1/12. Wide clinical variability in a family with a CACNA1A T666m mutation: hemiplegic migraine, coma, and progressive ataxia.We report a Japanese family carrying a T666M missense mutation of CACNA1A. Affected members demonstrated a strikingly wide clinical spectrum including migraine, hemiplegia, coma, and progressive cerebellar ataxia. Despite such variability of the clinical features, they demonstrated similar magnetic resonance imaging findings demonstrating cerebellar atrophy predominantly of the cerebellar vermis. These magnetic resonance images appeared not to correlate with clinical severity. Our findings should indicate that a T666M mutation of CACNA1A may be associated with more variable clinical features and that paroxysmal hemiplegic migraine attacks and progressive cerebellar atrophy should have distinct mechanisms of pathogenesis.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/12. Is acupuncture an useful tool for pain-treatment in ophthalmology?pain that does not respond to conventional treatment procedures makes it necessary to look for alternative methods. acupuncture is an ancient procedure with empirical effects on pain. Previous studies established the increased output of messengers at neuronal junctions in spinal cord and hypothalamic locations, especially of endorphins which inhibit the perception of pain. We treated several painful symptoms with acupuncture and evaluated the outcome of the treatment. patients with various kinds of therapy-refractory pain and patients in whom conventional treatment methods could not be applied were included in the study. The diagnoses included glaucoma. Tolosa-Hunt-Syndrome, ophthalmic migraine, blepharospasm, and dry eyes. In one case acupuncture was used for analgesia during surgery. acupuncture was performed with sterile disposable needles, at points known to have an empirical analgesic effect. The stimulation was adapted to the patient's individual needs. VAS assessments before and after acupuncture were compared. The t-test was used for statistical evaluation. acupuncture had no side effects, but reduced pain to a variable extent. Especially in cases of severe pain and in surgery, very effective pain reduction was achieved. In general, pain was significantly reduced in all patients by the use of acupuncture. A statistically significant effect was noted (p < 0.05). Further studies should be conducted to demonstrate the specific effect in larger patient populations. Monitoring neurotransmitter activity will possibly help to illustrate the effect.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
3/12. Migraine-like attacks in child with sturge-weber syndrome without facial nevus.The sturge-weber syndrome was recently subdivided into type I (facial and leptomeningeal angioma, possible glaucoma), type II (facial angioma, without evident endocranial involvement), and type III (exclusive leptomeningeal angioma). Thus far in the literature only 24 cases of sturge-weber syndrome type III have been reported. This study presents a case of a 2-year 9-month-old child with normal psychomotor development and skin free (no angiomas), who presented repeated episodes of severe headache, vertiginous symptoms, vomiting, and drowsiness, separated by complete recovery. The cranial computed tomography and magnetic resonance imaging with gadolinium revealed left occipital leptomeningeal angiomatosis with calcifications, suggesting a diagnosis of sturge-weber syndrome type III. Considering the normal psychomotor development, the improved electroencephalographic reports between the episodes, and the absence of hypoperfusion areas on single-photon emission computed tomography at 30 months of follow-up, the symptomatology appears an expression of migraine-like symptoms resulting from vasomotor disturbances within and around the angioma, more than an expression of partial seizures arising through an epileptic focus in the ischemic region around the vascular malformation.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
4/12. Recurrent prolonged coma due to basilar artery migraine. A case report.A 25 year old patient presented with recurrent prolonged episodes of life-threatening coma varying from 3 to 10 days. The clinical recovery was slow. The history and technical examinations led to the diagnosis of basilar artery migraine (BAM). The etiology of the coma episodes is thought to be related to ischemic dysfunction of the rostral part of the brainstem due to severe spasm of the basilar artery demonstrated by arteriography. Exceptional are the recurrent prolonged coma episodes of sudden onset, the severe spasm of the basilar artery, and the suppression-burst and FIRDA pattern on the EEG examinations during the coma episodes.- - - - - - - - - - ranking = 1.6keywords = coma (Clic here for more details about this article) |
5/12. Migraine versus glaucoma--a diagnostic dilemma.Episodic headaches associated with ocular symptoms is a frequent complaint in clinical practice. In the medical and medical related field of neurology, one of the most often considered diagnosis is that of classical migraine, whilst in ophthalmology, the condition of intermittent primary angle closure glaucoma must be entertained. This paper reports three cases in which the two conditions were confused, and follows with a discussion on the essential differentiating features that can help in the diagnosis.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/12. Familial migraine coma: a case study.A family suffering from a rare malignant type of migraine is described. The syndrome is characterized by episodes of coma with meningitic signs and fever and pareses as well as persistent cerebellar signs. Coma attacks last up to several days and can be precipitated by minor head trauma, vigorous work and angiography. From a study of this family and the literature, it is concluded that this syndrome has to be included in the differential diagnosis of coma and that angiography should be avoided in the patients.- - - - - - - - - - ranking = 1.2keywords = coma (Clic here for more details about this article) |
7/12. Migraine headaches in hydrocephalic children: a diagnostic dilemma.Headaches, vomiting, and altered sensorium can be seen in patients with shunt malfunction as well as in those with migraines. We report five cases in which children with hydrocephalus and CSF shunts presented with a variety of recurring symptoms, including headache, vomiting, impairment of consciousness to the point of coma, and, in one patient, decerebrate posturing. Various diagnoses were entertained: shunt malfunction, slit ventricle syndrome, and low pressure (overshunting). Repeated procedures were carried out in all patients, including shunt taps, multiple shunt revisions, and a subtemporal decompression. When the diagnosis of migraine was considered, four patients improved on propranolol therapy; one failed this therapy but responded to verapamil. We conclude that in patients with hydrocephalus and repeated bouts of symptoms such as headaches, vomiting, and impairment of consciousness and in the case of documented, adequate shunt function, the diagnosis of migraine be entertained before further operative intervention is undertaken.- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
8/12. Migraine coma. Meningitic migraine with cerebral oedema associated with a new form of autosomal dominant cerebellar ataxia.A family with hemiplegic migraine has been documented for a period of over forty years. From this study and the literature we conclude that (1) migraine is a cause of recurrent coma which may be associated with life-threatening cerebral hemisphere oedema; (2) hyperpyrexia with CSF pleocytosis occurs in hemiplegic migraine, which may thus simulate viral meningoencephalitis; and (3) cerebral angiography is hazardous in hemiplegic migraine and may exacerbate coma and cerebral oedema. In the family reported, cerebellar ataxia was present during recovery from attacks of hemiplegic migraine and affected patients ultimately suffered from persistent ataxia with radiological cerebellar atrophy. This syndrome thus constitutes a distinct form of late-onset autosomal dominant cerebellar ataxia and also of familial periodic ataxia. The status of 'cerebellar migraine' is reviewed.- - - - - - - - - - ranking = 1.2keywords = coma (Clic here for more details about this article) |
9/12. meningioma and the ophthalmologist: diagnostic pitfalls.In seven patients with intracranial meningioma whose presenting signs and symptoms were ophthalmologic the underlying problem was initially misdiagnosed. Three patients had sphenoidal meningiomas with compression of the anterior visual pathways, but the initial diagnoses were acute optic neuritis, chronic optic neuritis and glaucoma. Two other patients had large frontal meningiomas causing in one case unilateral pain and swelling of the upper lid plus ptosis and hypotropia, and in the other case bilateral frontal morning headaches and intermittent blurring of vision in one eye; they were thought to have a frontal lobe osteoma and migraine respectively. A sixth patient had a large parietal meningioma causing unilateral papilledema in an eye with a corneal graft; the papilledema was not initially recognized because of severe astigmatism in that eye. The last patient had an occipital meningioma that had caused a fixed homonymous field defect and many years of "classic migraine".- - - - - - - - - - ranking = 0.2keywords = coma (Clic here for more details about this article) |
10/12. Episodic coma due to acute basilar artery migraine: correlation of EEG and brainstem auditory evoked potential patterns.Our patient presented with three episodes of deep coma in 5 weeks, followed by a complete recovery. The neuroradiological tests and spinal fluid analysis excluded structural lesions, including subarachnoid hemorrhage, from the diagnosis. A nonconvulsive status was excluded by 24-hour EEG monitoring. The EEGs and brainstem auditory evoked responses were abnormal during ictus, but they reversed to normal with the clinical recovery. Timely neurophysiological tests helped in the diagnosis of basilar artery migraine.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
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