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Volume 7, No 4 - Fall 2010

Volume 7, No 4 - Fall 2010

Table of Contents

Course of Frequent/Daily Headache in the General Population and in Medical Practice Disease State Review
Frequent headache is defined as headaches ≥ 15 days/month and daily headache operationally as headaches ≥ 5 days/week. In this article, we review the outcome of frequent/daily headache in the general population and in medical practice. In the general population, within 1 year fewer than half of those with frequent/daily headache will still have frequent/daily headache, with a gradual further decrease over subsequent years. In medical practice, the results of studies suggest a one-third reduction in headache days/month over 6 to 12 months, with nearly 40% of patients with frequent/daily improving ≥ 50% in headache days/month over the same time period (50% responder rate). In terms of predictors of poor outcome, no clear picture emerges. [Rev Neurol Dis. 2010;7(4):103-110 doi: 10.3909/rind0259]© 2010 MedReviews®, LLC
Delirium: A Neurologist’s View—The Neurology of Agitation and Overactivity Disease State Review
Delirium is a term used variously to characterize a change in behavior. Neurologists most often use the term to describe a patient who has acutely developed a hyperactive agitated state. In many patients, agitation and overactivity are explained by toxic and metabolic factors and infections. Lesions, especially strokes, in some brain regions have been reported to cause sudden agitation and a hyperactive state, often with an increased amount of speech output, the topics of which flit from one subject to another. Strokes and other lesions that involve the temporal lobes, fusiform and lingual gyri, caudate nucleus, and anterior cingulum have been reported to cause an acute hyperactive state similar to that found in patients with delirium tremens related to alcohol withdrawal.[Rev Neurol Dis. 2010;7(4):111-118 doi: 10.3909/rind0261]© 2010 MedReviews®, LLC
Neurologic Complications of Bariatric Surgery Management Update
With the rapid rise in the number of bariatric surgeries performed for morbid obesity, several short- and long-term neurologic complications of this procedure have been identified. These complications affect various levels of the neuraxis, and most are likely secondary to deficiency of essential minerals and vitamins. We report on 3 patients who developed unusual and severe neurologic deficits after undergoing bariatric surgery, including Wernicke encephalopathy, acute and rapidly progressive polyneuropathy, myelopathy, and visual deficits. Two developed clinical features of Parkinsonism, a complication not previously reported in this patient population. None of our patients had attended a nutrition clinic postoperatively. All 3 had a rapid weight loss and intractable vomiting preceding the development of neurologic symptoms, and all were found to have significant vitamin deficiencies. Replacement of vitamins resulted in a slow and variable degree of neurologic recovery. Patients undergoing bariatric surgery should have close monitoring of their nutritional status postoperatively. Routine supplementation of vitamins and minerals may be a cost-effective strategy for preventing neurologic complications in these patients.[Rev Neurol Dis. 2010;7(4):119-124 doi: 10.3909/rind0265]© 2010 MedReviews®, LLC
Headache in Men: Forgotten in Practice and Ignored in Research Management Update
In general practice, the sex-specific consultation rate for headache is only slightly lower for men than it is for women. Headache is 2 to 3 times more common in women than it is in men, and women outnumber men in general practice by 2-fold. However, in headache practice they seem to outnumber men by 4- to 5-fold, suggesting a specific barrier to seeking specialty care. Although there is extensive literature specifically concerning headache in women, a PubMed search did not reveal any publications specifically addressing the problem in men, with the exception of cluster headache, a well-known headache condition that is more frequent in men. As a first attempt at filling this void, we analyzed the headache features, associated symptoms, and precipitating, aggravating, and relieving factors in 100 randomly selected men from a headache practice. Our results indicate that headache is a significant medical problem in men, and they seem to be underrepresented when it comes to seeking expert headache care.[Rev Neurol Dis. 2010;7(4):125-131 doi: 10.3909/rind0263]© 2010 MedReviews®, LLC
Improvement of Cutaneous Sensitivity in Diabetic Peripheral Neuropathy With Combination L-Methylfolate, Methylcobalamin, and Pyridoxal 5’-Phosphate Original Research
Studies of monotherapy with L-methylfolate, methylcobalamin, or pyridoxal 5’-phosphate suggest that these B vitamins may reverse both the symptoms and the pathophysiology of diabetic peripheral neuropathy (DPN). The efficacy of oralcombination L-methylfolate, 3 mg; methylcobalamin, 2 mg; and pyridoxal 5’-phosphate, 35 mg (LMF-MC-PP) in restoring cutaneous sensitivity in patients with type 2 diabetes with DPN was evaluated in 20 type 2 diabetic patients who were given LMF-MC-PP twice daily for 4 weeks and then once daily for an additional 48 weeks. Statistically significant improvement in 1-point (tactile) and 2-point (discriminatory) static testing at the right and left great toe and heel in the patients was observed in all 3 follow-up periods: 1) baseline to 6 months, 2) baseline to 1 year, and 3) 6 months to 1 year. The greatest improvement occurred between baseline and 1 year of treatment. Treatment with oral LMF-MC-PP appears to promote restoration of lost cutaneous sensation in DPN.[Rev Neurol Dis. 2010;7(4):132-139 doi: 10.3909/rind0264]© 2010 MedReviews®, LLC
Selected Contributions to Neurology by Philadelphia Neurologists Since 1980 Philadelphia Neurological Society Historical Review
On the occasion of the 125th anniversary of the Philadelphia Neurologic Society, 3 short talks were given that highlighted accomplishments by Philadelphia’s neurologists over the past 30 years. The theme for the celebration was “Contributions to Neurology by Philadelphia Neurologists, 1980-2008.” Each of the 3 speakers was chosen because of his contributions and the sequential time frames in which they occurred. Dr. Arthur K. Asbury detailed the original description of the Lewis-Sumner syndrome, Dr. Michael R. Sperling summarized the growth of epilepsy surgery in Philadelphia, and Dr. Geoffrey K. Aguirre depicted the roots of functional magnetic resonance imaging in Philadelphia.[Rev Neurol Dis. 2010;7(4):140-149 doi: 10.3909/rind0262]© 2010 MedReviews®, LLC
Presentation: A Late Complication of ? Knife Radiosurgery
An 85-year-old man was hospitalized after developing sudden weakness on his right side and mild expressive aphasia. He had undergone [1] knife stereotactic radiosurgery to the left thalamus 7.5 years earlier for a disabling essential tremor; the surgery had led to remarkable improvement in his ability to write and use utensils. He was being treated with warfarin for chronic atrial fibrillation. A computed tomography scan of the brain revealed a 2-cm left thalamic hemorrhage in the precise region of the prior thalamotomy.[Rev Neurol Dis. 2010;7(4):150-151 doi: 10.3909/rind0252a]© 2010 MedReviews®, LLC
Presentation: A Patient With Progressive Headache and Partial Optic Chiasm Involvement
A 69-year-old woman presented with a 2-month history of bilateral throbbing daily headaches and a 2-week history of progressive visual loss. Radiologic imaging, visual field test, and cerebrospinal fluid analysis findings are discussed. After treatment, the symptoms were resolved without deficit.[Rev Neurol Dis. 2010;7(4):152-153 doi: 10.3909/rind0258a]© 2010 MedReviews®, LLC
Headache and the Neck Cervical Headache
[Rev Neurol Dis. 2010;7(4):154-156 doi: 10.3909/rind0255]© 2010 MedReviews®, LLC
Discussion: A Late Complication of ? Knife Radiosurgery
[Rev Neurol Dis. 2010;7(4):157-159 doi: 10.3909/rind0252b]© 2010 MedReviews®, LLC