Background COVID-19 is a virus pandemic. According to the first obtained data, COVID-19 has defined with findings such as cough, fever, diarrhea, and fatigue although neurological symptoms of patients with COVID-19 have not been investigated in detail. This study aims to investigate the neurological findings via obtained face-to-face anamnesis and detailed neurological examination in patients with COVID-19. Methods Two hundred thirty-nine consecutive inpatients with COVID-19, supported with laboratory tests, were evaluated. Detailed neurological examinations and evaluations of all patients were performed. All evaluations and examinations were performed by two neurologists who have at least five-year experience. Results This study was carried out 239 patients (133 male + 106 female) with diagnosed COVID-19. Neurological findings were present in 83 of 239 patients (34.7%). The most common neurological finding was a headache (27.6%). D-dimer blood levels were detected to be significantly higher in patients with at least one neurological symptom than patients without the neurological symptom (p < 0.05). IL-6 level was found to be significantly higher in patients with headache than without headache (p < 0.05). Creatine kinase (CK) level was detected to be significantly higher in patients with muscle pain (p < 0.05). Conclusion Neurological symptoms are often seen in patients with COVID-19. Headache was the most common seen neurological symptom in this disease. Dizziness, impaired consciousness, smell and gustation impairments, cerebrovascular disorders, epileptic seizures, and myalgia were detected as other findings apart from the headache. It is suggested that determining these neurological symptoms prevents the diagnosis delay and helps to prohibit virus spread.

Background and objective Clinical studies on COVID-19 headache are limited. This prospective study aimed to define headache characteristics, associated clinical and laboratory factors, and treatment response in COVID-19. Methods Cross-sectional study enrolled 287 patients diagnosed with COVID-19 and hospitalized on a regular ward during the pandemic. All patients were examined face to face and followed by a neurologist during their stay in the hospital. The characteristics, concomitant symptoms, treatment responses, and laboratory findings of COVID-19-associated headaches were recorded. Results Eighty-three COVID-19 patients reported headache (28.9%), in which 85.5% had no prior headaches. Mean age was 48.40 ± 15.90 and 58% was men. Compared to COVID-19 patients without headache ( n = 204), patients with headache showed significantly higher frequency of pulmonary involvement (76%) and increased D-dimer levels. Fifty-nine percent of headaches responded iv paracetamol 1000 mg, and 85% of the paracetamol unresponsive headaches were relieved by greater occipital nerve (GON) blocks. Latent class cluster analysis identified 2 distinct class of bilateral, frontal, throbbing headaches: severe (VAS > 84), longer (> 14 h), frequent (> 7 headache days), paracetamol unresponsive-GON responsive headaches (85%), with pulmonary involvement (100%), and higher IL-6 levels (> 90 pg/mL) were classified in cluster 1. Cluster 2 included moderately affected patients (VAS > 54, > 6 h, > 4 days, 60% pulmonary involvement, > 20 pg/mL IL-6) and paracetamol responsive headaches (96%). VAS scores showed positive linear correlation with IL-6 levels ( p < 0.001; r = 0.567). Conclusion The intensity, duration, frequency, bilateral frontal location, and treatment response of COVID-19 headache was related to pulmonary involvement and IL-6 levels, which indicated a role of inflammation in determining the headache manifestations in moderately affected hospitalized patients. ROC curve cutoff values pointed that VAS > 70 severity, > 9 h duration, > 5 headache days, and IL-6 > 43 pg/mL levels can be diagnostic for COVID-19 headache. GON blocks can effectively abort headache when patients are unresponsive to paracetamol, and other NSAIDs are avoided during the SARS-CoV-2 infection.

Background and aim Pathogenesis of COVID-19 -related headache is unknown, though the induction of the trigeminal neurons through inflammation is proposed. We aimed to investigate key systemic circulating inflammatory molecules and their clinical relations in COVID-19 patients with headache. Methods This cross-sectional study enrolled 88 COVID-19 patients, hospitalized on a regular ward during the second wave of the pandemic. Clinical characteristics of COVID-19 patients were recorded, and laboratory tests were studied. Results The mean ages of 48 COVID-19 patients with headache (47.71 ± 10.8) and 40 COVID-19 patients without headache (45.70 ± 12.72) were comparable. COVID-19 patients suffered from headache had significantly higher serum levels of HMGB1, NLRP3, ACE2, and IL-6 than COVID-19 patients without headache, whereas CGRP and IL-10 levels were similar in the groups. Angiotensin II level was significantly decreased in the headache group. COVID-19 patients with headache showed an increased frequency of pulmonary involvement and increased D- dimer levels. Furthermore, COVID-19 was more frequently associated with weight loss, nausea, and diarrhea in patients with headache. Serum NLRP3 levels were correlated with headache duration and hospital stay, while headache response to paracetamol was negatively correlated with HMGB1 and positively associated with IL-10 levels. Conclusion Stronger inflammatory response is associated with headache in hospitalized COVID-19 patients with moderate disease severity. Increased levels of the circulating inflammatory and/or nociceptive molecules like HMGB1, NLRP3, and IL-6 may play a role in the potential induction of the trigeminal system and manifestation of headache secondary to SARS-CoV-2 infection.

Background/aim: Coronavirus 2019 disease (Covid-19) was first seen in December 2019 and afterwards it became a pandemic. Several systemic involvements have been reported in Covid-19 patients. In this study, it was aimed to investigate the cerebrovascular hemodynamics in patients with Covid-19. Materials and methods: The sample of this study was conducted on 20 patients hospitalized in our clinic diagnosed with Covid-19 via PCR modality and 20 healthy volunteers of similar age and sex. Bilateral middle cerebral arteries were investigated with Transcranial Doppler Ultrasonography. Basal serebral blood flow velocities and vasomotor reactivity rates were determined and compared as statistically. Results: When patient and control groups were compared, the mean blood flow velocity was found to be higher in Covid-19 patients than the healthy volunteers and it was statistically significant (p = 0.00). The mean vasomotor reactivity rates values were found to be lower in Covid-19 group than the healthy group and also it was statistically significant (p = 0.00). Conclusion: An increase in cerebral basal blood velocity and a decrease in vasomotor reactivity rates in patients with Covid-19 can be considered as an indicator of dysfunction of cerebral hemodynamics in central nervous system and this can be evaluated as a result of endothelial dysfunction.

AIm:Topiramate is an antiepileptic drug with multiple mechanisms of action that is also used for migraine prophylaxis. This study aimed to investigate the efficacy of topiramate therapy for migraine prophylaxis, based on vasomotor reactivity ([VMR] an indicator of cerebral autoregulation), and to identify changes in cerebral hemodynamics during the treatment. mATERIAL and mETHods:We included 20 migraine (with aura) patients (group 1) and 20 healthy controls (group 2) in the study. Transcranial Doppler monitoring was performed in both groups with patients in the supine and resting position. Using a two-sided temporal window at depths of 45-60 mm for the middle cerebral artery (MCA) and depths of 60-70 mm for the posterior cerebral artery (PCA), basal flow rates and VMR values were measured. Group 1 initially received 25 mg/d of topiramate orally, and then the dose was increased 25 mg every week. At the fourth week; the optimal dose was increased to 50 mg b.i.d. and the treatment was continued at this dose. Transcranial Doppler parameters were re-evaluated 2 months after treatment. In addition, the number of attacks per month, duration of pain, and visual analog scale (VAS) scores obtained before the treatment and 2 months after the treatment in group 1 were compared.REsuLTs: Basal flow rates and VMR values recorded from the right and left MCA in group 1 were significantly higher than those in the control group (P < 0.05). Flow velocities obtained from the right and left MCA, and the VMR values in group 1 after topiramate treatment did not differ significantly from those in the control group (P > 0.05). In addition, the number of attacks, duration of pain, and VAS scores in group 1 were significantly lower after the treatment than before the treatment (P < 0.05). CoNCLusIoN:Topiramate is an effective prophylactic treatment in migraine with aura patients and appeared to play a positive role in the regulation of cerebrovascular autonomic control. BuLGuLAR: Topiramat tedavisi öncesi migren grubunda OSA bazal akım hızları ile VMR değerleri istatistiksel olarak anlamlı derecede (p<0,05) yüksek bulundu. Migren grubunda topiramat tedavi sonrası saptanan, sağ ve sol OSA'dan elde edilen bazal akım hızları ile VMR değerleri, kontrol grubu ile karşılaştırıldığında farklılık saptanmadı (p>0,05).soNuÇ: Migrenli hastaların proflaktik tedavisinde, topiramatın iyi bir seçenek olduğu ve serebrovasküler otonomik kontrolün regülasyonunda rol oynadığı söylenebilir.