Cerebrovascular risk factors and MRI abnormalities in migraine

Case series have demonstrated an increased incidence of white matter lesions (WMLs) in patients with migraine. It is controversial whether the evidence of subclinical brain lesions relates to a higher risk of cerebrovascular disease. The objective of this study was to evaluate the association between magnetic resonance imaging (MRI) subclinical brain lesions and cerebrovascular risk factors (hyperhomocysteinaemia, MTHFR genotype, patent foramen ovale, hypertension, smoking and hypercholesterolaemia). From our database of 1201 patients followed at our Headache Clinic since September 2003 we analysed the MRI findings of 253 individuals. All MRI were blindly analysed by a second neuroradiologist (C.A.) and patients with WMLs (study group) were evaluated. In order to assess the association of WMLs with specific vascular risk factors, patients with WMLs were matched, according to age, sex and ICHD II diagnosis, with an equal number of individuals with normal MRI (control group). Headache was classified by the International Classification of Headache Disorders (ICHD 2004) criteria. We did not find any statistically significant difference between the two groups with regard to the presence of the cerebrovascular disease risk factors considered. Our results confirm that the WMLs are not related to the cerebrovascular disease risk factors.

     

Immigration and neurological diseases: a longitudinal study in an acute neurological care

Very few data exist on causes and outcomes of hospitalization of immigrants in Italy. Even though immigration is a real challenge for the western countries, we are still unaware of how it reflects on the costs and the management of an acute care department. This study was aimed to compare the patterns of hospital use by immigrants incoming to the Acute Care Department of Neurology in Brescia, Italy, with those of the resident Italian people. The study was based on the hospital discharge data. Discharges of immigrants were compared to those of a random selection of Italian patients matched by age and sex. The length of the study period was of 2.5?years. A similar pattern of hospital use by age was observed between foreigners and Italian patients; however, average length of hospitalization was significantly longer in immigrant population.     

Multislice CT in the study of insulinomas: preliminary experience

PURPOSE: To evaluate the potential of Multislice Computed Tomography (MSCT) in the study of pancreatic insulinomas. MATERIALS AND METHODS: Three patients with a suspected insulinoma underwent MSCT. All patients presented clinical and laboratory evidence of insulin secretive neoplasm. In all cases unenhanced and enhanced scans were performed. The enhanced scans were obtained after the injection of 2 ml/kg of non ionic contrast medium at a flow rate of 4 ml/sec with a scan delay of 35 and 55 sec. All the images were reformatted using MPR and MIP algorithms. RESULTS: In the three patients, CT showed the presence of an insulinoma (in two cases the neoplasm was sited in the head of the pancreas, in one case in the body). In two of the patients, MPR and MIP images did not add any diagnostic information. In one case, MIP and MPR reconstructions facilitated the diagnosis with a better depiction of anatomic relations between the lesion and pancreatic vessels. CONCLUSIONS: MSCT, in our limited experience, demonstrated good potential in the evaluation of insulinomas. MPR and MIP help in the evaluation of anatomic relations between lesions and vascular structures.     

Chest pain due to late huge coronary pseudoaneurysm following stent implantation

A 50-year-old man was referred to our hospital because of persistent atypical chest pain. His past medical history was remarkable for a non ST elevation myocardial infarction, treated five months previously with PCI on the right coronary artery. Two months later, for chest pain, he underwent coronary angiography that showed a right coronary artery with slight ectasia near the stent. Five months later for the persistence of atypical chest pain he came to our clinic. Chest CT showed a 31.5 mm hematoma of the right coronary artery. Coronary angiography revealed a giant aneurysm, proximal to the stent. In the light of rapid growth of aneurysm, the risk of rupture and symptoms, we decided to treat the aneurysm with covered stents. The patient underwent successful PCI with regression of symptoms.