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

This paper is intended to describe the expert system RHINOS for diagnosing patients whose chief complaints are headache and facial pain. RHINOS assists physicians in diagnosing the above-mentioned disease. For this purpose the authors surveyed diagnosing processes used by physicians to determine what advice physicians want. As a result, the author reached the conclusion that knowledge for diagnosing the above-mentioned disease should be categorized according to four types of rules: exclusive rules (if the patient has disease D, he must have symptoms S1, S2,....,Sn), inclusive rules (if the patient has symptoms S1, S2,...,Sn, he has disease D with a probability X (0 less than X less than 1)), associate rules (if the patient has symptoms S1, S2,...,Sn the probability that he has the disease D increases) and disease image (if the patient has disease D, he may have symptoms S1, S2,...,Sn). Through harmonious use of these four types of rules, RHINOS gives the advise that physicians want. RHINOS is widely available because it is implemented by Prolog-KABA which is operative on personal computers such as NEC PC9801 and IBM-PC.
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PMID:RHINOS: a consultation system for diagnosis of headache and facial pain. 352 51

The authors analyze a series of 53 patients who presented with unruptured intracranial aneurysms. Fifty were operated upon, 2 died during the post-operative period, 5 were left with their pre-operative neurological deficit, 43 were cured and have not subsequently presented with any cerebral or meningeal haemorrhages. None of the 3 patients who were not operated upon has since presented with a cerebro-vascular accident. Twenty-five aneurysms were asymptomatic, discovered fortuitously during angiographic examination, and their size was generally between 3 and 6 mm. Twenty-eight aneurysms presented with various neurological signs and symptoms (headaches, facial pain on 9 occasions, ischaemic vascular accidents on 7 occasions, ocular signs on 8 occasions and generalized epilepsy on 4 occasions), with a range in size from 7 to 10 mm. The clinical and autopsy series published in the literature show the usefulness of surgery when certain factors come together and increase the risk of rupture: middle-aged patients (between 40 and 65), arterial hypertension, aneurysm located on the anterior part of the circle of Willis and with a diameter close to the critical size (10 mm) for rupture.
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PMID:Surgical prognosis of unruptured intracranial arterial aneurysms. Report of 50 cases. 357 59

Spontaneous dissection of the internal carotid artery as a cause of Horner's syndrome has only been recognized in recent years. The authors describe three patients with this condition. Associated symptoms included ipsilateral orbital and frontal headache (3 patients), neck and facial pain (2), amaurosis fugax (1), and dysgeusia (1). The symptoms resolved in all patients within three months, yet oculosympathetic paralysis has persisted. Diagnosis of carotid dissection required cerebral arteriography, and the angiographic features are presented. Patients were treated with platelet antiaggregants, and they have remained neurologically stable during follow-up (mean, 12 months; range, 10-14 months).
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PMID:Painful Horner's syndrome due to spontaneous carotid artery dissection. 358 97

The main criteria of "cervicogenic headache" are considered to be as follows: relatively rare and long-lasting unilateral attacks of severe headache, although seemingly of a non-excruciating character, signs of neck involvement, and lack of "cluster pattern". In the present communication, the clinical manifestations in 11 patients fulfilling these criteria are described. All 11 patients selected in accordance with these criteria proved to be females, the age at onset ranging from 6 to 40 years (mean, 30 years). The mean duration of symptoms was 13 years. Six patients had had previous head/neck injuries. All patients had pain periorbitally, in the temporal region, and in the low occipital region (nape of the neck); less frequent were frontal, parietal, and facial pain and pain in the upper part of the occipital region. The duration of attacks was from 3 h to 3 weeks, and the interval between attacks lasted from 2 days to 2 months. The commonest accompanying phenomena were phonophobia, dizziness, ipsilateral eyelid edema, ipsilaterally blurred vision, and irritability. Some of the patients also had nausea (n = 7) and vomiting (n = 6). On physical examination, slight to moderate reduction of movements in the neck was noted, and five patients had ipsilaterally reduced sensation for touch in the trigeminal area. All the patients except one were severely afflicted. Attacks could, in addition to occurring spontaneously, be precipitated in all patients by head movements or by pressure at specific points in the neck.
Cephalalgia 1987 Jun
PMID:"Cervicogenic headache": clinical manifestation. 360 68

Between March, 1966, and June, 1985, 23 women and 12 men underwent partial or total resection of apical petrous or clivus meningiomas at The National Hospital for Nervous Diseases. Presenting symptoms were typically of long duration (mean 29 months) and consisted primarily of gait disturbance, headache, hearing loss, and facial pain. Cranial nerve deficits, especially affecting the fifth, seventh, and eighth nerves. were observed in nearly every patient. Tumor size, but not location, was generally associated with degree of preoperative disability. Plain skull films were usually unremarkable, but computerized tomography (CT) proved highly accurate in determining tumor location and size. A characteristic pattern of vascular displacement was seen on vertebral angiograms, although blood supply to the tumors was derived primarily from branches of the internal and external carotid arteries. Subtotal or total resection was undertaken in all cases; nine patients required adjunctive cerebrospinal fluid shunting procedures. Although surgical techniques evolved during the course of the 20-year study, a combined supra- and infratentorial approach proved a relatively safe and effective means of surgical treatment. New or worsened postoperative deficits, especially cranial nerve palsies, and complications in the immediate postoperative period frequently resulted in temporary deterioration of the clinical status during this period; the total operative mortality rate was 9%. Follow-up periods ranged up to 9 years; 70% of patients resumed an independent existence, and none is known to have required subsequent tumor surgery. The size of the lesion was the only significant factor in determining outcome. These data suggest that meningiomas of the clivus and apical petrous bone can be accurately diagnosed by CT and three-vessel angiography, and effectively treated by microsurgical resection.
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PMID:Meningiomas of the clivus and apical petrous bone. Report of 35 cases. 372 72

Men with PRL-producing macroadenomas often present with hypogonadism and impotence. This report documents exacerbation of a PRL-secreting tumor after two separate 200-mg testosterone enanthate (T) injections despite continued bromocriptine (BRC) therapy. A 37-yr-old man with a 60-mm invasive tumor and a serum PRL level of 13,969 +/- 332 ng/ml (mean +/- SD) responded to BRC therapy with rapid disappearance of visual field defect, headache, and facial pain as well as decrease in serum PRL to 5,103 +/- 1,446 ng/ml. T injection was followed by severe headache, facial pain, and increase in PRL to 13,471 ng/ml. Visual field deterioration and increased tumor size (height, 40-43 mm) by computed tomography were documented. A relationship between T injection and exacerbation of the prolactinoma was not recognized until after a second T injection 3 months later. After that therapy, baseline PRL increased from 6,900 to 12,995 ng/ml. The hypothesis that T was aromatized to estradiol, directly stimulating lactotrophs, was supported by an increase in serum estradiol from 24 to 51 pg/ml after the second T injection. Although T treatment is accepted as appropriate therapy for hypogonadism in men with prolactinomas, it may not only interfere with the response of the tumor to BRC therapy, but even stimulate tumor growth and secretion.
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PMID:Testosterone-related exacerbation of a prolactin-producing macroadenoma: possible role for estrogen. 379 56

Maxillary sinusitis may be diagnosed incorrectly as TMJ pain-dysfunction syndrome because of a similarity of signs and symptoms. Both conditions can manifest with headache, facial pain radiating to the ear and the maxillary teeth, preauricular pain, and pain in the buccal vestibule posterior and superior to the maxillary tuberosity. It can be concluded that (1) more consideration should be given to sinus disturbances as a differential diagnosis in TMJ pain-dysfunction syndrome, (2) it may be preferable to refer some patients with TMJ pain to a medical center where specialists in dentistry, otolaryngology, neurology, rheumatology, and psychiatry can evaluate the patient, and (3) TMJ pain-dysfunction syndrome should be evaluated and treated by a dentist experienced in management of this disorder.
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PMID:Maxillary sinusitis as a differential diagnosis in temporomandibular joint pain-dysfunction syndrome. 385 28

Analysis of face pain is predicated on knowledge of the structures of the face, head, and neck that may generate this sensation. Of particular importance in this process are historical data; characteristics of the pain, as elicited in history taking, should lead to the definition of recognized syndromes that may threaten a patient's survival or function and for which appropriate intervention may bring relief. Among these syndromes are trigeminal neuralgia and neuropathy, cluster headache, cranial arteritis, nasopharyngeal carcinoma, and psychogenic face pain.
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PMID:Neurologic analysis of face pain. 646 69

The centralization of treatment for functional masticatory disturbances by the Copenhagen Municipality Children's Dental Service has made possible the present survey of symptoms and results of treatment in a child population. Over a period of four years, a total of 366 children, aged six to sixteen (two thirds girls), were referred for treatment. Their symptoms differed from those reported by adult patients by a marked attrition of the mandibular incisors and concomitant sensitivity to thermal and mechanical stimulation. Other symptoms of functional disturbance, such as reduced mandibular mobility and muscle tenderness, were similar to those reported for adult subjects. Treatment conformed to conventional principles with widespread use of soft bite-splints (Figure 5). Both symptoms and signs were eliminated in about 60 percent of the patients, while 34 percent were essentially symptom-free at the conclusion of treatment. The survey showed that functional disturbances in the mandibular apparatus occur in children, and that many can be treated with good results. The symptomatology, however, resembles that of a wide range of other ailments, especially with respect to headache and facial pain, necessitating a careful differential diagnosis before functional corrective treatment is started.
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PMID:Functional disturbances of the masticatory system in school children. 658 Nov 87

A 35-year-old woman had partial, right-sided Horner's syndrome seven years prior to admission. Facial sweating was normal. Ipsilateral headache and facial pain followed a year later. Three months before admission a left-sided carotid body tumor was resected successfully. Soon thereafter, a mass was noted below the right mandibular angle and carotid angiography showed features typical of a carotid body tumor at the carotid bifurcation. To our knowledge this is the first report of such a lesion causing Raeder's syndrome. Review of other reported cases of this usually benign syndrome shows that some may be associated with serious but treatable diseases of the internal carotid artery.
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PMID:Carotid body tumor associated with partial Horner's syndrome and facial pain ('Raeder's syndrome'). 661 87


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