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

The authors report the case of an AIDS patient with rare neurologic manifestations: primary vasculitis of the central nervous system and VIII cranial nerve dysfunction. The authors make a review on the subject, and call special attention for the differential diagnosis. In fact, the patient, a 36 year old woman, with promiscuous life, presented with dizziness, gait ataxia, nausea, headache and hypoacusia. Seven days after the admission, she noted blurred vision in both eyes and soon she became blind. The physical examination showed bilateral optic neuritis and vestibulocochlear dysfunction, stiff neck and fever. No abnormalities were detected on CT scan. CSF showed 40 mononuclear cells/mm3, 79 mg/dl of proteins and normal glucose content. Microbiological research was negative. Serum anti-HIV test was positive. The hypothesis of primary CNS vasculitis was made, and pulse methylprednisolone therapy was introduced with good recovery of neurological syndrome except for persistent amaurosis.
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PMID:[Isolated vasculitis of the central nervous system and involvement of the 8th cranial nerve: rare manifestations of acquired immunodeficiency syndrome]. 130 67

Nervous system opportunistic infections are seen in about one fifth of AIDS cases and account for over 40% of the patients with neurological manifestations. Serious infections are seen in severely immunosuppressed patients, usually with CD4 counts of 200 ml-1 or less. The commonest is CMV, which can produce acute encephalitis, sometimes with focal hemisphere or brain-stem signs, dementia, retinitis, optic neuritis and an ascending radiculomyeloencephalitis. Cryptococcal meningitis is the most frequent fungal disease; a high degree of clinical suspicion is required in patients with fever, malaise, headache or seizures. Only CSF cultures are always positive; both serum and CSF cryptococcal antigen tests are highly sensitive and specific. Treatment with amphotericin B and flucytosine is successful in at least 70% of first episodes but side-effects are common. Without maintenance therapy 50% of patients relapse; fluconazole is recommended. Cerebral toxoplasmosis can present with focal cerebral or spinal cord signs but also as a diffuse encephalopathy; negative T. gondii serology is exceptional but positive serum titres are usually unhelpful. Treatment with sulfadiazine, pyrimethamine and folinic acid achieves good results in 90% of the first episodes, but side-effects are common. Appearances on CT scan or MRI may take several weeks to improve. The value of an empirical approach to treatment is well-established; an initial cerebral biopsy is difficult to justify. Without maintenance therapy a relapse rate of 50% can be expected; therapy with sulfadiazine and pyrimethamine may also prevent pneumocystosis. HIV disease appears to increase the likelihood of neurosyphilis, and the risk of relapse after conventional penicillin doses, in patients with syphilis; at least 3-4 weeks of appropriate therapy are recommended. A number of other diseases caused by viruses, fungi, bacteria and parasites are less common; these include progressive multifocal leukoencephalopathy, herpes simplex and zoster infections and tuberculosis.
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PMID:Central nervous system opportunistic infections in HIV disease: clinical aspects. 134 47

Multiple sclerosis (MS) is frequently regarded as a painless condition. A review of the literature reveals that approximately 2/3 of the patients with multiple sclerosis will experience painful syndromes during the course of disease and that these are associated with the disease. Acute syndromes are described: Trigeminal neuralgia, Lhermitte's sign, optic neuritis and tonic seizure. Chronic syndromes: Dysaesthesia, pain in extremities, muscular spasms, low back pain and headache. The frequency, causes and suggestions for treatment are mentioned. A Danish investigation has revealed that only 42% of a representative section of DS patients received adequate treatment for pain. It is thus concluded that optimal treatment of pain in MS patients is necessary.
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PMID:[Painful syndromes connected with disseminated sclerosis]. 153 48

The term "papilledema" describes optic disc swelling resulting from increased intracranial pressure. A complete history and direct funduscopic examination of the optic nerve head and adjacent vessels are necessary to differentiate papilledema from optic disc swelling due to other conditions. Signs of optic disc swelling include elevation and blurring of the disc and its margins, venous congestion, and retinal hard exudates, splinter hemorrhages and infarcts. Patients with papilledema usually present with signs or symptoms of elevated intracranial pressure, such as headache, nausea, vomiting, diplopia, ataxia or altered consciousness. Causes of papilledema include intracranial tumors, idiopathic intracranial hypertension (pseudotumor cerebri), subarachnoid hemorrhage, subdural hematoma and intracranial inflammation. Optic disc edema may also occur from many conditions other than papilledema, including central retinal artery or vein occlusion, congenital structural anomalies and optic neuritis.
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PMID:Papilledema: clinical clues and differential diagnosis. 154 98

Pain around the eye can be caused by local ophthalmic disorders or by disease of other structures sharing trigeminal nerve sensory innervation. In general, most ocular causes for pain also cause the eye to be red, thus alerting the examiner to the focality of the problem. However, conditions like eyestrain, intermittent angleclosure glaucoma or neovascular glaucoma, and low-grade intraocular inflammation can be painful and not be associated with obvious redness. Ocular signs and symptoms also occur with numerous other causes of headache. Double vision in association with periocular pain can result from orbital lesions, isolated cranial neuropathies, and cavernous sinus lesions. Pupillary abnormalities like Horner's syndrome may result from a variety of painful conditions, including cluster headache, parasellar neoplasms or aneurysms, internal carotid dissection or occlusion, and Tolosa-Hunt syndrome. Pain with a dilated and unreactive pupil may reflect a benign condition like Adie's syndrome or ophthalmoplegic migraine, or it may herald the presence of a life-threatening posterior communicating artery aneurysm. Headache and transient visual loss can be manifestations of classic migraine, or be symptoms of ocular hypoperfusion from ipsilateral internal carotid occlusion or increased intracranial pressure from pseudotumor cerebri. In a young patient, head pain with a fixed visual deficit may result from optic neuritis, in an older adult, temporal arteritis may be the culprit. Ophthalmologic aspects of headache thus encompass problems that range from simple and benign to complex and formidable.
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PMID:Ophthalmologic aspects of headache. 202 Feb 23

Eight cases of primary mucocele or tumor in the sphenoid sinus treated in our hospital from 1965 to 1988 are reported. Six were male, 2 female. The ages ranged from 18 to 33 years. The course of disease was 20 days to 4 years with an average of 16 months. The common symptoms were headache and serious visual disturbance or involvement of cranial nerves III, IV, V and VI. There were 4 cases of mucocele and 1 case of chondroma, aneurysmal bone cyst, squamous cell carcinoma and chondrosarcoma. All were operated and proven by pathology. The diseases of sphenoid sinus are very difficult to diagnose. In this series, 5 cases had been misdiagnosed. In the early stage, it was often misdiagnosed as retro-bulbar optic neuritis and in the late stage, as malignant tumor of the base of skull or pituitary tumor (4 cases). Sphenoid sinus cyst and benign tumor gave better results. Two patients with malignant tumor died 8 and 9 months of the operation.
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PMID:[Primary cyst and tumor in the sphenoid sinus]. 240 Nov 75

Visualization of transverse intracranial sinuses by means of standard radiograms of the skill is a rather unusual finding. In order to detect the radiological evidence of this important intracranial venous collector, the authors examined 5.638 radiograms, collected since January 1982 until December 1986 at the Neuroradiological Ophtalmic Centre of the University of Bologna. 87 cases (1.54%) resulted positive, with a prevalence of young (mean age 23 years) and female (88%) patients. Among these, an involvement of the optic nerve was the most consistent finding. In fact, it was observed in 47 cases (54%) suffering from: retrobulbar optic neuritis (25 cases), papillitis (13 cases), optic disk edema (6 cases), optic chiasma syndrome (2 cases) and stasis papilla (1 case). Moreover, the report of headache in 20 further cases may have significative implications with respect to the pathogenetic hypothesis about the accentuation of the transverse sinus. Our data suggest that a primitive inflammatory disorder, such as asymptomatic meningitis or meningoencephalitis--early developed in the life--, can induce a persistent local damage also with the radiological alteration. Thus, we presumed that this sign may represent a significant marker of a compromised anatomofunctional condition predisposing to relapsing inflammatory processes. A very interesting possible clinical correlation with demyelinating disorders is also discussed for its pathogenetic implications.
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PMID:Neuroophthalmological implications of the radiological finding of the transverse sinus. 277 May 30

A 16-year-old girl was admitted to our hospital in August 23, 1986, for headache, nausea and low grade fever. Marked increases in immunoglobulin indices were found in the cerebrospinal fluid. When she was 13, she was diagnosed as having SLE and lupus nephritis. On September 9, 1986, she complained of urinary retention, and pathological reflexes were elicited bilaterally. On September 13, she complained of a sudden loss of vision (count fingers) in the right eye which worsened to a visual acuity of light perception over the next 48 hours. A visual evoked response potentials (VEP) to flash stimulation gave a loss of amplitude and an increase in latency. On September 16, she complained of a similar loss of vision in the left eye. Leakage of dye around the left optic disc was found by a fluorescein angiogram on September 26. These results indicated a diagnosis of bilateral optic neuritis. Both visual acuity returned rapidly over the following month following oral prednisolone treatment. Optic neuritis is an exceedingly rare complication in SLE. Although the visual prognosis have been fairly good in the reported cases, some have resulted in various states of blindness. As for etiology of optic neuritis in our patient, ischemic change of optic nerves due to microvasculopathy as well as slight demyelinating process were speculated by the VEP pattern.
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PMID:[A case of systemic lupus erythematosus associated with meningitis, myelitis, and bilateral optic neuritis]. 277 56

A patient with paranasal sinus lymphoma (recognized retrospectively) developed unilateral, acute, self-limited optic neuritis during the course of chronic lymphocytic meningitis with elevated intracranial pressure and headache. Meningeal symptoms were adequately controlled with analgesics alone for 14 months and corticosteroids alone for a subsequent 11 months without evidence of development of other involvement of organs outside the central nervous system (CNS). Eventually, the visual alteration from optic neuritis prompted a repeat evaluation, which disclosed lymphoma in bone marrow. The subject of paraneoplastic optic neuritis is reviewed.
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PMID:Optic neuropathy associated with chronic lymphomatous meningitis. 297 50

Three patients with acute monocular central scotoma and headache had the initial diagnosis of optic neuritis. Computed tomography showed large pituitary adenomas with necrosis and cyst formation consistent with the clinical symptoms of a previous pituitary apoplexy. After transsphenoidal adenomectomy the visual disturbances disappeared.
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PMID:Acute monocular disturbances mimicking optic neuritis in pituitary apoplexy. 317 86


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