Migraine and premenstrual syndrome: comorbid disorders?

IntroductionHeadache is a common symptom among women, including during the menstrual cycle. The migraine frequency in women who present migraine associated with the menstrual period ranges from 50% to 70%. Premenstrual syndrome (PMS) is prevalent among women, affecting 80% to 90% of them throughout their lives.ObjectiveThe objectives of this study were to verify PMS prevalence and its characteristics among women who present with cephalalgia in the neurology ambulatory care unit and show the prevalence of headache and its association with PMS in the gynecology ambulatory care unit.MethodsIt is a descriptive and qualitative study which was carried out at Emilio Carlos Teaching Hospital in the neurology and gynecology ambulatory care units with women aged 18 to 52 years old. Eighty-seven questionnaires were distributed and self-applied throughout the year of 2018 for data collection. Each questionnaire consisted of 27 questions about the life cycle of the women and their headache episodes. The diagnostic criteria for headache and migraine from the International Headache Society were used. Criteria for PMS were met according to the quality of life questionnaire.ResultsIn gynecology unit group, 9% of the women did not present headache, 76% had PMS and 94% presented with headache during PMS. In neurology, 79% of the women had PMS and 79% of the women who presented with cephalalgia also had PMS.ConclusionThere is a large percentage of PMS in both groups, i.e. neurological unit and gynecological unit, showing it is not a spurious correlation.

Pathology at Boston City Hospital

This chapter discusses Fisher’s experiences as a neuropathologist and neurologist in training at the Boston City Hospital during 1949. This training propelled Fisher into a career in the field of stroke and cerebrovascular disease. The vigorous academic milieu implemented by the director of Boston City Hospital, Derek Denny-Brown, and the work ethic on the neurological unit were new experiences for Fisher. There, he contacted individuals who would prove to be role models, mentors, and colleagues during much of his later career. The neurology and pathology departments at the hospital are described in this chapter, as are the background and major characteristics of Drs. Derek Denny-Brown and Raymond Adams, the key physicians who trained Fisher at Boston City Hospital. Early discoveries about brain embolism are mentioned.

Spectrum of Neurological Diseases in Tertiary Care Centre of Nepal

Neurological cases in Nepal are not reported much. Neurological diseases are associated to poor health outcomes including mortality, disability and hospitalization. Epidemiology and clinical pattern of neurological disorders in developing countries remain largely unknown. This is a descriptive study to understand the burden of disease faced by neurologists and internists in a hospital of Nepal. This is a retrospective study of medical records of patients admitted in the Neurology unit of medical ward of Dhulikhel Hospital. A total of 318 patients were admitted during the period of July 2014to January 2015. Diagnosis was established by clinical, radiological, nerve conduction studies, electroencephalography and cerebrospinal fl uidanalysis. A total of 318 patients records during the above mentioned period were reviewed. Common neurological diseases identified were vascular: 138(43.40%); seizure: 60(18.87%); infectious: 20(6.29%); demyelinating: 12(3.77%); degenerative: 14(4.40%); peripheral neuropathy:14(4.40%); and others (mass lesion, ataxia, myelopathy) 60(18.87%). Cerebrovasculardisease is the most common cause of admission of patients in the neurological unit of the hospital. There are differences in the neurological diseases with respect to age, gender and ethnicity.

Unrecognized Pseudohypoparathyroidism Type 1A as a Cause of Hypocalcemia and Seizures in a 64-Year-Old Woman

Pseudohypoparathyroidism type 1A (PHP1A) is usually diagnosed in childhood or early adulthood. We describe the case of a 64-year-old woman admitted to the Neurological Unit for recurrent episodes of loss of consciousness and seizures. Glycemia and ECG were normal, while hypocalcemia was noted. Clinical history revealed carpo-pedal spasm since the age of 30 years, cognitive impairment, hypothyroidism since early adulthood, and menopause at 30 years. She was taking oral calcium and cholecalciferol for chronic hypocalcemia. Physical features suggested Albright’s osteodystrophy. Blood calcium was confirmed low, with increased parathyroid hormone, moderate 25OH-vitamin D deficiency, and normal creatinine. Brain CT scan revealed calcifications of the basal ganglia, cortical and subcortical white matter, and cerebellum. Therapy was switched to oral calcitriol, with normalization of calcium levels; levetiracetam was started and no further seizures occurred. The clinical diagnosis of PHP1A was confirmed by molecular analysis, which demonstrated the heterozygous c.568_571del mutation of the GNAS gene. Our report illustrates the natural history of a patient with PHP1A, which went undiagnosed until the age of 64 years, with multi-hormonal resistance and clinical sequelae evolving throughout life, and underlines the importance of diagnosing this rare disease, which has a great impact on patients and their family life.

Neurologists' detection and recognition of mental disorder in a tertiary in-patient neurological unit

Aims and methodPsychiatric disorders are common in neurological in-patients, but they are under-recognised and undertreated. We investigated the frequency of detection of mental disorder and referral to psychiatric services in a regional neuroscience centre. The results were compared with the expected prevalence. All in-patient referrals received in 2014 from the in-patient wards of the regional neuroscience centre and acute neurological unit were reviewed.ResultsA total of 129 ward referrals were identified; of these, 78 were from the regional in-patient neurological unit, which comprised 11.4% of the total of 679 admissions to that unit.Clinical implicationsA spectrum of neuropsychiatric conditions were recognised by neurologists, but overall rates of recognition were low. To address the problem of under-recognition, routine screening with validated assessment tools can represent a cost-effective and acceptable method to detect psychiatric disorders in an in-patient neurological setting.Declaration of InterestNone.

Comorbidity, Polytherapy, and Drug Interactions in a Neurological Context: An Example of a Multidisciplinary Approach to Promote the Rational Use of Drugs

Purpose: A high number of adverse drug reactions (ADRs), mainly caused by drug–drug interactions (DDIs), occur in neurological wards and few data are available about incidence and prevalence of DDIs in this context. This study investigated—(1) the prevalence of drug–drug and drug–disease interactions in patients admitted to a neurological unit in Italy, (2) the risk factors for DDIs, and (3) the diseases and the drug classes mostly involved in drug–drug and drug–disease interactions. Methods: For 2 months, we performed a retrospective, observational study in the neurological unit of St Bassiano Hospital, enrolling 79 patients who received a drug prescription at discharge. Results: About half of the patients were discharged with 5 or more prescribed drugs, and 72% of patients showed potential, clinically relevant DDIs. Linear correlations were observed between age and number of prescribed drugs ( P < .01) and between age and number of interactions ( P < .01). The number of prescribed drugs was associated with the number of detected DDIs ( P < .01). The application of drug interaction alerts and the use of medication inappropriateness criteria (ie, Beers criteria) were not satisfactory in choosing the best therapy for each patient. Therefore, multidisciplinary discussions of each clinical case was required. Conclusion: The study demonstrated that the neurological patient, especially if elderly, has a high risk of DDI and ADRs and that many of these can be avoided by case discussion in multidisciplinary team meetings, in which the presence of a dedicated clinical pharmacist is crucial.