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

Seventy-nine patients with known or suspected central nervous system lesions were studied with MRI in a phase III double-blind study. Forty were given gadopentetate dimeglumine (Gd-DTPA) and 39 gadodiamide injection (Gd-DTPA BMA), a new low-osmolar nonionic contrast enhancing medium. The dosage was 0.1 mmol/kg body weight, corresponding to 0.2 ml/kg. Spin-echo sequences were performed before and immediately after injection. The safety and efficacy of the two contrast media were assessed. No changes were observed in blood pressure, heart rate or neurological status. Five adverse effects (two episodes of headaches, two of nausea and one of dizziness) were reported by 2 patients who received gadodiamide injection and 1 who received gadopentetate dimeglumine. All events were mild and their relationship to the contrast media was uncertain. For both contrast media statistically significant changes in serum iron were observed 24 h after injection. More than 70% of the patients had abnormal findings on MRI, and in 56% of these contrast enhancement of the abnormal structure or lesion was seen. Contrast enhancement provided the diagnosis in about 50%, changed it in 40% and increased diagnostic confidence in 95%.
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PMID:A double-blind, comparative study of gadodiamide injection and gadopentetate dimeglumine in MRI of the central nervous system. 845 13

We encountered a rare case of craniospinal arachnoid cyst. A 54-year-old woman was admitted to our clinic for headache, posterior nuchal pain, and vomiting, which had started one month before. On admission she was drowsy, and neurological examination revealed papilledema and prompt deep tendon reflexes bilaterally. T1 weighted images of MRI revealed a homogeneous, round, low density mass in the left cerebellar hemisphere which extended down on the dorsal side of the spinal cord to the level of C2. It was high intensity on T2 weighted images and was not enhanced by Gd-DTPA. The fourth ventricle was compressed and obstructed and hydrocephalus was observed. An operation was performed via a left suboccipital craniectomy with C1 laminectomy. A large cyst was located in the left cerebellar hemisphere, and it extended into the spinal canal down to the C2 level where the cyst compressed the spinal cord right-anteriorly. The content of the cyst was xanthochromic fluid. After the removal of as much of the cyst as possible, the flattened tonsil was seen just dorsal to the medulla. The cyst extended into the cerebellar hemisphere via the widened fissura secunda. The arachnoid of the cisterna magna was incised and communication between the cisterna magna and the cyst was made. The cyst was markedly reduced on the following day, and disappeared on the 50th postoperative day. The patient was discharged without neurological deficit. Pathological diagnosis of the cyst wall in the cerebellum was that the molecular layer of the cerebellar cortex was covered by arachnoid membrane, which indicated arachnoid cyst. Five such cases have been reported apart from this one. The therapy is the extirpation of the cyst wall and making communication between the arachnoid cyst and the subarachnoid space. The etiology of craniospinal arachnoid cyst is not well known but postoperative prognosis is good.
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PMID:Craniospinal arachnoid cyst: case report. 855 70

A 67-year-old woman with a one-year history of tinnitus and headache had multiple cranial nerve palsies of V, VII, VIII, IX, X, XI and spastic paraparesis. She also had a secretory otitis media. Gd-DTPA-enhanced magnetic resonance imaging (MRI) revealed hypertrophy of the dura of the posterior fossa and spinal epidural mass which extended from C7 to T10. A biopsy of the epidural mass showed chronic granulomatous change. These lesions were completely cured with administration of antibiotics. We believe this case of double-lesion of hypertrophic cranial pachymeningitis and spinal epidural granulomatous lesion originated from a bacterial infection secondary to the secretory otitis media.
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PMID:Hypertrophic cranial pachymeningitis with spinal epidural granulomatous lesion. 856 27

A 36-year-old woman presented suffering from severe headache and diploia. Magnetic resonance imaging showed a diffuse thickening of the cranial dura mater which was enhanced by gadolinium-DTPA. Two months later, an improvement of the clinical symptoms and a spontaneous resolution of the dural thickening were noted. Hypertrophic cranial pachymeningitis and other diseases causing diffuse dural thickening are discussed.
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PMID:Spontaneous resolution of hypertrophic cranial pachymeningitis. 857 68

A 55-year-old man reported a severe headache of 3 days' duration, left ptosis and left lid swelling before examination. The ocular examination revealed left eye proptosis, severe edema of the left bulbar conjunctiva and lid, increasing intraocular pressure of the left eye and ptosis on the left side with decreased extraocular movement. The right eye was normal. Hematologic studies indicated mild inflammation. An enhanced computed tomography scan revealed proptosis of the left globe and enlargement of the superior ophthalmic vein and cavernous sinus of the left side. Angiography revealed an area of interrupted blood flow in the left cavernous sinus. Enhanced magnetic resonance imaging (MRI) with Gd-DTPA revealed a low-intensity area that was suspected to be a blood clot in the enlarged left cavernous sinus. This case indicates the efficacy of enhanced MRI examination in the early diagnosis of cavernous sinus thrombosis.
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PMID:Magnetic resonance imaging in the early diagnosis of cavernous sinus thrombosis. 857 Jan 57

A case of cranial hypertrophic pachymeningitis of unknown etiology in a patient with 15-year history of headaches, cranial nerve palsies, and gait disturbance is reported. A 77-year-old woman was brought to our institute in a coma. CT revealed intracerebral hemorrhage in the right temporal lobe and thickening of the falx and tentorium. Fifteen years previously the patient had undergone CT scanning because of headaches, cranial nerve palsies, and progressive gait disturbance and a thickened tentorium, mild hydrocephalus and edematous change in the right temporal lobe had been reported. Since the etiology of her symptoms was unclear at the time, she did not receive adequate treatment. Her symptoms gradually progressed thereafter, and her visual acuity and hearing deteriorated. MR imaging in 1994 showed the thickened tentorium as a hypointense area with hyperintense edges on Gd-DTPA enhanced images. Angiography revealed narrowing of posterior portion of the superior sagittal sinus. The patient's condition rapidly deteriorated due to the intracranial hypertension and she subsequently died. Autopsy revealed a thickened tentorium with xanthochromic surface. This hypertrophic change was also seen in the dura mater of the posterior and middle cranial fossa. Microscopic examination of the thickened tentorium revealed extensive fibrous tissue with a chronic inflammatory infiltrate, predominantly of lymphocytes. No specific lesions were revealed by staining with hematoxylin-eosin, PAS, Gram's or Ziehl-Neelsen stains. The patient had no inflammatory or infectious diseases of other organs, and a diagnosis of idiopathic cranial hypertrophic pachymeningitis of unknown etiology was made. Considering the above findings, the thickened tentorium depicted as a hypointense area on the T1- and T2-weighted images and the Gd-enhanced edges of the tentorium are thought to be represent fibrous tissue and inflammatory regions, respectively.
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PMID:[A case of cranial hypertrophic pachymeningitis with intracranial hemorrhage]. 867 7

We reported two early-childhood cases suffering from acute optic neuritis (ON). Case 1 was a 3-year-old girl, who had a preceding upper respiratory infection, headache, nausea and subsequent sudden visual disturbance. Cranial MRI revealed multiple T2-elongated lesions in the white matter. She showed two neurological relapses including ON, leading to the diagnosis of clinically probable multiple sclerosis (MS). Case 2 was a 2-year-old boy, who had an acute onset of visual disturbance without any other neurological deficits. MRI with Gd-DTPA enhancement revealed not only a disorder of optic nerves but involvement of the white matter in the acute phase. It has been suggested that there may be a broad spectrum of demyelinating disorders between ON and MS even in early-childhood. Therefore, we should bear in mind to the subsequent progression to MS in childhood ON cases with silent brain lesions.
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PMID:[Two early-childhood cases of optic neuritis]. 875 34

The authors report a rare case of ecchordosis physaliphora (EP) in the prepontine region. A 51-year-old woman was admitted with a small cystic mass in the prepontine region, complaining of headache and an episode of transient double vision. Plain X-ray and lateral tomography films showed a protrusive hyperostosis at the middle clival region. The CT scan showed no abnormal densities in the retroclival region, and CT cisternography showed an isolated small round mass in the prepontine cistern. A small cystic mass with no enhancement with Gd-DTPA was revealed on MRI, mildly compressing the basilar artery and the rostral surface of the pons. The totally excised mass was pedunculated and was contiguous with the dorsal wall of the clivus via a small dural defect. The histologic diagnosis was EP, consisting of scattered physaliphorous cell nests, which were not positive for MIB-1 staining. The pedicle consisted of mature cartilaginous cells. The authors briefly reviewed the few previously reported cases of symptomatic EP and intradural chordoma, and discussed the differences between them. The histological features, especially the proliferation potential, may be pathognomonic. The histogenesis and the clinical features of symptomatic EP are also provided.
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PMID:[A surgical case of ecchordosis physaliphora]. 893 71

A 59-year-old man presented with a rare cholesterol granuloma of the petrous apex manifesting as headache, left facial dysesthesia, diplopia, left hearing impairment, and left tinnitus. Neurological examination revealed dysesthesia of territory in all divisions of the left trigeminal nerve, left incomplete abducens nerve palsy, left mixed hearing impairment, and left tinnitus. Plain CT scan showed a smoothly marginated mass involving the left petrous apex. The mass was isodense with the brain parenchyma and not enhanced by contrast medium. The mass appeared heterogeneously slightly hyperintense on the T1-weighted MR image and homogeneously hyperintense on the T2-weighted MR image except for the peripheral portion. The mass was not enhanced after intravenous gadolinium DTPA administration. Surgery via a petrosal approach totally removed the mass in the intracranial, extradural space. Histological examination showed typical features of cholesterol granuloma, with cholesterin clefts, hemosiderin deposits, and erythrocytes in non-specific granulation tissue. Cholesterol granuloma most commonly occurs in the middle ear cavity, and rarely in the petrous apex. The characteristic hyperintense appearance of cholesterol granuloma on T1- and T2-weighted MR images is very useful for differentiation from other lesions of the petrous apex and the cerebellopontine angle such as cholesteatoma, mucocele, chordoma, and meningioma. Solid cholesterol granuloma of the petrous apex should be treated by total removal via craniotomy, not by drainage which is commonly performed by otorhinologists.
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PMID:[An operative case of cholesterol granuloma of the petrous apex]. 893 74

Midaortic syndrome (MAS) is a well-recognized but rare cause of renovascular hypertension (RVH). Several techniques have been described to treat RVH caused by MAS. The authors recently treated two children with MAS and RVH. In both patients the right kidney had two renal arteries. A 13-year-old boy presented with severe headaches, pain in his lower extremities with exertion, and marked hypertension (blood pressure, 170/110). An aortogram demonstrated 70% narrowing of his abdominal aorta from the suprarenal region to 5 cm above the iliac bifurcation. There was significant stenosis of the celiac axis, superior mesenteric artery, and left renal artery. The right kidney had two renal arteries, and the upper pole artery was stenotic at its origin. A 10-year-old girl, known to have hypertension for several years had an aortogram that demonstrated 70% narrowing of the abdominal aorta from the suprarenal region to 3 cm above the iliac bifurcation. There was involvement of the left renal artery at its orifice. She also had two renal arteries to the right kidney with the right upper pole artery being stenotic at its origin and in the mid-portion of the vessel. Aortic reconstruction was accomplished with a polytetrafluoroehtylene (PTFE) bypass graft in each case. The first case also involved patch angioplasty of the celiac axis. In both cases, the right kidney was autotransplanted. It was removed intraoperatively, cold perfused, and the two renal arteries reconstructed followed by transplantation to the right iliac vessels. In both cases the left renal artery was reimplanted into the PTFE graft. Both patients had uncomplicated postoperative courses. The 13-year-old boy had evidence of renal ischemia in a portion of the lower pole of the autotransplanted kidney by DTPA scan. He has mild hypertension controlled with antihypertensive medication. The 10-year-old girl has a normal DTPA scan and is normotensive. MAS is a rare and challenging congenital vascular anomaly that causes RVH. In the presence of double renal arteries the technique of autotransplantation with cold perfusion and "bench" vascular reconstruction reduces the warm ischemia time and should produce satisfactory results.
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PMID:Renal autotransplantation for renovascular hypertension caused by midaortic syndrome. 904 31


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