No abstract

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which is the agent of Coronavirus disease 2019 (COVID-19), may attack the central nervous system in addition to the respiratory system because of its neuro-invasive features. Increased inflammation, immobilization, hypoxia, and disseminated intravascular coagulation may predispose to the cerebrovascular diseases. A 73 years old man presenting to the emergency service with complaints of dyspnea, cough, and high fever was admitted to the hospital after being diagnosed as having COVID-19 upon findings of ground-glass densities and mild parenchymal involvement which was more prominent in the mid- and lower lobes of the lungs on his computerized tomography scan. His treatment was started with chloroquine, azithromycin, ceftriaxone and enoxaparin. On the neurological exam performed for symptoms of dizziness, imbalance, speech disorder and deviation of angle of mouth; he was conscious, cooperating, oriented limitedly and the right nasolabial groove was indistinct and he had dysarthria and ataxia. Acetyl salicylic acid was added to the treatment because cerebral diffusion magnetic resonance imaging revealed limited diffusion consistent with acute ischemia on the right posterolateral area of the bulbus. The patient whose respiratory distress worsened and who was admitted to the intensive care unit developed cardiac and respiratory arrest and he died despite all efforts of resuscitation. It should be kept in mind that the elderly patients with Covid-19 with prothrombotic risk factors are also at risk for cerebrovascular disease in addition to the infectious symptoms. In this case report, a patient infected with SARS-CoV-2 and diagnosed as acute ischemic stroke with anamnesis, clinical and radiological findings is presented.

Objective: According to the ICHD-3 criteria, menstrual migraine (MM) is divided into two groups: pure menstrual migraine (PMM) and menstrually-related migraine (MRM). The present study aimed to evaluate and compare the severity of headache using a visual analog scale (VAS) and the effect on quality of life using the Headache Impact Test (HIT) and Migraine Disability Assessment (MIDAS) tests before and after 3 months of treatment in using short-term prophylaxis with acetazolamide. Methods: Patients who presented to the headache outpatient clinic of the neurology department with a diagnosis of MM were retrospectively reviewed. Acetazolamide was given at a dosage of 500 mg daily for 5 days starting two days before the predicted onset of the menstrual cycle as a short-term prophylactic treatment. VAS, MIDAS, and HIT assessments were performed before and after treatment. Results: A total of 26 patients with PMM and 26 patients with MRM were identified. After acetazolamide treatment, statistically significant improvement was found in MIDAS, VAS and HIT scores in both groups of patients. The post-treatment MIDAS score was significantly lower in the MRM group, but there was no significant difference in post-treatment VAS and HIT scores between the groups. Conclusion: Using acetazolamide for short-term prophylaxis in patients with MM leads to decreased severity and frequency of headache and improvement in quality of life. The study is the first in the literature to use acetazolamide for short-term prophylaxis in patients diagnosed with MM.