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

The authors present a case of aneurysmal subarachnoid hemorrhage that were verified as cerebral vasospasm by using both three-dimensional CT angioraphy (3 D-CTA) and conventional angiography. A 45-year-old man was referred to our department 4th day after sudden onset of a severe headache. On admission, emergency 3 D-CTA showed the cerebral vasospasm involving M 1 segment. Conventional angiography performed at the same day of the left internal carotid artery confirmed the cerebral vasospasm of the same vessel as 3 D-CTA, and furthermore demonstrated the left middle cerebral artery (MCA) and anterior cerebral artery (ACA) genu aneurysms. The former was seen as a ruptured aneurysm from brain CT findings (Fisher group 3). On the 10th day after the onset, 3 D-CTA demonstrated the remaining severe cerebral vasospasm of the supraclinoid portion of left ICA and M 1 segment. Findings at the conventional angiography subsequently performed were concordant with those of 3 D-CTA. The patient was successfully treated with delayed surgical clipping for both aneurysms without the symptoms related to the cerebral vasospasm and discharged without neurological abnormality. We consider that 3 D-CTA shows promise as a minimally invasive method of evaluating the cerebral vasospasm and would take the place of the conventional angiography.
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PMID:[A case of subarachnoid hemorrhage verified as cerebral vasospasm by using three-dimensional CT angiography (3 D-CTA): reference to comparison with conventional angiography]. 1051 60

The aneurysm arising from a persistent primitive hypoglossal artery (PHA) is rare, and only 13 such cases have been reported in literature. We present a 62-year-old woman with an aneurysm of PHA at its junction with the basilar artery. The patient consulted our hospital for a transient loss of consciousness and headaches. No neurological deficit was found, but MRI and MRA showed an aneurysm of the vertebrobasilar junction. Cerebral angiogram after admission showed the aneurysm of PHA at its junction with the basilar artery. Perspective 3D-CTA and 3D-T2 weighted MR images were composed to simulate the condition and aneurysmal surgery via the transcondylar approach was carried out. The aneurysm was successfully clipped and the patient was discharged with no neurological deficits. Perspective 3 D-CTA and MRI simulation were very useful for this operation.
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PMID:[Persistent primitive hypoglossal artery aneurysm--case report]. 1126 Aug 93

Duplication of the middle cerebral artery is known as a rare anomalous vessel arising from the internal carotid artery and an aneurysm at the origin of the duplicated middle cerebral artery is very rare. We presented a case of ruptured aneurysm at the origin of the duplicated middle cerebral artery and discussed the usefulness of 3D-CTA (three-dimensional computed tomographic angiography) for its diagnosis. A 34-year-old female suffered from severe headache and was admitted to our hospital. CT scan revealed diffuse subarachnoid hemorrhage and angiography revealed duplication of the right middle cerebral artery and dilatation at its origin. We could not identify it as an aneurysm by angiography, so we performed 3D-CTA. 3D-CTA was able to demonstrate clearly the aneurysm at the origin of the duplicated middle cerebral artery and we performed neck clipping of the ruptured aneurysm. To our knowledge, previously there have been only 14 cases which reported such an aneurysm at the origin of a duplicated middle cerebral artery. We reviewed the 15 cases including ours and found that, in 4 cases, the aneurysm could not be detected by the initial angiography. We suspected that most of these aneurysms were small, so the detection of the aneurysms by angiography was difficult. We conclude that 3D-CTA is useful for diagnosing aneurysms at the origin of the duplicated middle cerebral artery even when thy can't be detected by angiography.
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PMID:[The usefulness of 3D-CTA for the diagnosis of a ruptured aneurysm at the origin of the duplicated middle cerebral artery: case report]. 1190 27

A 57-year-old woman had noticed occipital headache and neck pain bilaterally 6 weeks before admission. The headache and neck pain persisted for 3 weeks, then disappeared. Cranial magnetic resonance (MR) image obtained 4 weeks after the onset demonstrated intramural hematoma adjacent to intracranial left vertebral artery. MR image did not show any abnormal lesions in the brain parenchyma. Although cranial MR angiography did not show any definite aneurysms, three-dimensional CT angiography (3D-CTA) obtained 6 weeks after the onset disclosed an aneurysm of the left vertebral artery. The vessel distal to the aneurysm was occluded. Because the left posterior inferior cerebellar artery originated from the aneurysm, we did not perform embolization using coils. Spontaneous dissecting aneurysm of the left vertebral artery was diagnosed based on the clinical, MR image, and 3D-CTA findings. The systolic blood pressure was maintained under 130 mmHg using antihypertensive agents. Thereafter, 3D-CTA obtained 6 months after the onset showed recanalization of the occluded vessel distal to the aneurysm. The size of the aneurysm was unchanged. During these 6 months, there were no ischemic or hemorrhagic stroke events. In the present patient, headache and neck pain were the only manifestations of spontaneous dissection of the vertebral artery.
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PMID:[Headache and neck pain as only manifestations of spontaneous of the dissecting aneurysm vertebral artery--a case report]. 1661 44

In a pediatric patient with an isolated headache or a classic migraine unaccompanied by neurologic signs, presence of a seizure, or supporting historical data, an imaging workup is usually not indicated. For a sudden severe headache or a headache with positive neurologic signs or symptoms or supporting historical data, MRI or CT should be considered. For the acute severe (thunderclap) headache, CTA, MRA, or catheter angiography may be appropriate.
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PMID:ACR Appropriateness Criteria on headache-child. 1741 20

Fenestration of vertebral arteries has been reported in association with thromboembolic brain infarctions. However, few cases have been reported in which recurrent infarction occurred in spite of adequate anticoagulation. We report a young man with fenestrated vertebral arteries and stroke who failed to respond to standard anticoagulation therapy but did well with angiographic coil obliteration of an abnormal vertebral segment. An 18-year-old left-handed man presented with acute onset of dizziness and headache. No trauma or other stroke risk factors were identified. Left cerebellar infarction was seen on CT, but the cause could not be identified by brain and neck MRI, MRA, or CTA. Bilateral fenestrated vertebral arteries were identified with conventional angiography. Although the patient recovered fully and was treated with anticoagulation, he suffered a recurrent stroke 1 month later involving the right cerebellum while he was on a therapeutic dose of warfarin. Repeat arteriography showed a spontaneous dissection within one of the fenestrated vertebral segments. Since receiving angiographic coil obliteration of the pathologic segment, he has been free of all symptoms. We conclude that the patient sustained recurrent thromboembolic events in his posterior circulation due to spontaneous dissection within a fenestrated vertebral artery segment. Conventional angiography and emergent interventional embolization were essential to his diagnostic evaluation and therapeutic intervention.
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PMID:An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling. 1756 13

A 32-year-old female complained of a headache persisting for approximately one week. She was emergently brought to the hospital for sudden consciousness disorder early in the morning. Her neurological state was JCS 200 and WFNS Grade V. CT scan demonstrated a subarachnoid hemorrhage. 3D-CTA and DSA showed a right true posterior communicating artery fusiform aneurysm. We performed open surgery the same day, and found that the aneurysmal wall had thinned markedly. The aneurysm ruptured, and trapping was performed. A perforating artery from the aneurysm was sacrificed, but there was no apparent neurological deficit. The patient was ambulatory when discharged after a VP shunt was implanted, and she has returned to normal daily life. True posterior communicating artery fusiform aneurysm is very rare, and has been reported in detail in only 6 cases to date. A brief clinical review of the literature is presented. Since this type of aneurysm enlarges rapidly in some patients, and the possibility of re-rupture in the acute period is high, prompt trapping after onset is recommended.
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PMID:[Ruptured true posterior communicating artery fusiform aneurysm: case report]. 1763 13

A previously healthy 56-year-old woman presented with right-sided ophthalmic pain and diplopia following headache and fever. A neurological examination revealed 3rd and 6th right cranial nerve palsies. Brain magnetic resonance imaging (MRI) and 3D-computed tomography (CT) angiography (CTA) showed right-sided sphenoid sinusitis, cavernous sinus thrombophlebitis, and aneurysms in the right intracavernous carotid artery and in a portion of internal carotid-posterior communicating artery. We diagnosed her condition as cavernous sinus syndrome with an infectious aneurysm secondary to sphenoiditis; therefore, broad spectrum antibiotics were administered. However, 7 days after admission, she died of massive epistaxis. Macroscopically, coagulated blood was observed at the surface of the sphenoid sinus, suggesting bleeding in the cavernous sinus. A histopathological examination revealed severe infiltration of the inflammatory cells into the cavernous sinus and sphenoid mucosa. Rupture of the aneurysm in the cavernous sinus was also observed. However, no pathogenic organism was identified. We thought that the sphenoid sinusitis had spread through the venous flow into the cavernous, and the infectious aneurysm developed due to infiltration of inflammatory cells into the arterial wall. This is the first detailed clinico-pathological study of an infectious aneurysm in the intracavernous internal carotid artery occurring concomitantly with sphenoiditis.
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PMID:Infectious aneurysm of the intracavernous carotid artery occurring concomitantly with sphenoid sinusitis; an autopsy case report. 1910 50

Vertebral artery dissecting aneurysm (VADA) is a relatively rare cause of subarachnoid hemorrhage (SAH). Bilateral VADAs are even rarer, and there is no established treatment for this type of VADA. We report a case of bilateral VADAs with SAH. A 45-year-old man suddenly developed headache and consciousness disturbance and was referred to our hospital. CT scans demonstrated SAH mainly in the left cerebello-pontine cistern. Three dimensional computed tomographic angiography (3D-CTA) revealed fusiform dilatation of the bilateral vertebral arteries (VAs), suggesting dissecting aneurysms. The aneurysm on the left was larger in size than that on the right, and also had a bleb-like protrusion. Therefore, the left one was considered to be the cause of SAH. The patient was initially treated conservatively for one month to obtain spontaneous resolution of the aneurysms. On day 22, 3D-CTA revealed that the right VADA had decreased in size, however, the left VADA had slightly enlarged. On day 28, he underwent trapping of the ruptured left VADA. Postoperative course was uneventful. Occlusion of one VA may increase the hemodynamic pressure of the contralateral VA, inducing enlargement and subsequent rupture of the contralateral aneurysm. Therefore, both lesions of bilateral VADAs should be treated. However, if collateral blood flow through the posterior communicating artery is poor, occlusion of both VAs at the acute phase is considered to be intolerable. Therefore, waiting spontaneous resolution of the contralateral unnruptured dissecting aneurysm may be the treatment of choice for this type of lesion.
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PMID:[Case of bilateral vertebral artery dissecting aneurysm presenting with subarachnoid hemorrhage]. 1936 30

Dissection of extra- and intradural arteries is a common cause of cerebral insult in younger patients (<45 years). In patients with corresponding craniocervical injury and symptoms (carotidynie, ipsilateral headache, partial Horner syndrome, cranial nerve palsy) arterial dissection is always to be considered. Essential in diagnosing arterial dissection is the verification of the intramural hematoma and morphologic changes in the vessel (stenosis, pseudoaneurysm) by means of CT/CTA (acute phase) or MRI/MRA (subacute phase). These patients need to be monitored in an intensive care unit setting. The acute therapy includes anticoagulation or inhibition of thrombocyte aggregation. We present two cases with delayed cerebral infarction due to traumatic extra- and intradural arterial dissection after a motor vehicle accident. To perform primary diagnostic quickly and adequately may avoid permanent neurological deficit in these patients.
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PMID:[Traumatic dissection of extra- and intradural arteries]. 1973 49


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