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

Eighteen patients with cryptococcal infection of the central nervous system seen during a 10-year period were reviewed. Eleven patients (61 per cent) were immunocompromised due to underlying disease and seven of these were on steroids, cyclophosphamide or both. Two-thirds of patients presented with the triad of fever, headache and neck rigidity suggesting meningitis; seizures and mental confusion were uncommon. A high index of suspicion was essential for diagnosis particularly in immunocompromised subjects, and the diagnosis was established by positive Indian-ink preparation, culture or raised antigen titre in the cerebrospinal fluid. CT scan was helpful for diagnosis and progress monitoring. Amphotericin B and 5-fluorocytosine were the mainstay of treatment, and imidazole derivatives and garlic may be helpful adjuncts. Mortality was 39 per cent, but full recovery was the usual outcome in those who survived. The prognosis was worse with immunocompromised patients, and of those who died, comma and/or convulsion on admission and marked cerebral oedema and hydrocephalus on CT were notable features.
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PMID:Cryptococcal infection of the nervous system. 317 24

A retrospective clinical and pathological analysis has been performed of 24 cases of herpes simplex virus encephalitis (HSE) seen at the Institute of Neurological Sciences, Glasgow, between 1972 and 1985. All patients had been diagnosed on the basis of isolation of herpes simplex virus (HSV) from, and/or the demonstration of characteristic histological changes of acute necrotizing encephalitis (ANE) in brain biopsy and/or autopsy tissue. Clinical presentation on admission included a prodromal influenza-like illness (46%), sudden onset of headache and confusion (54%), meningism (38%), deep coma (42%), aphasia (54%) and focal neurological signs (79%). Seizures occurred in 46% of cases during the course of the illness. Of the 24 cases, 14 (58%) died and 10 (42%) survived. Intravenous acyclovir treatment was associated with the best prognosis. Cerebral biopsy of one temporal lobe was performed in 22 cases and in 19 of these a positive histological diagnosis of HSE could be made. HSV was isolated from 15 of the 19 (79%) biopsied cases in whom virus isolation was attempted. Only seven out of the 15 cases (47%) in which immunofluorescence assays for HSV antigens were performed were unequivocally positive. Herpes simplex virus was isolated in culture from all cases which were negative by immunofluorescence. Immunocytochemical analysis on tissue sections of five representative brain biopsies demonstrated the presence of HSV antigens in some astrocytes, neurons and macrophages especially within areas of inflammatory infiltration. In situ hybridization experiments with a cloned HSV DNA probe demonstrated viral RNA in astrocytes, neurons and macrophages in two human biopsies and mouse brains in areas broadly corresponding to the distribution of viral antigen labelling. The combined immunocytochemical and in situ hybridization procedure showed that many but not all of the cells containing viral RNA also contained HSV antigens, indicating a productive infection in these double-labelled cells.
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PMID:A clinico-pathological study of herpes simplex encephalitis. 320 Mar 68

The clinical features, investigative profiles and outcome of 46 patients with biopsy or autopsy-proven herpes simplex encephalitis admitted to the Institute of Neurological Sciences, Glasgow between 1962 and 1985 were analysed retrospectively. The protean presenting symptoms and signs included a history of a prodromal influenza-like illness (48 per cent), rapid onset of headache, clouding of consciousness and confusion (52 per cent), meningism (65 per cent), raised intracranial pressure (33 per cent), deep coma (35 per cent), mutism or aphasia (46 per cent), focal neurological signs (89 per cent), and seizures (61 per cent). When seizures occurred they were almost always focal. The electroencephalogram was the most useful diagnostic test being abnormal in all cases, the majority showing focal changes in one or other hemisphere. Of the neuroradiological procedures employed, computerized tomographic and isotope brain scanning most frequently demonstrated localizing abnormalities in one or both temporal and/or frontal lobes. Midline shift was seen in half the cases. The cerebrospinal fluid was abnormal in every case but was not diagnostic. Cerebral biopsy of one temporal lobe was performed in 40 cases and a positive diagnosis of acute necrotizing encephalitis was made in 37 of these. Herpes simplex virus was isolated from the brains of 29 of the 40 cases in which the procedure was attempted, but immunofluorescence assays for antigens to herpes simplex virus were only positive in 11 out of 25 cases. Serological assays showed a greater than four-fold rise in the anti-herpes simplex virus antibody titre in 13 out of 22 patients tested.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A retrospective analysis of forty-six cases of herpes simplex encephalitis seen in Glasgow between 1962 and 1985. 325 5

Twenty-two patients with subdural haematomas associated with long term oral anticoagulation have been reviewed. Clinical presentation was similar to other subdural haematomas, but patients were generally older and the clinical course was more rapid. The incidence of over-anticoagulation was 23% and there was no correlation between anticoagulant status and the extent of bleeding or prognosis. Mortality was 27%, a residual neurological deficit was present in 14% and 59% made a complete recovery. The results suggest that morbidity and mortality could be reduced by early diagnosis and treatment and any patient on oral anticoagulant therapy who develops a headache or confusion should have urgent neurological investigation, including a CT scan. The indications for long term anticoagulation, particularly in the elderly, should be critically reassessed.
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PMID:Subdural haematoma associated with long term oral anticoagulation. 326 19

Blunt trauma to the head results in acceleration of the brain within the skull. This takes 2 forms: linear or translational acceleration which produces focal lesions, and rotational acceleration which results in 'sheering stresses' with stretching of nerves and bridging veins. Deceleration of the brain within the skull occurs when the head strikes a stationary object (e.g. floor, ring post). Cerebrovascular events are not infrequently encountered. The most common vascular sequalae is the subdural haematoma, which is also the most frequent cause of death in boxers. Epidural bleeds rare, and are generally due to deceleration of the brain. Subarachnoid bleeds have been rarely reported, but, like intraparenchymal haemorrhages, they do occur. Sudden flexion/extension of the neck is suggested as the mechanism of the occasional brainstem haemorrhage reported in boxing. Thrombosis of the internal carotid artery can occur secondary to direct blows to the neck or stretching of the contralateral carotid artery. The best known sequalae of boxing is traumatic encephalopathy--the 'punch drunk' syndrome. This is most common in second-rate and slugging type fighters. Severity correlates with the length of a boxer's career and total number of bouts, with an incidence of approximately 18%. Three stages of clinical deterioration are seen, the encephalopathy may be progressive or may remain clinically stable at any level. The first stage consists of affective disturbances with psychiatric symptoms being most marked. During the second stage an accentuation of the psychiatric symptoms occurs and signs/symptoms of Parkinsonism develop. The final stage consists of a decrease in general cognitive function together with pyramidal tract disease. Generally 2 to 3 years elapse between the first and final stages. Neuropathological studies reveal abnormalities of the septum pellucidum, scarring of the cerebellar and cerebral cortices, and loss of pyramidal neurons in the substantia nigra with neurofibrillary tangles in the absence of senile plaques. A 'groggy state' can occur in some fighters with confusion, impaired active attention and alteration of consciousness. During this period the boxer is at greater risk to suffer brain injury as defensive reflexes are frequently lost. Other neurological syndromes have been reported in addition to the 'groggy state'. These include a midbrain syndrome, headaches and cervical spinal injuries. Additionally, boxing appears to be a significant risk factor for the development of meningiomas.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Neurological sequelae of boxing. 329 90

We gave some considerations to the significance of cyst formation in a case of cryptococcus meningitis by examining the cysts themselves and comparing the organisms in the cysts with those disseminated throughout the subarachnoid space by light and electron microscopy. An 18-year-old girl had complained of headache, stiffneck and fever at the onset. These symptoms worsened into confusion without any definite diagnosis, then resulted in an arrest of spontaneous respiration which led to use of respirator for 12 days. The patient died 40 days after the onset. The brain weighed 1440 g and showed moderate swelling with opacity of the leptomeninges, which was very evident over the convexity and around the basal side of the pons. Subarachnoid fresh hemorrhage was also observed around the basal side of the brain stem. Microscopic examination of the subarachnoid space revealed widely disseminated Cryptococcus neoformans varied in size, whose cell wall showed a positive staining reaction to PAS. The organisms had characteristic spicules positively stained with cresyl violet radiating out of the cell body, and were associated with infiltration of lymphocytes, macrophages and polymorphonuclear leukocytes throughout the subarachnoid space. Some portions of arachnoid membrane, dura mater and vessel walls in the subarachnoid space especially the adventitia of the basilar artery were replaced by multiple cysts. The cysts were tightly filled with large numbers of small uniformly sized organisms which often showed budding. These cysts showed no histological evidence for inflammation. Further studies to demonstrate those differences were carried out with electron microscopy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Light and electron microscopic observations of cysts in the brain from an autopsy case of cryptococcus meningitis]. 332 15

A 42-year-old woman presented with a history of headache. Results of funduscopic examination revealed elevated disc margins and bilateral optic nerve head drusen. Lumbar puncture, head computed tomography, and fluorescein fundus angiography results were consistent with the diagnosis of pseudotumor cerebri and coexistent disc drusen. Visual loss was demonstrated by formal perimetry. Headaches were unresponsive to a medical regimen that included prednisone, glycerol, acetazolamide, furosemide, and repeated lumbar punctures. A lumbar peritoneal shunt was performed, with immediate resolution of headache. Optic disc drusen can be associated with pseudotumor cerebri and can lead to diagnostic confusion.
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PMID:Optic nerve head drusen and pseudotumor cerebri. 333 76

Overall, acyclovir is a remarkably safe drug considering its potent antiviral effect. The most frequent reactions with short-term use of oral acyclovir are nausea and vomiting and with 6 months' use headache, diarrhea, nausea, and vomiting. These symptoms are also seen frequently with placebos. The most frequent adverse reaction to intravenous use has been inflammation and phlebitis at the injection site. The two most important serious adverse effects are (1) encephalopathic changes with abnormal electroencephalograms and lethargy, tremors, confusion, and seizures and (2) renal precipitation of the drug because of a rapid bolus of drug administered parenterally. Safety of acyclovir for use during pregnancy and in neonates and young children has not been established.
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PMID:Adverse reactions to acyclovir: topical, oral, and intravenous. 333 41

The combination of nifedipine and atenolol must be evaluated in terms of risks and benefits to the hypertensive patient. Disadvantages with single-agent therapy justify trials of combination regimens. beta-Blockers may be unacceptable to some patients because of gastrointestinal upset, musculoskeletal symptoms, tiredness, malaise, insomnia, depression or confusion, sweating, breathlessness or cold extremities. The side effect profile varies from patient to patient and between different beta-blockers. Calcium antagonists also have characteristic side effects, including severe headaches, flushing and oedema, tachycardia and possibly worrying palpitations, and polyuria. Combining a calcium antagonist and a beta-blocker can reduce some side effects; for example, tachycardia is offset by addition of beta-blocker to calcium antagonist therapy, and beta-blocker-induced cold extremities may be reversed with a drug such as nifedipine. Moreover, the antihypertensive efficacy is increased, which is useful in previously resistant patients. However, an excessive fall in blood pressure is a possible adverse effect of the combination. There is also the possibility of precipitating heart failure in patients with cardiomegaly and severely compromised left ventricular function. The combination of nifedipine and atenolol was evaluated in 25 patients in a randomised, crossover trial following a month's treatment with atenolol 50mg twice daily. Patients received either atenolol 50mg twice daily alone, or atenolol 50mg twice daily with sustained release nifedipine 20mg or 40mg twice daily, or placebo twice daily during three 4-week treatment periods. Additional antihypertensive benefit was obtained by addition of the low dose of nifedipine compared with atenolol alone, but no further advantage was obtained with the higher nifedipine dose.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Aims of combination therapy--improved quality of life or better blood pressure control? 337 14

There is some suggestion in the literature that patients with migraine may be at an increased risk for developing complications as a result of cerebral angiography. To assess this risk, we reviewed the charts of 142 patients with migraine. A total of 149 angiograms were performed for acute headache (55), new focal symptoms (40), exertional (including coital) headaches (nine), hemiplegic migraine (three), ophthalmoplegic migraine (five), vertebrobasilar migraine (six), migraine accompaniments (three), and other causes (14). Transient events were seen in six patients and these were transient amnesia (one), hemisensory changes (two), hemiparesis (one), global confusion (one), and angina (one). One patient with a history of severe ischemic heart disease developed a myocardial infarction two hours after angiography. Focal cerebral events occurred in 2.6% of cases. This compares with a rate of complications of 2.8% caused by angiography in a prospective study of 1002 patients from our center. According to our findings, it appears that a history of migraine does not increase the risk of complications caused by angiography. Angiography during episodes of acute headaches would also appear to be a safe procedure. Transient focal neurologic symptoms, however, are not infrequent, especially in cases of classic migraine.
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PMID:Migraine and the risks from angiography. 339 65


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