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

A 44-year-old man presented with a rare subfrontal schwannoma with headache. He had undergone radiation therapy for a pineal lesion 30 years previously, but the histology was not verified. On admission, neurological examination revealed no focal deficits including hyposmia. Computed tomography demonstrated a mass measuring 5 x 3 cm in the right anterior cranial fossa. Magnetic resonance imaging revealed a heterogeneously enhanced mass with multiple cysts. The tumor, which was clearly separable from the surrounding normal brain, was totally resected through a right frontal craniotomy. There was no adhesion between the tumor and the olfactory groove or cribriform plate. The frontal base dura was suspected to be the tumor attachment. The patient was discharged without hyposmia. Histological examination revealed a typical pattern of schwannoma consisting of Antoni type A and type B. Immunohistochemical staining was positive for S-100 protein but negative for epithelial membrane antigen. Subfrontal schwannoma not associated with the olfactory groove or cribriform plate is extremely rare. The operative findings and absence of hyposmia suggest that the meningeal branch of the trigeminal nerve was the origin of the tumor. However, the possibility of radiation-induced reactive Schwann cells cannot be excluded.
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PMID:Subfrontal schwannoma without hyposmia--case report. 1568 79

Hemicrania continua (HC) is an uncommon, primary headache disorder characterized by a continuous, strictly unilateral headache of moderate intensity with superimposed exacerbations of more severe pain and accompanying autonomic features. Whereas in the majority of HC patients the headache is continuous and without pain-free intervals, we report two new cases of the rare remitting form of HC. One patient described unusual olfactory sensation during episodes of exacerbation, which we classify as an olfactory aura.
Headache 2005 Jun
PMID:Remitting form of hemicrania continua: two new cases exhibiting one unusual autonomic feature. 1595 12

Malignant subfrontal (olfactory) peripheral nerve sheath tumors (MPNSTs) are exceedingly rare. Although meningiomas are the most common subfrontal extra-axial lesions, it is important to recognize that MPNSTs, which are radiographically similar to meningiomas, can also be present in this location. MPNSTs require more aggressive surgical and postoperative management than meningiomas. In this paper, we describe a patient with a subfrontal MPNST with unusual histological characteristics and present a review of the literature. A 49-year-old woman presented with chronic sinusitis and progressive headaches. A neurological examination revealed left-sided anosmia. Brain-imaging studies revealed a large left subfrontal mass with extension into the frontal and ethmoid sinuses and the nasal cavity. The patient underwent both a bifrontal transbasal craniotomy and a transnasal approach for an attempt at total resection of both the intradural and extradural components of the MPNST. The patient was treated postoperatively with radiation therapy, and had no evidence of recurrence at her follow-up examination 1-year after treatment. Subfrontal PNSTs are extremely rare and usually benign. The specific cell and nerve of origin for these tumors remains unknown. Our case shows that these rare lesions can present as a malignant variant and thus require aggressive surgical and postoperative management to provide long-term tumor control.
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PMID:Management of a sporadic malignant subfrontal peripheral nerve sheath tumor. 1613 91

A 55-year-old woman presented with a longstanding history of headache and personality change. Preoperative imaging suggested an olfactory groove meningioma invading the posterior nasal space. Following surgical removal of the lesion histopathology confirmed the presence of both a nasal schwannoma and an olfactory groove meningioma. This dual pathology may represent a variation of neurofibromatosis type 2 (NF-2).
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PMID:Combined nasal and skull base pathology: adjacent nasal schwannoma and olfactory groove meningioma. 1645 71

Several types of mass lesions may occur in the third and lateral ventricles. Typically they arise from the lining of the ventricular cavity or from contiguous structures, by extension into the ventricle. The authors describe two patients, each of whom presented with a different rare lesion of the ventricular system. The first was a 53-year-old woman with a history of hypertension who sustained a blunt traumatic injury to the occipital region and subsequently developed a progressively worsening right-sided headache. Radiological examinations over the next 2 years revealed an enlarged right lateral ventricle and, ultimately, a choroid plexus cyst in its anterior and middle third, near the foramen of Monro, which is a rare location for these lesions. The cyst was removed en bloc, and follow-up examinations showed a significant improvement in her headache and a minimal differences in size between right and left ventricles. The authors also describe a 57-year-old man with hypertension, diabetes mellitus, and an old mycardial infarct, who presented to an outside institution with a progressively worsening headache, generalized malaise, and loss of olfactory sensation. Diagnostic imaging revealed a 1.5-cm oval lesion centered in the lamina terminalis region, an open craniotomy was performed, and evaluation of a biopsy sample demonstrated the mass to be a chordoid glioma of the third ventricle, a recently described glioma subtype. Two days after surgery, he suffered a left parietal stroke and an anterior mycardial infarction. After convalescing, he presented to The University of Texas M. D. Anderson Cancer Center for radiotherapy and follow up; 7 months later he was readmitted complaining of headache, short-term memory loss, and worsening confusion and disorientation. Neuroimaging revealed progression of the tumor (now 2 cm in diameter), which was removed by gross-total resection. His headache resolved immediately, and 2 months later his only complaint was of episodes of confusion. Three weeks later he died of a massive myocardial infarction. These two patients represent the sixth case of an adult with a choroid plexus cyst in the anterior lateral ventricle and the 19th case of an adult with a chordoid glioma of the third ventricle, respectively.
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PMID:Choroid plexus cyst and chordoid glioma. Report of two cases. 1672 23

The aim of this study was to evaluate olfactory hypersensitivity (OHS) between attacks in migraine patients. Seventy-four migraine patients and 30 controls were enrolled. The presence of OHS was evaluated using an oral questionnaire and a chemical odour intolerance index. Subjects had to rate the intensity and hedonicity of 12 odourants using a linear rating scale. Twenty-six patients (35.2%) but no control subjects reported an interictal OHS (P<0.001). Logistic regression analysis showed that patients with OHS presented a greater attack frequency, a higher number of odour-induced migraines and visual hypersensitivity when compared with other patients. Disease duration, age, gender and auditory hypersensitivity were not associated with OHS. OHS patients judged odours less pleasant than did other patients and controls, whereas the intensity scores were identical in both groups. OHS between attacks was significantly associated with odour-triggered migraine and an alteration of hedonic judgement.
Cephalalgia 2006 Sep
PMID:Rating of olfactory judgements in migraine patients. 1691 63

A study of 1,915 patients operated on with a total of 4,285 endoscopic endonasal ethmoidal procedures during a period of 18 years is presented. The study comprises five groups of patients with (1) acute recurrent and chronic sinusitis--long-standing symptoms >3 months--(n = 733), (2) nasal/paranasal polyposis (n = 710), (3) sinogenic headache (n = 325), (4) mucoceles (n = 59) and (5) other nasal/paranasal disorders (n = 88). This group includes acute sinus infection with complications (n = 38), acute trauma/injury (n = 22), Grave's disease with exophthalmus (n = 12) and olfactory dysfunction (n = 16). The need for a thorough examination leading to a final diagnosis is emphasized. Endoscopy and CT/MRI are standard tools in the diagnostic and postoperative process. Close cooperation and educational teaching of the patient are necessary to obtain highest compliance. Long-standing medical treatment of inflammatory diseases is important to the long-term outcome and is of utmost importance to surgical success. Surgery is recommended to be performed under general anesthesia (total intravenous anesthesia or laryngeal mask anesthesia) with additional local, topical anesthetics, and can be easily performed on a day-case out-patient basis. The surgery is based upon the Messerklinger technique (MT). Peroperative complications are reduced by a skilled and meticulous surgical conduct and an adequate medication preoperatively. During this period of time, necessary controls within the first postoperative month were reduced from 3-4 to only one. Long-term follow-up secures a long-standing optimal result. Endoscopic surgery for more rare conditions, such as orbital decompression, CSF leaks and meningoceles, is recommended to be performed in specialized centers with adequate trained staff and necessary equipment. The possibilities of the picture archiving communication system, giving a number of different projections and angles and video-guided imaging peroperatively, facilitates safe surgical performances in areas usually associated with great risks and hazards. The long-term results are very good during the above circumstances. Reoperations are few and the patient satisfaction is very high.
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PMID:Endoscopic endonasal sinus surgery: a review of 18 years of practice and long-term follow-up. 1693 13

Esthesioneuroblastoma (olfactory neuroblastoma) is an uncommon neuroectodermal tumor. Its biological activity ranges from indolent growth to local recurrence and rapid widespread metastasis. Treatment options consist of surgical resection followed by radiation therapy for primary lesions and the addition of chemotherapy for advanced, recurrent, or metastatic lesions. Patients often present with nasal obstruction, rhinorrhea, recurrent epistaxis, hyposmia, or anosmia. However, we report the highly unusual case of a patient with an esthesioneuroblastoma who presented with atypical symptoms of headaches, sinus congestion, and fatigue before acutely losing consciousness. Imaging showed a large frontal skull-based tumor associated with intratumoral hemorrhage. The findings prompted an emergent combined anterior craniofacial resection with gross total resection of the tumor. Except for anosmia, the patient recovered almost completely. Postoperatively, she received adjuvant intensity-modulated radiation therapy and chemotherapy. This is the first reported case of an esthesioneuroblastoma presenting with hemorrhage and rapidly declining mental status, an acute neurological manifestation of which clinicians should be aware.
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PMID:Esthesioneuroblastoma (olfactory neuroblastoma) with hemorrhage: an unusual presentation. 1726 90

Treatment of nasal septal perforations which decrease quality of life is a surgical challenge with variable success rates. Numerous surgical methods have been proposed for closure of perforations. The technique described in this article, i.e. closure of the perforation with an upper lateral cartilage mucoperichondrial flap through an external septorhinoplasty approach, is an alternative surgical technique. Twenty-four patients with symptomatic nasal septal perforation were operated on using this technique and followed up for a mean duration of 28 months. Preoperative and postoperative symptom scores for crusting, nasal obstruction, bleeding, discharge, whistling, headache, nasal pain, snoring and olfactory loss as well as overall discomfort levels were compared using a visual analogue scale. Complete closure of the perforation was achieved in 19 patients.
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PMID:Upper lateral cartilage inner mucoperichondrial flap technique for the repair of nasal septal perforation. 1740 84

Recent studies have suggested that abnormalities of dopamine and trace amines (tyramine, octopamine, and synephrine), products of tyrosine metabolism, may constitute the metabolic events that predispose to the occurrence of cluster headache (CH) and migraine attacks. This hypothesis is supported by the following evidences: the discovery of trace amine associated receptors (TAARs), expressed on the olfactory epithelium, amigdala, hypothalamus, periacqueductal gray, and the biochemical anomalies of dopamine and trace amines. The possible effects of these biochemical abnormalities on TAARs and dopamine receptors, located in different areas of CNS, may explain the behaviour (restlessness, anxiety and, at times, hypersexuality) and the autonomic signs during the painful attacks of CH, and the premonitory symptoms of migraine crisis (thirst, craving, yawning, alteration of smell, depression etc.).
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PMID:Biochemistry of neuromodulation in primary headaches: focus on anomalies of tyrosine metabolism. 1750 88


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