Migraine is a highly disabling primary headache disease, accompanied by nausea, emesis, photophobia and phonophobia. Chronic migraine is usually developed from episodic migraine, and usually comorbids with anxiety, depression, and sleep disorders, further aggravating the disease burden. At present, the clinical diagnosis and treatment of migraine in China are not standard, and the migraine medical quality control evaluation system is lacking. In order to achieve standardized diagnosis and treatment of migraine, headache collaborators of Chinese Society of Neurology, based on national and international clinical research on diagnosis and treatment of migraine and combined with the current situation of China's medical system, drafted the expert consensus on the medical quality evaluation of inpatients with chronic migraine.
Humans ; Consensus ; Migraine Disorders/diagnosis* ; Nausea ; Photophobia/diagnosis* ; Headache

Intracranial hypotension usually arises in the context of known or suspected leak of cerebrospinal fluid (CSF). This leakage leads to a fall in intracranial CSF pressure and CSF volume. The most common clinical manifestation of intracranial hypotension is orthostatic headache. Post-dural puncture headache and CSF fistula headache are classified along with headache attributed to spontaneous intracranial hypotension as headache attributed to low CSF pressure by the International Classification of Headache Disorders. Headache attributed to low CSF pressure is usually but not always orthostatic. The orthostatic features at its onset can become less prominent over time. Other manifestations of intracranial hypotension are nausea, spine pain, neck stiffness, photophobia, hearing abnormalities, tinnitus, dizziness, gait unsteadiness, cognitive and mental status changes, movement disorders and upper extremity radicular symptoms. There are two presumed pathophysiologic mechanisms behind the development of various manifestations of intracranial hypotension. Firstly, CSF loss leads to downward shift of the brain causing traction on the anchoring and supporting structures of the brain. Secondly, CSF loss results in compensatory meningeal venodilation. Headaches presenting acutely after an intervention or trauma that is known to cause CSF leakage are easy to diagnose. However, a high degree of suspicion is required to make the diagnosis of spontaneous intracranial hypotension and understanding various neurological symptoms of intracranial hypotension may help clinicians.
Brain ; Cerebrospinal Fluid ; Cerebrospinal Fluid Leak ; Classification ; Diagnosis ; Dizziness ; Fistula ; Gait ; Headache ; Headache Disorders ; Hearing ; Intracranial Hypotension ; Movement Disorders ; Nausea ; Neck Pain ; Photophobia ; Post-Dural Puncture Headache ; Spine ; Tinnitus ; Traction ; Upper Extremity ; Ventriculoperitoneal Shunt

Epidemic keratoconjunctivitis is the most common type of infectious conjunctivitis, and is caused by adenoviruses. The mode of transmission is mainly through direct contact with ocular secretions. Epidemic keratoconjunctivitis is generally diagnosed based on a patient's clinical features, and additional measures, such as cell cultures, polymerase chain reaction, and rapid antigen detection tests, can further confirm the diagnosis. The most common symptoms include a foreign body sensation, tearing, and photophobia. The symptoms are usually expressed unilaterally in the initial phase, but gradually become bilateral. Frequently occurring complications include pseudomembrane formation and subepithelial infiltrates. Currently, no antiviral agent has been proven effective to alter the natural course of the disease, and treatment merely has a supportive role instead of a curative role. Therefore, preventive measures in medical offices and in the community are the most important methods of controlling the propagation of this disease.
Adenoviridae ; Adenovirus Infections, Human ; Cell Culture Techniques ; Conjunctivitis ; Conjunctivitis, Viral ; Diagnosis ; Foreign Bodies ; Humans ; Keratoconjunctivitis* ; Photophobia ; Polymerase Chain Reaction ; Sensation ; Tears

PURPOSE: To report a rare case of traction retinal detachment and retinal ischemia in inactive Takayasu's arteritis at ophthalmologic clinic. CASE SUMMARY: A 23-year-old woman presented with a floater, photophobia, and visual loss in her right eye one week prior to visit. She had no other systemic disease, such as diabetes mellitus or hypertension, or previous ophthalmic abnormalities except for a tumor in the adrenal gland. We found bilateral retinal ischemia and traction retinal detachment in the right eye on fundus examination without iris neovascularization. Pars plana vitrectomy, traction removal, endolaser treatment, and intravitreal bevacizumab injection were performed. Steroid eye drops and steroid systemic administration relieved the inflammation. On carotid doppler sonography, we found severe stenosis and thickness of the inner layer in both carotid arteries. We diagnosed the patient with an inactive phase of Takayasu's arteritis, which was conclusively correlated with the clinical features. Vascular anastomosis surgery along with follow-up was proposed by both the cardiology and vascular surgery departments. CONCLUSIONS: When a young patient presents with traction retinal detachment and retinal ischemia, Takayasu's arteritis should be considered for differential diagnosis and a systemic work-up should be performed as soon as possible.
Adrenal Glands ; Bevacizumab ; Cardiology ; Carotid Arteries ; Constriction, Pathologic ; Diabetes Mellitus ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Inflammation ; Iris ; Ischemia ; Ophthalmic Solutions ; Photophobia ; Retinal Detachment* ; Retinaldehyde* ; Takayasu Arteritis* ; Traction* ; Vitrectomy ; Young Adult

Cystinosis is a rare disease characterized by abnormal lysosomal cystine accumulation of cystine due to impaired lysosomal transport. We previously reported the first case of cystinosis in Korea in a 12-year-old boy with short stature, general weakness, and photophobia. The diagnosis was confirmed based on ophthalmic findings and biochemical analyses (serum leukocyte cystine measurement). Major endocrine manifestations at diagnosis included hypothyroidism, growth retardation, and hypogonadism. Despite oral cysteamine administration and renal replacement therapy, multiple complications including both endocrine and nonendocrine disorders developed during and after adolescence. In this report, we review the presenting features and factors related to the long-term complications in a patient with cystinosis.
Adolescent* ; Child ; Cysteamine ; Cystine ; Cystinosis* ; Diagnosis ; Humans ; Hypogonadism ; Hypothyroidism ; Korea ; Leukocytes ; Lysosomal Storage Diseases ; Male ; Photophobia ; Rare Diseases ; Renal Replacement Therapy

PURPOSE: To report a case of migraine attacks with aura that occurred after percutaneous closure of an atrial septal defect (ASD) with the Amplatzer septal occluder device. CASE SUMMARY: A 58-year-old female presented with glare and scintillation that lasted 3 days. She had a history of percutaneous ASD intervention 3 weeks prior. Because ophthalmologic examination revealed nothing remarkable, the patient underwent observation. However, two months later, she revisited our department, presenting with aggravated glare, scintillation, and severe photophobia. Also, she presented with scintillation followed by a headache starting from the right temporal area extending to the occipital area. The patient was diagnosed with migraine with aura, which was newly developed after percutaneous ASD closure. After switching medication from acetylsalicylic acid to clopidogrel, the frequency and intensity of the headaches were reduced. No recurrence of ophthalmic symptoms or headache was observed during the 1-year follow-up. CONCLUSIONS: Percutaneous closure of ASD can be complicated by the appearance of migraine attacks with aura. When patients present with glare and scintillation, ophthalmologists must consider the possibility of migraine with aura and migraine induced by secondary causes. Thus, detailed history taking should be taken in order to make an early diagnosis of migraine.
Aspirin ; Early Diagnosis ; Epilepsy ; Female ; Follow-Up Studies ; Glare ; Headache ; Heart Septal Defects, Atrial* ; Humans ; Middle Aged ; Migraine Disorders* ; Migraine with Aura* ; Photophobia ; Recurrence ; Septal Occluder Device

BACKGROUND AND OBJECTIVES: Migrainous vertigo (MV) is one of the recurrent vestibular syndromes and may present episodic vestibular and concurrent migraine symptoms. The clinical manifestations and neuro-otological findings of MV have been delineated over the last couple of decades, however, there are still lots of uncertainties. MATERIALS AND METHODS: We performed a comprehensive literature search regarding the clinical manifestations and neuro-otological findings of MV compatible with the diagnostic criteria proposed by Neuhuaser. We found the published articles that addressed the clinical and neuro-otological findings and we performed a pooled analysis. RESULTS: Even though the duration of MV attack was variable from seconds to days, the most common durations investigated in this study was minutes (range, 5-60 minutes). During MV attack, most patients had a migraine headache, but instead the other migraine symptoms (i.e., photophobia, phonophobia) could be found. There were positional nystagmus which may not meet a stimulated canal plane and spontaneous nystagmus and, less commonly, gaze-evoked nystagmus. Regarding bithermal caloric test, unilateral canal paresis could be found in 15-20% of MV patients as well as hyperexcitability in some patients. Oculomotor tests might show impaired pursuits (mainly saccadic pursuit) and saccadic abnormalities such as delayed latency and hypometric saccade. CONCLUSION: From the result of the pooled analysis, we have found several clinical and neuro-otological findings. However, vital neuro-otological findings which can provide a clue for the diagnosis of MV are still lacking. So the diagnosis of MV should depend on the clinical manifestations and a process of differential diagnosis.
Caloric Tests ; Diagnosis, Differential ; Humans ; Migraine Disorders ; Nystagmus, Physiologic ; Paresis ; Photophobia ; Vertigo ; Vestibular Function Tests

A 4-month-old female maltese dog was admitted to Veterinary Medical Teaching Hospital of Seoul National University for evaluation of abnormal color of bilateral irises. This patient had the photophobia in the light and exhibited the complete absence of pigment resulting in white hair, pink muzzle, eyelids and foot-pads. Central zone of the irises were yellow in color influenced by tapetal reflex, and peripheral zone were pale blue. The iridal capillaries were transparented on the irises. Ophthalmoscopic examination revealed a yellow tapetal fundus but no pigment in the nontapetal fundus.
Albinism, Oculocutaneous/diagnosis/*veterinary ; Animals ; Dog Diseases/*diagnosis ; Dogs ; Female ; Ophthalmoscopy/veterinary ; Photophobia/diagnosis/veterinary

Germinomas of the central nervous system are rare embryonal tumors(accounting for less than 1% of intracranial neoplasms) that may be located in the pineal region, in the floor of the third ventricle, or in the suprasellar area. We report a case of germinoma developed in periventricular deep white matter without pineal region tumors or suprasellar masses. The 19-year-old male patient presented with slowly progressing headache, dizziness, photophobia, and dysarthria. Initial brain MRI revealed a irregular and dense enhancement from lateral ventricles to 4th ventricle. The stereotactic biopsy of tumor and histologic examination revealed the germinoma. Craniospinal axis radiation therapy was performed. After radiation therapy patient was improved and no neurologic sequelae was seen at discharge. Periventricular germinomas without pineal or suprasellar lesion are very rare. The radiation therapy, as in our case, is beneficial as with other intracranial germinomas. Stereotactic biopsy of periventricular germinoma provides precise pathologic diagnosis and thus allows more specific management.
Axis, Cervical Vertebra ; Biopsy ; Brain ; Central Nervous System ; Diagnosis ; Dizziness ; Dysarthria ; Germinoma* ; Headache ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging ; Male ; Photophobia ; Third Ventricle ; Young Adult

PURPOSE: The purpose of this study is to help diagnosis migraine and tension-type headache in children with chronic recurrent headache by comparing clinical characteristics of migraine and tension-type headache. METHODS: We performed a clinical analysis of 89 children diagnosed as migraine and/or tension-type headache by using international headache society classification with the aid of Prenky's criteria of migraine and Jay's category of tension-type headache. RESULTS: The diagnosed group consisted of 39 children with migraine, 40 tension-type headache cases and coexisting migraine and tension-type headache in 10 cases. In the location of the headache, the incidence of temporal area was significantly higher in the migraine than in tension-type headache(P<0.001) and the incidence of occipital area was significantly higher in the tension-type headache than in migraine(P<0.01). In migraine, 27 cases(69.2%) had pulsating headache which was significantly higher than in the tension-type headache(P<0.001). In tension-type headache, 18 cases(45.0%) had dull headaches which were significantly higher than in migraine(P<0.01). Nausea, vomiting, dizziness, relief of headache after sleep, photophobia, and visual disturbance among associated symptoms with headache were significantly higher in migraine than tension-type headache(P<0.05). The incidence of family history of headache in migraine(71.8 %) was higher than in the tension-type headache(40.0%)(P<0.01). CONCLUSION: Diagnostic criteria are significant in diagnosis of migraine and tension-type headache. The characteristics of headache are overlapped in both headache types and there are differences of expression for headache in children, so there is a problem in diagnosing of headache type. The international Headache Society Classifications are useful for children, but there are problems that diagnostic criteria are too strictly applied to children.
Child* ; Classification ; Diagnosis ; Dizziness ; Headache ; Humans ; Incidence ; Migraine Disorders* ; Nausea ; Photophobia ; Tension-Type Headache* ; Vomiting