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

Craniopharyngioma, often with cystic diliatation, is difficult to resect radically. Fifty patients with huge craniopharyngioma (diameter of tumor was over 5 cm) treated with intratumoral irradiation of radioactive isotopes (32P and 90Y) through CT-guided Leksell stereotactic system are reported. The patients were 2 to 69 years of age with the disease of 1- to 12-year duration. Of the 50 patients, 21 had recurrent tumor after craniotomy, 29 without surgery operation before. All tumors were confirmed pathologically. The major clinical symptoms were as follows: visual field defect, headache, vomiting, diabetes insipidus, hemiplegia and growth retardation in juvenile cases. There was no death or serious complications following the treatment procedure. Partial response (> 50% reduction of tumor size on CT scanning with improvement of symptoms and signs) rate of the treatment was 82.0% at one month and 62.0% at 2 to 7 years after treatment.
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PMID:[Stereotactic intratumoral irradiation of huge craniopharyngioma]. 938 64

Fifty-six patients with craniopharyngiomas were operated by microsurgical techniques during a 20-year period. Of the 56 patients, 28 were males and 28 were females, with a mean age of 33 years (range 1 to 78 years). Twenty patients (35.7%) were less than 15 years of age. Remission was defined as clinical improvement with stable ophthalmological and neurological status, CT and/or MRI evidence of a decrease in tumor size or tumor disappearance when a patient was discharged from hospital. Ineffectiveness was defined as lack of change in the preoperative clinical status. The mean follow-up period in this study was 6.9 years, with 11 patients monitored. The most common presentation was visual dysfunction (69.6%). 33.9% of the patients presented with headache. The most frequent preoperative finding was a visual field defect, with 55.4% of the patients so affected; 39.5% of patients had preoperative hypothyroidism and 40% had hypoadrenalism. Diabetes insipidus was found preoperatively in 7.1%. Three female patients had amenorrhea. Hydrocephalus was uncommon, being present in only 10.7%. Unruptured aneurysms were found incidentally in 2 cases. A pterional approach was used in 29 patients (52%), a transcallosal approach in 13 (23%), a transcortical approach and a transsphenoidal approaches in 3 (5%), and a lamina terminalis approach in 1 patient. Multiple procedures were required in 8 patients in order to provide significant relief of compressive symptomatology. Overall, 12.5% of the tumors were completely resected. 92.9% of our patients were in remission, 2 had ineffectiveness result, and 2 died of postoperative complications. Except for the completely resected cases, all the other patients underwent radiotherapy postoperatively. The results of this series show that microsurgical management of craniopharyngiomas yields good operative results.
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PMID:Microsurgical management of craniopharyngiomas--outcomes in 56 patients. 965 51

Six adolescents, five males with prolactin-secreting pituitary macroadenomas and one female with idiopathic hyperprolactinaemia, are described. Their ages at presentation ranged from 13 years 7 months to 16 years 6 months. Presenting symptoms included headache, visual field defect, arrested growth and puberty. Only two cases had galactorrhoea. Every case had an elevated serum prolactin level. Three had surgery before the results of serum prolactin were to hand. Each patient was treated with bromocriptine. Bromocriptine suppressed serum prolactin level to normal in four cases, but in the girl with idiopathic hyperprolactinaemia, bromocriptine was not useful. In two boys, serum prolactin was not suppressed with bromocriptine therapy alone, and they were subsequently treated with cabergoline, surgery and irradiation. Nevertheless, in children and adolescents with prolactin-secreting pituitary adenoma, bromocriptine should be the first line of treatment.
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PMID:Hyperprolactinaemia and pituitary adenomas in adolescence. 977 74

A 71-year-old male presented with a history of sudden partial visual loss in the right eye with an inferior visual field defect over the past 3-4 days. He had no history of headache or of facial pain. Clinical examination confirmed that vision on the right side was reduced to 6/18 and on the left to 6/12. The right eye showed a relative afferent pupillary defect. There was no other abnormality of the anterior segment of either eye. The right retina showed a pale swollen optic disc and a provisional diagnosis of anterior ischaemic optic neuropathy (AION) was made. An urgent erythrocyte sedimentation rate (ESR) was ordered and the patient was asked to return to the eye clinic in one month. However, 16 days later--when it was first recognised that his ESR was elevated to 75 mm in the first hour--the patient was recalled immediately in order to commence systemic steroid treatment; but regrettably, by this time, his right eye had become totally blind. In this case, although the attending doctor made a correct clinical diagnosis on presentation, he failed to act upon the result of the blood test.
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PMID:Lessons to be learned: a case study approach--a case of temporal arteritis. 1007 56

Empty sella syndrome is an anatomical and clinical entity composed of intrasellar reposition of the CSF and compression of the pituitary tissue, resulting in a clinical picture of headache, visual field defect, CSF rhinorrhea and some mild endocrinological disturbances. While some cases are primary with no appreciable aetiology, secondary cases are associated with prior operation or radiotherapy of the region. In our series, 3 patients with primary empty sella syndrome were treated by the current approach of extradural filling of the sellar cavity. This technique was first described by Guiot and widely accepted thereafter. We used a detachable silicon balloon filled with HEMA or liquid silicone for obliteration of the sellar cavity and obtained clinically satisfactory results without complications. Visual symptoms regressed and headache disappeared. But at long term follow-up all the balloons were found to be deflated. Despite the facility and efficacy of the technique we do not recommend it in the treatment of the empty sella because the filling of the sella is only transient and relapses may occur.
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PMID:Extradural balloon obliteration of the empty sella report of three cases (intrasellar balloon obliteration). 1039 4

We report a case of transient headache and impaired vision following administration of intravenous thyrotropin-releasing hormone (TRH) to a woman with a non-functioning pituitary macroadenoma, visual field defect, and elevated thyroid-stimulating hormone (TSH). The symptoms lasted for two hours and then resolved without known sequelae. There are a few other reported cases of similar adverse reactions to neuroendocrine manipulation in patients with pituitary macroadenomas. This is the second reported case of such adverse reactions to TRH alone and the first in which the patient had prior elevation of TSH.
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PMID:Transient headache and impaired vision after intravenous thyrotropin-releasing hormone in a patient with pituitary macroadenoma. 1061 34

We report a 66 years old male, with an ophtalmologic history of long sightedness, admitted to the hospital due to paroxysmal atrial fibrillation crises in the context of a coronary heart disease. He was treated with i.v. amiodarone, receiving a total dose of 6 g in 72 hours. After the third day of treatment, the patient noticed a correction of his long sightedness and 24 h later, he complained of hlurred vision and orbital frontal headache. Visual field examination revealed a concentric retraction of visual field and a centrocecal scotoma in both eyes. Amiodarone was withdrawn and dexametasone treatment was begun. Three days after amiodarone discontinuation, sight improved and visual field returned to normal. Although retrobulbar neuritis has been associated to various drugs, amiodarone has not been considered as a possible agent.
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PMID:[Amiodarone induced retrobulbar neuritis. Clinical case]. 1066 91

An analysis of patients followed with a diagnosis of neurofibromatosis-1 and headache was conducted. Characterization of headache type was done after chart review of 81 patients with neurofibromatosis-1 and headache. Consent was obtained for subsequent telephone interviews using a standardized questionnaire concerning the onset, characteristics, timing, triggers, and associated symptoms of the patients' headaches. Data was summarized and tabulated. Of 132 patients with neurofibromatosis-1, 81 were identified with any headache by screening history. Recurrent headaches were present in 77% of patients and in 47% of our neurofibromatosis-1 clinic population. Fifty-three of 81 patients were accessible for and agreeable to telephone interview. There were 23 male patients and 30 female patients aged 5 6/12 to 49 6/12 years, with a mean age of 20.9 years. Eighty-one percent reported having experienced recurrent headaches within the year. The majority reported onset of headache prior to the age of 10 years. Headache characteristics included the following: frequency of monthly or less, frontotemporal location, pulsating or pressing quality, and moderate severity (pain scale 4 to 5 out of 10). Headaches interfered with daily activities, had weekend occurrence, and had a duration less than 2 hours. Common headache triggers included stress, "change in weather," menstruation, fatigue, and certain foods. A high percentage of patients reported associated symptoms of nausea with or without vomiting (37%), phonophobia, photophobia, pallor, and visual scotoma. We classified 34% of the patients as having migraine (25% with aura, 9% without aura), 45% with nonmigrainous headache only, and 15% with mixed headache types (either intermittently), and 7.5% with other head pains. We conclude that patients with neurofibromatosis-1 are at greater risk for headaches than the general population. While the prevalence of both migraine and nonnigraine headache is somewhat greater than in the general population, the proportion of tension-type headache, especially in young children, is greater than expected.
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PMID:Headaches in patients with neurofibromatosis-1. 1080 89

The time course of propagation of scotoma and blood flow changes during migraine aura parallels the phenomenon of cortical spreading depression (CSD). It was proposed that CSD generates a sterile neurogenic inflammation in the meninges, which may then lead to the activation or sensitization of nociceptors, thus generating headache. We performed rat experiments in which the effect of CSD on plasma extravasation in the dura mater and on neuronal activity in deep laminae of the trigeminal nucleus was assessed in vivo. CSD did not alter dural plasma extravasation measured by means of bovine serum albumin-coupled flourescein (n = 17 rats) compared to the CSD-free contralateral side. In an in vitro model, the application of KCl to the dura at concentrations extracellularly found during CSD did not alter the release of calcitonin gene-related peptide and prostaglandin E2 from the dura. In 33 rats, neither single CSDs nor a series of CSDs altered ongoing neuronal activity or mechanical and/or thermal sensitivity of the deeply located neurons to stimulation of their receptive fields in the dura mater. These results are at variance with data that showed increased c-Fos labeling in superficial laminae of the trigeminal nucleus following CSD. They do not suggest that CSD initiates migraine headache via neurogenic inflammation.
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PMID:Is there a correlation between spreading depression, neurogenic inflammation, and nociception that might cause migraine headache? 1119 95

Benign intracranial hypertension (BIH) is characterized by an elevation of the intracranial pressure not associated with an intracranial process or hydrocephaly, and with normal cerebrospinal fluid (CSF) contents. The elevation of the intracranial pressure is isolated; therefore, diseases such as cerebral venous thrombosis or dural fistulas should not be considered as etiologies of BIH. The exact definition of BIH remains debated, and other terms such as "pseudotumor cerebri" or "idiopathic intracranial hypertension" are often used in the literature. Although we agree that BIH is usually not a so benign disease, we suggest that BIH is still the most appropriate term to describe this entity which should be classified as "secondary BIH" or "idiopathic BIH" depending on whether there are precipitating factors for the development of BIH or not. We also propose new diagnostic criteria emphasizing the need for investigations for the diagnostic of secondary and idiopathic BIH. The management of patients with BIH depends mainly on the presence and severity of ocular symptoms and signs on which the prognostic of the disease is based. Repeated lumbar punctures associated with acetazolamide and weight loss are usually efficient enough. However a surgical treatment (optic nerve sheath fenestration or lumboperitoneal shunt) is required when appropriate medical management does not prevent progressive alteration of vision (visual loss or visual field defect), or when the patients complains of severe, refractory headaches. Careful follow-up with repeated formal visual field testing may help preventing a devastating visual loss in these patients.
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PMID:[Benign intracranial hypertension]. 1124 May 45


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