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

Germ cell tumors originating in the posterior fossa are very rare. Described herein is a case of primary germ cell tumor (yolk sac tumor) found in the cerebellar vermis. A 5-year-old boy who complained of headache was admitted. CT and MRI revealed a tumor with diffuse enhancement by contrast medium in the right cerebellar vermis. Total removal was performed and a diagnosis of medulloblastoma or ependymoma was suspected. However, the tumor proved to be a yolk sac tumor with embryonal carcinomatous components from histological findings. Abnormally high levels of alpha-fetoprotein were found in blood and cerebrospinal fluid. Extensive examination indicated that the intracranial lesion had not metastasized from a primary extracranial tumor.
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PMID:Cerebellar primary germ-cell tumor in a young boy. 789 60

Headache is a common complaint. In most patients, it is usually a problem of migrainous or tension-type headache. It is crucial that a physician is able to differentiate sinister causes of headache from the more benign ones. Six cases are presented to illustrate the fact that there are clues in the history to suggest a sinister cause of headache even though there are minimal or no neurological deficits on physical examination. At some point of time, these cases were examined by a senior physician but they were diagnosed as migrainous or tension-type headaches. The first case is a 41-year-old labourer with cryptococcal meningitis. He presented with severe headaches at a relatively late age. A 20-year-old female complained of the worst headache she ever had and this was due to a subarachnoid haemorrhage. The third case was a young woman with a large parietal meningioma. Her headaches had recently assumed a different character. The fourth case involved an investment manager who developed headaches with transient diplopia and projectile vomiting and investigations revealed an ependymoma. A shipyard worker complained of a constant headache which disturbed his sleep. Two weeks after medical consultation, the character of his headache changed and he developed diplopia in all directions of gaze. He succumbed to pituitary apoplexy. The final case is a 28-year-old woman who had a complicated migraine. CT scan of the brain showed a large arterio-venous malformation.
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PMID:Warning symptoms of sinister headache. 799 8

Intraventricular tumors present a major challenge for neurosurgeons because of their depth and the important structures around them. Between 1984 and 1991, we performed 60 computer-assisted volumetric stereotactic resection procedures in 58 patients with intraventricular tumors (30 patients with third ventricular tumors and 28 patients with lateral ventricular tumors). The pathological findings of the tumors were as follows: colloid cyst in 27, giant cell astrocytoma in 5, central neurocytoma in 4, pilocytic astrocytoma in 4, meningioma in 3, subependymoma in 3, metastatic tumor in 3, oligodendroglioma in 2, ependymoma in 2, and miscellaneous tumors in 5 patients. Most presenting symptoms were nonlocalized--headache or cognitive dysfunction. All third ventricular tumors were approached via a frontal trajectory, and lateral ventricular tumors were approached according to the site and shape of the lesion. Total resection was achieved in 55 procedures. Overall outcome was excellent in 45 cases, good (some deficit but independent) in 5, and poor (dependent) in 3 (memory impairment, 2 patients; visual field cut, 1 patient). Two patients (3.4%) died postoperatively (one had a postoperative thalamic hemorrhage and pulmonary embolus; one had a subdural hygroma). In follow-up, three patients died from the extension of a malignant tumor or from primary cancer. Permanent morbidity was seen in three cases (5%). The authors believe computer-assisted volumetric stereotaxis is useful in removing intraventricular tumors. This technique allows us to find a safe trajectory and to locate and separate the tumor margin from the surrounding vital structures.
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PMID:Resection of intraventricular tumors via a computer-assisted volumetric stereotactic approach. 832 92

The authors report an unusual case of a myxopapillary ependymoma arising from the lateral ventricle. The patient, a 37-year-old woman, developed recurrent symptoms including scotomata, disorientation, and headache during two successive pregnancies before the definitive diagnosis. The causes of this ependymoma variant and its relationship to pregnancy are discussed.
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PMID:Intracranial myxopapillary ependymoma: case report. 836 Jul 10

We report the case of a 16 year old male with a left temporal myxopapillary ependymoma which did not demonstrate any connection to the lateral ventricles. The patient had complained of headaches for ten months and signs of increased intracranial pressure for one month. One month post-operatively, because of lower back pain, further investigations disclosed two separate intraspinal myxopapillary ependymomas, one at T12-L1 level and the other at L5-S1 level. It is postulated that the cerebral myxopapillary ependymoma was in fact a secondary from one of the spinal cord tumors. There are only three reports of this type of ependymoma in the cerebrum.
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PMID:Cerebral and spinal cord myxopapillary ependymomas: a case report. 900 62

Ependymomas are neoplasms of the central nervous system that are capable of demonstrating remarkably heterogeneous histologic features. These tumors originate from ependymal cells lining the ventricles, the choroid plexus, the central canal of the spinal cord, and the filum terminale, so they are therefore seen throughout the neuraxis. We describe the case of a 26-year-old man who experienced a 3-week history of right-sided numbness and a 1-week history of worsening bifrontal headache. Computed tomographic scanning and magnetic resonance imaging of his head demonstrated an irregularly enhancing mass involving the left medial frontal lobe, with extension across the corpus callosum and expansion into the body and atrium of the left lateral ventricle. Histologic, immunohistochemical, and electron microscopic findings were consistent with an anaplastic ependymoma. Unique to this neoplasm was the presence of multiple tumor giant cells. The presence of pleomorphic tumor giant cells is a characteristic feature of the subependymal giant cell astrocytoma, and it is also commonly seen in pleomorphic xanthoastrocytoma and glioblastoma multiforme. Bizarre giant cells were recently described in two filum terminale ependymomas. This report presents the first case of a supratentorial giant cell ependymoma with anaplastic features.
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PMID:Supratentorial giant cell ependymoma: a case report. 957 93

A case of conus medullaris tumour (ependymoma) is reported in which the presenting symptom was subarachnoid haemorrhage, which has left bladder dysfunction. 70-year-old patient was admitted to the Department of Neurology due to symptoms of conus medullaris lesion with retention of urine and diminished pain sensitivity in perianal zona. He had been hospitalized 30 years ago due to vomiting, headache and pain in lumbar region. The cerebrospinal fluid examination confirmed the diagnosis of subarachnoid haemorrhage. Cerebral angiography failed to show the source of bleeding. Myelography and spinal arteriography showed nor tumour neither vascular malformation. Only MRI examination performed after 30 years following the first symptoms of tumour made possible the correct diagnosis--tumour in vertebral canal at L1-L2 level compressing conus medullaris. Surgical procedure confirmed the diagnosis. Histopathological examination--ependymoma myxopapillare.
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PMID:[Subarachnoid hemorrhage due to conus medullaris ependymoma]. 976 May 60

Between the years 1970 and 1997, 112 patients with tumors of the lateral ventricle were operated on at the University of Ankara, School of Medicine, Department of Neurosurgery. Seventy-one patients (63.4%) were male and 41 patients (36.6%) female. Headache (35.7%), nausea and vomiting (22.3%) were the most common presenting complaints. Papilloedema (42.9%), motor and sensory loss (25%) were the most common findings at neurological examination. Complete tumor removal was accomplished in 38.4% of the patients. Histopathologically, the most commonly seen types of the tumor were ependymoma (25%) and astrocytoma (21.4%). Among the various approach, the anterior transcortical (53.6%) and the posterior transcortical (16%) were the most commonly used. Eleven patients were reoperated for tumor recurrence. After surgery, radiation therapy was also performed on fourty-two patients. The morbidity and mortality rates were considerably higher before 1976 when the use of microneurosurgical techniques was introduced. After this, our morbidity and mortality rates decreased dramatically. The overall surgical mortality rate was 7.1% before 1976; during the last 10 years (n:46), it was 6.5%. In this report, our choice of operative approaches and the results will be discussed.
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PMID:Tumours of the lateral ventricle. A retrospective review of 112 cases operated upon 1970-1997. 979 47

Predicting behavior based on histologic appearance has been problematic in ependymomas. Sixty-one patients with ependymoma (excluding subependymoma and myxopapillary ependymoma) were studied. The patients included 36 men and ranged in age from 1.5 to 74 years (median, 33 years). The most common clinical presentations included headache (n = 19), weakness (n = 18), nausea/vomiting (n = 12), and gait disturbance (n = 10). Location included spinal cord (n = 24), fourth ventricle (n = 21), lateral ventricle (n = 8), and third ventricle (n = 5). Initial surgery included a gross total resection of tumor in 22 patients and subtotal resection or biopsy in the remaining patients. Thirty-five patients were known to have been treated with adjuvant radiation therapy and 13 patients received adjuvant chemotherapy. At last known follow-up, 20 patients were alive with no evidence of tumor (median, 66.5 months), 17 patients were alive with residual tumor (median, 14 months), and 12 patients died of tumor (median, 27.5 months). Two additional patients are alive with tumor status not known, two cases are current, and two patients were lost to follow-up. The additional six patients died either shortly after surgery or of surgical complications. Sixteen of 18 patients had at least one tumor recurrence at median 28.5 months. Fifty-one tumors had a predominantly glial pattern and 10 had a mixed glial-epithelial pattern. Of histologic features examined, patients with tumor recurrence or who died of tumor more frequently had observable mitotic figures, vascular proliferation, necrosis, and foci of increased cellularity. Eight of 18 recurrent tumors were classified as high grade ependymomas (anaplastic/malignant). Of patients who died of tumor, 4 of 12 had histologically high grade tumors versus 5 of 39 of the remaining tumors. MIB-1 immunostaining (marker of cell proliferation) was performed on 50 tumors. MIB-1 labeling indices (% positive tumor cell nuclei) ranged from 0.1 to 34.0 (median, 1.1). A higher percentage of patients with recurrent tumor (6 of 13, 46%) or who died of tumor (3 of 10, 30%) had MIB-1 indices >/= 4.0 versus the remaining patients (8 of 33, 24%). The conclusions are as follows: (1) histologic appearance and MIB-1 indices were not reliably predictive of tumor behavior, probably due in part to tumor heterogeneity; (2) tumors with two or more of the following features: identifiable mitotic figures, hypercellularity, vascular proliferation, and necrosis were more likely to behave in an aggressive manner; and (3) elevated MIB-1 labeling indices (>/=4.0 in this study) were encountered in a higher percentage of fatal and recurrent tumors than in nonfatal or nonrecurrent tumors.
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PMID:Clinicopathologic study of 61 patients with ependymoma including MIB-1 immunohistochemistry. 999 Jan 8

We describe a patient with a recurrent spinal cord ependymoma who initially presented with symptoms of increased intracranial pressure rather than symptoms directly relating to involvement of the conus medullaris. Brain magnetic resonance imaging with gadolinium showed communicating hydrocephalus. Magnetic resonance imaging of the entire spinal cord with gadolinium revealed recurrent tumor. Postoperatively, a permanent ventriculoperitoneal shunt was placed. Recognition of the association between spinal cord ependymoma and hydrocephalus is important in the evaluation of patients with headache.
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PMID:Recurrent lumbar ependymoma presenting as headache and communicating hydrocephalus. 1094 42


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