Background: Heterophile antibodies are one of the most common causes of false-positive troponin. Case summary: We report a case of a 53-year-old woman with false-positive troponin elevation and a clinical presentation understood and treated as non-ST-elevation acute coronary syndrome. Because of chronic basal elevation of troponin (at a ‘plateau’ level) and chest pain, the patient underwent several invasive coronary angiograms until false-positive increase of troponin due to heterophile antibodies was suspected. Borderline stenosis of a left circumflex coronary artery found on first coronary angiogram was a coincidental finding and heterophile antibodies in the patient’s serum were confirmed. Discussion: This interesting case report aims to remind the clinicians about the possibility of false-positive troponin level due to laboratory analytical interference caused by heterophile antibodies. In this case, it is important to suspect false-positive troponin elevation, even when coronary artery disease is found. This rare and less mentioned and/or recognized cause of troponin elevation may lead to unnecessary invasive diagnostics and aggressive treatment of patients.

The BNT162b2 (Pfizer BioNTech) mRNA vaccine is an effective vaccine against COVID-19 infection. Here, we report an adverse event following immunization (AEFI) in a 48-year-old female patient who presented with fasciculations, migraine auras without headaches and in an increased discomfort of previously present palpitations, as well as excitation and insomnia. Her fasciculations were intermittently present until the time this paper was written, starting from the 6th day post-vaccination; they changed localization and frequency, but most commonly they were generalized, affecting almost all muscle groups. The patient also suffered from two incidents of migraine auras with visual kaleidoscope-like phenomena without headaches a few months after the vaccination. These symptoms were considered to be AEFI and no causal relation with the vaccine could be proven.

Background and Objectives: Medically unexplained symptoms (MUS) represent a clinical syndrome encompassing conditions in which patients present with symptoms that cannot be adequately explained by identifiable organic pathology or do not meet established diagnostic criteria for organic disease. These symptoms pose a diagnostic and management challenge, particularly in acute care settings. The objective of this study was to determine the proportion of patients presenting with MUS to the Emergency Neurology Service of a tertiary care hospital. Materials and Methods: This retrospective study was conducted at the Emergency Neurology Service of Sveti Duh University Hospital. All patients who were triaged for neurological examination during the study period were included. Following clinical evaluation, attending neurologists assessed the extent to which each patient’s symptoms could be explained by organic disease (“organicity”). This assessment was recorded using a Likert scale ranging from “not at all explained” to “completely explained. Results: Out of 219 patients, 2.7% had symptoms that were rated as “not at all explained” by organic disease, 7.3% “somewhat explained”, 23.3% “largely explained” and 66.7% “completely explained” by organic disease. Conclusions: Approximately one-tenth of patients presenting to our Emergency Neurology Service have symptoms that are poorly explained by identifiable organic disease.

Recurrent painful ophthalmoplegic neuropathy (RPON) is a headache disorder classified as a cranial neuropathy. It is characterized by episodes of unilateral headache followed by ipsilateral ophthalmoplegia due to ocular cranial nerve palsy. Symptoms usually subside spontaneously within weeks to months. RPON commonly occurs in childhood, though it is overlooked at times as a possible differential diagnosis. The pathophysiology of RPON is not entirely clear. Typical magnetic resonance imaging (MRI) findings in children include nerve thickening and gadolinium enhancement. However, these findings are not specific to this condition. Nerve thickening in RPON can resemble schwannomas, thereby causing a diagnostic dilemma. Here, we present a 13-year-old boy with a history of unilateral headaches associated with ipsilateral ptosis and diplopia. The first MRI indicated thickening and gadolinium enhancement of the right oculomotor nerve, which was interpreted as a schwannoma. However, his symptoms resolved after a few weeks and the follow-up MRI showed resolution of nerve changes. This clinical presentation was consistent with RPON. This case demonstrates the need for a careful follow-up of RPON patients.

Background and Objectives: Headaches have become one of the global public health burdens in the 21st century. Although findings on the presence of headaches in general and older adult populations have been well-documented, little evidence has been observed for university students. Moreover, their level of quality of life seems to be impaired due to stressful events and the inability to cope with them. However, the mutual relations between headaches and quality of life in this population remain unknown. Therefore, the main purpose of the study was to examine the associations between lifetime headaches and the presence of headaches in the last 12 months with quality of life. Materials and Methods: In total, 1350 university students (age = 22.9 ± 2.3 years; 81.3% female) were recruited. Each participant was instructed to fulfill the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire, a reliable and valid tool to assess headache and quality-of-life characteristics. Headache characteristics, headache-related disability (HALT-90), and quality-of-life domains were analyzed using Spearman’s correlation analyses and structural equation modeling. Results: Participants with migraine reported more frequent and more intense headaches and substantially greater headache-related disability compared with those with tension-type or undifferentiated headache. The mean number of lost days in the previous 90 days (HALT-90) was 14.3 (SD 23.1) in the migraine group compared with 4.53 (SD 12.0) in the tension-type headache group and 5.77 (SD 10.9) in the undifferentiated headache group. Across most WHOQOL domains, students with migraine reported lower quality-of-life scores compared with other headache groups. The WHOQOL-8 total score averaged 30.9 (SD 4.79) in the migraine group and 33.6 (SD 3.93) among participants without headache. Greater headache burden was consistently associated with poorer quality of life, with headache-related disability showing the strongest correlation with energy for everyday life (r = −0.345, p < 0.001). Conclusions: These findings suggest that greater headache burden, particularly migraine and headache-related disability, is associated with poorer quality of life among university students. The results highlight the need for targeted prevention programs aimed at helping students manage stress more effectively and improve their quality of life.