Transcranial Doppler, electroencephalography, and single photon emission computed tomography were performed in a case of basilar migraine during the different phases of the attack. In the aura phase, the patient had bilateral blindness and ataxia. Doppler ultrasound studies showed a reduction in the mean flow velocity of the posterior cerebral arteries, electroencephalography showed slow activity confined to the posterior regions, and single photon emission computed tomography, an area of hypoperfusion in the right parietal and occipital regions. During the headache phase, when the neurological examination was normal, transcranial Doppler showed an increase in the mean flow velocity of both posterior cerebral arteries and the electroencephalogram revealed an increase: in the slow activity over the occipital regions. When the pain subsided, the electroencephalogram showed a progressive reduction of the slow abnormalities and transcranial Doppler was reported as normal. After a week, single photon emission computed tomography and cranial magnetic resonance imaging were normal. After a month, a follow-up electroencephalogram was also normal. All these findings indicated a transient focal reduction of cerebral blood flow during the aura phase. Transcranial Doppler (TCD) is an effective technique for the study of cerebral blood flow (CBF) in patients with migraine. The available data refer to the pain phase and the intericta period. 1,2 The possibility of documenting the CBF variation starting with the aura phase is a rare event limited to cases with prolonged aura. 3 In this case, the data suggest a decrease of CBF in the cortical area responsible for the neurological manifestations during the aura phase.Determinations of regional cerebral blood flow (rCBF) with Xenon-133 during migraine with aura have already demonstrated initial focal hypoperfusion followed by hyperemia. 4 More recently, the use of technetium Tc 99m hexamethyl propylenamine oxime (Tc 99m HMPAO) single photon emission computed tomography (SPECT) in patients with migraine without aura has failed to show evidence of CBF focal alterations. 5 A relative rCBF reduction during migraine attacks might account for the different electroencephalographic abnormalities described in these patients, the meaning of which is uncertain.We performed an EEG, TCD, and cerebral SPECT using Tc 99m HMPAO, during all phases of a basilar migraine attack in order to correlate the focal electroencephalographic abnormalities with the dynamic alterations of the rCBF.In view of the neurological deficit in the aura phase, we evaluated the TCD parameters with respect to the posterior cerebral arteries (PCAs) and compared them with those of the middle cerebral arteries (MCAs). The normal values for mean flow velocity (MFV) suggested by the Italian Society of Neurosonology 6 (PCA 51 to 26 cm/ sec, MCA 76 to 44 cm/sec, pulsatility index [PI] 0.99 to 0.69 cm/sec) were taken into account. CASE HISTORYA 25-year-old woman was hospitalized with complaints of positive scotomata and bilater...

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The objective of this study was to assess the efficacy and safety of Gabapentin as the sole analgesic in patients with HIV-related painful neuropathy. Nineteen patients with HIV-related painful neuropathy were administered Gabapentin. Efficacy was evaluated with two 100-mm Visual Analogue Scales (VAS) (0: no symptom; 100: worst symptom), rating pain and interference of pain with sleep, performed at baseline and monthly intervals. Main Pain VAS score decreased from a baseline of 55.7 +/- 19.1 mm to a final 14.7 +/- 18.6 mm (ANOVA P = 0.0001) and mean Sleep Interference VAS score decreased from a baseline of 60.4 +/- 31.9 mm to a final 15.5 +/- 27.7 mm (ANOVA P = 0.0001). Gabapentin provided significant pain relief in our patients with HIV-associated painful sensory neuropathy.

Various diseases are described as antecedents of Guillain-Barré syndrome (GBS), particularly gastroenteritis and respiratory infectious diseases, but epidemiological surveys are rare. This paper details a multicentre matched case-control study carried out within a well-defined Italian population. For each GBS case fulfilling the Asbury and Cornblath criteria, one control was recruited from a neurological (NC) ward and another from a non-neurological (NNC) ward, matched for age, sex, season of disease onset and area of residence. All cases and controls were administered a semistructured questionnaire. The OR was calculated according to the Mantel-Haenszel equation for triplets. Between 1 October 1996 and 30 September 1998, 75 triplets were included in the case-control study. The OR for flu-like syndrome was 7.14 (CI 95%, 3.28-15.52) and for gastroenteritis 3.57 (CI 95%, 1.31-9.72); no other factor reached significance. Our results, based on the clinical and anamnestic features of triplets of patients, support the possible role as risk factors for GBS of infectious diseases, particularly flu-like syndrome and gastroenteritis.

We report the case of a 72 year-old woman who developed acute polyradiculoneuritis 7 days after a series of 4 blood transfusion. While blood transfusion is not listed as an antedecent event of Guillain-Barré syndrome (GBS), GBS following surgical procedures is well known. In the present case the close temporal relationship and the absence of all factors which usually precede the onset of the disease including surgery, suggest a possible role of blood transfusion in the onset of the GBS.