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

Three years after radiation therapy for an intrasellar tumor, a 42-year-old housewife presented with headache, lethargy, and remarkable plain skull roentgenograms, in which dilated lateral and third ventricles were filled with air. Air apparently had entered the cranium through the sphenoid sinus and eroded sellar floor, extending directly through intrasellar remnants of the chromophobe adenoma and into the floor of the third ventricle. Frontal exploration showed an empty sella turcica and no residual tumor. She made an excellent recovery and has done well for 5 years after operative closure of the defect.
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PMID:Spontaneous pneumoventriculogram following radiation of a pituitary adenoma. 117 14

In a review of our series of patients with arteriovenous malformations (AVMs), a group with atypical angiographic and histopathological characteristics was discovered. Unlike the typical AVM, these lesions contained normal cerebral tissue between the abnormal vessels. We call these lesions diffuse AVMs, and think that this AVM represents one end of the AVM spectrum from a tight nidus to a diffuse lesion. The mean age of these patients was 18.1 years. Eight patients presented with an intracerebral hemorrhage, two with seizures, one with headache without hemorrhage, and one with ischemic symptoms compatible with vascular steal. Cerebral angiography revealed three AVMs to be 2 to 4 cm in diameter, four were 4 to 6 cm in diameter, and five were > 6 cm in diameter. Characteristic angiographic features included multiple small arterial feeders, small ectatic vessels in the malformation itself, multiple small draining veins, and a diffuse, puddling appearance of the contrast dye. Despite 16 operations in 11 patients, complete resection of the AVM was accomplished in only 8. The four patients with residual disease have received radiation therapy. Histopathology of the surgical specimens found AVM vessels interspersed among normal appearing neurons and white matter. Leptomeningeal angiodysplasia was noted when the cerebral cortex was involved. Gliosis was noted in some cases. Diffuse AVMs represent a difficult surgical challenge and recognition of the lesion aids in surgical planning.
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PMID:Diffuse arteriovenous malformations: a clinical, radiological, and pathological description. 143 9

A very rare large intraventricular hemangiopericytoma occurred in a 41-year-old male with a 2-month history of headache and paresthesia of the right shoulder and arm. The tumor was partially removed, followed by 50 Gy local Linac irradiation given over 6 weeks. Four months later the residual tumor demonstrated a marked decrease in size and vascularity. The residual tumor was totally removed with less operative bleeding than at the initial operation. This is the first reported case of hemangiopericytoma located in the trigone of the lateral ventricle.
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PMID:Intraventricular hemangiopericytoma--case report. 172 17

Two midline oligodendrogliomas in young males were successfully totally removed after preoperative irradiation. A 33-year-old male with right lower extremity weakness had a large hypervascular mass occupying the left lateral ventricle. Even after 31 Gy whole-brain irradiation, massive bleeding occurred at surgery and resulted in only partial removal. The residual tumor markedly regressed with disappearance of abnormal vascularity after subsequent local boost irradiation. At the second operation, the tumor was totally removed. A 32-year-old male with progressive headache had a hypervascular mass with gross calcification in the right lateral ventricle. The tumor was partially resected due to its abundant vascularity and blood loss. After 60 Gy local irradiation, the tumor was moderately shrunk with a significant reduction in vascularity. At the second operation, the tumor was totally removed. Preoperative irradiation as an adjunct to surgery may increase the resectability of highly vascular tumors such as midline oligodendrogliomas.
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PMID:[Efficacy of preoperative irradiation in midline oligodendrogliomas. Report of two cases]. 172 52

Extra-adrenal pheochromocytomas may arise in any portion of the paraganglion system, although they most commonly occur below the diaphragm. The most common site of occurrence of extra-adrenal pheochromocytoma is the superior para-aortic region between the diaphragm and lower renal poles. Although the traditional teaching has been that 10% of all pheochromocytomas are at extra-adrenal sites, this may be an underestimation. Extra-adrenal pheochromocytomas probably represent at least 15% of adult and 30% of childhood pheochromocytomas. They may be malignant in up to 40% of the cases, although conflicting data add to the uncertainty of this point. Patients with tumors arising at extra-adrenal sites commonly present with headache, palpitations, sweating and hypertension. The diagnosis is most often confirmed by demonstrating increased catecholamine production, usually by measurement of urinary catecholamines and/or their metabolites. CT scanning is presently the imaging procedure of choice for localization. The roles of MRI and 131I-MIBG scintigraphy in the localization process are still being determined. Thorough preoperative pharmacological preparation, attentive intraoperative monitoring and aggressive surgical therapy all have an important role in achieving the safest and most successful outcome. Complete surgical excision is the treatment of choice for primary extra-adrenal pheochromocytoma as well as recurrent or metastatic disease. When residual tumor cannot be resected, medical therapy for symptomatic relief is preferred, since radiotherapy and chemotherapy have limited effectiveness. Extra-adrenal pheochromocytomas are more likely to recur and to metastasize than their adrenal counterparts, making lifelong followup with annual determinations of catecholamine production essential.
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PMID:Extra-adrenal pheochromocytoma. 172 90

Thirty patients with histologically confirmed posterior fossa ependymomas operated on between January 1976 and December 1988 were reviewed. The median age was 44 years (range, 1-69 yr). There were 7 children (aged 5 yr or younger) and 23 adults (aged 16 yr or older). There were 18 female patients and 12 male patients. Headache, nausea and vomiting, and disequilibrium were the most frequent symptoms. The most common findings were ataxia and nystagmus. Gross total resection was performed in 8 patients (27%), subtotal resection in 21 patients (70%), and biopsy in only 1 patient (3%). Tumors were low grade in 73% and high grade in 27%. Twenty-seven patients underwent posterior fossa radiotherapy (median dose, 5400 cGy). Fourteen patients also underwent spinal irradiation (median dose, 3520 cGy). Age was the only significant prognostic factor identified (P less than 0.01). The 5-year survival rates were 76% for adults and 14% for children. All 14 patients who died had recurrent or residual tumor at the primary site. This review suggests that in patients with primary posterior fossa ependymomas the following is true: 1) the young patient (5 yr old or younger) has a poor prognosis; 2) there was a trend toward a better 5-year survival rate with a gross total resection; 3) if recurrence occurs, it will be at the primary intracranial site; and 4) symptomatic spinal seeding does not occur frequently.
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PMID:Posterior fossa ependymomas: report of 30 cases and review of the literature. 187 43

A 43-year-old man was admitted to our clinic with complaints of headache and nasal obstruction. He has noted increasing hand and foot size with decreasing libido and pollakiuria for ten years. On admission, he showed galactorrhea. His visual symptoms were slightly decreased. Endocrinological evaluation revealed high serum levels of GH and prolactin. A plain skull X-ray showed acromegalic features with remarkable destruction of dorsum sellae. A contrast enhanced CT demonstrated an intrasellar high density mass extending to the sphenoid sinus and the right ethmoidal sinus. A cerebral angiogram was nor.al. Surgery was then performed with the transsphenoidal approach. A soft reddish brown mass was found in the sphenoid sinus and the bilateral cavernous sinus extending from the sella turcica. Histologically the tumor was eosinophilic adenoma. There were numerous cells exhibiting immunostaining for both GH and PRL in the immunocytochemical study. Postoperative course was uneventful. His visual impairment improved soon after the operation. Serum GH and PRL levels decreased to 38 and 130 ng/ml. He was treated with conventional irradiation (500 rads), so remained galactorrhea and hyperhidrosis. One year after the operation, there is no regrowth of the residual tumor.
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PMID:[A case of male acromegaly with galactorrhea]. 284 24

A retrospective study was conducted on all 23 patients who underwent operation for residual or recurrent acoustic neuromas during the 10-year period January 1976 through December 1985. The most common symptoms at the time of reoperation were ataxia (16 patients), facial paresthesias (13 patients), and headaches (9 patients). Primary procedures had consisted of suboccipital posterior fossa approaches in 22 patients and a middle fossa approach in one. Reoperation for recurrent or residual tumor consisted of a retrosigmoid approach in 17 patients and a translabyrinthine or translabyrinthine/retrosigmoid approach in six patients. This study confirms that residual or recurrent acoustic tumors are not common. It also suggests that long-term follow-up, for at least 7 to 8 years, is indicated.
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PMID:Residual and recurrent acoustic neuromas. 365 63

Two long survival cases of primary malignant glioma are reported in terms of histopathological consideration comparing first surgical specimens with second surgical specimens followed by intraneoplastic local injection of Adriamycin (ADM). Case 1. A 56-year-old female was admitted to our hospital on October 24, 1977, with the complaints of headache and motor weakness on the left side of extremeties. Neurological examination revealed hemiparesis, homonymous hemianopsia and agnosia on the left side. Initial CT scan showed irregular high-density enhancing lesions in right parieto-occipital region with surrounding low-density area. Case 2. A 18-year-old male was admitted to our hospital on May 9, 1977, with the complaints of headache and nausea. Initial CT scan showed high-density enhancing resion in the left parieto-temporal region. In the microscopic findings of the recurrent tumor and surrounding necrotic tissue, there were massive coagulation necrosis of the tumor tissues and fibrinoid necrosis of vascular channels. In the surrounding area of the massive coagulation necrosis and small hemorrhages, there were many reactive collagenous tissues, increasing vascular channels, and infiltrating lymphocytes, granulocytes and foreign body giants cells, as well as so-called organized necrotic tissues. Residual tumor cells mainly composed of giant cells, gemistocytic astrocytes and spindle cells. The tumor was characteristic in that the tumor cells showed occasionally sarcomatous transformation in the other area. Some of anaplastic glial cells were positively stained for GFA protein in Case 1. Positive staining for GFA protain in the recurrent brain tumor are less than that of primary brain tumor. The cases were also discussed from the view point of pathology.
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PMID:[Effect of local injections of adriamycin on survival in malignant brain tumor: histopathological evaluation]. 687 Feb 95

A case of teratoma in the pineal region which recurred 4 years after the first tumor removal was reported in this paper. When the patient was 5 years old, she, complained of headache and vomiting, and visited our hospital. As a heterogeneous mass with no enhancement effect was found in the pineal region by CT scan, she was admitted on November 9, 1976. There was no abnormalities on physical examination but neurological examination revealed slight disturbance of conjugate upward gaze (Parinaud's sign). Left vertebral angiogram demonstrated posterior superior displacement of posterior choroidal artery and downward displacement of Rosenthal vein, but early venous filling and tumor stain were not seen. Under preoperative diagnosis of a teratoma in the pineal region, the first operation (left occipital craniotomy and total removal of the tumor) was performed on November 24, 1975. Microscopic examinations revealed that the removed tumor was a mature teratoma in the pineal region. Postoperative course was uneventful and discharged on December 20, 1975. The follow-up study was continued at outside clinic after discharge. There was no signs of recurrence until 3 years after the first operation, but on January, 1981 (4 years after the first operation), she suffered from severe headache and vomiting again and re-admitted to our hospital on February 3, 1981. There was no remarkable neurological deficits except for the mild intracranial hypertensive sign and no changes of findings on angiogram. But CT findings were markedly characteristic. It revealed a heterogenous mass with remarkable enhancement effect in the pineal region and ventricular enlargement. Because a mixed type (teratomatous and germinomatous) of pineal tumors was suspected from the CT findings, irradiation was done after V-P shunt. The tumor was reduced to half size after the first course of 2000 rads irradiation, but there is no more reduction of the size of the tumor following the second course of 2000 rads (total 4000 rads) irradiation. Against the residual tumor, tumor removal was performed on June 2, 1981. Microscopically, the most part of the resected tumor showed fibrous changes caused by irradiation and partially teratomatous compartment. From this result (radiosensitivity and histology) the authors assumed that the recurred tumor could be a mixed type (germinoma and teratoma) of pineal tumor. Postoperative course was uneventful except for a transient disturbance of conjugate upward gaze and she was discharged on June 25, 1981. And now, there is no signs of recurrence 12 months after the second operation. Conclusively, it will be stressed that we should continue follow-up study the case even after total removal of teratoma, especially in the pineal region. Moreover, it was considered that there is a possibility of the changes of the histological features on recurrence of the pineal teratoma. When germinomatous compartment is suspected, irradiation is the first choice and then microsurgical operation should be done against residual tumor.
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PMID:[Problems on recurrence after removal of teratoma in pineal region--an experience of recurrence of pineal teratoma 4 years after tumor removal]. 715 42


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