Exploring the symptoms and sleep disorders associated with migraines in women of Syria: A cross-sectional observational study.

Background and Aim: Migraine is a prevalent neurological disorder characterized by recurring episodes of debilitating headache accompanied by associated symptoms and sleep disorders. This study aims to investigate migraine-associated symptoms in female migraineurs within the Syrian population and the relation between migraines and sleep issues. Methods: A questionnaire-based cross-sectional observational study was conducted among the Syrian population. A total of 1009 women were enrolled in this study, including women without a history of migraine (Control group) and migraineurs (Case group) who had received a diagnosis of migraine from a hospital or private clinic. Data about migraine-related symptoms, including tingling, visual disturbances, Nausea/Vomiting, and epileptic seizures as well as sleep-related symptoms such as interrupted sleep, frequent awakenings, insomnia, snoring, and narcolepsy were gathered. Chi-square test was used to examine the relation between migraines and sleep issues. Results: A total of 1009 women were enrolled in this study including 531 migraineurs and 478 healthy women. The study revealed that the most commonly experienced symptoms during migraine attacks were nausea/vomiting and visual disturbances, followed by tingling. Total Unduplicated Reach and Frequency analysis showed that visual disturbances and nausea/vomiting were the two most frequent symptoms that co-occurred during migraine attacks. The study also demonstrated a significant relationship between snoring, insomnia, and narcolepsy with migraine (p = 0.038), with these sleep disorders being more prevalent among migraineurs. Conclusion: The findings indicate a significant association between migraines and sleep disorders, with migraineurs being at a significantly higher risk of experiencing poor sleep quality compared to healthy women. Addressing sleep disorders is crucial in managing patients with migraines. This study is the first of its kind in the Syrian population, providing valuable insights into the symptoms and sleep disorders associated with migraines in this population.

Spontaneous hemorrhage of spinal epidural capillary hemangioma resulting in hyperacute neurologic deficit: A case report.

INTRODUCTION: Spinal epidural capillary hemangioma is a very rare variety of tumors, usually with a predilection for the thoracic spine. CASE PRESENTATION: A 16-year-old female complained of hyperacute neurologic deficit progressed within hour, which presented by acute paraplegia, and loss of all sensations from her lower limbs up to her breasts. Neurologic exam revealed paralysis of lower limbs (0/5 on both legs) with a flaccid tone, absence of reflexes, weakness of the trunk with sensory level T4, bilateral flexion of plantar reflexes, and loss of sphincters' controls. Emergent magnetic resonance imaging showed a dumbbell-shaped epidural mass in the posterior aspect of the spinal canal at the T1-T2 level, measuring approximately 1.1 × 4.5 × 1.5 cm in size. The lesion was isointense on T1-weighted, hyperintense on T2-weighted, and a little enhancement after gadolinium administration. The surgery was obtained nearly 16 hours after paralysis, which eradicated the lesion with good hemostasis. Histological examination showed a well-organized vascular tissue that haphazardly arranged and confirmed the diagnosis of capillary hemangioma. Neurological improvement was quickly observed within days after surgery and further complete recovery was achieved 2 months after discharge. CONCLUSION: We report an extremely rare case of spinal epidural capillary hemangioma, where acute spontaneous hemorrhage in the lesion resulted in the hyperacute neurologic deficit within an hour. Since these are benign lesions, the immediate surgical intervention results in a very favorable prognosis and is considered the treatment of choice. Also, this case highlighted and rose the question of a better neurologic improvement in younger age patients with spinal cord injury.

Cerebral venous thrombosis and miliary tuberculosis: a case report from Syria.

Cerebral venous thrombosis (CVT) is a relatively common disease. Risk factors for CVT include pregnancy, cancer, autoimmune diseases, and hypercoagulation. Acute and chronic meningitis are also considered predisposing conditions for CVT. Cases of CVT associated with tuberculous meningitis and miliary tuberculosis (TB) are rare in the medical literature, and here the authors report the first case report from Middle East. Case presentation: The authors present a 33-year-old female patient diagnosed initially with CVT to discover the presence of tuberculous meningitis and miliary TB. Clinical discussion: CVT is an urgent condition and the outcome is usually good when treated quickly. The mechanisms of TB causing thrombosis are endothelial injury, slow venous flow, and increased platelet aggregation. The clinical presentation of CVT can be confused and falsely attributed to TB Meningitis. Conclusion: Infectious causes of CVT should always be remembered, especially TB should be in mind in developing countries.

Mononeuropathy multiplex as a first manifestation of renal cell carcinoma: a case report.

The neurologic symptoms that appear due to paraneoplastic syndrome may give manifestations of undiagnosed tumor, and give an opportunity for early detection and treatment of it. Case Presentation: Here the authors present a case of a 54-year-old woman who suffered from rapidly progressive muscle weakness, accompanied by right third cranial nerve palsy. Clinical Discussion: The nerve conduction study consistent with multiple mononeuropathy, and laboratories revealed undiagnosed diabetes mellitus but elevated erythrocyte sedimentation rate and the rapid progression prompted for additional investigations. Brain MRI, repetitive nerve stimulation, lumbar puncture, and paraneoplastic panel were all negative. Computed tomography scan with contrast for the abdomen showed a right renal mass consistent with renal cell carcinoma. The tumor was removed and steroids and intravenous immunoglobulin was started but without any clinical improvement because of the late presentation. Conclusion: Patients with renal cell carcinoma can present with paraneoplastic syndromes but multiple mononeuropathy are extremely rare. It is crucial to investigate for all possible causes of neuropathy and not attributing it to a new discovered diabetes in the presence of clinical and laboratory red flags such as rapid progression and elevated erythrocyte sedimentation rate.

Bilateral swollen optic nerve head etiology and management: A cross-sectional study.

Background: The differential diagnosis of optic disc edema varies according to the presence of unilateral or bilateral edema. Papilledema may occur due to benign and life-threatening causes, but even benign causes may leave serious consequences for vision if not treated emergently. This study aimed to find out the prevalence of these causes in two major hospitals in Syria and observing the response of edema to treatment within a month and how visual acuity can be saved if edema is treated urgently. Methods: This cross-sectional study was conducted in Al-Assad and Al-Mowasat Hospitals in Syria from October 2020 to the beginning of February 2022. It included 50 patients who had bilateral optic disc edema. Then a full study was carried out to reach the diagnosis and management appropriately and to monitor the extent of the efficacy of conservative measure in reducing edema, and how many of them needed surgical intervention. Results: the study included 50 patients, 13 males and 37 females, the most common diagnosis was venous sinus thrombosis (12 cases with 24%), followed by idiopathic intracranial hypertension and tumors (10 cases each by 20%), infectious meningitis (8 cases by 16%), leptomeningeal metastasis (5 cases by 10%), arterial hypertension (3 cases by 6%) and autoimmune meningitis (2 by 4%). Edema improved after management within a month in most patients (37 patients by 74%) and edema was accompanied by low visual acuity in 21 patients (42%). 20 patients (40%) needed surgical intervention. Visual acuity reduced in 10 patients (20%) despite all treatments. Conclusion: venous sinus thrombosis is the most common cause of bilateral optic disc edema then idiopathic intracranial hypertension and tumors, and despite the provision of all treatments, the visual acuity of 20% of patients has decreased.

Pineal region teratoma with metastases in uncommon locations: a case report.

BACKGROUND: We report a rare case in medical literature of a patient with pineal gland teratoma and uncommon metastases. Usually, metastases of this kind of tumor are located in several organs such as lung and breast, but here we found metastases to the spinal cord and vertebrae. CASE PRESENTATION: A 35-year-old Asian white man presented with diplopia and acute neural symptoms in the lower limbs such as numbness, tingling, and paralysis. His medical history was notable for pineal teratoma, treated 1 year previously with surgery, radiotherapy, and chemotherapy. Physical examination of the lower limbs showed absent reflexes and sensation with muscle power scale score of 1 in both limbs. Magnetic resonance imaging of brain and spine revealed many lesions in various locations, most compatible with neural, spinal, and vertebral metastases. Unfortunately, the patient died suddenly before any intervention was carried out. CONCLUSION: It is extremely rare for pineal region teratoma to metastasize to the spinal cord and vertebrae, thus more vigilant observation and examination should be provided to patients with pineal teratoma to detect any new lesions and prevent them from becoming dangerous.

Risk factors associated with epilepsy in children and adolescents: A case-control study from Syria.

INTRODUCTION: Epilepsy is a major public health concern in low-income countries (LIC) as they contain 80% of total cases worldwide. Syria has been in war since 2011 which made it difficult to prevent epilepsy risk factors which made this the first study on that matter. METHODS: This is a case-control study from 3 medical centers in Damascus, Syria. Data were collected using questionnaires introduced by trained doctors. The control group included patients from a general practice clinic while the cases were taken from the three pediatric neurology clinics. RESULTS: The sample consisted of 334 patients with 167 cases and 167 controls. Multivariable analysis confirmed the association between positive family history (FH) in 1st degree (OR, 3.37, 95%CI 1.2-9.47) and 2nd degree relatives (OR, 3.98, 95%CI 1.84-8.62), febrile seizures whether they were simple (OR, 15.08, 95%CI 3.27-69.5) or complex (OR, 13.32, 95%CI 1.58-112.32), developmental delay/regression (OR, 14.31, 95%CI 6.3-32.49), and central nervous system (CNS) infection (OR, 34.05, 95%CI 2.02-573.92). Head trauma, parental factors, consanguinity, asphyxia parameters, and other risk factors were not found to be significantly associated with epilepsy (P > 0.05). CONCLUSION: While some results were similar to other studies, others were not. Efforts should be made to facilitate healthcare access and proper diagnosis.