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

During 1988, an endemic outbreak of aseptic meningitis was noted in the Kaohsiung area. Throughout the year, a total of 89 cases were identified by cerebrospinal fluid (CSF) examination at the Pediatric Department of Kaohsiung Medical College. The peak incidence was from June to October. Scattered cases still occurred during November and December. The male to female ratio was 1.7:1 and the age distribution ranged from 1 month to 15 years old. Two peaks of age distribution were observed; one in infancy and the other in the 4-7 year old age group. Most of them exhibited fever (94.4%), headache (68.9%), and vomiting (68.5%). Other associated symptoms and signs included neck stiffness, sore throat, cough, Brudzinski's sign, abdominal pain, seizure, dizziness, rhinorrhea, diarrhea, Kernig's sign, skin rash, hyperemic conjunctiva, apnea, and oral ulcers. Most of them had CSF white blood cell (WBC) counts less than 1000/mm3, normal or mild elevated protein, and normal CSF/plasma sugar ratio. Three patients were found to have a virus in their CSF without pleocytosis. Virus isolations from CSF throat swabs and/or rectal swabs were performed in 65 patients, half of them (35/65, 53.8%) had positive results including echovirus type 9 (sixteen), echovirus type 30 (eighteen), and adenovirus type 3 (one). Echovirus type 9 was predominant during July and August whereas echovirus type 30 became predominant after September. All patients recovered spontaneously without any sequelae.
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PMID:Clinical observations and virological study of aseptic meningitis in the Kaohsiung area. 198 74

We prospectively examined the clinical signs of 54 febrile patients associated with recent-onset headache. They underwent lumbar puncture (LP) on suspicion of meningitis. The relation of each sign to cerebrospinal fluid (CSF) pleocytosis was estimated. Among 34 patients with pleocytosis, 33 had jolt accentuation (sensitivity: 97.1%), while only 5 of them had neck stiffness or Kernig's sign. Among 20 patients without pleocytosis, 12 had no jolt accentuation (specificity: 60%). We found jolt accentuation to be the most sensitive sign of CSF pleocytosis. If jolt accentuation is noted in a febrile patient associated with recent onset headache, the CSF should be examined even in the absence of neck stiffness or Kernig's sign.
Headache 1991 Mar
PMID:Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. 207 96

Nuchal symptoms were found in the majority of 100 consecutive patients with cluster headache. In 10%, pain was experienced in the neck with the initial typical orbitotemporal pain; in 37%, pain radiated from the orbit or temple to the ipsilateral side of the neck. Sometimes, neck pain heralded the onset of the attack by a few minutes. During an attack, neck stiffness was reported in 40% and tenderness in 29%. Movement of the neck, especially flexion, precipitated cluster headache in 9% of patients. This was particularly true of patients with chronic cluster headache. Neck movement aggravated the headache in 16 of 100 patients and an equal number reported amelioration of pain by neck movement, especially extension. The nuchal features did not necessarily accompany every attack and were usually overshadowed by the severity of the typical headache. Nevertheless, symptoms referable to the neck occur more commonly than is generally appreciated.
Headache 1990 May
PMID:Nuchal features of cluster headache. 237 Jan 35

The patient, a 37-year-old female, was hospitalized with a severe headache. Neurological examination on admission revealed no deficits except for neck stiffness and somnolence. Computed tomography showed a subarachnoid hemorrhage, which was especially prominent in the supracerebellar and quadrigeminal cisterns, but demonstrated no ventriculomegaly. Cerebral angiography on admission revealed no apparent abnormalities, but repeat angiography 8 days later disclosed a saccular aneurysm (2 X 3 mm) arising from the hemispheric branch of the left superior cerebellar artery (SCA). Three days after admission, the patient developed cerebellar dysarthria, which was assumed to be due to vasospasm. On the 24th day after admission, the aneurysm was successfully clipped through the infratentorial-supracerebellar approach. The postoperative course was uneventful and the patient was discharged with no neurological deficit. Nineteen other cases of peripheral SCA aneurysm have been reported in the literature. The presence of this type of aneurysm should be considered in patients who are fairly young and have focal neurological signs, such as third or fourth nerve palsy and/or cerebellar dysfunction. The prognosis for such patients is good, except in cases in which the neurological status is poor at the onset.
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PMID:[Peripheral superior cerebellar artery aneurysm. Case report]. 247 59

A 68-year-old male was hospitalized because of headache, nausea, and disturbance of consciousness. Neurological examination on admission disclosed somnolence, disorientation, marked neck stiffness, papilledema, and quadriparesis. Computed tomography (CT) scanning demonstrated a round mass with marked contrast enhancement in the right sylvian fissure and small contrast-enhanced masses in the interpeduncular, quadrigeminal and ambient cisterns. CT also showed marked peritumoral edema, a midline shift, and hydrocephalus. The patient's consciousness level and respiration deteriorated 3 days after admission and a craniotomy was performed. The tumor, which was well demarcated, firmly attached to the sphenoidal ridge, and grossly appeared to be a meningioma, was totally removed. Histologically, the tumor had two well defined components, glioblastoma and fibrosarcoma. The patient underwent ventriculoperitoneal shunting, chemotherapy, and radiotherapy after surgery, but the primary tumor soon recurred, with scalp metastasis, and he died 5 months postoperatively. Autopsy revealed metastases to the liver, spleen, and spinal cord. The histogenesis of this mixed tumor and the mechanism of extracranial metastasis are discussed, and the literature is reviewed.
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PMID:[Gliosarcoma with multiple extracranial metastases. Case report]. 248 46

The differentiation of bacterial from aseptic meningitis in postoperative neurosurgical patients has traditionally been based on the clinical setting, a recent history of steroid administration, and cerebrospinal fluid (CSF) studies, including the total and differential leukocyte counts, Gram stain, glucose, and total protein. Recent reports questioning both the validity of a relative CSF lymphocytosis in excluding bacterial meningitis and the usefulness of standard CSF testing prompted the authors to reevaluate these standard criteria. The type of operation, the presence of a foreign body, use of steroids, postoperative day on which symptoms developed, altered mental status, neck stiffness, headache, and nausea were not helpful in the differential diagnosis. High fever, new neurological deficits, an active CSF leak, and elevated leukocyte counts in the CSF and peripheral blood favored a bacterial etiology. The CSF glucose level and the differential leukocyte count were less helpful. No criterion or combination of criteria was sensitive and specific enough to reliably differentiate aseptic from bacterial meningitis in the majority of patients. The possibility of improving diagnostic accuracy with newer tests, such as CSF lactate, ferritin, total amino acids, C-reactive protein, and amyloid-A, should be assessed.
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PMID:Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients. 318 29

Here reported is a case of multiple septic intracranial aneurysms which were successfully treated with surgical and conservative therapy. A 44-year-old man was admitted to our hospital because of headache, vomiting and visual disturbance. He had had a fever and had been under treatment for a respiratory tract infection during the preceding 3 months. Physical examination on admission revealed pansystolic heart murmur over the cardiac apex. Neurological examination revealed neck stiffness, papilledema and right homonymous hemianopsia. Laboratory data showed the presence of inflammatory process. A CT scan showed a high density area in the left occipital region, and vertebral angiography showed a saccular aneurysm on a distal branch of the left occipitotemporal artery. Fourteen days after admission, the operation of clipping the neck of the aneurysmal artery was performed and the hematoma evacuated to lower the increased intracranial pressure. He had been well after the operation until 3 weeks later when a follow-up angiography showed a new unruptured aneurysm on a distal branch of the right middle cerebral artery with a relapse of the infection. Then, he was treated with appropriate antibiotics and antifibrinolytic agents. A repeated angiography 1 month later showed resolution of the aneurysm. The mechanism of resolution of septic aneurysm and its treatment are discussed.
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PMID:[A case of multiple septic intracranial aneurysms--successful treatment with surgical and conservative therapy in the same case]. 361 37

A case with two cerebral aneurysms, in which one at the origin of the left superior cerebellar artery (SCA) grew and presented with Weber's syndrome and obstructive hydrocephalus, is reported. The patient was a 69-year-old female, who had severe headache and vomited. On admission, neck stiffness was recognized. CT scan showed findings of subarachnoid hemorrhage. Angiograms demonstrated two saccular aneurysms at the right middle cerebral artery (MCA) bifurcation and at the origin of the left SCA. Craniotomy and neck clipping of the aneurysm at the right MCA was performed. After discharge, left oculomotor palsy appeared and gradually progressed. Severe headache and right hemiparesis suddenly occurred two years after the first attack. On the second admission, CT scan revealed high density on the brain surface and a well enhanced round lesion at the left ambient cistern. Left vertebral angiogram demonstrated increase in size of the aneurysm at the left SCA. The patient was discharged after conservative therapy. Drowsiness and urinary incontinence appeared, and she was admitted for the third time three years after the first admission. CT scan showed an enhancing mass lesion sized 25 X 30 mm beside the left midbrain and obstructive hydrocephalus. The aneurysm at the SCA no longer seen on the left vertebral angiogram. V-P shunt was performed. Both Weber's syndrome and obstructive hydrocephalus in this case indicate an aneurysmal natural history, in which aneurysm becomes gigantic and thrombosed spontaneously.
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PMID:[Growing aneurysm presenting with Weber's syndrome and obstructive hydrocephalus--a case report]. 367 May 48

A 38-year-old man was admitted to our hospital because of severe headache following reduced level of consciousness on February 13, 1979. He was lethargic and showed neck stiffness. A lumbar puncture revealed bloody cerebrospinal fluid. Left carotid angiography showed a berry aneurysm of 11 mm in diameter at the bifurcation of the middle cerebral artery (MCA). Rebleeding occurred on February 21, and he fell into semicoma. But, his consciousness recovered to lethargy on the next day. On February 26, a direct intracranial operation was performed and a Sugita clip was placed to the aneurysmal neck. The postoperative course was uneventful. But, left carotid angiography on 8th day after operation showed a newly originated aneurysm proximal to the operated aneurysm. On the 12th postoperative day, he suddenly fell into coma. CT showed subarachnoid blood in the basal cisterns and intraparenchymal hematoma in the left temporal lobe. On the same day, left carotid angiography was performed and it showed the enlarged aneurysm. He died on the 19th day after operation. Autopsy was not performed. Three factors have been considered dealing with the recurrence of the operated aneurysm in the previous reports: first, local fragility of the vascular wall due to the clip edge. Secondly, macro- or microscopic residual aneurysmal neck, thirdly, broken or slipped clip. Our case had the following characteristics from the angiographical and operative findings: the orifice of the operated aneurysm was situated on the superior side of the parent artery and the aneurysm protruded posterosuperiorly at an angle of approximately 90 degrees to the long axis of M1.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Rapid growth and rupture of a newly originated aneurysm near the clipped middle cerebral artery aneurysm]. 371 83

Symptomatic subependymomas in the pediatric age group are rare. A 14-year-old girl with a IV ventricle subependymoma is described. She had a 2-month history of progressive headache, neck stiffness and nausea. Computed tomography revealed hydrocephalus for which a ventriculoperitoneal shunt was inserted. A nuclear magnetic resonance (NMR) scan later displayed a mass lesion in the roof of the IV ventricle. A suboccipital craniectomy was performed with total excision of a subependymoma.
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PMID:Symptomatic subependymoma in a 14-year-old girl, diagnosed by NMR scan. 373 Nov 63


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