The biochemistry of migraine.
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Biomedical subjects
Publications and source records attributed to G W Bruyn.
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Following an exhaustive literature review of 126 cases, a personal series of 8 instances is presented. The following inferences are drawn: 1) the condition is not an anatomical variant, but a pathological lesion. 2) the lesion occurs in all races, and at all latitudes; its prevalence can be estimated to range between 0.4 and 0.5%. 3) the lesion occurs predominantly in females (sex ratio male: female = 1 : 2.5) and after the age of 60. 4) histological evidence indicated erosion of the external table, compensated by remodeling of the diploe, with resultant loss of the diploe. 5) Neither senility nor senescence, nor chronic trauma, nor muscular traction, nor inflammation, can explain the lesion, its symmetry, its site or its age/sex predilection.
Although patients diagnosed as having migraine, have been studied extensively, there is no definite proof of a primary biochemical abnormality which is of significance in the pathogenesis of migraine. Several authors have suggested that increased serum ammonia levels may play a decisive role in the pathogenesis of migraine. This possibility was first put forth by Russell, who studied a single family with ornithine carbamyl transferase deficiency and 8 juveniles with migraine, RUSSELL'S finding was supported by a preliminary study carried out by one of the authors in which hyperammo-naemia was found in 22 adults during migraine attacks. In order to etknd these earlier findings, serum ammonia levels were determined in 35 adults with either classic or complicated migraine and in 20 healthy adults. No significant difference was found between the patients (44 microgram/100 ml +/- 13.9) and the controls (74 microgram/100 ml +/- 9.5). Ammonia level was determined in 10 patients within two hours of the onset of an acute migraine and was unchanged (65 microgram/100 ml). This study suggests that alterations in serum ammonia level are not important in the pathogenesis of migraine in adults.
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A case of a girl with popliteal webbing associated with limited extension of the knee, flexion contractures of the third, fourth, and fifth digits, hypothrophia of leg musculature, and absent tendon reflexes in the legs is reported. Between 19 months and 6 years of age, the digital contractures, popliteal webbing, and limitation of knee extension progressively improved. This is the first reported instance of this combination of signs and the first report of regression of some of these physical findings.
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