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

Thirty-seven patients with pituitary apoplexy were analyzed with an emphasis on clinical presentation and visual outcome. Their mean age was 56.6 years, with a male to female ratio of 2:1. Presenting symptoms included headache (95%), vomiting (69%), ocular paresis (78%), and reduction in visual fields (64%) or acuities (52%). Computed tomographic scanning correctly identified pituitary hemorrhage in only 46% of those scanned. Thirty-six patients underwent transsphenoidal decompression. By immunostaining criteria, null-cell adenomas were the most frequent tumor type (50%). Long-term steroid or thyroid hormone replacement therapy was necessary in 82% and 89% of patients, respectively. Long-term desmopressin therapy was required in 11%, and 64% of the male patients required testosterone replacement therapy. Surgery resulted in improvement in visual acuity deficits in 88%, visual field deficits in 95%, and ocular paresis in 100%. Analysis of the degree of improvement in preoperative visual deficits with the timing of the surgery demonstrated that those who underwent surgery within a week of apoplexy had significant recovery in their visual acuities. In the stable, conscious patient with residual vision in each eye, surgical decompression should be performed as soon as possible, because delays beyond 1 week may retard the return of visual function.
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PMID:A retrospective analysis of pituitary apoplexy. 823 99

We present a female patient with typical third stage neuroborreliosis with progressive chronic encephalomyelitis. One month after a tick bite, in the first stage of Lyme disease, she had myalgias during ten days and after one year polyarthralgias and polyarthritis. Neurological problems occurred 15 years after the tick bite with headache, nystagmus, intentional tremor and spastic paraparesis with sphincter disturbances. Etiological diagnosis was established after three years. Cytobiochemical findings in cerebrospinal liquor were normal but oligoclonal IgG bands were found. Fluorescent antibody test was positive in serum (1:75) as well as ELISA (1:447). The patient reacted favourably to intravenous crystal penicillin 20 x 10(6) units daily during 18 days. Till now, she is in remission and has only mild paresis of the left leg.
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PMID:[Chronic encephalomyelitis caused by Borrelia burgdorferi. Case report]. 826 11

A 23-year-old female with a six year history of migraine without aura twice developed a nearly complete internal and external III nerve paresis ipsilateral to her headache, two days after the onset of migraineous headache. An MR scan performed one week after the second episode showed a contrast enhanced lesion of the prepontine III nerve, where it enters the cavernous sinus on the left side. The headache, as well as the paresis ameliorated spontaneously. We suggest this is a further well documented case of "ophthalmoplegic migraine" which might reflect Tolosa-Hunt syndrome.
Headache 1993 Sep
PMID:A contrast enhanced lesion of the III nerve on MR of a patient with ophthalmoplegic migraine as evidence for a Tolosa-Hunt syndrome. 804 24

The author reports on the prevalence and stability of the course of neurologically relevant psychogenic symptoms as well as their dependence on age and sex. Altogether 240 probands from the Mannheim Cohort Study on the epidemiology of psychogenic disorders were examined for psychogenic impairment over a 10-year period during three investigation periods. On the whole, seven neurologically relevant groups of symptoms (headache, lumbar and cervical vertebral complaints, non-systematic vertigo, functional hyperkinesia, functional paresis, sleep disturbances, concentration disturbances) differ clearly in frequency, characteristics of the course and clinical relevance.
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PMID:[Incidence and follow-up characteristics of neurologically relevant psychogenic symptoms]. 833 29

Psychogenic dizziness is defined as recurring or persistent symptoms of balance dysfunction, inconsistent with organic vestibular disease as determined by history, clinical examination and pertinent investigations, and consistent with emotional origin. Of 1,335 patients seen in our dizziness clinic between January 1988 and August 1991, psychogenic dizziness was diagnosed in 180 (13.5%) patients. There were 67 men and 113 women aged from 12 to 77 years (mean age 40.2 years). The characteristics of psychogenic dizziness are: (1) continuous dizziness for long periods of time; (2) younger patients; (3) predominant female; (4) associated symptoms of panic attack, such as headache, breathlessness, nausea, sleep disturbance, paresthesias, anxiety and palpitation; (5) symptoms of aggravation due to stressful life events; (6) normal neurotological bedside examination; (7) hyperventilation reproduced accurately. The electronystagmographic results of 74 patients show normal bithermal caloric responses in 47 patients (63.5%), caloric hyperactivity in 21 patients (28.4%), canal paresis in four patients (5.4%), canal paresis with directional preponderance in two patients (2.7%), large random voluntary eye swings or severe blinking in 35 patients (47.3%), and spontaneous nystagmus (slow phase velocity < 6.5 degrees/s) in four patients (5.4%). There were 31 patients who consulted psychiatrists with diagnoses of anxiety (51.6%), depression (16.1%), insomnia (12.9%), psychosomatic disorder and adjustment disorder. Treatment of patients with psychogenic dizziness must be directed at the underlying anxiety. Psychiatric consultation is necessary.
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PMID:[Psychogenic dizziness]. 848 48

Preservation of hearing was attempted in 161 cases of histologically confirmed acoustic neuroma removed by the senior author between January 1, 1970, and September 30, 1991. There were 136 patients with unilateral tumors; 22 patients had bilateral tumors (neurofibromatosis 2) and underwent a total of 25 procedures. Hearing was initially preserved in 35% of patients with unilateral tumors and in 44% of those with bilateral tumors. Results are reported in terms of pre- and postoperative pure tone average and speech discrimination scores. Surgical access to the tumor was obtained via middle cranial fossa and suboccipital approaches. The latter has been used more often over the past 5 years because of a lower associated incidence of transient facial paresis. Persistent postoperative headaches have been the most common complication following the suboccipital approach. The results of preoperative brain-stem auditory evoked response (BAER) studies were useful in predicting the outcome of hearing preservation attempts. Patients with intact BAER waveform morphology and normal or delayed latencies had a higher probability of hearing preservation in comparison to those with abnormal preoperative BAER morphology.
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PMID:Preservation of hearing in surgery for acoustic neuromas. 811 Feb 85

The incidence of intracranial dissecting aneurysms is lower than that of berry aneurysms. Following the recent spread of the use of cerebral angiography, however, the number of patients identified as having this type of aneurysm has been increasing. In a majority of cases of intracranial dissecting aneurysms, the aneurysm afflicted the vertebral and basilar arteries. After these, the internal carotid artery and the middle cerebral artery are the next most frequently affected. It is very rare that this type of aneurysm develops in the anterior cerebral artery. According to our search of the literature, only 17 cases of dissecting aneurysm of the anterior cerebral artery have been reported to date (including the case to be presented here). The case we recently encountered was that of a 52-year-old male. On October 25, 1994, the man suddenly developed a headache and strong paresis of the left leg while performing clerical work. The plain head CT, taken next day, revealed low density in the area supplied by the right anterior cerebral artery. An angiogram taken 6 days after onset disclosed characteristic signs of dissecting aneurysm (i.e., double lumen, etc.) at the A2 segment of the right anterior cerebral artery, as well as the presence of non-ruptured berry aneurysms at the bifurcation of the right middle cerebral artery. The non-ruptured berry aneurysms were treated by neck clipping, while the dissecting aneurysms were treated conservatively. The patient was discharged on March 21, 1995, without needing any assistance to walk. We analyzed the 17 reported cases of dissecting aneurysms of the anterior cerebral artery. The cause of this aneurysm was often hypertension, and only 3 of the 17 cases were rated as being idiopathic cases. The site of this aneurysm was often the pericallosal artery (segments A2, A3, etc.). Of the 17 patients, 11 were middle-aged or elderly (over 40). The male-to-female ratio was 13: 4, indicating a predominance of males. The incidence did not differ significantly between the right and left hemispheres. The number of ischemic cases was more than double that of hemorrhagic cases. Most ischemic cases had a good prognosis, even when treated conservatively. All 3 patients with the hemorrhagic type, who were treated conservatively, died.
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PMID:[A case of anterior cerebral artery dissecting aneurysm]. 855 72

Spinal cerebrospinal fluid (CSF) leaks are often implicated as the cause of the syndrome of spontaneous intracranial hypotension, but they have rarely been demonstrated radiographically or surgically. The authors reviewed their experience with documented cases of spinal CSF leaks of spontaneous onset in 11 patients including their surgical observations in four of the patients. The mean age of the six women and five men included in the study was 38 years (range 22-51 years). All patients presented with a postural headache; however, most had additional symptoms, including nausea, emesis, sixth cranial-nerve paresis, or local back pain at the level of the CSF leak. All patients underwent indium-111 radionucleotide cisternography or computerized tomographic (CT) myelography. The location of the spontaneous CSF leak was in the cervical spine in two patients, the cervicothoracic junction in three patients, the thoracic spine in five patients, and the lumbar spine in one patient. The false negative rate for radionucleotide cisternography was high (30%). Subdural fluid collections, meningeal enhancement, and downward displacement of the cerebellum, resembling a Chiari I malformation, were commonly found on cranial imaging studies. In most patients, the symptoms resolved in response to supportive measures or an epidural blood patch. Leaking meningeal diverticula were found to be the cause of the CSF leak in four patients who underwent surgery. In three patients these diverticula could be ligated with good result but in one patient an extensive complex of meningeal diverticula was found to be inoperable. Two patients had an unusual body habitus and joint hypermobility, and two other patients had suffered a spontaneous retinal detachment at a young age. In conclusion, spontaneous spinal CSF leaks are uncommon, but they are increasingly recognized as a cause of spontaneous intracranial hypotension. Most spinal CSF leaks are located at the cervicothoracic junction or in the thoracic spine, and they may be associated with meningeal diverticula. The radiographic study of choice is CT myelography. The disease is usually self-limiting, but in selected cases our experience with surgical ligation of leaking meningeal diverticula has been satisfactory. An underlying connective tissue disorder may be present in some patients with a spontaneous spinal CSF leak.
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PMID:Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. 898 98

A 38-year-old housewife presented with a ruptured aneurysm associated with unilateral internal carotid artery agenesis. She had been in good health until May 31, 1994, when she was admitted to our facility immediately after sudden onset of headache and nausea. She was alert and exhibited no focal neurological deficit on admission. Cerebral angiography demonstrated an aneurysm arising from the junction of the horizontal segment of the right posterior cerebral artery and posterior communicating artery. The right internal carotid artery was totally absent. High resolution computed tomography demonstrated absence of the right carotid canal in the skull base. Neck clipping of the aneurysm was carried out through the right pterional approach on June 2. She returned home 52 days after the surgery with mild paresis of the left upper extremity and has since resumed household activities. Early surgery may be recommended in a patient with a ruptured aneurysm associated with agenesis of the internal carotid artery to prevent catastrophic rebleeding, if the initial insult is mild and subsequent vasospasm is unlikely to occur.
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PMID:Posterior cerebral artery aneurysm associated with unilateral internal carotid artery agenesis--Case report. 865 36

A young obese woman with menstrual irregularities presented with bilateral papilledema, abducens nerve paresis, visual obscurations and severe headache. Neuroimaging studies were normal but CSF opening pressure was elevated. The diagnosis of idiopathic intracranial hypertension was made. Insertion of a shunt quickly alleviated the symptoms. A few weeks later the patient developed a left femoral nerve paresis and an ulnar nerve paresis on the right. Electrodiagnostic tests confirmed the diagnosis of mononeuropathia multiplex. Bone marrow histology showed a vasculitis. We hypothesize that the vasculitis is underlying both, idiopathic intracranial hypertension and mononeuropathia multiplex.
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PMID:Mononeuropathia multiplex and idiopathic intracranial hypertension. 868 77


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