Sleep Cures Chronic Pain

A new research from the University of Warwick reveals that the way chronic pain patients think about pain and sleep leads to insomnia and poor management of pain. Study could lead to specific cognitive therapy to cure insomnia and treat chronic pain.

Researchers from the Sleep and Pain Lab in the Department of Psychology have demonstrated that conditions like back pain, fibromyalgia, and arthritis are directly linked with negative thoughts about insomnia and pain, and this can be effectively managed by cognitive-behavioural therapy (CBT).

Esther Afolalu and colleagues have formulated a pioneering scale to measure beliefs about sleep and pain in long-term pain patients, alongside their quality of sleep, the first of its type to combine both pain and sleep and explore the vicious cycle between sleep and pain problems.

The scale was tested on four groups of patients suffering from long-term pain and bad sleeping patterns, with the result showing that people who believe they won’t be able to sleep as a result of their pain are more likely to suffer from insomnia, thus causing worse pain.

The results show that the scale was vital in predicting patients’ level of insomnia and pain difficulties. With better sleep, pain problems are significantly reduced, especially after receiving a short course of CBT for both pain and insomnia.

The study has provided therapists the means with which to identify and monitor rigid thoughts about sleep and pain that are sleep-interfering, allowing the application of the proven effective CBT for insomnia in people with chronic pain.

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Esther Afolalu explains: “Current psychological treatments for chronic pain have mostly focused on pain management and a lesser emphasis on sleep but there is a recent interest in developing therapies to tackle both pain and sleep problems simultaneously. This scale provides a useful clinical tool to assess and monitor treatment progress during these therapies.”

 

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Dr. Nicole Tang, the study senior author, comments: “Thoughts can have a direct and/or indirect impact on our emotion, behaviour and even physiology. The way how we think about sleep and its interaction with pain can influence the way how we cope with pain and manage sleeplessness. Based on clinical experience, whilst some of these beliefs are healthy and useful, others are rigid and misinformed. The new scale, PBAS, is developed to help us pick up those beliefs that have a potential role in worsening the insomnia and pain experience.”

Cellfie of the Day: A Highly Invasive Human Paediatric Brain Tumour

This Confocal Laser Scanning Microscopy (CLSM) features of a highly invasive tumour cells derived from a rare paediatric brain tumour. The cells were derived from the biopsy of a 10-year-old female patient, taken from the left thalamic tumour and diagnosed as Glioblastoma Multiforme (GBM).

In order to better understand how these tumour cells invade normal brain tissue, small clusters of tumour cells were grown in an artificial semi-solid substrate to mimic their spread in the patient. Fluorescently labelled antibodies were used to detect two proteins of interest, nestin (green) which is commonly found in these tumour cells but not in normal adult cells, and glial fibrillary protein (GFAP; red), which is found in many normal cells in the central nervous system. A sub-population of these cells (yellow) express both proteins. Cell nuclei were stained with DAPI to label DNA (blue).

The most aggressive cells are those with high levels of nestin which have formed clear clusters in the centre (fascicules; centre right of image). The prognosis for these young patients is currently poor so research is focused towards better understanding the invasive nature of these tumours, in order to find effective treatments for this aggressive brain cancer.

Biopsy specimen was provided by Dr Andrew Moore of the Queensland Children’s Medical Research Institute.

A New Way in Preventing the Most Cancerous Tumour of the Brain

Glioblastoma is one of the most common types of malignant brain tumors in adults. They are fast growing and can spread easily. The tumor has threadlike tendrils that extend into other parts of the brain making it difficult to remove it all. It is the most aggressive and often hard to treat brain tumor.

Although there have been great advances made in the treatment of leukemias and other cancers, little is known about how glioblastomas are formed and how these tumors infiltrate the brain tissue.

Researchers from the University of Southampton have discovered a potential way of stopping this aggressive types of brain tumor from spreading, which helps in better patient survival.

A study led by Dr Elodie Siney under the supervision of Dr Sandrine Willaime-Morawek, Lecturer in Stem Cells and Brain Repair at the University, analyzed how enzymes called ADAMs affect the movement and function of the human tumor cells. Published in Molecular Neurobiology on August 19, 2016.

The findings suggest that if a specific enzymes called ADAM10 and  ADAM17   are blocked the tumor stops growing and spreading. It also moves the cancer cells away from the place where they were growing which could allow them to be removed through traditional cancer treatments such as radiotherapy, chemotherapy or surgery.

Glioblastoma is a devastating disease which is often non-treatable. By blocking ADAMs lead to reduced tumor growth and less recurrence following conventional treatments, improving the chance of complete surgical removal and improving survival rates.

This new finding will be of great importance for patients and clinicians. It has been confirmed in animal models of glioblastoma.

Schizophrenia

A serious disabling mental illness. People with this condition may hear voices, see imaginary sights, or believe other people control their thoughts. These sensations can frighten the person and lead to erratic behaviour. Although there is no cure, treatment can usually manage the most serious symptoms.  It is not the same as multiple personality disorder.

What Are the Symptoms?

Major symptoms are:

Hallucinations: hearing or seeing imaginary things

Delusions: wildly false beliefs

Paranoia: the fear that others are plotting against you

Other signs are: lack of enjoyment in everyday life and withdrawal from social activities, it may mimic depression.

They may have trouble organizing their thoughts or making logical connections. They may feel like the mind is racing from one unrelated thought to another. Sometimes they have “thought withdrawal,” a feeling that thoughts are removed from their head, or “thought blocking,” when someone’s flow of thinking suddenly gets interrupted.

People may talk but not make sense, or they make up words. They may be agitated or show no expression. Many have trouble keeping themselves or their homes clean.  Some repeat behaviours, such as pacing. Despite myths, the risk of violence against others is rare.

Symptoms usually start between ages 16 and 30. It tends to begin earlier in men than in women. Schizophrenia rarely starts during childhood or after age 45. People with schizophrenia or other psychotic disorders in their family may be more likely to get it.

Scientists don’t know the exact cause. A person’s genes, experiences, and setting may all be involved. Theories include how active and how well certain areas of the brain work, as well as problems with brain chemicals such as dopamine and glutamate. There may be structural differences, too, like loss of nerve cells that result in larger fluid-filled cavities or “ventricles” in the brain.

People with schizophrenia are much more likely than other people to abuse alcohol or illicit drugs. Some substances, including marijuana and cocaine, can make symptoms worse. Drug abuse also interferes with treatments for schizophrenia.

There are no lab tests to find schizophrenia, diagnosis is usually based on a person’s history and symptoms. Once other medical causes are rule out, in teens, a combination of family history and certain behaviours can help predict the start of schizophrenia. These behaviours include withdrawing from social groups and expressing unusual suspicions, but that’s not enough for a diagnosis.

Medications can reduce symptoms such as abnormal thinking, hallucinations, and delusions. Some people have troubling side effects, including tremors and gaining lots of weight. Drugs may also interfere with other medicines or supplements. But in most cases, medication is a must to treat schizophrenia.

Counselling can help people develop better ways to recognize and handle their behavioural problem and thoughts, and improve how they relate to others. In Cognitive Behavioural Therapy (CBT), people learn to test the reality of their thoughts and better manage symptoms. Other forms of therapy aim to improve self-care, communication, and relationship skills.

Rehabilitation programs for schizophrenia teach people how to do everyday things, like use public transportation, manage money, shop for groceries, or find and keep a job. These programs work best when someone receives proper medications and also gets therapy.

People with schizophrenia sometimes quit their medications because of side effects or not understanding their illness. This raises the risk of serious symptoms returning, which can lead to a psychotic episode, in which someone loses touch with reality. Regular counselling can help people stick with their treatment and avoid a relapse or the need for hospitalization.

People with schizophrenia often have trouble finding or keeping a job. This is partly because the disease affects thinking, concentration, and communication. But it also stems from the fact that symptoms start in young adulthood, when many people are starting their careers. Vocational training can help people develop practical job skills.

Relationships can be rocky for people with schizophrenia. Their unusual thoughts and behaviours may keep friends, co-workers, and family members away. Treatment can help. One form of therapy focuses on forming and nurturing relationships. Family members and support group should get counselling, so they can get support and learn more about what they are going through.

Women with schizophrenia who plan to get pregnant should discuss with their doctors to make sure that their medications are OK to take during pregnancy.  Schizophrenia drug are safe during pregnancy.  But although there are no definitive links between medications for schizophrenia and birth defects or serious pregnancy complications, it’s important to talk about it with the doctor first.

Treatment often begins when a psychotic episode results in a hospital stay. It can be hard to convince someone with schizophrenia to get help. Once the person is stabilized, family members can do these things to help prevent a relapse:

Encourage the person to stay on medication

Go with them to their follow-up appointments and

Be supportive and respectful.

 

 

 

 

 

 

Migraine: Some Facts

Migraine is a throbbing headache with pain that is usually worse on one side of the head. The pain is often severe enough to affect daily activities and may last from four hours to three days if untreated.

Women are three times more likely to have migraines than men. More than one in 6 women, have migraines, but many have been told mistakenly that they have a sinus or tension headache. Foods, stress, and hormones can be migraine triggers.

Throbbing pain typically occurs on one side near the temples, forehead, and eyes. Migraines are very sensitive to light, sound, or mild exertion, such as climbing the stairs. Many people have nausea, vomiting, or vision problems. The pain can be disabling, forcing people to miss work or other activities.

About 20% of people who suffer from migraines will have an aura about 20 minutes to an hour before the pain starts. They may see flashing lights, wavy lines, or dots, or they may have blurry vision or blind spots. These are called “classic migraines.”

Some people may have a change in mood before a migraine begins. They may become more excitable or irritable or depressed. Others may detect a sensation, such as a funny smell or taste. They may feel more fatigued, yawn frequently, or experience muscle tension. About 1 in 4 people experience this prodromal phase, which can occur as early as 24 hours before any head pain.

The exact cause of migraines is still not well understood, but the problem is considered to be neurological, it is believed that brain chemicals, blood vessels, and nerves of the brain are involved.

Migraines may be precipitated by some specific cause, such as flickering lights. This could be a reflection from snow or water or from fluorescent bulbs or television or movie screens. Wearing polarizing sunglasses outside and using daylight spectrum fluorescent bulbs inside may help.

Emotional stress is a common trigger of migraines. It’s impossible to completely avoid stress, but relaxation exercises and deep breathing exercises helps. Some people find that thinking of a peaceful scene or listening to favorite music helps.

Regular pattern of meals and sleep are important for people prone to migraines. Low blood sugar from skipping meals can trigger a migraine. Eating too much sugar also can cause a spike, then a “crash” in blood sugar. Drink water throughout the day to avoid dehydration and sleep at least six to eight hours a night is important to avoid an attack.

For many women, migraines are tied to their menstrual cycle, occurring either a few days before or during their period, when estrogen levels drop. Some women may benefit from anti-inflammatory medication before their headaches begin, or hormonal birth control such as pills, patches, or rings. Others may have no benefit or worse migraines with hormonal birth control.

Migraine sufferers often report that certain foods trigger their headaches. Common culprits include MSG, red wine, cheese, chocolate, soy sauce, and processed meats. However, scientific studies haven’t confirmed any particular food as a migraine trigger.

Aged, fermented, and stored foods have higher levels of tyramine, a substance created from the breakdown of the amino acid tyrosine. Tyramine may cause blood vessels to constrict then expand, and it may be a trigger for some migraines. Some headache experts advise limiting fermented or aged foods, such as cheese, soy sauce, pickles, and pepperoni.

Management

When combined with some pain medications, caffeine can help provide relief. Most migraine sufferers can drink a cup or two a day of coffee without any problems. However, too much caffeine can lead to headaches when the stimulant effect wears off.

Migraine runs in families. Experts believe migraines may be related to mutations in genes that affect certain areas of the brain. Migraines are also more common among people who have epilepsy, depression, asthma, anxiety, stroke, and some other neurological and hereditary disorders.

About 5% of the children with headache problems suffer from migraines. Both boys and girls can get migraines, but after puberty they are more common among girls. Children may have symptoms other than headache, including stomach pain (abdominal migraine) or forceful and frequent vomiting (cyclic vomiting). If young children become wobbly on their feet, pale, and fussy, or have involuntary eye movements or vomiting, they may have a form of migraine called benign paroxysmal vertigo.

Migraines are diagnosed primarily from symptoms, but a CT scan or a MRI scan to be done rule out other causes of headaches, such as a brain tumor or bleeding in the brain.

Combinations of common pain relievers, like aspirin, naproxen sodium or acetaminophen and anti-inflammatory like ibuprofen may help. Some have been formulated specifically to treat migraines. But overuse may actually make headaches worse or may lead to ulcers or other gastrointestinal problems.

Triptans, the most common medication prescribed for migraines, are most effective when taken early in an attack. Common triptans include Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Treximet, and Zomig. People with high blood pressure, heart disease, stroke, and other conditions may not be able to take triptans. And because of possible serious drug interactions, it should be taken only under supervision of a doctor. Side effects of triptans include nausea, dizziness, tingling, numbness, and chest pain. Be sure to take medications early in the attack, at least within two hours of migraine pain.

Dihydroergotamine (Migranal) or ergotamines (Cafergot or Migergot) as tablets, nasal sprays, or injections are used if triptans doesn’t relieve the pain. These drugs narrow the blood vessels and can cause nausea, dizziness, muscle pain, or a bad taste in the mouth. They are not usually as effective as triptans and also have some interactions with other drugs.

Overuse of medications can sometimes lead to chronic headaches. It should not be taken not more than two times per week. Chronic headaches can be avoided by tapering and discontinuing medication under a doctor’s supervision. Pain medicines containing narcotics should be taken only when other medications fail to relieve pain because they can be habit-forming.

If migraines are frequent or very severe, drugs used to treat high blood pressure is prescribed and to be taken every day to prevent attacks.  They include beta blockers and calcium channel blockers. Several types of antidepressants can also be used to prevent migraine, as well as anticonvulsants. Even Botox, which is normally used to treat wrinkles, can keep migraines at bay for some people.

Biofeedback and relaxation training can give relief the pain similar to medications. Biofeedback uses a monitor to recognize the onset of muscle tension and train changes in body temperature that are signals of stress.

Some researchers have found acupuncture causes the brain to release chemicals that affect pain. However, studies on the effectiveness of acupuncture for migraine symptoms has been mixed.

Migraines most often strike in the prime of life, between the ages of 20 and 60. While elderly people still get migraines, they often decrease in severity and frequency as they age, or even disappear entirely. Good management of migraines may help to get rid of migraines for good.

Any new headache that is unusually severe or lasts more than a couple of days should be checked by a doctor. A headache accompanied by paralysis, confusion, fever, or stiff neck, seek emergency medical care.

WORLD ALZHEIMER’S DAY: SEPTEMBER 21

September 21st of each year, is a day on which Alzheimer’s organizations around the world concentrate their efforts on raising awareness about Alzheimer’s and dementia.

September 2016 will mark the fifth global World Alzheimer’s Month, an international campaign to raise awareness and challenge the stigma that surrounds dementia.

The theme for World Alzheimer’s Month 2016 is ‘Remember Me’.

Alzheimer’s disease is the most common form of dementia, a group of disorders that impairs mental functioning. The symptoms include memory loss and difficulties with thinking, problem solving or language. The symptoms occur when the brain is damaged. Every 68 seconds, someone develops Alzheimer’s disease. At current rates, experts believe the number of Alzheimer’s will quadruple to as many as 16 million by the year 2050.

Alzheimer’s disease is often called a family disease, because the chronic stress of watching a loved one slowly decline affects everyone.

Alzheimer’s disease is the sixth-leading cause of death and the only cause of death among the top 10 that cannot be prevented, cured or even slowed. With the increases in life spans and baby boomers coming of age, support for Alzheimer’s research is more critical in families than ever.

ALZHEIMER’S is a progressive disease, where more and more parts of the brain will be damaged over time and the symptoms become more severe.

Like all types of dementia, Alzheimer’s is caused by brain cell death. It is caused by parts of the brain wasting away. It is a neurodegenerative disease, with progressive brain cell death which happens over a course of time. The total brain size shrinks with Alzheimer’s – the tissue has progressively fewer nerve cells and connections. It is called Brain Atrophy

During the course of the disease, proteins build up in the brain to form structures known as “plaques” and “tangles” which leads to the loss of connections between nerve cells and their eventual death.

Amyloid Plaques are found between the dying cells in the brain from the build-up of a protein called beta-amyloid. The tangles are within the brain neurons from a disintegration of another protein, called Tau.

People with the disease also have a shortage of some chemicals in their brain, which help to transmit signals. When there is a shortage, the signals are not transmitted as effectively.

Dementia has a huge impact on women. Dementia is one of the leading cause of death among women and they are also far more likely to become carers of those with dementia, such as spouses or other family members. Without adequate support, this can lead to emotional and physical stress as well as job losses.

Some progress has been made, though. In August, an antibody therapy designed to reduce the build-up of amyloid plaques in the brains of patients with a mild form of the disease showed promising results in early clinical trials.

What triggers the condition is still unknown, but there are several risk factors associated with developing Alzheimer’s.

Age is the most significant factor, as the likelihood of developing the condition doubles every five years after the age of 65. However, a number of people develop early-onset Alzheimer’s, which can affect people from around 40 years of age.

Studies have shown smoking, obesity, high cholesterol, high blood pressure and diabetes can be risk factors in developing the disease, as can some head injuries.

Family history is also a factor and genes can contribute to your risk of developing Alzheimer’s – although the actual increase in risk is small even if a close family member has the condition.

People with Down’s syndrome can also be at increased risk of developing Alzheimer’s.

Recently certain environmental toxins present in some soils and lakes of the Pacific Island of Guam was shown to increase the risk for Alzheimer’s disease and other neurodegenerative disorders.

Gum disease is an unpleasant condition, causing bad breath, bleeding and painful gums, ulcers and even tooth loss. But people with Alzheimer’s disease might fare worse, after a new study suggests gum disease may speed up cognitive decline.

Rosacea is a chronic, inflammatory skin condition which principally affects the face. People with rosacea appear to have a slightly higher risk of developing dementia, and Alzheimer’s disease in particular, compared with people without the common chronic inflammatory skin condition.

Alzheimer’s disease is not simple to diagnose, there is no single test for it. For this reason, the first thing doctors do is to rule out other problems before confirming whether mental signs and symptoms are severe enough to be a kind of dementia or something else.

There must be memory loss and an impairment in one other area of cognition for a diagnosis of dementia such as Alzheimer’s to be made. These criteria also need to be progressive, and severe enough to affect daily activities.

Genetic Test is possible in some settings to indicate the likelihood of someone having or developing the disease but this is controversial and not entirely reliable. A gene known as the APOE-e4 is associated with higher chances of people over the age of 55 years developing Alzheimer’s.

A study published in the Journal of the Neurological Sciences found interesting differences in ability to smell peanut butter between people with Alzheimer’s disease versus those with different kinds of dementia. Involvement of smell is considered as an early sign of Alzheimer.

Another study shows a person’s risk of Alzheimer’s disease can be predicted through a simple saliva test.

A team of researchers at King’s College London in the UK has announced the development of a “gene signature” that predict Alzheimer’s disease years before symptoms arise.

According to a new research from University College London (UCL) in the UK, a noticeable change in humour sense may be an early indicator for dementia. They found that people whose sense of humour became darker with age is an early indicator to have Alzheimer.

Inflammatory brain changes related to Alzheimer’s disease may occur as many as 20 years before the onset of symptoms, according to new research, a finding that could pave the way for early interventions that could halt disease development.

Treatment

There is currently no cure for Alzheimer’s, the death of brain cells in the dementia cannot be halted or reversed. There are no disease-modifying drugs available for Alzheimer’s disease but some options may reduce its symptoms and help improve quality of life. There are four drugs in a class called cholinesterase inhibitor approved for symptomatic relief.

Donepezil (brand name Aricept)

Alantamine (Reminyl)

Rivastigmine (Exelon)

Tacrine (Cognex).

A different kind of drug, memantine (Namenda), an NMDA receptor antagonist, may also be used, alone or in combination with a cholinesterase inhibitor.

A new study, published in the Journal of Alzheimer’s Disease, finds that any kind of exercise can improve brain volume and cut the risk of Alzheimer’s disease by 50%.

Blueberries are a “superfood,” containing a wide variety of nutrients that offer protection against conditions such as cancer and heart disease. Now, researchers believe that they may have a part to play in the fight against Alzheimer’s disease.

Another study details the creation of an implantable capsule that researchers say could stop the condition in its tracks.

Research into the disease is uncovering more about the condition. Although there have been trials for different drugs, none have so far been successful and those that do exist only treat the symptoms of the disease and slow down its progression.

 

Cancer risk Higher for Tall Persons

Cancer risk increases with height! suggest researchers from Karolinska Institutet and University of Stockholm in Sweden. For every 10-centimeter [4 inches] increase in height, overall cancer is increased by 18% in women and 11% in men.

Studies have already shown that taller people have a higher risk of developing different types of cancer, including breast cancer and melanoma, say the researchers.

A team led by Emelie Benyi, a Ph.D. student at Karolinska, examined medical and other records and tracked a large group of people, a total of 5.5 million men and women, all born in Sweden between 1938 and 1991, ranging in height (as adults) from 100 cm (3-foot-3) to 225 cm (7-foot-3). The team derived information from various databases, including the Swedish Medical Birth, the Swedish Conscription, the Swedish Passport Registers, and the Swedish Cancer Register. Tracking the group until the end of 2011, the researchers came to some surprising results.

The research team found that total cancer risk and risks of breast cancer and melanoma were higher with increasing height in the Swedish population. With each 10 cm of height, cancer risk increased by 18% in women and 11% in men. For both men and women, the risk of developing melanoma increased by nearly 30% per 10 cm, while taller women had a 20% greater risk of developing breast cancer.

According to the data where breast cancer is increased by 20% for each 10 cm increase in height, women of a height of 160 cm would in a life time risk of breast cancer of about 8% and women of 180 cm would have a life time risk of about 12%.

Why is height linked to cancer?

Possibly, the taller people are exposed to higher levels of growth factors, which could possibly promote cancer development.

Another hypothesis could be that taller people simply have a larger number of cells in their bodies that then could potentially transform into cancer.

A third possible explanation is that taller individuals have a higher caloric intake, which has also previously been linked to cancer.

There’s nothing we can do about our height. We can’t stop ourselves from growing, so there’s no point in worrying about how our height will affect our mortality.

Next time when you find yourself sulking because you’re the shortest member of your crew, remember that being the last to feel rainfall could also mean you’ll be the last to kick the bucket.

Common Neurological Disorders presenting with Eye Problems in Women

When a women enter an ophthalmologist’s office complaining of headaches with sudden visual problems, the physician must be aware that these symptoms can be indicators of some neurological conditions that target women. The common eye complaints may be pain, double vision, redness or visual loss.

Ophthalmologists are often the first physicians to see patients who are experiencing migraines or the onset of multiple sclerosis.

Multiple Sclerosis

One neurological disorder which often presents with visual symptoms initially in women is multiple sclerosis. They present first to an ophthalmologist because they notice their loss of vision from optic neuritis or double vision due to inflammation.

The initial signs of multiple sclerosis include monocular vision loss associated with pain on eye movement, diplopia, oscillopsia (objects appear to oscillate), nystagmus, dorsal midbrain syndrome and homonymous hemianopia. A small percentage of patients present with pars planitis, perivenous sheathing or uveitis.

An examination may show visual acuity loss, relative afferent pupillary defect or visual field defect, and the patient could have optic disc oedema.

Anyone with optic neuritis needs an MRI, both with and without gadolinium to see for brain lesions.

Treatment may include intravenous corticosteroids like Solu-Medrol (methylprednisolone sodium succinate) immunomodulating agents, and symptomatic treatment of spasticity, depression and bladder dysfunction.

Oral prednisone not used because the Optic Neuritis Treatment Trial showed that patients are more likely to have another attack of optic neuritis if treated with prednisone.

Migraine

Migraines can occur at any age after puberty, usually starts in the 20s and continue on until 50. Women are more likely to suffer from this vision-affecting headaches, twice as many women have migraines as men.

Many patients with migraines present with visual phenomena or aura, which can range from zigzag lines or aura to fragmented vision or complete visual loss. These types of symptoms are associated with classic migraines. They experience visual images as a part of migraine event, so patients often go to ophthalmologists to understand the nature of the problem. The role of an ophthalmologist is to recognize that it’s a migrainous event and refer the patient to a neurologist.

The location and consistency of the visual loss and pain is very important. Investigate any headache that is always on the same side and doesn’t follow the rules, if the aura takes longer than the typical time or it’s always on the same side or there are visual field defects in between attacks, then go aggressively and look for some other reason for the headache.

There are occasional instances in which visual phenomena will be misinterpreted to be relating to migraine but, in fact, could be related to some other more significant neurological problem. MRI is indicated in such cases. If the patient experiences persistent visual loss without a headache or if the visual phenomena last longer than the typical hour, neuroimaging should be pursued.

Ophthalmoplegic Migraine, a variant accompanied by diplopia and ptosis. It consists of a headache followed by an oculomotor nerve palsy that may last weeks after the pain resolves. It is most likely inflammatory, rather than migrainous.

There is no specific treatment for aura or visual phenomena, the migrainous headaches may be treated by prophylactic or symptomatic therapy. Transient monocular visual loss is often successfully prevented with verapamil.

Thyroid Eye Disease

Thyroid eye disease, also known as Graves’ orbitopathy or Graves’ disease, affects women in their 50s and 60s and may be associated with thyroid abnormalities. It is often heralded by dry eye symptoms.

Patients usually present with eye irritation and other signs and symptoms of dry eyes, including conjunctival injection, diplopia and periocular pain.

An examination shows corneal exposure, conjunctival injection, injection over the extraocular muscle insertions, unilateral or bilateral proptosis, restriction of ocular motility, eyelid retraction, lid lag, lid erythema or oedema.

Patients with orbitopathy of Graves’ disease most typically experience discomfort because of problems on the ocular surface, so they have low-level chronic discomfort of the eye. The eyes become protuberant, causing cosmetic problems.

In the worst cases, inflammation could be so great that the muscles swell and press on the optic nerve, causing visual loss.

If there is no known thyroid disease, patients should be evaluated for it.

In thyroid eye disease, the antibodies that are made to the thyroid gland attack the eye muscles, and the eye muscles get infiltrated with lymphocytes. They are inflamed and they don’t contract, resulting in double vision.

Since it is an autoimmune disease, one can develop the orbitopathy of Graves’ disease with a hyperactive thyroid gland, a hypoactive thyroid gland or a normally functioning thyroid gland, so the two conditions are related but not directly.

Treating the thyroid condition usually has no significant effect on the ophthalmic manifestations. Ophthalmic treatment comes in the form of lubricants and patching to avoid diplopia, along with radiation therapy and orbital decompression surgery.

Corticosteroids are sometimes used, although there is conflicting data regarding their efficacy. Although signs of optic neuropathy are uncommon, all patients in the active phase of the disease should have routine perimetry every few months.

The disorder generally runs 18 months and then stabilizes, but it can leave the patient with dry eyes, permanent disfigurement from lid retraction, lid erythema and proptosis, diplopia and, rarely, visual loss from optic neuropathy.

Giant Cell Arteritis

Giant cell, or temporal, arteritis presents in women 60 or older with symptoms that may lead the patient directly to the ophthalmologist.

Some patients have early visual symptoms, others will seek care with an internist, dentist, psychiatrist or neurologist. The symptoms may be vague, and a high index of suspicion is needed.

Visual symptoms include amaurosis fugax (sudden black outs), diplopia and sudden visual loss from ischemic optic neuropathy. Other symptoms include headaches, jaw claudication, scalp tenderness or necrosis, fever, weight loss, myalgias and arthralgias, malaise and night sweats.

Typical presentation would be a 75-year-old woman who starts having worsening of her arthritis: aches and pains every place. When she chews, her jaw gets tired. She can’t put her shirt on over her head because her scalp is so sensitive. She can’t comb her hair because her scalp hurts so much when she touches it. She has terrible headaches and then starts to have obscurations of her vision.

If the condition is not treated immediately with steroids, the patient can lose vision quickly. If it’s not recognized and treated immediately it can turn a healthy 75-year-old woman into a blind person who needs to be taken care of. They can lose vision in one eye and 5 minutes later lose vision in the other eye.

Start corticosteroids immediately and then check the sedimentation rate, C-reactive protein, complete blood cell count with platelet count and arrange for a temporal artery biopsy to be performed within a week.

A patient complaining of aches and pains, think temporal arteritis. It’s sufficiently common, especially in 80-year-olds. It gets more and more common as one gets older.

Fish out the history by asking, “Does your jaw get tired when you chew? Do you have scalp sensitivity? Do you have headache?’ And if there’s any inkling that they have temporal arteritis, they should be given prednisone immediately and ask questions later because they can lose vision from anterior ischemic optic neuropathy at any time.

Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension is primarily a disorder that affects overweight women of childbearing age, although there are atypical cases.

The initial symptoms include headache, short but frequent transient obscurations of vision unilaterally or bilaterally, pulsatile tinnitus, diplopia and photophobia. Other neurologic symptoms include neck and back pain, radicular pain, ataxia and facial palsy.

An examination shows visual acuity loss, visual field defect, such as an enlarged blind spot, generalized constriction, inferonasal loss or central scotoma, and relative afferent pupillary defect if there is an asymmetrical optic neuropathy. Papilledema is the hallmark of this disorder, although it may be subtle or asymmetrical.

It produces headache and swelling of the optic nerves because of the pressure inside of the skull. The swelling of the optic nerves, when it persists for months, can cause a slow and permanent visual loss.

Neuroimaging and lumbar puncture should be done immediately.

Treatment include diuretics, headache treatments, or surgical procedures such as optic nerve sheath fenestration or shunt.

The patient needs to have a regular examination of the visual field and regular examination of the optic nerve because complications, progression of visual loss could occur and the ophthalmologist is well-suited to detect that and then to communicate the results to the neurologist, which may result in a change in medicine or perhaps even recommendation of surgery if visual loss is progressing.

Cerebral Venous Sinus Thrombosis can have an identical presentation to idiopathic intracranial hypertension. Consider that in a women taking oral contraceptives, smokers and women in the peripartum period. There may be an underlying coagulation disorder.

 

 

 

 

 

Exposure to Toxins even before Birth Affects Memory

Aerobic Exercise improves Cognitive function is a well-known fact. But not for people exposed to high levels of mercury before birth!

Adults with high prenatal exposure to methylmercury, which mainly comes from maternal consumption of fish with high mercury levels, did not experience the faster cognitive processing and better short term memory benefits of exercise that were seen in those with low prenatal methylmercury exposures.

This is one of the first studies to examine how methylmercury exposure in the womb may affect cognitive function in adults. Mercury comes from industrial pollution in the air that falls into the water, where it turns into methylmercury and accumulates in fish.

The scientists, based at the Harvard T.H. Chan School of Public Health, suspect that prenatal exposure to methylmercury, known to have toxic effects on the developing brain and nervous system, limit the ability of nervous system tissues to grow and develop in response to increased aerobic fitness.

Neurodevelopment is a delicate process that is especially sensitive to methylmercury and other environmental toxins, scientists are still discovering the lifelong ripple effects of these exposures. This research points to adult cognitive function as a new area of concern.

Gwen Collman, PhD, director of the NIEHS Division of Extramural Research and Training studied 197 participants from the Faroe Islands, 200 miles (323 km) north of England. Fish is a major component of the diet for them. Their health has been followed since they were in the womb in the late 1980s. At age 22, this subset of the original 1,022 participants took part in a follow-up examination of cognitive tests related to short-term memory, verbal comprehension and knowledge, psychomotor speed, visual processing, long-term storage and retrieval, and cognitive processing speed.

But when the researchers divided the participants into two groups based on the methylmercury levels in their mothers while they were pregnant, they found that the benefits were confined to the group with the lowest exposure. Participants with prenatal methylmercury levels in the bottom 67%, or levels of less than 35 micrograms per liter in umbilical cord blood, still demonstrated better cognitive efficiency. However, for participants with higher methylmercury levels, cognitive function did not improve with aerobic exercise.

Aerobic exercise is an important part of a healthy lifestyle, but these findings suggest that early-life exposure to pollutants may reduce the potential benefits.

The U.S. Food and Drug Administration recommends that children and women of childbearing age eat two to three weekly servings of fish low in mercury as part of a healthy diet. Low mercury fish include salmon, shrimp, pollock, canned light tuna, tilapia, catfish, and cod. Four types of fish should be avoided because of typically high mercury levels—tilefish from the Gulf of Mexico, shark, swordfish, and king mackerel.

We need to pay special attention to the environment we create for pregnant moms and babies

Aerobic Fitness and Neurocognitive Function Scores in Young Faroese Adults and Potential Modification by Prenatal Methylmercury Exposure.’

Published in the journal Environmental Health Perspectives on September 9 2016.

Computers Defeat Doctors in Detecting Brain Cancer

Computer programs have defeated humans in chess and Go. Now a program developed at Case Western Reserve University has outperformed physicians in accurate detection of Brain Cancer.

One of the biggest challenges with the evaluation of brain tumour treatment is distinguishing between the confusing effects of radiation and cancer recurrence. On an MRI, they look very similar. Treatments for radiation necrosis and cancer recurrence are far different. Quick identification can help speed prognosis, therapy and improve patient outcomes. Brain biopsies are currently the only definitive test but are highly invasive and risky, causing considerable morbidity and mortality.

The computer program was nearly twice as accurate as two neuro-radiologists in determining whether abnormal tissue seen on magnetic resonance images (MRI) were dead brain cells caused by radiation, called radiation necrosis, or if brain cancer had returned.

The study published in the American Journal of Neuroradiology on September 15 2016. Pallavi Tiwari, assistant professor of biomedical engineering at Case Western Reserve was the leader of the study.

In the direct comparison, two physicians and the computer program analyzed MRI scans from 15 patients from University of Texas Southwest Medical Center. One neuroradiologist diagnosed seven patients correctly, and the second physician correctly diagnosed eight patients. The computer program was correct on 12 of the 15.

With further confirmation of its accuracy, radiologists using their expertise and the program may eliminate unnecessary and costly biopsies.

The physicians use the intensity of pixels on MRI scans as a guide, the computer looks at the edges of each pixel. If the edges all point to the same direction, the architecture is preserved. If they point in different directions, the architecture is disrupted. The entropy, or disorder, and heterogeneity are higher.

The researchers don’t expect the computer program would be used alone, but as a decision support to assist neuro-radiologists in improving their confidence in identifying a suspicious lesion as radiation necrosis or cancer recurrence.

The researchers are seeking to validate and the algorithms’ accuracy using a much larger collection of images from across different sites.