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

We report an analysis of clinical course of 18 patients presenting with Staphylococcus aureus sepsis. Community acquired infection was caused by Methicillin susceptible S. aureus (MSSA) in 11 patients. MSSA in 3 and Methicillin Resistant S. aureus strains (MRSA) in 4 patients, were the etiologic factor in 7 patients with nosocomial infection. From anamnestic data patients presented with: elevated body temperature--18/18, arthralgia and myalgia--9/18, headache--8/18, nausea--6/18, chills--2/18. Physical examination on admission revealed: meningismus--12/18, hepatomegaly--11/18, purulent and haemorrhagic skin lesions--7/18 and impaired neurological status (Glasgow Coma Scale < or = 12)--6/18. The mean APACHE III score, calculated from data collected at diagnosis of sepsis was 47 (7-114). Several complications had been observed: endocarditis--10, purulent meningitis--5, focal CNS lesions--5, pneumonia--8, pulmonary abscess--3, hydrothorax--1, abscesses of the spleen--5, renum--4, osteomyelitis--2. 11/18 patients required ICU treatment. Ventilator assistance of respiration was necessary in 7/18. Acute thrombocytopenia (< 100,000/ml) was diagnosed in 60%. In 5 patients suppurative meningitis had been diagnosed with a mean pleocytosis-837 (173-1898) microL. The results of treatment were satisfactory in 11 patients, 3 patients required further surgical treatment (2--cardiosurgery, 1--orthopedic surgery), 4 patients died. Infection caused by community acquired MSSA strains had been characterized by severe clinical course with increased incidence of endocarditis, organ failure and abscess forming. We conclude that Staphylococcus aureus sepsis is still a life-threatening disease, which should be treated at centers with immediate access to imaging techniques of CNS and circulatory system as well as intensive care and cardiosurgery. Community acquired S. aureus sepsis compared with nosocomial infection is characterized by more severe clinical course and higher mortality, despite of a great susceptibility to most antibiotics of causative S. aureus strains.
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PMID:[Staphylococcus aureus sepsis--still life threatening disease]. 1177 Mar 18

A 52-year-old man complaining of headache and nuchal pain was treated initially under a diagnosis of bacterial meningitis. The meningitis resisted antibiotic therapy, and one week later was complicated by a ruptured retropharyngeal abscess, which led to the correct diagnosis of osteomyelitis of the odontoid process of the axis. His neck was immobilized in a high neck collar and the retropharyngeal abscess was treated by repeated drainage and irrigation. A long course of antibiotic administration finally resolved the infection. Osteomyelitis of the odontoid process is rare and presents with peculiar signs and symptoms. Careful consideration of the differential diagnosis is needed for the early detection of this potentially serious condition.
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PMID:Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess--case report. 1241 70

Acute frontal sinusitis can be a serious condition because of its potential life-threatening complications. These complications, including spread of infection to the frontal bone and intracranially, require prompt diagnosis and intervention to avoid morbidity and mortality. We report a case of acute frontal sinusitis in a 16-year-old girl who presented with fever, severe headache, and vomiting of 3 days' duration. Generalized fluctuant swelling of the nasal root, and bilateral supraorbital and frontoparietal regions was noted. Computed tomography (CT) demonstrated left pansinusitis, extensive subgaleal abscess and epidural empyema with osteomyelitis of the frontal bone. External frontoethmoidectomy with mucoperiostectomy were performed. Endoscopic sinus surgery was then conducted for intranasal ethmoidectomy. Intraoperative cultures grew viridans streptococci, coagulase-negative staphylococci and Peptostreptococcus micros. The patient received 3 weeks of treatment with intravenous antibiotics (penicillin 3 MU 4-hourly, ceftriaxone 500 mg 12-hourly, metronidazole 500 mg 6-hourly) and was discharged uneventfully and prescribed additional oral antibiotics for 5 weeks (clindamycin 150 mg 6-hourly and chloramphenicol 250 mg 6-hourly). CT revealed complete resolution of the abscess and clear maxillary and ethmoid sinuses at 7 weeks posttreatment. The patient was free of sinus infection at 4-years follow-up, without noticeable cosmetic deformity.
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PMID:Extensive subgaleal abscess and epidural empyema in a patient with acute frontal sinusitis. 1287 74

We report on a 70-year-old female with acute onset of headache, meningism, xanthochromic cerebrospinal fluid, and developing laboratory parameters indicating a systemic infection. Initially, a subarachnoidal hemorrhage was assumed. However, magnetic resonance imaging showed upper cervical osteomyelitis and extending spinal epidural abscess. After application of broad systemic antibiotics, secluded abscess formation was achieved and successful neurosurgical debridement performed. The unusual cranial concentration of the complaints is probably due to the involvement of the craniocervical transition. Cervical epidural spinal abscess represents a potentially dangerous bacterial infection of the upper spine. Inadequate treatment can lead to irreversible neurological deficits. Cervical magnetic resonance imaging is an effective tool for diagnosis, since early diagnosis is important for good prognosis.
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PMID:[Acute headache with meningism and xanthochromic cerebrospinal fluid.An unusual manifestation of cervical epidural abscess]. 1290 72

The surgical records of three podiatric physicians were reviewed to identify all chevron-type osteotomies performed during 2000-2001 for the correction of bunion deformity, and complications were reviewed for each. In the 95 cases identified, 15 complications occurred in 12 patients. Of these 15 complications, 4 were soft-tissue infections (4 patients), 4 were cases of painful hardware (3 patients), 4 were cases of second metatarsal head pain (2 patients), 2 were cases of cystic changes initially interpreted as osteomyelitis but later determined to be degenerative changes (2 patients), and 1 was a case of stiff toe (1 patient). There were no cases of avascular necrosis, hallux varus, or recurrence.
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PMID:Complications of screw-fixated chevron osteotomies for the correction of hallux abducto valgus. 1462 93

Bilateral Osteomyelitis following frontal sinusitis is a rare complication in the antibiotic era. The main risk of a progredient course is mainly the formation of external subperiostal, epidural, subdural abscesses or brain abscesses with potentially life-threatening complications. This is a report on a patient who presented in our department with progredient cephalgia and swelling in the area around the glabella and frontal sinus. Macroscopical examination revealed septum deviation to the right side and nasal polyposis of the right nasal passage. A computed tomography of the paranasal sinuses showed subtotal soft tissue obstruction of all sinuses with the exception of the sphenoidal sinus. Bilateral osteolysis of the ventral osseous borders of the frontal sinus with accompanying osteosclerosis was also observed. The therapy consisted of radical frontal sinus surgery via Unterberger approach. This case demonstrates a rare case of bilateral frontal osteomyelitis together with the necessary diagnostic and therapeutic measures. The management consisted of the removal of all osteomyelitic bone and antibiotic therapy. Differential diagnostic procedures must be carried out in order to exclude orbital and intracranial complications. Regular follow-up examinations and a CT scan of the paranasal sinuses are part of the standard therapy.
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PMID:[The interesting case -- case no. 65]. 1553 65

Ring-enhancement on CT (RECT) is generally considered a sine qua non in diagnosing a cerebral abscess. We describe a 16-year-old female who presented with headaches, vomiting and drowsiness, which over 2 weeks rapidly progressed to coma. CT demonstrated a moderately large left frontal extradural abscess, associated with contiguous left frontal osteomyelitis, and underlying frontal and ethmoidal sinusitis. In addition, there was a large circular low density area within the left frontal lobe associated with midline shift that, owing to negative RECT, was assumed to represent nascent ischaemic cerebritis. Despite emergency twist-drill drainage of the extradural abscess, and antibiotic/corticosteroids administration, her clinical condition continued to deteriorate and two episodes of uncal herniation were reversed medically. Repeated CT, however, continued to demonstrate negative enhancement within the left frontal low density, although significant enhancement continued to be apparent with recurrent contiguous extradural suppuration. At definitive craniotomy, a large, well-encapsulated abscess cavity was excised from the left frontal lobe corresponding precisely to the area of previously negative enhancement, along with drainage of the recurrent extradural abscess. Thus, in addition to well-known 'false-positives' for RECT with a cerebral abscess, our case highlights the rare occurrence of a 'false-negative'. A low density mass lesion on CT with persistent negative RECT can neither be assumed to represent early cerebritis nor to exclude a mature abscess.
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PMID:Persistent absence of ring-enhancement on CT with an encapsulated brain abscess. 1570 39

Clinical and laboratory features, complications and treatment were retrospectively studied in 70 patients with bacteriologically documented typhoid fever, treated between January 1995 and June 2002 at Principal Hospital in Dakar, Senegal. Data analysis was done on a global basis as well as comparatively between the 37 children (under 15 years) and 33 adults. Mean age was 16.7 years (range, 1 to 52). The sex ratio was 1.4. Clinical manifestations included fever (97%), headache (50%), vomiting (71%), abdominal pain (54%), diarrhoea (49%), nnd splenomegaly (10%) without statistically significant difference between children and adults. Lyinphopenia was found in 51% of patients and anaemia in 78%. Coexisting illnesses Included malaria in 25.5% (mainly children) and hepatitis (transminases > 10N) in 24%. Complications included cholecystitis in 3 patients, gastrointestinal haemorrhage in 2, peritonitis in one, endocnrditis in one and osteomyelitis in one. Only one patient (HIV-positive) died. The incidence of antibiotic resistance was low, i.e., ainoxicilline: 2%, nalidixic acid: 1% and cotrimoxazole: 8.2%. No multidrug resistance was observed. This study shows that typhoid fever remains a major health problem in Dakar with slow resolution and potential complications. Amoxicililne and chloramphenicol can still be used for first-line treatment of typhoid fever. Little difference was found between children and adults.
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PMID:[Clinical and laboratory features of typhoid fever in Senegal. A 70-case study]. 1655 13

The Pott puffy tumor is a subperiosteal abscess of the frontal bone that appears as a localized swelling of the overlying region of the forehead associated with frontal osteomyelitis. The authors report the case of an 11-year-old boy who presented with a 6-week history of frontal headaches and a recent sudden-onset, progressively enlarging swelling of his midline forehead associated with immediate relief of headaches. A computed tomography (CT) study revealed 1) a subperiosteal abscess with intracranial extension through the perforated posterior table of the frontal sinus and 2) a large epidural abscess overlying a compressed and narrowed superior sagittal sinus. Emergency surgical relief of the epidural abscess, curettage of the osteomyelitic bone, and excision of the periosteal granulomatous puffy lump were performed. A 6-week course of intravenous antibiotic medication was completed, and the patient had an excellent recovery. The Pott puffy tumor remains a serious complication of frontal sinusitis. In the past 5 years, the frequency of published pediatric cases has increased. Undiagnosed or partially treated frontal sinusitis may lead to this serious complication, and the apparent increase in incidence rate may suggest that this complication of frontal sinusitis could be underestimated in clinical practice. The authors conclude that early diagnosis and complete treatment of frontal sinusitis is crucial.
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PMID:The Pott puffy tumor revisited: neurosurgical implications of this unforgotten entity. Case report and review of the literature. 1692 77

Osteomyelitis of the skull base is a rare disorder, and even more so when the etiology is noninfectious. Symptoms are noisome and include headache and cranial nerve deficits. Because of the possibility of neoplasia, thorough evaluation, accurate diagnosis, and effective treatment are mandatory. In the case reported herein, a 58-year-old man with a 3-month history of symptoms is presented. Physical examination disclosed cranial nerve involvement. Nasopharyngeal biopsy and culture in combination with MRI and a gallium bone scan established the diagnosis of osteomyelitis at the base of the skull. The patient was effectively treated with antibiotics and had a complete recovery.
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PMID:Idiopathic osteomyelitis at the base of the skull. 1710 33


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