Non-cardiac manifestations of Marfan syndrome

Because of the widespread distribution of fibrillin 1 in the body, Marfan syndrome (MFS) affects virtually every system. The expression of this single dominantly inherited gene is variable within a family, and between families. There is some genotype-phenotype correlation which is helpful in guiding long-term prognosis, and management. In general gene mutations have been reported in clusters, with those having mainly ocular manifestations occurring in exons 1 to 15 of this 65-exon gene; those causing cardiac problems often involving cysteine replacement in a calcium binding EGF-like sequence; the most severe mutations occurring in exons 25-32, causing neonatal MFS diagnosed at birth, and severe enough to cause death frequently before the age of 2. Other correlations will certainly be found in future. This condition is progressive, and the manifestations unfold according to age. For example, if the lens is going to dislocate this usually occurs by age 10; scoliosis usually presents itself between the ages of 8 and 15; height should be monitored carefully between the onset of puberty and cessation of growth approximately age 17 or 18. Holistic care should be offered by one doctor who oversees the patient's welfare. This should be a paediatrician, paediatric cardiologist, or general practitioner in the case of an affected child. Thereafter, the physician in charge of the most seriously affected system should be aware that other systems need to be managed through a referral network.

The Link Between Migraine, Reversible Cerebral Vasoconstriction Syndrome and Cervical Artery Dissection

Headache is the common thread of migraine, reversible cerebral vasoconstriction syndrome (RCVS) and cervical artery dissection (CeAD), three medical conditions that otherwise appear to be very different. However, epidemiological, clinical and genetic data suggest that these conditions share common and complex features and are, at least partly, linked. The purpose of this manuscript is to review existing evidence for an association between migraine, RCVS and CeAD and discuss the potential underlying mechanisms.

A new near-infrared spectroscopy parameter as marker for patients with migraine

Due to the lack of markers for migraine, diagnosis relies entirely on symptomatology. The aim is to evaluate the utility of a new near-infrared spectroscopy parameter as potential marker for patients with episodic migraine with (MA+) and without aura (MA-) during the interictal period of migraine. We studied 10 patients with MA+ (age 39.5 ± 12.2 years) and 10 with MA- (age 40.3 ± 10.2 years), according to ICHD-II criteria 2004, during the interictal period of migraine and 15 age and sex matched healthy control subjects. The cases and controls were free from vascular risk factors and migraine prophylactic medications. At rest in all the participants, the time delay in millisecond (ms), between the R-wave of an electrocardiogram and the arterial pulse wave of cerebral microcirculation detected by transcranial near-infrared Spectroscopy (R-APWCMtd) on the frontal cortex of both side, was determined. The patients with migraine had a significantly longer R-APWCMtd than the control subjects: the patients with MA+: +38.3 ms, p < 0.0002; the patients with MA-: +34.7 ms, p < 0.0002, and there was no significant difference between MA+ and MA-, p = 0.71. We used receiver-operator characteristic (ROC) curve to assess the diagnostic potential of the R-APWCMtd measurement for diagnosis of migraine; we found an ROC area of 0.92, p < 0.0001, sensitivity 77.8 %, specificity 100 % and cutoff of 242 ms. Our study seems to indicate that the longer R-APWCMtd is independently associated with a diagnosis of migraine, and may be considered a new marker for migraine, especially in patients with MA+.