Preliminary study: cognitive behavioural therapy for insomnia in adolescents with anorexia nervosa.

Purpose: Insomnia and anorexia nervosa (AN) are frequently comorbid, negatively affecting the evolution and the prognosis of AN. Within this framework, the management of sleep disorders appears as critical. The aim of this retrospective study is to assess, for the first time, the efficacy of cognitive and behavioural therapy for insomnia (CBT-I) on sleep disturbances in adolescents with AN.

Wall-eyed Bilateral Internuclear Ophthalmoplegia (WEBINO) in a Patient With Idiopathic Intracranial Hypertension.

Introduction: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a variant syndrome of internuclear ophthalmoplegia, consisting of primary gaze exotropia, adduction impairment, nystagmus of the abducting eye, and vertical gaze-evoked nystagmus. It seems to be most frequently associated with multiple sclerosis, although other etiologies such as brainstem ischemia or hydrocephalus have also been described.

Case Report: We report the case of a 25-year-old woman who presented with subacute progressive oculomotor disturbances, resulting in the development of a WEBINO over a few days.

Autonomic function in migraine patients: ictal and interictal pupillometry.

Objective And Background: Pupillometric investigations into migraine have suggested that an autonomic disturbance is part of the pathogenesis of that condition. This observation is controversial, however, which may reflect that the putative sympathetic hypofunction is either subtle or transient. In this study, we assessed the sympathetic function of migraine patients and controls during both a symptom-free phase and a migraine attack, and challenged patients with apraclonidine to reveal small changes in autonomic function.

Patients with migraine correctly estimate the visual verticality.

Objective: We wanted to study otolith function by measuring the static subjective visual vertical (SVV) in migraine patients and in controls with and without kinetosis (motion sickness).

Methods And Material: Forty-seven patients with moderately severe migraine and 96 healthy controls were enrolled. Using a questionnaire, persons with kinetosis were identified.

Saccade behaviour in migraine patients.

Background: Voxel-based morphometry studies in migraine patients showed significant grey matter volume reduction in regions involved in the control of saccadic eye movements. We hypothesized that these changes would be reflected in dysfunctional saccadic behaviour.

Methods: Saccades were recorded by infrared oculography using three different paradigms (pro-saccade with gap, pro-saccade overlap and anti-saccade with gap).

Apraclonidine and my pupil.

Purpose: Used in the diagnosis of Horner's syndrome, apraclonidine 1% dilatates the involved eye due to denervation supersensitivity. Recent literature suggests that in healthy volunteers, apraclonidine provokes a mild miotic effect. Since the comparison of both the pathologic and the non-pathologic eye is important, we wanted to further investigate the effect of apraclonidine on the healthy eye.

Cerebral oedema in episodic ataxia.

We report a patient with episodic ataxia (presumably of type 2) who developed cerebral oedema secondary to a common infection (presumably viral). Cerebral oedema may be a part of the clinical spectrum of familial episodic ataxia and argues for an overlap with hemiplegic migraine. It is suggested to consider a diagnosis of episodic ataxia or familial hemiplegic migraine in catastrophic reactions to apparent trivial trauma or infection.

Diagnostic and therapeutic trajectory of cluster headache patients in Flanders.

Objective: A fraction of cluster headache (CH) patients face diagnostic delay, misdiagnosis, undertreatment and mismanagement. Specific data for Flanders are warranted.

Methods: Data on CH characteristics, diagnostic process and treatment history were gathered using a self-administered questionnaire with 90 items in CH patients that presented to 4 neurology outpatient clinics.

Saccadic ping pong gaze in coma.

In this report, we describe the peculiar eye movements of a young man who became comatose after a head injury. The eyes moved rhythmically from one side to another, without pausing in the lateral positions. This phenomenon has been described as "ping pong gaze" (PPG), referring to short-cycling periodic alternating gaze with smooth eye deviations.

False perception of visual verticality in multiple sclerosis.

We wanted to investigate to what extent patients with multiple sclerosis (MS), not complaining of dizziness or disequilibrium, may have problems with the estimation of gravidity. Therefore, we studied the static 'subjective visual vertical' (SVV), a test that is thought to reflect mainly otolith function. Further, we correlated SVV measures with the degree of disease disability.

Practical management of medication-overuse headache.

Epidemiological studies suggest that medication-overuse as defined by the International Headache Society is extremely common in patients with chronic daily headache. If all medication-overuse produces medication-overuse headache (MOH) in headache patients, it would be the third most frequent form of headache, after tension-type headache and migraine. Treatment of MOH is hindered by the absence of placebo-controlled, double-blind, randomised clinical trials.

Brachioradial pruritus--a peculiar neuropathic disorder.

The case is presented of a middle-aged woman who suffered from lancinating itch on the dorsolateral aspect of the upper arm after a loco-regional injury, first on the right and later on the left side. Brachioradial pruritus (BRP) was diagnosed. Neurophysiologic examination was compatible with a neuropathy at the C5-C6 level, while a negative nerve root block supported an additional central impact.

Carotid artery aneurysm in human immunodeficiency virus infection.

The case is reported of a patient with human immunodeficiency virus (HIV) infection presenting with isolated headache as the presumed manifestation of a cavernous carotid aneurysm. The relationship between HIV and aneurysms is discussed. Clinicians should be aware of the possibility of carotid aneurysms in HIV-positive patients, even in areas where HIV is not endemic and when no neurological deficit is present.

Effect of repetitive transcranial magnetic stimulation on saccades in depression: a pilot study.

Therapeutic repetitive transcranial magnetic stimulation (rTMS) in depression is applied over the prefrontal cortex. This brain region is known to play an important role in the control of saccades. We wanted to investigate whether the fast rTMS procedure affected saccadic activity in depression.

Magnetic resonance angiography of the circle of Willis in migraine patients.

We analysed records of 244 consecutive adult outpatients who presented at our neurological polyclinic between 1996 and 2001 with migraine and who underwent a MRA of the circle of Willis. In 80 cases, a definitive migraine diagnosis according to the International Headache Society criteria (1988) could be retrieved from the patient records. Of these, 63 patients had migraine without aura and 17 patients had migraine with aura.

Visuo-spatial processing in Parkinson's disease: evidence for diminished visuo-spatial sketch pad and central executive resources.

A dual-task study compared the visuo-spatial sketch pad and central executive components of working memory as potential cognitive mechanisms of visuo-spatial dysfunction in Parkinson's disease. Mildly to moderately affected Parkinsonian patients (n = 15) and controls (n = 15) performed the Corsi blocks task concurrently with tasks designed to load on the visuo-spatial sketch pad (spatial tapping) or the central executive (random interval repetition). Patients performed more poorly in both concurrent task conditions, implicating a reduction in both visuo-spatial sketch pad and central executive resources.

Migraine-related vertigo: towards a distinctive entity.

Both migraine and vertigo are common complaints. Although they may coincide by chance, there is growing evidence for a clinical entity of recurrent vestibular symptoms related to migraine. This syndrome implies a possible causal relationship although the pathophysiology of migraine-related vertigo has not been fully elucidated.

Gap effect in reflexive and intentional prosaccades.

The analysis of saccadic eye movements has assumed an important role as a pathophysiological approach in neuropsychiatric diseases. However, before abnormal cognitive saccade behavior can be fully understood, some basic psychophysiological aspects have to be further investigated. Previous studies have demonstrated a shortening of saccade latency when the fixation stimulus was removed prior to the appearance of a peripheral visual target.

Treatment of anterior canal benign paroxysmal positional vertigo by a prolonged forced position procedure.

This report presents a therapeutic procedure for refractory benign paroxysmal positional vertigo (antBPPV) of the anterior canal. Two patients with refractory antBPPV were treated by a prolonged forced position procedure (PFPP). The technique is based on the assumption that the pathophysiological mechanism of antBPPV is similar to that generating posterior canal canalolithiasis.

Effect of intention and visual fixation disengagement on prosaccades in Parkinson's disease patients.

In a previous study, we postulated a divergence in reflexive versus voluntary saccade behavior in Parkinson's disease (PD) patients and hypothesized a fronto-striatal dysfunction. The voluntary saccade tasks included antisaccades (AS) and remembered saccades (RemS). However, multiple cognitive processes are involved in AS and RemS and the procedures lack a visual target.

Visual extinction for motion.

Purpose: To alert clinicians to the heretofore undescribed visual behavioral phenomenon of visual extinction limited to motion.

Methods: Neuro-ophthalmological, neuropsychological and neuroimaging assessment of a 57-year-old man with vague visual complaints.

Results: Extinction limited to visual motion perception in the left hemifield was demonstrated.

Painful isolated Horner's syndrome caused by pontine ischaemia.

Purpose: To alert ophthalmologists to the possibility of brainstem ischaemia in patients with isolated Horner's syndrome.

Design: Observational case report.

Methods: Neuro-ophthalmological and neuroimaging assessment of a 59-year-old woman presenting with an isolated Horner's syndrome after an episode of headache.