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

Several scores exist to clinically differentiate between ischemic and hemorrhagic stroke, but none has been developed in the emergency situation in which transient ischemic attack (TIA) and cerebral infarction might not yet be clearly distinguished. Information on 540 patients with ischemia (including TIA) or hemorrhage was abstracted from medical charts. Of 540 patients hospitalized with stroke, 98 had a hemorrhage. Age, obesity, anamnestic stroke/TIA, peripheral arterial disease, onset during physical activity, headache, impaired consciousness, hemisyndrome, meningismus and systolic blood pressure contributed to the differential diagnosis and were included in our proposed score. The score performed well in comparison with existing scores. The inclusion of TIA and the explicit incorporation of incomplete information may enhance the applicability of differential diagnostic scores in the prehospital emergency situation.
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PMID:Clinical diagnosis of ischemic versus hemorrhagic stroke: applicability of existing scores in the emergency situation and proposal of a new score. 1174 20

A 79-year-old man with herpes zoster was referred to our hospital for pain control. He was a survivor of the atomic bombing of Hiroshima, and had a history of cerebral infarction and hypertension. A cervical epidural catheter was placed for continuous analgesic infusion. After 20 days of catheterization, he gradually developed a high fever and confusion, and complained of nausea and headaches. An urgent blood examination revealed a white blood cell count of 15,200 mm-3 and a C-reactive protein of 32.4 mg.dl-1. The catheter was removed and antibiotic therapy was started. Repeated magnetic resonance imaging could not confirm epidural abscess formation. The bacterial culture of the cerebrospinal fluid was negative, but the cultures of the blood, the catheter tip, and the nasal cavity swab were positive for methicillin-resistant Staphylococcus aureus. Although intravenous vancomycin was administered, systemic inflammation persisted. The patient consecutively suffered varied disorders such as acute renal failure, disseminated intravascular coagulation, and gastrointestinal bleeding. Although symptomatic treatment had been prolonging his life, 58 days after the catheter removal, the patient suddenly developed cerebellopontine infarction, which made mechanical ventilation necessary. He remained unconscious until his death 117 days after the catheter removal. We discussed the possible pathogenetic mechanisms of the present case.
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PMID:[The development of methicillin-resistant Staphylococcus aureus sepsis in a patient with herpes zoster during treatment with continuous epidural infusion]. 1192 98

Sudden onset headache is a common condition that sometimes indicates a life-threatening subarachnoid haemorrhage (SAH) but is mostly harmless. We have performed a prospective study of 137 consecutive patients with this kind of headache (thunderclap headache=TCH). The examination included a CT scan, CSF examination and follow-up of patients with no SAH during the period between 2 days and 12 months after the headache attack. The incidence was 43 per 100 000 inhabitants >18 years of age per year; 11.3% of the patients with TCH had SAH. Findings in other patients indicated cerebral infarction (five), intracerebral haematoma (three), aseptic meningitis (four), cerebral oedema (one) and sinus thrombosis (one). Thus no specific finding indicating the underlying cause of the TCH attack was found in the majority of the patients. A slightly increased prevalence of migraine was found in the non-SAH patients (28%). The attacks occurred in 11 cases (8%) during sexual activity and two of these had an SAH. Nausea, neck stiffness, occipital location and impaired consciousness were significantly more frequent with SAH but did not occur in all cases. Location in the temporal region and pressing headache quality were the only features that were more common in non-SAH patients. Recurrent attacks of TCH occurred in 24% of the non-SAH patients. No SAH occurred later in this group, nor in any of the other patients. It was concluded that attacks caused by a SAH cannot be distinguished from non-SAH attacks on clinical grounds. It is important that patients with their first TCH attack are investigated with CT and CSF examination to exclude SAH, meningitis or cerebral infarction. The results from this and previous studies indicate that it is not necessary to perform angiography in patients with a TCH attack, provided that no symptoms or signs indicate a possible brain lesion and a CT scan and CSF examination have not indicated SAH.
Cephalalgia 2002 Jun
PMID:Sudden onset headache: a prospective study of features, incidence and causes. 1211 Jan 11

Two cases of Streptococcus agalactiae meningitis in adults are reported. The first patient was a 40-year-old man who presented with acute fever, headache, stiffness of the neck and confusion. During treatment, he developed left hemiparesis from cerebral infarction and bilateral deafness. The other was an 80-year-old man who presented with acute confusion and stiffness of the neck. During treatment, he developed septic shock and generalized tonic-clonic convulsions. Diagnosis was established by latex agglutination of streptococcus B-antigen and confirmed by cerebrospinal fluid-culture later on. The first patient survived but continued to have deafness whilst the other died from septic shock.
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PMID:Streptococcus agalactiae meningitis in adults: report of two cases. 1211 31

Yangkyuk-Sanhwa-Tang (YS-Tang), a specific prescription composed of nine herbal mixtures, has been developed as a formula for the Soyangin cerebral infarction (CI) patients according to Sasang constitutional philosophy. However, the mechanisms by which this formula affects CI remain unknown. This study revealed changes in cytokine production in the acute stage of Soyangin constitution CI patients after YS-Tang administration. Clinical signs (vertigo, headache and slurred speech) of CI disappeared significantly in about 2 weeks after oral administration of YS-Tang (P < .05). The mean interleukin (IL)-2 plasma levels were lower by 15% in the patients with CI than in the normal groups, whereas the mean TNF-alpha, IL-4, IL-6 and IgE levels were significantly higher in the patients (P < .01). There were no significant differences in interferon-gamma (IFN-gamma) levels between the groups. Serum IFN-gamma and IL-2 levels were elevated significantly (P < .01) in the patients with CI by YS-Tang administration. Significant reduced plasma levels (P < .01) of TNF-alpha, IL-4, IL-6 and IgE were observed in the patients treated with YS-Tang. During the period of YS-Tang administration, there were no other adverse effects. The data indicate that YS-Tang has an enhancing effect on antiinflammatory cytokines and an inhibitory effect on inflammatory cytokines. These results may implicate a good CI treatment effect of YS-tang and that its action may be due to regulation of cytokine production.
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PMID:Yangkyuk-Sanhwa-Tang induces changes in serum cytokines and improves outcome in focal stroke patients. 1261 92

A 38-year-old man was admitted to our hospital with headache, dysarthria and paraparesis. Brain CT and diffusion MRI disclosed cerebral infarction at bilateral anterior cerebral artery (ACA) territories. His symptoms and signs deteriorated in several days despite intensive antithrombotic therapy, resulting in right hemiparesis, akinetic mutism, memory disturbance, change of personality, urinary incontinence, forced grasping, and starting delay of speech and motion. Cerebral angiography demonstrated occlusion with contrast pooling at the right ACA A2 portion. Stenosis and dilatation were found at left ACA A2 portion. An intimal flap was also demonstrated on serial angiography. This case was diagnosed as cerebral infarction caused by dissection of bilateral ACA. Although no definite primary arteriopathy was demonstrated, bilateral dissection could be occurred simultaneously.
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PMID:[A case of juvenile cerebral infarction caused by bilateral anterior cerebral artery dissection]. 1266 Nov 8

A 34-year-old woman who presented with only severe headache for 12 days was reported. She was initially diagnosed with cerebral infarction of the right temporal lobe and treated with aspirin, without improvement. On admission, she had bilateral papilledema. Other findings were unremarkable. CT scan and MRI of the brain revealed an area of cerebritis at the right temporal lobe. Lumbar puncture showed high opening pressure with normal CSF profiles. The patient was treated with intravenous acyclovir which gave a favorable outcome.
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PMID:Benign form of herpes simplex encephalitis. 1297 69

Bruxism characterized by clenching and grinding of teeth can lead to toothwear, headaches and depression. While bruxism has been associated with a number of neurological diseases, it has not been highlighted following cerebral infarction. An elderly man presented with an acute onset of tooth grinding and jaw clenching associated with dysarthria. His bruxism was worse during the day and resolved during sleep. He had frequent jaw aches, headaches and swallowing difficulty. Examination demonstrated the presence of dysarthria with jaw clenching and tooth grinding, producing persistent high pitch and loud squeaky sounds. A magnetic resonance imaging and angiography examination revealed a recent infarct in the right thalamus. In addition, chronic lacunar infarcts were present in the bilateral caudate nuclei with severe basilar artery stenosis. He was successfully treated with botulinum toxin. We discuss the pathophysiologic mechanisms of bruxism associated with basal ganglia infarcts. Dysfunction of the efferent and/or afferent thalamic or striatopallidal tracts may play a role in bruxism. Early recognition of bruxism following stroke could reduce unnecessary suffering since the condition can be effectively treated.
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PMID:Severe bruxism following basal ganglia infarcts: insights into pathophysiology. 1470 29

We report on a 13-year-old female with systemic lupus erythematosus (SLE) who exhibited symptoms of severe migraine and familial moyamoya disease. Cerebral magnetic resonance angiography (MRA) showed stenosis and occlusion of the bilateral internal carotid arteries associated with the development of collateral circulation (moyamoya vessels). In a child, as in this case, headaches with cerebral infarction associated with moyamoya disease are unusual. Few cases of SLE associated with familial moyamoya disease have been reported, with no previous reports of such cases from Korea. There were no evidences of antiphospholipid syndrome, and activity of SLE or other risk factors for cerebral occlusion were also absent.
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PMID:Systemic lupus erythematosus associated with familial moyamoya disease. 1471 35

Computed tomography (CT) is the initial radiological investigation of patients with an acute neurological event. A 64-year-old woman presenting with generalised weakness and headache for two days was diagnosed on CT to have subarachnoid haemorrhage. Digital subtraction angiography confirmed the cause to be a ruptured posterior communicating artery aneurysm. The patient was treated by neuroradiological intervention using occlusive coils. The CT features of subarachnoid haemorrhage are discussed. Accurate CT interpretation is essential to direct appropriate investigations and management in patients with stroke, particularly as acute cerebral infarction may occasionally mimic subarachnoid haemorrhage. The role of magnetic resonance (MR) imaging in evaluation of cerebral infarct is also discussed.
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PMID:Clinics in diagnostic imaging (91). Subarachnoid haemorrhage. 1500 3


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