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

A 46-year-old female presented with a 1-week history of mental change, confusion and headaches. Investigations revealed evidence of sterile meningitis. CAT scanning of the brain demonstrated marked contrast enhancement around the ependyma, and later examinations showed extension of the process deep into the white matter, Cerebral biopsies were non-diagnostic and, despite ventricular drainage and treatment with antibiotics and high dose steriods, the patent died. At postmortem there was extensive tumour tissue distributed in a butterfly shape around the ventricles, and microscopy revealed typical apperances of primary CNS lymphoma. On the basis of the experience of this case and a review of recent literature, it is suggested that the CAT scan appearances of this tumour are quite typical, and that cranial irradiation may be justified in the absence of specific histological diagnosis.
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PMID:Primary lymphoma of the central nervous system: a case report. 55 Sep 37

Primary central nervous system (CNS) lymphoma appears to be on the increase. This increase is real rather than due to changes in nosology, physician awareness or increase in high-risk groups. Diagnostic guidelines appear to be well defined and widely accepted. We report 9 cases of primary CNS lymphoma seen at our institution over a 5-year period. The clinical presentation was variable, but consisted mostly of headache, motor dysfunction, and memory and behavioural disturbance. Surgery is of value for diagnosis. In general, surgical decompression is not recommended. Glucocorticoids and radiotherapy appear effective in the short term. The role of chemotherapy is uncertain.
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PMID:Primary central nervous system lymphoma. A report of 9 cases and review of the literature. 202 95

The authors present 22 cases of primary lymphoma of the central nervous system (CNS) from Stanford University Medical Center. Fifteen other published series comprising 400 patients with this disease are also reviewed. Males were affected more often than females. The majority of patients were in the sixth decade of life. The most common presenting symptoms were headache, nausea, vomiting, and mental status changes. The most common presenting signs were hemiparesis and papilledema. An elevated protein concentration was the most common cerebrospinal fluid (CSF) abnormality. The CSF cytology was rarely positive prior to surgery. If a mass was seen on computerized tomography, it always enhanced with infusion of contrast material. On angiography, the tumor was generally seen as an avascular mass. The most and least common sites of involvement supratentorially were the frontal and occipital lobes, respectively. Infratentorially, the cerebellum was most often involved. Histologically, the most common tissue type according to the Rappaport and Working Formulation systems were diffuse histiocytic lymphoma and immunoblastic lymphoma, respectively. Therapy primarily involved surgery for biopsy or subtotal resection and radiation therapy. The majority of patients died, and the median survival time of those dying was distinctly shorter than the follow-up period of those patients still alive. This difference in survival time suggests that primary CNS lymphoma consists of more than one disease group. Statistical analysis of our series showed those patients with either a diffuse mixed lymphoma histology or an infratentorial location of disease had a poorer prognosis. These two factors cannot totally account for the division of cases into separate survival-related groups.
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PMID:Primary lymphoma of the central nervous system. Clinicopathological study of experience at Stanford. 668 33

Complications of human immunodeficiency virus type 1 infection and acquired immunodeficiency syndrome may involve any level of the central or peripheral nervous system. Acute encephalitis, aseptic meningitis and acute demyelinating polyneuropathy may occur early in the course of HIV infection, while dementia, central nervous system-related cancer, opportunistic infections and autonomic neuropathy typically present later. Headache and mental status changes are common early manifestations of central nervous system involvement. Most severe headaches are related to an identifiable cause, including a mass lesion, opportunistic cerebral infection and medication side effect. Memory deficits, concentration difficulties and abnormalities on mental status testing may represent early AIDS dementia complex (HIV encephalopathy), the most common neurologic complication. In patients with AIDs, the differential diagnosis of cerebral mass lesions on computed tomography or magnetic resonance imaging includes cerebral toxoplasmosis, tuberculous or fungal abscess, focal viral encephalitis, metastatic resonance imaging includes cerebral toxoplasmosis, tuberculous or fungal abscess, focal viral encephalitis, metastatic Kaposi's sarcoma and primary CNS lymphoma. Peripheral neuromuscular disease, including distal symmetric polyneuropathy, autonomic neuropathy, and HIV and chronic zidovudine myopathy, affects 15 to 40 percent of all persons with HIV infection or AIDS.
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PMID:Common neurologic complications of HIV-1 infection and AIDS. 784 35

The authors report 24 patients with primary central nervous system lymphoma (PCNSL) treated from 1977 to 1992. There were 13 females and 11 males. Median age was 57 (range: 17-84). Patients were symptomatic for a median of 3 months. Headache was the most common complaint. Median Karnofsky performance score was 70. There were 19 patients with solitary PCNSL, and 5 had multiple deposits. Disease was confined to the supratentorium in 23 patients. Cerebrospinal fluid cytology was positive in 5 of 22 patients examined. All patients received whole-brain irradiation with or without supplemental tumor boost. Tumor doses ranged from 10 to 60 Gy. Intrathecal chemotherapy was administered to 16 patients and 7 received systemic agents. After follow-up ranging from 1 to 66 months, median survival and progression-free survival were each 8 months. One- and 3-year actuarial survival rates were 50% and 36%, respectively. One- and 3-year actuarial progression-free rates were 41% and 15%, respectively. Relapse occurred in 18 patients, and in 17 there was a component of local progression. Lesions recurred in the spinal meninges in 1 patients and in the vitreous in 1. Patients with Karnofsky performance status > or = 70 demonstrated median progression-free survival of 27 months, compared to 4 months for patients < 70 (p = .024). No other significant patient or treatment-related prognostic factors were identified. Clinical dementia occurred in 2 of 11 patients surviving at least 1 year. Review of the literature indicates PCNSL demonstrates relative radioresistance. The most immediate improvement in prognosis for patients with PCNSL can be achieved by properly sequencing systemic and intrathecal chemotherapy with radiation therapy.
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PMID:Primary central nervous system lymphoma. Results at the University of California at Los Angeles and review of the literature. 804 89

MR imaging of a rare case of primary central nervous system lymphoma in a 12-year-old boy with headache and seizure is presented. MR imaging showed a mass lesion located in the corpus callosum. Diagnosis was made by stereotactic biopsy. The patient was treated with radiotherapy. Early control MR imaging showed a decrease in tumor size but after 12 months an increase in tumor size was detected.
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PMID:MR findings of primary central nervous system lymphoma in a child. A case report. 981 51

About one third of patients with HIV infection show neurological complications with considerable morbidity and high mortality. This is an actualized review of the most important neurological manifestations resulting from primary HIV infection, from secondary opportunistic infections, or as complications of antiretroviral therapy. The primary neurological manifestations, including HIV-associated dementia complex, myelopathies, peripheral neuropathies and myopathies, the more common opportunistic infections, primary central nervous system lymphoma and cerebrovascular diseases, are discussed in the light of new evidence in diagnosis, therapy and prognosis. Cognitive and psychiatric symptoms, visual changes, headache, seizures, dizziness, involuntary movements, gait disturbances, cranial neuropathies and focal deficits are the common neurological symptoms in HIV infection which are described under the aspect of differential diagnosis. It is important to bear in mind that nearly all information available to date on this subject concerns HIV patients in the period before combination therapies (including protease inhibitors). The introduction of highly active antiretroviral therapy (HAART) with protease inhibitors in 1995, and non-nucleoside reverse transcriptase inhibitors, have opened up new therapeutic modalities with a new emphasis on earlier detection and treatment of neurological complications. The prognosis of different HIV-associated neurological diseases has considerably improved, as recently shown in the case, for example, of progressive multifocal leucoencephalopathy.
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PMID:[Neurological complications of HIV infection. Review: new diagnostic, therapeutic and prognostic aspects]. 1081 41

A case with systemic non-Hodgkin lymphoma involving the sella turcica and kidney is reported. A 69-year-old man presented with a progressive two month history of visual disturbance and headache. Neurological examination revealed bilateral visual disturbance and right optic atrophy. MRI showed a contrast-enhancing mass in the sella turcica. The tumor extended to the right optic nerve. Without extensive studies for systemic disease, the patient immediately underwent transsphenoidal surgery. The slightly firm, fibrous and vascular-rich tumor was subtotally removed. The histopathological examination revealed a malignant lymphoma, diffuse-large-cell type with B-cell phenotype. The postoperative course was uneventful and the patient's symptoms subsided gradually. The patient received radiation therapy and the tumor disappeared. Postoperative CT examinations of the abdomen and pelvis revealed a large mass at the upper portion of the left kidney. Ga-scan also suggested the mass to be consistent with the abdominal CT. However, the patient suddenly died of acute heart failure with unknown cause just before starting chemotherapy for systemic lymphoma. Patients presenting primary central nervous system lymphoma (PCNSL) may have systemic non-Hodgkin lymphoma. To exclude systemic non-Hodgkin lymphoma, systemic investigation is essential for the initial management of patients presenting PCNSL.
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PMID:[Systemic non-Hodgkin lymphoma initially presented with visual disturbance due to intrasellar lymphoma--a case report]. 1121 68

A rare case of primary angiitis of the central nervous system (PACNS) is reported with its clinical and magnetic resonance imaging (MRI) features. A 20-year-old girl presented with headache, projectile vomiting, unsteadiness of gait and urgency of micturition. She had left seventh nerve upper motor neuron type paresis, increased tone in all four limbs, exaggerated deep tendon reflexes, cerebellar signs, and papilloedema. Cerebrospinal fluid showed lymphocytosis with elevated protein and normal glucose level. Cerebral computerised tomographic scan and MRI showed bilateral diffuse asymmetric supra- and infra-tentorial lesions (predominantly in the supratentorial and left cerebrum). On MRI, the lesions were hyperintense on T2, and proton density-weighted images and hypointense on T1-weighted images. Based on the clinical findings of raised intracranial tension and MRI features, initial diagnoses of gliomatosis cerebrii, tuberculous meningitis, primary central nervous system lymphoma and chronic viral encephalitis were considered. PACNS was not included in the initial differentials and, an open brain biopsy was advised which established the definitive diagnosis.
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PMID:Primary angiitis of the central nervous system: an ante-mortem diagnosis. 1143 55

A 36 year-old woman with systemic lupus erythematosus was admitted to our hospital with headache, brachiocrural hemiparesis and hemianesthesia. She had been treated with prednisone and cyclophosphamide. CT scan and MRI revealed a 15 mm nodular mass enhanced with gadolinium in left frontal convexity. CNS biopsy was performed and a diffuse large B-cell lymphoma was diagnosed. She was treated with radiation therapy without response and died. There are few reports of erythematosus systemic lupus associated with primary central nervous system lymphoma.
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PMID:[Primary central nervous system lymphoma in a patient with systemic lupus erythematosus]. 1287 6


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