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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report a case of so-called "infected subdural hematoma" as a complication of chronic subdural hematoma. The patient was a 55-year-old man who had sustained a small laceration of the forehead in a traffic accident on March 29, 1995. No fractures were detected on skull roentgenograms, and general and neurological examinations failed to reveal any abnormal findings. In early August 1995, the patient began to experience headaches, and on August 5 he developed a fever of 38 degrees C. On August 8 he suffered a left motor seizure and was admitted to our hospital. Laboratory studies revealed a peripheral leukocyte count of 10,800/mm3 and a C-reactive protein level of 18.1 mg/dl. Computed tomography scans showed a thick right fronto-parietal subdural low density mass and a thin left frontal subdural low density mass. An emergency operation was performed via a single right fronto-parietal burr hole. A chronic subdural hematoma containing slightly yellowish, bloody, purulent fluid was found beneath an outer membrane. The hematoma was irrigated with physiological saline containing antibiotics, and a drain was inserted into the subdural space. A subdural membrane was also present on the left but it contained no pus. Aggressive antibiotic therapy was performed, and the patient was discharged without any neurological deficit. Histologically the membrane was determined to be the outer membrane of a typical chronic subdural hematoma. Enterococcus faecalis, which has rarely been reported to cause infection of the central nervous system, was detected in a bacterial culture of the pus. Systemic investigation showed no evidence of otorhinologic or other focal infection. The above clinical findings suggested that hematogenous seeding of a chronic subdural hematoma had occurred in this patient. Subdural empyema arising from hematogenous seeding to a pre-existing subdural hematoma by an infection is very rare, but this type of complication must be kept in mind not only in the elderly, infants, and compromised hosts, but in patients without complications as well.
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PMID:[A case of infected subdural hematoma complicating chronic subdural hematoma in a healthy adult man]. 902 8

Ocular-central nervous system malignant B-cell lymphoma initially caused diplopia and morning headaches in a 10-year-old boy. After initial diagnosis of pseudotumor cerebri was made, based on normal findings from magnetic resonance imaging and magnetic resonance angiography elsewhere, he was treated with acetazolamide. Standardized echography demonstrated a combination of solid infiltration and fluid within the optic nerve sheaths. Lumbar puncture showed elevated opening pressure and cerebrospinal diagnostic of central nervous system (CNS) B-cell lymphoma, which was confirmed by gene rearrangement. Results of peripheral blood study were negative. Aggressive treatment with chemotherapy and external-beam radiation produced complete resolution of solid optic nerve sheath infiltration in both eyes. This report discusses the clinical and ultrasonographic characteristics of CNS malignant B-cell lymphoma with ocular involvement and its differentiation from pseudotumor cerebri.
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PMID:Central nervous system malignant B-cell lymphoma identified with standardized echography of the optic nerve. 942 75

The imaging features of benign osseous lesions of the bone are often characteristic and suggestive of a specific diagnosis. This is particularly true for skeletal benign bone-forming lesions such as enostosis, osteoma, osteoid osteoma and osteoblastoma. Enostosis or bone island is an incidental finding in the axial skeleton (pelvis, spine, ribs) of asymptomatic patients; it appears as a small (0.2-2 cm) round to oval sclerotic area with irregular, radiating ('thorny') spicules peripherally. Osteoma is a benign slow-growth tumor and usually an incidental finding in cranial sinuses, vault and mandible, and presenting as a homogeneous, sharply defined bone mass arising from bone surface; its signs and symptoms are rare and depend on the tumor size and location--e.g. sinusitis, headache, exophthalmos, diplopia. Osteoid osteoma is a painful highly vascularized benign tumor usually affecting the long bone diaphysis cortex of young patients; it generally appears as a small radiolucent nidus with or without central calcification and surrounding bone sclerosis on radiographs, and as a 'hot' spot on scintigraphy. CT is the method of choice for the definite location of the nidus especially in sites of complex anatomy, such as the spine, pelvis and hindfoot. Osteoblastoma is a rare tumor, histologically similar to osteoid osteoma but with a significantly different clinical potential because of the possibilities of postoperative recurrence, of its locally aggressive behavior or, rarer still, malignant transformation; the spine and long bones are affected in more than half the cases. Its radiologic appearance is not always distinctive and usually characterized by a lytic lesion with varying bone production and expansile behavior; CT and MRI are required for the diagnosis of spinal osteoblastomas. When a bone-producing tumor or tumor-like lesion is suspected but no specific diagnosis can be made, the knowledge of the range of the imaging findings of these lesions will allow a suitably ordered differential diagnosis. Radiography is the single most effective imaging method in this respect. CT is required for the tumors in complex anatomical sites, such as the spine, pelvis and hindfoot, as well as for the optimal assessment of the tumor matrix. MRI is specifically required to study the lesion effect on the spinal canal.
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PMID:Skeletal benign bone-forming lesions. 965 8

5-Hydroxytryptophan (5-HTP) is the intermediate metabolite of the essential amino acid L-tryptophan (LT) in the biosynthesis of serotonin. Intestinal absorption of 5-HTP does not require the presence of a transport molecule, and is not affected by the presence of other amino acids; therefore it may be taken with meals without reducing its effectiveness. Unlike LT, 5-HTP cannot be shunted into niacin or protein production. Therapeutic use of 5-HTP bypasses the conversion of LT into 5-HTP by the enzyme tryptophan hydroxylase, which is the rate-limiting step in the synthesis of serotonin. 5-HTP is well absorbed from an oral dose, with about 70 percent ending up in the bloodstream. It easily crosses the blood-brain barrier and effectively increases central nervous system (CNS) synthesis of serotonin. In the CNS, serotonin levels have been implicated in the regulation of sleep, depression, anxiety, aggression, appetite, temperature, sexual behaviour, and pain sensation. Therapeutic administration of 5-HTP has been shown to be effective in treating a wide variety of conditions, including depression, fibromyalgia, binge eating associated with obesity, chronic headaches, and insomnia.
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PMID:5-Hydroxytryptophan: a clinically-effective serotonin precursor. 972 88

More aggressive neurosurgical management of intractably elevated intracranial pressure has resulted in increased survival of severely brain injured patients, many of whom are transferred for inpatient rehabilitation status post-craniectomy. Positional headache due to intracranial hypotension has been described in the literature, but is rarely reported as a complicating factor for patients receiving rehabilitation therapies. Low cerebrospinal fluid (CSF) pressure symptoms include postural headache, vertigo, nausea, vomiting, visual symptoms, auditory symptoms, and rarely cognitive changes. This report describes a patient who sustained a severe traumatic brain injury requiring craniectomy for management of increased intracranial pressure who subsequently developed intracranial hypotension. One month post-craniectomy, she developed postural headaches with cognitive and functional decline, which significantly impaired her rehabilitation. Aggressive efforts at conservative management including hydration and empiric blood patch were unsuccessful. Once the bone flap was replaced, she made rapid and dramatic functional gains, with total resolution of headache. This paper hypothesizes that the mechanism of low CSF pressure after extensive craniectomy is related to loss of hydrostatic pressure following removal of the skull vault. In rehabilitation of severely brain injured patients with craniectomies, it is important to recognize and appropriately treat this syndrome to avoid compromising patient care and prolonging hospitalization.
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PMID:Post-craniectomy intracranial hypotension: potential impact on rehabilitation. 978 87

The choice of anaesthesia for Caesarean sections, in patient with recent cerebral ischemic-hemorrhagic injuries, is a big problem. A case is reported of a woman submitted to Caesarean section in spinal anaesthesia who, in the first quarter, suffered an ischemic-hemorrhagic cerebral injury. Spinal anaesthesia was made by hyperbaric bupivacaine 0.5% at 10 mg dose + fentanyl 25 micrograms using 24G Sprotte needle. Spinal anaesthesia guarantees a good neuroendocrine protection to surgical aggression and a good hemodynamic stability. Hypotension prophylaxis by pre-filled is necessary and its treatment with ephedrine must be timely carried out. Risk of post-dural puncture headache, by atraumatic and very thin needles, is negligible. Spinal anaesthesia avoids general anaesthesia which may cause cardiovascular damages due to oro-tracheal intubation leading to possible cerebral damage. Induction-delivery time is more dangerous: the use of alogenate, oppioids, and/or some medicaments which may control the mother's adrenergic response, exhibit the newborn to risks.
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PMID:[Cesarean section in a patient with cerebral ischemic pathology. Spinal anesthesia]. 983 32

Between April 1991 and April 1997, 46 patients were treated in our department presenting with intracranial cavernomas. Initial symptoms were focal seizures, bleeding episodes, and/or headaches. Mean age was 41 year (range 9 to 68 years). There were 24 female and 22 male patients. Computed tomography and magnetic resonance imaging were performed in order to establish the diagnosis, angiography was only indicated when the hemorrhaged area was so close to the subarachnoid space in the vicinity of the basal cisterns that an aneurysm had to be ruled out. Aggressive indication for surgery also in brainstem cavernomas was based on the natural history of the lesion, since the majority of patients presenting with intracranial bleeding had suffered several (up to six) episodes of previous hemorrhages. Patients' clinical status upon admission and accessibility of the cavernoma were taken into account for planning the operation. The operative planning and approach were greatly facilitated by using a neuronavigational device and intraoperative electrophysiological monitoring particularly in cavernomas located in the brainstem, thalamus, and medulla oblongata. Surgical removal of the lesions resulted in a new permanent neurological deficit only in two patients (4%). These data show that patients benefit from modern neurosurgical techniques in contrast to conservative approach in this disease of rather prolonged natural course.
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PMID:Intracranial cavernomas: indications for and results of surgery. 1023 13

We attempted to determine the efficacy of endoscopic sinus surgery in adult patients with asthma and chronic rhinosinusitis or nasal polyposis. Fifty asthmatic patients from 17 to 74 years of age with a history of either chronic rhinosinusitis or nasal polyposis were examined. Sinonasal disease was confirmed endoscopically and with computerized tomography, and all had failed aggressive medical management of their sinonasal disease before undergoing endoscopic sinus surgery performed by the same surgeon in all cases. The following were compared for 12 months: preoperative and postoperative overall asthma control, peak flow measurements, asthma medication requirements, including the use of oral steroids, and hospitalizations for asthma. Twenty patients felt that their asthma control had improved postoperatively. Twenty per cent used less steroid inhaler, and 28% less bronchodilator inhaler. Of those 23 patients measuring peak flows, seven achieved higher levels and seven noted fewer dips and swings. Significant reductions in oral steroid requirements (p < 0.001) and hospitalization for asthma (p < 0.025) were also recorded postoperatively. Irrespective of whether the patient had chronic rhinosinusitis or nasal polyposis, both groups improved postoperatively. The commonest symptoms experienced by the group as whole and by the nasal polyposis patients were hyposmia and nasal obstruction. Postnasal discharge and headache were more important in the chronic rhinosinusitis group. Mean visual analog scores improved for all symptoms; in particular for nasal obstruction and sense of smell. Aggressive management of sinonasal pathology can improve asthma status. No major differences were recorded for outcomes when comparing patients with chronic rhinosinusitis or nasal polyposis; in particular there was no evidence for a worsening of asthma after nasal polypectomy.
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PMID:The effect of endoscopic sinus surgery on asthma: management of patients with chronic rhinosinusitis, nasal polyposis, and asthma. 1048 11

The anticonvulsant (AED) history for 216 children and adolescents with epilepsy was reviewed to determine the incidence and types of significant side effects (SSE) which warranted ceasing the drug (not due to a lack of response or a high dose). All parents of patients with epilepsy seen by the author over a 2 year period (March 1996 - March 1998) were questioned about SSE to previous AEDs, and the child's current therapy was also monitored prospectively to determine SSE. There were 107 girls and 109 boys ranging in age from 3 months - 18 years. Eighty-three patients had been exposed to a single AED while 133 had multiple AED exposures: mean 3.6 drugs; range 2-10 drugs. They were exposed to a total of 568 AEDs with SSE occurring in 15% of drug contacts: 7% due to behavioural changes such as irritability, aggression or hyperactivity; 8% were due to other factors such as a rash, headache, gastrointestinal disturbance or drowsiness. Fifty-seven children (26%) had experienced at least one SSE with 19 (9%) having SSE to more than one AED (range 2-4). Global developmental delay or an intellectual disability (ID) were present in 67 patients, and 27 (40%) of these experienced SSE compared with 30 (20%) of the group with normal cognition. This difference was principally due to the higher incidence of behavioural SSE in the ID group 28% versus 6% for the normal cognition group. Allowing for the higher number of AEDs used in the ID group (implying that their epilepsy was more difficult to control), behavioural SSE were still significantly more likely to occur in this group, i.e. 1: 9.6 drug exposures compared with 1: 31. 8 exposures for the normal cognition group (P<0.001). Monotherapy trials underestimate the true incidence of SSE in clinical practice as 26% of children had experienced at least one SSE and 9% had SSE to more than one AED. Those with ID were three times more likely to have behavioural SSE than children with normal cognition.
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PMID:Significant anticonvulsant side-effects in children and adolescents. 1083 18

Cyclic vomiting syndrome in children is a manifestation of various etiologies, including gastroenterological and renal disorders, central and autonomic nervous system abnormalities, as well as metabolic and endocrine dysfunction. Frequently no organic cause is found. Personality profiles of children with cyclic vomiting reveal perfectionism, competitiveness, and aggressive behavior. Vomiting attacks have been induced by anxiety and excitement in patients with cyclic vomiting. We describe an 8-year-old girl with cyclic vomiting, frequently associated with occipital headaches, photophobia or dizziness. Psychiatric evaluation indicated a generalized anxiety disorder.
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PMID:[Cyclic vomiting syndrome in children]. 1091 24


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