Certainly, most patients with CADASIL ultimately present with far more than migraines with aura – significant NVP-LDE225 chemical structure behavioral abnormalities

and strokes in addition to the severe headaches. There is no effective disease-altering treatment at present, as was pointed out by Dr. Vollbracht. To make matters worse, triptan and ergot derivatives are contraindicated. Recently, it has been suggested that Friedrich Nietsche who developed headaches and severe mental illness suffered from CADASIL, as opposed to syphilis as was previously supposed (Hemelsoet D, Hemelsoet K, Devreese D. The neurological illness of Friedrich Nietzsche. Acta Neurol Belg 2008;108:9-16). As a point of interest, white matter lesions

(WMLs) and headaches can be seen in other settings including mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS), cerebral vasculitis (either primary or as part of a systemic vasculitis), and multiple sclerosis. There are differences EX 527 in vivo however in the location and appearance of the WMLs. The WMLs of CADASIL are symmetrical and confluent, and are best seen on FLAIR and T2 MRI sequences. Small ischemic lesions are the norm, with the appearance of lacunes. The WMLs in MELAS and in cerebral vasculitides are more assymetrical and involve both gray and white matter. In MELAS, WMLs tend to be clustered in frontal and anterior temporal regions. WMLs in MS frequently involve the corpus callosum, brainstem, and cerebellum, and they often have an ovoid shape with orientation perpendicular to the lateral ventricles (Dawson’s Fingers). What are “red flags” (ie, reasons

to pursue a more thorough work see more up) for headaches in the postpartum period? What constitutes a thorough work-up of a suspicious postpartum headache? How can you distinguish between SAH and RCVS when there is SAH seen on CT or MRI? How do the ischemic changes seen in CADASIL differ from more common cerebrovascular ischemic disease? Draw a typical genogram for a family with CADASIL. Draw a typical genogram for a family with MELAS. This case presentation and discussion address the following areas of competency in post-graduate medical education: patient care, medical knowledge, practice-based learning and improvement, communication skills, and systems-based practice. “
“(Headache 2011;51;S2:77-83) Chronic migraine (CM) is the most disabling of the 4 types of primary chronic daily headache (CDH) of long duration, a syndrome defined by primary headaches 15 or more days per month for at least 3 months with attacks that last 4 hours or more per day on average. CDH of long duration includes CM, chronic tension-type headache, new daily persistent headache, and hemicrania continua.