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

Leptospirosis is not an exotic disease, still it is seen more frequent in southern countries. Microsymptoms, such as supraorbital headache, muscle pain in the legs, herpes naso-labialis or axillaris (often symmetrical), pharynxenanthema, fugitive rash, epistaxis, confusion, etc., are very important for early diagnosis. An intradermal test for early diagnosis was developed and is described here.
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PMID:[Microsymptoms in leptospirosis]. 91 23

A 71-year-old man was admitted to the Wake Forest University/Baptist Hospital Medical Center on February 1, 1989, with pharyngitis and a cutaneous eruption that began that day. The past history was significant for a diagnosis of chronic lymphocytic leukemia (CLL) made in 1984, and for longstanding hypertension, severe coronary artery disease, and prostatic hypertrophy. The patient had required no therapy for his CLL until August, 1988, when he developed hemolytic anemia and was treated with oral chlorambucil, 4 mg/day, and a tapering course of prednisone. By December, 1988, the prednisone therapy had been discontinued, but the patient required hospital admission for pneumococcal pneumonia, which responded well to intravenous antibiotic therapy. One day prior to the current admission the patient complained of persistent fevers, sore throat, productive cough, and headache. He noted a new cutaneous eruption on the day of admission in February, 1989. The past history was positive for occasional herpes stomatitis. The patient did not know if he had previously been infected with varicella. Skin examination revealed multiple (greater than 20), single, and grouped vesicles in a generalized distribution involving the bilateral trunk, head, neck, arms, and legs. The heaviest involvement was on the right posterior auricular area and on the neck. A Tzanck preparation obtained from an early lesion was positive for multinucleated giant cells. Viral culture was negative at 24 hours and at 1 week. A skin biopsy of an early vesicular lesion was performed and revealed intraepidermal vesicles with acantholysis and giant cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Granuloma annulare and disseminated herpes zoster. 145 73

The chronic fatigue syndrome is a poorly defined symptoms complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including psychological symptoms, sore throat, lymph node pain, headache, myalgia, arthralgias. Psychological disturbances, ranging from mild depression or anxiety to severe behavioral abnormalities, are always present. Chronic fatigue syndrome is the name that more accurately describes this symptom complex of unknown cause. A viral aetiology has long been hypothesized: many viruses are potential candidates, including any of the 23 Coxsackie A or 6 Coxsackie B viruses, herpes viruses, particularly Epstein-Barr virus and varicella. These studies, though interesting, remain unconvincing because of methodological flaws such as a poor case definition and inadequate control groups. This syndrome may represent an infection by a yet unidentified virus. It is more likely due to an abnormal immune response toward different intracellular pathogens. There is no treatment to ameliorate the chronic fatigue syndrome. Epidemiological studies are essential with explicit operational case definition before progress can be made in the management of this distressing disorder.
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PMID:[The chronic fatigue syndrome. A multifactorial approach and the treatment possibilities]. 207 78

A post-mortem examined case of herpetic brainstem encephalitis is presented. Clinically, the patient had cephalalgia followed by ataxia, drowsiness and multiple palsies of some cranial nerves, developing into death in eight days. The pathologic examination of the brain showed necrotizing encephalitis in multiple foci limited to the brainstem, more distinctly in the pons and medulla oblongata. The technique of immunoperoxidase revealed rare glial cells with intranuclear immunoreactivity for herpes antigen. Rare viral particles with the morphological characteristics of the herpesvirus were identified in the nuclei of neurons in 10% formol fixed material. This is the second reported case of herpetic brainstem encephalitis confirmed by post-mortem examination. The pathway used by the virus to reach the central nervous system and its posterior dissemination to the oral cavity, the orbitofrontal region and the temporal lobes as well as to the brainstem, after a period of latency and reactivation, are discussed.
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PMID:[Herpetic brain stem encephalitis: report of an autopsied case with immunohistochemical and electron microscopy studies]. 303 59

Herpes simplex encephalitis is the most common cause of sporadic encephalitis in the western world. Patients usually have altered levels of consciousness, altered levels of mentation, fever, headache, and personality changes. These may progress to hemiparesis and seizures. Exact diagnosis must be established by brain biopsy and identification of the virus in biopsy material. There is a great need for a noninvasive test that is positive early in the disease. Without antiviral treatment the mortality rate is greater than 70%, and many survivors have serious disabilities. Both adenine arabinoside and acyclovir decrease death and morbidity, but acyclovir is the preferred drug. With acyclovir about 40% of patients will survive with normal development or minor levels of impairment but more than half of the patients will die or suffer significant impairment. It is essential to treat early; patients who are young and have not reached coma or impaired consciousness may show 65% recovery and return to normal function. Development of new antiviral drugs or other types of therapies is desirable. Herpetic skin lesions are likely to be more confusing than diagnostic because other types of encephalitis with fever often precipitate recurrent herpes that is unrelated to the encephalitis.
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PMID:Antiviral treatment of a serious herpes simplex infection: encephalitis. 333 44

A case of severe generalised herpes simplex type 2 infection is described in an adult male who had known exposure to herpes. The patient first complained of headache, fever and neurological symptoms, and three to six days later of conjunctivitis, severe pharyngitis, arthralgia and vesicular lesions about the body. During the first 14 days of illness, including three in hospital, the patient was diagnosed as having infection with varicella virus, vesicular stomatitis virus, or hand-foot-and-mouth disease virus. The diagnosis of infection with herpesvirus was not considered until herpesvirus was visualised in vesicular fluid by electron microscopy six weeks after onset. HSV-2 was then repeatedly isolated from vesicular fluids over the next four years. Detailed serological tests on the patient's sequential serum samples demonstrated a specific and continued response to HSV-2. He possibly acquired the virus iatrogenically, either by oral droplet transmission into or finger contamination of a PPD injection site, from the nurse who administered the injection and then palpated the site.
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PMID:Herpes type 2 infection with unusual generalised manifestations and delayed diagnosis in an adult male. 687 92

Two previously healthy men, aged 54 and 41 years, fell ill with headaches and increased fatiguability, one also with vomiting, the other with fever, transitory visual disturbances and slight weakness of the left hand. Both of them had a stiff neck and clouded consciousness. The EEG had moderate to severe dysrhythmia, predominantly over the temporal area, CSF showed an increased cell count of 1000/3, predominantly lymphocytes, and increased protein. The younger patient also had global aphasia and the computed tomography indicated an area of decreased density in the left temporal region. In the CSF there were locally produced IgG. The clinical findings were similar to those of herpes encephalitis, but were milder and regressed more quickly. Severe months later only a few minor organic behavioural changes were present. Antibody findings in CSF and serum suggest varicella-zoster virus as the causative agent, although in both instances no rash was observed throughout the entire period of observation.
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PMID:[Zoster encephalitis without rash: report of two cases (author's transl)]. 707 5

The authors discuss computed tomography (CT) and magnetic resonance imaging (MRI) findings of herpes encephalitis as important adjuncts to the early diagnosis of this entity. The patient was a 42-year-old HIV-negative male who presented with a history of dizziness, headaches, and fever.
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PMID:Imaging of herpes simplex encephalitis. 841 11

Infections of the nervous system remain a significant source of morbidity and mortality in patients with cancer. This paper reviews the main pathogens and emphasizes some of the principles of diagnosis and management of nervous system infections in cancer patients. Due to immunosuppression, diagnosis is more difficult in this group, secondary to the multitude of potential pathogens, and often by their atypical presentations. Fever or headache are often the only symptoms. Clinical history and general examination should guide appropriate studies such as neuroimaging. CSF analysis, cultures, and brain biopsy. Diagnostic evaluation should be pursued rapidly and aggressively since specific treatments can often reduce morbidity and mortality. Bacterial infections are generally due to break-down of the natural barriers and neutropenia. In neutropenia, Pseudomonas aeruginosa, and Enterobacteriae are the most frequent etiology. If all causes of immunodepression are included, Listeria monocytogenes meningitis is the main bacterial infection encountered. Fungal infections have emerged as a major cause of death among cancer patients. The prognosis of cryptococcosis and histoplasmosis meningitis are markedly improved with new antifungal therapy. Aspergillosis and Mucormycosis, which may cause cerebral abcesses and secondary vascular complications, are almost always fatal. The incidence of meningo-cerebral Candidiasis is often underestimated. Similar to Histoplasmosis, it is frequently disseminated. Viral infections are mainly seen in patients with T-lymphocyte defects. Herpes-simplex virus and Varicella-Zoster virus encephalitis should quicky lead to intravenous treatment with Acyclovir. As in AIDS patients, cerebral toxoplasmosis is the most frequent parasitic infection and appropriate therapy greatly reduces morbidity. It should be emphasized that multitude pathogens are often seen in cancer patients. Despite development of new therapeutic agents, central nervous system infections should still be considered life-threatening. Therefore, antibacterial, antifungal, and antiviral prophylaxis should be the rule for all cancer patients.
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PMID:[Central nervous system infections in patients with malignant diseases]. 903 51

Aseptic meningitis is not an uncommon complication to primary genital herpes infection caused by herpes simplex virus type 2 (HSV-2). Compared with other types of viral meningitis, HSV-2-meningitis is associated with a significant rate of neurological complications in the acute stage. In addition, some patients will suffer from recurrent aseptic meningitis (Mollaret's meningitis) later. We describe six patients, five women and one man, age 26-35 years, with aseptic meningitis caused by HSV-2. All the patients showed serological evidence of primary herpes infection (negative HSV-IgG and/or positive HSV-IgM in serum samples). Polymerase chain reaction detected HSV-2 in cerebrospinal fluid in all five of five cases, while virus cultures were positive in two of the six cases. Only three patients showed clinical signs of simultaneous genital herpes infection. One patient, a 28-year-old female, developed transient autonomic nervous system dysfunction with urinary retention, constipation, and neuralgic pain in the buttocks, perineum and lower limbs. 13 months later she was hospitalised for a genital herpes infection with headache, parestesia and fever, but spinal fluid examination showed no abnormality.
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PMID:[Serous meningitis associated with primary genital herpes infection]. 926 74


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