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

The most common clinical signs for chronic subdural hematoma in adults are: motor weakness, increased intracranial pressure, confusion and loss of consciousness. This pathology is more frequent in the elderly over 65 years, the diagnosis also being more difficult in this case. Some misleading clinical presentations may delay the decision to perform a CT scan to assess the diagnosis. Preoperative headaches and isodensity in CT-scan are features of good prognosis. Chronic alcoholism and postoperative pneumocephalus are related with poor prognosis.
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PMID:[Clinical forms and prognostic factors of chronic subdural hematoma in the adult]. 1191 59

We report the case of a 76-year-old man who received a spinal anaesthesia for inguinal hernia repair surgery. A cranial CT scan which was performed because the patient complained of postoperative headache and hemiparesis showed an important pneumocephalus. Because postoperative questioning revealed that the patient had a chronic and neglected rhinorrhea, we hypothesise that this pneumocephalus was secondary to an old unknown osteodural leak with intracranial air entry secondary to the spinal anaesthesia-releated decrease in CSF pressure.
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PMID:[Pneumocephalus after spinal anesthesia]. 1196 88

Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil-based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma. Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal. Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.
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PMID:Neurologic deficits and arachnoiditis following neuroaxial anesthesia. 1249 90

Recently, a controversy has arisen as to whether air or saline should be recommended for the correct localization of the epidural space with the loss of resistance technique. I report a case of a previously healthy parturient who developed pneumocephalus and severe headache following the use of the loss of resistance to air (LORA) technique to identify the epidural space. This case report raises one more time the question about the safety of the LORA technique for labor analgesia.
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PMID:Post-dural puncture headache, intracranial air and obstetric anesthesia. 1450 6

Pneumocephalus is commonly seen after head and facial trauma, tumors of the skull base, after neurosurgery or otorhinolaryngology, and rarely spontaneously. Venous air embolism can result from right-to-left shunting or pneumocephalus. We report two cases of pneumocephalus, one after surgery of the paranasal sinus and the other after transabdominal prostatectomy. Clinical signs of the pneumocephalus were headache followed by epileptic seizures and, respectively, severely impaired consciousness after the operation. Treatment was either revision of the skull base with craniotomy or conservative therapy of the brain edema. Based on these case reports and the medical literature on pneumocephalus, we review the causes and treatment of this rare condition.
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PMID:[Management and causes of pneumocephalus. Case report and review of the literature]. 1590 80

We report a case of atraumatic pneumocephalus associated with prolonged use of nasal continuous positive airway pressure. Initial symptoms included headache, ataxia, vertigo, and a "gurgling" sensation in the head; and a CT image showed small air bubbles along the falx of cerebrum and adjacent to the temporal epidural spaces bilaterally. Although no evidence of cerebrospinal fluid (CSF) leak was either reported by the patient or found at initial clinical examination, subsequent nasal discharge tested positive for beta2-transferrin, a finding consistent with CSF leak in the paranasal sinus region or through the cribriform plate. To try to prevent infection from an open communication between the paranasal sinuses and intracranial structures, an attempt should be made to localize the anatomic defect.
Headache 2005 May
PMID:Atypical headache after prolonged treatment with nasal continuous positive airway pressure. 1595 84

Pneumocephalus in hydrocephalic shunted patients is very rare. So far only 46 cases have been described in the literature. A case of pneumocephalus in a patient with shunted hydrocephalus, and the diagnostic and therapeutic problems were described. A 38-year-old woman suffered from a subacute headache, dizziness and bradyphrenia. Eight years ago, the ventriculo-atrial shunt was implanted due to idiopathic hydrocephalus, and the shunt was changed 2 months before the present admission (ventriculo-peritoneal valve). CT and MRI revealed pneumocephalus, but neither clinical nor radiological symptoms of the CSF fistula were found. After temporary ligation of a distal catheter, the anterior fossa and a sellar area were directly repaired via right fronto-temporal craniotomy, with a good outcome. In the case of pneumocephalus in hydrocephalic shunted patients, the direct closure of the skull base fistula via craniotomy combined with restoration of the proper shunt function is usually the most effective treatment. If the site of the fistula can not be established, dural cranioplasty in the most likely site of the fistula is recommended.
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PMID:[Pneumocephalus after shunt in a patient with hydrocephalus. A case report and review of the literature]. 1635 12

Pneumocephalus is a rare complication of epidural block which typically occurs when the loss of resistance to air technique is used to identify the epidural space. We present a case of pneumocephalus with headache in a parturient following apparently uncomplicated labour epidural analgesia.
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PMID:Pneumocephalus with headache complicating labour epidural analgesia: should we still be using air? 1728 74

Chronic otitis media, unlike trauma, seldom leads to the development of tension pneumocephalus. Rarely, it occurs as a complication of mastoid surgery. A Melanesian woman sought treatment for loss of speech, hemiparesis, and headache 4 weeks after undergoing canal-down mastoidectomy for cholesteatoma. The tension pneumocephalus was decompressed urgently by aspirating air via a cannula through the burr hole, and the mastoid cavity was obliterated. She recovered completely. Twelve additional patients with postmastoidectomy pneumocephalus reported in the literature are reviewed.
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PMID:Postmastoidectomy pneumocephalus: case report. 1716 74

Unintentional dural puncture is the most frequent cause of postdural puncture headache (PDPH) in epidural anesthesia and analgesia. Conservative treatments of PDPH include bed rest, oral analgesics, and hydration. When conservative measures fail, epidural blood patch is an effective substitute. However, epidural blood patch carries some risks, such as subdural hematoma, pneumocephalus, exacerbation of PDPH and new dural puncture. Many patients may refuse the procedure due to the risks involved. We describe a female patient who had her PDPH successfully treated with epidural saline delivered by a patient-controlled analgesia device (Abbott Pain Management-APM) without molestation of her daily activities.
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PMID:Management of postdural puncture headache by epidural saline delivered with a patient-controlled pump--a case report. 1723 68


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