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

A double-blind random study compared the effects of lorazepam and pantopon an intra-muscular premedication in healthy women for uterine curettage (D & C). Anxiety, as assessed by a self-rating test by the patient and by a trained observer, showed a significant reduction at one and one-half hours after lorazepam and a smaller reduction after pantopon, which was not significant. Sedation was satisfactory with no significant difference between the two drugs in the change before and after the premedication. Lorazepam showed much more amnesia than pantopon (p less than 0.001). The patients who had lorazepam required higher doses of thiopentone for the operation, and this, in part, led to longer intervals in recovery times after lorazepam. However, it is suggested that lorazepam itself was partly responsible for the longer recovery. Pantopon was followed by more nausea, vomiting and headaches, than lorazepam. The intra-muscular injection of lorazepam hurt more patients than did pantopon, but other local complications were negligible and comparable in both groups. The results of this study show that lorazepam produces better reduction of anxiety and much more amnesia than pantopon, with comparable sedation and much less nausea and vomiting. The only disadvantage of lorazepam is the lack of analgesia and, therefore, the need for more anaesthesia during the operation. The conclusion is that lorazepam is a very satisfactory premedication and warrants more use as such.
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PMID:Lorazepam as a premedication. 0 77

A double-blind random study compared lorazepam with diazepam as i.m. premedicants in 84 healthy women undergoing uterine curettage. Anxiety, assessed by a self-rating test by the patient and by a trained observer, was reduced 90 min after both lorazepam (P less than 0.001) and diazepam (P less than 0.01). There was more sedation and a longer recovery time after lorazepam than after diazepam. Amnesia at 24 h after operation (lack of recall rather than lack of recognition) was greater after lorazepam. There was transient local discomfort at the site of the injection in most patients in both groups, but no serious effects. Local erythema was present in 12 patients who received lorazepam and 10 who received diazepam 90 min after the injection, disappearing after 24 h in the former group but remaining in the latter. The incidence of nausea, vomiting and headache in both groups was small and similar, but there was more restlessness and dizziness after diazepam in the early recovery period.
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PMID:Comparison of lorazepam and diazepam as premedicants. 2 39

A stystematic neurological and electroencephalographical follow-up study in 344 head injured adults gave the following results: 1. 52% of all the hospitalized (mostly primarily amnesic) patients had a cerebral contusion. A contusion was assumed in cases with focal neurological signs (13%), amnesias of more than 8 hours (16%) and/or EEG-abnormalities lasting for more than 24 hours (49%). 2. Traumatic EEG-abnormalities were general slowing (43%) and foci (32%). In 40% of the cases with general slowing the slowing (greater than or equal to 1.5/sec) was within the alpha-frequency band and could only retrospectively be assed. 3. The EEG was invariably abnormal in cases with an amnesia exceeding 8 hours. If the amnesia exceeded 1 hour abnormalities were found in 73%. 4. Among the patients with contusion 6.5% had no amnesia, 48% less than 30 minutes and only 30% an amnesia for more than 8 hours. In 75% of the patients with concussion amnesia lasted less than one hour. 5. Skull fractures were mostly combined with contusion (74%). 6. Impaired drive, reduced ability to concentrate, memory deficits, headache and dizziness were significantly more frequent 6 months after contusion than after concussion. 7. 21% of the patients with traumatic dizziness (44%) had a labyrinthine contusion. 8. Among the contusions diagnosed with the aid of EEG recordings 58% would have been missed after exclusive neurological examination and 82% after application of the classical criteria used by surgeons and general practitioners.
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PMID:[Neurological and EEG-follow-up studies in head-injured adults: criteria for the clinical diagnosis concussion and contusion (author's transl)]. 24 14

The results of a systematic neurological and electro-encephalographical follow-up study in 344 head injured adults and 116 children were compared. The results show that posttraumatic EEG abnormalities lasting more than 24 hours, are equally frequent in children (53%) and in adults (49%). Mostly short lasting neurological signs of focal tissue damage are however significantly more frequent in children (30% vs. 13% and EEG-abnormalities (foci and general slowing) are on the average more pronounced. The recovery of EEG abnormalities follows the same pattern as in adults, occurs however faster among children. In both groups the normalization of general slowing precedes that of focal abnormalities only in 25% of the cases. Amnesias on the average last shorter in infants. Their duration seems of lesser significance for the judgement of the severity of the trauma in children than in adults. 6 months after the trauma children complain less frequently about headache, dizziness, or impaired memory and diminished ability to concentrate; emotional lability and impairement of drive, however, are more frequent than in adults. The results indicate an equal diagnostic and prognostic importance of systematic EEG studies (within 2 days, after 1 week and 6 month after the trauma) in both groups.
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PMID:[Similarities and differences after head injuries in children and adults (author's transl)]. 85 41

The value of the radiographic finding of a skull fracture in predicting intracranial haematoma is assessed in this study. Patients with a skull injury can be divided into three risk groups, based on the history and examination findings. The low-risk group includes patients who are asymptomatic or have scalp haematoma, lacerations, headache or dizziness. The moderate-risk group includes patients who have posttraumatic amnesia and/or alcohol intoxication and those who are suspected of having a skull fracture. The patients in the high-risk group have clear symptoms and signs such as depressed level of consciousness or focal neurological signs. The records of 1218 patients were studied. The risk group, the existence of a skull fracture and development of intracranial haematoma were determined. Not a single haematoma was found in the low-risk group. Therefore skull radiography had no significance in this group. In the moderate-risk group two patients had an intracranial haematoma, of whom one patient had a skull fracture. Negative skull radiography therefore did not fully exclude intracranial complications. There were many patients with an intracranial haematoma in the high-risk group, both in the presence and the absence of a skull fracture. CT scanning is the best method of detecting an intracranial haematoma in this group.
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PMID:[Is skull radiography indicated in patients with head injuries?]. 844 15

A 40-year-old woman developed high fever and headache. Five days later, she was admitted because of consciousness disturbance and tremulous movements in upper extremities. The paired sera showed more than fourfold elevation in complement fixation titer to Japanese encephalitis virus. She was diagnosed as Japanese encephalitis from the clinical features and serological tests. Magnetic resonance imaging (MRI), which was performed about seven months after the onset, revealed abnormal intensity areas bilaterally in the thalamus, hippocampus, substantia nigra, globus pallidus and white matter around the lateral ventricle. Eight months after the onset, she was left with bradykinesia, disturbance of rightening reflex, emotional lability and impairment of recent memory with a long period of amnesia, including not only her illness and subsequent events but also about several years before her illness. The characteristic memory dysfunction seems to be due to disorder of bilateral hippocampus, where MRI revealed abnormal intensity areas. And disorder of medial thalamic nucleus would be related to emotional liability. The relation between the clinical features and MRI findings is also discussed.
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PMID:[A case of Japanese encephalitis demonstrating characteristic changes in MRI]. 166 72

The degree of sedation and amnesia, subjective assessment of awakening and side effects after intravenous injection of 3-4 mg midazolam and 1 mg flumazenil or placebo were studied directly after colonoscopy, and on the first and the eight day. A total of 91 patients were studied; 45 patients were given flumazenil and 46 patients a placebo. Five minutes after injection of the test drugs all 45 patients given flumazenil but only 38 patients given the placebo were alert (p = 0.006). All three response criteria (for sedation, amnesia and subjective assessment of awakening) were fulfilled by 84.4% of the patients given flumazenil and 45.7% of the patients given the placebo (p = 0.0002). Thirty minutes after injection of the test drugs dizziness, nausea, and fatigue were found in 3 patients given flumazenil and in 10 patients given placebo. One day after colonoscopy 9 of 45 patients (20%) given midazolam and flumazenil complained of fatigue and 9 of 46 patients (19.5%) given midazolam and placebo. Eight days (+/- 1 day) later two patients in each group complained of headache, nausea and fatigue. No patient developed phlebitis at the injection site. Flumazenil seems to be a safe and efficient drug for reversing the sedative effect of midazolam, premedication after colonoscopy. However, resedation due to the effects of midazolam may occur. Flumazenil thus permits administration of a higher dose of midazolam without prolongation of the surveillance time. Improved exploitation of time, space and nursing resources is thus possible without jeopardizing patient safety, although caution is necessary since patients may not be fit to resume all normal activities.
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PMID:A randomised controlled trial to evaluate the effects of flumazenil after midazolam premedication in outpatients undergoing colonoscopy. 177 38

The authors have studied 30 patients with transient global amnesia aged between 49 and 76 years (median age of 63 years), without focal neurologic signs that have been followed for periods varying between 6 months and 10 years. Three of the patients had recurrent attacks of transient global amnesia, and another three had a stroke, although at some distance from the amnesia attack. Association was noted with certain risk factors including high blood pressure, and angiopathic changes of the eye fundus (in 50% of the patients), dyslipidemia (in 30%), diabetes (in 10%), and essential polyglobulia (in 7%). Coagulation studies including thrombelastograms were carried out in 22 patients, and demonstrated hypercoagulability in 50% of them. Changes in the arterial wall were noted in 85% of the 14 patients in whom carotid sphygmograms were recorded. The presence of these risk factors could explain the occurrence of cerebrovascular accidents in patients with transient global amnesia. Electroencephalograms performed immediately or a short time after the amnesia attack have evidenced in 18 patients rapid-type dysrhythmia, or diffuse theta waves, predominantly located in the deep layers of the left and right temporal areas. The EEG tracings were either flat or normal in the remaining 12 patients. Of the 30 patients presenting with global transient amnesia only two had migraine in antecedents, and another six had headache during the evolution of amnesia. The neurologic examination did not reveal any abnormality in 27 of the patients. Sequelar signs of neurological deficits were noted in the remaining three patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Transient global amnesia (a study of 30 cases)]. 223 8

Communicating normal pressure hydrocephalus (NPH) is an important remote complication of traumatic brain injury (TBI). The diagnosis of this hydrocephalus depends largely on clinical signs and symptoms, including cognitive deterioration, gait changes and incontinence. However, many of these signs are also seen during post-traumatic amnesia, making early recognition of this syndrome difficult. A case study of one man post-TBI, who presented with new-onset hypertension as a sign of NPH, prompted a retrospective chart review of all patients admitted over a 2-year period with a diagnosis of NPH. Ninety per cent of patients had one or more of the classic triad of NPH and 25% of patients had symptoms suggestive of raised intracranial pressure (unexplained nausea, headache and visual disturbance). Mean systolic and diastolic blood pressures among the 20 subjects for six consecutive days pre-operatively compared with those for days 8-14 and 15-21 post-operatively showed no significant differences; a subgroup of five patients (25%), however, demonstrated a significant change in blood pressure temporally related to shunting. We suggest that demonstration of new-onset systemic hypertension may also be a clinical sign suggestive of NPH useful in the evaluation of the TBI patient.
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PMID:Relationship of new-onset systemic hypertension and normal pressure hydrocephalus. 239 Jun 49

A case is presented of a 60 year old woman with severe headache after spinal anaesthesia. She did not respond to fluid, rest in bed and analgesics, and was therefore treated with an epidural blood-patch. Immediately after the epidural needle was withdrawn the patient developed tonic convulsions for 10-15 seconds. After regaining consciousness she had amnesia but no neurological sequelae. The EEG was normal and the patient had no history of previous convulsions.
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PMID:[General seizures in connection with an epidural blood patch]. 260 52


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