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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 basilar migraine headache in a young woman is presented. Although the patient had been treated by a neurologist for 2 years, the diagnosis was not established. When she presented to the emergency room of a local hospital, another neurologist diagnosed conversion reaction. Although there had been problems in the family, neurological examination during an episode of headache revealed the typical features of basilar migraine headache. This case illustrates the need for sharp neurological diagnostic skills among psychiatrists, as well as the need to avoid mind-body dichotomies when possible. With treatment for migraine, the patient has done well for several months posthospitalization.
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PMID:Single case study basilar artery migraine presenting as conversion hysteria. 72 3

We discuss four patients with the clinical diagnosis of basilar migraine and suspected coexisting epilepsy who were referred to our epilepsy center. Their symptoms suggested episodic dysfunction in the distribution of the basilar artery, followed by pulsating headache with nausea. Verbal unresponsiveness and sensory symptoms occurred in all four patients; two also had focal paresis or jerking movements. Diagnostic studies excluded other disorders with similar symptoms. None of the patients improved with antimigraine or antiepileptic drugs. Provocation tests with suggestion elicited typical events in three patients and aura and headache in one patient. There were no EEG or ECG abnormalities during spontaneous or provoked episodes. Two patients improved with psychiatric treatment. Conversion disorder or malingering should be considered in patients whose symptoms of basilar migraine are atypical or refractory to treatment.
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PMID:Psychogenic basilar migraine: report of four cases. 871 Jan 6

Problems in expert opinion on headache patients are encountered in particular with cases of so-called posttraumatic headache. Symptoms in the vegetative field due to a head injury are characterized by a close time relationship with the accident or trauma. So is genuine post-traumatic headache. Like the so-called postconcussional syndrome, post-traumatic headache is very vaguely defined. To verify the causal connection between headache and head injury an in-depth neurological analysis is necessary. Lesions of intra- and extra-cranial structures sensitive to pain are apt to bring about subjective complaints in the form of headache. Severe craniocerebral injuries with persisting headache may be suggestive of chronic disturbances in cerebrospinal fluid circulation. On the other hand, extensive compound skull fractures and large cranial trephination defects rarely give rise to headache. Cephalgia occurring after cerebral concussions and minor cerebral contusions subside within a short period of time. The evolution of migraine following a head injury is extremely unusual. However, severe subjective complaints may be caused by traumatic subarachnoidal hemorrhage. An exceptional situation is that of neuralgic pain after an accident with injury to the head, especially in the wake of trigeminal nerve lesions. It seems important to mention the possibility of the combination of organic and psychological factors for cephalgia following craniocerebral trauma. Symptomatic headache generally does not cause special difficulties for expert opinion. However, more problems are encountered in the evaluation and appraisal of persistent headache and other subjective complaints in conversion neurosis and psychogenic disorders. Pensions for headache should only be considered in the most severe cases.
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PMID:[Legal problems in headache]. 805 16

We report a case of a 14-year-old girl who presented, following a sudden onset, with bilateral ptosis, gait disturbance, difficulty swallowing and loss of appetite, right hypochondriacal pain, and frontal headache. Protracted neurological and medical examinations were unremarkable; neither was precipitating psychological stresses evident. The condition, which manifest as typical conversion disorder, lasted for one year. "Treatment" involving electrical stimulation of both eyes muscles and legs with positive reassurance resolved the symptom. This case supports the view that conversion disorder, not only involves a strong element of suggestion, but also incorporates socio-cultural sanctioned prescription.
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PMID:A case of bilateral ptosis with unsteady gait: suggestibility and culture in conversion disorder. 1176 Aug 65

We report a 16-year-old female who developed double vision. The diplopia was in the horizontal plane and persisted for 3 weeks. She also complained of headache and nausea. She kept her eyes closed unless she was told to open. When eyelids were passively open, both eyes deviated inward in an adducted position. The pupil size and the reaction to light were normal. No weakness was noted in the extraocular muscles when each eye was examined individually. The rest of the neurologic examinations were normal. We thought that she had a convergence spasm. Brain CT and MRI were normal. The CSF and blood chemistries were also normal. We treated her with supportive psychotherapy and her convergence spasm disappeared. We concluded that her convergence spasm was a manifestation of conversion hysteria.
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PMID:[A case of convergence spasm in hysteria improved with a brief psychiatric assessment]. 1180 23

In a 6-month period, three patients aged 5-11 years were transferred to our tertiary care children's hospital for management of severe complications following adenotonsillectomy. The first patient presented with headaches and lethargy and was found to have a sagittal sinus thrombosis from severe dehydration. The second patient was admitted immediately following an intra-operative oral cavity fire due to electrocautery malfunction. She suffered partial-thickness burns to the buccal mucosa, palate, and lips. The third patient was admitted with torticollis. Grisel's syndrome was initially suspected, but a thorough work up resulted in the diagnosis of a conversion disorder. These cases comprise an interesting cohort of three little-known complications of adenotonsillectomy.
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PMID:Three extraordinary complications of adenotonsillectomy. 1628 Jan 74

Agenesis of corpus callosum can have various neuropsychiatric manifestations. Following case report highlights the case of a young man presenting with features of recurrent brief depressive disorder, each lasting for about 3 to 7 days, for over a year. He had history of occasional headache and episodes of swooning attack in between, usually precipitated by emotional events. His neuroimaging revealed agenesis of corpus callosum. He was experiencing swooning attacks as he became aware that some 'unusual' findings were present in his reports. Recurrent brief depression can be a manifestation of this congenital anomaly, and conversion disorder can be present as comorbid diagnosis perhaps due to ignorance and fear of this apparently innocuous congenital malformation.
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PMID:A case of corpus callosum agenesis presenting with recurrent brief depression. 2193 2

This is a report of a 24-year-old woman who presented to the emergency department (ED) at Imam Hossein Hospital in Tehran, Iran with a one-week history of headache and agitation following her father's death. Before presenting to our ED, a diagnosis of conversion reaction was suggested by three physicians in different outpatient clinics. Cerebral venous thrombosis (CVT) was confirmed in this case on the basis of brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). In this report, current knowledge regarding cerebral venous thrombosis and its related clinical features are discussed.
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PMID:A headache misunderstood for a grief reaction: an unusual cerebral venous thrombosis presentation. 2303 78

We describe the case of a 29-year-old parturient who, after undergoing elective cesarean delivery, displayed symptoms of lower extremity weakness and sensory deficit. Her past medical history was significant for asymptomatic Arnold Chiari Type I malformation and asthma. She had received spinal anesthesia that failed to achieve an adequate surgical level requiring conversion to general anesthesia. After tracheal extubation, she exhibited bilateral leg weakness that did not resolve over the next 4-6h. An urgent magnetic resonance imaging scan revealed a normal spine with no evidence of hematoma. The lower extremity paresis persisted and a neurologist diagnosed psychogenic paresis, a type of conversion disorder. Interestingly, the patient's postoperative leg paresis was not her first occurrence of neurological dysfunction after dural puncture. At 27 weeks of gestation, she had similar lower extremity symptoms after a lumbar puncture, performed to exclude meningitis for severe headache symptoms. Psychogenic paresis is not commonly reported in the medical literature and we found no reports of psychogenic paresis after spinal anesthesia in a parturient or recurrent psychogenic paresis. We review the various risk factors, etiology, neurological signs and symptoms, types, therapy and future management of a patient with recurrent conversion disorder.
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PMID:Recurrent psychogenic paresis after dural puncture in a parturient. 2347 80

Stroke can be categorized as ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Awakening with or experiencing the abrupt onset of focal neurologic deficits is the hallmark of the diagnosis of ischemic stroke. The most common presenting symptoms of ischemic stroke are speech disturbance and weakness on one-half of the body. The most common conditions that can mimic a stroke are seizure, conversion disorder, migraine headache, and hypoglycemia. Taking a patient history and performing diagnostic studies will usually exclude stroke mimics. Neuroimaging is required to differentiate ischemic stroke from intracerebral hemorrhage, as well as to diagnose entities other than stroke. The choice of neuroimaging depends on availability of the method, the patient's eligibility for thrombolysis, and presence of contraindications. Subarachnoid hemorrhage presents most commonly with sudden onset of a severe headache, and noncontrast head computed tomography is the imaging test of choice. Cerebrospinal fluid inspection for bilirubin is recommended if subarachnoid hemorrhage is suspected in a patient with a normal computed tomography result. Public education about common presenting stroke symptoms may improve patient knowledge and clinical outcomes.
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PMID:Diagnosis of acute stroke. 2588 71


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