Article
Emergency Medicine
Matthew D. Monaco, Levi K. Kitchen, Robert L. Frank, Kenneth D. McManus
Summary: Acute headache is a common chief complaint in the emergency department which may have serious underlying conditions like subarachnoid hemorrhage (SAH). With advancements in computed tomography (CT), CT angiography is now being used to rule out SAH.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2022)
Article
Medicine, General & Internal
M. Rodriguez-Camacho, P. A. Guirado-Ruiz, F. J. Barrero-Hernandez
Summary: This study aimed to determine the incidence of PDPH and identify predisposing factors for its appearance. The incidence of PDPH was found to be 38.6%, and factors associated with its onset included young age and previous history of headache. Larger scale studies are needed to further validate these findings.
REVISTA CLINICA ESPANOLA
(2023)
Article
Medicine, General & Internal
Chien-Shu Tai, Shang-Liang Wu, Shao-Yu Lin, Ying Liang, Shuu-Jiun Wang, Shih-Pin Chen
Summary: The study found that bed rest following lumbar puncture does not prevent PDPH and might even slightly increase the risk of PDPH. This suggests a need for amending the current post-lumbar puncture care guidelines to improve patient outcomes.
JOURNAL OF THE CHINESE MEDICAL ASSOCIATION
(2021)
Article
Emergency Medicine
Emmanuel Cognat, Berengere Koehl, Matthieu Lilamand, Stephane Goutagny, Anissa Belbachir, Louise de Charentenay, Tamazoust Guiddir, Paul Zetlaoui, Caroline Roos, Claire Paquet
Summary: Older age, female sex, lower body mass index, and history of headache may increase the risk of post-lumbar puncture headache. The use of atraumatic, noncutting needles is the most effective intervention for prevention, while other measures seem to have limited impact.
ANNALS OF EMERGENCY MEDICINE
(2021)
Article
Pediatrics
David C. Schorling, Astrid Pechmann, Matthias Eckenweiler, Cornelia K. Mueller, Thorsten Langer, Janbernd Kirschner
Summary: This study found that the prevalence of PDPH after therapeutic LPs in SMA patients was significantly lower than in general pediatric patients. The overall prevalence of PDPH in pediatric patients was similar to that reported in larger adult cohorts.
Review
Biology
Valentina Baglioni, Silvia Orecchio, Dario Esposito, Noemi Faedda, Giulia Natalucci, Vincenzo Guidetti
Summary: In pediatric neurology, tension-type headache (TTH) is a common primary headache among children. However, it is often underestimated and difficult to differentiate from secondary and other primary headaches in childhood. There can be clinical overlap between migraine and TTH in children, with migraine attacks presenting tension headache-like features and TTH displaying migraine-like symptoms. Factors such as hormonal changes, triggers, and genetic and epigenetic factors play a role in the complex trajectory of headache evolution. This review aims to summarize the literature on the differential diagnosis of TTH in pediatrics, the possible outcomes during development, and appropriate therapeutic strategies.
Article
Anesthesiology
Kyle J. Morgan, Rahul Mohan, Seth E. Karol, Jamie Flerlage
Summary: Many anaesthetists are hesitant to perform epidural blood patch in patients with cancer due to the potential risk of spreading malignant cells to the central nervous system. Recent evidence suggests that malignancy may be viewed as a relative rather than absolute contraindication to this procedure.
BRITISH JOURNAL OF ANAESTHESIA
(2021)
Article
Clinical Neurology
Jasem Al-Hashel, Azza Rady, Fathi Massoud, Ismail Ibrahim Ismail
Summary: This study aimed to investigate the incidence, risk factors, and clinical characteristics of post-dural puncture headache (PDPH) in patients admitted to a main tertiary neurology hospital in Kuwait. The results showed that younger age, female gender, lower BMI, pre-procedural headache, history of previous PDPH, and number of lumbar puncture attempts were identified as independent risk factors for developing PDPH.
Article
Emergency Medicine
Juho An, Sung-Eun Lee, Yura Ko, Heewon Yang
Summary: This study aimed to investigate the association between traumatic tap and the incidence of postdural puncture headache (PDPH) following lumbar puncture (LP) among patients who underwent LP with a primary discharge diagnosis of primary headache in the emergency department (ED). The results showed that among patients who underwent emergency department lumbar puncture, 34.8% reported PDPH and 35.7% required hospitalization. Furthermore, there were significant differences in the hospitalization rate and incidence of PDPH between patients with traumatic LP and those with primary headaches.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2023)
Article
Obstetrics & Gynecology
Xiaoyu Wu, Xiangqi Cao, Mengyuan Zhang, Qingfan Wang, Jiaxin Han, Xinyue Sun, Kang Huo, Suhang Shang, Guogang Luo
Summary: Through this case report, we found that positional headaches after epidural anesthesia in parturients may not solely indicate low intracranial pressure, but may also be combined with pneumocephalus. Therefore, head computed tomography is essential when using the loss of resistance to air technique for anesthesia to rule out other possible conditions such as pneumocephalus.
BMC PREGNANCY AND CHILDBIRTH
(2023)
Article
Clinical Neurology
Olivia Reese, Candice Wright, Anny Sandoval, Bethany Lebron, Anam Dhorajiwala, Alan Shepard, Jennifer Viamille, Rimas V. Lukas, Katherine Carroll
Summary: The study demonstrates that transitioning acute migraine management requiring infusion therapies from the Emergency Department to the outpatient setting can result in shorter clinical encounters and cost savings, while still providing adequate headache relief for patients.
JOURNAL OF THE NEUROLOGICAL SCIENCES
(2021)
Review
Anesthesiology
Qianpian Zhang, Sing Y. Pang, Christopher W. Liu
Summary: This review examines the relationship between post-dural puncture headache (PDPH) and chronic headaches, explores the pathophysiology of chronic headache after a dural puncture, and makes recommendations for follow-up and treatment. The evidence suggests that patients with accidental dural puncture have a higher risk of developing chronic headache, and suggest including the risk of chronic headache in informed consent discussions for neuraxial procedures. Patients with PDPH should receive close follow-up after discharge.
BRITISH JOURNAL OF ANAESTHESIA
(2022)
Article
Clinical Neurology
Fabian Boesl, Heinrich Audebert, Matthias Endres, Harald Pruess, Christiana Franke
Summary: This study reports on the clinical presentation of the first 100 patients with post-COVID-19 syndrome presenting to a Neurology outpatient clinic, showing common symptoms such as cognitive impairment, fatigue, headache, and persisting hyposmia. Most patients were female and had initially mild COVID-19 without hospitalization.
FRONTIERS IN NEUROLOGY
(2021)
Article
Medicine, General & Internal
Saleheen Huq, Menaka G. Iyer, Samson O. Oyibo
Summary: Post lumbar puncture headaches are common and should be explained to patients before and after the procedure. Prolonged headaches lasting more than 7-14 days may require further investigation to exclude life-threatening complications.
Article
Medicine, General & Internal
Kinley Roberts, Linda Harrington, Sinead M. Murphy
Summary: The study found that most patients referred to neurology outpatient clinics with headaches have primary headache disorders, suggesting alternative pathways should be considered to reduce the burden on Ireland's limited neurology resources without compromising patient safety.
IRISH JOURNAL OF MEDICAL SCIENCE
(2021)
Editorial Material
Clinical Neurology
Michael Levy
MULTIPLE SCLEROSIS JOURNAL
(2020)
Article
Clinical Neurology
Itay Lotan, Robert W. Charlson, Lana Zhovtis Ryerson, Michael Levy, Ilya Kister
MULTIPLE SCLEROSIS AND RELATED DISORDERS
(2020)
Editorial Material
Clinical Neurology
Anastasia Vishnevetsky, Michael Levy
MULTIPLE SCLEROSIS AND RELATED DISORDERS
(2020)
Article
Clinical Neurology
Itay Lotan, Tamar Bacon, Ilya Kister, Michael Levy
MULTIPLE SCLEROSIS AND RELATED DISORDERS
(2020)
Article
Clinical Neurology
Angeliki G. Filippatou, Eleni S. Vasileiou, Yufan He, Kathryn C. Fitzgerald, Grigorios Kalaitzidis, Jeffrey Lambe, Maureen A. Mealy, Michael Levy, Yihao Liu, Jerry L. Prince, Ellen M. Mowry, Shiv Saidha, Peter A. Calabresi, Elias S. Sotirchos
Summary: This study compared retinal layer thicknesses between AQP4-IgG+ NMOSD eyes without a history of ON and healthy controls using OCT, finding evidence of subclinical retinal ganglion cell neuronal and axonal loss, as well as photoreceptor layer involvement in AQP4-nonON eyes. These results suggest that subclinical anterior visual pathway involvement may occur in AQP4-IgG+ NMOSD.
MULTIPLE SCLEROSIS JOURNAL
(2021)
Article
Clinical Neurology
Dean M. Wingerchuk, Kazuo Fujihara, Jacqueline Palace, Achim Berthele, Michael Levy, Ho Jin Kim, Ichiro Nakashima, Celia Oreja-Guevara, Kai-Chen Wang, Larisa Miller, Shulian Shang, Guido Sabatella, Marcus Yountz, Sean J. Pittock
Summary: This study demonstrates that the long-term safety profile of eculizumab in NMOSD is consistent with its established profile across other indications. Long-term treatment with eculizumab has shown sustained ability to reduce relapse risk in patients with AQP4-IgG+ NMOSD, with some patients also reducing or stopping background immunosuppressive therapy.
ANNALS OF NEUROLOGY
(2021)
Review
Clinical Neurology
Sara Salama, Michael Levy
Summary: It is important to diagnose NMOSD early to initiate long-term treatment and avoid potentially harmful treatments. Spinal imaging features such as LETM and BSLs can aid in diagnosis.
MULTIPLE SCLEROSIS JOURNAL
(2022)
Article
Clinical Neurology
Sean J. Pittock, Kazuo Fujihara, Jacqueline Palace, Achim Berthele, Ho Jin Kim, Celia Oreja-Guevara, Ichiro Nakashima, Michael Levy, Shulian Shang, Marcus Yountz, Larisa Miller, Roisin Armstrong, Dean M. Wingerchuk
Summary: Eculizumab monotherapy effectively prevents relapses in AQP4-IgG + NMOSD patients, relieving the burden of chronic immunosuppression.
MULTIPLE SCLEROSIS JOURNAL
(2022)
Article
Clinical Neurology
Paula Barreras, Eleni S. Vasileiou, Angeliki G. Filippatou, Kathryn C. Fitzgerald, Michael Levy, Carlos A. Pardo, Scott D. Newsome, Ellen M. Mowry, Peter A. Calabresi, Elias S. Sotirchos
Summary: Rituximab treatment reduces the annualized relapse rate in AQP4-IgG-seropositive NMOSD, especially when administered consistently without gaps in treatment or B-cell reconstitution. In MOGAD patients, although a decrease in relapses was observed after rituximab initiation, this effect appeared to be less pronounced compared to AQP4-IgG-seropositive NMOSD. Severe infections and hypogammaglobulinemia were seen in a significant number of patients, underscoring the importance of close monitoring for infectious complications.
Review
Biotechnology & Applied Microbiology
Anastasia Vishnevetsky, Tamara B. Kaplan, Michael Levy
Summary: This review focuses on the practical questions of managing and switching immunotherapies for NMOSD. It highlights the challenges faced and future research directions in this area.
EXPERT OPINION ON BIOLOGICAL THERAPY
(2022)
Article
Clinical Neurology
Sean J. Pittock, Michael Barnett, Jeffrey L. Bennett, Achim Berthele, Jerome de Seze, Michael Levy, Ichiro Nakashima, Celia Oreja-Guevara, Jacqueline Palace, Friedemann Paul, Carlo Pozzilli, Marcus Yountz, Kerstin Allen, Yasmin Mashhoon, Ho Jin Kim
Summary: The CHAMPION-NMOSD study evaluated the efficacy and safety of ravulizumab in adult patients with anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder. Ravulizumab, which has a longer half-life compared to eculizumab, significantly reduced relapse risk in these patients.
ANNALS OF NEUROLOGY
(2023)
Article
Clinical Neurology
Itay Lotan, Gabriela Romanow, Rebecca Salky, Negar Molazadeh, Anastasia Vishnevetsky, Monique Anderson, Phillipe-Antoine Bilodeau, Gary Cutter, Michael Levy
Summary: This study aimed to assess the mortality rate in patients with MOGAD and found a lower mortality rate compared to other neuroinflammatory diseases, similar to the age-adjusted mortality rates of the general population in the United States. Further studies are needed to confirm this observation.
ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY
(2023)
Article
Clinical Neurology
Hannah Kelly, Anastasia Vishnevetsky, Lori B. Chibnik, Michael Levy
Summary: This study compared strategies to manage secondary hypogammaglobulinemia in neuroimmunology patients, including reducing anti-CD20 dose and dosing frequency, IVIG/SCIG, anti-CD20 cessation, and DMT switches. The results suggest that IVIG/SCIG may yield the greatest recovery in IgG while also reducing infection frequency and severity. Stopping anti-CD20 therapy and/or switching DMTs can also increase IgG and lower infection risk.
MULTIPLE SCLEROSIS JOURNAL-EXPERIMENTAL TRANSLATIONAL AND CLINICAL
(2023)
Review
Clinical Neurology
Negar Molazadeh, Gauruv Bose, Itay Lotan, Michael Levy
Summary: MOGAD shares similarities with AQP4-IgG + NMOSD in clinical presentations and treatment responses, but has less clear associations with autoimmune diseases and cancers compared to AQP4-IgG + NMOSD, suggesting routine screening for overlapping autoimmunity and neoplasms in MOGAD patients may not be necessary.
MULTIPLE SCLEROSIS JOURNAL-EXPERIMENTAL TRANSLATIONAL AND CLINICAL
(2022)
Review
Medicine, General & Internal
Julien J. Cavanagh, Michael Levy
Summary: This review aims to help clinicians differentiate between multiple sclerosis and other similar conditions, highlighting the importance of carefully considering the differences between various diseases in diagnosis and treatment.