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

A first case of cavernous angioma of falx cerebri is reported. A 62-year-old woman who had a history of intermittent headache and dizziness was admitted to our hospital. On admission she had no neurological deficit, but CT scan showed a slightly high density tumor located beneath the falx cerebri. This was markedly and homogeneously enhanced by contrast medium. MRI showed a tumor with low intensity in T1-weighted image and high intensity speckled with low intensity in T2-weighted image. Angiogram revealed a faint tumor-stain fed by the bilateral pericallosal arteries at middle arterial to late venous phases. With the tumor attached to the lower edge, the falx was totally removed through a left front-parietal craniotomy. Histologically the tumor was diagnosed as cavernous angioma and thought to have originated from the dura mater of the falx. A search in the literature revealed that only 7 cases of extracerebral cavernous angiomas excluding ones in the middle cranial fossa have been previously reported. Five of them were located at the tentorium cerebelli and two at the convexity. The MRI finding such as speckled mixed intensity may reflect the vascular lumens or their thromboses in the tumor. Angiographic finding such as faint tumor stain at middle arterial to late venous phases due to slow blood flow in the tumor are thought to be specific to intracranial cavernous angiomas. These findings are of particular importance in differentiating cavernous angiomas from meningiomas.
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PMID:[Cavernous angioma of falx cerebri; case report]. 176 59

Venous angiomas (developmental venous anomalies) are vascular malformations increasingly recognized in general neurosurgical or neurological practice. They are associated with intracranial hemorrhage, seizures, or progressive neurological deficits or found as incidental findings in patients who present with headaches or have neuroimaging studies for investigation of unrelated neurological disorders. Since venous angiomas drain normal cerebral tissue within a functionally normal arterial territory, resection can lead to venous infarction. This report studies 27 patients with venous angiomas, all of whom had conservative treatment. The venous angioma was considered to be responsible for the onset of neurological symptoms in 14 patients (7 with hemorrhage, 3 with hemorrhage and seizures, 2 with seizures, one with an extrapyramidal movement disorder, and one with motor deficit). Thirteen patients had incidental lesions (8 with headache, and 5 with unrelated neurological symptoms). Ten venous angiomas were in the posterior fossa; seven in the cerebellum. Location did not correlate with symptomatic presentation. No patient with hemorrhage required surgical evacuation of the hematoma. No patient died or had significant morbidity during the follow-up interval (mean of 3.7 years). Venous angiomas are low flow, low resistance vascular malformations, many of which are not associated with neurological sequelae. Our series supports the concept that surgical removal or radiosurgical obliteration should not be performed unless a patient has a second life threatening hemorrhage.
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PMID:The case for conservative management of venous angiomas. 191 63

The incidence and natural history of the cavernous angioma have remained unclear in part because of the difficulty of diagnosing and following this lesion prior to surgical excision. The introduction of magnetic resonance (MR) imaging has improved the sensitivity and specificity of diagnosing and following this vascular malformation. Seventy-six lesions with an MR appearance typical of a presumed cavernous angioma were discovered in 66 patients among 14,035 consecutive MR images performed at the Cleveland Clinic between 1984 and 1989. Follow-up studies in 86% of the cases over a mean period of 26 months provided 143 lesion-years of clinical survey of this condition. The most frequent presenting features were seizure, focal neurological deficit, and headache. While most lesions exhibited evidence of occult bleeding on MR imaging, there was overt hemorrhage in seven of the 57 symptomatic patients and only one overt hemorrhage occurred during the follow-up interval. The annualized bleeding rate was 0.7%. Analysis of the hemorrhage group revealed a significantly greater risk of overt hemorrhage in females. Pathological confirmation of cavernous angioma was obtained in all 14 surgical cases. This information assists in rational therapeutic planning and prognosis in patients with MR images showing lesions suggestive of cavernous angioma.
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PMID:Natural history of the cavernous angioma. 191 92

Cerebral venous angiomas are congenital anomalies of the intracranial venous drainage. Many believe that they are associated with a high risk of hemorrhage and neurological dysfunction, but newer neurodiagnostic imaging techniques are showing not only that they are more common than previously known but also that many have no associated symptoms. In this retrospective study, the natural history of venous angiomas was examined in 100 patients (48 males and 52 females) with radiographically identifiable lesions treated over a 14-year period. Information on the natural history of the lesion was obtained from clinical records and follow-up data. Imaging studies included angiography, computerized tomography, and magnetic resonance imaging. Angioma locations were classified as frontal (42 cases), parietal (24 cases), occipital (4 cases), temporal (2 cases), basal or ventricular (11 cases), cerebellar (14 cases), or brain stem (3 cases); 47 lesions were on the left side. Headache as a presenting symptom was common (36 patients) and often led to other radiographic studies, but this appeared to be related to the vascular lesion in only four patients. Other possibly related complications were hemorrhage in one patient, seizures in five, and transient focal deficits in eight. Fifteen patients had no neurological signs or symptoms. The mean patient age at last contact was 45.3 years (range 3 to 94 years). All patients have been managed without surgery. It is concluded that significant complications secondary to venous angiomas are infrequent and that surgical resection of these lesions and of surrounding brain is rarely indicated.
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PMID:The natural history of intracranial venous angiomas. 191 93

The authors report 14 cases of unilateral hydrocephalus in adults. Headache was the most common presenting symptom. Unilateral hydrocephalus was documented in each patient with computed tomography scans; magnetic resonance imaging was also used in seven patients in the latter part of the series. Unilateral hydrocephalus was caused by tumor (seven patients), venous angioma (one patient), ependymal cyst (one patient), postinflammatory gliosis (one patient), and was idiopathic in four patients. The primary surgical treatment was craniotomy with fenestration of the septum pellucidum, which relieved symptoms in eight of nine patients for whom long-term follow-up data were available.
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PMID:Unilateral hydrocephalus in adults. 198 77

Two patients are described with large intracranial arteriovenous angioma with minimal neurological symptoms. The first patient suffered from repeated right fronto-temporal headache. Migraine was diagnosed and he was treated with analgesic drugs. We carried out scintigraphic investigation and computerized tomography of the brain. The results of these examinations suggested the presence of large brain lesion (tumour or vascular malformation). Bilateral carotid angiography and aortic arch angiography were done in this patient. A large arteriovenous angioma was discovered in the right occipital area. The second patient complained of throbbing headaches. A bruit could be heard over the left eye which was exophthalmic. Angiograms showed a carotid-cavernous fistula on the left side and a large angioma in the fronto-parietal area. The angioma was clinically "silent". It diminished the symptoms of the carotid-cavernous fistula through the uptake of blood. Both patients were regarded as unsuitable for surgery. The reasons were the great dimension of these angiomas and a large number of supplying arteries.
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PMID:[Giant arteriovenous angiomas of the brain with scant clinical manifestations]. 203 22

A 25-year-old patient with headache was admitted to the neurology department. Computerized tomography revealed an intracerebral abscess of unknown origin, which was removed by craniotomy. After an uneventful operation and anesthetic low arterial oxygen tensions were noted that did not respond to increased FiO2. Angiography revealed a pulmonary arteriovenous (a-v) fistula (angioma), which was responsible for the right-left shunt. A Swan-Ganz catheter was inserted and the effects of varying levels of PEEP on the magnitude of the shunt during spontaneous breathing of 100% oxygen were determined. At zero PEEP the arterial pO2 was 211 mm Hg (AaDO2 470 mm Hg). 5 mbar PEEP caused the arterial pO2 to fall to 118 mm Hg (AaDO2 563 mm Hg). Increasing PEEP to 15 mbar caused a further decrease in arterial pO2 to 72 mm Hg (AaDO2 603 mm Hg), which resulted in arterial desaturation. The arterial pCO2 remained constant. At a virtually constant cardiac output the shunt volume increased from 23% at zero PEEP to 30% at a PEEP of 15 mbar--a relative increase of 30%. Elevating the intrathoracic pressure presumably caused redistribution of the pulmonary perfusion toward the shunt vessels, probably because the vascular resistance increased more rapidly in the normal vasculature than in the angioma. The therapeutic consequences were to reduce the PEEP and avoid mechanical ventilation. Pulmonary a-v-fistulas are not uncommonly associated with brain abscesses, probably because the normal filter function of the pulmonary vascular bed is disrupted. Therapy consists either in resecting the afflicted lung segment or in transvenous occlusion of the fistula with a silicon ballon.
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PMID:[Deterioration of pulmonary gas exchange caused by PEEP in a pulmonary vascular shunt (Rendu-Osler-Weber syndrome)]. 203 23

A case is reported of venous angioma at the right basal ganglia simulating the encapsulated chronic intracerebral hematoma. A 29-year-old man was admitted to our hospital on July 14, 1988 with a two-month history of headache. Neurological examination revealed left homonymous lower quadrantic anopsia. CT scans showed a mosaic high density lesion at the right basal ganglia with extensive adjacent edema. MRI revealed that the high density lesion on CT scans was the combination of a reticulated core of mixed signal intensity with a surrounding rim of decreased signal intensity. The lesion was accompanied with extensive edema. Followed up CT scans showed the transformation of the lesion and ring-shaped enhancement. A right frontotemporal craniotomy was performed on August 9, 1988. After thorough dissection of the sylvian fissure and small corticotomy to the insula, a tough capsule was seen. There was blood in various stages of organization in the capsule. A histological examination gave a diagnosis of venous angioma in the membrane similar to the outer membrane of chronic subdural hematomas. Postoperatively, the patient showed slight left motor weakness, but it gradually improved and he was discharged on foot, on October 19, 1988. There have been a lot of reports about angiographically occult intracranial vascular malformation (AOIVM). But AOIVM at the basal ganglia is rare, and to our knowledge, only 8 cases have been reported. In our case, the presence of adjacent extensive edema, and ring-shaped enhancement on CT scans confused the preoperative diagnosis. Those findings might have been caused by encapsulation. By using CT scans and MRI, a complete and accurate diagnosis was impossible.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Encapsulated chronic intracerebral hematoma caused by venous angioma of the basal ganglia: a case report]. 221 67

Recurrent headache is a common pediatric problem. As the differential diagnosis of headache is extensive, physicians rely on the mode of presentation to focus any investigation. A report of an adolescent in whom atypical facial and head pain caused by a preexisting cerebellar cavernous angioma is presented. Facial pain and headache resolved following excision of the tumor.
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PMID:Cavernous angioma presenting as atypical facial and head pain. 229 36

This study was designed to investigate the hemodynamic characteristics of cavernous angiomas of the brain. Five adult patients with a cavernous angioma underwent local cortical blood flow studies and vascular pressure measurements during surgery for the excision of the cavernous angioma. Clinical presentation included headache in four patients, seizures in four patients, and recurring diplopia in one patient. Magnetic resonance imaging demonstrated the cavernous angiomas in all patients and revealed an associated small hematoma in two. Four patients with a cerebral cavernous angioma were operated on in the supine position and the remaining patient, whose lesion involved the brain stem, was operated on in the sitting position. Mean local cortical blood flow (+/- standard error of the mean) in the cerebral cortex adjacent to the lesion was 60.5 +/- 8.3 ml/100 gm/min at a mean PaCO2 of 35.0 +/- 0.6 torr. Mean CO2 reactivity was 1.1 +/- 0.2 ml/100 gm/min/torr. The local cortical blood flow results were similar to established normal control findings. Mean pressure within the lesion in the patients undergoing surgery while supine was 38.2 +/- 0.5 mm Hg; a slight decline in cavernous angioma pressure occurred with a drop in mean systemic arterial blood pressure and PaCO2. Mean pressure in the cavernous angioma in the patient operated on in the sitting position was 7 mm Hg. Jugular compression resulted in a 9-mm Hg rise in cavernous angioma pressure in one supine patient but no change in the patient in the sitting position. Direct microscopic observation revealed slow circulation within the lesions. The hemodynamic features demonstrated in this study indicate that cavernous angiomas are relatively passive vascular anomalies that are unlikely to produce ischemia in adjacent brain. Frank hemorrhage would be expected to be self-limiting because of relatively low driving pressures.
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PMID:Vascular pressures and cortical blood flow in cavernous angioma of the brain. 239 87


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