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

A case of right temporo-occipital subcortical hemorrhage with amnestic syndrome was reported. A 65-year-old woman presented with visual disturbance and headache. CT and MRI demonstrated a hemorrhagic lesion in the right occipital lobe involving parahippocampal gyrus. Neurological examination on admission revealed left homonymous hemianopsia and anterograde and retrograde amnesia. Neuropsychological examination revealed marked recent memory disturbance, but she had visual retention and verbal retention, and her value in WAIS (Wechsler Adult Intelligence Scale) was normal. After 40 days, she was discharged without improvement of amnesia. These findings suggest that the cortico-medial temporal lobe pathway was disturbed by subcortical hemorrhage, and we think there are connective fibers between visual and verbal memory systems. This is the first report of hippocampal amnesia following temporo-occipital subcortical hemorrhage.
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PMID:[Amnestic syndrome after right temporo-occipital subcortical hemorrhage]. 775 25

A multicentre post-marketing surveillance study was conducted in Switzerland in routine practice and involved 1972 insomniac patients treated with zolpidem, an imidazopyridine hypnotic agent. The patients were representative of the general insomniac population (65% women; mean age 55 years; 29% over 65). Of the patients, 87% were treated with a zolpidem dosage of 10 mg/day and the median treatment duration was 30 days. All adverse events were collected through spontaneous reporting. A total of 175 patients (8.9%) reported 343 adverse events, and 102 (5.2%) of them discontinued treatment. CNS (central nervous system)-related adverse events accounted for 66% of the total, the most common events being residual daytime sedation and insufficient efficacy in 3.7% and 1.6%, respectively; confusion, disorientation, nervousness, nightmares, amnesia, impaired concentration and anxiety were observed in a lower proportion. Gastro-intestinal symptoms, headache and skin reactions were the most frequent non-CNS related effects. No serious adverse event was reported and no new risk factors or at-risk populations were identified. The safety profile of zolpidem is thus consistent with its known pharmacological properties, the results of previous clinical trials, and the cumulative international experience gained with this short-acting hypnotic drug.
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PMID:Zolpidem in insomnia: a 3-year post-marketing surveillance study in Switzerland. 777 60

Acute confusional migraine in children and transient global amnesia in adults share a number of similar clinical manifestations. Acute confusional migraine in 6 children (mean age: 11.7 years; range: 7.5-17 years) was characterized by transient episodes of amnesia and acute confusion lasting 1-12 hours. Episodes were preceded by headache and vomiting in 4 patients. In 2 patients acute confusional migraine was the initial symptom. A history of preceding trivial head injury was reported in 3 patients and migraine in 4. Urine and serum drug screens were negative. Cerebral imaging studies and interictal electroencephalograms were normal. Ictal electroencephalograms in 3 patients revealed diffuse or bioccipital delta wave slowing. Recurrent episodes of acute confusional migraine occurred in 2 children during 1-3 years of follow-up. The clinical manifestations of acute confusional migraine in this series of children are similar to those reported in transient global amnesia. The similarity of the clinical manifestations of acute confusional migraine in children and transient global amnesia in adults suggests that these disorders may share a common pathophysiology.
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PMID:Acute confusional migraine: variant of transient global amnesia. 777 9

In 1986 a Royal College of Surgeons Working Party published guidelines, based on over 15 years of clinical research both here and in the U.S.A., on when to perform skull X-rays on a head injury patient. In this retrospective study the recorded details of 405 patients who presented to an accident and emergency (A&E) department over a 3-month period in 1991 are analysed, and the Report criteria applied to each one to assess whether the guidelines are being followed in performing a skull X-ray. According to these guidelines, 191 of these patients (47.2%) should have been X-rayed, however, only 83 were. Only one patient was thought to have been X-rayed inappropriately. The Report criteria most commonly thought by the A&E doctors not to warrant skull X-ray, were loss of consciousness, amnesia, dizziness, blurred vision, headache, and alcohol intoxication. The reasons why these criteria are being ignored are examined, and together with reference to recent studies, slight alterations to the Working Party guidelines are suggested to make them more applicable to everyday situations of head injury encountered in a casualty department.
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PMID:Skull X-ray after head injury: the recommendations of the Royal College of Surgeons Working Party report in practice. 821 84

Charts from 1,074 consecutive emergency department patients who underwent cranial computed tomography (CT) were reviewed for predictors of a CT abnormality. Twenty-six clinical variables and the results of neurologic examination were compared with cranial CT findings. Patients with focal neurologic deficit, unresponsiveness, and hypertension had an increased risk of a CT abnormality. Blurred vision, trauma, loss of consciousness, headache, and dizziness were each associated with a lower risk of a CT abnormality. Multivariate analysis showed that only focal neurologic deficit and unresponsiveness effectively helped predict a CT abnormality. In patients with negative neurologic findings, only intoxication and amnesia were associated with greater than 10% positive scans and an increased risk for a CT abnormality. The data indicate that positive neurologic findings coupled with intoxication and amnesia would have helped detect 90.7% of the positive scans and provide an effective initial approximation strategy for selecting patients to undergo CT. Although 15 patients with positive scans (1.4%) would have been missed, this strategy would have yielded a negative predictive value of 97.3% and eliminated 53.9% of the CT scans obtained.
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PMID:Unenhanced emergency cranial CT: optimizing patient selection with univariate and multivariate analyses. 843 Jan 85

Minor head injury accounts for 95% of all head injury. In this study 62 patients, hospitalized after minor head injury, were assessed within 48 h, and invited to attend for review and retesting 3 months later. Thirty-five patients were followed up in this way and 11 more were interviewed over the telephone. There was significant improvement on all psychometric tests between initial evaluation and follow-up. Between 51% and 86% reported troublesome late post-concussional symptoms, of which headaches and tiredness were the most frequently reported symptoms. Length of post-traumatic amnesia (PTA) was related to severity of symptoms. Clinical levels of anxiety and stress were noted in approximately one-third of the whole group; 95% of the group had returned to work by 3 months with a mean absence rate of 9.4 days. The therapeutic implications of these results are discussed.
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PMID:A follow-up study of patients hospitalized after minor head injury. 874

Head injury is a frequent cause of morbidity and mortality in pediatric trauma. Guidelines for obtaining computed tomographic (CT) scans in the child with mild head injury are poorly defined. This study investigated the utility of head CT scanning in the pediatric patient presenting with normal neurologic examination. All patients undergoing head CT scanning for trauma in the emergency department (ED) at a tertiary care pediatric trauma center during 1992 were identified (508). Charts were reviewed for historical and physical examination findings, CT results, and need for neurosurgical intervention. Patients were excluded if they had an abnormal neurologic examination (179), known depressed skull fracture (11), bleeding diathesis (3), age older than 18 years (1), or developmental delay (1). Included were 313 patients (median 5.5 years) who presented with clinical variables including sleepiness (38%), vomiting (34%), headache (30%), loss of consciousness (LOC) (25%), irritability (22%), amnesia (20%), and seizures (8%). An abnormal head CT was noted in 88 cases (28%); 79 (25%) were traumatic abnormalities involving the skull and/or contents. Thirteen patients (4%) had intracranial injuries (ICI); all had either a linear (10), basilar (2), or depressed (1) skull fracture noted on CT. Four patients required neurosurgery, three for epidural hematoma, and one for a complicated orbital fracture (without ICI). No clinical variables (seizure, LOC, vomiting, headache, confusion, irritability, sleepiness, amnesia) were associated with ICI (P > 0.05). In pediatric head trauma patients, with normal neurologic examinations in the ED, ICI occurs < 5% of the time and neurosurgery is needed in 1% of the cases. Commonly used clinical variables are not associated with ICI in these children.
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PMID:The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department. 880 36

The study group on Head Injury of the Italian Society for Neurosurgery suggests the following guidelines for minor head injured patients management. Patients either oriented to time, space and person (GCS 15) or confused (GCS 14) are included among the group of minor head injury. Criteria of exclusion are the presence of focal neurological deficits, open injury and a GCS < or = 13. Six categories of risk factors (coagulopathies, alcoholism, drug abuse, epilepsy, previous neurosurgical treatments and disabled elderly patients) relevant to the clinical course are identified. Three group of patients are distinguished. Patients in the Group 0 (GCS 15, without loss of consciousness, amnesia, diffuse headache, vomiting) could be sent home from Emergency Department after at least 6 hours period of observation with an information sheet. Patients in the Group 1 (GCS 15, with loss of consciousness and/or amnesia and/or diffuse headache and/or vomiting) require clinical observation (> or = 6 hours) and neuroradiological assessment. According to hospital availability, either skull-X rays or CT scan is obtained. In the presence of a skull fracture a CT scan is mandatory. In the presence of intracranial lesions, neurosurgical consultation is requested. In the absence of skull fractures or intracranial lesions the patient is admitted for observation (> or = 24 hours). Patients in the Group 0 and in the Group 1 with a risk factor (R) are admitted to the hospital (> or = 24 hours) and submitted to a CT scan. In patients with coagulopathies or in treatment with anticoagulants a CT scan should be repeated before discharge even in the absence of intracranial lesion on the first CT. In patients in the Group 2 (GCS 14) a CT scan is obtained in all cases independent of the presence of a risk factor.
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PMID:Guidelines for minor head injured patients' management in adult age. The Study Group on Head Injury of the Italian Society for Neurosurgery. 891 56

We report a case of migraine-associated ischemic stroke causing amnesia, wherein treatment with propranolol may have been contributory. The possible mechanisms involved in migrainous stroke occurring in association with use of propranolol are discussed.
Headache 1997 Oct
PMID:Migrainous stroke causing thalamic infarction and amnesia during treatment with propranolol. 938 61

About 35% of subjects with head injury (HI) suffer from postconcussion syndrome (PCS). These disturbances can be chronic or even permanent. Such patients are discharged from hospital without any apparent problems, but it is often the case that their families, and sometimes even they themselves, start to notice the emergence of new problems. They may exhibit affective changes, such as thinking that they are worthless, alone and without any future perspectives. When they are left without the help of specialists and/or family and friends, their problems gain even greater significance. PCS includes subjective physical complaints (i.e. headache, dizziness) and cognitive, emotional and behavioral changes. PCS influences all areas of the patient's life. Subjects who have sustained head injury often have problems with marital relationships, maintaining of independence, employment, leisure activities and other functions which are related to social adjustment. Various studies have attempted to predict the post-injury status of HI patients from information available, such as data on the severity of head injury, the duration of post-traumatic amnesia (PTA) and the results of neuropsychological assessment. This kind of prediction is important in planning of rehabilitation services and thus improving the kind of help available to survivors of HI. Early prediction of post-injury psychological status may also help the patient and his family in coping with the difficulties related to the trauma. We know a great deal about head injury and its consequences, but many questions still need to be answered. Among these are issues such as: the role of neurobehavioral data in the prediction of outcome for HI patients, the identification of variables determining the extent of PCS and the search for reliable factors which may influence future employment or school status. The assessment of patients for invalidity and other social security benefits also requires a more rational approach, based on the data available.
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PMID:[Pathogenesis and psychosocial consequences of post-concussion syndrome]. 951 61


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