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Liene Elsone, Ardis Platkajis, Guntis Karelis, Sarmite Dzelzite and Maira Murzina

Tumefactive Multiple Sclerosis Mimicking Neoplasm

Acute demyelination may present as a rapidly expanding space-occupying or tumefactive lesion (TDL). Tumefactive demyelinating lesions are misdiagnosed quite frequently and can result in unnecessary and potentially harmful surgical resection, radiation or toxic chemotherapeutic interventions therapy. Systematic literature review from available articles and abstracts in PubMed database was summarized in purpose to describe typical presentation and diagnostically challenging features of TDL. One clinical case report presenting tumor-like lesion of the brain, when the diagnosis of TDL was established, is added as an illustrative material.

Open access

Aelita Plinta, Inara Logina, Ardis Platkajis and Daina Jegere

Invasive and Non-invasive Methods in Diagnostic of Migraine: a Literature Review

Migraine is one of the most common neurological disorders worldwide. Prevalence varies in different reports but on average it is up to 15% of adults, mostly women, and up to 14,5 % in school age children. Although the diagnosis of migraine in children is not easy, migraine prevalence of migraine in childhood is very high. Morbidity of migraine is strongly related to positive family history and it illustrates ascertain close relation to genetic matter. Medical and social burden of migraine is tremendous since it affects all range of ages, starting from young children to seniors, and severe attacks can be even as disabling as quadriplegia. Despite there are thousands of trials done, indisputable cause of migraine as well as pathophysiological treatment is not clear. There are several forms of migraine, two of which are the most common- migraine without aura and migraine with aura. Diagnosis of migraine is based mainly on anamnesis data and clinical symptoms according to The International Classification of Headache Disorders (ICHD), neuroimaging is recommended only in case of so called red flag symptoms and is oriented to exclude secondary headache. Invasive investigations such as lumbar puncture and angiography with contrast are integral parts of investigational plan when migraine has to be differentiated from subarachnoid haemorrhage or pulmonary and cardiac right-to-left shunts. Modern neuroimaging reveals migraine as a kind of neurodegenerative disease that in severe and/or frequent form leads to brain white matter lesions, subclinical infarcts in the posterior circulation and increased iron deposition in brain. On the scientific laboratory level, it is possible now to diagnose migraine on affirmative base, and this is believed to be the future of neuroimaging in clinical practice regarding migraine.