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

Rathke's cleft cysts (RCCs) are non neoplastic epithelial lesions of the sellar region that have been rarely reported as a clinical entity. We retrospectively reviewed the magnetic resonance imaging (MRI), intraoperative, and pathological findings of a series of 16 cases of RCCs operated at our institution since 1992. Concurrently, we discussed the different hypotheses about their embryological origin. The patients included 12 females and 4 males, 11 to 73 years of age. Endocrine disturbance was the most common presentation, followed by headaches and visual impairment. The location of the cyst was intrasellar in 7 cases, intrasellar and suprasellar in 6 cases, and suprasellar in 3 cases. The size of the cyst ranged from 8 to 26 mm (mean 12 mm). MRI signal intensity was quite variable on T1-weighted images. The cyst appeared hyperintense in 6 cases, hypointense in 6 cases, isointence in 3 cases, and heterogeneous in one case. On T2-weighted images (available in 13 cases), the signal intensity was more constant and appeared hyperintense in 11 cases and hypointense in 2 cases. After Gd-DTPA, we did not observe enhancement either of the cyst contents or of the cyst wall, but only of the pituitary gland in all patient. Most often, the pituitary gland was displaced inferiorly by the cyst located above showing a typical image of "an egg in a cup". Fifteen patients were operated upon via the transsphenoidal approach and one upon a frontal craniotomy. Intraoperatively, the cyst contents were gelatinous or thick, and dark colored. In 2 cases, it was cerebrospinal fluid-like corresponding to the signal observed on MRI. The position of the pituitary gland confirmed by surgery in 15 cases coincided with enhancement seen and MR imaging. In 13 cases where biopsy of the cyst wall was performed, it confirmed focally ciliated columnar or cuboid epithelium. A coexistent adenoma was found in one case. In conclusion, we consider that RCCs have varied MRI characteristics so that no pathognomonic sign may be observed. Except in few cases, there were no correlation between MRI and intraoperative findings. Therefore, even with MRI studies, differential diagnoses with others cystic lesions of the sellar region remains extremely difficult. The most interesting findings on MRI studies of RCCs were to locate the pituitary gland to help the surgeon to preserve pituitary tissue during surgery.
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PMID:Rathke's cleft cysts: surgical-MRI correlation in 16 symptomatic cases. 1065 72

We present a case of a spontaneous dissecting aneurysm at the vertebrobasilar artery including the right PICA in a 44-year-old man, who suffered from headache, hiccup and ataxic gait. The arteriograms showed an irregular narrowing and dilatation in the right PICA and in the vertebrobasilar artery, and showed fusiform dilatations in the bilateral middle cerebral arteries. We observed intramural hematoma and true lumen at the right PICA dissecting aneurysm on T1-weighted images on magnetic resonance imaging (1.5T, MRI), and the intimal flap was enhanced on T1-weighted image after intravenous injection of Gd-DTPA. The shape of the intramural hematoma showed a unique "two dumplings on a skewer" appearance, and the intensity of its hematoma in the false lumen decreased in gradient from adventitia to intimal flap on T1-weighted image on MRI. The dissecting aneurysm of the PICA was occluded spontaneously 1 month later, and it caused cerebellar infarction. However, the patient has been left only with the symptom of slight trunkal ataxia. Various shapes of intramural hematomas on MRI have been reported by Kitanaka in association with intracranial vertebrobasilar dissections. We suggest that "two dumplings on a skewer" shape which corresponds to the flow void of the true lumen, accompanied by intramural hematoma and enhanced intimal flap, on contrast-enhanced T1-weighted image, should be regarded as a true "diagnostic sign" of a dissecting aneurysm.
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PMID:[Spontaneous occlusion of a dissecting aneurysm in the shape of "two dumplings on a skewer" at righ posterior inferior cerebellar artery (PICA): report of a case and neuroradiological findings]. 1087 15

We reported a fourteen years old male with subdural empyema followed by consecutive magnetic resonance imaging (MRI) examination. He was admitted to our hospital, complaining incomplete paresis of the left upper extremities, headache and high fever. The first MRI T2-weighted image at admission revealed an abnormal high intensity in the right frontal subdural space, indicating an abscess. Antibiotics therapy and a burr hole operation were effective and he made a remarkable recovery. One month later, the third MRI T2-weighted image showed an abnormal high intensity in the deep white matter of the right frontal lobe, which had not been detected in the subsequent MRI after the operation. On the other hand, the meningeal enhancement on the second Gd-DTPA enhanced MRI was more thickened than the previous meningeal enhancement. This abnormal high intensity on MRI had disappeared two month later, when the meningeal enhancement had grown thin. These data suggested the meningeal enhancement was relative to the transient high intensity which was considered to represent brain edema. We concluded that careful observation and serial MRI examination might be necessary in patient with subdural empyema even after disappearance of all symptoms.
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PMID:[A case of subdural empyema with transient cerebral white matter lesions]. 1114 73

This case report clearly illustrates defined simultaneous cerebrospinal fluid leaks at the cervicothoracic and upper lumbar areas. A 53-year-old woman without a remarkable medical history was hospitalized for sudden onset of severe headache. The headache lasted more than 1 week and standing or sitting positions exaggerated the symptoms, although it was relieved when the patient was recumbent. Radionuclide cisternography was performed using 150 MBq (4 mCi) Tc-99m DTPA. It revealed two cerebrospinal fluid leaks from the cervicothoracic junction bilaterally and the left side of the upper lumbar area. Epidural blood patching was tried at the lumbar level (L1-L2) and showed only a transient effect. A second trial of this method at the level of C7-T1 performed 2 days later resulted in immediate improvement of the symptoms without recurrence. The simultaneous cerebrospinal fluid leaks were detected successfully with radionuclide cisternography using Tc-99m DTPA, which provided a useful guideline for treatment despite the limitations of delayed scanning.
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PMID:Radionuclide cisternography in spontaneous intracranial hypotension with simultaneous leaks at the cervicothoracic and lumbar levels. 1120 66

A 20-year-old male presented fever, nausea and headache 1 week after eating uncooked liver. On admission, it was revealed he had suffered a closed head injury 3 months before without unconsciousness. On admission, computed tomography scan showed a left chronic subdural hematoma. Gd-DTPA magnetic resonance images revealed unusual enhancement of the capsule and linear enhancement of the subarachnoid space. The patient underwent burr hole irrigation and drainage. The culture of the hematoma content showed Campylobacter fetus. Therefore, the diagnose was infected subdural hematoma. A drainage operation and administration of antibiotics were effective. Our case suggests that enhanced magnetic resonance images are useful for diagnosis and follow-up of infected subdural hematoma.
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PMID:[A case of infected subdural hematoma due to Campyrobacter fetus]. 1132 97

We report a case of a 44-year-old woman successfully treated by an epidural blood patch for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the thoracic cavity after thoracic spine surgery. The patient was admitted to our hospital with the complaint of postural headaches. She had received anterior thoracic instrumentation for thoracic disc herniation four months earlier. Lumbar puncture demonstrated low CSF pressure, and Gd-enhanced MR images displayed diffuse dural enhancement. Accordingly, she was diagnosed as having intracranial hypotension. 111In-DTPA cisternography revealed a CSF leakage into the left thoracic cavity, possibly caused by dural laceration during thoracic spine surgery. To avoid the risk of direct surgery, we performed epidural blood patch; 3 ml of autologous blood was injected into the epidural cavity. Postoperatively postural headaches immediately disappeared. MRI taken one year later revealed disappearance of diffuse dural enhancement, and 111In-DTPA cisternography revealed no CSF fluid leaks. Epidural blood patch seems to be a choice of treatment for CSF leak after spinal surgery.
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PMID:[Epidural blood patch for the treatment of intracranial hypotension due to cerebrospinal fluid leakage after thoracic spine surgery]. 1159 71

A 24-year-old male presented with headache. He had been treated with antituberculous drugs for 19 months. MRI revealed 4 intracranial Gd-DTPA enhanced lesions surrounded by massive edema in the right frontal, both occipital and left basal ganglionic regions. Digital subtraction angiography showed no tumor stain. Two procedures for tumor resection were performed for the right frontal and left occipital regions, the latter of which definitively diagnosed by the polymerase chain reaction method. The tumors were well demarcated, showed a rough surface, and were elastically hard. The two residual lesions responded differently to chemotherapy. The lesion in the right occipital region decreased in size, while the other in the left basal ganglionic region continued to grow gradually 26 months after the antituberculous chemotherapy was started. According to previous reports, treatment should be continued for as long as 12-30 months in cases showing paradoxical expansion. In this case, the left basal ganglionic lesion began to decrease in size after 28 months of administration of anti-tuberculous drugs. We report successful treatment of a case of multiple tuberculomas presenting with paradoxical expansion managed by a combination of surgery and continuous chemotherapy.
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PMID:[Multiple cerebral tuberculomas presenting with paradoxical expansion: a case report]. 1175 15

We present a case of a symptomatic subependymoma (SE) in a young. The patient was a 20-year-old female who suffered from severe headache and vomiting. Precontrast CT scans revealed a large spotty-calcified isodensity mass lesion in the right anterior lateral ventricle, showing scarce contrast enhancement at the center of the mass and with marked hydrocephalus. MRI demonstrated the lesion as slightly hypo-intensity on T1-weighted image, hyper-intensity on T2-weighted image. On FLAIR imaging, the lesion indicated remarkable hyperintensity and was clearly distinguishable from surrounding brain parenchyma and the cerebrospinal fluid. After Gd-DTPA infusion central vein was revealed, but no tumor enhancement was seen. The tumor was totally extirpated through the transcortical approach. Histological diagnosis was SE, and high MIB-1 staining index (9.3%) was seen. FLAIR imaging is useful for the preoperative diagnosis and the postoperative assessment of SEs.
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PMID:[Symptomatic subependymoma of the lateral ventricle in a young female]. 1180 20

We present a rare case of a Rathke's cleft cyst in association with a ruptured aneurysm of the anterior cerebral artery (ACA). A 44-year-old man suffered from sudden onset of headache. Initial computed tomographic (CT) scan revealed a high-density mass lesion in the suprasellar region and a diffuse high-density area in the basal cistern. Using emergent magnetic resonance imaging (MRI), we found a cyst showed homogeneously high and iso-intensity on T1 and T2-weighted image, respectively. The cyst showed no enhancement of the cyst wall, but on Gd-DTPA, it was shown to compress the normal pituitary gland. Angiography showed an aneurysm at the A1 portion of the left ACA. Based on/these findings, we were able to diagnose Rathke's cleft cyst and a ruptured aneurysm. An operation was performed through the interhemispheric approach. The suprasellar cystic mass compressed the optic nerves and chiasm upward. Neck clipping of the aneurysm and opening of the cyst were performed. We confirmed the cause of the subarachnoid hemorrhage as being a ruptured aneurysm at the A1 portion of the left ACA. Histological diagnosis was Rathke's cleft cyst. Postoperative course was uneventful. There has been only one reported case of Rathke's cleft cyst in association with a ruptured aneurysm. When we encounter a case presenting subarachnoid hemorrhage with suprasellar mass and intracerebral aneurysm, we must discriminate between ruptured aneurysm and pituitary apoplexy in the acute stage as the cause of the subarachnoid hemorrhage. If the mass is Rathke's cleft cyst, we speculate that the cause of the subarachnoid hemorrhage is a ruptured aneurysm, because there are no reports of Rathke's cleft cyst with subarachnoid hemorrhage.
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PMID:[A case of Rathke's cleft cyst in association with a ruptured aneurysm of the anterior cerebral artery mimicking pituitary apoplexy]. 1185 45

A 44-year-old male patient complaining of severe headache right after twisting his body during aerobic exercises in a swimming pool underwent In-111 DTPA radionuclide cisternography. Leakage of cerebrospinal fluid (CSF) was proved on the right side of T2 and T3 vertebrae. Cisternography after bed and conservative treatments demonstrated the disappearance of abnormal tracer accumulations. Radionuclide cisternography is of great value in diagnosing cerebral-spinal fluid leak and in evaluating the therapeutic effect.
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PMID:Radionuclide cisternography in intracranial hypotension syndrome. 1192 13


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