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)

Between 1974 and 1991, hearing preservation surgery was attempted on 161 of 476 patients with a variety of cerebellopontine (CPA) tumors, at New York University School of Medicine. This included 146 unilateral acoustic neuromas, seven meningiomas, and six cases of neurofibromatosis. The suboccipital/retrosigmoid approach was used almost exclusively. The cochlear nerve was anatomically preserved in 131 cases, 32 percent of whom had successful hearing preservation. In the most successful group, hearing was preserved in 9 of 12 patients (75%). Success was defined as a postoperative pure-tone average (PTA) or speech reception threshold (SRT) of no more than 50 dB, and a speech discrimination score (SDS) of at least 50 percent. In those patients whose preoperative hearing was worse that this, success was based on a loss of no more than 10 dB in PTA or SRT, and 10 percent in SDS. Success was dependent mostly on extracanalicular (EC) tumor size, with the smallest tumors yielding the best results. When controlled for EC size, intracanalicular size and preoperative hearing were statistically significant variables. Origin from the superior vestibular nerve was also a favorable prognostic indicator. The character and duration of hearing loss, the patient's age, and the histology of the tumor did not have prognostic value. Auditory monitoring with either auditory brainstem response (ABR) or direct eighth nerve electrodes did not have a significant impact on success. Complications were somewhat increased by attempted hearing preservation. Facial nerve function was type I or II in 93 percent of patients. Cerebrospinal fluid leaks occurred in 15 percent of cases, but only 4 percent required surgical repair. There was one death, a patient with a 2.5-cm tumor. Early in the series, when a classic long vertical nuchal incision was used, headache and neck pain were common.
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PMID:Hearing preservation in cerebellopontine angle tumor surgery: the NYU experience 1974-1991. 812 2

The study was designed as retro-prospective and the study period was 3.5 years. A total of 66 (42 prospective and 24 retrospective) consecutive patients were included in the study. The commonest tumor in CPA is the Schwannoma (76%) followed by Meningioma (13.3%) and Epidermoid (4.44%). Unusual forms are Ependymoma and Hemangiopericytoma. Amongst the troublesome clinical features headache, hearing loss, vertigo and imbalance, vomiting and tinnitus were more important besides visual failure and features of lower cranial nerve involvement. The objective of the study is to "Review the Large Cerebello Pontile Angle tumors clinically". In this study 66 large CPA tumors were included and analyzed. Analysis of variance (ANOVA) was implied for the test of significance. On the whole, n=66 Schwannoma represents 76.70% and Meningioma 15.38%. Of these there are 45 cases with histological verification. The most common presenting (average duration is 1.3 years) symptoms were Headache (94.54%) and Hearing loss of varying grade (85.45%). Vertigo or imbalance was present in 67.27% cases. Vomiting was found in 54.54% of the times and difficulties in deglutition or voice change were complained of in 29.09% cases. Tinnitus was found only in 27.27% cases and it was the complaint mostly in lower diameter tumors. By maximum diameter, there were 24 cases measuring 3-4 cm, 15 more than 4 cm and only one case <3 cm sized tumors. Volume-wise tumors with volume <10 cc were 5 cases, 10-20 cc were 10, 20-30 cc were 13, 30-40 cc were 6 and >40 cc were 6. Similarly tumor volume and posterior fossa volume ratio was as follows: <10% were 6 cases, 10-20% were 15 cases, 20-30% were 7 cases and >30% were 6 cases. Amongst the schwannomas, the consistency of the tumor has been shown to be important factor for LCN involvement. The softer variety involved LCN more often than the harder (p<0.05). The involvement of the different groups of lower cranial nerve ranged from 7% to 92%.
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PMID:A clinical review of large cerebello pontile angle tumors. 1467 17

We hereby report an extremely unusual case of cystic angiomatous meningioma in the CPA region in a 58-year-old male patient. He presented with complaints of headache, repeated episodes of vomiting and increasing unsteadiness of gait. Neuroimaging showed a large multicystic left-sided tentorial tumor projecting into the cerebellum and CPA with contrast-enhancing peripheral solid rim. He underwent a left retromastoid craniectomy and total excision of the tumor. Histopathology revealed an angiomatous meningioma with predominant microvascular component and extensive cystic changes. Immunopositivity for epithelial membrane antigen (EMA), vimentin and S-100 protein proved vital in excluding a hemangioblastoma.
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PMID:Cystic angiomatous meningioma in the cerebellopontine angle mimicking hemangioblastoma. 2135 2

In recent years the use of stereotactic radiation for vestibular schwannomas has increased worldwide. However, malignant transformation associated with radiation, although uncommon, has been reported in recent publications. We present a case of the 34 year-old female who had left vestibular schwannoma and who underwent surgery and postoperative stereotactic radiotherapy (SRT), hypofraction in 2005. At 6 years after SRT, the patient came with left facial palsy and severe headache. CT brain revealed progression in size with cystic and hemorrhagic changes of the preexisting tumor at left CPA with new obstructive hydrocephalus. Partial tumor removal was done, and the pathological report was malignant peripheral nerve sheath tumor (MPNST). Regarding the uncertainty of carcinogenesis risk, we should still practice radiation therapy with caution, especially in the young patient with tumor predisposition syndrome. Because of low incidence of MPNST after radiation, it should not be a major decision about giving radiotherapy. However, with the poor prognosis of MPNST, this possibility should be explained to the patient before radiation treatment option.
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PMID:Radiation-induced peripheral malignant nerve sheath tumor arising from vestibular schwannoma after linac-based stereotactic radiation therapy: a case report and review of literatures. 2282 40

Background and objective Posttraumatic headache (PTH) is one of the most common, debilitating and difficult symptoms to manage after a mild traumatic brain injury, or concussion. However, the mechanisms underlying PTH remain elusive, in part due to the lack of a clinically relevant animal model. Here, we characterized for the first time, headache and pain-related behaviours in a rat model of concussion evoked by a mild closed head injury (mCHI) - the major type of military and civilian related trauma associated with PTH - and tested responses to current and novel headache therapies. Methods Concussion was induced in adult male rats using a weight-drop device. Characterization of headache and pain related behaviours included assessment of cutaneous tactile pain sensitivity, using von Frey monofilaments, and ongoing pain using the conditioned place preference or aversion (CPP/CPA) paradigms. Sensitivity to headache/migraine triggers was tested by exposing rats to low-dose glyceryl trinitrate (GTN). Treatments included acute systemic administration of sumatriptan and chronic systemic administration of a mouse anti-CGRP monoclonal antibody. Results Concussed rats developed cephalic tactile pain hypersensitivity that was resolved by two weeks post-injury and was ameliorated by treatment with sumatriptan or anti-CGRP monoclonal antibody. Sumatriptan also produced CPP seven days post mCHI, but not in sham animals. Following the resolution of the concussion-evoked cephalic hypersensitivity, administration of GTN produced a renewed and pronounced cephalic pain hypersensitivity that was inhibited by sumatriptan or anti-CGRP antibody treatment as well as a CGRP-dependent CPA. GTN had no effect in sham animals. Conclusions Concussion leads to the development of headache and pain-related behaviours, in particular sustained enhanced responses to GTN, that are mediated through a CGRP-dependent mechanism. Treatment with anti-CGRP antibodies may be a useful approach to treat PTH.
Cephalalgia 2018 02
PMID:Development of CGRP-dependent pain and headache related behaviours in a rat model of concussion: Implications for mechanisms of post-traumatic headache. 2789 34