Sinus arrhythmia and pupil size in Chiari I malformation: evidence of autonomic dysfunction.

In a prospective study on latent autonomic dysfunction in the Chiari type I malformation, 15 patients were examined for degree of sinus arrhythmia in the supine and the sitting positions with a deep breathing test, and for pupil size and function with electronic pupillometry after sympathicomimetic eyedrop stimulation. The 5 patients with brainstem signs had a marked disturbance of sinus arrhythmia, which was more pronounced in the supine than in the sitting position. The clinical signs suggested a dysfunction of the reflex centers in the medulla rather than of the lower cranial nerves.

Cluster headache in identical twins.

Twin brothers with cluster headache are described. Monozygosity was demonstrated by conventional genetic markers and DNA-typing. Both had "mini-bouts" in the early stages.

Headache associated with the Chiari type I malformation.

The main purpose of the present study was to define and understand more clearly the headache, and in particular the long-lasting attacks or continuous pain associated with the Chiari type I malformation. Of 34 patients with the malformation, the 20 patients who had or had had headache problems were interviewed according to a standardized questionnaire. Many patients had several headache types.

Posterior cranial fossa dimensions in the Chiari I malformation: relation to pathogenesis and clinical presentation.

Skull dimensions were measured on lateral skull radiographs in 33 adult patients with MRI-verified Chiari I malformations and in 40 controls. The posterior cranial fossa was significantly smaller and shallower in patients than in controls. In the patients, there was a positive correlation between posterior fossa size and the degree of the cerebellar ectopia, which might indicate that a posterior cranial fossa which was originally too small had been expanded by the herniation of hindbrain structures at an early stage.

Common migraine ("migraine without aura"): localization of the initial pain of attack.

In classical migraine ("migraine with aura"), the attack pain is usually initially felt in the oculo-fronto-temporal area (around 90% of the cases). A fronto-temporal onset of pain is in other words a typical trait of classic migraine. The initial location of pain in common migraine ("migraine without aura") is not so well known.

Syringomyelia in Chiari malformation: relation to extent of cerebellar tissue herniation.

In 47 patients with Chiari malformations (41 with Type I, 6 with Type II) diagnosed by magnetic resonance imaging, syringomyelia was found significantly more frequently in those who had a herniation of 9 to 14 mm (9 of 16, 56%) than in those who had a smaller (2 of 15, 13%) or larger (2 of 16, 13%) herniation. Syringomyelia associated with the Chiari malformation is generally considered to be due to mechanical factors induced by altered cerebrospinal fluid hydrodynamics. On the basis of the present study, one may speculate whether these mechanical factors affect the cord most efficiently at an intermediate level of herniation, which may prove to be a risk factor for the development of syringomyelia.

Headache and Chiari type I malformation: occurrence in female monozygotic twins and first-degree relatives.

The Chiari type I malformation has recently been reported in three generations of a family, including female monozygotic twins. Headache was the main symptom in several family members. Various headache patterns consistent with migraine without aura, cough headache, tension headache and hypoliquorrhoeic headache were present, and different patterns might coexist in the same patient.

Laterality of pain and other migraine criteria in common migraine. A comparison with cervicogenic headache.

Patients diagnosed as suffering from common migraine according to the "Ad hoc committee" criteria of 1962 have been studied as for type of unilaterality of headache. Patients, with trauma to the face, head, and neck were excluded, together with patients with the faintest suspicion of aura and those with chronification of the headache. Common migraine criteria, as stipulated by the IHS and Vahlquist, were counted in every patient (n = 32), except the laterality which was a free variable (a total of 8 variables remaining).

Cluster headache: phospholipid metabolism in polymorphonuclear cells.

Our group has previously reported significant changes in the incorporation of precursors into glycerophospholipids, particularly phosphatidylserine, in polymorphonuclear cells obtained from the peripheral blood of cluster headache patients, when compared with controls. The potential of these results led to further work using both the previous methodology and a modified isolation technique to obtain polymorphonuclear cells in as pure a state as possible. Neither the new results obtained using the original technique, nor the results with high purity polymorphonuclear cells from controls and cluster headache patients, confirm the marked changes in precursor uptake into glycerophospholipids originally reported.

The Chiari type I malformation in two monozygotic twins and first-degree relatives.

The presence of the Chiari type I malformation in 2 adult monozygotic female twins, their mother, and possibly in 2 of their 4 daughters is reported. The diagnosis was made by magnetic resonance imaging and confirmed at the time of surgery in 1 twin. Monozygosity of the twins was proved by DNA typing.

[Laboratory diagnosis of multiple sclerosis].

In 26 patients with multiple sclerosis 100% responded abnormally to magnetic resonance imaging of the brain. Lesions in the posterior fossa were observed in 18 patients. The auditory brain stem response was abnormal in 15 patients, and 22 had abnormal immunoglobulins in the cerebrospinal fluid.

Somatomedin C (insulin-like growth factor 1) in adults with Down's syndrome.

In a Norwegian institution for the mentally retarded, 29 adults with chromosomally verified Down's syndrome were compared to other mentally retarded patients with respect to serum somatomedin C (SmC) (insulin-like growth factor 1 [IGF-1]). Contrary to what has been observed in children, no shortage of SmC could be demonstrated in the adults with Down's syndrome. The results were within the normal range, and there was no difference between those with Down's syndrome and the other mentally retarded patients.

Hormonal and biochemical disturbances in Down's syndrome.

Clinical and laboratory endocrine variables in 29 adult institutionalized patients with Down's syndrome were compared with those of matched controls consisting of other mentally retarded patients from the same institution. Of the clinical variables, testes volume and body height were significantly lower in patients with Down's syndrome than in control patients. The thyroid function tests documented a higher average TSH level in Down's syndrome than in other mentally retarded patients.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, etc. (SUNCT): III. Another Norwegian case.

"SUNCT" is a recently reported head pain syndrome characterized by shortlasting, unilateral neuralgiform paroxysms with conjunctival injection and tearing, and to a lesser extent nasal secretion, and (subclinical) sweating. Another case--that of a 56 year old male--is reported herein. The attacks lasted 1/2-1 min.

Dental caries and periodontitis in persons with Down syndrome.

In a central institution for persons with mental retardation, the dental status in 30 adult patients with Down syndrome was compared with that in a carefully selected group of gender- and age-matched mentally retarded patients. This investigation showed an increased frequency of periodontitis in the population with Down syndrome. The caries rate, however, did not differ demonstrably between the groups.

"Hemicrania continua": a clinical review.

Hemicrania continua (HC) is a headache entity completely responsive to indomethacin. Since 1984, 18 cases have been described, 15 females and 3 males, i.e.

Lumbar iohexol myelography and diagnostic lumbar puncture. Headache and associated side effects in relation to neurological signs and diagnosis, previous mental symptoms and pain history.

Various possible risk factors for postlumbar puncture (and postiohexol-myelographic) headache and associated side effects were analysed. Headache and nausea occurred significantly more often in patients without clinical findings than in those with findings. We found significantly different incidences of severe headache and nausea between diagnostic subgroups after a lumbar puncture.

Side effects after lumbar iohexol myelography. Relation to radiological diagnosis, sex and age.

Side effects of iohexol lumbar myelography have been analyzed with respect to the influence of the type of radiological abnormality, sex and age in a group of 200 patients. Headache, postural headache, nausea and back/leg pain were significantly more frequent in patients without definite radiological abnormalities. Postural headache, nausea, dizziness and mental symptoms were more frequent in women, while headache, postural headache, nausea, dizziness, minor mental symptoms (i.

Increased incorporation of L-(U-14C)serine into phosphatidylserine in polymorphonuclear cells from cluster headache patients.

It has recently been demonstrated by our group that polymorphonuclear cells (PMNs) from cluster headache patients incorporate more arachidonic acid (AA) into phosphatidylserine (PS) than PMNs from controls. In the present report, the incorporation of L-(U-14C)serine into PS in PMNs from 14 healthy volunteers and 12 cluster headache patients was studied. PMNs from controls incorporated 1194 +/- 578 (mean +/- SD) cpm of L-(U-14C)serine into PS, 268 +/- 292 cpm into phosphatidylethanolamine, and 57 +/- 71 cpm into sphingomyeline.

Cluster headache: increased incorporation of (1-14C)arachidonic acid into phosphatidylserine in polymorphonuclear cells.

Vasoactive metabolites deriving from arachidonic acid (AA) have been considered as putative mediators in the pathogenesis of various types of headache. In the present study we therefore compare the ability to synthesize AA containing precursor phospholipids in polymorphonuclear cells (PMNs) from healthy controls and cluster headache patients. 3.

Cluster headache: incorporation of (1-14C)oleic acid into phosphatidylserine in polymorphonuclear cells.

As recently demonstrated by our group, polymorphonuclear cells (PMNs) from cluster headache patients have an increased ability to incorporate arachidonic acid (AA) and L-serine into phosphatidylserine (PS). To evaluate whether there is an increased incorporation into PS also from fatty acids not involved in eicosanoid metabolism, PMNs from controls (n = 14) and cluster headache patients (n = 12) were incubated with (1-14C)oleic acid. After 1 h 2.

Side effects after ambulatory lumbar iohexol myelography.

Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n = 107) as compared to non-ambulatory myelography (26%, n = 58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant.