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

We encountered 8 cases of acute subdural hematoma caused by mild head trauma in the aged. In this report, these cases were analyzed, taking into consideration clinical symptoms, CT scan, operative findings and outcome. The age ranged from 70 to 92 years (mean age of 79.7 years). 4 patients were male and 4 female. Head trauma was caused by falls in 4 patients, but in the other 4 patients the causes were unknown. Initial symptoms were headache, nausea and vomiting in 5 patients and mild disturbance of consciousness with lucid intervals in 3 patients. Seven patients had more than 100 on JCS and less than 9 on GCS on admission. Small craniotomy (HITT) was performed in 4 patients. Large craniotomy was performed in 2 patients, and decompressive craniectomy was carried out in 2 patients. The bleeding focus came from the cortical artery of the middle cerebral artery in 4 patients, cerebral contusion in 2 patients, and was unknown in 2 patients for HITT. CT scan on admission showed mixed density area of acute subdural hematoma in all of the patients, and intraventricular hemorrhage, intracerebral hemorrhage and subarachnoid hemorrhage in 3 patients. CT scan after operation revealed a new area of cerebral contusion in 3 patients, delayed traumatic intracerebral hematoma (DTICH) in 2 patients, and hypertensive intracerebral hemorrhage in 1 patient. Two patients recovered to good and fair without general complication. But the outcome in 5 patients with general complication was poor for 3 patients and fatal for 2 patients. In conclusion, large craniotomy is recommended because of bleeding from the cortical artery of the middle cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acute subdural hematoma caused by mild head trauma in the aged]. 157 61

Running of gas-cylinder buses (GCB) fueled with liquefied propane-butane mixture added with ethyl mercaptan odorant leads to undesirable medical and social consequences. Statistically proved was considerably higher morbidity rate among GCS drivers in comparison with petrol-fueled buses' drivers. A questionnaire technique was used to show that most GCB drivers (from 61.8% to 98.2% in different bus depots) had been suffering from the irritating smell of the gaseous fuel and consequent headaches, dizziness, slow reactivity and general weakness, specifically by the end of the working shift. The result of the study proved the necessity to stop further running of GCB until technical improvement of the equipment and normal working conditions for GCB drivers have been attained.
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PMID:[Morbidity with temporary disability of gas-cylinder bus drivers]. 171 52

A case of deep-seated brain abscess that ruptured twice into the ventricle and resulted in death is presented. A 45-year-old man had experienced pyrexia and headache for 3 days before admission. On admission he was somnolent (GCS: 13) but there were no abnormal neurological findings except nuchal rigidity and Kernig's sign. Computed tomography (CT) scan showed a ring enhanced mass near the left caudate head and dilated ventricles. In comparison with CT performed at the former hospital it was diagnosed that a rupture into the ventricle of the brain abscess had occurred. Ventricular drainage was performed at once and white purulent cerebrospinal fluid was obtained. Thereafter, he was treated with some antibiotics and his conditions seemed to stabilize for a while. Serial CT images demonstrated that the size of the abscess seemed to be enlarging. Just when we planned to undertake stereotactic aspiration, the second ventricular rupture occurred and he died. According to this case, it is suggested that once a deep-seated brain abscess near the ventricular system is suspected, it should be aspirated by means of CT-guided stereotactic surgery immediately.
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PMID:[A case of brain abscess of the basal ganglia which resulted in disastrous outcome due to ventricular ruptures]. 816 7

The thalamus is believed to play an integrative role in the central nervous system. In the present study, thalamic rCBF was measured in 65 CVD patients and 15 normal volunteers by stable Xe/CT scanning. ROIs were chosen in the thalamic slice at a level 5cm over the OM line, and mean CBF was 7 cm over the OM line. The clinical factors focused on in multiple regression analysis were: age (A), sex (Se), stage from onset (St), lesion side (Sd); unilaterality or bilaterality, size (Sz) thalamic lesion (Tl). GCS (G), HDS-R (H); Hasegawa dementia score (revised), symptoms (Ss) such as anxiety, dizziness, head-headed feeling and headache, and neurological deficits (N). Each factor was graded and scored. Statistically, there was a significant correlation between thalamic rCBF (Y) and mean CBF (X) in the less affected hemisphere: Y = 1.82X + 2.2, r = 0.801, p < 0.001, n = 65. Multiple regression analysis of the thalamic rCBF revealed that the Sz factor was significant (p < 0.0001) on the lesion side: Y = 76.7-10.2Sz, r = 0.644, p < 0.001, n = 51, while the Se, Sd and St factors were significant (p < 0.005) on the less affected side: Y = 71.9 + 9.7Se-6.8Sd-5.0St, R = 0.585, p < 0.001, n = 65. The thalamic index (X), an indicator of thalamic atrophy, and thalamic rCBF were significantly correlated: Y = 28.7X + 10.2, r = 0.386, p < 0.001, n = 80. In conclusion, thalamic rCBF appeared to reflect the degree of organic changes and time course in the cerebral hemisphere, because factors such as size, sex and stage were statistically significant.
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PMID:[Assessment of thalamic regional cerebral blood flow in patients with cerebrovascular disease]. 888 29

The study group on Head Injury of the Italian Society for Neurosurgery suggests the following guidelines for minor head injured patients management. Patients either oriented to time, space and person (GCS 15) or confused (GCS 14) are included among the group of minor head injury. Criteria of exclusion are the presence of focal neurological deficits, open injury and a GCS < or = 13. Six categories of risk factors (coagulopathies, alcoholism, drug abuse, epilepsy, previous neurosurgical treatments and disabled elderly patients) relevant to the clinical course are identified. Three group of patients are distinguished. Patients in the Group 0 (GCS 15, without loss of consciousness, amnesia, diffuse headache, vomiting) could be sent home from Emergency Department after at least 6 hours period of observation with an information sheet. Patients in the Group 1 (GCS 15, with loss of consciousness and/or amnesia and/or diffuse headache and/or vomiting) require clinical observation (> or = 6 hours) and neuroradiological assessment. According to hospital availability, either skull-X rays or CT scan is obtained. In the presence of a skull fracture a CT scan is mandatory. In the presence of intracranial lesions, neurosurgical consultation is requested. In the absence of skull fractures or intracranial lesions the patient is admitted for observation (> or = 24 hours). Patients in the Group 0 and in the Group 1 with a risk factor (R) are admitted to the hospital (> or = 24 hours) and submitted to a CT scan. In patients with coagulopathies or in treatment with anticoagulants a CT scan should be repeated before discharge even in the absence of intracranial lesion on the first CT. In patients in the Group 2 (GCS 14) a CT scan is obtained in all cases independent of the presence of a risk factor.
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PMID:Guidelines for minor head injured patients' management in adult age. The Study Group on Head Injury of the Italian Society for Neurosurgery. 891 56

The clinical course of patients admitted following minor head injuries (Glasgow Coma Score [GCS] 13-15) has been studied less extensively than in severely head injured patients. Admission criteria, methods and indications for radiological evaluation are controversial. To study this further, a retrospective review of 633 patients admitted following such injuries to King Khalid University Hospital between 1986 and 1993 was undertaken. Their ages ranged from one month to 80 years (average 17 years). The mechanisms of injury were mainly falls in 339 (53.5%) cases and road traffic accidents in 234 (37%). None of the cases resulted from a non-accidental injury. Radiological evaluation was by skull radiography in 616 (97.3%) cases followed by CT scan in 131 (20.7%). These studies revealed a skull fracture in 78 (12.7%) cases. Six of these 78 patients with skull fracture required a neurosurgical procedure during the first week post injury. These represented 0.97% of the cases who had skull radiographs. A base of skull fracture was an ominous sign, since 3 of the 5 cases with such fractures required ventilation of which one resulted in the only mortality of this series, the fourth developed meningitis. Of the cases studied, 3 (0.5%) developed growing skull fractures all had the initial injury during their first year of life. Other complications were as follows: 25 (3.9%) early post-traumatic seizures, 10 (1.6%) chronic subdural haematomas, 9 (1.4%) extradural haematomas, 2 (0.3%) post-traumatic hydrocephalus and one (0.2%) cerebral abscess. We conclude that patients who have an abnormal GCS, a neurological deficit, post-traumatic seizure, signs or suspicion of basal or depressed skull fracture should be admitted for observation because of the risk of deterioration. Patients with a history of loss of consciousness or amnesia without any of the previous may be discharged to be observed at home by a competent observer, otherwise, will need admission for observation. Radiological evaluation once indicated must be by CT scan. There is no benefit from immediate skull radiography in the initial evaluation of minor head injuries. The indications for CT are an abnormal GCS, presence of neurological deficit, signs of basilar or depressed fracture and persistent or progressive headache or vomiting. Infants with minor injuries should be followed up at least once after two to three months for possible growing fractures.
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PMID:Management of minor head injuries: admission criteria, radiological evaluation and treatment of complications. 952 9

A 40-year-old woman presented with chronic headaches. She had undergone ventriculo-peritoneal (VP) shunt 7 years previously for treatment of hydrocephalus secondary to aqueduct stenosis. Intracranial pressure (ICP) monitoring revealed a resting ICP of less than 5 mmHg. Headaches were thought to be due to low ICP and the shunt tubing was ligated. Over the next 4 h there was an increase in ICP to 14 mmHg, decrease in GCS to 13 and ventriculomegaly on CT. These changes were reversed by the removal of the ligature. This unusual case highlights the fact that, in some shunted patients with over drainage of ventricles and a low resting ICP, small increases in ICP are poorly tolerated. This may be due to altered visco-elastic properties of the ventricles and the brain parenchyma.
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PMID:14 mmHg: a case of raised intracranial pressure? 1532 39

Traumatic head injury continues to be a major problem facing the pediatric specialists despite efforts to reduce its incidence. Aims of our study were assessment of the incidence of hospital admissions of children with minor head injuries, their treatment and outcome. In this prospective study we included 101 patient with head injury. We assessed the hospital admission criteria of children with minor head injuries, their length of stay, symptoms and neurological status, in-hospital imaging and consultations to other medical specialities, together with the outcome of patients on their discharge from the hospital. Of 101 patient 54 (53.46%) were male and 47 (46.53%) female. Average age was 3 years with age range from 5/52 to 12 years. Majority of patients (46.53%) were less than 1 year old. Fall was the most common mechanism of injury (92.07% of all patients). Injuries were witnessed in 51 case (50.49%), unwitnessed in 19 cases (18.81%) and unknown in 31 cases (30.69%). 95 patients did not have associated extracranial injuries, while 5 patients had associated lacerations and one had associated extracranial fracture. Length of stay was from 1 day in 80.19% of all cases to more than 2 days in 6.93%. GCS was recorded on admission and discharge and majority of patients were discharged with GCS of 15. 93% of admissions had no neurological deficit. 79% had 1 or more symptoms including vomiting, sleepiness, LOC and headaches. Over half of patients (55%) had no imaging done. 45 patients (45%) had skull x-ray. CT was performed in 7 (15%) patients and 7 fractures were found on x-ray and CT. 3 patients were admitted to ICU. All injuries were closed and all received conservative treatment. In less than 1 year old group of patients 95% of them were also seen by medical team and social worker. The outcome was good for all patients. We conclude that majority of patients with minor head injury could be supervised and observed at home by a competent care giver. Admitted patients need radiological evaluation, preferably a CT scan.
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PMID:Minor head injuries in children. 1697 86

The factors affecting outcome were analyzed in 1,064 patients, 621 males and 443 females aged 10 to 104 years (mean 46 +/- 23 years), with mild head injury (Glasgow Coma Scale [GCS] score > or =14) but no neurological signs presenting within 6 hours after injury. Intracranial lesion was found in 4.7% (50/1,064), and 0.66% (7/1,064) required surgical treatment. The Japan Coma Scale (JCS) and GCS assessments were well correlated (r = 0.797). Multivariate analysis revealed significant correlations between computed tomography (CT) abnormality and age > or =60 years, male sex, JCS score > or =1, alcohol consumption, headache, nausea/vomiting, and transient loss of consciousness (LOC)/amnesia. Univariate analysis revealed that pedestrian in a motor vehicle accident, falling from height, and mechanisms of injuries except blows were correlated to intracranial injury. No significant correlations were found between craniofacial soft tissue injury and intracranial injury. Patients with occipital impact, nonfrontal impact, or skull fracture were more likely have intracranial lesions. Bleeding tendency was not correlated with CT abnormality. The following indications were proposed for CT: JCS score >0, presence of accessory symptoms (headache, nausea/vomiting, LOC/amnesia), and age > or =60 years. These criteria would reduce the frequency of CT by 29% (309/1,064). Applying these indications to subsequent patients with GCS scores 14-15, 114 of 168 patients required CT, and intracranial lesions were found in 13. Two refused CT. Fifty-four of the 168 patients did not need CT according to the indications, but 38 of the 54 patients actually underwent CT because of social reasons (n = 21) or patient request (n = 17). These indications for CT including JCS may be useful in the management of patients with mild head injury.
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PMID:Indications for computed tomography in patients with mild head injury. 1765 14

Primary intracerebral haemorrhage (ICH) results in significant morbidity and mortality among patients. There is a paucity of epidemiological data on this condition in Malaysia. The purpose of this hospital based study was to define the clinical profile in patients with primary spontaneous intracerebral haemorrhage at University of Malaya Medical Centre (UMMC) and to determine the mortality rate of intracerebral haemorrhage at the time of discharge, the prognostic factors and one year outcome of this cohort of patients. Sixty-six patients were admitted at the Neurosurgical unit of University of Malaya Medical Centre for a period of 13 months from March 2002 to March 2003. Fifty percent of the subjects were female. The mean age was 61.6 +/- 16.7 years. Among our patients with intracerebral haemorrhage, the common risk factors were: hypertension (80.3%), diabetes mellitus (25.7%) and smoking (27.2%). Common presenting features for our series were: weakness (61.8%), LOC (58.5%), headache (56.3%) and speech disturbances (45.3%). On neuroimaging, the lesions were seen in basal ganglia/thalamus (45.1%), lobar (32.9%), brainstem (13.4%) and cerebelli (8.5%). The overall 30 days mortality rate for intracerebral haemorrhage (ICH) was 43.9%. The important predictors of for mortality were the GCS score on admission (p < 0.0001), haematoma volume > 30 mls (p < 0.0001), evidence of intraventricular extension (p = 0.011) and ICH score (p < 0.0001). At one year follow up, 48.5% (n = 32) were dead, 33.3% (n = 11) obtained good recovery, 36.4% (n = 12) moderate disability, 18.2% (n = 6) severe disability and 3% remain vegetative state. The overall mortality rate for our series of patients with primary intracerebral haemorrhage is quite similar to previously published epidemiological studies. ICH scoring is useful in the prognostication.
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PMID:Primary intracerebral haemorrhage in Malaysia: in-hospital mortality and outcome in patients from a hospital based registry. 1855 35


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