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

Computerized tomography revealed a thrombosed giant intracavernous carotid aneurysm in a man who presented with ophthalmoplegia and headache. Angiography confirmed complete aneurysmal thrombosis and also revealed complete occlusion of the ipsilateral internal carotid artery. Aneurysmotomy and thrombectomy produced substantial reduction in mass effect, with symptomatic improvement. The spontaneous thrombosis of giant intracranial aneurysms is discussed.
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PMID:Spontaneous thrombosis of a giant intracranial aneurysm and ipsilateral internal carotid artery. Case report. 705 41

Visual and oculomotor changes may be the only abnormalities in patients complaining of headache. Ocular signs are common during episodes of migraine and cluster headache. Temporal arteritis may be an extracranial cause of ocular signs. Intracranial disorders include painful ophthalmoplegia, pseudotumor cerebri and various causes of increased intracranial pressure. Neurophthalmologic evaluation in headache patients must include assessment of visual acuity and visual fields, examination of pupils (including pharmacologic testing), ophthalmoscopic examination and auscultation for bruits.
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PMID:Neurophthalmologic signs in headache syndromes. 706 59

The differential diagnosis of chronic facial pain is facilitated by a knowledge of anatomy. Nasal and dental conditions are prevalent causes of facial pain. Orbital discomfort with ophthalmoplegia or Horner's syndrome generally has a vascular etiology. The lower-half headache or atypical facial neuralgia also is vascular in origin and should be referred to as facial migraine. Previously, chronic iatrogenic trigeminal neuralgia has been erroneously included in the category of lower-half headaches. This disabling condition is due to repeated trauma to the trigeminal nerve.
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PMID:Differential diagnosis of chronic facial pain. 723 31

Thirty eight consecutive cases of intracranial arterial aneurysms collected during the last decade in the same department of neurology are reported, the aneurysms being revealed by a non hemorrhhagic semeiology, i.e. without clinical meningeal syndrome. In 31 cases, the aneurysm seemed to be related to the clinical manifestation: in 14 cases, it was an acute headache, characterized by its suddenness, immediate maximum intensity, spontaneous and fastly regressive course. It occurred without any symptoms (6 cases) or associated with an epileptic seizure (1 case), or an ophthalmoplegia (7 cases). The course was often relapsing. In 8 cases, it was a cerebrovascular accident of ischemic type; in 6 cases, a pseudo-tumoral syndrome; in 2 cases, an epilepsy; in 1 case, a migraine. For the further 7 cases, the aneurysm was diagnosed fortuitously when investigating a non related disease. The present series shows: the high incidence of the non hemorrhagic forms of aneurysms since they account for 40 p. 100 of the aneurysms cases detected during the same period in our neurological department. The various clinical manifestations are already well-known, mainly the acute headache and the pseudo-tumoral forms. The aneurysm-related cerebrovascular accidents seem to be relatively frequent; 2 cases of the present series give the opportunity for a discussion about the relations between a spontaneous thrombosis and a definitive anatomical cure of the aneurysm. Finally, other cases lead to suspect aneurysms as a possible cause of epilepsy or of migraine. The prognosis of these non hemorragic forms of aneurysms is much better than that of ruptured aneurysms. The direct intracranial surgical cure of the lesion gives on the whole excellent results. Such a treatment must be advocated whenever possible for any unruptured symptomatic aneurysm, as the risk of their rupture or clinical relapse is far from being negligible. The strategy is more difficult to define for asymptomatic unruptured aneurysms as the actual risk of subsequent rupture or other clinical manifestations is not sufficiently known.
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PMID:[Non-hemorrhagic forms of intracranial arterial aneurysms]. 725 63

Nine cases of mitochondrial myopathy are presented and the literature is reviewed. The clinical picture ranges from virtually pure ophthalmoplegia, through 'ophthalmoplegia plus' to predominantly central nervous system disturbance. Morphological mitochondrial abnormalities are likely to reflect generalised metabolic abnormalities of diverse aetiology, but producing common pathophysiological consequences. The association of mitochondrial myopathy with CNS disorders, which may ante-date muscle weakness, is emphasised. The myopathies constitute a clinical continuum within which the following syndromes may be delineated: (1) Kearns-Sayre syndrome (2) Luft's disease (3) a variant of Ramsay Hunt syndrome (4) relapsing febrile neurological deficits with headache and seizures. These may be specific diseases or artificially separated manifestations of some common metabolic disorder(s). There is a similarity between the CNS pathology, and also some clinical features, of Leigh's disease and the findings in certain of the mitochondrial myopathies. The review suggests that the following should be regarded as associations of mitochondrial myopathy and progressive external ophthalmoplegia (a) diabetes mellitus (b) cataracts, in which calcium deposits may, like basal ganglia calcification, be due to abnormal calcium metabolism. Diplopia, although unusual, does occur in progressive external ophthalmoplegia with mitochondrial myopathy.
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PMID:The mitochondrial myopathies: 9 case reports and a literature review. 734 99

Mitochondrial myopathy, encephalopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome is one of the mitochondrial encephalomyopathies that has distinct clinical features including stroke-like episodes with migraine-like headache, nausea, vomiting, encephalopathy and lactic acidosis. We report a 27-year-old woman who presented with partial seizure, stroke-like episodes including hemiparesis, hemianopia and hemihypethesia, sensorineural hearing loss, migraine-like headache, and lactic acidosis. Brain computed tomographic scan showed encephalomalacia in the right parieto-occipital area and recent hypodensity in the left temporoparieto-occipital area with cortical atrophy. Muscle biopsy revealed ragged-red fibers and paracrystaline inclusions in the mitochondria. Genetic study revealed an A to G point mutation at nucleotide position (np) 3243 of mitochondrial DNA. External ophthalmoplegia and ptosis were also found during two exaggerated episodes in this patient. Therefore, the overlapping syndrome of chronic progressive external ophthalmoplegia in the MELAS syndrome is considered in this case. Furthermore, we also found carnitine deficiency in this patient and she was responsive well to steroid therapy. Muscle biopsy also revealed excessive lipid droplets deposits. Therefore, the carnitine deficiency may occur in MELAS syndrome with the A to G point mutation at np 3243. We recommend the steroid or carnitine supplement therapy be applied to the MELAS syndrome with carnitine deficiency.
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PMID:CPEO and carnitine deficiency overlapping in MELAS syndrome. 748 81

A prospective study was conducted to evaluate the usefulness and limitations of conservative treatment in patients with pituitary apoplexy. Twelve patients presenting sudden headache, visual impairment, or ophthalmoplegia had the diagnosis of pituitary apoplexy established by computerized tomographic scans. Initially, 11 patients received iv dexamethasone (2.0-16.0 mg/day). Surgery was indicated when dexamethasone failed to improve visual or consciousness impairment. Among the 7 patients who were treated conservatively, ophthalmoplegia recovered completely in 6 and improved in 1. Follow-up computerized tomographic scans showed resolution of the tumor in 4 patients and residual masses in 3 patients who were treated conservatively. Five patients had surgery and experienced improvement of vision and consciousness. Follow-up computerized tomographic scans showed residual masses in all surgical patients. Recurrences were observed in 2 patients, one in each group. The prevalence of pituitary deficiencies in the conservative group (9 of 17) was similar to that of the surgical group (3 of 14), but when only patients whose tumors were resolved by the apoplexy were analyzed, a significantly higher prevalence (8 of 12) was observed (P = 0.02). A retrospective analysis of presenting clinical and computerized tomography data on the basis of the response to dexamethasone showed that visual impairment did not improve during treatment with dexamethasone, whereas the presence of a large hypodense area within the tumor predicted complete tumor resolution. These results support conservative management of pituitary apoplexy in patients who are selected on the basis of clinical and tomographic findings.
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PMID:Conservative management of pituitary apoplexy: a prospective study. 760 78

Pituitary apoplexy is a rare but sometimes dramatic complication of pituitary tumors. We report the case of a 64-year-old man with a macroadenoma who complained of a sudden and intense headache after a dynamic TRH (200 micrograms) and GnRH (100 micrograms) test. Two days later, he presented an acute ophthalmoplegia with fever and deteriorating consciousness. Emergency CT scan showed contrast hypofixation compatible with necrosis of the adenoma. Surgical, tumoral decompression resolved quickly almost all symptoms. Immunohistochemical study of the tumor confirmed the diagnosis of gonadotropinoma. Several similar cases of pituitary apoplexy occurring after TRH or GnRH tests have been described the last ten years. As this test may sometimes confirm the diagnosis of gonadotropinoma, it should be performed with caution in cases of clinically non functioning pituitary macroadenoma.
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PMID:[Pituitary apoplexy of a gonadotrophinoma and TRH/GnRH tests. Literature review]. 763 32

A 71-year-old man suffered from left-side throbbing headache over the region of the fifth cranial nerve first division, followed by left ptosis and ophthalmoplegia. Under tentative diagnosis of Tolosa-Hunt syndrome (THS), oral prednisolone 60 mg was given daily. His headache and ophthalmoplegia dramatically improved within 24 hours. Magnetic resonance (MR) imaging and computed tomography (CT) of the head were negative. However, irregularity in the siphon of the left internal carotid artery was disclosed by angiography. This case illustrates that angiography may be useful in diagnosing THS, when CT and MR imaging are negative.
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PMID:Angiographic findings in Tolosa-Hunt syndrome: a case report. 764 Nov 28

A 62-year-old man presented with progressive diplopia, left ptosis, proptosis, complete ophthalmoplegia, facial numbness, and headache of 2 1/2 months' duration. The symptoms started 1 month after surgical resection of a squamous cell carcinoma in the left side of the forehead. Imaging studies helped localize the lesion, correlating with clinical features. The differential diagnosis is discussed. The final diagnosis was confirmed by autopsy.
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PMID:Ophthalmoplegia and facial numbness following treated squamous carcinoma of the forehead. 771 37


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