eNeurologicalScieNeurologicalSci Vol 32

September 2023

ABCs of Headache

Headache advocacy

Wolfgang Grisold, David W. Dodick


Review Article

Secondary headaches - red and green flags and their significance for diagnostics

Tissa Wijeratne, Chanith Wijeratne, Nadja Korajkic, Stefanie Bird, Carmela Sales, Franz Riederer

  • Article 100473
  • https://doi.org/10.1016/j.ensci.2023.100473
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  • Abstract

    A small percentage of patients suffer from a secondary headache syndrome. It is imperative that clinicians are able to differentiate primary headache syndromes from secondary headache syndromes, as failure to do so significantly worsens morbidity and mortality. Recent advances in our understanding of pathobiological mechanisms offer useful information on these enigmatic disorders. We now understand that the causes of secondary headache syndromes can vary significantly – these may be infectious, inflammatory, vascular, traumatic or structural in origin.

    A well-taken history and targeted physical examination coupled with appropriate investigations can enable these syndromes to be recognized consistently and thus allow their timely and appropriate treatment. Along with their epidemiology, some of their key characteristics shall thus be discussed in this review so as to aid the busy clinician at the bedside. Red flags including sudden onset, high pain intensity, pattern of change of a preexisting headache, focal neurological signs or seizure, systemic signs and precipitation by physical activity can guide the clinician to suspect a secondary headache. Importantly a preexisting headache is not an exclusion of a secondary headache – it might even be a predisposition in certain cases.


Original Articles

Ischemic strokes revealing neurosyphilis: Study of six (6) observations at the neurology Department of the University Hospital of Conakry

M.L. Touré, T.H. Baldé, M.S. Diallo, G. Carlos Othon, ... A. Cissé

  • Article 100470
  • https://doi.org/10.1016/j.ensci.2023.100470
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  • Abstract

    In sub-Saharan Africa (SSA), stroke is a major public health problem and the etiological aspects are poorly studied and documented because of under-medicalization; the syphilitic etiology is rarely mentioned. Patients and methods

    We performed a retrospective study of 472 patients hospitalized for ischemic stroke between 2016 and 2021 in the Neurology Department of the University Hospital of Conakry, confirmed by neuroradiological explorations (brain CT, MRI-Angio) and a biological workup including VDRL-TPHA serological reactions in blood and CSF.

Effects of cancer on stroke recurrence and mortality: A single-center retrospective cohort study

Kang-Po Lee, Hui-Chi Huang, Jui-Yao Tsai, Li-Chi Hsu

  • Article 100474
  • https://doi.org/10.1016/j.ensci.2023.100474
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  • Abstract

    Whether patients with stroke and cancer have specific characteristics remains controversial. In addition, research regarding the effects of individual cancer types on stroke outcomes remains scarce. This study investigated the mortality and stroke recurrence rates in patients with stroke and concomitant cancer and evaluated outcome predictors. Methods

    This study retrospectively enrolled 2610 patients in the Taipei Veterans General Hospital Stroke Registry registered from January 2019 to December 2020. A total of 1868 patients were included after excluding those without acute ischemic stroke or hospitalization. The patients were then categorized into the following diagnostic groups: cancer-associated stroke (CAS), stroke and inactive cancer, and stroke without cancer. The discharge mortality rate, 1-year mortality rate, and 1-year stroke recurrence rate were compared. Multiple clinical characteristics and comorbidities—age, sex, stroke severity, coagulopathy, common vascular risk factors, and acute stroke treatment—were also assessed.

    Patients with stroke and active cancer had similar stroke severity. However, the 1-year mortality and stroke recurrence rates were higher in these patients than in patients with inactive cancer or the control group.


Case Reports

An adult progressive Langerhans cell histiocytosis with central nervous system involvement for 10 years: A case report

Hanxing Liu, Yumin Liu, Hong Cao, Yanping Liu

  • Article 100471
  • https://doi.org/10.1016/j.ensci.2023.100471
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  • Abstract

    Langerhans cell histiocytosis (LCH) is a rare disease that usually occurs in children <15 years of age. Adult-onset LCH is extremely rare. Previous published guidelines and studies mainly focused on pediatric patients. The rarity and also insufficient knowledge of LCH in adults, especially central neuvous system (CNS) involvement of LCH, often resulted in missed and delayed diagnosis.

    A 35-year-old woman presented with cognitive impairment, anxietydepression, decreased eyesight, skin rash, hypernatremia, gonadal hormone deficiency and hypothyroidism. She had experienced menstrual disturbance and infertility since 10 years ago. MRI examination showed a mass lesion in the hypothalamic-pituitary region. Sighs of radiologic neurodegeneration were not found on brain MRI scans, however. Biopsy of skin rash confirmed the the diagnosis of multisystem LCH. BRAF V600E mutation was detected in the peripheral blood mononuclear cells. She accepted combination chemotherapy of vindesine and prednisone and accquired partial remission. The patient died of severe pneumonia during the second course of chemotherapy.

    Given the complicated differential diagnoses of neuroendocrine disorders, it was essential to be aware of CNS involvement of LCH at first, especially in adults. BRAF V600E mutation may participated in disease progression.