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

The orthopaedic surgeon is often the first consultant to whom a patient with syringomyelia is referred. The disease is not as rare as he may suppose, but its early presenting features are very variable; if he relies solely on such familiar features as pes cavus and scoliosis, he may well miss the diagnosis. The commonest presenting symptom is pain in the head, neck, trunk or limbs; headache or neckache made worse by straining is particularly significant. A history of birth injury also may suggest the possibility of syringomyelia, especially if any spasticity subsequently worsens. Neurological features which may be diagnostic include nystagmus, dissociated sensory loss, muscle wasting, spasticity of the lower limbs or Charcot's joints. Radiographic features include erosion of the bodies of cervical vertebrae and widening of the spinal canal; if, at C5, the size of the canal exceeds that of the body by 6 millimetres in the adult, pathological dilatation is present. The presence of basilar invagination or other abnormalities of the foramen magnum, of spina bifida occulta and of scoliosis are further pointers. Thermography is a useful way of showing asymmetrical sympathetic involvement in early cases. A greater awareness of the prevalence of syringomyelia may lead to earlier diagnosis and to early operation, which appears to hold out the best hope of arresting what is all too commonly a severely disabling and progressive condition.
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PMID:Orthopaedic features in the presentation of syringomyelia. 15 24

CSF pressure recordings have been taken from the lumbar region and the cisterna magna of 16 patients during coughing in the sitting position. Isolated coughs of low amplitude have been studied. The lumbar pressure waves occur sooner and lower. Thus there is a phase during which the lumbar pressure exceeds the cisternal, followed by one in which the cisternal exceeds the lumbar. These phenomena may be conveniently displayed on a differential trace. The phase during which the cisternal pressure exceeds the lumbar may be protracted. It is suggested that Froin's syndrome, central subarachnoid pouches and syringobulbia may be associated with upward pressure waves. Cough headache, the filling stages of communicating syringomyelia and tonsillar herniation may be associated with valve-like blockage at the foramen magnum which produces craniospinal pressure dissociation by interfering with downward or rebound pulsation. Decompensation of hydrocephalus after birth may be related to pulsation in association with crying; also after removal of a meningocele sac decompensation may be related to the effects of similar pulsation modified by changes in capacitance following operation. The cord destruction of syringomyelia, and the mechanisms which fill spinal subarachnoid cysts may be related to pressure waves directed both upwards and downwards. The merits and limitations of cough impulse as a clinical test for spinal blockage are discussed, and the suggestion is made that after further evaluation they may provide a more sensitive indication of spinal blockage than Queckenstedt's test.
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PMID:Cerebrospinal fluid pressure changes in response to coughing. 99 Sep

Syringobulbia is a term which has been clinically applied to brain stem symptoms or signs in patients with syringomyelia. Syringobulbia clefts are found on investigation or at necropsy caused by cutting outwards of the CSF under pressure from the fourth ventricle into the medulla. These should be differentiated from the ascending syringobulbia which may occur from upward impulsive fluid movements in a previously established syringomyelia. Clinical analysis of 54 patients suggests that bulbar features are most often found with neither of the above mechanisms but are due to the effects of pressure differences acting downward upon the hind-brain with consequent distortion of the cerebellum and brainstem, traction on cranial nerves or indentation of the brain-stem by vascular loops. The commonest symptoms in the 54 patients were headache (35), vertigo (27), dysphonia or dysarthria (21), trigeminal paraesthesiae (27), dysphagia (24), diplopia (16), tinnitus (11), palatal palsy (11) and hypoglossal involvement (11). Careful attention to hydrocephalus is advisable before craniovertebral surgery, but the decompression of the hindbrain and the correction of craniospinal pressure dissociation remains the mainstay of surgical treatment. The results of careful surgery are good, 45 of the 54 cases reported improvement. Most of the reported deterioration occurred in a few patients who did conspicuously badly.
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PMID:Syringobulbia: a surgical appraisal. 147 91

Two patients with Arnold-Chiari malformation, associated with syringomyelia, are described. They presented with headache caused by coughing, sneezing and straining. The pathogenesis and diagnosis are discussed. The treatment of this condition consists in a fossa posterior decompression, in some cases followed by a syringoperitoneal or a syringosubarachnoid shunt.
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PMID:Headache caused by craniospinal pressure dissociation in the Arnold-Chiari-syringomyelia syndrome. 160 88

A patient with high cervical tetraplegia with new-onset headaches and posttraumatic syringomyelia is presented. Percutaneous drainage of the syrinx resulted in a resolution of the headaches and collapse of the syrinx on follow-up magnetic resonance imaging (MRI). The return of the symptoms correlated with the re-expansion of the syrinx on MRI. The patient underwent syringopleural shunting with persistent resolution of the symptoms and collapse of the syrinx on MRI. The value of percutaneous drainage and serial MRI to determine the clinical significance of posttraumatic syringomyelia is discussed.
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PMID:Percutaneous drainage and serial magnetic resonance imaging in the diagnosis of symptomatic posttraumatic syringomyelia: case report and review of the literature. 192 11

A case of solitary syringobulbia without syringomyelia diagnosed by MRI was reported. A 63-year-old female, who had a history of progressive gait disturbance for 9 months, was admitted to our department because of severe headache. Neurological examination revealed that the patient was suffering from right pyramidal sign as well as left deep sensory disturbance without apparent impairment of cranial nerves or nystagmus. The somatosensory evoked potential stimulated by the left median nerve showed delay in latency and low amplitude, however, the auditory brainstem response showed normal records bilaterally. A syringobulbia associated with platybasia, basilar impression, obstructive hydrocephalus and Arnold-Chiari malformation was diagnosed by the neuroradiological examinations including plain X-ray films of the skull, CT scan and MRI of the brain. Subsequent to the decompression around the cisterna magna by suboccipital craniectomy and laminectomy of the atlas, the opening of the Foramen Monro which was obstructed by a thick membrane was carried out, and prevention of communication between the fourth ventricle and the syrinx was accomplished by using a piece of muscle. This operative procedure was thought to be compatible with Gardner's operation for syringomyelia. The patient showed gradual improvement of gait disturbance as well as headache 3 months after surgery, and this neurological improvement was proved by decrease in the size of the known syringobulbia on MRI, and by normalized somatosensory evoked potential stimulated by the median nerve. Pathophysiology of the solitary syringobulbia with relatively acute onset of the neurological symptoms was assumed to have taken place in the following manner.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of solitary syringobulbia]. 200 Jan 59

A 12-year-old boy had a long history of headache since the age of 4 years. Numbness and weakness of the upper extremities and chest tightness, especially in the morning, were noted since 2 years ago. The headache became more severe and frequent and attacked even in sleep since one year ago. Arnold-Chiari type 1 malformation, cervical syringomyelia and mild hydrocephalus were demonstrated by MRI scan of the central nervous system. Headache and other symptoms disappeared immediately after surgical intervention. The formation of syringomyelia may be multifactorial, but Arnold-Chiari type 1 malformation and uneventful birth history play an important role in the underlying cause of this case. We presented this youngest case who had Arnold-Chiari type 1 malformation and onset of headache from the age of 4 years, discussed the pathogenesis of syringomyelia and reviewed the literature.
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PMID:Arnold-Chiari type 1 malformation and syringomyelia. 217 27

A case of asymptomatic syringomyelia associated with tentorial meningioma is reported. A 53-year-old female was admitted to our hospital with the complaints of headache, decrease of bilateral visual acuity and gait disturbance. Neurological examination revealed no abnormality except for bilateral papilledema and left cerebellar sign. Motor and sensory systems were also intact. CT and MRI scans showed a left tentorial mass lesion, cervical syringomyelia and left tonsillar herniation. A relationship between the fourth ventricle and syringomyelia was not clearly identified. The tumor was totally removed and a histological diagnosis of fibroblastic meningioma was made. Postoperative radiological examination showed a diminishing of syringomyelia with the improved tonsillar herniation. Association of syringomyelia with brain tumor was reviewed, and its pathogenesis was discussed.
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PMID:[Association of asymptomatic syringomyelia with tentorial meningioma]. 268 36

A sneeze caused acute left arm pain in a 36-year-old woman with a lumboperitoneal (LP) shunt that had been placed 3 years earlier for relief of headaches caused by pseudotumor cerebri. Numbness progressed up the left arm, neck, and back of the head and finally into the left face along with weakness of the hand and arm. Magnetic resonance imaging (MRI) and computed tomography revealed new tonsillar herniation and a large eccentric syrinx extending from C2 to T6. The functioning LP shunt was clamped, and a ventriculoatrial shunt was placed. Pain lessened and motor function improved slightly. MRI revealed complete resolution of the syrinx and resolution of the tonsillar herniation. Theories of syringomyelia formation, the relationship to Chiari I malformation, and the implications of this case are discussed.
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PMID:Resolution of syringomyelia and Chiari I malformation by ventriculoatrial shunting in a patient with pseudotumor cerebri and a lumboperitoneal shunt. 337 86

A population of 41 non-hydrocephalic patients in whom a lumbo-peritoneal shunt (LPS) was inserted for various conditions is reviewed. 19 had persistent cerebro-spinal fluid rhinorrhoea following cranial injury, basal skull surgery or of unknown origin, 3 had recalcitrant benign intra-cranial hypertension, 14 had a persistent bulging craniotomy site after operations for intra-cranial tumours or head trauma, 4 had syringomyelia and 1 had a postoperative cervical meningocele. There was no shunt-related mortality. LPS was effective in treating the initial symptomatology in 31 patients. Further revision or removal of LPS were needed on 9 occasions in 8 patients showing shunt-related mechanical or infectious complications or persistent postural headaches. This report demonstrates the safety of the LPS procedure experienced in another population of 146 patients with communicating hydrocephalus operated on in the meantime. According to the authors' experience, the versatility of the clinical applications of LPS seems well established. LPS should be considered when a CSF diversion is required in patients showing absent or minimal ventricular enlargement in the CT scan.
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PMID:Lumbo-peritoneal shunt in non-hydrocephalic patients. A review of 41 cases. 371 95


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