The most promising biomarker is tau-binding radionuclide PET signal because it is most specific to the underlying neuropathology and differentiated CTE from both controls and patients with Alzheimer disease (P < 0.0001). Multimodal imaging will improve specificity further. Future research should minimize variability in identification of suspected cases of CTE using published clinical criteria.

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Background Migraine-tic syndrome was first reported in 2004 in a 44-year-old woman who had concomitant symptoms of both typical trigeminal neuralgia and migraine. We report here two further cases of migraine-tic syndrome and speculate on the relevance of this condition to the pathophysiology of headache. Case reports A 43-year-old woman presented with typical trigeminal neuralgia symptoms that preceded the onset of migraine headache; both headache types responded to treatment with sumatriptan. A 35-year-old woman presented with trigeminal neuralgia that consistently followed the onset of migraine headache. The former aspect responded to baclofen, but the migraine headache required treatment with amitriptyline. Discussion These two patients provide further support for the presence of an overlap syndrome of migraine-tic. We suggest that there is a common pathway for trigeminal neuralgia and migraine.

Primary angiitis of the central nervous system (PACNS) is a rare inflammatory vasculitis that may present with nonspecific symptoms and requires a histological diagnosis. Here, we report a case of PACNS that presented atypically, and also responded poorly to immunosuppressive treatment. We discuss the steps necessary for confirming the diagnosis, and the on-going management during this process. This case highlights the diagnostic conundrum offered by non-specific inflammatory conditions of the CNS.A 15-year-old girl initially presented with migrainous episodes. Some months later she was admitted with headache and vomiting, which developed into an encephalitic illness with associated seizures. Her medical history was only notable for bilateral serous otitis media at the age of three. On admission, vital signs were normal and there was no evidence of meningism. Examination revealed brisk reflexes, increased tone, and sustained ankle clonus bilaterally in addition to extensor plantar responses. Power and sensation were normal, but she displayed mild left sided finger-nose and heel-shin dysmetria and was unable to tandem walk. The remainder of the examination was unremarkable.MRI showed diffuse hyperintense lesions, the CSF was acellular with a mildly elevated protein (530 mg/l), and an infection and autoimmune screen were negative. A cerebral angiogram had also been normal and peripheral vasculitis markers including ANA and ANCA were all negative.