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

Fifteen children, aged 0.3 to 10.5 years (mean 3.8 years) after repair of coarctation of the aorta, underwent cerebral arteriography as part of postoperative catheterization. Four manifested central nervous system symptoms postoperative catheterization. Four manifested central nervous system symptoms postoperatively: Two had persistent headaches, one had exercise-induced hemianopsia and one had major motor seizures. All four had greater blood pressure in the right arm than in the left and evidence of subclavian steal, with retrograde filling of the left vertebral and left subclavian arteries on selective right vertebral arteriography. Ligation of the left vertebral artery in three patients and left subclavian graft arterioplasty in one resulted in disappearance of symptoms. None of the 11 asymptomatic patients manifested cerebrovascular anomalies, and no patient in the series had berry aneurysm. This study suggests that patients with central nervous system symptoms and a disparity of blood pressure in the arms after surgery for coarctation of the aorta should be evaluated carefully to exclude subclavian steal as the cause of the symptoms.
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PMID:Cerebrovascular abnormalities in postoperative coarctation of aorta. Four cases demonstrating left subclavian steal on aortography. 67 42

An operative case of 12-year-old boy with a saccular aneurysm at the anterior communicating artery was reported. He had episodes of occasional headache during one year before admission. He was attacked by a severe headache associated with nausea and vomiting, and was admitted to Ooita Pref. Hospital under the diagnosis of subarachnoid hemorrhage four days later. On admission physical examinations revealed almost normal findings except for moderate dehydration and a blood pressure of 130/70 mmHg. Routine examinations (blood, serum including total cholesterol, urine, ECG and plain chest X-film) were normal. Neurologically there were lethalgic state, moderate nuchal rigidity and bilateral abducens paresis. Slightly hemorrhagic and xanthochromic CSF was demonstrated by a spinal puncture. An aneurysm was found at the anterior communicating artery on the right carotid arteriogram. The left carotid and the left vertebral arteriograms showed no pathologic findings. Operation via right fronto-temporal approach disclosed a berry aneurysm about 4 mm in diameter arising from the bifurcation of the right anterior cerebral and the anterior communicating artery. There was a plaque presumably an atherosclerotic change at the neck of the aneurysm. Clipping of the aneurysmal neck was done. The aneurysm was not visualized on the postoperative arteriogram, and the patient was discharged in good condition two weeks after the operation. It is true that this patient had a lesion which seemed to be an atherosclerotic plaque at the neck of the aneurysm macroscopically, but he did not have any evidence of generalized atherosclerosis or other metabolic disturbance. This plaque may be of special significance in etiological respect. In general, however, degenerative lesions like atherosclerosis occur predominantly in larger arteries than smaller arteries of the brain. Also the location of this aneurysm was at the anterior communicating artery which is reported to be implicated in anomalous vascularity on occasion. From these facts the authors considered combined congenital and acquired factors in the development of this aneurysm.
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PMID:[Intracranial aneurysm in a child--a case report and some considerations on etiology (author's transl)]. 94 72

Pathologic examination in a case of fatal intracerebral hemorrhage from a berry aneurysm showed that the "sentinel" or warning headache in this patient was due to the leakage of blood into the subarachnoid space through a previous small tear in the wall of her saccular aneurysm. Oribital pain, transient, dysphasia, dizziness and, later, meningismus might have prompted the performing of a lumbar puncture to determine the presence of blood in the cerebrospinal fluid. This type of event is the likely pathogenetic mechanism for the premonitory headache that may precede a lethal rupture of a saccular aneurysm.
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PMID:Pathogenesis of the "sentinel headache" preceding berry aneurysm rupture. 110 29

A case of recurrent cerebral aneurysm after complete neck clipping is described. A 47-year-old male who presented with headache and nausea underwent neck clipping of a berry aneurysm of the left middle cerebral artery. Ten days later, angiographic findings suggested the presence of a second, large aneurysm adjacent to the first, which suggested misplaced clipping. Reoperation confirmed that a new aneurysm had formed next to the original aneurysm. A possible explanation of the recurrence is as follows. The M1 flowed into the M2 at a right angle. The aneurysmal neck was situated on the distal end of the M1 and the dome protruded antero-inferiorly at an angle of nearly 90 degrees to the long axis of the M1 opposite the origin of the M2. The parent artery bulged slightly, and its wall was thin and reddish, just distal to the aneurysmal neck. Proximal to the neck there was another small bulge, but the wall here was normal. These bulges were coated with Oxycel and Biobond at the time of aneurysmal neck clipping. After clipping, blood flow into the dome was interrupted, and the consequent hemodynamic stress caused the bulges to expand dramatically and form a new aneurysm. The authors conclude that there is a likelihood of early recurrence after neck clipping if the parent artery exhibits such morphological features as observed in this case.
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PMID:[Recurrent cerebral aneurysm suggestive of misplaced clipping. Case report]. 247 14

At the age of 29, a woman developed central nervous system manifestations of incontinence, psychosis and a grand mal seizure in February 1982. She was diagnosed as having systemic lupus erythematosus (SLE) based on photosensitivity, oral ulcers and elevated antinuclear and anti-DNA antibodies titers. Three years and one month later the patient had episodes of severe headache and vomiting during the course of maintenance treatment. CT examination of the head revealed blood within subarachnoid cisterns, and a small berry aneurysm was found at the distal portion of the basilar artery by cerebral angiography. The possible role of SLE-associated cerebral vascular changes in the development of this aneurysm is discussed.
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PMID:A case of central nervous system lupus associated with ruptured cerebral berry aneurysm. 250 73

Many patients with a ruptured berry aneurysm report an intense sentinel headache of sudden onset in the weeks before rupture. Such headaches have been attributed to a leak of blood, which implies that partial rupture has occurred. A case is reported of a patient who had severe headaches which seemed to be caused by an unruptured cerebral aneurysm, accompanied by diffuse cerebral vasospasm. Headache episodes with the thunderclap profile may require angiography for diagnosis even if the cerebrospinal fluid is bloodless.
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PMID:Thunderclap headache: symptom of unruptured cerebral aneurysm. 287 33

We obtained CTs in 259 patients with a first alcohol-related convulsion. Each subject had generalized convulsions, recent abstinence from alcohol abuse, and no obvious etiology for seizures other than alcohol withdrawal. Patients with only focal seizures, major head injury, coma, or a severe toxic-metabolic disorder were excluded. We recorded history and signs of minor head injury, presence of headache, level of consciousness, neurologic signs, routine medical examination findings, and subsequent clinical course. Sixteen patients (6.2%) had intracranial lesions on CT. Eight had subdural hematomas or hygromas, two had vascular malformations, two had neurocysticercosis, and one each showed a Berry aneurysm, possible tumor, skull fracture with subarachnoid hemorrhage, and probable cerebral infarction. In ten cases (3.9%), clinical management was altered because of the CT result. History or signs of minor head trauma, headache, level of consciousness, or focal neurologic signs did not significantly correlate with CT abnormality.
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PMID:Intracranial lesions shown by CT scans in 259 cases of first alcohol-related seizures. 341 99

A 38-year-old man was admitted to our hospital because of severe headache following reduced level of consciousness on February 13, 1979. He was lethargic and showed neck stiffness. A lumbar puncture revealed bloody cerebrospinal fluid. Left carotid angiography showed a berry aneurysm of 11 mm in diameter at the bifurcation of the middle cerebral artery (MCA). Rebleeding occurred on February 21, and he fell into semicoma. But, his consciousness recovered to lethargy on the next day. On February 26, a direct intracranial operation was performed and a Sugita clip was placed to the aneurysmal neck. The postoperative course was uneventful. But, left carotid angiography on 8th day after operation showed a newly originated aneurysm proximal to the operated aneurysm. On the 12th postoperative day, he suddenly fell into coma. CT showed subarachnoid blood in the basal cisterns and intraparenchymal hematoma in the left temporal lobe. On the same day, left carotid angiography was performed and it showed the enlarged aneurysm. He died on the 19th day after operation. Autopsy was not performed. Three factors have been considered dealing with the recurrence of the operated aneurysm in the previous reports: first, local fragility of the vascular wall due to the clip edge. Secondly, macro- or microscopic residual aneurysmal neck, thirdly, broken or slipped clip. Our case had the following characteristics from the angiographical and operative findings: the orifice of the operated aneurysm was situated on the superior side of the parent artery and the aneurysm protruded posterosuperiorly at an angle of approximately 90 degrees to the long axis of M1.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Rapid growth and rupture of a newly originated aneurysm near the clipped middle cerebral artery aneurysm]. 371 83

Patients with subarachnoid haemorrhage (SAH) frequently describe the occurrence of an underestimated or even ignored severe headache in the days or weeks preceding the bleeding. If recognised early, this warning headache might lead to specific investigations and, if indicated, a surgical approach might avoid a dramatic haemorrhagic event. In a recent and exhaustive systematic review, the incidence of a sentinel headache (SH) was evaluated in a range of 10-43% of SAH patients. SH seems to be due to a minor bleeding from a leak of a berry aneurysm and usually occurs in the preceding two weeks. Such a period is similar to the one for rebleeding in SAH and supports the hypothesis of the warning leak. Nevertheless, a warning headache can precede a SAH in unruptured aneurysm even without a minor bleeding. Underestimation or misdiagnosis of SH depends on incorrect evaluation of the headache characteristics (unusual, severe, abrupt, thunderclap), overestimation of cranial CT sensitivity (false negative increasing over the elapsing time), failure to perform lumbar puncture (LP) in patients with negative CT, incorrect evaluation of CSF findings (xanthochromia may be absent in the first 12 h) and failure to differentiate traumatic tap from true SAH. Considering the diagnosis of SH in all cases of a severe, sudden-onset (thunderclap) headache, and performing all the appropriate diagnostic exams, including LP if necessary, could prevent subsequent massive bleeding and its invalidating or fatal consequences.
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PMID:Sentinel headache. 1554 40

Headache is a very common presenting symptom in the emergency department, and distinguishing subarachnoid haemorrhage from more benign causes of headache can be challenging. This particular presentation of subarachnoid haemorrhage was made more difficult by concurrent-related cardiac pathophysiology. This case report describes the evolving differential diagnosis of a 54-year-old woman initially presenting with headache and confusion, with signs and investigations suggestive of ST elevation myocardial infarction and resultant left ventricular failure. The importance of prompt primary percutaenous coronary intervention left clinicians with a difficult decision about which specialty was most appropriate for the patient to be transferred to. Ultimately the symptoms were explained by radiographic confirmation of subarachnoid haemorrhage and subsequent adrenergic storm, causing myocyte injury and myocardial contractile dysfunction. This patient was transferred for coiling of a ruptured cerebral artery berry aneurysm. Her left ventricular failure improved from severe to mild within 48 h of presentation.
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PMID:Listening to the head and not the heart: subarachnoid haemorrhage associated with severe acute left ventricular failure. 2398 19


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