Electroencephalogram and HIV infection: a prospective study in 100 patients.

In order to study the correlation between central nervous system (CNS) involvement and EEG abnormalities in HIV infection we studied 100 consecutive HIV patients. Patients were divided into 4 groups; Group I: 42 neurologically asymptomatic subjects; Group II: 6 patients with peripheral neuropathies; Group III: 28 patients with AIDS Dementia Complex; Group IV: 24 patients with secondary CNS involvement. The results of this study emphasize that abnormal EEGs are correlated with CNS involvement. Neurologically asymptomatic patients showed no abnormal tracings, but the presence of borderline EEGs (33%) in asymptomatic patients should be evaluated prospectively.

Impairment of memory and consciousness in migraine: clinical and EEG study.

We report the clinical and EEG study of three migraine patients who presented with peculiar clinical phenomena related to migraine attack. The first case is a transient global amnesia that followed a classic migraine status. The second is a confusional state that complicated a classic migraine attack. The third is a complex attack with combined features of migraine and epilepsy.

Cardiovascular and biochemical assessment in migraine patients submitted to tilt test.

Ten migraine patients underwent a tilt test both during migraine attack and headache-free interval, and the following parameters were assessed: plasma levels of norepinephrine (NE), and serum dopamine beta hydroxylase (D beta H), systolic and diastolic blood pressure and heart rate (SBP, DBP, HR). SBP during the tilt test showed a fall greater than 30 mmHg in 2 cases in the headache-free interval and in 4 cases during migraine attack. In migraine patients in headache-free interval, tilt test increased NE and D beta H as it did in the control group, while in migraine attack tilt test increased NE and D beta H less than in the control group. This impairment of the sympathetic nervous system during the migraine attack is discussed.

Fatal cerebral haemorrhage after liver transplantation in a patient with transthyretin variant (gly53glu) amyloidosis.

Transthyretin (TTR) amyloidosis is a form of systemic amyloidosis caused by an amyloidogenetic TTR variant. The most common mutant forms of TTR are mainly produced by the liver and therefore orthotopic liver transplantation (OLT) is currently accepted as the only known curative treatment. We describe the clinical and pathological features of a patient with TTR variant (gly53glu) with TTR amyloid infiltration of the leptomeningeal vessels in whom fatal cerebral haemorrhage occurred two months after OLT, soon after severe viral pneumonia.

Epidemiology of status epilepticus in a rural area of northern Italy: a 2-year population-based study.

We performed a 2-year population-based study on status epilepticus (SE) in adults in the rural area of Lugo di Romagna, northern Italy, to verify whether an area of low-level urbanization has a lower risk of occurrence of SE (as recently suggested), different clinical features and short-term prognosis than areas of high-level urbanization. We found crude and age- and sex-adjusted annual incidence rates of SE of 16.5/100 000 and 11.6/100 000, respectively. In patients under 60 years crude incidence was 2.9/100 000 and in the elderly (>/=60 years) 38.6/100 000. Acute symptomatic SE accounted for 30% and a cerebrovascular pathology was the most frequently associated etiologic condition (60%). A history of seizures was reported in 41% of patients. The first therapeutic intervention was mainly benzodiazepines (lorazepam 46%; diazepam 33%). The 30-day case fatality was 7%. We observed that the adult population of an area with a low level of urbanization has the same risk for SE, clinical features and short-term prognosis as European urban areas. The only contrasting result is the 30-day case fatality of 7% against the 39% found in the other Italian study (Bologna), despite the similarity of the SE features in these two areas of the same region. We infer that the short-term prognosis of SE could also be considerably influenced by differences in health service organization (and hence management) possibly due to different levels of urbanization.

Migraine with aura and photosensitive epileptic seizures: a case report.

An 18-year-old female presented with two seizures induced by photic stimulation. She had a positive family history for migraine and a history of febrile convulsions. Since the age of 13 she had suffered from migraine attacks with aura. A brain computerized tomography with contrast enhancement was negative and several electroencephalograms showed a photoparoxysmal response. At the age of 18 she had a partial secondary generalized seizure after photic stimulation during routine electroencephalogram. The onset of seizure was in the occipital region. Two days later, the patient presented with a typical migrainous attack with aura. Interictal apomorphine test (1.5 mg s.c.) blocked the photoparoxysmal response. According to Quesnay, dopaminergic failure of the occipital cortex may account for both epileptic and migraine features.

Transient abnormalities on magnetic resonance imaging after partial status epilepticus.

We report two patients who developed focal abnormalities on MRI after partial status epilepticus. Maximum radiological modification occurred in the area of maximal epileptic discharge. Subsequent MRI failed to demonstrate persistent abnormalities. These transient abnormalities on MRI could be an expression of cerebral edema caused by focal epileptic status.

Accuracy of ICD-9 codes in identifying ischemic stroke in the General Hospital of Lugo di Romagna (Italy).

We assessed the sensitivity and the positive predictive value (PPV) of the ICD-9 codes in identifying ischemic strokes. The study involved the cross-sectional comparison between patients with an ischemic stroke diagnosis made by neurologists and patients with the 434 or 436 discharge codes. Sensitivity of the codes (all diagnostic levels and first level respectively) was 82% and 76%; PPV: 71% and 76%. The annual crude incidence of ischemic stroke was 2.62 per 1000 based on verified strokes and 3.03 per 1000 based on 434 or 436 coded medical records (at all diagnostic levels). Thirty-day case fatality ratio was 22.3% in verified strokes and 36.8% among patients diagnosed with codes 434 or 436 but without stroke (all levels). Our results disclosed inaccuracy in use of the ICD-9 codes in the diagnosis of ischemic stroke in the general hospital of Lugo di Romagna, Ravenna Province, Italy. The misdiagnosis of patients could be influenced by the degree of severity of clinical features. Epidemiological data and cost-analysis forecasts based only on the ICD-9 system must be considered with caution.

Normal muscle mitochondrial function in Ramsay-Hunt syndrome.

Mitochondrial encephalomyopathies may display clinical features similar to Ramsay-Hunt syndrome (RHS). We studied muscles mitochondrial function in 2 patients with RHS. Histochemical and ultrastructural studies of muscle biopsies and biochemical analysis of muscle mitochondrial enzymes were normal. There is no evidence for a disturbance of muscle mitochondrial function in RHS.

Acute psychosis and epileptic seizures as the presenting symptom of late-onset epilepsy.

We report two patients with no history of psychosis or epilepsy presenting with acute psychosis and epileptic seizures as the initial symptom of late-onset epilepsy. Seizures and psychosis resolved with phenytoin. Case 1 presented a recurrence of both psychosis and seizures following abrupt withdrawal of antiepileptic drugs.

Status epilepticus with cognitive symptomatology in a patient with partial complex epilepsy.

A 16-year-old patient who had a history of complex partial seizures, had frequent episodes of status epilepticus with diffuse slow-wave discharges. The clinical manifestations were apparently insignificant due to the fact that vigilance, orientation and behaviour were unimpaired. Neuropsychological investigations showed that the cognitive processes were selectively impaired during such episodes. The electroclinical pattern was interrupted by break-off of contact concomitant with high-frequency spike discharges. Cognitive impairment is believed to represent the specific feature peculiar to this type of status epilepticus.

Late seizures in patients with internal carotid and middle cerebral artery occlusive disease following ischaemic events.

The occurrence of post-infarction epilepsy was investigated in 68 patients with angiographically proven internal carotid artery occlusion and in 56 patients with middle cerebral artery occlusion. Epileptic seizures occurred during follow-up in 9% of the carotid artery group and in 21.4% of the middle cerebral artery group. The different incidence of seizures in the two groups was statistically significant. The physiopathological mechanism of the late post-infarction epilepsy is discussed.

Epidemiology of headache in the Republic of San Marino.

An epidemiological survey on headache was performed in the Republic of San Marino, which is the smallest independent State in the world, located near the Adriatic Coast, within Italy. Among a random sample of 1500 inhabitants over 7 years of age the frequency of headache, severe headache and migraine in the previous year was 35.3%, 12.2%, 9.3% respectively for men, and 46.2%, 20.6%, 18% for women. The most common factors reported to provoke headache were emotional stress, physical strain, lack of sleep, particular foods or drinks and for women menstruation. Migraine patients differed from people without headache in that they had a higher consumption of coffee, more frequently reported bad sleep, allergic disease and previous appendectomy. Furthermore, migraine patients and severe headache sufferers had a higher diastolic blood pressure than non headache subjects.

Analysis of outcome predictors of migraine towards chronicity.

Long-term migraine evolution is still undefined. The poorest outcome is the transformation from episodic attacks to a pattern of daily attacks or continuous headache with intermittent attacks. We called these cases "chronic migraine". The aim of our study was to investigate whether some clinical variables contributed to migraine chronicity. We interviewed 50 patients with chronic migraine from 2 to 15 years and 90 patients with episodic migraine matched for sex and age as a control group. Univariate analysis revealed two correlations with a chronic outcome: (1) In the control group a significantly higher number of women took oral contraceptives. (2) In the group who developed chronic migraine, there were a greater number of smokers, without reaching statistical significance. The stepwise multiple logistic regression method showed that these two variables influence the prognosis with a maximum likelihood estimate of 65%, hence not much higher than random probability.

Flunarizine in common migraine: Italian cooperative trial. II. Long-term follow-up.

The effects of flunarizine administration (10 mg/day, at bed time) were studied in 120 common migraine patients who were followed for 24 months with quarterly controls. Besides headache index (HI) and analgesic use, other variables were monitored, such as arousal (Tolouse Pieron test), mood (Hamilton rating scale for depression), sleep/wake (hrs) and body weight. The study was open-type and after the 6th month control some responder (R) cases (HI reduction greater than or equal to 60%) presenting HI scores less than or equal to 4 could continue the survey off-treatment. The percentage of R cases was 54.5% at the 3rd month, a figure that further increased up to 72% by the 9th month; relapses on treatment were not observed and rebound-headache occurred in 1/4 of R cases let off-treatment. Lower (p less than 0.05) baseline HI values characterized non-responders. Side-effects not requiring withdrawal were drowsiness (42% within the 1st month) and weight gain (mean 7.9 +/- 6.9 kg) in 54% of the cases, while a retarded type depression was the most frequent cause of drop-out from trial (7.5%). The results, while confirming the high prophylactic activity of flunarizine in common migraine, stress the importance of clinical long-term survey of side-effects using antimigraine drugs and suggest the need for further investigations about flunarizine effects on CNS.

Status epilepticus in acute ischemic stroke.

Stroke is one of the most frequent causes of acute symptomatic status epilepticus. The aim of this study was to investigate the electroclinical features of status epilepticus in acute ischemic stroke. Nine consecutively admitted patients with status epilepticus during ischemic stroke were examined: five of them had convulsive unilateral or generalized status epilepticus for from 24 hours to 9 days after a large hemispheric infarction, always associated with EEG epileptiform abnormalities; the remaining four had focal motor status epilepticus during the first 24 hours after a small cortical or subcortical infarction, and showed no clear EEG changes. Status epilepticus in acute ischemic stroke may have two distinct electroclinical patterns of different prognostic significance.