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

Tuberculous meningitis (TBM) presents clinically as either acute meningitis syndrome characterized by coma, raised intracranial pressures, seizures, and focal neurological deficits, or as a slowly progressive dementing illness. When the infection presents as the former, characteristic signs and symptoms are headache, malaise meningismus, papilloedema, vomiting, confusion, seizures, and cranial nerve deficits. Patients admitted with lethargy or stupor may enter coma in a matter of days, and fever may or may not be present. However, TBM more commonly presents as a slowly progressive dementing illness, with memory deficits and personality changes typical of frontal lobe-like disease. TBM is described with regard to its history, clinical presentations, complications, diagnosis, C.S.F. abnormalities, treatment, prognostic factors, and indications of steroids. Combination drug therapy involving isoniazid, rifampin, pyrazinamide, and pyridoxine is the recommended treatment strategy for adults. The patient's level of consciousness at the start of therapy is the most important prognostic factor reported in TBM cases, with the greater the change in mental status, the worse the outcome. The mortality rate of patients who are comatose before the initiation of therapy is 50-70%.
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PMID:Tuberculous meningitis. 1229 51

In most cases a saccular aneurysm is the cause of acute subarachnoidal hemorrhage (SAH). The usual symptoms are severe headache and meningism. Due to the high mortality rate caused by rebleeding an early occlusion of the aneurysm should be strived for. For this early diagnosis an exact identification of the aneurysm and its configuration is essential.
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PMID:[Clinic, diagnosis, and therapy of subarachnoidal hemorrhage]. 1245 38

Pituitary apoplexy can occur spontaneously or following anterior pituitary stimulation tests. Apoplexy is a rare complication of Cushing's disease. We report a 19-year-old woman who was admitted to the National Institutes of Health for evaluation of possible Cushing's syndrome. Her symptoms and initial laboratory work were suggestive of Cushing's disease. Magnetic resonance imaging (MRI) revealed a macroadenoma of the pituitary gland. As part of her evaluation she received corticotrophin-releasing hormone (CRH). Two days later she developed severe headache, accompanied by nausea and vomiting, followed by meningismus, ptosis and diplopia. A diagnosis of pituitary apoplexy was made and she was treated conservatively with dexamethasone. Her neurological symptoms resolved shortly afterwards. By the time of discharge her anterior pituitary function was suppressed. All symptoms and signs of Cushing's syndrome resolved thereafter. This is the first case to demonstrate that CRH administration can induce pituitary apoplexy in a patient with Cushing's disease. Therapy with glucocorticoids was effective in our case, suggesting that conservative treatment can be successfully and safely applied in certain cases with pituitary apoplexy.
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PMID:Pituitary apoplexy induced by corticotrophin-releasing hormone in a patient with Cushing's disease. 1269 33

First time experienced severe headache combined with fever or meningism requires immediate evaluation by computer tomography (CT) to exclude subarachnoidal or cerebral hemorrhage, hydrocephalus or a tumor. If CT is normal,lumbar puncture must be performed to exclude meningitis and meningoencephalitis. Chronic or chronic recurrent headache without focal neurological deficits does not require EEG or CT. CT must be performed if the headache characteristics change or if the headache is combined with neurological deficits.
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PMID:[Usefulness of electrophysiology and neuroimaging in the evaluation of headache]. 1279 59

We report on a 70-year-old female with acute onset of headache, meningism, xanthochromic cerebrospinal fluid, and developing laboratory parameters indicating a systemic infection. Initially, a subarachnoidal hemorrhage was assumed. However, magnetic resonance imaging showed upper cervical osteomyelitis and extending spinal epidural abscess. After application of broad systemic antibiotics, secluded abscess formation was achieved and successful neurosurgical debridement performed. The unusual cranial concentration of the complaints is probably due to the involvement of the craniocervical transition. Cervical epidural spinal abscess represents a potentially dangerous bacterial infection of the upper spine. Inadequate treatment can lead to irreversible neurological deficits. Cervical magnetic resonance imaging is an effective tool for diagnosis, since early diagnosis is important for good prognosis.
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PMID:[Acute headache with meningism and xanthochromic cerebrospinal fluid.An unusual manifestation of cervical epidural abscess]. 1290 72

A 14-year-old girl developed fever, severe headache, vomiting, and no light perception in both eyes over a 3-day period without a previous complaint of visual or other neurologic difficulties. Neuro-ophthalmologic examination was normal apart from meningismus and blindness. Brain imaging showed ventriculomegaly and multiple enhancing nodules around the optic chiasm. Lumbar puncture showed an elevated opening pressure with lymphocytic pleocytosis. Polymerase chain reaction and enzyme-linked immunoabsorbent antibody tests on the cerebrospinal fluid were positive for Mycobacterium tuberculosis. There was no evidence of tuberculosis elsewhere in the body. Standard antituberculous treatment, including corticosteroids, did not reverse the blindness.
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PMID:Irreversible blindness due to multiple tuberculomas in the suprasellar cistern. 1450 94

Pituitary apoplexy is a rare and underdiagnosed clinical syndrome. It results from hemorrhagic infarction of the pituitary gland. In its classical form it is characterized by acute headache, ophthalmoplegia, visual loss and pituitary insufficiency. Meningeal irritation signs, clinically indistinguishable from infectious meningitis, are considered rare and have not been reported as presenting signs. We report a 53-yr-old man who was admitted to hospital following acute headache, fever, neck stiffness and paresis of the left oculomotor and abducent nerves. A lumbar puncture revealed an increased number of polymorphs but with a sterile cerebral spinal fluid. Magnetic resonance imaging (MRI) showed an intrasellar mass with central necrosis in an enlarged sella. Endocrinological evaluation demonstrated insufficient thyroid, adrenocortical, and gonadal function. Necrosis within a chromophobe adenoma was found upon surgical decompression of the sella. After surgery anterior panhypopituitarism did not recover, while ophthalmoplegia subsided. The patient is now in good health under appropriate hormonal replacement therapy.
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PMID:Acute sterile meningitis as a primary manifestation of pituitary apoplexy. 1466 31

This report describes a fatal case of central nervous system pseudallescheriasis. A 32 year old white man presented with headache and meningismus 15 days after nearly drowning in a swine sewage reservoir. Computerised tomography and magnetic resonance imaging of the head revealed multiple brain granulomata, which vanished when steroid and broad spectrum antimicrobial and antifungal agents, in addition to dexamethasone, were started. Cerebrospinal fluid analysis disclosed a neutrophilic meningitis. Treatment with antibiotics and amphotericin B, together with fluconazole and later itraconazole, was ineffective. Miconazole was added through an Ommaya reservoir, but was insufficient to halt the infection. Pseudallescheria boydii was finally isolated and identified in cerebrospinal fluid cultures, a few days before death, three and a half months after the symptoms began. Diagnosis was delayed because of a reduction in the lesions after partial treatment, which prevented a stereotactic biopsy. Physicians should be aware of this condition, and provide prompt stereotactic biopsy. Confirmed cases should perhaps be treated with voriconazole, probably the most effective, currently available treatment for this agent.
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PMID:Infection of the CNS by Scedosporium apiospermum after near drowning. Report of a fatal case and analysis of its confounding factors. 1474 53

A 44-year-old woman suffered fever, headache and meningism during a summer stay in a region of central Italy where sand-fly fever is endemic. A few days after returning to the Netherlands, she appeared mentally and physically slow but had no fever. Because of the possibility of viral meningitis an examination of the cerebrospinal fluid (CSF) was carried out. This revealed a cell count of 1074/3 cells. Toscana virus antibodies of the IgG and IgM subclass were detected in two respective serum samples and in the CSF. This led to the diagnosis 'Toscana virus meningo-encephalitis'. Toscana virus is classified amongst the sandfly fever virus group. These viruses are transmitted by sand flies (Phlebotomus species) which reside in humid areas around the Mediterranean. Toscana virus is the main cause of viral meningoencephalitis in some areas of central Italy and possibly in southern Spain. The patient recovered within a few days without antiviral therapy. Toscana virus meningo-encephalitis should be included in the differential diagnosis of holidaymakers with neurological symptoms returning from the Mediterranean.
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PMID:[Meningitis caused by Toscana virus during a summer stay in Italy]. 1500 57

Pituitary tumor apoplexy is an uncommon event heralded by abrupt onset of severe headache, restriction of visual fields, deterioration of visual acuity, and weakness of ocular motility frequently coupled with clinical indications of decreased endocrine function. Hemorrhage into or necrosis of a preexisting sellar mass, usually a pituitary macroadenoma, produces an expansion of sellar contents. Compression of adjacent structures elicits the variable expression of symptoms referable to displacement of the optic nerves and chiasm and impingement of the third, fourth, and sixth cranial nerves. Damage to or destruction of the anterior pituitary leads to multiple acute and/or chronic hormone deficiencies in many patients. Medical management may be used in rare cases in which the signs and symptoms are mild and restricted to meningismus or ophthalmoplegia deemed to be stable. In patients with visual or oculomotor lability or an altered level of consciousness, expeditious surgical decompression, accomplished most commonly through a transsphenoidal approach, should be performed to save life and vision and to optimize the chance of regaining or maintaining pituitary function.
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PMID:Pituitary tumor apoplexy: characteristics, treatment, and outcomes. 1519 35


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