The burden and health care use of patients with migraine and tension-type headache in post-conflict area of Serbia.

PURPOSE: The aim of the present study was to assess the burden and health care use of adult patients with migraine and tension type headache in a post-conflict area of Serbia. METHODS: This cross-sectional study was conducted on a representative sample of adults, living in predominantly Serb communities on the Kosovo and Metohija territory. The required data was obtained through a survey, utilizing a culturally-adapted questionnaire. The study sample comprised of 1,062 adults. RESULTS: In the year preceding the study, 49.7% of included subjects suffering from migraines and 27.5% of those experiencing tension type headache sought medical assistance for their condition. The majority (88.5%) of the respondents utilized non steroid antiinfammatory drugs as analgesic, while 14.2% used prophylactic treatment. Migraine sufferers reported losing on average 11.1 days in a 3-month period, while those experiencing tension type headache lost 4.7 days (p < 0.001) due to headaches, preventing them from partaking in professional, family and social activities. On headache-free days, 24.5% of the respondents were anxious or tense in anticipation of a headache onset, while 30% did not feel that the headache had completely resolved. Moreover, 11.5% of the sample reported never or rarely feeling in control of the headache, while 20% of the respondents were of view that their headaches were not taken seriously by their employer and co-workers and rarely discuss them. Adverse effect of headaches on education is more frequently noted by migraine sufferers than those experiencing tension type headache (p = 0.001), and this disparity persists in relation to career (p < 0.001) and family planning (p = 0.001). CONCLUSIONS: In Kosovo and Metohija, primary headaches exert a profound influence on the affected individuals and their community, and thus require recognition as one of the priorities of social initiatives aimed at the enhancement of public health.

The first prevalence study of primary headaches in adults in a post-conflict area of Serbia.

AIM: The aim of the present study was to establish annual prevalence of primary headaches, migraine, and tension-type headache among adults in a post-conflict area of Serbia. METHODS: The data for this cross-sectional study was obtained via face-to-face interviews using questionnaires specifically designed for this purpose, in line with the available guidelines. The study sample included adults aged 18-65 years whose native language is Serbian with residence in six predominantly Serbian communities in Kosovo and Metohija. Relevant diagnoses were established according to the diagnostic criteria of the International Classification of Headache Disorders, 3rd edition. RESULTS: The study included 1062 adults. Analyses indicated 47.7% prevalence of primary headaches. The 1-year prevalence of migraine (with aura and without aura) and tension-type headache was established at 15.2% (3.3% and 11.9%), and 32.2%, respectively. One-year prevalence of chronic headache was calculated at 3.5%, while the prevalence of medication overuse headache was slightly lower at 2.9%. Primary headaches were more prevalent among women, participants residing south of the river Ibar, married or cohabiting individuals, as well as among interviewees (persons) who reported feeling unsafe in Kosovo and Metohija. This is the first study of the prevalence of primary headache disorders in Serbia. The obtained data is comparable to the data available for other countries, especially those in the Balkan region.

The right vertebral artery arising from the right common carotid artery: report of a rare case.

Anomalous origins of the vertebral arteries are uncommon and generally associated with other abnormalities of the supra-aortic vessels. We present an extremely rare case where the right vertebral artery is arising from the right common carotid artery, with an absent brachiocephalic trunk, and the right common carotid artery as the first branch of the aortic arch followed by right subclavian artery, without any other abnormalities of the supra-aortic vessels. This vessel variation can affect endovascular procedures, surgical interventions and cause some unexpected clinical symptoms.

Vasculature and neurovascular relationships of the trigeminal nerve root.

BACKGROUND: Specific microanatomical characteristics of the trigeminal nerve root (TNR) blood supply and close neurovascular relationships with surrounding vessels as well as their possible clinical significance were the main reasons for this study. METHOD: The vasculature of 25 adult and four fetal TNRs were microdissected and examined under the stereoscopic microscope, after injecting their arteries with India ink. RESULTS: The trigeminal vessels, which varied between two and five in number, arose from two or three of the following arteries: the superolateral pontine (92%), anterior inferior cerebellar (AICA) (88%), inferolateral pontine (72%), and superior cerebellar (SCA) (12%). The trigeminal vascular twigs had a mean diameter of 0.215 mm. A single vessel may supply either the motor portion of the nerve root or the sensory portion or both. The trigeminal vasculature formed the proximal and distal rings. The proximal ring was located at the trigeminal root entry zone. Its central branches extended along the TNR to the principal sensory and motor trigeminal nuclei while its peripheral longitudinal twigs followed the TNR fascicles. The incomplete distal arterial ring embraced the middle portion of the TNR before the level of its entrance into the arachnoid sleeve. The most frequent contact of the TNR was noticed with the SCA (20%), the petrosal or Dandy's vein (24%), and the AICA (12%). CONCLUSIONS: The observed characteristics of the TNR vasculature could be the anatomical basis for decompressive neurovascular surgery.

Morphometric analysis of the fascicular organisation of the optic nerve.

BACKGROUND/AIM: The optic nerve is anatomically observed in four segments: intrabulbar, orbital, canalicular, and cranial. According to the literature, the surface of the transversal cut of the nerve is different through it. The aim of this study was to evaluate the fascicular organisation of the optic nerve, throughout its three segments fromthe eye. METHODS: Five pairs of optic nerves, obtained from the autopsies were examined. Using Heidenhain's (azan) staining, the cuts were prepared for microscopy. Morphometric analysis was performed using the stereological methods for morphometric cytology--the Weible's testing system M42. The following measures were established: the surface of the transverse cut of the nerve, the entire surface of fasciculi, the entire surface of connective tissue and blood vessels, the number of fasciculi, the surface of a single fasciculus. RESULTS: The surface of the transverse cut of the nerve was found to grow from the orbital to the cranial segment, as well as the entire surface of fasciculi. While their number is significantly lower in the cranial segment, the number of fasciculi varied slightly between the orbital and the canalicular segment. The surface of a single fasciculus grows from the bulb to the chiasma. There is probable a cause to believe that this may be due to fusion of the "small" fasciculi in the orbitocranial direction. CONCLUSION: There are significant differences among the examined parameters of the different parts of the optic nerve.

Intramesencephalic course of the oculomotor nerve fibers: microanatomy and possible clinical significance.

Comprehension of the mesencephalic syndromes that affect oculomotor nerve fascicles requires a detailed knowledge of their relationship with the adjacent structures and the blood supply of the central midbrain region. This was the reasoning behind our study, which was performed in ten serially sectioned midbrains stained with cresyl violet and luxol fast blue, in three microdissected midbrains, and in two injected and cleared specimens. Three continuous groups of the intramesencephalic oculomotor nerve fascicles were distinguished: the caudal, intermediate and rostral. The caudal fascicles, which most likely innervate the superior rectus and the levator palpebrae superioris muscles, extend through the superior cerebellar peduncle just caudal to the red nucleus and close to the lateral lemniscus. The intermediate fascicles, devoted to the medial rectus and the inferior oblique muscles, always pass through the superior cerebellar peduncle, just medial to the caudal part of the red nucleus (60 %), and less frequently (40 %) through the nucleus itself. The rostral oculomotor fascicles, which terminate in the inferior rectus and sphincter pupillae muscles, course medial to the rostral part of the red nucleus. While the rostral and intermediate oculomotor fascicles are supplied only by the medial twigs of the paramedian mesencephalic perforating arteries, the caudal fascicles are also nourished by the lateral branches of the same perforating arteries. The data obtained form an important basis for the explanation of certain mesencephalic syndromes, and even anticipate some new syndromes not yet described in the literature.

[Vasculature of the distal part of optic nerve].

BACKGROUND/AIM: Vascularisation of the distal, namely intracranial and intracanalicular parts of the optic nerve have not been explained in conventional textbooks of anatomy, while there have been explanations of proximal, that is intraorbital segment. The aim of this research was to study the pattern of arterial supply of the intracranial and intracanalicular part (the distal part) of human optic nerve. METHODS: The optic nerve and the ophthalmic artery (OA), predominately in their intracranial and intracanalicular parts, were investigated in 25 human specimens by three different methods: macroscopic, stereomicroscopic, and histological observations. Mixture with 10% of India ink and gelatin was injected through the intracranial part of the internal carotid artery, and the most proximal part of the OA. Each optic canal specimen was fixed in formaldehyde and finally paraffin embedded, sectioned, and stained with Masson trichrome, Azan, Toluidin blue, and Van Gieson methods. RESULTS: OA passed through the optic canal within the dural sheath of the optic nerve. In 44% of our specimens the OA was on the inferomedial side of the optic nerve at the entrance point to the optic canal. OA left the optic canal at its lateral border in the apex of the orbit in 72% of our specimens. The intracanalicular portion of the optic nerve receives arterial blood principally from the intracanalicular part of OA. OA gives one (72% of the specimens) to two branches that supply the intracanalicular part of the optic nerve. Each branch pierces the dura mater from below and then supplies the nerve through the pia mater. These arteries then terminate in a pial vascular network of continuous transverse centripetal arterioles and capillaries that surround each optic nerve. The rich anastomoses with branches of superior hypophyseal artery, from the cranial cavity, which take part in the optic nerve vascularization in its hole length, was observed. There were no intraaxial vessels in the intracranial and intracanalicular parts of the nerve in our specimens. CONCLUSION: These anatomical data offer important informations for understanding the variety of the pathology in the region of optic canal and orbito-cranial junction, and is also useful for designing operative strategies. This report indicates the delicacy and vulnerability of the intracranial and intracanalicular capillary network to traumatic disruption.

[Blood supply of the internal capsule and basal nuclei].

The internal capsule and basal nuclei are supplied by perforating branches of the anterior cerebral artery (ACA), Heubner's artery, middle cerebral artery (MCA), internal carotid artery (ICA) and anterior choroidal artery (AChA). Some of the mentioned perforators vascularize both the internal capsule and basal nuclei, while some of them also perfuse the adjacent brain structures. Dorsal part of the anterior limb, knee and posterior limb of the internal capsule are commonly supplied by lateral MCA perforators. The intermediate part of the anterior limb is perfused by medial MCA perforators, while its ventral part is nourished by ACA perforators and Heubner's artery. The intermediate part of the knee is supplied by medial MCA perforators, while its ventral part is mostly vascularized by ICA and proximal AChA perforators. The intermediate part of the posterior limb is perfused by medial MCA perforators anteriorly and the proximal AChA perforators posteriorly. The ventral part is supplied by AChA perforators. The retrolenticular and sublenticular portions of the internal capsule are mainly nourished by distal AChA perforators. The caudate nucleus is supplied by perforators of the ACA, MCA and AChA, as well as by branches of the lateral posterior choroidal artery. Most of the putamen is vascularized by MCA perforators, and smaller parts by ACA and AChA perforators. The lateral segment of the globus pallidus is perfused by MCA perforators and partially by Heubner's artery and ACA, while its medial segment is supplied by ICA and AChA perforators. The ACA perforators, that most often originate from the initial 5.9 mm of the A1 segment, range in number from 1 to 5 (mean, 2.2) and in diameter between 80 pm and 710 pm (average, 295 microm). Heubner's artery, which most often arises close to the anterior communicating artery, can be singular (72.5%), double (23%) or triple (4.5%). It varies in diameter from 190 microm to 1,600 pm (average, 750 microm) and in length between 11 mm and 36 mm (mean, 22.4 mm). The MCA perforators, that most frequently originate from M1 segment (90.7%) and leptomeningeal branches (62.6%), range in number between 2 and 13 (mean, 8.1) and in diameter from 80 microm to 1,300 microm (mean, 520 microm). Many perforators arise as individual vessels, and some of them with common trunks (70.8%). Medial and lateral group of these perforators can be distinguished. The ICA perforators, which more often arise close to the AChA originating site (35.4%) than from the ICA bifurcation point (10.4%), vary in number from 1 to 5 (average, 3) and in diameter between 70 microm and 500 microm (mean, 236 microm). The AChA perforators that originate from its cisternal segment, range in number from 2 to 9 (mean, 4.5) and in diameter from 90 microm to 600 pm (mean, 325 microm).