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Ilya Kister - One of the best experts on this subject based on the ideXlab platform.

  • pontine Infarction as a complication of basilar type migraine status migrainosus p01 093
    Neurology, 2013
    Co-Authors: Sarah E Vollbracht, Matthew S. Robbins, Ilya Kister
    Abstract:

    OBJECTIVE: To present a patient with basilar-type migraine (BTM) sustaining a pontine Infarction during status migrainosus and to discuss the case in the context of the International Classification of Headache Disorders, 2nd Edition (ICHD-2) criteria for Migrainous Infarction. BACKGROUND: The ICHD-2 defines Migrainous Infarction as one or more otherwise typical aura symptoms that persist beyond one hour with neuroimaging confirmation of an ischemic Infarction in the affected territory. The ICHD-2 criteria exclude patients with new onset aura as well as patients who develop “extra-aural” symptoms at the time of Infarction. DESIGN/METHODS: Case report from a tertiary medical center. RESULTS: A 42-year-old woman with BTM whose aura symptoms included vertigo, tinnitus, hypacusis, gait unsteadiness, and disorientation developed her typical constellation of aura symptoms followed by a two-week period of status migrainosus, which she was treating with eletriptan 40 to 80mg mg daily. Several days into the headache phase she experienced acute, maximal-at-onset dysarthria and left face, arm, and leg numbness and weakness. These symptoms minimally improved over several weeks, leaving her with mild residual left-sided sensorimotor deficits and dysarthria. She had also been taking estrogen-containing oral contraception. MRI and MRA of the brain revealed a pontine ischemic lesion and basilar artery fenestration. CONCLUSIONS: This patient presents a diagnostic dilemma, since her stroke symptoms were not part of her typical aura syndrome and therefore does not fulfill ICHD-2 criteria for Migrainous Infarction. These restrictions on what constitutes a bona fide Migrainous Infarction may improve specificity at the expense of sensitivity, potentially underestimating the role of migraine in stroke etiology. Disclosure: Dr. Vollbracht9s family owns stock and/or stock options in Allergan, Inc. Dr. Robbins has nothing to disclose. Dr. Kister has nothing to disclose.

  • pontine Infarction as a complication of basilar type migraine status migrainosus p01 093
    Neurology, 2013
    Co-Authors: Sarah E Vollbracht, Matthew S. Robbins, Ilya Kister
    Abstract:

    OBJECTIVE: To present a patient with basilar-type migraine (BTM) sustaining a pontine Infarction during status migrainosus and to discuss the case in the context of the International Classification of Headache Disorders, 2nd Edition (ICHD-2) criteria for Migrainous Infarction. BACKGROUND: The ICHD-2 defines Migrainous Infarction as one or more otherwise typical aura symptoms that persist beyond one hour with neuroimaging confirmation of an ischemic Infarction in the affected territory. The ICHD-2 criteria exclude patients with new onset aura as well as patients who develop “extra-aural” symptoms at the time of Infarction. DESIGN/METHODS: Case report from a tertiary medical center. RESULTS: A 42-year-old woman with BTM whose aura symptoms included vertigo, tinnitus, hypacusis, gait unsteadiness, and disorientation developed her typical constellation of aura symptoms followed by a two-week period of status migrainosus, which she was treating with eletriptan 40 to 80mg mg daily. Several days into the headache phase she experienced acute, maximal-at-onset dysarthria and left face, arm, and leg numbness and weakness. These symptoms minimally improved over several weeks, leaving her with mild residual left-sided sensorimotor deficits and dysarthria. She had also been taking estrogen-containing oral contraception. MRI and MRA of the brain revealed a pontine ischemic lesion and basilar artery fenestration. CONCLUSIONS: This patient presents a diagnostic dilemma, since her stroke symptoms were not part of her typical aura syndrome and therefore does not fulfill ICHD-2 criteria for Migrainous Infarction. These restrictions on what constitutes a bona fide Migrainous Infarction may improve specificity at the expense of sensitivity, potentially underestimating the role of migraine in stroke etiology. Disclosure: Dr. Vollbracht9s family owns stock and/or stock options in Allergan, Inc. Dr. Robbins has nothing to disclose. Dr. Kister has nothing to disclose.

Sarah E Vollbracht - One of the best experts on this subject based on the ideXlab platform.

  • pontine Infarction as a complication of basilar type migraine status migrainosus p01 093
    Neurology, 2013
    Co-Authors: Sarah E Vollbracht, Matthew S. Robbins, Ilya Kister
    Abstract:

    OBJECTIVE: To present a patient with basilar-type migraine (BTM) sustaining a pontine Infarction during status migrainosus and to discuss the case in the context of the International Classification of Headache Disorders, 2nd Edition (ICHD-2) criteria for Migrainous Infarction. BACKGROUND: The ICHD-2 defines Migrainous Infarction as one or more otherwise typical aura symptoms that persist beyond one hour with neuroimaging confirmation of an ischemic Infarction in the affected territory. The ICHD-2 criteria exclude patients with new onset aura as well as patients who develop “extra-aural” symptoms at the time of Infarction. DESIGN/METHODS: Case report from a tertiary medical center. RESULTS: A 42-year-old woman with BTM whose aura symptoms included vertigo, tinnitus, hypacusis, gait unsteadiness, and disorientation developed her typical constellation of aura symptoms followed by a two-week period of status migrainosus, which she was treating with eletriptan 40 to 80mg mg daily. Several days into the headache phase she experienced acute, maximal-at-onset dysarthria and left face, arm, and leg numbness and weakness. These symptoms minimally improved over several weeks, leaving her with mild residual left-sided sensorimotor deficits and dysarthria. She had also been taking estrogen-containing oral contraception. MRI and MRA of the brain revealed a pontine ischemic lesion and basilar artery fenestration. CONCLUSIONS: This patient presents a diagnostic dilemma, since her stroke symptoms were not part of her typical aura syndrome and therefore does not fulfill ICHD-2 criteria for Migrainous Infarction. These restrictions on what constitutes a bona fide Migrainous Infarction may improve specificity at the expense of sensitivity, potentially underestimating the role of migraine in stroke etiology. Disclosure: Dr. Vollbracht9s family owns stock and/or stock options in Allergan, Inc. Dr. Robbins has nothing to disclose. Dr. Kister has nothing to disclose.

  • pontine Infarction as a complication of basilar type migraine status migrainosus p01 093
    Neurology, 2013
    Co-Authors: Sarah E Vollbracht, Matthew S. Robbins, Ilya Kister
    Abstract:

    OBJECTIVE: To present a patient with basilar-type migraine (BTM) sustaining a pontine Infarction during status migrainosus and to discuss the case in the context of the International Classification of Headache Disorders, 2nd Edition (ICHD-2) criteria for Migrainous Infarction. BACKGROUND: The ICHD-2 defines Migrainous Infarction as one or more otherwise typical aura symptoms that persist beyond one hour with neuroimaging confirmation of an ischemic Infarction in the affected territory. The ICHD-2 criteria exclude patients with new onset aura as well as patients who develop “extra-aural” symptoms at the time of Infarction. DESIGN/METHODS: Case report from a tertiary medical center. RESULTS: A 42-year-old woman with BTM whose aura symptoms included vertigo, tinnitus, hypacusis, gait unsteadiness, and disorientation developed her typical constellation of aura symptoms followed by a two-week period of status migrainosus, which she was treating with eletriptan 40 to 80mg mg daily. Several days into the headache phase she experienced acute, maximal-at-onset dysarthria and left face, arm, and leg numbness and weakness. These symptoms minimally improved over several weeks, leaving her with mild residual left-sided sensorimotor deficits and dysarthria. She had also been taking estrogen-containing oral contraception. MRI and MRA of the brain revealed a pontine ischemic lesion and basilar artery fenestration. CONCLUSIONS: This patient presents a diagnostic dilemma, since her stroke symptoms were not part of her typical aura syndrome and therefore does not fulfill ICHD-2 criteria for Migrainous Infarction. These restrictions on what constitutes a bona fide Migrainous Infarction may improve specificity at the expense of sensitivity, potentially underestimating the role of migraine in stroke etiology. Disclosure: Dr. Vollbracht9s family owns stock and/or stock options in Allergan, Inc. Dr. Robbins has nothing to disclose. Dr. Kister has nothing to disclose.

Matthew S. Robbins - One of the best experts on this subject based on the ideXlab platform.

  • pontine Infarction as a complication of basilar type migraine status migrainosus p01 093
    Neurology, 2013
    Co-Authors: Sarah E Vollbracht, Matthew S. Robbins, Ilya Kister
    Abstract:

    OBJECTIVE: To present a patient with basilar-type migraine (BTM) sustaining a pontine Infarction during status migrainosus and to discuss the case in the context of the International Classification of Headache Disorders, 2nd Edition (ICHD-2) criteria for Migrainous Infarction. BACKGROUND: The ICHD-2 defines Migrainous Infarction as one or more otherwise typical aura symptoms that persist beyond one hour with neuroimaging confirmation of an ischemic Infarction in the affected territory. The ICHD-2 criteria exclude patients with new onset aura as well as patients who develop “extra-aural” symptoms at the time of Infarction. DESIGN/METHODS: Case report from a tertiary medical center. RESULTS: A 42-year-old woman with BTM whose aura symptoms included vertigo, tinnitus, hypacusis, gait unsteadiness, and disorientation developed her typical constellation of aura symptoms followed by a two-week period of status migrainosus, which she was treating with eletriptan 40 to 80mg mg daily. Several days into the headache phase she experienced acute, maximal-at-onset dysarthria and left face, arm, and leg numbness and weakness. These symptoms minimally improved over several weeks, leaving her with mild residual left-sided sensorimotor deficits and dysarthria. She had also been taking estrogen-containing oral contraception. MRI and MRA of the brain revealed a pontine ischemic lesion and basilar artery fenestration. CONCLUSIONS: This patient presents a diagnostic dilemma, since her stroke symptoms were not part of her typical aura syndrome and therefore does not fulfill ICHD-2 criteria for Migrainous Infarction. These restrictions on what constitutes a bona fide Migrainous Infarction may improve specificity at the expense of sensitivity, potentially underestimating the role of migraine in stroke etiology. Disclosure: Dr. Vollbracht9s family owns stock and/or stock options in Allergan, Inc. Dr. Robbins has nothing to disclose. Dr. Kister has nothing to disclose.

  • pontine Infarction as a complication of basilar type migraine status migrainosus p01 093
    Neurology, 2013
    Co-Authors: Sarah E Vollbracht, Matthew S. Robbins, Ilya Kister
    Abstract:

    OBJECTIVE: To present a patient with basilar-type migraine (BTM) sustaining a pontine Infarction during status migrainosus and to discuss the case in the context of the International Classification of Headache Disorders, 2nd Edition (ICHD-2) criteria for Migrainous Infarction. BACKGROUND: The ICHD-2 defines Migrainous Infarction as one or more otherwise typical aura symptoms that persist beyond one hour with neuroimaging confirmation of an ischemic Infarction in the affected territory. The ICHD-2 criteria exclude patients with new onset aura as well as patients who develop “extra-aural” symptoms at the time of Infarction. DESIGN/METHODS: Case report from a tertiary medical center. RESULTS: A 42-year-old woman with BTM whose aura symptoms included vertigo, tinnitus, hypacusis, gait unsteadiness, and disorientation developed her typical constellation of aura symptoms followed by a two-week period of status migrainosus, which she was treating with eletriptan 40 to 80mg mg daily. Several days into the headache phase she experienced acute, maximal-at-onset dysarthria and left face, arm, and leg numbness and weakness. These symptoms minimally improved over several weeks, leaving her with mild residual left-sided sensorimotor deficits and dysarthria. She had also been taking estrogen-containing oral contraception. MRI and MRA of the brain revealed a pontine ischemic lesion and basilar artery fenestration. CONCLUSIONS: This patient presents a diagnostic dilemma, since her stroke symptoms were not part of her typical aura syndrome and therefore does not fulfill ICHD-2 criteria for Migrainous Infarction. These restrictions on what constitutes a bona fide Migrainous Infarction may improve specificity at the expense of sensitivity, potentially underestimating the role of migraine in stroke etiology. Disclosure: Dr. Vollbracht9s family owns stock and/or stock options in Allergan, Inc. Dr. Robbins has nothing to disclose. Dr. Kister has nothing to disclose.

Mary Naglak - One of the best experts on this subject based on the ideXlab platform.

  • safety of dihydroergotamine use in patients with symptoms of hemiplegic or basilar type migraine p7 200
    Neurology, 2014
    Co-Authors: Brad C Klein, Wael Hanna, Bhuvin Buddhdev, Mary Naglak
    Abstract:

    Background Dihydroergotamine (DHE) use is contraindicated in hemiplegic migraine (HM) and basilar type migraine (BTM) for fear of Migrainous Infarction. Objective The purpose of this study was to determine the tolerability of DHE administration in patients with symptoms of HM or BTM. Methods A retrospective analysis of a case series of patients who received intravenous DHE for migraine meeting ICHD II criteria with one or more symptoms to suggest HM or BTM was performed. All electronic (inpatient) and paper (outpatient) medical records from October 2008 to October 2011 were reviewed consecutively and independently by two investigators to identify patients meeting specific inclusion criteria. Frequency and types of adverse events, prior triptan use, and pain levels were reviewed and analyzed. Results Thirty five patients’ charts meeting inclusion criteria were reviewed; 28 (80%) were female. Mean age was 37.4 years. 74% of patients had previously used a triptan without serious adverse events. After DHE infusion, the mean pain severity decreased from 6.8 ±2.1 to 2.2±2.4 on a 10 point visual analog scale (p <0.0005). Only 5 (14%) patients experienced minor side effects (e.g., EKG changes and chest pain) during DHE infusion. None (0/35 (95% CI: 0-34%) of the patients had an ischemic stroke or myocardial Infarction. Conclusion Dihydroergotamine use showed no serious adverse events in this case series of patients meeting ICHD II criteria for migraine in whom HM or BTM was suggested. Study limitations preclude generalizability of results to other populations. Additional case series are needed before prospective trials can be justified. Disclosure: Dr. Klein has received personal compensation for activities with Allergan, Inc., Zogenix, UCB Pharma, Nautilus, and US WorldMeds. Dr. Hanna has nothing to disclose. Dr. Buddhdev has nothing to disclose. Dr. Naglak has nothing to disclose.

  • safety of dihydroergotamine use in patients with symptoms of hemiplegic or basilar type migraine p7 200
    Neurology, 2014
    Co-Authors: Brad C Klein, Wael Hanna, Bhuvin Buddhdev, Mary Naglak
    Abstract:

    Background Dihydroergotamine (DHE) use is contraindicated in hemiplegic migraine (HM) and basilar type migraine (BTM) for fear of Migrainous Infarction. Objective The purpose of this study was to determine the tolerability of DHE administration in patients with symptoms of HM or BTM. Methods A retrospective analysis of a case series of patients who received intravenous DHE for migraine meeting ICHD II criteria with one or more symptoms to suggest HM or BTM was performed. All electronic (inpatient) and paper (outpatient) medical records from October 2008 to October 2011 were reviewed consecutively and independently by two investigators to identify patients meeting specific inclusion criteria. Frequency and types of adverse events, prior triptan use, and pain levels were reviewed and analyzed. Results Thirty five patients’ charts meeting inclusion criteria were reviewed; 28 (80%) were female. Mean age was 37.4 years. 74% of patients had previously used a triptan without serious adverse events. After DHE infusion, the mean pain severity decreased from 6.8 ±2.1 to 2.2±2.4 on a 10 point visual analog scale (p <0.0005). Only 5 (14%) patients experienced minor side effects (e.g., EKG changes and chest pain) during DHE infusion. None (0/35 (95% CI: 0-34%) of the patients had an ischemic stroke or myocardial Infarction. Conclusion Dihydroergotamine use showed no serious adverse events in this case series of patients meeting ICHD II criteria for migraine in whom HM or BTM was suggested. Study limitations preclude generalizability of results to other populations. Additional case series are needed before prospective trials can be justified. Disclosure: Dr. Klein has received personal compensation for activities with Allergan, Inc., Zogenix, UCB Pharma, Nautilus, and US WorldMeds. Dr. Hanna has nothing to disclose. Dr. Buddhdev has nothing to disclose. Dr. Naglak has nothing to disclose.

Rolf Kern - One of the best experts on this subject based on the ideXlab platform.

  • clinical and mri characteristics of acute Migrainous Infarction
    Neurology, 2011
    Co-Authors: Marc E Wolf, Kristina Szabo, Martin Griebe, A Forster, Achim Gass, M G Hennerici, Rolf Kern
    Abstract:

    Objective: Migrainous Infarction is considered a rare complication of migraine. Although several studies reported silent brain lesions on neuroimaging in patients with migraine with aura, knowledge about lesion patterns in acute Migrainous Infarction is scarce. We investigated clinical and MRI characteristics in a series of patients with migraine-associated acute cerebral ischemia. Methods: Seventeen patients among 8,137 stroke patients over an 11-year period were included. All had undergone a dedicated stroke workup including diffusion-weighted imaging (DWI) and a detailed assessment of clinical features and of vascular risk factors. Results: The majority of patients presented with prolonged aura symptoms (visual aura 82.3%, sensory dysfunction 41.2%, and aphasia 5.9%; median NIH Stroke Scale score 2). Presentation at hospital was significantly delayed after symptom onset (mean 33 hours). A total of 70.6% had acute ischemic lesions in the posterior circulation; the middle cerebral artery territory was affected in 29.4%. Small lesions were present in 64.7%; multiple lesions were found in 41.2%. No overlapping ischemic lesions of different vascular territories were found. The prevalence of a patent foramen ovale was high (64.7%). Conclusions: This study supports previous observations that Migrainous Infarction mostly occurs in the posterior circulation, and in younger women with a history of migraine with aura. Acute ischemic lesions were often multiple and located in distinct arterial territories. As there were no overlapping ischemic lesions, hemodynamic compromise during the development of migraine is unlikely the cause of Infarction. Differentiation between Migrainous Infarction and prolonged migraine aura is difficult and associated with delayed admission of patients.