Identifying idiopathic intracranial hypertension in a hospital-based chronic headache population: Utility of magnetic resonance imaging, magnetic resonance venography and trans-orbital sonography.

BACKGROUND: One of the most underestimated types of chronic headaches is headaches as a result of cerebro-spinal fluid dysregulation disorders. Idiopathic intracranial hypertension (IIH) presents with headache and visual symptoms and usually is associated with papilledema. We identified patients with IIH in a chronic headache population presenting to a hospital-based headache clinic, and studied its associations with clinical, sonographic and magnetic resonance imaging (MRI) findings. METHODS: Of 168 patients, 141 chronic headache patients were identified and completed the study procedures (semi-structured medical interview, fundus examination, MRI brain with magnetic resonance venography (MRV) and trans-orbital sonography (TOS)). Patients with abnormal findings underwent lumbar puncture for opening pressure. RESULTS: The prevalence of IIH was 27%. IIH patients were of higher age, had gnawing/throbbing headache in the vertex in most cases, and had higher body mass index. Fundus examination had a sensitivity of 79% and a specificity of 98% for the detection of IIH cases. Approximately 23% of IIH patients had no papilledema. The most sensitive MR sign was found to be transverse sinus stenosis. TOS showed optic nerve sheath dilation in 35.7% of IIH without papilledema cases. CONCLUSIONS: The prevalence of IIH is high in the chronic headache population and should be suspected in the headache clinic setting, particularly because there is significant overlap with migraine symptomatology. MRI/MR venography and TOS can be useful adjunct tests to identify IIH patients.

Sexual dysfunction in male patients with Parkinson's disease: related factors and impact on quality of life.

BACKGROUND: Sexual dysfunction (SD) is a common, yet under-reported, non-motor symptom (NMS) of Parkinson's disease (PD). The present study investigated the sexual functions in PD male patients, its correlation with motor and other NMSs, and their impact on health-related quality of life (HRQoL). METHODS: The sexual functions of 40 PD male patients were assessed using the International Index of Erectile Function (IIEF) and compared to 25 healthy age-matched controls. Patients were evaluated using the NMS Scale (NMSS) and the Arabic version of the Parkinson's-Disease Questionnaire (PDQ-39). We compared the sexual functions of younger (≤ 55 years) and elder (> 55 years) males and tested the correlations between sexual functions and motor, other NMSs, and HRQoL. RESULTS: Seventy percent of PD male patients reported erectile dysfunction. They showed significantly worse total (p < 0.001) and subscores of IIEF, compared to healthy controls. The total IIEF was inversely correlated to age of patients (p = 0.013), age at onset (p = 0.043), total, cognitive/mood, gastrointestinal and urinary domains of NMSS, and the cognitive domain of PDQ-39 (p = 0.013). Age was the main predictor (ß = - 0.581, p = 0.006) of SD. Elder patients showed worse sexual functions, stronger correlations to other NMSs, and more impact on HRQoL than younger patients. CONCLUSION: Sexual functions are worse among PD male patients with age as the main predictor. SD was associated with worse cognitive/mood and urinary domains of NMSS and has a negative impact on the patients' HRQoL among elder males.

Intracranial steno-occlusive arterial disease and its associations in Egyptian ischemic stroke patients.

BACKGROUND AND PURPOSE: Intracranial arterial steno-occlusive disease is prevalent among non-white populations. We explored whether a similar pattern exists in Egyptians and assessed its clinical-radiological associations. METHODS: Consecutive acute ischemic stroke patients were recruited for 6 months and had magnetic resonance imaging/magnetic resonance angiography of brain within 2 days of the event. Magnetic resonance angiography was analyzed for significant stenosis (>50%), flow gaps, and complete occlusions in the major intracranial arteries. RESULTS: A total of 143 patients completed the study (62.4 ± 12.6 years, 58.7% males). Magnetic resonance angiography showed symptomatic arterial stenosis in 27.3%, asymptomatic stenosis in 16.1%, and occlusions in 23.7% patients. Carotid duplex showed stenosis >70% in only 7.7% patients. Patients with intracranial arterial steno-occlusive disease had higher National Institutes of Health Stroke Score at admission (10.9 ± 7 versus 8 ± 5.6; P=0.01). CONCLUSIONS: Symptomatic and asymptomatic intracranial arterial steno-occlusive disease was prevalent in this Egyptian acute stroke sample. This might have important implications on stroke management in this population.

Association of white matter hyperintensities with migraine phenotypes and response to treatment.

INTRODUCTION: White matter hyperintensities (WMHs) are frequently found in migraineurs. However, their clinical significance and correlation to different migraine phenotypes and treatment responses are not well defined. The study aimed to examine the association of WMHs with migraine clinical patterns and treatment response. AIM OF WORK: We aimed to evaluate the association between WMHs and migraine phenotypes and explore the relationship of WMHs to treatment response. METHODS: Our cross-sectional study formed of 500 migraineurs who sought treatment in Kafr el-sheik university hospital and underwent (3 T) MRI to evaluate WMHs. Different migraine phenotypes were compared between patients with and without WMHs. According to reduced headache pain intensity and frequency, these patients were divided into treatment responder and non-responder groups. RESULTS: A total of 145 patients (29%) had WMHs. Patients with WMHs were significantly older, had a longer disease duration, and higher attack frequency. Patients who did not respond to acute and maintenance medications had a higher frequency of WMHs and high WMHs Scheltens score. Migraine with Aura and the presence of vomiting and dizziness were predictors for the development of WMHs. CONCLUSION: WMHs are more common in migraine with aura. It is more frequent in migraine associated with vomiting and dizziness. WMHs increased with advancing age and more severe disease burden. Poorer response to acute and prophylactic medications was found in patients with WMHs.

Kyphoplasty experience in an elderly.

OBJECTIVE: Vertebral compression fractures due to osteoporosis are seen frequently. Osteoporotic compression fractures can cause severe pain, limitation of physical activities and impairment of quality of life. Kyphoplasty, a minimally invasive procedure, could be effective in many cases and can provide fast pain relief. CASE: A patient with a history of falling from a height of 8 months duration visited our pain clinic. Opioids and anti-inflammatory analgesics were administered together with physical therapy and facet joint injections with no improvement. Radiological examination of the patient showed collapse fracture of L2 and L4 vertebrae on top of severe osteoporosis. Kyphoplasty was performed at the level of L2 vertebrae followed by 50% relieve in her pain (VAS score reduction from 8 to 3) and hence she was capable to resume her daily activities. CONCLUSION: Percutaneous balloon kyphoplasty is a safe and effective procedure for the treatment of elder patient with osteoporotic vertebral compression fractures.