Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The patient, a 25-year-old male, was admitted with a 2-year history of double vision and recurrent suboccipital headache. Neurological findings on admission revealed nystagmus, double vision in the far field, bilateral abducense palsy, weakness in the bilateral legs, hypalgesia and hypesthesia under the L5 level, gait disturbance and hypotonia of the anal sphincter. Plain skull X-ray showed marked digital impression and disappearance of the posterior clinoid process and the dorsum sella. Myelography disclosed a filling defect dorsal to upper and midcervical cord. Intraventricular injection of metrizamide outline cystic dilatation and caudal migration of the fourth ventricle. Occipital craniectomy and laminectomy from C1 to C6 was performed. Operative findings showed thickened arachnoid membranes and cystic expansion of the fourth ventricle lying dorsal to the cervical cord. Caudal portion of the ventricle was removed, and V-P shunt was placed into the fourth ventricle to maintain decompression of the cystic part of the fourth ventricle. This patient is considered to represent a case of cystic dilatation (or ventricular diverticulum) of the fourth ventricle in Arnold-Chiari malformation. We stress that posterior decompression with V-P shunting procedure is recommended as the treatment of choice for such Arnold-Chiari type II malformation.
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PMID:[Cystic dilatation of the fourth ventricle--case report]. 179 25

This report defines the C2 and C3 pain dermatomes by the distribution of: the hypalgesia clearing after surgical root decompression; the dysaesthesias produced by electrical root stimulation; and the hypalgesia produced by anaesthetic root block. The C2 pain dermatome, so defined, consists of an occipital parietal area 6-8 cm wide, ascending paramedially from the subocciput to the vertex. The C3 pain dermatome is a craniofacial area including the scalp around the ear, the pinna, the lateral cheek over the angle of the jaw, the submental region and the lateral and anterior aspects of the upper neck. These C2 and C3 pain dermatomes do not overlap and are smaller than the C2 and C3 tactile dermatomes described in the literature.
Cephalalgia 1991 Jul
PMID:C2 and C3 pain dermatomes in man. 188 73

Twenty nine patients with trigeminal neuralgia were treated by retrogasserian glycerol injection method. Two of 29 were postherpetic and 27 were idiopathic trigeminal neuralgia. The mean age of these 27 was 65.2 years old ranging from 35 to 83 and the mean duration of symptoms was 7.6 years ranging from 6 months to 25 years. As previous surgical treatment there were 9 alcohol block, 5 thermorhizotomy of the Gasserian ganglion and one microvascular decompression. Twenty-two gauge needle was introduced into the trigeminal cistern via foramen ovale under the fluoroscopic control. Before injection of glycerol trigeminal cisternography using metrizamide of 300 mgI/dl was done to ascertain whether or not the needle tip was properly placed in the cistern. Patients' neck being flexed anteriorly, pure glycerol, amounting from 0.15 to 0.6 ml, was injected into the cistern with small increments through the needle. If the needle was inserted too deeply in the cistern, it is more probable that glycerol should escape from the cistern into the posterior fossa. So it was advisable that needle tip should be placed in the bottom of the cistern. When there was no pain relief, second injection was performed usually 7 days after the first injection. Complications were as follows; dysesthesia (81%), hypertension (70%), hypalgesia and hypesthesia (48%) headache (22%), ocular dysesthesia (11%), masseter weakness (7%), hyperalgesia (7%), attack of paroxysmal pain (7%). Most of these complications subsided within 8 weeks. Dysesthesia and hypalgesia that had persisted over 8 weeks were recognized in 30% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Glycerol injection method for trigeminal neuralgia]. 401 Aug 77

A case of atlanto-axial rotatory fixation (AARF) was presented in a 19-year-old female who developed sudden onset of neck pain and limitation of neck movement after direct carotid angiography for seizure disorder. Neurological examination was negative except for cock-robin posture and mild hypesthesia and hypalgesia in left C2 distribution. Plain films of the cervical spine disclosed abnormal alignment of C1-C2 and possible rotational dislocation. Bilateral selective vertebral angiography showed marked anterior and posterior displacement of left and right vertebral artery, respectively, at the level of C1. On CT metrizamide myelography, there was clockwise rotation of C1 on C2 with locked facet on the left but no evidence of cord compression was found. With diagnosis of AARF, manual reduction under general anesthesia and with fluoroscopic control was first attempted without success. Therefore, the patient underwent open reduction by using high speed air-drill and posterior fusion of C1 to C3 with acryl and wire. Postoperative course was uneventful and the patient went back to work as a computer operator in three months. The etiology of AARF was described by many authors, but in our case, congenital hypogenesis of transverse and alar ligaments plus minor trauma was most suggested. For neurological manifestations of AARF, occipital neuralgia, headache, neck pain, limitation of neck movement and cock-robin posture were reported, but the cock-robin posture was most characteristic and was an important symptom for the early diagnosis. In neuroradiological findings of AARF, plain CT and CT metrizamide myelography are very useful. Because they clearly demonstrate the degree of rotation and interlocking of atlanto-axial joints, and the presence of cord compression.
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PMID:[CT findings and surgical treatment of atlanto-axial rotatory fixation: a case report]. 648 6

A case of spontaneous thrombosis of azygos anterior cerebral artery aneurysm was reported. A 39-year-old man was admitted to our hospital on April 23, 1979, 5 days following an apparent attack of subarachnoid hemorrhage. On admission, he complained a headache and left hemiparesthesia. Neurologic examination revealed a very slight nuchal rigidity, left hemihypesthesia and hypalgesia. Routine laboratory studies were noncontributory. Left and right carotid angiograms showed an azygos anterior cerebral artery aneurysm. Twelve days after the attack, a left carotid angiogram demonstrated a segmental narrowing and widening of an azygos anterior cerebral artery, and then the aneurysm was filled incompletely. Nineteen days after the attack, the aneurysm was not visualized on right carotid angiogram. Neck clipping and resection of the aneurysm was performed on May 8, 1979. Cross section of the aneurysm exposed a thrombus. He showed postoperatively a slight hypesthesia in the left lower limb. Complete thrombosis of intracranial aneurysm occurring spontaneously is rare. We collected 42 such cases including the present case from the literature and discussed some factors facilitating intraluminal thrombosis. Although the shortest previous period of thrombosis is noted to be over a course of 5 days, the thrombosis in our case in 19 days after subarachnoid hemorrhage was certainly a relative rapid event.
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PMID:[Spontaneous thrombosis of an azygos anterior cerebral artery aneurysm--report of a case (author's transl)]. 707 95

Although the primary treatment of chronic cluster headache is medical, surgical treatment is sometimes used. The authors reviewed the charts of seven patients (ages 36 to 68 years) with chronic cluster headache to identify who responded best to percutaneous stereotactic radiofrequency rhizotomy after medical treatment failed. All patients had immediate pain relief after surgery. At follow-up (median 5 years, range 2 to 20 years), two patients remained pain-free 7 and 20 years later (excellent results); three patients had mild pain recurrence that was well controlled on medications (good results) 6 to 12 months after surgery; and two patients had major pain recurrence 4 days and 2 months after surgery (poor results). Six patients had relief of vasomotor symptoms. One patient had transient diplopia and keratitis without permanent sequelae. Both patients with excellent results had preoperative major pain around the eye; both patients with poor results had major pain around the temple, ear, and cheek; and the three patients with good results had pain equally severe in the eye, temple, and cheek. There was no association between patient age or sex, pain duration, preoperative response to lidocaine blockade, or previous surgery with pain relief. No differences occurred in pain relief between patients with dense hypalgesia and patients with analgesia. The authors conclude that (1) some patients with chronic cluster headache treated by percutaneous stereotactic radiofrequency rhizotomy achieve long-term pain relief, and (2) surgery on the trigeminovascular system alone may not cure the condition in patients with major pain around the temple, ear, and cheek.
Headache 1995 Apr
PMID:Long-term results of radiofrequency rhizotomy in the treatment of cluster headache. 777 74

The association between systemic hypertension and headache remains controversial and its pathophysiologic basis is uncertain. A rather characteristic early-morning pulsating headache is commonly seen in hypertensive patients, and a recent meta-analysis supports the link between these 2 entities. Epidemiologic evidence has paradoxically suggested a negative association between hypertension and headache. Unpredictable clinical association between severe hypertension and headache indicates that another cranial perfusion-related variable exerts a critical role. Neuroanatomically, head and neck pain primarily involves the ophthalmic division of the trigeminal nerve (V1). A link between systemic hypertension, pulsatile choroidal blood flow (CBF), and intraocular pressure (IOP) has been established. I propose that a trait ocular sympathetic hypofunction permits rapid episodic ocular choroidal overperfusion that stretches the ocular globe in the cohort of hypertensive patients with headache. Rapid distension of the pain-sensitive corneoscleral envelope can stimulate corneoscleral and iridial pain-sensitive V1 nerve endings and generate headache. Ocular tamponade function physiologically limits choroidal overperfusion. A higher basal IOP in some patients with moderate-to-severe hypertension may dampen pulsatile CBF and account for the negative epidemiologic link between sustained systemic hypertension and headache. Besides activation of the baroreceptor reflex, the association of hypalgesia with hypertension probably involves activation of the vasopressin-endorphin adaptive system consequent to mechanical stimulation of V1. The analogy between hypertensive headache and angle-closure glaucoma is rather limited because typical ocular and visual signs and symptoms of angle-closure glaucoma are not seen in hypertension-related headache. Hypertensive crises, including those associated with pheochromocytoma, are not accompanied by attacks of angle-closure glaucoma. Glaucoma is not associated with ocular choroidal congestion, but with reduced pulsatile CBF. The predisposition to develop angle-closure glaucoma is theoretically not associated with ocular autonomic hypofunction and should be conceptually dissociated from this hypothesis. The hypothesis can be evaluated by establishing significant circadian elevations of blood pressure, including nondipping nighttime pattern as well as circadian and periheadache measurements of IOP in patients with attacks of hypertension-related headache.
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PMID:Systemic hypertension, headache, and ocular hemodynamics: a new hypothesis. 1740 87