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

Patients suffering from vascular disease are often a challenge for the acute pain service. Ischaemia, impaired wound healing, stump and phantom limb pain often require a complex analgesic regimen. Invasive measures such as spinal or epidural catheters can be very helpful but carry the risk of infection, as shown by this case report. A 53-year-old woman with a ten-year history of diabetes developed arterial vascular disease. Her right lower leg had been amputated two years previously. She was now admitted with necroses of the left forefoot. A bypass operation was performed under general anaesthesia. Because of intractable ischaemic pain, she was provided with an epidural catheter by the acute pain service. The bypass occluded, however, and a few days later her left lower leg also had to be amputated, this operation being performed under epidural anaesthesia with bupivacaine. The catheter was subsequently used for postoperative pain control and as a means to prevent phantom limb pain. When signs of superficial catheter infection were noticed days later, the catheter was immediately removed. Intractable pain then developed in the left leg which could not be sufficiently controlled with opioids and NSAIDs, and so a second epidural catheter was inserted one segment rostrally. Several days later the infected vascular prosthesis had to be removed followed by amputation of the thigh, this operation also being performed in epidural anaesthesia. Eleven days after insertion of the first epidural catheter, the patient complained of low back pain and headache. Examination by a neurologist revealed no signs of intraspinal infection. The second epidural catheter dislocated at this point in time and it was decided to introduce a third one, this being the only means to treat the otherwise intractable stump pain. Ten days later meningism, Kernig's sign and leucocytosis developed. NMR tomography detected intraspinal fluid in the epidural space at the dorsal border of the spinal canal. A hemilaminectomy was performed. The spinal epidural space showed signs of inflammation of the adipose tissue, but no pus. A little necrotic material and residues of an old haematoma were removed and the epidural space was lavaged. Specimens taken from the epidural material revealed colonisation with staphylococcus epidermidis, which was sensitive to the broad spectrum antibiotics formerly given to the patient to treat the infection in the left stump. By the next day, all signs of epiduritis had disappeared and the patient recovered completely.
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PMID:[Epiduritis after long-term pain therapy with an epidural catheter--review of the literature with a current case report]. 932 67

Cerebral amyloid angiopathy affects the cerebral vasculature selectively, and there is no systemic amyloidosis. Amyloid is deposited in small and medium-sized vessels of the cortex and leptomeninges. Cerebral amyloid angiopathy is a common cause of spontaneous lobar haemorrhage in elderly patients. However, cerebral amyloid angiopathy may have atypical clinical and radiological presentations. We report on five patients (three males and two females, aged 43-77 years) with histologically verified cerebral amyloid angiopathy. One patient experienced an acute headache attack and classical lobar haemorrhage. The other patients had various neurological symptoms and signs, such as seizure, disturbed vision, pareses, aphasia, and dementia that were initially diagnosed as cerebral infarction or tumour. Two patients with cerebral amyloid angiopathy and granulomatous angiitis responded to immunosuppressive treatment.
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PMID:[Cerebral amyloid angiopathy]. 976 Aug 54

Eighty subjects--30 migraineurs during the attack, 30 patients in the interictal period, and 20 healthy volunteers--were studied using two technologies for functional assessment: transcranial Doppler ultrasound and magnetoencephalography. Transcranial Doppler studies showed an increased mean flow velocity at rest (p less than 0.05) in the middle cerebral artery on the side of the headache and a decreased vasomotor response to CO 2 (p less than 0.001) on the same side compared to control subjects. Biomagnetic measurements of somatosensory evoked fields of 11 patients and 11 control subjects in this study did not demonstrate differences between migraineurs and the control group in current flow or latency measures. The data from this study tend to support the hypothesis of vascular disease as a primary underlying deficit in migraine.
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PMID:Transcranial Doppler ultrasound and magnetoencephalography in migraine. 1014 29

Cerebral angiopathy of the postpartum period is a rare entity, sometimes promoted by vasoconstrictives drug prescription. Its clinical presentation includes headaches, seizures and focal neurological deficits, which develop shortly after a normal pregnancy. The diagnosis is based on clinical findings and angiography, showing multiple narrowing of the intracranial cerebral arteries. This neurological feature is reversible and the clinical outcome is good. We report a case of benign cerebral angiopathy in a 20-year-old woman in the postpartum period, occurring after administration of sumatriptan and ergot derivates.
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PMID:Postpartum cerebral angiopathy associated with the administration of sumatriptan and dihydroergotamine--a case report. 1040 52

A 50-year-old woman with a history of migraine without aura, predominantly occurring around her menstrual periods, developed a spinal cord lesion following the use of zolmitriptan. The partial lesion of the cord at T7 predominantly involved the spinothalamic pathways on the left side. Clinical features suggested that the lesion was an ischemic infarct, and this was confirmed by an MRI scan. There were no other known risk factors for vascular disease. There has been mild improvement of her symptoms, but most of the symptoms did not resolve. There are isolated case reports of stroke secondary to the use of triptans, however, this is the first case of spinal cord infarction reported following the use of this group of drugs. The temporal relationship suggests that the spinal cord infarction may be related to the use of zolmitriptan.
Headache 2000 Jan
PMID:Spinal cord infarction during use of zolmitriptan: a case report. 1075 7

We report a new case of giant cell angiitis of the central nervous system associated with cerebral amyloid angiopathy (GA/CAA). A 67-year-old woman was hospitalized with a history of headaches and lapses of consciousness. After improvement with corticosteroidtherpay, treatment was stopped. She relapsed and died 33 days after first admission. Pathological examination showed unusual extension of GA/CAA lesions, in the superficial and deep layer of the cerebral cortex, and in the cerebellum. Simultaneous occurrence of GA and CAA is rare. Histopathologic findings and immunological pathogenesis of the process are discussed: 1) arguments over pre-existence of CAA, responsible for GA; 2) primitive inflammatory process inducing amyloid deposits; 3) GA/CAA may represent an association of histological lesions related to 2 different types of disease: i) neurodegenerative disease with specific lesions (such as presence of diffuse senile plaques and neurofibrillary tangles) inducing inflammatory reaction ii) inflammatory disease, with few or no degenerative lesions, responding to immunotherapy.
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PMID:Giant cell angiitis of the central nervous system with amyloid angiopathy. A case report and review of the literature. 1081 37

Intracranial fibromuscular dysplasia is a nonatheromatous angiopathy that most commonly affects adult women and is rarely recognized in children. Symptoms include stroke and headache, although the vasculopathy may be asymptomatic. Diagnosis is based on angiographic appearance, commonly described as a "string of beads." The etiology of intracranial fibromuscular dysplasia is not known, although possible causes include genetic predisposition, trauma, and underlying connective tissue disease. Treatment of intracranial fibromuscular dysplasia is largely supportive once symptoms become manifest. We report a 6-year-old girl who presented to our center for further evaluation of a large left middle cerebral artery distribution infarction. The patient was previously healthy, without known risk factors for stroke. Initial symptoms consisted of a dense global aphasia and a right hemiparesis. On arrival, the patient's aphasia had improved but she continued to have significant deficits in both receptive and expressive language as well as residual right hemiparesis. Magnetic resonance imaging and conventional angiographic studies demonstrated characteristic beading of the distal portion of the left internal carotid artery, as well as the proximal middle cerebral artery. Laboratory evaluation, echocardiogram, and renal ultrasound were normal. The renal vasculature did not demonstrate evidence of intracranial fibromuscular dysplasia. In conclusion, intracranial fibromuscular dysplasia should be considered in the differential diagnosis of childhood stroke. When recognized, other sites of vascular involvement should be sought, and consideration of underlying disorders is important, as connective tissue disorders have been associated with a propensity to develop this vascular abnormality. Careful follow-up is warranted, due to possible progression of disease.
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PMID:Intracranial fibromuscular dysplasia in a six-year-old child: a rare cause of childhood stroke. 1096 98

A 25-year-old woman with a history of chronic severe migraine with aura presented in an apoplectic state 1 week after the delivery of her third child. She developed a severe headache and within hours lapsed into a coma. A CT scan of the brain showed cerebral edema and an occipital hemorrhage. A four-vessel angiogram showed diffuse arterial narrowing of all the intracranial vessels with segmental narrowing of the suprasellar portion of the internal carotid arteries bilaterally. She had no risk factors for stroke or vasculitis. Her pregnancy and delivery were uneventful with no preeclampsia or eclampsia. Apart from ergometrine at the time of the delivery, no vasoconstrictor drugs were used. She recovered spontaneously. Serial CT scans of the brain demonstrated resolution of the edema and hemorrhage with the development of cortical and watershed infarcts. A repeat cerebral angiogram was normal. She was, therefore, diagnosed as having suffered from postpartum cerebral angiopathy, a form of reversible cerebral vasoconstriction, called the Call or Call-Fleming syndrome. The relationship between migraine and postpartum angiopathy in the development of reversible cerebral vasoconstriction is discussed.
Headache 2000 Sep
PMID:Case reports: postpartum cerebral angiopathy in a patient with chronic migraine with aura. 1097 65

A 36-year-old woman (gravida 2, para 2) delivered a healthy child by cesarean section at the 37th week of an unremarkable gestation. Blood pressure remained within normal range throughout the pregnancy, surgery, and for the 9 following days. On day 10, about 36 hours after the initiation of oral methergoline to suppress lactation, the patient complained of severe posterior headache, flashing scotomata, hypertension, tonico-clonic seizures and then homonymous left hemianopsia and hemiparesis. Blood pressure monitoring confirmed intermittent and severe hypertension. Angiography demonstrated diffuse narrowing of the small and medium cerebral arteries. Transcranial Doppler ultrasound examination disclosed a bilateral increase in mean flow velocity. Progressive normalization of blood pressure, obtained with labetalol and oral clonidine, was accompanied by amelioration of the neurological deficits until a complete recovery and normalization of transcranial Doppler flow velocity occurred. This case provides further evidences that hypertension might play a major pathogenetic role in reversible cerebral angiopathy. Some ergot derivatives (including methergoline) might trigger the initial rise in blood pressure.
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PMID:Severe postpartum hypertension and reversible cerebral angiopathy associated with ergot derivative (methergoline) administration. 1120 34

Brain vascular disease as the first presentation of temporal arteritis is unusual. We present two cases in which the diagnosis emerged from the anamnesis. A 54 years old woman has had a left cerebral infarct 3 months ago. She was getting better when severe visual loss occurred and the family decided to get a second opinion. The patient have had right hemiparesis, aphasia and a left visual disturbance in the first episode; now she had severe bilateral visual disturbance. We suspected temporal arteritis was the etiology. HSR was 97 mm and fundoscopy disclosed severe ischemic optic neuritis. A 75 years old man presented Wallenberg syndrome. The history disclosed temporal headache and the examination showed inflammation in temporal artery. HSR was 70 mm and biopsy confirmed the diagnosis. "Tecnolatry" is affecting medical practice; it's necessary to put back in the center the clinical sovereignty.
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PMID:[Brain vascular disease presenting as first manifestation of temporal arteritis: report of two cases]. 1146 Jan 98


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