Cold-stimulus headache is a primary headache syndrome which is provoked by an external application or ingestion or inhalation of cold stimulus. It has not been reported to occur secondary to another focal structural brain lesion, or as a reversible illness. This is a report of two women who developed cold-stimulus headache on taking ice cold food after the onset of thalamic hemorrhage. The headache was typical of cold-stimulus headache except a relatively long duration of pain lasting half an hour. There was spontaneous remission after a few months. Our patients suggest that cold-stimulus headache can be secondary to thalamic hemorrhage..

Background: Nummular headache is a new category of primary headache disorder characterized by consistent location, size, and shape of painful areas. The pathogenesis is uncertain. Bifocal painful areas are rare manifestations but may expand the clinical diversity of nummular headache. Methods: The clinical characteristics of 5 bifocal nummular headache patients were reported and those of 11 patients in previous studies were reviewed. Bifocal nummular headache was classifi ed into two types. Type I was defi ned as a simultaneous activation of two painful areas while type II was defi ned as two painful areas occurring in different times. Results: All 16 patients were female, with mean age of onset and initial presentation of 54.7 years and 58.2 years, respectively. There were seven type I and nine type II patients. The parietal area, especially the tuber parietale, was the leading site of involvement in both types of patients. The shape and size of painful areas were also similar between these two groups. There was an equal frequency of ipsilateral and contralateral painful areas. The pain intensity was similar in both types of patients but was milder in new painful areas than in previous painful areas in type II patients. Conclusions: Bifocal nummular headache suggests a central role of nummular headache but does not debunk the peripheral theory of nummular headache. The accumulated fi ndings in bifocal NH patients do not support a generalization of pain occurrence or a reproduction of local process of epicranial neuralgia at multiple sites in nummular headache.

Objectives: The early local vasodilator response to local warming is predominantly dependent on neural reflexes. However, it is suggested that systemic vasomotor activities are unaffected by a local warming at early stage. The purposes of this study were to assess the hypothesis that systemic vasomotor activities might make an adjustment at early stage of hand warming. Materials and Methods: Thirty-nine young volunteers who were healthy were recruited. Each participant received a right hand bathing at 40°C for 10 minutes. Doppler ultrasound technique was used to monitor the brachial artery mean blood velocity (aMBV) at the heated arm, and changes in aMBV were used to evaluate local vasodilator response to hand warming. Photoplethysmographic technique was used to monitor digital volume pulse (DVP) at the unheated finger, and changes in the DVP derived peak amplitude (DVPampl), reflection index (DVPRI), stiffness index (DVPSI), and heart rate (HR) were used to evaluate vascular distensibility of the unheated upper limb, small artery tone in the lower body, large artery stiffness, and cardiac regulation respectively. The data collected in each minute were averaged as an interval. Comparisons of aMBV, DVPRI, DVPSI, and HR at each interval with their respective baseline values were performed using one-way ANOVA. Results: Plots of one-minute intervals versus aMBV, DVPampl, DVPRI, DVPSI, and HR were shown in Figure. aMBV values presented significant increases with a early peak at the third minute. DVPampl presented significant decrease in the first minute and then reversed to a significant increase at the sixth minute. DVPRI presented a significant increase in the first three minutes, and then returned to the level of baseline. DVPSI and HR did not present any significant changes. Conclusion: At the period of early local vasodilator response to hand warming, systemic vasomotor activities did make a significant adjustment by decreasing vascular distensibility of the unheated upper limb and increasing small artery tone of the lower body, though the activities in heart rate and large artery tone were unaffected. Later, vascular distensibility of the unheated upper limb made a reverse adjustment and reached a significant increase.

Objective: This is a review of our cases and published literature on cheiro-oral syndrome (COS), to better understand its localization, etiology and outcome. Methods: In addition to our database, we reviewed the medical database (including PUBMED, BIOSIS, EMBASE, and SCOPUS) and other sources, searched by the keyword of “cheiro-oral”. The defi nition of COS was a subjective or an objective sensory disturbance confi ned to the perioral area and the fi nger(s)/hand without a detectable abnormality in mental, motor or cerebellar function. Only cases of COS where the clinicoanatomic correlation could be identifi ed by neuroimaging study, autopsy or stereotatic surgery was included. Results: There were a total of 174 patients; 85 patients from our database, 76 patients from medical database, and 13 patients from other sources. They were 111 men and 63 women. Their age ranged from 12 to 85 years; average being 58.2 years. Stroke is the leading etiology and constituted 74% of the patients. The most common location of lesion was thalamus, followed by pons and cortex. Classical unilateral COS was seen in 81% of patients, atypical COS in 19%. Whereas the lesions were from cortex to cervical spinal cord in unilateral COS, atypical COS was associated with lesions in pons or medulla oblongata. An early deterioration was seen in 16.5% of patients, especially in large cortical infarction and subdural hemorrhage. Structural lesions were found in 85% of patients. Conclusion: Classical unilateral COS do not have a high localizing value, the atypical COS is associated with lesion in pons or medulla.