Pulsed Radiofrequency for Treating Trigeminal Neuralgia.

Background: Trigeminal neuralgia is the most common cause of facial pain but can be challenging to treat. Some patients fail on medications, and while surgical procedures achieve short-term efficacy, they can be associated with numerous complications. We present a case series suggesting the efficacy and safety of using pulsed radiofrequency (PRF) through the transcoronoid approach to treat trigeminal neuralgia.

Radiofrequency Ablation of Pericranial Nerves for Treating Headache Conditions: A Promising Option for Patients.

Background: Chronic daily headache, including chronic migraine, can be challenging to treat. Medications often only provide limited improvement, and surgical interventions can be associated with significant adverse effects. We present our experience with using radiofrequency ablation (RFA) for pericranial nerves to treat chronic headache conditions.

Surgical decision making in temporal lobe epilepsy: a comparison of [(18)F]FDG-PET, MRI, and EEG.

Objectives: The goals of this work were (1) to determine the effect of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET), MRI, and EEG on the decision to perform temporal lobe epilepsy (TLE) surgery, and (2) to determine if FDG-PET, MRI, or EEG predicts surgical outcome.

Methods: All PET scans ordered (2000-2010) for epilepsy or seizures were tabulated. Medical records were investigated to determine eligibility and collect data.

Isolated Broca's area aphasia and ischemic stroke mechanism.

Cerebral embolism has been considered to be the most common stroke mechanism when the resulting stroke has at least some amount of aphasia as part of its clinical manifestations. To determine stroke mechanism and risk factor profile in patients with isolated Broca's area aphasia (Broca's infarct), we studied 34 consecutive patients with recent infarcts whose only or predominant clinical feature was that of nonfluent speech and compared these cases with 68 control patients with cortical infarcts in the middle cerebral artery distribution whose clinical features were not restricted to an isolated aphasia. Controls were age- and sex-matched and were selected from ischemic infarcts seen at our institutions over the same observation period.

Aspirin "failures," clopidogrel added to aspirin, and secondary stroke prevention in veterans presenting with TIA or mild-to-moderate ischemic stroke.

Our objective was to investigate whether clopidogrel added to low-dose aspirin reduced vascular events in male patients at our VA hospital who had "failed" aspirin therapy because of a mild-to-moderate stroke or a transient ischemic attack. Of 179 consecutive patients who both reported daily aspirin usage at the time of their newest ischemic event as well as were then operationally defined as aspirin "failures," 134 (group A) were treated with combined aspirin-clopidogrel, 15 (group B) underwent an early arterial procedure, 25 (group C) were anticoagulated, and 5 were not entered or continued because of either non-compliance or a refusal to participate. Study therapies were modified because of a vascular event in 4.

Carotid angioplasty and intra-arterial thrombolysis in acute carotid circulation stroke: a case report.

Background: Early treatment with intra-arterial thrombolysis has been shown to be effective in the treatment of acute ischemic stroke because of occlusion of the middle cerebral artery. It is unclear how to use this therapy, however, when there is also occlusion of the parent internal carotid artery.

Case Report: A 43-year-old woman presented within 15 minutes of symptom onset caused by a large right anterior circulation ischemic stroke.

Pulsatile tinnitus in cerebrovascular arterial diseases.

In a prospective study of 100 patients evaluated at the University of Wisconsin Stroke Program, we sought to document cases of incidental pulsatile tinnitus that could be ascribed to stenotic, occluded, ectatic, tortuous, or dissected craniocerebral arteries. Angiographic detail, magnetic resonance angiography, catheter-generated x-ray angiography, or both were necessary for inclusion into either Group 1 (n=29), those with pulsatile tinnitus, or Group 2 (n=71), those without pulsatile tinnitus. Patients did not appear to have head/neck tumors, aneurysms, arteriovenous malformations, transmitted cardiac murmurs, or venous etiologies for their tinnitus.

Ischemic stroke associated with activated protein C resistance and aortic valvular papillary fibroelastoma.

We report an unusual case of a pontine ischemic stroke associated with activated protein C resistance as well as an embolic source in the form of a cardiac valvular lesion. A 31-year-old man had a sudden onset of right hemiparesis and a severe dysarthria. Cranial magnetic resonance imaging (MRI) showed a nonhemorrhagic pontine lesion with essentially negative craniocervical MR angiography.

Differing mechanisms between posterior and middle cerebral artery infarctions.

Cardiac embolism has been thought to be one of the principal causes of posterior cerebral artery territory infarction. To determine stroke mechanisms and stroke risk factors in patients with posterior cerebral artery infarction, we studied 23 consecutive patients with recent infarcts in the posterior cerebral artery distribution (PCA infarcts) and compared these with a case-control group of 46 patients with recent infarcts in the middle cerebral artery distribution (MCA infarcts). All patients were similarly studied, including angiography and echocardiography.

Relationship between age and mortality due to intracerebral versus subarachnoid hemorrhage.

This cross-sectional study compares trends in mortality by age for intracerebral and subarachnoid hemorrhage. United States mortality data from the Centers for Disease Control from the years 1991 to 1992 are examined with the program CDC Wonder, and mortality rates for 10-year age groups for each disease are compared. As expected, the crude mortality rate attributable to intracerebral hemorrhage, at 7.

Hemiplegic migraine: hyperperfusion and abortive therapy with intravenous verapamil.

A 20-year-old female with hemiplegic migraine was treated during an acute attack with intravenous verapamil, which reproducibly resolved the headache within 20 min but did not affect her hemiplegia. Magnetic resonance (MR) and computed tomographic (CT) angiography and perfusion performed during the attack showed vasodilation and hyperperfusion. Cerebral hyperperfusion concurrent with hemiplegia suggests a dissociation between cerebral perfusion and neuronal function in hemiplegic migraine.

Inpatient and community ischemic strokes in a university hospital.

Background: Previous studies have shown that inpatient strokes are common and severe. We sought to characterize the risk factors, stroke subtypes, timing of acute stroke evaluation and frequency of thrombolytic therapy in inpatient ischemic strokes compared with community ischemic strokes.

Design/methods: The hospital records of patients admitted for acute ischemic stroke between 1996 and 2002 were reviewed.

Serial headache drawings by children with migraine: correlation with clinical headache status.

Children's artistic self-depictions of headache provide valuable insights into their experience of pain and aid in the diagnostic differentiation of headache types. In a previous study, we compared the clinical diagnosis (gold standard) and artistic diagnosis of headaches in 226 children. In approximately 90% of cases, the drawing predicted the clinical diagnosis of migraine versus nonmigraine headache correctly.

Atrial fibrillation is associated with severe acute ischemic stroke.

Atrial fibrillation (AF) is a common risk factor for disabling ischemic stroke in the elderly, but it is not clear that its severity is generally worse than that of ischemic stroke due to other etiologies. We reviewed the clinical presentations of patients with acute ischemic stroke admitted between 1990 and 2001. The etiologies of these strokes were also classified using well-established criteria.

Attitudes and approaches to acute ischemic stroke in Wisconsin hospitals.

Although acute stroke is a common presentation to an emergency room, the presentation of a patient with acute ischemic stroke, within a limited time window as an appropriate candidate for cerebral thrombolysis, is not common. In many of these patients, their candidacy can be improved through community education toward emergent transfer to an emergency room if they manifest symptoms of stroke. This would improve the "symptom-to-door" time.

Isolated petrous carotid stenosis and transient ischemic attack.

Although anterior circulation transient ischemic attacks (TIAs) tend to be more common in patients with extra- cranial carotid arterial disease than in those with intracranial carotid or middle cerebral arterial disease, the authors recently encountered 4 patients with both recurrent, stereotypical TIAs as well as isolated stenosis of their petrous internal carotid artery (ICA). While the gold standard for establishing the diagnosis of intracranial large-artery disease has always been conventional angiography, magnetic resonance angiography changes, confirmed with intra-arterial digital subtraction angiography in 2 of these patients, were quite sufficient to define the occlusive disease in each of the cases. Petrous ICA stenosis is not uncommon, but it has often been overshadowed by the search for extracranial ICA disease that might be amenable to surgical reconstruction.

Initial clinical experience with IV tissue plasminogen activator for acute ischemic stroke: a multicenter survey. The t-PA Stroke Survey Group.

We assessed initial clinical experience with IV tissue plasminogen activator (t-PA) treatment of acute ischemic stroke in a standardized retrospective survey of hospitals with experienced acute stroke treatment systems. The incidence of symptomatic intracerebral hemorrhage (ICH) was 6% (11 of 189 patients; 95% CI 3 to 11%), similar to that in the National Institute of Neurological Disorders and Stroke (NINDS) t-PA Stroke Study. Deviations from the NINDS protocol guidelines were identified in 30% of patients (56 of 189).

Naratriptan: an alternative for migraine.

Objective: To critically evaluate the literature regarding naratriptan's clinical pharmacology, efficacy, safety, and indications.

Data Source: A MEDLINE search was conducted for the period from January 1990 to June 1998. Key words used included naratriptan, triptan, serotonin agonists, migraine, and migraine therapy.

Tortuosity of carotid and vertebral arteries: a magnetic resonance angiographic study.

Nine patients (group A) were found on magnetic resonance angiography (MRA) to have excessive carotid artery, vertebral artery, and vertebrobasilar junction tortuosity. A control group (group B) were age- and sex-matched to group A patients, were selected randomly from our MRA or stroke data banks, and had not undergone MRA for evaluation of migraine, "carotidynia," or pulsatile tinnitus. Factors more prevalent in group A patients included migraine, chronic daily headache, carotidynia, pulsatile tinnitus, and a positive family history of headache.