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

There is a quite good definition of medical care for patients suffering from chronicle neurological diseases. However the neurologist role in taking care of urgent cases is substantially less determined. This paper is analyzing one year efforts of the on duty neurological team in the Out Patient Department and Emergency Division of the Neurology Department in Sarajevo. During this period the on duty neurological team examined the total of 3939 patients, out of which 1022 patients where kept for treatment. The patients where most frequently assigned to the Emergency unit for following reasons: vascular incident of the Central Nervous System(1955 patients or 50%), cerebrovascular accident represented with 1290 or 33%, and TIA of the carotid and vertebrobasilar area 544 or 14% along with hypertensive encephalopathia, 118 or 3%. This is followed by the group of the short-term disturbance of consciousness (472 or 125), out of which the consciousness crises represented 257 or 7%, and epileptic crises 215 or 5%. Following are the lower percentages of the headaches (287 or 7%), radicular painful syndrome of cervical and lumbal area (209 or 5%), vertigo (183 or 5%), neurophatia (167 or 4%), etc. The more extensive number of patients admitted at the Emergency Division where suffering from brain stroke (800 or 78%), TIA was represented by a lower number (172 or 17%). Only 50 patients had other diagnosis. The ischemic stroke represented 674 or 81% with patients suffering from the brain stroke and the hemorrhagic stroke 153 or 19%. Today, the urgent neurological conditions represent a particular area of Neurology, not only neurologists need to know but also other medical doctors, to enable the patients to be forwarded on time to the appropriate care institution.
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PMID:[Urgent neurologic states: experience at the Neurology Clinic in Sarajevo]. 1520 12

Headache is reported by about one third of patients using dipyridamole (DP) after stroke or TIA. No study has systematically examined if initial dipyridamole titration may affect this headache. We therefore randomised patients to (1) standard aspirin and dipyridamole treatment b.i.d. for 2 weeks or (2) titration with aspirin only in the morning and aspirin and dipyridamole in the evening for 5 days, followed by 9 days of standard aspirin and dipyridamole treatment. Among 57 patients included for analysis, moderate to severe headache was reported by 28% in the standard treatment group and 25% in the titration group (n.s.). Headache for more than two consecutive days occurred in 24% and 11%, respectively. Rescue medication because of headache for more than 2 days was used by 14% and 0% in the respective groups. The cumulative number of days with headache was more than twice as high in the standard treatment group. The total numbers of other side effects were 25 and 11 in the two groups. The observed differences in this pilot study were not statistically significant, but nevertheless suggest that titration with an initially lower dose of dipyridamole may be considered to reduce headache and thereby increase compliance. A larger study is needed to clarify this with sufficient statistical power.
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PMID:Dipyridamole and headache--a pilot study of initial dose titration. 1533 20

Ischaemic strokes and TIA are increasingly being found to be due to arterial cervical dissection, particularly in young adults. Physicians have better knowledge of this disease, and diagnostic neuroimagery has improved. Sometimes traumatic, arterial dissection can also be truly spontaneous or coincides with ordinary neck movement. Dissection consists in an intramural hematoma, and affects most commonly the carotid artery. In 25% of cases, two or more cervical arteries appear to be affected simultaneously, suggesting fibromuscular dysplasia. Pathophysiological considerations remain unclear and several hypotheses are considered. Clinical manifestations are evocative and cervical warning signs such as pain, headache or Horner's syndrom provide an opportunity to recognize the patients few hours or days before cerebral or ocular ischemia occurs. Conventional angiography remains the gold standard in the diagnosis of arterial dissections but ultrasonography and magnetic resonance techniques are more and more often informative. Although no therapeutical trial is available, anticoagulant therapy has been recommended, except in intracranial dissection. Recurrent dissections are very rare and long term functional prognosis seems to be favourable.
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PMID:[Dissections of the carotid and vertebrobasilar arteries]. 1536 50

Behcet's disease ( BD ) is a systemic inflammatory vascular disease with variable clinical manifestations and numerous clinical masquerades. The venous involvement may affect veins of different size with tendency for thrombosis. BD is the commonest cause of cerebral venous thrombosis in some Middle Eastern countries. However, in Thailand, this clinical entity has been rarely described as a cause of cerebral venous sinus thrombosis. A 38 year-old man presented with recurrent attacks of transient ischemic attack (TIA) for 9 months. Two months after the TIA, he developed right hemiparesis and persistent diffuse headache. He had a 10 year history of recurrent oral and genital ulcers. Physical examination revealed bilateral uveitis, right hemiparesis, bilateral sixth cranial nerve paresis and bilateral papilloedema. Pathergy skin test showed positive result. Neuroimaging demonstrated empty delta sign on CT-scan and thrombosis of the posterior part of superior saggital sinus, transverse sinus, straight sinus and internal jugular vein on magnetic resonance venography (MRV). Cerebrospinal fluid (CSF) analysis revealed increased intracranial pressure and aseptic CSF profiles. Prednisolone, chlorambucil and anticoagulant had been prescribed. The clinical course improved gradually.
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PMID:Cerebral venous sinus thrombosis in Behcet's disease: a case report. 1552 Dec 44

Headache and transient neurological deficits can occur both in patients with migraine and in patients suffering a transient ischaemic attack (TIA). Consequently differentiating between these two disorders may be difficult. Recently, silent cerebral infarcts and ischaemic lesions in the subcortical white matter were found to be associated with migraine and in particular, with migraine with aura. The predominance of cerebellar infarcts in these patients is difficult to understand. Whether ischaemic damage in the brain of patients with migraine should be managed in a manner similar to that of patients with TIAs, should be the subject of future research.
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PMID:[Migraine and TIAs; possibly more overlap than difference]. 1552 28

In many areas of secondary care, symptoms unexplained by disease account for around one-third of all patients seen. We sought to investigate patients presenting with medically unexplained stroke-like symptoms to identify distinguishing features which may help to identify a non-organic aetiology. Patients given a discharge diagnosis of medically unexplained stroke-like symptoms over the preceding 11 years were identified retrospectively from a prospectively completed stroke unit database. Age- and sex-matched controls with ischaemic or haemorrhagic stroke or transient ischaemic attack were also identified. Clinical features on presentation, ischaemic risk factors, alcohol history, marital status and history of depression or anxiety were examined. Previous or subsequent admissions with medically unexplained syndromes were also examined via record linkage with hospital discharge records. A medically unexplained syndrome was assumed to be present if an International Classification of Diseases 9 discharge code for one or more of the thirteen conditions forming recognized functional syndromes was given. Logistic regression was applied to determine predictors of non-organicity. One hundred and five patients and controls, 1.6% of all stroke unit admissions were identified, 62% (65 patients) were females. Mean age was 50.3 +/- 14.9. Compared with age- and sex-matched controls patients with medically unexplained stroke-like symptoms were significantly more probable to have a headache at presentation (47% vs. 26%, P = 0.0004), have a diagnosis of one or more additional medically unexplained syndromes (24% vs. 11%, P = 0.007) but significantly less probable to present with symptoms of vertebrobasilar dysfunction (32% vs. 61%, P < 0.0001). A history of anxiety or depression, as recorded in the notes, was not found to be associated with a medically unexplained presentation. Medically unexplained stroke-like presentations are common (1.6% of all stroke presentations), they are most strongly predicted by the presence of other functional somatic syndromes, headache and the absence of symptoms of vertebrobasilar dysfunction.
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PMID:Clinical features associated with medically unexplained stroke-like symptoms presenting to an acute stroke unit. 1567 94

The hyperperfusion syndrome is a rare delayed postoperative complication of carotid endarterectomy (CEA) characterized by headache and seizure, with or without intracranial edema or hemorrhage. Between January 1996 and December 2003, 1,602 CEAs were performed. Six patients (0.4%) developed symptoms of hyperperfusion within 2 weeks of surgery. All patients had critical stenoses, five > or =90% and one 80-90%, with poor backbleeding from the distal internal carotid artery noted at operation in all cases. Five patients were asymptomatic prior to operation; one had a hemispheric transient ischemic attack. Three patients had severe contralateral internal carotid disease (two occlusions and one severe stenosis). Two patients developed severe, self-limiting headache that prolonged hospitalization. Three patients had ipsilateral intracranial bleeding, two occurring after an uneventful postoperative course. After initial discharge from the hospital, severe intracranial hemorrhage caused death in two patients. One patient experienced focal seizures 1 week after discharge. Hypertension did not appear to be related to the symptoms in any case. During the study period, the hyperperfusion syndrome caused three of five perioperative strokes (60%) and two of seven deaths (29%) in the entire endarterectomy population. Although rare, the hyperperfusion syndrome accounts for a significant percentage of the neurological morbidity and mortality following CEA.
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PMID:Hyperperfusion syndrome after carotid endarterectomy. 1596 93

Although the prevalence of seizures in children with sickle cell disease (SCD) is 10 times that of the general population, there are few prospectively collected data on mechanism. With transcranial Doppler and magnetic resonance imaging (MRI) and angiography, we evaluated 76 patients with sickle cell disease, 29 asymptomatic and 47 with neurological complications (seizures, stroke, transient ischemic attack, learning difficulty, headaches, or abnormal transcranial Doppler), who also underwent bolus-tracking perfusion MRI. The six patients with recent seizures also had electroencephalography. Group comparisons (seizure, nonseizure, and asymptomatic) indicated that abnormal transcranial Doppler was more common in the seizure (4/6; 67%) and nonseizure (26/41; 63%) groups than in the asymptomatic (10/29; 34%) group (chi2; p = 0.045), but abnormal structural MRI (chi2; p = 0.7) or magnetic resonance angiography (chi2; p = 0.2) were not. Relative decreased cerebral perfusion was found in all seizure patients and in 16 of 32 of the remaining patients with successful perfusion MRI (p = 0.03). In the seizure patients, the perfusion abnormalities in five were ipsilateral to electroencephalographic abnormalities; one had normal electroencephalogram results. These findings suggest that vasculopathy and focal hypoperfusion may be factors in the development of sickle cell disease-associated seizures.
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PMID:Sickle cell disease: ischemia and seizures. 1631 82

The authors report a 6-year-old girl presented with headache and transient ischemic attack due to moyamoya disease. MR angiography (MRA) revealed that her symptoms were closely related to reversible deterioration of stenosis in the left middle cerebral artery (MCA). Deterioration of stenosis led to a decreased flow signal in the distal branches of the left MCA. MRA could also detect reversible stenotic changes in the right MCA, although she did not develop any neurological symptom. Although precise mechanism of reversible MR angiographic findings is still unknown, the phenomenon may play an important role in disease progression in pediatric patients with moyamoya disease.
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PMID:[Repeated, reversible MR angiographic findings in pediatric moyamoya disease: case report]. 1661 22

Aggrenox (Boehringer Ingelheim, Ingelheim, Germany), a novel combination of low-dose aspirin with dipyridamole, represents a safe and promising combination alternative for mild but sustained platelet inhibition, and reduction of both arterial and venous thrombi occurrences. In a large, well-controlled randomized trial (ESPS-2 ) evaluating antiplatelet agents for stroke prevention, Aggrenox was twice as effective as monotherapy with either aspirin or dipyridamole. There is an increasing body of evidence that a delicate strategy with Aggrenox provides modest inhibition of platelet activity, especially in a chronic, long-term setting. Mild platelet inhibition beyond conventional aggregation may represent a substantial advantage over aggressive antiplatelet regimens for the treatment, and especially for secondary prevention, of cerebrovascular ischemic events. Although there is no doubt that the concept of inhibiting platelets is vital for the treatment of vascular ischemic disease in general and ischemic stroke and transient ischemic attack (TIA) in particular, the optimal degree of such inhibition still remains an unsolved mystery. It seems that the concepts of "the more, the better" and "one size fits all" may no longer be valid for ideal antiplatelet protection in such high-risk populations. Without routine individual laboratory assessment of platelet function, mild regimens have the advantage of being more suitable for the majority of patients and will contribute substantially to the success of dipyridamole. Conversely, if we can determine baseline platelet status and intelligently apply therapy based on platelet activity in each particular patient, clinical outcomes may be better. Avoiding excessive bleeding risks after aggressive strategies in patients with normal or already decreased platelet function, but targeting those who exhibit activated platelets, may improve risk stratification and save lives. Therefore, Aggrenox should be considered a drug of choice to prevent the second stroke. Eliminating, or at least minimizing, the most frequent side effect, namely transitory headaches at the beginning of therapy with Aggrenox, will benefit patients and increase the use of this agent. Should the PRoFESS (Prevention Regimen For Effectively avoiding Second Strokes) trial show an advantage in event reduction with Aggrenox over clopidogrel, the increase will be especially dramatic. In short, based on current evidence most guidelines include Aggrenox as a first-line option for secondary prevention of ischemic stroke or TIA, and some recent versions suggest it may be preferable in other clinical scenarios.
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PMID:The action of dipyridamole to prevent thrombosis: practical implications for the treatment and prevention of stroke. 1663 41


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