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

Meningiomas and neurofibromas are the most common extramedullary tumors in the region of the foramen magnum. The clinical symptoms are variable, including headache, occipitocervical pain, and hoarseness. Neurological symptoms are present only in 40% of cases. The age group ranges from 4 to 56 years. A number of patients are misdiagnosed as multiple sclerosis, syringomyelia, and cervical disc disease. The overall incidence of these tumors vary from 1.6 to 2.4%. The majority of meningiomas are histologically benign. Papillary (malignant) meningiomas are even rarer in this location. The present report is that of a 46-year-old man who developed a painless mass in the nape of his neck, without any neurological symptoms. Following initial biopsy at another hospital, a definitive resection was undertaken at Loyola University Medical Center. The diagnosis of a malignant meningioma was made after extensive immunohistochemical and electron microscopic studies. The patient developed a positive cervical lymph node 1 year later, which was excised and showed identical histopathologic features.
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PMID:Papillary (malignant) meningioma of the foramen magnum presenting as a posterior neck mass. 1717 Nov 67

The type I Chiari malformation consists of an caudal descent of the cerebellar tonsils through the foramen magno towards the spinal cervical channel. The usual clinical presentation are occipital headaches and cervical pain, as well as some otoneurological symptoms. Among them are common dizziness and crisis of central positional vertigo in which down beating nystagmus can be observed. We present our experience with three cases presenting with neurotological manifestations in which MRI showed a type I Chiari malformation. Case 1: a patient of 24 years that had frequent instability, and common crisis ofpositional vertigo. It was possible to see the presence of positional down-beating nystagmus, of central characteristics, that improved after neurosurgical treatment. Case 2: patient of 11 years who suffered from occasional headaches, dizziness and positional vertigo, without severe handicap, and did not need surgery. Case 3: lady of 63 years who had common episodes of vertigo with head tilt, and unsteadiness during walks. Due to the coexistence of hydrocephalus and syringomyelia, surgery was indicated. A revision is done on otoneurological presentation of type I Chiari malformation, especially as differential diagnosis on central positional vertigo.
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PMID:[Neuro-otological manifestations as presentacion of type I Chiari malformation]. 1723 77

The authors report the case of a patient who harbored a large intrinsic brainstem tumor associated with tonsillar herniation, hydrocephalus, and severe cervicothoracic syringomyelia. This 15-year-old girl had a 2-month history of progressively worsening headaches. Magnetic resonance imaging showed a large tumor in the dorsolateral brainstem accompanied by hydrocephalus as well as a cervicothoracic syrinx extending to the level of T-8. She underwent endoscopic third ventriculostomy that resulted in a marked decrease in the ventricle size as well as complete resolution of the syrinx and tonsillar herniation within 4 days. Clinical and neuroimaging findings of the case along with a pertinent literature review are presented.
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PMID:Immediate resolution of tonsillar herniation and severe cervicothoracic syringomyelia after third ventriculostomy for hydrocephalus caused by a brainstem tumor. Case report. 1723 12

We present our experience in the diagnosis, surgical management and long-term follow-up of congenital and acquired osseous-ligamentous abnormalities or pathologies of the craniovertebral junction. The purpose of this study was: (i) to determine the incidence and degree of cervicomedullary compression in pediatric and young adult patients with congenital and acquired abnormalities, and (ii) to correlate cervicomedullary compression with other imaging and clinical factors to determine to what extend cervicomedullary compression is successfully treated with a posterior decompressive procedure, transoral decompression, and medical management. Between January 1995 and December 2004, 26 cases were managed in our department. These patients had: rheumatoid arthritis (RA) (3); traumatic injury (2); congenital basilar impression (5, in 2 cases a posteriorly oriented or retroflexed odontoid); infection (10); craniovertebral junction Pott's disease (9); os odonteideum (3); condylus tertius (1); and tumor (2). Six of the patients (23.1%) had syringomyelia. Only three (11.3%) were in the pediatric age group. Symptoms and signs included headache (72%), ataxia (38%), lower cranial nerve dysfunction (54%), quadriparesis (44%), hyperreflexia (76%), Hoffman positivity (72%), achilles clonus (72%) nystagmus (33%) and dysphagia (22%). The mean follow-up time was 44 months (range 3-85). Twelve (46.2%) had undergone posterior fossa decompression; seven (26.6%) had ventral decompression. Seven of the patients (26.6%) had medical management. The major morbidity included pharyngeal wound sepsis leading to dehiscence (3.8%), valopharyngeal insufficiency (3.8%), cerebrospinal fluid leakage (3.8%), postoperative macroglossia (3.8%) and inadequate anterior decompression (3.8%). Transient neurological deterioration occurred in two patients (7.6%). Our management paradigm will result in some neurologic improvements and limit the progression of symptoms. Patients with these pathologies are likely to show a good neurologic outcome when treatment, whether with or without surgery, is administered early in the course of the disease.
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PMID:Management of cervicomedullary compression in patients with congenital and acquired osseous-ligamentous pathologies. 1733 28

The authors report the case of a 21-year-old woman who presented with headaches, frequent sensations of loss of equilibrium, and intermittent strabismus. A tectal arteriovenous malformation (AVM) was diagnosed based on magnetic resonance (MR) imaging findings. The AVM drained toward the straight sinus and was associated with a tonsillar prolapse (Chiari malformation Type I [CM-I]) and cervical syringomyelia. The tectal AVM was embolized with N-butyl cyanoacrylate, and disconnection of about 80% of the lesion was obtained. All clinical symptoms resolved after embolization, and radiosurgery was proposed to treat the malformation remnant. A control MR image confirmed the regression of the tonsillar prolapse and the disappearance of the syrinx. This report emphasizes that CM-I and syringomyelia may be acquired and related to hydrovenous disorders.
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PMID:Reversible tonsillar prolapse and syringomyelia after embolization of a tectal arteriovenous malformation. Case report and review of the literature. 1769 98

A 54 year-old female has a clinical diagnosis of chronic paroxysmal hemicrania (CPH) according to IHS-criteria (2004) three years ago. Six months after that, she developed symptoms compatible with trigeminal neuralgia (TN) involving the second and third trigeminal territories also at the left side. Cranial and cervical spine resonance magnetic images showed extensive cervical syringomyelia that included nucleus caudalis (C2 level) region and a posterior fossa Chiari I malformation without hydrocephalus. The association between CPH and TN is called chronic paroxysmal hemicrania-tic syndrome (CPH-tic). This is the first clinical description of a secondary cause of CPH-tic syndrome in the literature.
Cephalalgia 2007 Dec
PMID:Paroxysmal hemicrania-tic and Chiari I malformation: an unusual association. 1794 59

The occurrence of subdural cerebrospinal fluid collections and ventricular dilatation (external hydrocephalus) after foramen magnum decompression is extremely rare. The authors report on a 37-year-old man who developed symptomatic subdural fluid collections (SFC) after uncomplicated foramen magnum decompression for Chiari I-syringomyelia complex. Postoperative magnetic resonance imaging revealed a supratentorial SFC with prominent midline shift. In addition, bilateral infratentorial SFCs extending supratentorially through the tentorial notch, pseudomeningocele and initial shrinkage of the syrinx were observed. Few days after evacuation of supratentorial collection, the patient experienced increasing headache and a computerized tomography scan demonstrated a contralateral subdural collection as well as ventricular dilatation. A programmable ventriculoperitoneal shunt was placed with resolution of supratentorial collection and progressive improvement of infratentorial collections and pseudomeningocele. Although previous reports described the occurrence of extra-axial fluid collections and hydrocephalus after foramen magnum decompression for Chiari malformation, to our knowledge, this is the only report of acute external hydrocephalus after foramen magnum decompression requiring urgent evacuation of SFC in order to reduce the mass effect.
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PMID:Acute external hydrocephalus complicating craniocervical decompression for syringomyelia-Chiari I complex: case report and review of the literature. 1831 92

A 29-year-old woman with acute lancinating headache, throbbed nuchal pain and subacute paraparesis underwent brain MRI in supine position that depicted: the absence of the cisterna magna, filled by non herniated cerebellar tonsils and compression of the brain stem and cisternae of the posterior fossa, which are aspects of the impacted cisterna magna without syringomyelia and without hydrocephalus. During eight days, pain was constant and resistant to drug treatment. Osteodural-neural decompression of the posterior fossa, performed with the patient in sitting position, revealed: compression of the brainstem, fourth ventricle and foramen of Magendie by herniated cerebellar tonsils, which were aspirated. Immediately after surgery, the headache and nuchal pain remmited. MRI depicted the large created cisterna magna and also that the cerebellar tonsils did not compress the fourth ventricle, the foramen of Magendie and the brainstem, besides the enlargement of posterior fossa cisternae. Four months after surgery, headache, nuchal pain and paraparesis had disappeared but hyperactive patellar and Achilles reflexes remained.
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PMID:Impacted cisterna magna without syringomyelia associated with lancinating headache, throbbed nuchal pain and paraparesis treated byposterior fossa decompression. 1834 36

The authors present the case of a 13-year-old boy who experienced frequent disabling episodes of typical postural induced headaches, which revealed a Chiari I malformation, syringomyelia and cervical spinal cord edema. This boy had received a valveless lumboperitoneal (LP) shunt at the age of 18 months for macrocephaly. At this time, cranial CT scan showed moderate enlargement of the subarachnoid spaces without hydrocephalus or tonsillar herniation. The LP shunt was clamped but the patient experienced signs of brain stem dysfunction and increased intracranial pressure. Finally, an adjustable valve (110 mm Hg) was inserted and all the symptoms resolved. Although some authors consider LP shunt as a safe and effective procedure even in the pediatric population, our case reminds us that these shunts, especially when valveless, may expose the patient to the risk of symptomatic acquired Chiari I malformation and syringomyelia consecutive to a chronic spinal CSF leakage.
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PMID:Acquired Chiari I malformation and syringomyelia after valveless lumboperitoneal shunt in infancy. 1835 64

Pain experienced by patients who have syringomyelia associated with Chiari I malformation (SACM) includes headache, cervicalgia and radiculalgia. We studied the correlation of clinical and imaging factors with the evolution of pain and surgical outcome at 12 months. We performed a prospective study of 13 patients who presented with SACM and who underwent suboccipital decompression, C1 laminectomy, tonsillar coagulation and duraplasty. The Bidzinski Outcome Scale was used. Post-operatively, pain improvement was observed in 11 patients and the syrinx resolved in 6 patients and reduced in 7. Eleven patients had a good or very good outcome, while 2 patients had a poor outcome. A post-operative medullary axial occupation of the syrinx less than 75% of the spinal canal was associated with improved post-operative pain. Longer duration of symptomatology was associated with a poor outcome and failed pain control. The size and form of the syrinx, as well as early surgical treatment, are the factors that most influence the control of pain post-surgery in patients with SACM.
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PMID:Pain improvement in patients with syringomyelia and Chiari I malformation treated with suboccipital decompression and tonsillar coagulation. 1923 Nov 99


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