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

Hallmarks of central nervous system (CNS) disease in AIDS patients are headaches, fever, subtle cognitive changes, abnormal reflexes, and ataxia. Dementia and severe sensory and motor dysfunction characterize more severe disease. Autoimmune-like peripheral neuropathies, cerebrovascular disease, and brain tumors are also observed. Histological changes include inflammation, astrocytosis, microglial nodule formation, and diffuse de- or dysmyelination. Focal demyelination can also be seen. It is clear that AIDS-associated neurological diseases are correlated with greater levels of HIV-1 antigen or genome in tissues. In AIDS dementia, macrophages and microglial cells of the CNS are the predominant cell types infected and producing HIV-1. However, manifestations of the disease make it unlikely that direct infection by HIV-1 is responsible. It seems more likely that the effects are mediated through secretion of viral proteins or viral induction of cytokines that bind to glial cells and neurons. HIV-1 induction of such cytokines as interleukin 1 (IL 1) and tumor necrosis factor-alpha (TNF alpha) may lead to an autocrine feedback loop involving further productive virus replication and induction of other cytokines such as interleukin 6 (IL 6) and granulocyte-macrophage colony-stimulating factor (GMCSF). Interleukin 1 and TNF alpha in combination with IL 6 and GMCSF could account for many clinical and histopathological findings in AIDS nervous system diseases. As HIV-1 infected patients produce elevated levels of IL 1, TNF alpha, and IL 6, it will be important to make a formal connection between the presence of these factors in the CNS, which are all products of activated macrophages, astroglia, and microglia, their in vivo induction directly by virus or indirectly by virus-induced intermediates, and the clinical and pathological conditions seen in the nervous system in this disease.
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PMID:HIV-1, macrophages, glial cells, and cytokines in AIDS nervous system disease. 206 87

We investigated 288 elderly subjects with various degree of dementia, focusing on headaches. Seventy-three of 288 elderly subjects (25.3%) complained of some headaches. The most common type was the tension-type headache, from which 43 of the 73 subjects with headaches (58.9%) suffered. The degree of cognitive disturbances, evaluated by Hasegawa's intelligence scale, significantly correlated to the prevalence of headaches, and indicated that patients with dementia appeared to have less headaches. The methodological issues and views on headache research in dementia were assessed, and it is concluded that the field is a difficult one, with potential for error.
Headache 1990 Nov
PMID:Headaches in dementia. 207 68

Clinical and computed tomographic findings in 24 patients with hereditary cerebral hemorrhage with amyloidosis-Dutch type were reviewed. The common initial symptoms were headache and vomiting. Computed tomographic scans showed 50 hypodense and 49 hyperdense cortical lesions and in 20 patients the scans also showed generalized white matter hypodensity. Impairment of consciousness was related to the size of the hemorrhagic lesion. Dementia, seen in 11 patients, was related to the duration of the disease and the number of focal lesions on the computed tomographic scans, but not to the presence of white matter hypodensity. It is concluded that in hereditary cerebral hemorrhage with amyloidosis-Dutch type, lobar hemorrhages account predominantly for the acute clinical syndromes. The hemorrhages often have an irregular shape and are responsible for progression of the symptoms after an acute onset. Furthermore, cerebral amyloid angiopathy leads to a generalized abnormality of the white matter, probably due to chronic hypoperfusion.
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PMID:Hereditary cerebral hemorrhage with amyloidosis-Dutch type. Clinical and computed tomographic analysis of 24 cases. 234 93

Inpatient and community-based care can be complementary in relation to the management of HIV disease. Medical records from 200 inpatients of Chikankata Hospital near Lusaka, Zambia and 200 home based patients were examined and compared for the common symptoms of presentation of HIV disease, associated opportunistic infections, and treatment protocols. Drug costs of both groups were also compared. The most common respiratory symptoms in the 2 groups are cough, chest pains, weight loss, and hemoptysis. Treatment employed for these symptoms were cortimoxazole, penicillin V, erthromycin, and tetracycline. Acetyl saliclic acid and paracetamol were used for pain relief in both groups. Gastointestinal system symptoms for both groups were diarrhea, weight loss, abdominal pain, and vomiting. Cotrimoxazole and metronidazole were used in treating diarrhea. Additional treatment protocol for the 2 patient samples included oral rehydration therapy for dehydration, antacid or bismuth subsalicylate for diarrhea and enteritis, and mycostatin for oral candidiasis. Central nervous system symptomatology included headache, dementia, neckace, and lethargy. Chloramphenicol was employed in treating bacterial meningitis. Diazepam and chlorpromazine were effective for restless patients. Genito-urinary system symptomatology for the 2 groups included dysuria, genital ulcers, hematuria, viral warts, and buboes. Antibodies were used for sexually transmitted diseases and infections. Skin symptomatology included rash and dermatitis, herpes zoster, abscess, kaposi's sarcoma, ulcers, furunculosis, and discharging anal sinus. In treating these symptoms, hospital based care and home based care were similar. Overall, it was found that hospital treatment protocols were detailed, expensive, and time consuming. Furthermore, hospital treatment for HIV positive patients is more expensive than HIV negative patients; hospital costs for 50 HIV negative patients totaled US$415.94 compared to US$1204.98 HIV positive/PTB negative patients and US$1705.62 for HIV positive/PTB positive patients. Drug cost/patient admission is increased by 469% if HIV positive. (author's modified).
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PMID:Clinical care as part of integrated AIDS management in a Zambian rural community. 248 94

A 41-year-old female of mitochondrial myopathy characterized by recurrent paralytic ileus and atonic bladder with the evidence of peripheral nerve involvement was described. This patient was admitted to our hospital because of the episode of paralytic ileus and atonic bladder at the age of 40 and 41 (1987). She had noticed sporadic headache from 1967, constipation from 1977, tinnitus and hearing disturbance from 1984. One month after her second admission in 1987, her symptoms of paralytic ileus and atonic bladder gradually disappeared. She was then transferred to the department of neurology for the evaluation of underlining neurological disorders. Neurological examination revealed dementia, oro-lingual dyskinesia, and proximal muscular weakness. However, none of the following signs or symptoms were observed; Ophthalmoplegia, blepharoptosis, retinitis pigmentosa, myoclonus, cerebellar ataxia, sensory disturbance, and orthostatic hypotension. Deep tendon reflexes were normal. Planter responses were flexor. Pyruvate and lactate were elevated in both serum and cerebrospinal fluid. Brain CT scan displayed moderate cerebral atrophy and basal ganglia calcifications. EMG was normal except for the external anal sphincter muscles which showed a denervation pattern. Motor nerve conduction velocity was normal in the right median and the right peroneal nerves. Sensory nerve conduction velocity was also normal in the right median and the right sural nerves. However, the amplitude of sensory potential was low in both these nerves. Atonic type of neurogenic bladder was noted on cystometry. There was a lack of voiding desire. The number of active sweat glands iontophoretically stimulated by pilocarpine was reduced. The most prominent feature of the muscle biopsy (the left biceps brachii) was myopathic changes with ragged-red fibers.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Paralytic ileus and atonic bladder in a case of mitochondrial encephalomyopathy--electrophysiological, chemical and pathological study with evidence of the peripheral nerve involvement]. 255 55

We experienced a case of glioblastoma multiforme which exhibited dementia, gait disturbance, headache, and urinary incontinence six months after subtotal removal of the tumor. These symptoms were not due to tumor recurrence, but to communicating hydrocephalus. Communicating hydrocephalus in cases of malignant brain tumors has not often been reported. We discuss the development of this abnormality.
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PMID:Communicating hydrocephalus occurring in the postoperative course of glioblastoma multiforme. 256

Utilizing data from seven independent double-blind controlled trials for cerebrovascular diseases (CVD) in chronic stages, a study was performed to describe the short-term prognosis of cognitive impairment with CVD patients and to identify correlating factors. 943 patients out of 2,818 with CVD (cerebral infarction, cerebral hemorrhage and brain arteriosclerosis) were selected. The subjects had more than moderate intellectual deterioration, i.e., less than 21.5 points on Hasegawa's dementia scale (HDS) at the baseline of the trials. The improvement rate was estimated at 11% (102/943) with more than a 10 point change on HDS in 8 weeks and 34% (322/943) with more than a 5 point change. Long duration of illness, old age, severe initial global severity rating and severe initial cognitive impairment were correlated significantly with aggravation of cognitive impairment. However, sex, type of CVD, complication and rehabilitation were not markedly related with aggravation. In addition, it appeared clear that there was a tendency of improving cognitive impairment on patients with severe subjective symptoms (vertigo, headache, dull headache, feeling of congestion), anxiety, irritability in consequence of the covariance analysis of adjusting for duration of illness, age, global severity and initial cognitive impairment. On the other hand, incontinence, impairment of activities of daily living (excretion), motor weakness and low total protein correlated significantly with aggravation. These findings might be explained on the basis of changes in stages from reversible to irreversible with cognitive impairment, the contribution of aging and the influence of peripheral symptoms.
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PMID:[Short-term therapeutic prognosis of cognitive impairment with cerebrovascular diseases in chronic stages]. 261 1

An unusual case of adult-onset aqueduct stenosis is discussed. The patient presented with a 3-year history of bowel and bladder incontinence without associated dementia, gait disturbance, headache, visual loss, or hypothalamic dysfunction. The absence of the midportion of the sylvian aqueduct in this patient is verified by magnetic resonance imaging.
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PMID:Adult aqueductal stenosis presenting as double incontinence: a case report with magnetic resonance imaging. 230 64

Clinical and pathological studies were made on 5 patients (1 male and 4 females; average age, 58.2 years) with primary malignant lymphoma of the brain. One case had received long-term immunosuppressive therapy for SLE. The most common initial signs and symptoms were non-specific and non-localized. They included headache, disorientation and consciousness disturbance. During the course, the signs and symptoms consisted of consciousness disturbance (5 cases), hemiparesis (4 cases), headache (3 cases), dementia (2 cases), seizures (2 cases), and diplopia (1 case). The tumors on CT scans appeared as slight hyperdense areas in 3 cases, and as isodense areas in 1 case with enhancement following contrast media infusion, which was compatible with previously reported results. However, the other case showed diffuse hypodense areas without enhancement which has rarely been reported. Multiple lesions were found in 4 cases. Three cases underwent cerebral angiography which demonstrated avascular masses. Pathologically, the tumors were located in the cerebral hemispheres in 5 cases, the basal ganglia and thalamus in 3 cases, the brain stem in 2 cases, and the cerebellum in 2 cases. Three cases were classified as of the diffuse, large cell type, 1 case as small cleaved cell and 1 case as immunoblastic. Thus, the clinical diagnosis of primary malignant lymphoma of the brain still remains difficult because the symptoms and CT findings are so varied.
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PMID:Primary malignant lymphoma of the brain--clinical and pathological investigations. 272 42

A 60-year-old woman with a history of hypertension and chronic headache initially presented with irritative personality change and mild but steadily progressive dementia and oral tendency, left-sided hemiplegia, intense nuchal stiffness, and swallowing difficulty in the later stage. She died of bronchopneumonia at the age of 76. The brain showed marked loss of nerve cells with gliosis in the cerebral cortex and fibrillary gliosis in the white matter in addition to the typical pathological findings of progressive supranuclear palsy (PSP): extensive subcortical neurofibrillary tangles (NFTs) and loss of nerve cells with gliosis accentuated in the globus pallidus, Luys body and substantia nigra. In many case reports on PSP, the cerebral cortex is described as normal or within normal limits [Jellinger 1971, Steele et al. 1964], and to our knowledge, there is no reported case of severe cortical atrophy as seen in this case. The differential diagnosis of this case is also discussed.
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PMID:Severe cerebral atrophy in progressive supranuclear palsy: a case report. 277 86


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