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

Unilateral ptosis is seen in a limited number of conditions such as Horner syndrome, cluster headache, trauma, tumor, stroke, old age, nerve injury, lacrimal gland tumor, temporal arteritis or disorders of the upper eyelid. The authors present a case of unilateral ptosis secondary to Burkitt lymphoma metastasis to brain with excellent response to chemotherapy and complete resolution of ptosis in a man with human immunodeficiency virus. This vignette emphasizes the importance of recognizing ptosis as an initial presentation of Burkitt lymphoma in a patient with human immunodeficiency virus under appropriate clinical settings.
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PMID:Burkitt lymphoma presenting as ptosis in a man with human immunodeficiency virus. 2198 2

A woman aged 31 years presented to the emergency department after a minor head injury. She reported mild headache and a metallic taste in her mouth. Full neurologic examination was remarkable only for left-sided Horner syndrome. Left internal carotid artery dissection was confirmed on magnetic resonance imaging. She was treated with aspirin. Symptoms and signs persisted 3 months later, but there was no additional neurologic deficit. We stress the importance of early detection of Horner syndrome to minimize the risk of disabling stroke.
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PMID:Carotid artery dissection presenting with isolated headache and Horner syndrome after minor head injury. 2263 27

Agenesis of the internal carotid artery is a rare, usually asymptomatic congenital anomaly. Patients may remain asymptomatic because a network of collaterals develops in response to agenesis of the internal carotid artery, which is usually diagnosed as an incidental finding after magnetic resonance imaging. The collateral circulation is prone to developing aneurysms and subarachnoid hemorrhages. We report on a 16-year-old boy with a 1-year history of chronic daily headache. He manifested left-sided miosis and ptosis, with no evidence of anhidrosis, flushing, or pain. He was diagnosed with agenesis of the internal carotid artery with established collateral circulation. The association of Horner syndrome with agenesis of the internal carotid artery is not well reported. Agenesis of the internal carotid artery should be further evaluated to delineate the underlying mechanism, using computed tomography to examine the integrity of the bony carotid canal. Hypoplasia or agenesis of the carotid canal will confirm the congenital cause of the condition. If the canal is intact, dissection of the internal carotid artery should be considered.
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PMID:Agenesis of the internal carotid artery associated with ipsilateral Horner syndrome in a child. 2270 23

A 44-year-old man presented with acute onset headache and isolated anisocoria. Dilation lag was noted in the smaller pupil and Horner syndrome was suspected despite the lack of eyelid ptosis. Cocaine testing confirmed the clinical diagnosis, and urgent neuroimaging found an internal carotid artery dissection. The patient was managed with systemic anticoagulation with a good final outcome. Horner syndrome should be suspected in any patient with aniscoria and dilation lag, despite the absence of eyelid ptosis or other associated findings.
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PMID:But it's not all there. 2278 76

The patient, a 32-year-old man, presented with sudden onset of occipital headache, vertigo, dysarthria, gait ataxia, right Horner syndrome, numbness of the right hand, and mild right hemiparesis. On magnetic resonance imaging, an acute small infarction was located on the right side of the caudal medulla extending dorsomedially. Magnetic resonance angiography showed severe right vertebral artery stenosis. Lateral medullary infarction associated with ipsilateral sensorimotor deficits in the limb is very rare, and the lesion probably involved the ipsilateral dorsal column or decussating lemniscal fibers and corticospinal fibers caudal to the pyramidal decussation or compression of the decussation.
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PMID:Ipsilateral sensorimotor deficits in lateral medullary infarction: a case report. 2321 98

A 30-year-old woman with severe preeclampsia presented at 27 weeks of amenorrhea with left headache, neck pain, blurred vision and numbness of left hemiface that resolved spontaneously within 2 hours. A week later, hypertension remained poorly controlled despite combination of nicardipine and labetalol intravenous therapy; an urgent caesarean section was eventually performed due to onset of HELLP syndrome. At day 5 postpartum, the patient had a Horner syndrome with right ipsilateral disabling tinnitus. A CT-angiography of supra-aortic trunks was performed urgently; it showed a bilateral carotid arterial dissection without stroke, which was subsequently confirmed by MRI angiography. The patient was transferred in neurovascular intensive care unit. Anticoagulant therapy was implemented to prevent cerebral and retinal ischemic lesions. Symptoms resolved quickly and the patient was discharged at day 7 postpartum. MR-angiography performed 4 months later showed a full resolution of the bilateral carotid dissection. Anticoagulant therapy was therefore discontinued.
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PMID:[Bilateral carotid artery dissection in a severe preeclamptic setting: an unusual cause of postpartum headache]. 2349 56

Cervical artery dissection (CeAD) occurs preferentially in the middle-aged, and its annual incidence rate is 2.6 to 3.0 per 100,000.(1) Manifestations of internal carotid artery dissection (ICAD) include ischemic stroke and TIA (>70% of patients), headache, neck pain, Horner syndrome, cranial nerve palsy, pulsatile tinnitus, and, rarely, subarachnoid hemorrhage.(2) Cerebral hyperperfusion syndrome is known to occur after carotid artery revascularization procedures and it is thought to result from the combination of several factors that impair cerebral vascular autoregulatory mechanisms.(3.)
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PMID:Cerebral hyperperfusion syndrome: a novel presentation of internal carotid artery dissection. 2382 78

Spontaneous dissection of a vertebral artery is uncommon, but potentially harmful and initially easily misdiagnosed as ordinary headache, neck pain or dizziness. The condition may progress with infarctions in the brainstem and cerebellar areas and ataxia, nystagmus, Horner syndrome, dysarthria, cranial nerve palsy or hemiparesis. We report an initially misdiagnosed case and remind about the clinical clues which lead to a correct diagnosis: young age, no risk factors for thromboembolism, the typical clinical findings and the presence of neck pain.
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PMID:[Dissection in the vertebral arteries is uncommon and may be misdiagnosed]. 2549 59

A 52-year-old man developed sudden occipital headache followed by vomiting and vertigo. On admission, he displayed right Horner syndrome with ipsilateral reduced facial sensation to pain and temperature that crossed in the body, affecting the left limbs. In addition, he had right hemiparesis. Diffusion weighted magnetic resonance images showed a high intensity lesion localized in the lower and right lateral medulla oblongata. Magnetic resonance angiography showed severe luminal stenosis in the right vertebral artery and T2-weighted sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) showed arterial wall expansion. T1-weighted SPACE showed subacute intramural hematoma at that point, suggesting arterial dissection. First described in 1946, Opalski syndrome is considered a variant of Wallenberg syndrome with ipsilateral hemiparesis. This motor impairment is considered as a result of extension of the ischemia from the lateral medulla to the upper cervical cord involving corticospinal fibers caudal to pyramidal decussation. This case adds information regarding the anatomy of the pyramidal decussation.
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PMID:[Opalski syndrome caused by vertebral artery dissection]. 2600 59

OBJECTIVE Dissection of the carotid and vertebral arteries can result in the development of aneurysmal dilations. These dissecting pseudoaneurysms can enlarge and cause symptoms. The objective of this study is to provide insight into the progression of dissecting pseudoaneurysms and the treatments required to manage them. METHODS A review of the electronic medical records was conducted to detect patients with carotid and vertebral artery dissection. An imaging review was conducted to identify patients with dissecting pseudoaneurysms. One hundred twelve patients with 120 dissecting pseudoaneurysms were identified. Univariate and multivariate analyses were conducted to assess the factors associated with undergoing further interventions other than medical treatment, pseudoaneurysm enlargement, pseudoaneurysms resulting in ischemic and nonischemic symptoms, and clinical outcome. RESULTS Overall, 18.3% of pseudoaneurysms were intracranial and 81.7% were extracranial, and the average size was 7.3 mm. The mean follow-up time was 29.3 months; 3.3% of patients had a recurrent transient ischemic attack, no patients had a recurrent stroke, and 14.2% of patients had recurrence of nonischemic symptoms (headache, neck pain, Horner syndrome, or cranial nerve palsy). Follow-up imaging demonstrated that 13.8% of pseudoaneurysms had enlarged, 30.2% had healed, and 56% had remained stable. In total, 20.8% of patients had an intervention other than medical treatment. Interventions included stenting, coiling, flow diversion, and clipping. Predictors of intervention included increasing size, size > 10 mm, location in the C2 (petrous) segment of the internal carotid artery (ICA), younger age, hyperlipidemia, pseudoaneurysm enlargement, and any symptom development. Significant predictors of enlargement included smoking, history of trauma, C2 location, hyperlipidemia, and larger initial pseudoaneurysm size. Predictors of pseudoaneurysm resulting in recurrent ischemic and nonischemic symptoms included increasing size and location in the petrous segment of the ICA. Smoking was a predictor of unfavorable outcome. CONCLUSIONS Dissecting pseudoaneurysms have a benign course and most will not cause symptoms or enlarge on follow-up. Medical treatment can be a sufficient, initial treatment for dissecting pseudoaneurysms.
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PMID:Dissecting pseudoaneurysms: predictors of symptom occurrence, enlargement, clinical outcome, and treatment. 2682 74


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