Neurologic disorders associated with mitral valve prolapse

Central nervous system abnormalities in migraine

Migraine is associated with structural and functional CNS changes, for example, ictal hyperalgesia and allodynia and interictal neural excitation. Structural abnormalities, most notably white matter changes, occur in greater prevalence in migraineurs (16 - 40%). Several studies have examined the neuropsychological correlates of migraine and/or white matter abnormalities. These studies suggest mild, interictal dysfunction in migraineurs. More research is needed to correlate migraine severity, frequency and/or treatment with neuropsychological testing. Additional studies should: identify interictal cognitive changes; clarify the contribution to long-term cognitive changes from migraine genotype, sequelae of repeated pain episodes or their treatment and the consequences of co-morbid vascular disease; and include cognitive measures as secondary end points in clinical trials.

Migraine associated with panic attacks

Migraine headache and panic disorder are two conditions that have a number of underlying physiological and psychological abnormalities in common. The temporal relationship between the occurrence of migraine headache and panic attacks could be different, however. According to our observations, some migraine subjects develop panic attacks with the typical symptoms (palpitation, dyspnea, anxiety/fear, shiver, sweating, polyuria) on the "peak" of their attacks. This variant of migraine without aura was conditionally defined as "panic migraine". Here we describe two patients suffering from migraine without aura in whom migraine was associated with the typical panic attack. It is suggested that a pronounced autonomic dysregulation along with marked psychological abnormalities could be responsible for the constellation of migraine and panic symptoms during one episode. Taking into account the previously obtained results, it is concluded that compared to "pure" migraine, "migraine associated with panic attacks" is characterized by a severe course, marked autonomic and emotional disturbances during pain-free intervals, seriously impaired quality of life, and requires a specific therapeutic approach.

Patent foramen ovale: association between the degree of shunt by contrast transesophageal echocardiography and the risk of future ischemic neurologic events

This study investigated whether there is an association between the degree of interatrial shunting across a patent foramen ovale, as determined by saline contrast transesophageal echocardiography, and the risk of subsequent systemic embolic events, including stroke. Thirty-four patients found to have foramen ovale during transesophageal echocardiography were divided into two groups on the basis of the maximum number of microbubbles in the left heart in any single frame after intravenous saline contrast injection: group 1 (n = 16) with a "large" degree of shunt ( > or = 20 microbubbles) and group 2 (n = 18) with a "small" degree of shunt ( > or = 3 microbubbles). Patients were followed up over a mean period of 21 months for subsequent systemic embolic events, including transient ischemic attack and stroke. Five (31%) of the patients with large shunts had subsequent ischemic neurologic events, whereas none of the patients with small shunts had embolic events (p = 0.03). These events occurred in spite of antiplatelet or anticoagulant therapy. We conclude that patients with a large degree of shunt across a patient foramen ovale, as determined by contrast transesophageal echocardiography, are at a significantly higher risk of subsequent adverse neurologic events compared with patients with a small degree of shunt.

Amaurosis fugax in young people

Nine young adults (median age 19.5 years) who suffered from amaurosis fugax (AF) are described. The attacks of AF were short in duration and preceded by premonitory symptoms in five cases and by a migrainous headache in two. In five patients the visual loss progressed in a lacunar pattern unlike the 'curtain' pattern characteristic of AF in older patients. Investigation revealed no evidence of an embolic or atheromatous aetiology. In two cases a minor abnormality was found on echocardiography. We conclude that AF in young adults has a different clinical pattern and may have a different aetiology, possibly migrainous, compared with that seen in older patients. The pattern of visual loss in some of the cases suggests that the choroidal circulation rather than the retinal circulation is primarily affected.

Cardiac arrhythmias in the differential diagnosis of epilepsy

Symptomatic attacks or seizures associated with cardiac arrhythmias may cause difficulty in differential diagnosis. Two patients are reported in whom disturbances of cardiac conduction induced attacks which clinically resembled attacks of psychogenic and epileptic origin and were abolished after implantation of a demand-type pacemaker. A third patient is described who had epileptic seizures resulting in cardiac arrhythmias. In the differential diagnosis of these cases, simultaneous ambulatory EEG and ECG recording was essential.

Enhancement of adenosine-induced relaxant responses of the guinea-pig isolated taenia coli and aortae by a novel nootropic agent BY-1949: comparison with dipyridamole

In muscle strips of guinea-pig taenia coli and aortae, the effects of 3-methoxy-11-methyldibenz[b,f][1,4]oxazepine-8-carboxylate (BY-1949) on the relaxant response to adenosine have been compared with those of dipyridamole. BY-1949 (3 x 10(-5)-10(-4) M) as well as dipyridamole (3 x 10(-7)-10(-5) M) resulted in a significant potentiation of relaxant responses to a cumulative administration of adenosine (10(-6)-10(-3) M), but the drugs did not affect the response to noradrenaline and acetylcholine. The results indicate that BY-1949 exerts a selective potentiating effect on reactivity to exogenous adenosine.