Clinical Neuroscience

[Impaired aortic elastic properties in young females with migraine]

AKTURK Faruk1, ERTURK Mehmet1, TOPCULAR Baris2, ALTINKAYA Ayca2, BEHREM Neshilan3, GUL Gunay3, ORTEN Murat4, YALCIN Arif Ahmet1, UZUN Fatih1

MAY 25, 2014

Clinical Neuroscience - 2014;67(05-06)

[Migraine is a common health problem affecting women more commonly. It has been associated with an increased risk for cardiovascular events. In this study, we investigated whether aortic elastic properties is altered in migraineurs with low cardiovascular risk compared with healthy controls, in order to elicit further evidence on tentative association between migraine and increased risk of cardiovascular disease. Methods - Forty-three migraine patients with low CVD risk were enrolled to the study. Thirty-three volunteers, with a similar age and sex distribution served as a control group. Following parameters of the aortic elasticity were calculated: aortic strain, aortic stiffness (β) index and aortic distensibility. Results - Aortic strain was not statistically different between the study and control group. However, aortic distensibility and β index were significantly impaired in patients with migraine compared to control subjects Discussion - The elastic properties of the aorta in migreineurs may be different from normal by using easily available echocardiographic methods. This information may be a clue for clarification of cardiovascular system involvement in migraine.]


  1. Istanbul Mehmet Akif Ersoy Teaching and Research Hospital, Department of Cardiology; Istanbul
  2. Istanbul Bilim University Medical Faculty, Department of Neurology; Istanbul
  3. Bakirkoy Prof. Dr. Mazhar Osman Teaching and Research Hospital for Mental Health and Neurological Disorders, Department of Neurology; Istanbul
  4. Istanbul Mehmet Akif Ersoy Teaching and Research Hospital, Department of Neurology; Istanbul



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[LADA type diabetes, celiac diasease, cerebellar ataxia and stiff person syndrome. A rare association of autoimmune disorders]

SOÓS Zsuzsanna, SALAMON Mónika, ERDEI Katalin, KASZÁS Nóra, FOLYOVICH András, SZŰCS Anna, BARCS Gábor, ARÁNYI Zsuzsanna, SKALICZKI József, VADASDI Károly, WINKLER Gábor

[Celiac disease - in its typical form - is a chronic immunemediated enteropathy with typical clinical symptoms that develops against gliadin content of cereal grains, and is often associated with other autoimmune diseases. In cases of atypical manifestation classic symptoms may be absent or mild, and extra-intestinal symptoms or associated syndromes dominate clinical picture. The authors present a longitudinal follow-up of such a case. A 63-years old woman was diagnosed with epilepsy at the age of 19, and with progressive limb ataxia at the age of 36, which was initially thought to be caused by cerebellar atrophy, later probably by stiff person syndrome. At the age 59, her diabetes mellitus manifested with type 2 diabetic phenotype, but based on GAD positivity later was reclassified as type 1 diabetes. Only the last check-up discovered the celiac disease, retrospectively explaining the entire disease course and neurological symptoms. By presenting this case, the authors would like to draw attention to the fact that one should think of the possibility of celiac disease when cerebellar ataxia, progressive neurological symptoms and diabetes are present at the same time. An early diagnosis may help to delay the progression of disease and help better treatment.]

Clinical Neuroscience

[The Comprehensive Headache-related Quality of life Questionnaire shows significant improvement after withdrawal treatment in medication overuse headache: a pilot study]


[Background and purpose - Medication overuse headache (MOH) is a common form of disabling headache presenting in as much as 30% of the patients seen in headache subspecialty practice. Quality of life (QOL) is frequently used as a secondary endpoint in headache trials. In MOH, previous trials of QOL focused mostly on generic QOL. We report the results of a pilot study that examined the feasibility of using a new QOL questionnaire, the 23-item Comprehensive Headache-related Quality of life Questionnaire (CHQQ), as an indicator of treatment response in MOH. Patients and methods - Fifteen patients (13 women and two men; mean age: 39.7±12.5 years) suffering from MOH were enrolled in a complex treatment programme consisting of acute medication withdrawal, preventive pharmacological treatment, structured advice and lifestyle intervention. The clinical data were collected using a detailed headache diary. CHQQ was completed before and after the treatment programme. Results - MOH patients had low QOL values at baseline which was comparable to the QOL of episodic migraine patients. The treatment programme resulted in significant reductions of the number of headache days and attacks, headache severity and analgesic consumption. The dimensions and total score of CHQQ showed a significant increase after the treatment period. Seventeen of CHQQ’s 23 individual items also improved significantly. Conclusion - In this study the new headache-specific quality of life instrument CHQQ was able to demonstrate significant improvements after adequate treatment of MOH. This result indicates that the CHQQ may be an adequate tool for assessing quality of life in headache treatment trials.]

Clinical Neuroscience

[Temperature sensitivity of some nerve conduction parameters in diabetic polyneuropathy]


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Clinical Neuroscience

[Analysis of patients applying for emergency treatment with vertigo related symptoms]

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[Objective - Analyzing the medical record data of patients with the main symptom of vertigo in “Kaposi Mór” Hospital’s Emergency Department. Method - Retrospective evaluation of patients’s medical history with vertigo related diagnoses according to BNO classification. Results - In the year of 2010, 18 000 patients were presented to ED. In 471 cases the symptoms were vertigo related which makes up 3% of the total. Almost half, 46% of these patients were brought in by ambulance medical car. The ratio of women was twice as high as of the men. One fifth, 19% of patients with vertigo gained admission to the ward and 81% of them were discharged in 24 hours. According to the interviews, 4 types of vertigo have been identified: “whirling style” vertigo in 37% of the cases, dizziness in 33% of the cases, presyncope in 12% and „light headedness” in 9%. The remaining 9% couldn’t be classified. Conclusion - Vertigo is common presenting symptom in emergency department, however it rarely indicates severe condition. The diagnostic value of vertigo classification based on history and brain CT result in identifying the severity of the background condition is questionable. We found that in recognizing the cases which need prompt intervention, thorough neurological examination and the clarification of the vertigo’s circumstances proved to be helpful.]

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Lege Artis Medicinae

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Hypertension and nephrology

[Cardiovascular risk assessment in chronic kidney disease, significance of left ventricular myocardial mass index]

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[Introduction: Earlier studies have shown that cardiovascular (CV) mortality and morbidity in chronic kidney disease (CKD) often exceed their average population, and left ventricular hypertrophy (LVH) is an independent risk factor for CV disease. However, in CKD, the relationship between LVH, arterial stiffness (AS) and renal function has not yet been fully elucidated. Little data is available on their prognostic role. Aims of our study a) cross-sectional examination of the relationship between left ventricular mass index (LVMI), arterial vascular stiffness, and renal function, b) in our follow-up study, clarification of the LVMI, the prognostic role of AS in patients with CKD, IgA nephropathy (IgAN). Methods: In our cross-sectional study, 79 IgAN patients were examined in our clinic. The myocardial mass index (LVMI) was determined using an estimation formula after echocardiographic measurements. Arterial stiffness was measured using a photoplethizmography technique (PulseTrace) and characterized by the stiffness index (SI). The MDRD formula was used to estimate renal function (GFR) (eGFR, ml/min/1.73 m2). In the prognostic study the primary combined endpoint was total mortality, the most important CV events (stroke, myocardial infarction or cardiovascular interventions such as revascularization) and end stage renal disease. Secondary endpoints were CV and renal endpoints separately. Results: Of the 79 patients included in our cross-sectional study, 50 were men, with an average age of 46 ± 11 years. The mean value of LVMI was 106.66 ± 22.98 g/m2. Patients were divided into groups of 115 g/m2 for males considered to be abnormal and 95 g/m2 for women. LVMI is closely correlated with SI and inversely with eGFR (corr. coeff: 0.358; p <0.05 or -0.526; p <0.001). In case of LVH, SI was significantly higher in both sexes (p = 0.005 in males, p = 0.04 in females). In case of higher LVMI, renal function was significantly lower (p = 0.002 in males, p = 0.01 in females). Metabolic syndrome occurred in several cases in both sexes with LVH, but the difference was only significant in male patients (males 6 vs. 10, p = 0.008; females 2 vs. 4, p = 0.29). In our follow-up study, the presence of LVH in men significantly reduced survival in both primary and secondary endpoints, whereas in women there was no significant difference. Conclusion: In IgAN decreasing of renal function is closely related to left ventricular hypertrophy and vascular stiffness, as well as a close relationship was found between LVMI and AS. Reduced renal function is associated with an increase in LVMI and an increase in AS, which may result in a worse prognosis for both CV and renal outcomes. The underlying role of all these can be assumed to be a common vascular and myocardial pathological remodeling.]