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

We encountered a case with a giant partially-thrombosed vertebral artery aneurysm successfully treated by endovascular trapping following a surgical parent artery clipping two years previously. The patient complained only of headache on her admission. Initial CT showed no subarachnoid hemorrhage, and MRI of the left anterior aspect of the pons showed flow void and hematoma. The angiogram showed fusiform dilatation of the left vertebral artery just proximal to the vertebral union. At first, the patient was treated by surgical proximal clipping of the left vertebral artery, under a diagnosis of arterial dissection. Her symptom improved and the angiogram showed a slight retrograde aneurysmal filling after the operation. Two years later, she complained of dysphasia, right hemiparesis, and hemidysesthesia caused by the compression of the brain stem. On MRI study, a partially-thrombosed giant aneurysm was detected in the left anterior aspect of the brain stem. The retrograde filling did not change remarkably on the angiogram. We performed the GDC embolization of the left distal vertebral artery and non-thrombosed residual neck with an assisting balloon positioned through the right vertebral artery to the basilar artery. After the embolization, the patient's neurological deficits caused by the compression of the brain stem disappeared. MRI study showed the mass volume reducing gradually over a two-years follow-up period. Treatment for a partially-thrombosed giant vertebral artery aneurysm is difficult and controversial. It is necessary to shut off the blood flow into the aneurysm completely, so we consider that endovascular trapping with intraaneurysmal embolization is the most effective procedure.
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PMID:[Intraaneurysmal embolization and parent artery trapping to treat a giant partial thrombosed vertebral artery aneurysm after surgical proximal clipping]. 1102 83

We report facial palsy as the sole cranial neuropathy complicating an ipsilateral internal carotid artery dissection. A previously healthy 44-year-old man developed retro-orbital and temporal headache with associated nausea while engaged in modest physical exercise. On the following morning he noticed a left ptosis and miotic pupil. One week later he woke with a left facial weakness. On the same day he had a 90-minute episode of expressive dysphasia. Magnetic resonance imaging and angiography demonstrated left internal carotid artery dissection. The temporal association between our patient's facial nerve palsy and typical features of spontaneous internal carotid artery dissection suggests a common aetiology. We suggest that involvement of the VII cranial nerve in isolation followed disruption of an anomalous nutrient artery. The delay in clinical manifestation may imply extension of the dissection.
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PMID:Facial nerve palsy secondary to internal carotid artery dissection. 1113 63

The authors' Survey of headache specialists highlights a number of controversial issues in migraine management including the following: acute treatment, focusing on use of triptans, and preventative medications; treatment of migraine with prolonged aura and basilar migraine; and the use of oral contraceptives in migraine. Interestingly, the prevalence of migraine among the headache specialists themselves is much higher than in the general population. Although triptans have revolutionized the acute treatment of migraine, treatment is still problematic for the sizable percentages of patients with an incomplete or no response and recurrence of headache. Triptans are generally very safe when the physician, aware of the potential for coronary artery vasoconstriction, appropriately screens patients before and during their use. Serotonin syndrome as a complication of triptan use is quite rare. Although there is no definite evidence of teratogenesis, triptans should not be taken during pregnancy unless the potential benefit justifies the potential risk to the fetus. Caution is also advised when using a triptan during breastfeeding. The United States Headache Consortium parameters, which consider indications for preventative treatment and propose general principles of management, are reviewed. Unfortunately, the experience of many migraineurs with preventative medications is less than satisfactory because of side effects or lack of efficacy. Treatment of both migraine with prolonged aura and basilar migraine is anecdotally based. Many headache specialists do not use beta blockers for prevention for those with prolonged aura and basilar migraines because of concerns over the potential limitation of compensatory vasodilatory capacitance. There are seven case reports in the literature of an association between stroke and the use of beta blockers in migraineurs. Prevention using divalproex sodium and verapamil is favored by many headache specialists. Triptans are contraindicated in the treatment of patients with hemiplegic or basilar migraine because of concern over the potential for cerebral vasoconstriction. The frequency of migraine is usually unchanged with the use of oral contraceptives although, occasionally, migraine may occur for the first time or increase in frequency. Studies have produced conflicting results as to whether low-dose estrogen oral contraception increases the risk of stroke. Migraine alone increases the risk of stroke, at least in women under the age of 45 years. Most women with migraine without aura and migraine with visual aura lasting less than 1 hour can safely use low-dose estrogen oral contraceptives when there are no other contraindications. Those with aura symptoms such as hemiparesis or dysphasia or prolonged focal neurologic symptoms and signs lasting more than 1 hour should avoid starting low-dose estrogen oral contraceptives and stop the medication if they are already taking it.
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PMID:Topics in migraine management: a survey of headache specialists highlights some controversies. 1147 58

Subdural haematoma is a well-documented complication of accidental dural puncture, and is thought to be preventable by prompt treatment with an epidural blood patch. An accidental dural puncture occurred in a 39-yr-old primagravida during the siting of an epidural catheter for pain relief in labour. Twenty hours after the puncture, the mother developed a typical postdural puncture headache, which increased in severity over the subsequent 24 h. An epidural blood patch was performed at 48 h, and this initially relieved the headache. After discharge from hospital, and 14 days after the dural puncture, the headache recurred, together with expressive dysphasia, poor co-ordination and sensory loss in the right arm. A magnetic resonance imaging scan demonstrated a left sided subdural haematoma, which was drained successfully with complete recovery.
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PMID:Subdural haematoma after dural puncture headache treated by epidural blood patch. 1157 51

This extremely rare case was one of secondary solitary cerebral echinococcosis associated with possible cerebral thromboembolism. A 7-year-old girl living in a rural area was admitted to our hospital with a history of headache, right-sided hemiparesis, and dysphasia. She had been treated 6 months previously for a cerebral infarct, diagnosed from sudden altered consciousness and a myoclonic generalised convulsion. The growth rate determined for the cerebral hydatid cyst was about 4.5 cm during the 6-month period. In children a parasitic cyst can be the source of a cerebral embolus, particularly in areas where hydatid disease resulting from cardiac echinococcosis is endemic.
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PMID:Growth rate of cerebral hydatid cyst, with a review of the literature. 1186 41

The percentage of aneurysms measuring more than 2'5 cm in diameter ranges from 3 to 13%, and occur more commonly in females. They come to clinical attention later than nongiant aneurysms, but 20% of them appear in patients 20 years of age or younger. Its natural history is incompletely understood. We present the case of a 24-year-old female admitted following a generalized seizure with postictal dysphasia and right hemiparesis caused by a subarachnoid hemorrhage due to a ruptured giant aneurysm located in the left temporal fossa, who died few hours later because of rebleeding. This patient had been followed during the last seven years at our unit because of untreated frontal osteomas, without evidence of any intracranial lesion in the computerized axial tomography (CT). Some months before her death, she had suffered a left micotic otitis, and she was studied because of the reappearance of her left cephalalgia without neurological deficit. This case is another evidence of quick appearance of a giant aneurysm, "silent" until the fatal outcome.
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PMID:[Giant aneurysm of fast development]. 1214 67

Masson's vegetant intravascular hemangioendothelioma has only been reported intracranially in 12 patients. The pathological diagnosis is important given its benign natural history. We report the 13th case in a woman who presented with headaches and dysphasia. A thorough literature review is presented and an appropriate management strategy is proposed.
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PMID:Masson's vegetant hemangioendothelioma: case report and literature review. 1258 91

The prospective studies available today confirm the experience gained from several retrospective studies that TBE is a disease with a severe acute clinical course and considerable long-term morbidity. A defined post-encephalitic TBE syndrome exists, causing long-lasting morbidity that often affects the quality of life and sometimes also forces the individual to a change in life-style. The sequelae render high costs for individual patients and the society. Three clinical courses may be identified: one with complete recovery within 2 months, occurring in approximately one fourth of patients, one with protracted, mainly cognitive dysfunction, and one with persisting spinal nerve paralysis with or without other post-encephalitic symptoms. Up to 46% of patients are left with permanent sequelae at long-time follow-up, the most commonly reported residuals being various cognitive or neuropsychiatric complaints, balance disorders, headache, dysphasia, hearing defects, and spinal paralysis. This knowledge enhances the need for continued local epidemiological surveillance of TBE to form a basis for vaccination policies. Even though knowledge of the clinical course of TBE has improved in recent years, there are still several aspects of this disease that warrant further studies. These comprise the clinical picture and prognosis in children, an evaluation of different rehabilitation strategies, and an improved understanding of pathogenic mechanisms to permit the development of antiviral or, maybe more probable, immune modulatory treatment strategies.
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PMID:Tick-borne encephalitis--pathogenesis, clinical course and long-term follow-up. 1262 10

We report a case of a 66-year-old male with diffuse infiltration of neoplasm from the paranasal sinuses to the orbit and left cerebral hemisphere, associated with prominent edema. Initial complaints were headache and swelling of the forehead, which were followed by progressive symptoms, such as epistaxis, dacryops, and severe pains. Neuroimaging showed marked invasion of a neoplasm from the left paranasal sinuses into the intracranial space and to the frontal skull. Radical removal of the neoplasm and left orbital content with reconstruction of the anterior skull base using musculocutaneous flap was carried out by a multidisciplinary team. The pathological diagnosis was "poorly differentiated carcinoma from the paranasal sinus". Postoperatively the patient received radiation and chemotherapy. He is still alive with mild right hemiparesis and mild dysphasia, more than 2 years after surgery.
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PMID:[A case of sinonasal carcinoma with intracranial invasion treated by a multidisciplinary team]. 1283 78

A relatively rare condition of ossified chronic subdural hematoma (SDH) mimicking cerebral stroke is presented. A 67-year-old man presented with headache, dysphasia, and left-sided hemiparesis. Routine skull x-ray showed a huge calcification extending from the frontal to the parietal regions in the right side. CT and MRI scan revealed a huge ossified SDH covering the right hemisphere. Right frontoparietal craniotomy was performed and the ossified SDH was completely removed. Severe adhesion was noticed between the pia mater and the inner surface of the ossified mass. The subdural mass had ossified hard outer and inner rims and a soft central part. The postoperative course was uneventful and 3 months after the operation, the patient was neurologically intact. The authors report the successful treatment of a patient with a huge ossified SDH covering the right hemisphere. Careful dissection and total removal are needed in such symptomatic cases to avoid cortical injury and to improve results.
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PMID:Ossified chronic subdural hematoma. 1458 11


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