Literature Review.

Autoimmune diseases are a heterogeneous group resulting from dysregulation or dysfunction of the immune system due to genetic predisposition and environmental triggers. It is common for these diseases to coexist. However, except for a single case secondary to varicella zoster virus infection, the association between juvenile idiopathic arthritis and acute cerebellitis has not been reported in the literature. A 9-year-old girl with juvenile idiopathic arthritis, initially presenting with symptoms of headache, nausea and vomiting, was diagnosed with diffuse bihemispheric acute cerebellitis by magnetic resonance imaging (MRI). Various tests were performed to determine the etiology of the disease. Infectious, metabolic, and autoimmune causes were excluded. This case report illustrates an ultra-rare association between juvenile idiopathic arthritis and acute cerebellitis, with a successful outcome following treatment and monitoring. There are 17 children, including our patient, who were followed with juvenile idiopathic arthritis and were found to have central nervous system disorders in the literature. Cerebral vasculitis and optic neuritis were the most commonly diagnosed neurologic disorders. Biologic agents have been implicated in some cases of optic neuritis and aseptic meningitis. Prompt treatment with corticosteroids and discontinuation of suspected biologic agents leads to favorable outcomes. This literature review highlights that early diagnosis and intervention can significantly improve outcomes.

The safety and feasibility of transcranial direct current stimulation and exercise therapy for the treatment of cervicogenic headaches: A randomized pilot trial.

Our primary objective was to evaluate the safety and feasibility of transcranial direct current stimulation combined with exercise therapy for the treatment of cervicogenic headache. Our exploratory objectives compared symptoms of headache, mood, pain, and quality of life between active and sham transcranial direct stimulation combined with exercise therapy. Cervicogenic headache arises from injury to the cervical spine or degenerative diseases impacting cervical spine structure resulting in pain, reduced quality of life, and impaired function. Current standard-of-care treatments such as radiofrequency ablation, pharmacotherapy, manual therapy, and exercise therapy lack efficacy for some patients. Transcranial direct current stimulation is a neuromodulation technique that has shown promise in treating chronic pain conditions by positively altering neuronal activity but has not been evaluated as treatment for cervicogenic headache. This double-blind, sham-controlled, randomized, feasibility trial recruited 32 participants between the ages of 18 and 65 years that met the International Classification of Headache Disorders third edition criteria for cervicogenic headache. Participants were randomized to receive either active or sham transcranial direct current stimulation both combined with daily exercise therapy over 6 weeks. Transcranial direct current stimulation was applied over the primary motor cortex ipsilateral to worse pain for 20 min at 2 mA with a 30 s ramp up/down period. Recruitment, retention, and adherence were evaluated for feasibility. Safety was assessed through serious and minor adverse events and an adverse effect questionnaire. Clinical outcome measures assessed headache, pain, quality of life, and mood symptoms at pre-treatment, post-treatment, and 6- and 12-weeks post-treatment. A total of 97 participants were contacted to participate with 32 recruited, 16 randomized into each group, and 14 completing the treatment protocol in both groups. Within each group 12 (active) and nine (sham) completed treatment within the proposed 6 weeks (three sessions per week), others received 18 sessions but took longer. Exercise therapy was completed on an average of 87% of days for both groups. Transcranial direct current stimulation was safe, with no serious adverse events and one minor adverse event in the active group. Itching was a more common post-intervention complaint in the active group (64% active vs. 43% sham). Exploratory analysis revealed significant group × time interactions for average headache pain from pre- to post-treatment (β = -1.012, 95% confidence interval [CI] -1.751 to -0.273; p = 0.008), 6-weeks (β = -1.370, 95% CI -2.109 to -0.631; p < 0.001), and 12-weeks (β = -1.842, 95% CI -2.600 to -1.085; p < 0.001) post-treatment, and for neck pain from pre- to post-treatment (β = -1.184, 95% CI -2.076 to -0.292; p = 0.010) and 12-weeks (β = -1.029, 95% CI -1.944 to -0.114; p = 0.028) post-treatment favoring active vs. sham. There were no significant group × time interactions for quality of life or mood. The combination of transcranial direct stimulation and exercise therapy is safe and feasible for treating cervicogenic headache. While some promise has been shown for reducing headache and neck pain, larger scale trials with adequate power are needed to confirm these findings.

Relative frequency of primary headaches in patients with neuromyelitis optica spectrum disorder: A cross-sectional study

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease predominantly affecting the central nervous system (CNS). Headaches, although common in patients with multiple sclerosis (MS), have been less studied in NMOSD. This study aimed to investigate the prevalence, characteristics, and associated symptoms of headaches in patients with NMOSD. Methods: This cross-sectional study included 120 patients with NMOSD recruited from MS clinics in Isfahan City, Iran, between 2023 and 2024. Patients were assessed for headache prevalence and characteristics. An expert neurologist conducted examinations to exclude secondary causes of headaches and classified headache types according to the International Classification of Headache Disorders (ICHD-3). Results: Eighteen patients (15%) reported headaches, all of whom were women. The average age of these patients was 41.27 ± 11.33 years, and the average onset age of NMOSD was 34.60 ± 12.12 years. Of the 18 patients, 14 were diagnosed with migraine and 4 with tension headaches. Patients with migraine reported more severe pain (severity score: 6.00 ± 1.42) than those with tension headaches (4.20 ± 1.35). Headache onset was equally likely to occur before or after an NMOSD diagnosis. photophobia, phonophobia, and nausea in patients with migraine, with a substantial impact on occupational disability reported by 57% of migraine sufferers and 50% of tension headache sufferers. Conclusion: Headaches, particularly migraines, are prevalent in patients with NMOSD and significantly impact their quality of life (QOL) and occupational functioning. These findings emphasize the need for clinicians to recognize headache patterns in NMOSD for accurate diagnosis and effective management. Further longitudinal studies are warranted to explore causal mechanisms and develop targeted interventions.

Aspectos de saúde geral, mental e auditiva de trabalhadores da equipe de enfermagem de um hospital público acometidos pela Covid-19

ABSTRACT Purpose: to analyze possible impacts on the general, mental and hearing health of nursing workers affected by the COVID-19 virus. Methods: an exploratory, cross-sectional study, carried out with nursing professionals from a public hospital in Southern Brazil, who answered a questionnaire on general and auditory symptoms after COVID-19 infection, and the Oldenburg Burnout Inventory (OLBI). Statistical analysis was performed using the Chi-square test of independence, the ANOVA test with Tukey's post-test and Pearson's Linear Correlation, with a p-value of 5%. Results: 52 workers participated (17 nurses, 30 technicians, five aides). The symptoms of headache, loss of smell and taste, fatigue and muscle pain were reported by more than 75% of workers; 80.8% either had already been classified as burnout (40.4%) or featured high scores for exhaustion or work disengagement (40.4%), with a correlation with the symptoms of cough (p=0.0327) and fever (p=0.0235); 44.23% had auditory symptoms, with dizziness/vertigo reported by 34.6% and tinnitus by 13.5%, although without correlation with burnout levels (p=0.4250). Conclusion: there were impacts on the general, mental and hearing health of nursing workers who were diagnosed with COVID-19, mainly cough and fever, burnout, tinnitus and dizziness.

Syringa oblata Lindl extract alleviated corticosterone-induced depression via the cAMP/PKA-CREB-BDNF pathway.

Syringa oblata Lindl (ZDX) is a plant in the Oleaceae family that is the primary ingredient in the classic Tibetan medicine AKARU sinensis. The plant's stem is used as a medicine, and Tibetan doctors often use it as a sedative, a use with a history of nearly 100 years. Tibetan medicine mainly uses lilac to treat headache, forgetfulness, insomnia, irritability and other symptoms. Depression is a chronic mental disorder characterized by low mood, cognitive impairments, and physical discomfort, and it has become a significant public health issue. Given the limitations of existing treatments, interest in alternative therapies, including herbal medicines, is increasing. To elucidate the mechanism of ZDX extract in the treatment of depression. A depression-like mouse model was established via the subcutaneous injection of corticosterone (CORT) into the groin, and a model of PC12cell injury was established via CORT treatment. The antidepressant effect of the ZDX extract was subsequently evaluated via weight measurements, the sucrose preference test (SPT), the forced swimming test (FST), the open field test(OFT), the tail suspension test (TST), HE staining, Nissl staining and ELISA. Moreover, immunofluorescence staining, qRT‒PCR and Western blotting were used to determine whether ZDX extract can regulate the cAMP/PKA-CREB-BDNF pathway to prevent depression and neuronal apoptosis. ZDX extract significantly improved depression-like behaviours; inhibited decreases in the protein levels of cAMP, PKA, CREB and BDNF; and increased proliferative activity in the hippocampus and cortex. In addition, in vitro, ZDX extract attenuated CORT-induced injury and apoptosis in hippocampal neurons and inhibited CORT-induced decreases in the mRNA expression levels of cAMP, PKA, CREB and BDNF. These findings suggest that ZDX extract has potential as a novel antidepressant therapeutic agent, offering a complementary approach to current treatments by targeting multiple pathways involved in the pathogenesis of depression. Further research is warranted to explore the clinical applications of ZDX extract in the treatment of depression.

Endoscopic Electric Drilling in the Correction of Nasal Septal Spur of the Vomer

Abstract: Background: Nasal septal spurs (NSS) are a frequent cause of nasal obstruction, headache, and other symptoms. Endoscopic septoplasty (ES), particularly with endoscopic electric drilling (EED), has emerged as a promising alternative to traditional septoplasty, offering superior precision and reducing the incidence of complications. This study aimed to evaluate the effectiveness of EED in the treatment of NSS. Methods: This prospective study was conducted on a cohort of 60 patients with NSS was treated using EED between March 2022 and February 2024. Preoperative assessments included nasal endoscopy, computed tomography (CT), and medical history. Intraoperative bleeding and operative time were recorded, and postoperative complications were monitored. Symptom improvement was assessed using the NOSE (Nasal Obstruction Symptom Evaluation) score. Results: The mean age of the participants was 25.17 ± 7.04 years, with male predominance (53.3%). The average operative time was 9.49 ± 1.14 minutes, and the intraoperative bleeding was 110.33 ± 10.57 ml. Postoperatively, NOSE scores decreased significantly from 70.5 to 15.2 (p &lt; 0.001), indicating substantial symptom relief. Only 1.7% of patients developed septal perforation and 1.7% developed synechia, both of which were managed successfully. Conclusion: EED is a safe, efficient, and minimally invasive technique for correcting nasal septal spurs, providing significant symptom relief with minimal bleeding and a low complication rate. This technique is a promising alternative to traditional septoplasty, particularly for isolated septal spurs. Further studies with larger sample sizes and long-term follow-up are needed to confirm the long-term efficacy of the study.

The Chronic Headache Self-Efficacy Scale: Development and assessment of measurement properties.

To develop and assess the psychometrics of the Chronic Headache Self-Efficacy Scale (CHASE). Existing scales assess self-efficacy in coping strategies and management of symptoms and triggers but do not measure other important self-efficacy domains, such as performing daily activities and socializing in patients with chronic daily headache (CDH). The study had two phases: (i) Development of the 14-item CHASE, with items derived from patients with CDH and a multidisciplinary healthcare team; (ii) longitudinal observational study for psychometric evaluation. Participants with CDH (N = 79) completed the CHASE, Headache Management Self-Efficacy Scale (HMSE), six-item Headache Impact Test-6 (HIT-6), and 12-item Short Form Health Survey (SF-12) at baseline, 24-72 h after baseline, and 12 weeks after baseline. The Global Rating of Change (GROC) assessed perceived change in symptoms. We assessed internal consistency, day-to-day reliability, convergent and known group discriminant validity, dimensionality, and responsiveness via minimal clinical important difference (MCID). For day-to-day reliability, the CHASE intraclass correlation coefficient was 0.68 (95% confidence interval 0.49-0.81), with standard error of measurement and minimal detectable change of 10.3% and 24%, respectively. The CHASE had two independent factors (total R2 = 54.5%) that can be combined into a single score (Cronbach's alpha internal consistency 0.88). For convergent validity, the CHASE score was related to the HIT-6, HMSE, and SF-12 (R2: 0.17-0.29, all p < 0.001). For known group discriminant validity, individuals with an active headache had a lower CHASE score than those without (mean [standard deviation] 47.7 [17.3]% vs. 57.2 [19.8]%, p < 0.001). Classification and regression tree analysis showed the MCID for meaningful positive symptom change on the GROC was a CHASE change of >8% or CHASE change of 8% with baseline CHASE >67%. The CHASE is a reliable and valid questionnaire for assessing self-efficacy in performing daily activities, socializing, managing headache symptoms and triggers, and guiding treatment plans for patients with CDH.

Survey of Association Between Indoor CO and CO2 Levels and Symptoms of Sick Building Syndrome Among Employees at Alang-Alang Lebar and Plaju Health Centers

Poor air quality and exceptionally high CO and CO2 pollutants can be contributing factors to Sick Building Syndrome (SBS). This study evaluated the relationship between individual factors and CO and CO2 levels with Sick Building Syndrome (SBS) symptoms in health center employees. 74 respondents work in the room of Alang-Alang Lebar and Plaju Health Center. Then, the respondents will fill out a questionnaire related to SBS symptoms. The rooms in the selected health centers will be measured for CO and CO2 levels. The results of filling out the questionnaire will be analyzed to determine whether SBS or not, and the results of measuring CO and CO2 levels will also be categorized as normal or not. Univariate and bivariate analyses related to individual employee factors, SBS symptoms, and CO and CO2. The results of 74 respondents showed that 36 respondents (48.6%) experienced SBS. The highest SBS symptoms were red, itchy, dry, or watery eyes (75%), and symptoms of dizziness or headache (71.4%). The highest CO level measurement result was seven ppm, the lowest was six ppm, while the highest CO2 level was 561 ppm, and the lowest was 498 ppm. These measurement results are still within the normal limits of the standards set. Bivariate test results showed that individual factors, CO and CO2, are not significantly related to SBS symptoms (p &gt; 0.05).

Evaluating a 12-week aerobic exercise intervention in adults with persisting post-concussive symptoms.

Although guidelines support aerobic exercise in sub-acute mild traumatic brain injury (mTBI), evidence for adults with persisting post-concussive symptoms (PPCS) after mTBI is lacking. The objective was to evaluate the impact of a sub-symptom threshold aerobic exercise intervention on overall symptom burden and quality of life in adults with PPCS. This prospective cohort study was nested within the ACTBI Trial (Aerobic Exercise for treatment of Chronic symptoms following mild Traumatic Brain Injury). A total of 50 adults with a diagnosis of mTBI, PPCS and exercise intolerance completed a 12-week sub-symptom threshold aerobic exercise intervention either immediately after enrollment (i-AEP group; n = 27) or following 6-weeks of stretching (d-AEP group; n = 23). Data from all participants (n = 50) were included in the combined AEP (c-AEP) group. The primary outcome was symptom burden on the Rivermead Post Concussion Symptoms Questionnaire (RPQ). Secondary outcomes included measures of quality of life and specific post-concussive symptoms (depressive and anxiety symptoms, functional impact of headache, fatigue, sleep, dizziness and exercise tolerance). Heart rate, blood pressure and heart rate variability were also assessed to understand autonomic function response to intervention. Participants were a mean (SD) of 42.6 (10.9) years old (74% female) and 25.1 (14.1) months post-mTBI. Following 12-weeks of intervention participants had a significant improvement in symptom burden on the RPQ (i-AEP: mean change = -9.415, p < 0.001; d-AEP: mean change = -3.478, p = 0.034; c-AEP: mean change = -6.446, p < 0.001). Participants also had significant improvement in quality of life (i-AEP: mean change = 9.879, p < 0.001; d-AEP: mean change = 7.994, p < 0.001, c-AEP: mean change = 8.937, p < 0.001), dizziness (i-AEP: mean change = -11.159, p = 0.001; d-AEP: mean change = -6.516, p = 0.019; c-AEP: -8.837, p < 0.001) and exercise tolerance (i-AEP: mean change = 5.987, p < 0.001; d-AEP: mean change = 3.421, p < 0.001; c-AEP: mean change = 4.703, p < 0.001). Headache (mean change = -5.522, p < 0.001) and depressive symptoms (mean change = -3.032, p = 0.001) improved in the i-AEP group. There was no change in measures of autonomic function. A 12-week aerobic exercise intervention improves overall symptom burden, quality of life and specific symptom domains in adults with PPCS. Clinicians should consider prescription of progressive, individualized, sub-symptom threshold aerobic exercise for adults with PPCS even if presenting with exercise intolerance and months-to-years of symptoms.

Concurrent symptom domains and associations with recovery timelines among collegiate athletes with sport-related concussion

ObjectiveConcussion symptoms can be clustered into domains and understanding how multiple symptom domains present clinically may guide more accurate interventions. We investigate the associations between concurrent symptom domains and clinical...

Combined Effectiveness of Nortriptyline and Topiramate in Comparison to Nortriptyline Alone as Migraine Prophylaxis

Background: Migraine is a chronic neurological illness characterized by recurrent episodes of headache and other related symptoms. Patients who experience severe headaches frequently need to use both acute and preventive medication treatments for migraine. Prophylactic treatment is intended to improve the patient's capacity to function normally, to increase the benefits of acute treatments, and to lessen the frequency, duration, or severity of attacks. Objective: The aim of this study was to compare the combined effectiveness of Nortriptyline and Topiramate in comparison to Nortriptyline alone as migraine prophylaxis. Methods: The Randomized controlled trail was conducted in the department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka, from January 2022 to December 2022. A total of 42 patients were enrolled by block random sampling block of 3, 1:1 design. The Participants were divided into two groups. The 21 patients treated with Nortriptyline were in group A and the 21 patients treated with Nortriptyline-Topiramate were in group B. Results: In this study, in both Group, highest patients in age group 20-29 years. Male: Female ratio was 1:4 and 1:3 respectively in Group A and Group B. At the end of 3rd month, headache frequency was same between two groups (0.0day/month). Median duration of headache and VAS score significantly decreased in two groups. Maximum decreased in Group B compared to Group A. There was the highest reduction of HIT-6 score in Group B (64.3±5.2 to 45.0±5.2). Conclusion: Both drugs were effective in reducing headache. Between them, Nortriptyline-Topiramate provided the best improvement. J Com Med Col Teachers Asso July 2024; 28(2): 48-52

Dysplastic ganglion cell tumor of the right cerebellum: A case report and literature review.

This study aims to present a case of cerebellar dysplastic ganglioneuroma, which is commonly referred to as Lhermitte-Duclos disease (LDD). Furthermore, the study aims to provide an extensive review of the essential aspects of LDD, thereby providing essential information for its accurate diagnosis and effective treatment. A 54-year-old woman was admitted with symptoms of headache, facial numbness, and a visible cerebellar mass. Imaging studies revealed specific features such as the "tiger stripe sign" on magnetic resonance imaging, including hydrocephalus compression and abnormal vasculature. The diagnosis of LDD was made. The cerebellar mass was resected via a paracentral approach. The patient underwent surgery for a cerebellar dysplastic ganglion cell tumor (WHO grade I), confirmed by postoperative pathology. Despite sub-complete resection with minor residuals, the patient experienced significant improvement in symptoms. A postoperative computed tomography scan revealed a large cavity with frontal lobe hemorrhage. PTEN gene testing was recommended but declined due to financial constraints. The patient was discharged without complications. LDD presents both benign and tumor characteristics, with a low likelihood of malignancy. Total resection is the recommended treatment, although challenges in complete excision may lead to recurrence. The importance of considering Cowden syndrome and genetic testing, particularly the PTEN gene, in patients with LDD, is emphasized. Long-term follow-up care is crucial for monitoring recurrence and related conditions.

Secondary nummular headache: Are they more common thanwe thought?

To provide a detailed description of symptomatic nummular headache (NH) and to compare them with primary cases in a large series. While most published cases of NH are primary headache, some 'secondary' cases have been reported since its initial description. It remains uncertain why identical clinical presentations can result from primary and 'secondary' etiologies. Thanks to the possibility of offering specific treatments for symptomatic NH, it is crucial to be able to distinguish between them effectively. This monocentric retrospective study included a cohort of patients diagnosed with NH according to the International Classification of Headache Disorders, Second (ICHD-2) and Third Editions (ICHD-3), and the Pareja etal. first description, over a 20-year period (2002 to 2022). Established ICHD-3 diagnoses were used for each symptomatic case. Causality was attributed if (i) headache had developed in close temporal relation to other symptoms and/or clinical signs, or had led to its diagnosis, and (ii) either the headache had significantly worsened in parallel with other symptoms or clinical or radiological signs of worsening of the underlying disease, or the headache had resolved after treatment of the presumed causative disorder. Symptomatic NH were divided into two groups: "definite" or "probable." A comparison between the "primary" and "secondary" groups is presented. A total of 131 patients (88, 67.2% females) were included in the study. The median (interquartile range) age at onset of symptoms was 52 (36-63.2) years. In all, 34 patients (25.9%) were diagnosed as symptomatic NH (nine post-traumatic, seven attributed to a disorder of the cranial bones, six due to intracranial neoplasia, five attributed to arachnoid cysts, three attributed to vascular malformations, two due to cutaneous disturbances, and two attributed to hypertension). Eight patients were classified as "definite symptomatic NH" and 26 as "probable symptomatic NH." Neuroimaging was performed in all cases. Any previous headache (52.9% vs. 29.9%; p = 0.016), a remote head trauma (26.5% vs. 9.3%; p = 0.015), and a longer disease duration (18 vs. 12 months; p = 0.036) were more likely in patients with symptomatic NH. Preventive treatment was more effective (achieved >50% reduction in monthly headache days) in patients with symptomatic NH (72.2% vs. 30.3%; p = 0.002) due to a cause-specific treatment. Symptomatic NH are frequent. The presence of any previous headache or remote head trauma may suggest a diagnosis of symptomatic NH; however, as certain NH might be an early symptom of intracranial mass lesions, neuroimaging is necessary. Finding the cause of NH is essential to offer the most effective targeted treatment.

Cranial vault expansion in treatment of paediatric idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is a rare clinical entity in the paediatric population. Clinical presentation is mostly similar to adult counterpart and can include headaches, vomiting, papilloedema, deterioration in visual acuity or fields, and 6th cranial nerve palsy, leading to significant morbidity. Therapeutic lumbar puncture and medical treatment with acetazolamide are usually the first-line treatments. In a minority of refractory cases, particularly where visual function is threatened, CSF diversion has been traditionally used in clinical practice. CSF diversion in IIH patients can be associated with high rate of shunt malfunction and revision due to small ventricular size leading to repeated procedures. We describe our experience with cranial vault expansion as a method of treatment of paediatric IIH cases refractory to medical treatment as a CSF diversion sparing method. Following review of IIH cases undergoing surgical treatment in our unit over 15years (years 2009-2024), cases receiving cranial vault expansion as primary surgical treatment were selected and further analysed. Inclusion criteria were paediatric cases (age < 16) undergoing vault expansion as first surgical treatment for IIH refractory to pharmacological treatment for vision-threatening papilloedema. All cases were discussed within multidisciplinary meeting and selected following consideration of all management options. Over the studied period, we identified two cases of refractory IIH with severe papilloedema undergoing cranial vault expansion as primary shunt-sparing surgery. Both patients presented with symptoms of headaches, vomiting, and blurred vision with ophthalmological confirmation of severe papilloedema despite pharmacological therapy. Following multidisciplinary discussions, both underwent successful supratentorial vault expansion. Pharmacological treatment was discontinued in both cases following surgery. Evaluation at latest follow-up showed resolution of symptoms and papilloedema with no need for subsequent cerebrospinal fluid diversion at the latest follow-up. Cranial vault expansion is a viable and safe alternative surgical option in paediatric IIH cases refractory to medical treatment obviating the need for repeated shunt procedures. In cases with extremely small ventricles or where parental choice precludes CSF diversion, cranial vault expansion can be considered.

Feasibility of Fish Oil Supplementation on Headache Symptoms and Blood Lipids in Migraine Patients.

Migraine is a chronic, recurring, and disabling disease. Fish oil intervention was used to investigate its effects on headache symptoms and blood lipids of migraine patients. All subjects were collected at the Kuang Tian General Hospital from March 2020 to May 2021. Experimental group subjects took 1g/time of fish oil (including EPA 900mg/tablet) after breakfast and dinner. Placebo group subjects took 100% soybean oil twice daily. Before and after the test, the migraine improvement questionnaire was used to analyze headaches during attacks, dietary intake, and headache triggers. The average age of the 47 subjects in this study was 40.3 ± 9.2 years old, the body mass index (BMI) was 24.3 ± 6.0kg/m2. At Week 12, subjects in the fish oil group were significantly improved relative to the control group (p < 0.05). Blood lipid indexes TC, LDL-C, and TG were reduced, and the frequency, duration, and pain degree of migraine. Fish oil may be used as an adjunctive therapeutic food for relieving migraine attack symptoms and blood lipids.

Preliminary exploration of metabolomics mechanisms in patients with patent foramen ovale and migraine.

This study aimed to investigate the metabolic mechanisms underlying the combination of patent foramen ovale (PFO) and migraine by assessing metabolite expression before and after interventional occlusion surgery. The study included 11 PFO patients from the Heart Center of Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine, who underwent transcatheter PFO intervention and occlusion surgery between January 2018 and February 2023, and 11 healthy controls. Blood samples were collected pre-surgery, 3 days post-surgery, and 30 days post-surgery for metabolomics analysis. The goal was to identify differentially expressed metabolites between groups. Statistical analyses were performed to evaluate these metabolites alongside migraine disability, assessed using the Migraine Disability Assessment (MIDAS) score. Preliminary analysis of metabolic pathways was also conducted. Results showed significant differences in serum metabolites, including dopamine, L-proline, L-tyrosine, D-proline, acetylcarnitine, and dulcitol, between PFO migraine patients and healthy controls based on Liquid Chromatography-Mass Spectrometry (LC-MS) non-targeted metabolomics analysis. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of these metabolites revealed enrichment in protein digestion, absorption, and metabolic signaling pathways, highlighting the role of metabolism in the disease process. Elevated levels of dopamine and other metabolites were found in migraine patients, with differential metabolites primarily associated with the arginine metabolic pathway, suggesting its importance in the condition's progression. Additionally, patients with PFO and migraine showed significant improvements in headache frequency, duration, and severity post-treatment (p < 0.05), though accompanying symptoms did not show statistically significant changes (p > 0.05). Overall, interventional closure surgery for PFO significantly alleviates headache symptoms in patients.

Endoscopic Occipital Transtentorial Approach for Dorsal Midbrain Cavernous Malformation: Technical Notes With Illustrative Case

BackgroundThe dorsal midbrain, an anatomically intricate region, presents significant challenges for traditional surgical interventions due to the heightened risk of vascular and neurological injury, and the necessity of brain tissue retraction. MethodsThis study retrospectively reviewed the case of a 29-year-old male diagnosed with a cavernous malformation located in the dorsal aspect of the left midbrain. The patient underwent resection via the endoscopic occipital transtentorial approach (EOTA) in July 2024. Comprehensive records were analyzed, including preoperative magnetic resonance imaging (MRI) and computed tomography (CT) imaging, detailed surgical notes, and postoperative outcomes. ResultsThe patient initially presented with headaches and diplopia. Imaging revealed a 17x13 mm tumor in the dorsal aspect of the left midbrain, associated with obstructive hydrocephalus. The 2.5-hour EOTA surgery resulted in complete resection of the tumor, with the resolution of headache symptoms and improvement of diplopia. No new complications were reported postoperatively. The patient was discharged seven days post-surgery without the need for intensive care unit admission. Pathological examination confirmed the diagnosis of a cavernous malformation. Additionally, the EOTA facilitated a concurrent endoscopic third ventriculostomy, and no evidence of hydrocephalus was observed during the three-month follow-up period. ConclusionThe EOTA constitutes a significant advancement in neurosurgical techniques for the resection of dorsal midbrain tumors, enhancing surgical precision and safety. This approach contributes to improved patient outcomes and a reduction in complication rates. Further studies are warranted to validate these findings and to establish standardized protocols for the application of EOTA in midbrain tumor resection.

Comparison of Clinical Symptoms and Laboratory Findings in Typhoid Fever and Dengue Fever Patients

Abstract: Background: Typhoid fever and dengue hemorrhagic fever (DHF) are two infections that often occur in tropical and subtropical areas, including Indonesia, with similar clinical symptoms but different pathogens. Accurate diagnosis is essential for proper management. Objective: This study aims to analyze the differences in clinical symptoms and laboratory findings in typhoid fever and dengue fever patients at Aek Kanopan Regional Hospital, North Labuhan Batu Regency, North Sumatra. Method: This research is an observational comparative study involving 100 patients diagnosed with typhoid fever and dengue fever during the period December 2023 to February 2024. Data on clinical symptoms and laboratory examination results were collected and analyzed using descriptive and inferential statistics. Results: Results show that symptoms of stomach ache and headache are more common in typhoid fever patients, while rash and muscle pain are more prevalent in dengue fever patients. From a laboratory perspective, typhoid fever patients have an increased number of leukocytes (12,000 ± 3,500 cells/µL) compared to dengue fever (9,000 ± 2,000 cells/µL), while platelets in dengue fever patients are on average lower (45,000 ± 15,000 cells/µL) compared to typhoid fever (75,000 ± 20,000 cells/µL). Conclusion: This study confirms the importance of understanding the clinical and laboratory differences between typhoid fever and dengue fever to improve the accuracy of diagnosis and patient management. These results contribute to the development of better clinical guidelines for managing febrile infections in areas with high prevalence.