Solar insolation in springtime influences age of onset of bipolar I disorder.

OBJECTIVE: To confirm prior findings that the larger the maximum monthly increase in solar insolation in springtime, the younger the age of onset of bipolar disorder. METHOD: Data were collected from 5536 patients at 50 sites in 32 countries on six continents. Onset occurred at 456 locations in 57 countries. Variables included solar insolation, birth-cohort, family history, polarity of first episode and country physician density. RESULTS: There was a significant, inverse association between the maximum monthly increase in solar insolation at the onset location, and the age of onset. This effect was reduced in those without a family history of mood disorders and with a first episode of mania rather than depression. The maximum monthly increase occurred in springtime. The youngest birth-cohort had the youngest age of onset. All prior relationships were confirmed using both the entire sample, and only the youngest birth-cohort (all estimated coefficients P < 0.001). CONCLUSION: A large increase in springtime solar insolation may impact the onset of bipolar disorder, especially with a family history of mood disorders. Recent societal changes that affect light exposure (LED lighting, mobile devices backlit with LEDs) may influence adaptability to a springtime circadian challenge.

Revolutionizing migraine management: advances and challenges in CGRP-targeted therapies and their clinical implications.

Migraine, a prevalent neurological disorder, affects approximately 14.1% of the global population and disproportionately impacts females. This debilitating condition significantly compromises quality of life, productivity, and incurs high healthcare costs, presenting a challenge not only to individuals but to societal structures as a whole. Despite advances in our understanding of migraine pathophysiology, treatment options remain limited, necessitating ongoing research into effective therapies. This review delves into the complexity of migraine management, examining the roles of genetic predisposition, environmental influences, personalized treatment approaches, comorbidities, efficacy and safety of existing acute and preventive treatments. It further explores the continuum between migraine and tension-type headaches and discusses the intricacies of treating various migraine subtypes, including those with and without aura. We emphasize the recent paradigm shift toward trigeminovascular activation and the release of vasoactive substances, such as calcitonin gene-related peptide (CGRP), which offer novel therapeutic targets. We assess groundbreaking clinical trials, pharmacokinetic and pharmacodynamic perspectives, safety, tolerability, and the real-world application of CGRP monoclonal antibodies and gepants. In the face of persisting treatment barriers such as misdiagnosis, medication overuse headaches, and limited access to specialist care, we discuss innovative CGRP-targeted strategies, the high cost and scarcity of long-term efficacy data, and suggest comprehensive solutions tailored to Turkiye and developing countries. The review offers strategic recommendations including the formulation of primary care guidelines, establishment of specialized outpatient clinics, updating physicians on novel treatments, enhancing global accessibility to advanced therapies, and fostering patient education. Emphasizing the importance of lifestyle modifications and holistic approaches, the review underscores the potential of mass media and patient groups in disseminating critical health information and shaping the future of migraine management.

Y-stent-assisted coil embolization of wide-neck intracranial aneurysms. A single center experience.

This report evaluated the short and midterm results of the safety and effectiveness of the treatment technique with hybrid and non-hybrid Y-configured, dual stent-assisted coil embolization of wide-neck intracranial aneurysms, and reviewed the literature concerning this technique. Nine patients, eight with unruptured and one with ruptured aneurysms were included in the study. Of aneurysms embolized with a hybrid (with two different stents) and non-hybrid (with two identical stents) technique, three were located in the anterior communicating artery, three at the tip and one at the distal site of basilar artery, and two in the middle cerebral artery. All aneurysms included the orifices of bifurcation vessels. All aneurysms were stented and embolized during the same session. While Neuroform and Enterprise stents were used in the hybrid technique, two Enterprise stents were used in the non-hybrid technique. Dual Y-stent assisted coil embolization was performed successfully in eight of nine patients (88.9%), including five patients (55.6%) with hybrid and three patients (33.3%) with non-hybrid technique. No procedural complication, no mortality and no minor or major neurological complications were seen during the angiographic or clinical follow-up. When an attempt was made at passing the second stent through the first Enterprise stent, the stent protruded inside the aneurysm in one patient (11.1%). Hybrid or non-hybrid dual Y-stent-assisted coil embolization in the treatment of ruptured or unruptured wide-neck and complex intracranial aneurysms is a safe and effective method from the viewpoint of short and midterm results.

Perfusion and diffusion magnetic resonance imaging in idiopathic intracranial hypertension.

OBJECTIVES: Idiopathic intracranial hypertension (IIH) is characterized by abnormal elevation of intracranial pressure without any underlying etiologic factor. Papilledema is the major clinical finding whereas neuroradiological imaging findings are almost always normal. The aim of this preliminary study was to determine if diffusion and perfusion magnetic resonance imaging in patients with IIH might be beneficial in the management of the disease. MATERIALS AND METHODS: Prospectively, we evaluated standard magnetic resonance, magnetic resonance angiographies and venographies, diffusion and perfusion magnetic resonance findings of 16 patients with IIH and of 16 age-, sex-, and weight-matched normal individuals as a control group. Patients with IIH underwent a detailed neuroophthalmologic examination and lumbar puncture for evaluation of cerebrospinal fluid pressure. Magnetic resonance imaging was performed with 1.5 T equipment. RESULTS: On physical examination, all patients had characteristic papilledema, varying degrees of headache, blurred vision and tinnitus. Cerebrospinal fluid pressure was higher than 250 mm H2O in all patients. A statistically significant decrease in cerebral blood flow in six patients, whereas insignificant increase in two were detected. Cerebral blood volume values were almost similar to normal control group's values. Significant mean transit time prolongation was found in six patients as well. CONCLUSIONS: Idiopathic intracranial hypertension is a clinical syndrome which requires prompt diagnosis and a thorough evaluation. Treatment is crucial for preventing visual loss and improving associated symptoms. It is also important to detect cerebral perfusion changes, as cerebrovascular complications may be associated. Although our patient group is small for statistical evaluation, it is a preliminary study using perfusion and diffusion magnetic resonance which may contribute to IIH management.

Accuracy of bedside diagnosis versus Allen and Siriraj stroke scores in Turkish patients.

Computerized tomography and magnetic resonance imaging allow the accurate diagnosis in stroke and distinction of ischemic from hemorrhagic lesions. However, clinical diagnosis is still critical where neuroimaging techniques are not available, especially to establish first-aid measures in a stroke patient. In this prospective study of 300 patients with stroke, the diagnosis of ischemic and hemorrhagic strokes was made as an informal bedside diagnosis prior to neuroimaging. The accuracy of bedside diagnosis was also compared with the results of the Allen and Siriraj stroke scores. Then, the reliability of these scores and our informal bedside diagnosis, along with the final diagnosis, were compared with each other. Our informal bedside diagnosis was correct in 250 of the 300 patients (83.3%). The diagnostic sensitivity and positive predictive value (PPV) of bedside diagnosis for ischemic stroke were 87.8% and 86.0% and for intracerebral hemorrhage 75.7% and 78.5%, respectively. Sensitivity and PPV for every cut-off value of the Allen and Siriraj stroke scores were less than that of sensitivity and PPV of informal bedside diagnosis. When the receiver operating curves obtained from the Allen and Siriraj stroke scores were compared, the Allen stroke score was found to be a better predictor in the final diagnosis. Our data suggest that an informal bedside diagnoses is as good as diagnoses made on certain intracerebral hemorrhages and on certain ischemic strokes by the Siriraj and Allen stroke scores; when compared, the Allen score seems to be better than the Siriraj stroke score. Hence, the use of both scores is recommended in epidemiologic studies as a screening tool as suggested by previous studies employing other diagnostic tools in clinics.