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

Lymphocyte subsets from 5 groups of patients with different types of chronic headaches were analyzed by flow cytometry to determine the number of cells bearing the following markers: T11 (E-rosette receptor), T3 (total T cells), T4 (T-helper/inducer cells), T8 (T-cytotoxic/suppressor cells), B1 (B-cells), NKH-1 (Natural killer cells), I2 (Class II histocompatibility antigens, monomorphic determinants) and Mo2 (monocytes). In 4 of 5 of these groups, the absolute number of T8 lymphocytes was significantly lower than that of control group. In addition, the T4:T8 ratio was higher in these 4 groups. These findings may suggest a relationship between the immune system and the cause of chronic headaches.
Headache 1989 May
PMID:Flow cytometric analysis of lymphocyte subsets in peripheral blood of chronic headache patients. 278 8

One hundred and twenty-eight ASA I-III patients less than 40 yr of age, undergoing orthopaedic or trauma lower limb surgery, were allocated randomly to receive either continuous spinal anaesthesia (CSA) using a 32-gauge polyimide microcatheter with a permanent stylet (Rusch/TFX Medical, Duluth, GA, USA) or single-dose spinal anaesthesia (SDSA) with a 24-gauge x 103-mm Sprotte spinal needle (Pajunk, Germany). Plain bupivacaine (0.5%) was used as the local anaesthetic. The initial doses were 1 ml (5 mg) of CSA and 3 ml (15 mg) of SDSA, while the re-injection doses were 1 ml (5 mg) in the CSA group. SDSA was quicker to perform: mean 4.4 (SD 1.6) min compared with 6.2 (2.6) min for CSA (P < 0.01). Times to onset and surgical anaesthesia were also significantly greater in the CSA group (P < 0.01). The quality of the block was better in the SDSA group (P < 0.05), but was associated with greater haemodynamic instability (P < 0.05). The segmental level of analgesia was significantly lower in the CSA group (median T10 (range T12-T8)) than in the SDSA group (T9 (T11-T5)) (P < 0.05). There were no significant differences in the incidence of postoperative complications, with two mild spinal headaches in both groups. We conclude that CSA using a microcatheter in young patients is difficult to perform and affords no advantages over SDSA with a small gauge atraumatic needle.
 ...
PMID:Comparison of continuous spinal anaesthesia using a 32-gauge catheter with anaesthesia using a single-dose 24-gauge atraumatic needle in young patients. 788 Jun 57

Charcot spinal arthropathy has been described as a late complication of spinal cord injury. In patients with these injuries in whom the spine below the level of injury is insensate, joint trauma can progress until spinal instability ensues. The authors describe the case of a 50-year-old man with complete C-8 tetraplegia who experienced a 4-month history of episodic severe headaches, profuse sweating over his face and arms, and episodic severe hypertension in addition to a "grinding" sensation in the lower back. Charcot arthropathy at the T11-12 levels with pathological mobility was demonstrated on neuroimaging. Intraoperatively, a complete spinal cord transection was identified. Anterior and posterior thoracolumbar fusion across the mobile segment resulted in complete amelioration of signs and symptoms of autonomic dysreflexia. This entity, a common condition in the setting of spinal cord injury, has many triggers. Definitive treatment is targeted at the removal of the underlying cause. As demonstrated here, Charcot spinal arthropathy can act as a powerful trigger for induction of autonomic dysreflexia. Treatment of the associated spinal instability resulted in eradication of all signs and symptoms of the dysreflexia.
 ...
PMID:Charcot arthropathy in relation to autonomic dysreflexia in spinal cord injury: case report and review of the literature. 1587 89

Nontraumatic intracranial subarachnoid hemorrhage (SAH) attributable to the thoracolumbar dural arteriovenous fistulas (DAVFs) has been extremely rare. A 41-year-old male patient was admitted with severe acute headache, neck stiffness, and pronounced low-back pain radiating to both legs. The T2-weighted MR imaging showed irregular signal void and enlarged, varix like pouch formation with spinal cord compression at the T11-12 level. The angiogram revealed a DAVF.We report a DAVF case with SAH that revealed an extensive infarction from C5 to the conus medullaris after undergoing operative treatment.
 ...
PMID:Extensive spinal cord infarction after surgical interruption of thoracolumbar dural arteriovenous fistula presenting with subarachnoid hemorrhage. 1970 96

A 60-year-old female presented with sudden onset of severe headache and back pain, followed by nausea. The initial head computed tomography (CT) scan revealed posterior fossa subarachnoid hemorrhage (SAH). Spinal T(2)-weighted magnetic resonance imaging demonstrated SAH, and a homogeneous and slightly low signal intensity mass at T11. Spinal angiography in the early arterial phase revealed a small pearl and string-like aneurysm of the proximal radiculomedullary artery on the left side at the T12 level. Forty days after the onset of SAH, CT angiography demonstrated complete occlusion of the dissecting aneurysm and the preserved anterior spinal artery. The present case of ruptured dissecting aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with SAH underwent subsequent spontaneous occlusion, indicating that the wait-and-see strategy may be justified and will provide adequate treatment.
 ...
PMID:Dissection aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with subarachnoid hemorrhage. 2194 30

We report a case of refractory spontaneous intracranial hypotension (SIH) following epidural anesthesia. In this case, typical clinical symptoms and concomitant use of regional anesthesia led to the misdiagnosis of SIH as post-dural puncture headache (PDPH). A 56-year-old man received a successful appendectomy under epidural anesthesia performed at a T11-T12 intravertebral space. About 20 h later, the patient started complaining about orthostatic headache when getting up from his lying position, then a PDPH was diagnosed. However, the patient did not respond well to conservative treatment. Three months later, the first epidural blood patch was performed at the L3-L4 level, however, the patient still had an orthostatic headache. Five days later, spine magnetic resonance imaging showed multiple meningeal diverticulum in the cervicothoracic junction, and computerized tomography myelography demonstrated a C5-C6 spinal dural tear suggesting cerebrospinal fluid leaks. Finally, the patient was diagnosed as SIH and received a second epidural blood patch at the T2-T3 level and responded with improvements in symptomatology. The patient was then discharged, and at a 2-year follow-up, he had fully recovered except for some remaining neck stiffness. This case illustrates that SIH was misdiagnosed as PDPH because of the common clinical symptoms and potentially confounding events (epidural/spinal anesthesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. For a successful treatment of SIH, a timely epidural blood patch should be considered as soon as the diagnosis is established.
...
PMID:Spontaneous intracranial hypotension following epidural anesthesia: a case report. 2693 69

Spinal leakage of cerebrospinal fluid (CSF) is considered to be the primary cause of spontaneous intracranial hypotension (SIH). Subdural haematoma (SDH) is a serious complication of SIH. This current report presents a case of bilateral SDH with SIH that was treated with epidural blood patching (EBP). A 43-year-old male complained of experiencing orthostatic headaches for 2 months without neurological signs. The patient worsened in a local hospital and was transferred to the Sir Run Run Hospital. Brain computed tomography showed bilateral SDH with a midline shift. The patient underwent emergency trephination in the left frontal temporal region. Postoperative magnetic resonance myelography showed a CSF leak originating at the T11-L2 level. As a consequence of clinical deterioration of the patient, EBP was subsequently performed at the T12-L1 level. The headache was rapidly relieved and later the SDH was completely absorbed. This case report and literature review aims to remind clinicians that SIH can cause SDH and that EBP is a viable treatment option.
...
PMID:Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review. 2722 63

Spontaneous intracranial hypotension (SIH) caused by spontaneous spinal cerebrospinal fluid (CSF) leaks produces orthostatic headaches. Although upper arm pain or paresthesia is reportedly associated with SIH from spontaneous spinal CSF leak in the presence of orthostatic headache, low thoracic radicular pain due to spontaneous spinal CSF leak unassociated with postural headache is extremely rare. We report a 67-year-old female who presented with chronic, positional radicular right T11 pain. Computed tomography myelography showed a spontaneous lumbar spinal CSF leak at L2-3 and repeated lumbar epidural blood patches significantly alleviated chronic, positional, and lower thoracic radiculopathic pain. The authors speculate that a chronic spontaneous spinal CSF leak not severe enough to cause typical orthostatic headache or epidural CSF collection may cause local symptoms such as irritation of a remote nerve root. There might be considerable variabilities in the clinical features of SIH which can present a diagnostic challenge.
 ...
PMID:The Relief of Unilateral Painful Thoracic Radiculopathy without Headache from Remote Spontaneous Spinal Cerebrospinal Fluid Leak. 2744 13

Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. We reported the case of a 46-year-old man with a history of postural headache and dizziness. The patient was treated with bed rest and daily hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not resolve, and he became drowsy and disoriented with incomprehensible speech. Magnetic resonance imaging demonstrated diffuse dural enhancement on the postcontrast study, sagging of the midbrain, and CSF leakage over right lateral posterior thecal sac at C2 level. We performed EBP at the level of T10-T11. We injected 14 mL of autologous blood slowly in the Trendelenburg position. Within 30 minutes, he became alert and oriented to people, place, and time. We chose thoracic EBP as first line treatment in consideration of the risk of cervical EBP such as spinal cord and nerve root compression or puncture, chemical meningitis. Also we put our patient in Trendelenburg position to make blood travel towards the site of the leak. Untreated IHS may delay the course of resolution and affect the patient's consciousness. Delivery of EBP via an epidural catheter inserted from the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective treatment for patients with IHS caused by CSF leak even at C2.Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage; epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial hypotension syndrome; Trendelenburg position.
 ...
PMID:Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level. 2833 49

Spinal subarachnoid haemorrhage is a rare complication of spinal anaesthesia, especially following atraumatic lumbar puncture and in the absence of coagulopathies. The initial presentation of spinal subarachnoid haemorrhage is variable and paraplegia with full recovery within a few hours is rare. Bleeding can extend into the intracranial subarachnoid space, but there are only a few reports of symptomatic intracranial and spinal subarachnoid haemorrhage after spinal anaesthesia. We report co-existing spinal subarachnoid haemorrhage and intracranial subarachnoid haemorrhage after atraumatic spinal anaesthesia in a 69-year-old woman without a coagulopathy. The day after surgery she developed flaccid paraplegia that spontaneously resolved in a few hours. Magnetic resonance imaging demonstrated subarachnoid high signal intensity from T11-S2, consistent with spinal subarachnoid haemorrhage. On the same day the patient complained of severe headache which was later followed by diplopia. Neurological imaging studies revealed diffuse distribution of blood in the subarachnoid space but no intracranial vascular malformations. At the time of diagnosis spontaneous recovery of spinal symptoms had already begun and the clinical manifestations eventually resolved with conservative management. The possibility of an intracranial haemorrhage should always be considered when spinal subarachnoid haemorrhage is identified, even in cases of uncomplicated spinal anaesthesia in patients with no known risk factors for spinal haemorrhage.
 ...
PMID:Transient paraplegia due to subarachnoid haemorrhage following spinal anaesthesia. 3252 91


1 2 Next >>