Spotlight on Patent foramen ovale

In this article, Dr. Shadi Yaghi and Dr. Shawna Cutting of the Warren Alpert Medical School of Brown University discuss patent foramen ovale, a highly prevalent anomaly occurring in 25% to 30% of the general population.

Patent foramen ovale represents the postnatal persistence of the normally present foramen ovale, a flap valve structure formed by the septum primum and septum secundum in the fetus. Although it is generally asymptomatic, studies have found associations with ischemic stroke and migraine. The best treatment strategy for patent foramen ovale in the setting of ischemic stroke or migraine remains unclear. Randomized controlled trials on patent foramen ovale closure showed no benefit for secondary stroke prevention or migraine improvement.

To view the complete article, click here and log in.

Spotlight on Status migrainosus

In this article, Dr. Shuhan Zhu of Jefferson Headache Center discusses status migrainosus, an attack of severe migraine lasting more than 72 hours accompanied by debilitating symptoms that is not attributable to another disorder.

Status migrainosus may occur in migraineurs with or without aura. For patients presenting with the first or worst prolonged headache, a thorough neurologic evaluation with collateral imaging and/or spinal fluid sampling is indicated to assess for secondary causes of pain. In a patient with underlying diagnosis of migraine and without a secondary attributable cause of prolonged headaches, focus should be on swift and effective treatment with the primary aim of aborting the migraine.

To view the complete article, click here and log in.

Spotlight on Migraine aura without headache

Migraine is a common neurologic disorder that is prevalent in the younger population. With age, migraine prevalence decreases, but some people continue to experience migraine auras without the subsequent or associated headache pain. In this article, Dr. Shih-Pin Chen of the National Yang-Ming University School of Medicine reviews the clinical manifestations, prevalence, pathophysiology, therapeutic options, and prognosis for this selective group of patients. Breakthroughs in understanding the pathogenesis and clinical manifestations are highlighted.

To view the complete article, click here and log in.

Spotlight on Retinal migraine

In this article, Dr. Brian Grosberg and Dr. Seymour Solomon, both of Albert Einstein College of Medicine and Montefiore Headache Center, discuss clinical manifestations, biological basis, and prognosis of retinal migraine.

Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Retinal migraine is most common in women of childbearing age who have a history of migraine with aura. In the typical attack, monocular visual features consist of partial or complete visual loss lasting less than 1 hour. Although the current diagnostic criteria for retinal migraine require fully reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum. Nearly half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss.

To view the complete article, click here and log in.

Spotlight on Vestibular migraine

Vestibular migraine presents with attacks of spontaneous or positional vertigo (head motion–induced) and visual vertigo lasting 5 minutes to 3 days. The diagnosis requires a history of migraine, temporal association of migraine symptoms with vertigo attacks, and exclusion of other causes. Because headache is often absent during acute attacks, other migraine features such as photophobia or auras have to be specifically inquired about. The pathophysiology of vestibular migraine is unknown, but several mechanisms link the trigeminal system, which is activated during migraine attacks, and the vestibular system. Treatment includes antiemetics for severe acute attacks, pharmacological migraine prophylaxis, and lifestyle changes.

In this clinical article, Dr. Thomas Lempert of Charité University Hospital and Dr. Michael von Brevern of Humboldt University discuss the manifestations, biological basis, diagnosis, and mananagement of vestibular migraine.

To view the complete article, click here and log in.

Spotlight on Transient visual loss

Clarification of the mechanism and cause of transient visual loss first depends on separating monocular and binocular symptoms and signs. Binocular transient visual loss usually reflects cerebrovascular vertebrobasilar circulation thromboembolism, systemic hypoperfusion, or migraine. Monocular transient visual loss is often attributable to arteriostenotic disease of the internal carotid artery in the cervical or intracranial segment or stenosis of the ophthalmic artery or its central retinal artery branch. However, reports show that migrainous vasoconstriction and various nonvascular mechanisms are also common causes of monocular transient visual loss and that familial hemiplegic migraine can be associated with multiple daily episodes of transient monocular vision loss in families with SCN1 mutations. Case reports also document that Whipple disease with bilateral optic disc edema and the use of latanoprost for glaucoma have both been associated with transient monocular vision loss in individual patients.

In this article, Dr. James Goodwin of the University of Illinois at Chicago cites case reports in which acute glaucoma led to transient vision loss in one or both eyes, which is important for the neurologist to include in the differential diagnosis so that an appropriate ophthalmologic referral can be made in order to prevent permanent vision loss.

To view the complete article, click here and log in.

Spotlight on Abdominal migraine

Abdominal migraine is recognized as the migraine equivalent of infancy, childhood, and adolescence and is often underdiagnosed in those with chronic, idiopathic, and recurrent abdominal pain. Abdominal migraine is recognized as a periodic paroxysmal syndrome without associated headache, which is thought to be migrainous in etiology. In this clinical summary, Dr. Shuu-Jiun Wang, Professor at National Yang-Ming University School of Medicine and Deputy Director of the Neurological Institute at Taipei Veterans General Hospital in Taipei, Taiwan, updates new findings for abdominal migraine as well as for a condition referred to as cyclic vomiting syndrome.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Childhood migraine

Childhood migraine is common, affecting 4% of children. Migraine in children commonly causes bilateral or midfrontal headaches. The peak incidence for migraine in males of all ages is 10 to 14 years, and for females, it is 20 to 24 years. Adverse lifestyles increase the prevalence of childhood headaches. The biggest concerns parents have regarding the etiology of childhood headaches are brain tumors or vascular problems, particularly aneurysms. However, when the exam is normal and the headaches are episodic, these concerns are usually unwarranted. More recognition is being paid to chronic daily headaches. Dr. Raymond Kandt of Wake Forest University Baptist Medical Center reviews the clinical manifestations and highlights acute and preventive treatment strategies.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Epidemiology of headache

Headache is one of the most common complaints encountered in neurologic services. Information concerning sociodemographic, distribution, impact, familial, and environmental risk factors may provide clues to diagnosis and management of headache preventive strategies and disease mechanisms. Dr. Chaichana Nimnuan and Dr. Anan Srikiatkhachorn of Chulalongkorn University in Bangkok, Thailand review the epidemiology of primary headaches, including migraine, tension-type headache, chronic daily headache, and cluster headache.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Migraine with brainstem aura

In this clinical summary, Dr. Kai-Chen Wang of Cheng Hsin General Hospital in Taiwan discusses migraine with brainstem aura, formerly known as “basilar-type migraine.” This is a variant of migraine with the aura symptoms arising from the brainstem or bilateral occipital hemispheres. The onset of the disease usually occurs at the second or third decade. The diagnosis is based on the finding of at least 2 migraine attacks accompanied by at least 2 of the following fully reversible symptoms: dysarthria, vertigo, tinnitus, impaired hearing, double vision, ataxia, and decreased level consciousness. The differential diagnosis should include cerebrovascular diseases, seizures, CADASIL, MELAS, and the pathology of posterior fossa. Despite the lack of data suggesting migraine with brainstem aura as a vasospastic condition, the use of triptans has been considered prohibited. Anticonvulsants and calcium channel blockers may be the drugs of choice in the prophylaxis.

To view the complete clinical summary, click here.

MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.