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

Fifty-two patients underwent MR imaging and conventional radiography of the neck within 4 days after a hyperextension-flexion injury. The patients also had follow-up investigations during the first 2 years. The images did not reveal any serious lesions in any of them. Based on the main MR and radiographical findings the patients were divided into 4 groups; no findings, posture abnormalities, spondylosis and disc pathology (from MR images) or reduced intervertebral space (from the radiographs). The outcomes of the different groups were compared with reference to neck stiffness, neck pain and headache during a 2-year follow-up period. The patient groups did not correspond completely when diagnosed from MR imaging and radiography. However, patients with pre-existing spondylosis had more symptoms when examined by both modalities. Based on the radiographs, the group with posture abnormalities had significant fewer symptoms than the other groups.
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PMID:MR imaging and radiography of patients with cervical hyperextension-flexion injuries after car accidents. 761 24

Increased cerebrospinal fluid pressure of usually unknown etiology is called pseudotumor cerebri. The key symptoms are headache, papilledema and fluctuating visual disturbances. Six cases are presented to illustrate the clinical variability of this syndrome. Headache or papilledema may be missing in individual cases. The clinical diagnosis can be facilitated by the recognition of accessory signs and symptoms, such as VIth nerve palsy, tinnitus and other cranial nerve disorders or neck stiffness. For the therapeutic outcome it is essential to detect and monitor visual disturbances early in the course of the disease.
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PMID:[Clinical variants of pseudotumor cerebri syndrome]. 763 26

The authors report a case of primary Ki-1 lymphoma of the brain. The patient was a 4 1/2-year-old black girl who presented with a 4- and 5-day history of headaches, nausea, vomiting, neck stiffness, and difficulty in walking. Computed tomography (CT) scan of the brain showed two discrete densities in the left occipital lobe and in the brain stem. Magnetic resonance imaging (MRI) showed multiple densities scattered over the brain surface and brain stem. Microscopically, the tumor was an anaplastic neoplasm that diffusely infiltrated brain parenchyma. The neoplastic cells were large with amphophilic cytoplasm, large nuclei with irregular nuclear contours and prominent nucleoli. A high mitotic rate including atypical mitotic figures was noted. Immunohistochemical stains showed diffuse strong positivity for CD30 and moderate focal staining for epithelial membrane antigen. Leukocyte common antigen, cytokeratin, neuron specific enolase, monocyte/macrophage and B- and T-marker stains were negative. The histology was characteristic for Ki-1 large cell lymphoma. Cytologic examination of cerebrospinal fluid (CSF) demonstrated similar neoplastic cells. This is one of the first reports of this variant in the pediatric population.
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PMID:Primary Ki-1 (anaplastic large cell) lymphoma of the brain and spinal cord. 772 50

Seventy-seven episodes of pneumococcal meningitis in 69 patients were reviewed. Twelve (15.6%) episodes occurred in those over 60 years old, 14 (18.2%) in patients between 10 and 60 years, 22 (28.6%) in patients between 2 and 10 years and 29 (37.7%) in those under 2 years. Overall mortality was 13.0% (10/77) and age of > 60 years was significantly associated with mortality (P < 0.05). Twelve episodes resulted in disabilities, eight of which were in those under 2 years, and took the form of hearing impairment in nine. Many patients had predisposing conditions with aural pathology, malignancy and diabetes mellitus being commonest in those over 10 years of age and aural pathology, preceding viral infection, renal disease, sinusitis or recent lower respiratory tract infection commonest in those aged between 2 and 10 years. Three of five patients with recurrent meningitis had CSF leaks. The most common features at presentation were fits, irritability, diarrhoea, and bulging fontanelles in those under 6 months; vomiting, drowsiness and poor feeding in those between 6 months and 2 years; neck stiffness, vomiting and drowsiness in those between 2 and 10 years while neck stiffness, focal neurology, headache and vomiting were commonest in those over 10 years old. Fever was common in all age groups as were foci of infection outside the CSF, with chest infections being significantly associated with mortality (P < 0.05). Of the laboratory parameters measured, low platelets (< 100 x 10(9)/l and high blood urea (> 7 mmol/l) were associated with mortality (P < 0.05). Blood cultures grew Streptococcus pneumoniae in 79.7% patients. Seventy-four (96%) patients had CSF taken of which 81% had gram films which were positive and interpreted correctly as showing pneumococci. Pneumococci were grown in 87.8% CSF cultures and all were sensitive to penicillin but a single isolate was chloramphenicol resistant. Many different antimicrobial drugs were used but penicillin plus chloramphenicol was the most commonly employed after the results of CSF microscopy were known and penicillin alone after culture results were available. Penicillin mono-therapy was associated with a low mortality.
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PMID:A review of the clinical presentation, laboratory features, antimicrobial therapy and outcome of 77 episodes of pneumococcal meningitis occurring in children and adults. 780 80

We report a case of carcinomatous meningitis from transitional cell carcinoma of the urinary bladder. A 70-year-old man with invasive bladder cancer and multiple pulmonary metastases received 3 courses of systemic M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy, after which the primary tumor and pulmonary metastases diminished in size and number. During the 4th course of chemotherapy, he complained of nausea, headache, diplopia, and neck stiffness. Computer tomographic (CT) scan of the brain showed no evidence of parenchymal metastases, cerebral hemorrhage, or infarction. Cerebrospinal fluid examination revealed an increase in cells along with elevated protein and depressed glucose concentrations, but no malignant cells were identified. He died two weeks after the onset of neurological symptoms. Autopsy revealed numerous tiny metastatic lesions in the leptomeninx, so called carcinomatous meningitis, without parenchymal metastases in the brain. Although metastases to the central nervous system from transitional cell carcinoma of the bladder, especially carcinomatous meningitis rarely have been reported, this unusual complication will be seen more frequently with the development of more effective systemic chemotherapy such as M-VAC.
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PMID:[A case of carcinomatous meningitis from transitional cell carcinoma of the urinary bladder]. 786 65

In a prospective study, 17 Brazilian patients with parenchymatous neurocysticercosis were monitored for a period of 12 months after treatment with praziquantel. Taenia solium-specific IgG antibodies, interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha, neopterin, and soluble interleukin-2 receptor (sIL-2R) were measured in serum and CSF before starting the therapy, on the last day of treatment, 5 weeks after treatment, and 3, 6, and 12 months after treatment. The most common symptoms and signs found in patients before treatment were headache, neck stiffness, and seizures. Six months after commencement of therapy, 13 of the 17 patients were free of complaints. Clinical normalization was paralleled by a significant decrease (p < 0.05) in the amount of intrathecally produced anti-T solium IgG 1 year after treatment. IL-1 beta was undetectable in serum at all times, whereas in the CSF it was within the normal range during the whole study period. The mean concentration of sIL-2R in the CSF was 65 kU/l (normal, < 50 kU/l) 5 weeks after treatment, whereas in all subsequent investigations sIL-2R was undetectable. The median CSF neopterin level was slightly elevated before treatment (6.8 nmol/l). One year after treatment, it had dropped by 69% (p < 0.001) to a median value of 2.1 nmol/l. The size of planimetrically measured focal cystic brain lesions on CT correlated with the amount of intrathecally synthesized anti-T solium IgG at the end of the study (r = 0.89, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical and immunologic follow-up study of patients with neurocysticercosis after treatment with praziquantel. 890 70

There were 78 patients who had been examined at our institution prior to the diagnosis of subarachnoid hemorrhage (SAH) among the 1114 patients with ruptured aneurysm stet between April 1974 and March 1992. Among these 78 cases these were 35 patients who might have been treated at an earlier stage, i.e., 26 patients in which the diagnosis was made belatedly and 9 patients in which an unruptured aneurysm was missed. All 26 patients with belatedly diagnosed SAH had headache without neck stiffness or neurological deficits and thus were Hunt and Kosnic grade 1-2 while 25 cases were categorized so called "minor leak". The causes in 6 of the 7 patients with poor outcome was rerupture or vasospasm due to delay in the diagnosis of SAH. Because the diagnosis of mild SAH is not always easy, it is important to take a careful medical history. MRI or lumbar puncture should be performed when SAH is suspected from the history, even if CT shows no evidence of SAH. The cause of failure to diagnose unruptured aneurysms, in addition to misreading was blood vessel overlapping as a result of non-selective angiography, poor contrast, etc. Angiography should be performed selectively and the inclusion of oblique, magnified, stereoscopic, and other imaging techniques is advisable, if an unruptured aneurysm is suspected, and angiographic follow-up is necessary when an ruptured aneurysm is uncertain.
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PMID:[Review of cases of ruptured cerebral aneurysm with a history of examination at our institution prior to the diagnosis of subarachnoid hemorrhage--in order to improve treatment outcome in patients with intracranial aneurysms]. 802 33

Ninety patients with subdural empyema were treated in the period after computerized tomography (CT) became available (1979 to 1991). Males predominated by a ratio of 2:1, and 40 patients were between 11 and 20 years old. The site of origin was the paranasal air sinuses in 53 patients, the middle ear in 19, and a superficial infection in eight; the source of infection was not known in 10. The most common clinical presentation was headache, fever, neck stiffness, seizures, or periorbital swelling; only seven patients had status epilepticus. While the erythrocyte sedimentation rate and white blood cell count were invariably elevated, the cerebrospinal fluid showed nonspecific pleocytosis in the 60 patients who underwent lumbar puncture. The definitive preoperative diagnosis was made by contrast-enhanced CT in all cases. Surgical treatment was by multiple burr holes in 37 patients, burr holes and small craniectomies in 33, burr holes with catheter drainage in seven, and a large craniotomy in 12. One patient was treated without surgery. The mortality rate was 7.7%, with 86% making a good recovery. These results compare favorably with those reported in other studies using craniotomy alone, and suggest that burr holes should not be disregarded as a method of treating subdural empyema where contrast-enhanced CT facilities are available.
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PMID:Subdural empyema: burr holes or craniotomy? A retrospective computerized tomography-era analysis of treatment in 90 cases. 809 19

In Malawi, a physician from Queen Elizabeth Central Hospital in Blantyre and one from Kamuzu Central Hospital in Lilongwe retrospectively analyzed laboratory records to determine the clinical features, cerebrospinal fluid (CSF) findings, treatment, and outcome of 31 patients with cryptococcal meningitis admitted to the hospitals between July, 1991, and January, 1993. Cryptococcal meningitis is a common manifestation of cryptococcosis in people with AIDS. It has become prevalent in Malawi in the last 5 years. The incidence of cryptococcal meningitis cases among medical admissions at both hospitals was 0.1%/year. The median ages of the 16 men and 15 women were 38 and 28 years, respectively. Symptoms lasted from 1 day to 5 months (median, 2 weeks). The leading signs and symptoms included headache (97%), neck stiffness (74%), fever (61%), altered consciousness (58%). The records revealed nonspecific readings for CSF white blood cell count and glucose and protein concentrations. 81% of the cases did not receive antifungal chemotherapy because they could not afford it. None of these untreated patients survived longer than 30 days after diagnosis of cryptococcal meningitis. Most died within the 1st 4 days. In fact, the median survival time after diagnosis for all 31 patients was 4 days. The patients who could afford antifungal chemotherapy survived 4 to at least 9 months. Diagnosis helps clinicians to make more accurate prognoses and keeps them from prescribing unnecessary treatment, especially if tuberculosis meningitis is the other diagnosis. As the prevalence of AIDS increase in Malawi, so should cryptococcal meningitis.
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PMID:Cryptococcal meningitis in Lilongwe and Blantyre, Malawi. 816 34

A 55-year-old man first noted a swelling on his back in September 1990, when CT scan of his chest suggested a pleural fistula and a cold abscess. In the following month, he became pyrexial and felt nauseated with headache. Subsequently he was transferred to our hospital. Results of neurological examination were abnormal only in that he had neck stiffness and bilateral nystagmus with drowsiness. Cerebrospinal fluid (CSF) showed turbid yellowish fluid with an opening pressure of 360 mmH2O, a protein content of 173 mg/dl, a glucose level of 19 mg/dl, and a white blood cell count of 3,024/ml (75% polymorphs, 25% lymphocytes). Tryptophane test was positive. No bacteria, fungi or acid-fast bacilli were seen on direct smear. Adenosine deaminase activity in CSF was 13.9 IU/l. Antibiotics, antituberculous drugs, corticosteroids and glycerol were administered. The clinical course in the hospital was satisfactory for the next two months, but a contrast enhanced CT scan showed prominent enhancement in the left choroid plexus, and MRI revealed another mass in the subarachnoidal space under the right frontal lobe. An open biopsy was done on the massive lesion in the frontal lobe. Macroscopically, this lesion was an encapsulated granulomatous one. On the other hand, there were groups of epitheloid cells with micronecrosis in their centers microscopically. These findings were compatible with tuberculoma, in spite of the absence of acid-fast bacilli or caseous necrosis. Medication was intensively continued: a follow-up CT showed gradual reduction of the choroid plexus lesion and shrinkage of the left lateral ventricle.
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PMID:[A case of tuberculous meningitis with abnormal contrast enhancement of choroid plexus on CT and MRI]. 829 13


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