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

A preadolescent with headache and stiff neck presented for emergency department care. The presumptive diagnosis of viral meningitis was entertained on the basis of clinical examination and cerebrospinal fluid analysis. Events subsequent to his release from the department formed the stimulus for this report. It is apparent that patients with complicated sinusitis may present with a constellation of findings consistent with viral meningitis.
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PMID:An aseptic meningitis picture from incipient brain abscess. 151 39

We review the 257 patients hospitalized for meningitis in the Cantonal University Hospital, Geneva between 1st January 1980 and 31st December 1986. 104 patients had acute bacterial meningitis (32 Str. pneumoniae, 21 N. meningitidis, 10 Listeria monocytogenes, 8 streptococci, 5 H. influenzae, 5 staphylococci, 4 gram negative bacilli and 19 without identified bacteria), 124 patients had viral meningitis and 29 meningitis of other etiologies (6 tuberculous meningitis, 2 fungal meningitis, 1 leptospiral meningitis, 5 neoplastic meningitis--one already counted because of a meningitis due to Staph. epidermidis--2 meningitis consecutive to a meningeal irritation, 4 already treated meningitis of undetermined etiology, 2 chronic meningitis and 8 meningoencephalitis). The total mortality was 14.4%. It was zero in viral meningitis and 28% in bacterial meningitis (47% in cases of Str. pneumoniae, 5% in cases of N. meningitidis, 20% in cases of Listeria monocytogenes, 38% in cases of streptococci, 0% in cases of H. influenzae, 60% in cases of staphylococci, 50% in cases of gram negative bacilli, 16% in cases of unidentified bacteria). The striking difference in mortality emphasizes the importance of recognizing a bacterial etiology in order to institute antibiotic therapy as soon as possible. The delay between admission and lumbar puncture averaged 15 hours (range 0.25-96 h) in patients with acute bacterial meningitis and 6.3 hours (0.5-80 h) in patients with viral meningitis. The delay between admission and institution of the antibiotics averaged 5.3 hours (1-48 h) in cases of acute bacterial meningitis and 4.8 hours (0.5-48 h) in cases of viral meningitis. A better clinical workup may provide a reliable diagnosis sooner. In the collective with bacterial and viral meningitis headaches, fever or nuchal rigidity were present in over 80% of the cases. The following features were significantly associated with a bacterial etiology: age over 30 years, alcoholism, concomitant neoplasm, cough, coma, pulmonary rales, new neurological signs or petechia. At least one of these 4 latter signs was present in more than 70% of the cases with acute bacterial meningitis compared to 6% in cases of viral meningitis. Thus the clinical presentation alone serves to recognize the meningitis and to differentiate between a bacterial or viral etiology, thus permitting an immediate therapeutic decision without waiting for complementary investigations. The 104 patients with acute bacterial meningitis were treated with antibiotics: 60 with penicillin, 17 with ampicillin and 26 with other antibiotics; one case did not receive antibiotics. More than the half of the cases with viral meningitis have got antibiotics (52%).
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PMID:[Meningitis in adults in Geneva. Review of 257 cases]. 185 79

Mumps virus is one of the most common causes of viral meningitis. Although brain involvement has been observed in a low proportion of children with mumps meningitis, a pure form of mumps encephalitis is extremely uncommon in the adult. A 23 year-old man presented with a rapidly evolving syndrome of cephalalgia , vomiting, mutism, disorders of gait, somnolence and dystonic movements. The electroencephalogram showed a diffusely slowed background activity. The CSF contained no cells, but the total protein concentration was elevated. The patient recovered without sequelae, but severe intellectual and motor disturbances persisted during more than a month. Serological studies showed an increase of blood IgM mumps-specific antibodies. We conclude that mumps encephalitis, although infrequent, should be considered among viral diseases that mimic herpes simplex encephalitis in the adulthood.
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PMID:[Mumps encephalitis in adulthood]. 205

In Part I of this article, we present our data collected over the past 8 years on the clinical evaluations of pediatric brain tumors with an emphasis placed on the more common neoplasms. Our data consists of 385 children ranging in age from newborn to 18 years. The majority of children presented with signs of raised intracranial pressure (including nausea, vomiting, and headaches), seizures or other focal neurologic deficits. Five percent of our children presented to outlying hospitals with symptoms that retrospectively turned out to be due to brain neoplasms but were misdiagnosed as "gastroenteritis," "viral upper respiratory tract infection," or even viral meningitis. These delays in diagnosis can cause serious negative outcomes for these patients and can be avoided through more careful neurologic and ophthalmologic examination at the time of first presentation. Central nervous system neoplasms are not uncommon in children and any child presenting with nausea, vomiting, and headaches should raise the suspicion of a primary brain tumor and should receive both a thorough neurologic exam and screening for papilledema. If papilledema is present, these children should be referred for proper neuroradiologic evaluation (which will be addressed in Part II.
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PMID:The clinical and radiological evaluation of primary brain tumors in children, Part I: Clinical evaluation. 836 34

A retrospective analysis of all patients admitted with the diagnostic codes of aseptic or viral meningitis was performed at two institutions over 3 years. Forty-one patients with cerebrospinal fluid confirmation of aseptic meningitis (increased protein; increased white count; negative gram stain; and negative fungal, tuberculosis, and bacterial cultures) were analyzed. All the patients had headache, which was typically severe and bilateral in 39 of the 41 patients. The headache was of abrupt onset or the worst of the patient's life in 24 of the patients. The quality of the headache, when described, was usually throbbing (11 of 14). Nineteen patients had prodromal symptoms, including malaise, myalgia, gastrointestinal symptoms, and urinary tract infections. All had associated symptoms, including nausea (25), vomiting (23), photophobia (18), stiff neck (25), and back pain (11). Thirty patients were febrile. Lumbar puncture was performed for headache and fever unexplained by systemic illness in 30 patients, meningeal signs in 15, headache of abrupt onset or the worst headache ever in 24, neurologic signs or symptoms in 12, and for other reasons in 2. Computerized tomography, when performed, was negative in all cases. Focal neurologic findings were present in 5 patients, a decreased level of consciousness in 6, and papilledema in 1. A severe headache that worsens, is abrupt in onset, or is the worst of the patient's life could be due to aseptic meningitis, bacterial meningitis, or a subarachnoid hemorrhage. Although not universally present, meningeal signs, fever, and neurologic signs or symptoms should alert one to a possible central nervous system infection.
Headache 1995 Oct
PMID:Headache associated with aseptic meningitis. 853 Feb 75

Dihydroergotamine and metoclopramide have been used in the treatment of benign headache for many years. The presumed mechanism of action of dihydroergotamine and metoclopramide is related to these drugs' affinity for serotonergic receptors. We present three cases of the use of dihydroergotamine and metoclopramide in patients with organic headache (two patients with viral meningitis and one patient with meningeal carcinomatosis). All three patients had excellent symptomatic relief. Our results demonstrate that dihydroergotamine and metoclopramide can be effective in treating organic headache and, therefore, symptomatic relief can not be assumed to signify benign disease.
Headache
PMID:Dihydroergotamine and metoclopramide in the treatment of organic headache. 855 Mar 66

A 33-yr-old man came to the emergency department with the chief complaint of a severe headache and decreased sensation in his right hand following a deep dive on scuba. Physical examination before recompression treatment was remarkable only for hypesthesia on the right hand. We diagnosed type II decompression sickness and the patient underwent standard recompression therapy. The patient experienced near-complete resolution of his symptoms, his only residual complaint being that of neck pain with head movement. To investigate other causes of headache, a computed tomography of the head was performed which was normal, and a lumbar puncture was performed which was consistent with viral meningitis. This is the first reported case of recompression treatment on a patient with viral meningitis and decompression sickness.
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PMID:Case report on a diver with type II decompression sickness and viral meningitis. 898 55

Intracranial hypotension causes the postural headache that sometimes follows lumbar puncture. When postural headache and associated symptoms occur after lumbar puncture, the diagnosis is usually obvious. However, similar symptoms may occur after minor trauma or without an obvious precipitating cause (spontaneous intracranial hypotension: SIH). SIH is rare, but is now increasingly recognized as a cause of postural headache. We encountered two cases of SIH showing typical neuroradiological findings. Case 1 is a 47-year-old man who was admitted with severe frontalgia. CT scan revealed vague visualization of bilateral Sylvian fissures and slit ventricles. Spinal fluid pressure was 6cm H2O in the lateral recumbent position. Cerebrospinal fluid (CSF) showed slight lymphocytic pleocytosis. We treated him as having viral meningitis. His headache improved gradually and he was discharged 2 weeks later with slight occipitalgia. One week after discharge, he complained of severe headache again and plain CT showed bilateral subdural hematoma. The subdural hematoma in both sides was evacuated and his headache improved after the operation. Follow-up CT scans two months later showed normalization of ventricle size and cisterns. Case 2 is a 52-year-old woman who was admitted with severe occipitalgia. CT scan on admission showed slit ventricles and the disappearance of the suprasellar cistern and the Sylvian fissure. Spinal fluid pressure was 3cm H2O. Gd-enhanced MRI showed remarkable meningeal enhancement and effacement of the optic chiasm suggesting brain sagging. Her headache improved 2 weeks later after strict bed rest and oral pain relief drugs. The follow-up MRI showed disappearance of abnormal meningeal enhancement and normalization of optic chiasma effacement. SIH is one of the important differential diagnoses of patients complaining of postural headache. Meningeal enhancement of gadolinium-enhanced MRI is an important finding to diagnose SIH. We have to consider SIH when diagnosing postural headache.
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PMID:[Spontaneous intracranial hypotension with severe headache and typical neuroradiological findings: report of two cases]. 914 2

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

Ferritin concentrations in cerebrospinal fluid (CSF) of 16 patients with glioblastoma were found to be very high (mean, 103.0 ng/mL) relative to 29 patients with viral meningitis and 20 patients with headache (mean concentrations, 5.4 and 4.3 ng/mL respectively). Simultaneous measurement of ferritin in CSF and serum revealed CSF concentrations exceeding those in serum in 11 of 16 patients with glioblastoma (CSF vs. serum ratio, 132.6%), contrasting with very low ratios in patients with meningitis (7.9%) or headache (4.9%). Ferritin was detected immunocytochemically in tumor cell cytoplasm in a resected glioblastoma. Thus, ferritin in CSF appears to be produced by glioblastoma cells, with a biologic significance requiring further investigation.
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PMID:Cerebrospinal fluid ferritin in glioblastoma: evidence for tumor synthesis. 987 85


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