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

That migraine can present with a severe headache of sudden onset mimicking that of subarachnoid hemorrhage--the so-called "complicated migraine with meningeal manifestations" of Pearce and Foster--is not readily appreciated. Over the past three years, seven patients have been referred to us with a presumable diagnosis of subarachmoid hemorrage. In each one of these patients, the clinical features (an explosive headache, relapsing in three, and a normal neurological examination) together with appropriate laboratory investigations (cerebro-spinal fluid analysis, electroencephalography, echoencephalography, brain scan, arteriography, pneumoencephalography) have ruled out the diagnosis of subarachnoid hemorrhage, as well as less common causes of explosive headaches such as ball-valve tumors of the ventricular system, intra-cerebral hemorrhage, hemorrhage into a tumor. In three out of these seven patients, there was no history of migraine. Bening explosive headaches mimicking subarachnoid hemorrhage, occurring in patients with or without antecedents of migraine, are not as unusual as one might conclude from a review of the literature. Proper recognition of this syndrome is important since it might help to sort out those patients with explosive headaches who need not be submitted indiscriminately to risk-fraught procedures.
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PMID:[Headache simulating meningeal hemorrhage]. 86 64

Louse-borne relapsing fever seems to have become endemic in the southern Sudan. The epidemic history of the disease in the Sudan is reviewed. We have studied 363 Sudanese patients involved in an outbreak of louse-borne relapsing fever in Khartoum (Sudan) between January and June 1974. 318 of the 363 patients were new immigrants from the soughern Sudan to Khartoum. The clinical presentation varied. The common clinical fetures of the disease were: fever (94%), headache (85%), hepatosplenomegaly (74%), body and joint pains (66%), abdominal pain and tenderness (63%), jaundice (46%) and epistaxis (40%). Thrombocytopenia was common. Biochemical evidence of hepatocellular and renal damage was present in most patients. The mortality rate was 5-5% with treatment. Post-mortem examination was performed on six cases. The organs predominantly involved were the liver, spleen, brain and lungs. The common causes of death were severe hepatic damage, lobar pneumonia, subarachnoid haemorrhage and splenic rupture.
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PMID:Louse-borne relapsing fever: I. A clinical and laboratory study of 363 cases in the Sudan. 87 Oct 32

Headache may be the presenting symptom of many diseases in the elderly. Some headaches are caused by significant intracranial disease, and the patient's age and general cardiologic and respiratory status may not allow investigation or neurosurgical management. Conditions that demand urgent neurosurgical attention are subarachnoid hemorrhage, pituitary apoplexy, subdural hematoma, and meningioma. Cranial arteritis, too, should be remembered as a possible medical cause of headache in the elderly.
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PMID:Differentiating causes of headache. 88 44

An operative case of 12-year-old boy with a saccular aneurysm at the anterior communicating artery was reported. He had episodes of occasional headache during one year before admission. He was attacked by a severe headache associated with nausea and vomiting, and was admitted to Ooita Pref. Hospital under the diagnosis of subarachnoid hemorrhage four days later. On admission physical examinations revealed almost normal findings except for moderate dehydration and a blood pressure of 130/70 mmHg. Routine examinations (blood, serum including total cholesterol, urine, ECG and plain chest X-film) were normal. Neurologically there were lethalgic state, moderate nuchal rigidity and bilateral abducens paresis. Slightly hemorrhagic and xanthochromic CSF was demonstrated by a spinal puncture. An aneurysm was found at the anterior communicating artery on the right carotid arteriogram. The left carotid and the left vertebral arteriograms showed no pathologic findings. Operation via right fronto-temporal approach disclosed a berry aneurysm about 4 mm in diameter arising from the bifurcation of the right anterior cerebral and the anterior communicating artery. There was a plaque presumably an atherosclerotic change at the neck of the aneurysm. Clipping of the aneurysmal neck was done. The aneurysm was not visualized on the postoperative arteriogram, and the patient was discharged in good condition two weeks after the operation. It is true that this patient had a lesion which seemed to be an atherosclerotic plaque at the neck of the aneurysm macroscopically, but he did not have any evidence of generalized atherosclerosis or other metabolic disturbance. This plaque may be of special significance in etiological respect. In general, however, degenerative lesions like atherosclerosis occur predominantly in larger arteries than smaller arteries of the brain. Also the location of this aneurysm was at the anterior communicating artery which is reported to be implicated in anomalous vascularity on occasion. From these facts the authors considered combined congenital and acquired factors in the development of this aneurysm.
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PMID:[Intracranial aneurysm in a child--a case report and some considerations on etiology (author's transl)]. 94 72

As a causative factor in spontaneous subarachnoid hemorrhage, vascular anomalies, especially aneurysm or arteriovenous malformation, have been generally recognized. On the other hand, subarachnoid hemorrhage from brain tumor and cryptic vascular malformation are rare. We experienced two cases showing subarachnoid hemorrhage from angioblastic meningioma and vascular hamartoma as an initial symptom. Case 1: A 48-year-old woman, who complained of severe headache and vomiting on Feb. 10th, 1972, gradually became lethargic. Lumbar puncture revealed moderately hemorrhagic C.S.F.. On the fifth day after the onset, she was admitted to our hospital. On admission she showed disorientation and disturbance of resent memory. Aphasia and agnosia were slightly observed. On ophthalmologic examination right homonymous lower quadrant hemianopsia was observed. The carotid angiogram showed slight square shift of the anterior cerebral artery to the right side, elevation of the middle serebral artery and a homogeneous tumor stain in the occipital region in capillary phase. A walnut sized tumor invading the middle portion of the left lateral sinus and showing firm adhesion to the tentrium was found. There was an intracerebral hematoma behined the tumor. The tumor, the tentrium and the lateral sinus were extirpated en bloc and the intracerebral hematoma was aspirated. Histologically, the tumor was angioblastic meningioma. Case 2: A 7-year-old boy, who complained of severe abrupt headache, nuchal pain and vomiting on Sept. 17th, 1972, became gradually lethargic. Lumbar puncture revealed hemorrhagic C.S.F., On the tenth day after the onset, he was admitted to our hospital. He showed confusion and agitation. The carotid angiogram showed an unrolling of the pericallosal artery, but no findings of space taking lesions. An air study indicated a globular filling defect protruding into the anterior horn of the right lateral ventricle. The tumor located in the laterobasal wall of the anterior horn was removed picemiel by transventricular approach. Histologically, the tumor was vascular hamartoma. Furthermore, we discussed various brain tumors showing subarachnoid hemorrhage as an initial symptom, its frequency and bleeding mechanism on the literature.
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PMID:[Two cases showing subarachnoid hemorrhage from angioblastic meningioma and vascular hamartoma (author's transl)]. 98 94

The management of pituitary apoplexy with reference to both diagnosis and operative sequelae remains a major challenge. Acute onset of retro-orbital headache in association with visual loss and ophthalmoplegia are the cardinal symptoms; however, obtundation and signs of subarachnoid hemorrhage also may be present. Good quality plain skull radiographs and complete angiography prove sufficient for preoperative radiographic studies. Preoperative endocrine preparation focuses on supplemental glucocorticoids since these patients must be presumed deficient in cortisol reserve. Residual visual deficit appears to be more a function of the extent of damage at the time of ictus rather than rapidity of decompression. Our experience indicates that transsphenoidal decompression in appropriate cases offers an ideal opportunity to minimize mortality and morbidity. The acute onset of severe retro-orbital headache in association with stupor and ocular palsies would alert most physicians to the potential diagnosis of spontaneous subarachnoid hemorrhage. The association of complex ophthalmoplegias and visual defects in this constellation of symptoms should, in addition, alert one to the possibility of an acute intrasellar or parassellar expansile process. During the past two years, we have had the opportunity to care for 8 such patients with confirmed diagnoses of acute hemorrhagic infarction of the pituitary enabling us to formulate diagnostic and therapeutic schemata with reference to management of this problem.
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PMID:Pituitary apoplexy, therapeutic assessment. 103 16

In addition to progressive endocrine dysfunction and progressive visual loss, pituitary neoplasms may annouce their presence by the more catastrophic alternative of spontaneous tumor infarction. In two patients reported, illness due to the spontaneous infraction of pituitary tumors was heralded by sudden onset of focal headache associated with diplopia. Stupor, confusion, and evidence of increased intracranial pressure occurred without subarachnoid hemorrhage or massive extrasellar extension of tumor. One patient developed inappropriate antidiuretic hormone secretion with spontaneous infarction in a large but clinically silent chromophobe adenoma. In both patients, skull x-rays suggested a long-standing intrasella mass. Both underwent prompt treatment with endocrinologic replacement therapy and subsequent successful transsphenoidal removal of voluminous, infarcted, pituitary masses.
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PMID:Spontaneous infarction in pituitary tumors: neurologic and therapeutic aspects. 116 78

A rare case of bilateral abducens nerve paralyses after rupture of an anterior communicating artery (AcoA) aneurysm occurred in a 56-year-old female after sudden onset of severe headache. Bilateral abducens nerve paralyses were present without additional neuro-ophthalmological signs. Computed tomography revealed subarachnoid hemorrhage (SAH). Angiography showed an AcoA aneurysm (15 mm in diameter, directed antero-inferiorly) that was successfully clipped. Postoperatively, the bilateral abducens nerve paralyses gradually recovered and disappeared 3 months after onset. Bilateral abducens nerve paralyses may occur after SAH due to ruptured AcoA aneurysm, and neurosurgeons should be alert to this possibility.
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PMID:Ruptured anterior communicating artery aneurysm causing bilateral abducens nerve paralyses--case report. 137 80

We report the case of an 8-year-old boy with a huge intradural spinal arteriovenous fistula (AVF), which was successfully obliterated by surgery. The symptoms were episodic headaches and progressive motor and sensory deficits. He had suffered a subarachnoid hemorrhage twice before but no ensuing neurological deficits. Neuroradiological examinations revealed an intradural AVF with a huge venous aneurysm ventral to the spinal cord of C7 to T2, which was fed by the left 5th intercostal artery and the right thyrocervical artery. These two feeding arteries were occluded intradurally just at the venous aneurysm emerging point. MR images taken sequentially after surgery demonstrated complete thrombosis and subsequent disappearance of the thrombosed malformation. Neurological symptoms improved gradually. Treatment of such malformations is discussed.
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PMID:Successful surgical obliteration of a huge intradural arteriovenous fistula of the spinal cord in a child. 139 83

Headache is a common complaint in patients presenting to the emergency department. Most such headaches are benign, but some have a more severe organic cause. Occasionally, patients present with a chronic headache disorder with which they can no longer cope. The new International Headache Society Classification of Headache is reviewed along with the differential diagnosis of benign headache disorders. Headache diagnosis by history is examined in detail followed by a discussion of the emergency presentation of headache patients. Causes for concern are presented, along with a detailed discussion of differential diagnosis, including subarachnoid hemorrhage, meningitis, sinusitis, glaucoma, internal carotid artery dissection, and cerebro-vascular disease. Also discussed are medications used for the symptomatic treatment of headache, including analgesics, NSAIDs, narcotics, and ergotamine preparations. Approaches to the treatment of the severe, persistent headache in the emergency department are outlined and treatment options suggested. Headache medication overuse is discussed and guidelines are presented to recognize the condition and prevent its recurrence.
Headache 1992 Sep
PMID:Evaluation and emergency treatment of headache. 139 62


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