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

Sixty-seven patients with brain abscess were managed over 19 years (1975-1993). Our series had a 2.5 to 1 male predominance; the age distribution was from 3 days to 81 years. The underlying conditions of hematogenic brain abscesses (n = 33; 49%) included lung infections (n = 16), heart disease (n = 4), sepsis (n = 10), and other foci (n = 3). Otolaryngologic infections led to the abscess in 10 cases; there were 9 traumatic abscesses. The causes remained unknown in 15 cases. There were 47 solitary abscesses (70%) and 20 multiple abscesses. The most frequent presenting signs and symptoms were neurologic deficits (n = 17), disturbances of consciousness (n = 14), seizures (n = 6), and headaches, meningism and vomiting (n = 13). Causative organisms were isolated in 39 cases (58%) and included staphylococci (n = 6), streptococci (n = 6), enterobacteriae (n = 2), and anaerobic pathogens (n = 9). The most reliable laboratory sign of inflammation was an elevated ESR (52/59 patients). With the advent of computed tomography, burr hole aspiration of the abscess with or without drainage was possible in 30 cases; the mortality in this subgroup was 9%. All 4 patients with surgical excision in the pre CT-era died. The mortality of patients treated with antibiotics only was 62% (18/29). Overall mortality was 37% (25/67), including 5 cases with post mortem-diagnosis of brain abscess. Good recovery was achieved in 29/42 survivors. Predictors of a poor outcome were the patient's age, the level of consciousness, multiple abscesses, polybacterial cultures, and a hematogenic etiology, but not the size of the abscess.
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PMID:[Bacterial brain abscess--experiences with 67 patients]. 880 80

Herpes simplex virus (HSV) typically causes mucocutaneous disease, encephalitis, and acute men ingitis. There have been no previous reports of chronic meningitis due to this virus. A case of chronic meningitis due to herpes simplex virus type 2 (HSV-2) in a previously healthy 35-year-old woman whose predominant symptoms were headache and meningism without fever is described. Analysis of cerebrospinal fluid (CSF) revealed a lymphocytic pleocytosis, elevated protein, and hypoglycorrhachia. The diagnosis of herpes simplex meningitis was supported by the detection of HSV-2 DNA in CSF by polymerase chain reaction and by intrathecal production of HSV-specific antibody. The patient recovered after treatment with intravenous acyclovir and glucocorticoids.
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PMID:Chronic meningitis due to herpes simplex virus in an immunocompetent host. 889 73

A 30-year-old male patient was admitted to our outpatient clinic because of fever, headache and cerebellar symptoms. Clinically he presented with a slight meningism. After exclusion of a focal intracerebral process by head scanning, a first diagnosis of an aseptic meningitis was made by the analysis of the cerebrospinal fluid. With the hint of repeated tick bites, the diagnosis of an early-summer meningoencephalitis was confirmed. The patient recovered without neurological residua within two months. The clinical course, dates of new epidemiologic studies and problems of vaccination are discussed.
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PMID:[Fever and headache]. 892 97

A 78-year-old female with a prior history of migraine and mild hypertension presented to the emergency room with severe headache and mild meningism. The patient had transient significant reactive lymphocytosis, and a computed tomography scan of the head followed by a cerebral angiogram revealed an acute right-sided middle cerebral artery aneurysm rupture. This case illustrates that acute changes in the peripheral blood smear may suggest a more sinister cause for the presentation such as that of a ruptured middle cerebral artery aneurysm, particularly when multiple etiology for the presentation is possible.
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PMID:Transient reactive lymphocytosis associated with acute middle cerebral artery aneurysmal rupture. 914 34

The last epidemic outbreak of poliomyelitis in Norway lasted from 1950 to 1954. The article describes the occurrence of poliomyelitis in Western Norway on the basis of 243 medical records from this period. The epidemic reached its peak in Western Norway in 1952, while the highest number of new cases of poliomyelitis in Norway as a whole occurred in 1951. We found equal representation of both sexes. Most cases were recorded in late summer and autumn. Most patients (96%) had general symptoms, most frequently headache. The fever was moderate. Meningeal irritation (neck stiffness) was recorded in 56% of the cases. The most frequent neurological symptom was asymmetric limb paralysis. 6% of the patients died. High fever, extensive paralysis and inadequate respiration had a negative effect on the prognosis. 57 patients had aparalytic poliomyelitis and were hospitalized for a short time.
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PMID:[Poliomyelitis--not an extinct disease. Outbreak of poliomyelitis in Vestlandet 1950-54]. 914 45

Human monocytic ehrlichiosis is a recently described tick-borne infection with the rickettsial organism Ehrlichia chaffeensis. We describe a patient with documented E chaffeensis infection and multiple organ system involvement. Prominent neurologic symptoms and signs included severe headache, meningismus, and altered mental status. Additional neurologic findings included unilateral arm weakness and a Bell's palsy. Biopsy of brain and meninges demonstrated an infiltrate of atypical lymphoid cells in the leptomeninges with involvement of blood vessel walls and extension into the Virchow-Robin spaces. Bone marrow biopsy revealed fibrin-ringed granulomas. The patient also developed a nonspecific increase in immunoglobulin production. Host immune response may play a critical role in the pathophysiology of ehrlichiosis.
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PMID:A case of acute monocytic ehrlichiosis with prominent neurologic signs. 919 77

A 40 year old architect presents to you with severe headache and testicular pain. He has been unwell for several days with illness that started with influenzal-type symptoms with a mild pharyngitis and myalgias. His headache has become increasingly more severe in the past 36 hours and is occipital in location. His testicular pain has become more intense in the past 24 hours. Examination discloses a temperature of 38.2 degrees C and moderate meningism. There are no focal neurological signs. His right testis is exquisitely tender to palpation. He has had no significant past history of note.
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PMID:Headache and testicular pain. 926 63

Patients suffering from vascular disease are often a challenge for the acute pain service. Ischaemia, impaired wound healing, stump and phantom limb pain often require a complex analgesic regimen. Invasive measures such as spinal or epidural catheters can be very helpful but carry the risk of infection, as shown by this case report. A 53-year-old woman with a ten-year history of diabetes developed arterial vascular disease. Her right lower leg had been amputated two years previously. She was now admitted with necroses of the left forefoot. A bypass operation was performed under general anaesthesia. Because of intractable ischaemic pain, she was provided with an epidural catheter by the acute pain service. The bypass occluded, however, and a few days later her left lower leg also had to be amputated, this operation being performed under epidural anaesthesia with bupivacaine. The catheter was subsequently used for postoperative pain control and as a means to prevent phantom limb pain. When signs of superficial catheter infection were noticed days later, the catheter was immediately removed. Intractable pain then developed in the left leg which could not be sufficiently controlled with opioids and NSAIDs, and so a second epidural catheter was inserted one segment rostrally. Several days later the infected vascular prosthesis had to be removed followed by amputation of the thigh, this operation also being performed in epidural anaesthesia. Eleven days after insertion of the first epidural catheter, the patient complained of low back pain and headache. Examination by a neurologist revealed no signs of intraspinal infection. The second epidural catheter dislocated at this point in time and it was decided to introduce a third one, this being the only means to treat the otherwise intractable stump pain. Ten days later meningism, Kernig's sign and leucocytosis developed. NMR tomography detected intraspinal fluid in the epidural space at the dorsal border of the spinal canal. A hemilaminectomy was performed. The spinal epidural space showed signs of inflammation of the adipose tissue, but no pus. A little necrotic material and residues of an old haematoma were removed and the epidural space was lavaged. Specimens taken from the epidural material revealed colonisation with staphylococcus epidermidis, which was sensitive to the broad spectrum antibiotics formerly given to the patient to treat the infection in the left stump. By the next day, all signs of epiduritis had disappeared and the patient recovered completely.
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PMID:[Epiduritis after long-term pain therapy with an epidural catheter--review of the literature with a current case report]. 932 67

A prospective observational study was conducted over a 10-month period to determine the clinical and laboratory manifestations of cryptococcal meningitis in Zimbabwe, a country where antifungal agents are not widely available. Eighty-nine patients with cryptococcal meningitis (median age, 34 years; range, 11-63 years; 56 males) were identified from 406 patients for whom a clinical diagnosis of meningitis had been made. All patients tested were positive for antibody to human immunodeficiency virus. Cryptococcal meningitis was the first AIDS-defining illness in 88% of patients. Typical presentations were headache, mental impairment, and meningism (median duration, 14 days; range, 1-180 days). The median CD4+ cell count was 70/microL (range, 0-651/microL). The cumulative median survival from the time of diagnosis was 14 days (range, 0-233 days); 22% of patients survived for >30 days. Independent indicators of a good prognosis were not identified. This study provides a unique basis for the development of novel management strategies for patients with cryptococcal meningitis who reside in resource-poor countries.
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PMID:Cryptococcal meningitis in human immunodeficiency virus-infected patients in Harare, Zimbabwe. 1045 Nov 91

Pituitary apoplexy is rare and underdiagnosed. It results from either infarction or hemorrhage into an adenoma of the pituitary gland. The clinical presentation comprises a rapid development of impaired consciousness, severe headache, and amblyopia or diplopia. Meningeal irritation signs are considered rare and have not been reported as presenting signs. We report a 64-year-old patient whose presentation with necrosis of a pituitary adenoma was clinically indistinguishable from infectious meningitis.
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PMID:Pituitary apoplexy manifested by sterile meningitis. 958 May 73


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