Objective: To assess the available evidence for the diagnostic accuracy of CSF testing for protein 14-3-3 in patients with suspected sporadic Creutzfeldt-Jakob disease (sCJD). Methods:The authors performed a systematic review of the available literature from 1995 to January 1, 2011, to identify articles involving patients who were suspected of having sCJD and who had CSF analysis for protein 14-3-3. Studies were rated according to the American Academy of Neurology classification of evidence scheme for diagnostic studies, and recommendations were linked to the strength of the evidence. A pooled estimate of sensitivity and specificity was obtained for all studies rated Class II or higher. The question asked is "Does CSF 14-3-3 protein accurately identify Creutzfeldt-Jakob disease (CJD) in patients with sCJD?" Results:The analysis was conducted on the basis of samples of 1,849 patients with suspected sCJD from 9 Class II studies. Assays for CSF 14-3-3 protein are probably moderately accurate in diagnosing sCJD: sensitivity 92% (95% confidence interval [CI] 89.8-93.6), specificity 80% (95% CI 77.4-83.0), likelihood ratio of 4.7, and negative likelihood ratio of 0.10. Recommendation:For patients who have rapidly progressive dementia and are strongly suspected of having sCJD and for whom diagnosis remains uncertain (pretest probability ϳ20%-90%), clinicians should order CSF 14-3-3 assays to reduce the uncertainty of the diagnosis (Level B). Neurology ® 2012;79:1499-1506 GLOSSARY CI ϭ confidence interval; CJD ϭ Creutzfeldt-Jakob disease; DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; NSE ϭ neuron-specific enolase; PSWC ϭ periodic sharp and slow wave complexes; ROC ϭ receiver operator characteristic; sCJD ϭ sporadic Creutzfeldt-Jakob disease; WB ϭ Western blot.

Background: We aimed to assess the prevalence of headache and migraine, along with comorbidities, in a large ­Saudi sample. Methods: Self-reported information was collected about headache, migraine and migraine comorbidities including depression, restless legs syndrome (RLS), syncope, bruxism, hypertension and ischaemic disease. The OR was estimated using logistic regression for any associations with headache and migraine. We then analyzed to find a trend of increasing migraine symptoms for each significant comorbidity. Results: Out of 4,943 respondents, 4,158 (84.12%) had recurring headaches. Migraine was present in 1,333 (26.97%), with female predominance (ratio of 1: 2.9). There were statistically significant ORs between migraine and female sex, current smokers, higher income, hypertension, depression, syncope, RLS and bruxism. Non-migraine headaches were significantly associated with female sex, age, RLS and ischaemic disease. Migraine with aura was significantly associated with syncope, ischaemic disease, higher income and BMI. There was an overall significant trend of increasing migraine features in the presence of depression, syncope, RLS, bruxism and hypertension. Conclusions: Headache in general and migraine in particular are associated with multiple comorbidities in comparison to non-headache participants in our cohort, with an estimated prevalence similar to that of western countries.

Case 1: A previously healthy 51-year-old man came to hospital complaining of headache of 3 weeks' duration and several days of nausea, vomiting and confusion. He had some difficulty recalling the events of the preceding 3 weeks, but the results of his general and neurologic examinations were otherwise normal. A CT scan of the brain showed bilateral, symmetric infarcts in the heads of the caudate nuclei, with hyperdensity surrounding the anterior communicating artery. The infarcts were confirmed via MRI; conventional angiography showed a 4-mm saccular aneurysm of the anterior communicating artery (Fig. 1). To treat the aneurysm, we successfully inserted detachable coils endovascularly. Afterward, the patient remained medically stable and was discharged home 2 weeks later.One month after discharge, he returned to hospital with a sudden onset of slurred speech, left-sided facial weakness and unsteady gait. Another CT scan revealed a new left thalamic hypodensity; MRI showed an acute infarct in the