High sensitivity C-reactive protein and cerebral white matter hyperintensities on magnetic resonance imaging in migraine patients.

BACKGROUND: Migraine is a common headache disorder that may be associated with vascular disease and cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scan. High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that may predict subclinical atherosclerosis. However, the relation between migraine, vascular risks, and WMHs is unknown. We evaluated hs-CRP levels and the relation between hs-CRP level and WMHs in adult migraine patients. METHODS: This case-control study included 432 subjects (216 migraine patients [without aura, 143 patients; with aura, 73 patients]; 216 healthy control subjects without migraine; age range 18-50 y). Migraine diagnosis was determined according to the International Classification of Headache Disorders II diagnostic criteria. The migraine patients and control subjects had no known vascular risk factors, inflammatory disease, or comorbid disease. The presence and number of WMHs on MRI scans were determined, and serum hs-CRP levels were measured by latex-enhanced immunoturbidimetry. RESULTS: Mean hs-CRP level was significantly greater in migraine patients (1.94 ± 2.03 mg/L) than control subjects (0.82 ± 0.58 mg/L; P ≤ .0001). The mean number of WMHs per subject and the presence of WMHs was significantly greater in migraine patients (69 patients [31.9%]; 1.68 ± 3.12 mg/dL) than control subjects (21 subjects [9.7%]; 0.3 ± 1.3; P ≤ .001). However, there was no correlation between hs-CRP level and WMHs in migraine patients (r = 0.024; not significant). The presence of WMHs was increased 4.35-fold in migraine patients (odds ratio 4.35, P ≤ .001). CONCLUSIONS: High hs-CRP level may be a marker of the proinflammatory state in migraine patients. However, the absence of correlation between hs-CRP level and WMHs suggests that hs-CRP is not causally involved in the pathogenesis of WMHs in migraine patients. The WMHs were located mostly in the frontal lobe and subcortical area.

Evaluation of the cognitive functions in patients with chronic renal failure before and after renal transplantation.

Chronic renal failure (CRF) and dialysis treatment affect central nervous system and studies have shown that neurocognitive dysfunctions are caused by CRF and dialysis treatment. The aim of this study was to evaluate the changes in cognitive functions of CRF patients after renal transplantation. Neurocognitive functions of 40 renal transplantation patients aged 18-65 years were determined before, 6 and 12 months after transplantation between 2008 and 2010 using neuropsychological tests. Rey Auditory-Verbal Learning Test (RVLT), Rey Complex Figure Test (RCFT), ADAS-cog Test, Stroop Test (ST), Digit Span Test (DST), and Trail Making Test (TMT) were applied. The test results were statistically compared taking into consideration the patients' levels of education, age, gender, donor type, duration of dialysis, dialysis type, and duration of CRF. Neuropsychological test results statistically significantly increased in all the patients after renal transplantation (p < 0.05). The female patients' RVLT test results were statistically higher than the test results of the male patients (p < 0.05). DST, RCFT, RVLT, and (Verbal Fluency Test) VFT results were statistically higher in the patients who were 33 years old or younger (p < 0.05). The patients with high school and college education had statistically significantly higher results in all the tests when compared with the patients that were elementary school graduates (p < 0.05). DST forward task, ST, and RVLT results of the patients, who had received dialysis treatment for 1 year or less, were found to be statistically higher than the results of the patients who had received dialysis for more than 1 year (p < 0.05). The results of RCFT, RVLT, DST backward task, and VFT were statistically higher in the peritoneal dialysis patients than in the hemodialysis patients (p < 0.05). The donor type and the duration of CRF had no significant effects on the results (p > 0.05). The results of this study showed significant improvement in attention, memory, executive functions, pace of data processing and language functions in CRF patients after renal transplantation, as proven with neuropsychological tests.

The effects of interferon beta-1a on proton MR spectroscopic imaging in patients with multiple sclerosis, a controlled study, preliminary results.

To evaluate the effects of interferon beta-1a(INFbeta-1a) on brain metabolites in patients with multiple sclerosis (MS), we performed Magnetic Resonance Spectroscopy Imaging (MRSI) on five patients treated with INFbeta-1a (Rebif 44 microg), and on five untreated patients. Six healthy volunteers were used as controls. Patients were evaluated at the beginning, in the first, third, sixth, and twelfth month. There were no significant differences in normal appearing white matter (NAWM) metabolite peaks of the control group and patients with MS. However, in white matter lesions (WML) and NAWM there was significant differences between the basal and the other months' metabolic peaks (p < 0.05) in the treatment group although no differences emerged in the untreated group. These data suggest that INFbeta-1a has a favorable effect on restoration of metabolites in MS lesions.

Osmotic myelinolysis in a normonatremic patient.

Osmotic demyelination syndrome is usually associated with hyponatremia or rapid correction of this condition. The prognosis is usually fatal. We treated a 34-year-old chronic renal failure patient who did not have hyponatremia but developed severe pontine myelinolysis demonstrated with MRI. Serial MRI revealed gradual reduction of the lesions over 2 months. This case demonstrates that osmotic demyelination syndrome is not always associated with hyponatremia, and that, although the prognosis is usually poor, some patients recover.