BACKGROUND:

Chronic tension-type headache (CTTH) is recognized as the most common type of headache and can be further defined as either episodic or chronic. Regarding the chronic nature of CTTH and intolerance or side effects of drugs that are used for treatment, other methods of treatment such as Transcutaneous Electrical Nerve Stimulation (TENS) has been used as a convenient and available method for treatment and prevention of CTTH. In the current study, we evaluated the efficacy of the imipramine versus TENS in the prevention of the CTTH as a prospective clinical trial.

METHODS:

In this study, 138 patients with confirmed CTTH were randomized to be treated either with imipramine or TENS method. Sixty nine patients were treated with TENS and 69 cases were regarded as controls and were treated with imipramine. In the Imipramine group, treatment was performed by imipramine tablet, 25mg, twice daily. In the TENS group, patients were treated thrice weekly for ten weeks, each lasting 15 minutes in temporal and occipital regions.

RESULTS:

Three months after treatment, both the TENS and imipramine significantly reduced the severity of tension headache (p < 0.05). However, imipramine was significantly more effective than TENS in reduction of the headache severity (p < 0.05).

CONCLUSIONS:

It appears that TENS method may be a good alternative method for patients suffering from CTTH. To better evaluate the efficacy of this method in the prevention and treatment of CTTH, more studies are recommended.

Stroke is a medical emergency with a mortality rate higher than most forms of cancer. It is the second leading cause of death in developed countries and the most common cause of serious, long-term disability in adults.

Primary intracerebral hemorrhage (ICH) is a major clinical problem that accounts for 15% of all acute stroke hospitalizations. Currently, there is no medical therapy available for these patients, with options being limited to supportive care or invasive neurosurgical evacuation. The damage induced by an ICH appears to be related to a combination of different factors. In addition to direct mechanical disruption from the hematoma, surrounding injury secondary to edema formation and ischemia are contributing factors for brain injury following ICH. Citicoline (cytidine-5-diphosphocholine) is an essential precursor for the synthesis of phosphatidylcholine that is key component of cell membranes. Citicoline is a naturally occurring endogenous compound. For clinical use, the sodium salt of this compound usually utilized. During ischemia, phosphatidylcholine is broken down into free fatty acids, which in turn are used to generate free radicals that potentiate ischemic injury. Citicoline is a neuroprotectant drug with some beneficial effects in human ischemic stroke and primary intracerebral hemorrhage (ICH) with an excellent safety profile.

In the current paper, we review published papers regarding use of citicoline in the treatment of human ischemic stroke and primary intracerebral hemorrhage (ICH).

Background

Systemic lupus Erythematosus is a chronic autodestructive disease, with loss of immune tolerance to nucleic acid and other cross reactive antigens. Despite of the numerous studies, the presence of some new manifestations indicates the greater proportion of unknown data.

Case presentation

Our case, is a 26-year-old female, by the chief complaint of headache, vomiting, fever and arthralgia. Some hemorrhagic ulcers in her mouth with fulminant pethechia/purpura on her limbs and buttocks were prominent. On admission, she was in hypotensive state. By the clinical suspicion to meningococcal septicemia, lumbar puncture was performed, and antibiotic therapy was started. Cerebrospinal fluid was normal. Suddenly, on the 3rd day of admission, hemorrhagic bullae were evolved from those purpuric lesions. Leukocytosis, immune hemolytic anemia, thrombocytopenia and high antinuclear antibody/double stranded DNA level and hypocomplemania were present simultaneously. In skin biopsy, immune complex deposition in dermoepidermal junction was seen. The diagnosis of Systemic lupus Erythematosus was made. The patient responded well to corticosteroid therapy.

Conclusion

Coetaneous manifestations are very common in Systemic lupus Erythematosus, and help the physician making differential diagnoses and proper diagnosis. The rapidly evolving hemorrhagic bulla from primary purpuric lesions, with rapid response to Prednisolone, is a rare manifestation of Systemic lupus Erythematosus, which should be considered in such a disease setting.