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

A case of a brain stem hemangioblastoma with recurrent episodes of hypacusis due to progression of hydrocephalus is reported. The patient was a 25-year-old female, admitted to the department of otorhinolaryngology with complaints of hearing difficulty, headache and blurred vision. Neuroradiological studies showed a tumor from the medulla oblongata, obliterating the IVth ventricle, and a secondary hydrocephalus. Hearing loss fluctuated as hydrocephalus progressed. Multiple V-P shunting procedures relieved episodic hypacusis. The patient remains asymptomatic at present and has resumed normal activity. The mechanism of episodic hearing loss due to hydrocephalus is though to be due to the fact that through the ductus perilymphaticus and the ductus endolymphaticus, especially the former, increased intracranial pressure is transmitted to the inner ear. Through the ductus perilymphaticus there is communication between the perilymphatic space and the intracranial subarachnoid space. Through the ductus endolymphaticus there is communication with the subdural space. Increased ICP effects the inner ear. It is suspected that, in this particular case, the progression of hydrocephalus effected the patient's hearing.
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PMID:[A case of hydrocephalus with hypacusis due to hemangioblastoma]. 204 55

Two cases of skullbase-penetrating injuries caused by umbrella tips are reported. Case 1: 24-year-old male. Admitted with disturbance of consciousness, left hemiparesis, nasal bleeding, and laceration of left lower eyelid because of having been stabbed by an umbrella tip. Pupils and fundi revealed no definite findings. Plain skull X-ray showed turbid ethmoid sinus and fracture of planum sphenoidale. Cranial CT showed right putaminal hematoma with intraventricular hemorrhage and pneumocephalus. Increased ICP necessitated surgery two days after the injury. Dural laceration of planum sphnoidale, laceration of left optic nerve, right rectal gyrus contusion and rebleeding from the right lenticulostriate branch were observed. Dural plasty and removal of hematoma with external decompression were carried out. He had a good postoperative course, but left visual loss and left hemiparesis remained. Case 2: 29-year-old male. Admitted with excoriation of his right nostril because of having been stabbed by an umbrella tip, severe headache, and nasal discharge. Oculomotor palsy was observed as well as CSF rhinorrhea and meningeal irritability. Plain skull X-ray showed niveau in sphenoidal sinus, pneumocephalus, and fracture of sella turcica. His complaint disappeared after conservative therapy. We reviewed the literature and found only 4 similar cases. The skullbase, because of its anatomical character, is likely to be penetrated in orbital and periorbital injury caused by umbrella tips. Cases which include disturbance of consciousness have a poor prognosis. We hope the fact that umbrella tips can easily become life-threatening objects will come to the attention of the general public so that similar cases may be avoided.
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PMID:[Skullbase-penetrating injuries caused by umbrella tips: case reports]. 218 93

Thirty-two cases of congenital arachnoid cyst (AC), 26 cases of supratentorial, and 6 cases of infratentorial cyst are reported. They were encountered over a period of 9 years. The 26 supratentorial cysts consisted of 21 cases located in the middle fossa, 2 in the frontal, and 3 in the suprasellar. Patients' ages ranged from 7 months to 67 years (mean: 19.3 years), with a male to female ratio of 23:9. The most common symptoms were headache, epileptic seizure, and cranial enlargement. Based on observations between neuroradiological examinations including analysis of the cyst content, and operation, typical AC might be defined as "duplicated arachnoid and its splitting", and it may be said that "there is continuous existence of cerebral structure such as cortex and white matter lying adjacent to AC on MRI". Out of 32 cases, 15 received surgical treatment because of mass effect of AC itself, abnormal dynamics of the AC fluid, and/or increasing sign of ICP. 13 cases had resection of AC outer membrane with craniotomy, and the remaining two had cystoperitoneal shunt. One of the shunting cases complicated subdural hematoma. Surgical treatment was discussed and radical craniotomy rather than a shunt procedure was preferred. Prognosis of all cases was favorable and uneventful.
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PMID:[Clinical study on intracranial arachnoid cyst: with reference to the middle cranial fossa]. 273 5

From 1973 to 1986, 50 infants with sagittal synostosis have been operated by three different methods of craniectomy (linear craniectomy and extended craniectomies, as proposed by Schut and Epstein et al.). Preoperatively, the mean cephalic index was 67 +/- 4, 35.5% had clinical findings as cerebral palsy, psychomotor retardation and/or neurological signs, and intraoperatively the epidural pressure was more than 200 mm H2O in 60% (recorded in the last 20 patients). The mean follow-up time was 4.7 (1-10.6) years. Postoperatively, only 14.5% had minor clinical signs, which were mostly not in relation to the former scaphocephaly. Half of the patients with increased ICP had clinical signs preoperatively, and none of the 20 patients had distinct findings postoperatively. Out of the 20 children operated on by linear craniectomy or by Schut's method up to 1980, two-thirds had no school problems and one-third some school problems; one-third had occasionally headaches and one-quarter ametropia. Concerning the aesthetic results, Epstein's method and, somewhat less Schut's method, were superior to linear craniectomy, as verified by craniometry and by the tracings of the outlines of the neurocranium 0.4-0.7 and 1.6-2.0 years postoperatively: mean cephalic indices 73 +/- 5 (normal in one-fourth), 74 +/- 7 (normal in half) and 79 +/- 4 (normal in nearly all patients). Epstein's method is superior to the other two methods because it renders it possible to increase the breadth the greatest during the period of greatest postnatal brain growth. In addition to the effect on the neurocranium, the extended craniectomies add to normalization of the base of the skull (in contrast to the natural history of scaphocephaly). In the long run, the results obtained remain the same. The disadvantage of residual skull defects (approximately 11% of the patients with extended craniectomies) can be avoided by performing surgery prior to 4-6 months of age or by preserving the removed bone in a deep-freeze for a limited time.
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PMID:Sagittal synostosis--its clinical significance and the results of three different methods of craniectomy. 273 51

The authors report a rare case of a huge jugular foramen neurinoma extending to pharyngeal region in a 64 year-old woman who visited an otolaryngologist with complaints of dysphagia, hoarseness and headache in 1984. At that time a submucosal lump was noted in her left pharyngeal region. Biopsy of the tumor proved it to be neurinoma. A CT scan disclosed a dumbell shaped jugular foramen neurinoma and noncommunicating hydrocephalus. Because her symptoms slowly progressed and cerebellar signs as well as signs of increased intracranial pressure was noted, she was referred to our hospital in 1986. She had shown typical sings of left Vernet syndrome, VIIth, VIIIth cranial nerve impairment as well as cerebellar, long tract and increased ICP signs. A subtotal removal was performed from the extracranial and posterior fossa in one stage. The tumor seemed to originate from the Xth cranial nerve. The histological diagnosis of neurinoma was confirmed. Postoperatively, although her dysphagia increased for several weeks, a tracheostomy was not necessary. She was discharged 2 months later and returned to her usual occupation as a house wife. Slight dysphagia and hoarseness were her only chronic symptoms. So far, 88 cases of jugular foramen neurinoma have been reported, 15 of them including our case from Japan. Our case is probably the largest of these reported tumors. Tumors in jugular foramen often masquerade as an acoustic neurinoma or other tumor. However, recently this can usually be diagnosed preoperatively with a careful neurological examination and by means of neuroradiological investigations such as jugular venography, CT scan and MRI.
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PMID:[Huge jugular foramen neurinoma extending to the pharyngeal region: a case report]. 341 64

Since the CT has become the main diagnostic tool in head trauma, more cases of DEDH have become confirmed and published although some have been classified among other entities and under different criteria. This review tries to describe the characteristics of DEDH based on the cases previously published, as well as on three of our own cases. The entity is mainly radiological i.e. appearance of an epidural hematoma in a CT scan following up a previous one which has not shown this pathology. Although not specific, we have found some common features among the cases published. The patients are usually young people. The cause of many injuries is either a fall injury or involvement of a pedestrian in a road accident. Skull fracture under which the DEDH develops is the rule. DEDH is not found in the usual location of the classic epidural hematoma (the temporal fossa). Some of the patients developed DEDH after an earlier neurosurgical operation for evacuation of another traumatic mass lesion for urgent decompression. Others developed DEDH after medical treatment aimed at restoring normal blood pressure or reducing increased ICP. This main group of patients had other associated lesions, mainly intracranial. The others (including our case no. 1) were considered to have a skull fracture associated only with concussion of the brain, as the clinical picture changed or persistent headache developed, another CT scan was indicated and DEDH was then found. This group constitutes those patients in whom the prognosis is expected to be good or excellent. Keeping in mind the necessity for repeated CT scans in this group (we think the number will increase in the future), other patients will benefit from the awareness of the clinician of the importance of this diagnostic tool. CT scan is efficient, accurate and can be repeated at short intervals. It enables a correct diagnosis to be made in nearly 100% of cases of head trauma. Although this liberal use of CT may increase the number of negative scans, it will also increase the number of DEDH's diagnosable at an earlier stage.
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PMID:Delayed epidural hematoma. A review. 354 24

After reviewing the literature, a personal series of 10 adult patients with cerebellar infarction diagnosed by CT scan is described. The clinical picture in young adult men is characterized by rapid onset of headache, vomiting, vertigo, ataxia and blurred vision. After this sudden onset the patients may present a stable course or a rapid or delayed onset of brain stem compression, revealed by impairment of consciousness. CT scan is the diagnostic method of choice. The correlation between angiographic and CT localization of the infarction is not good. For therapy the following policy is suggested: in alert and clinically stable patients: medical treatment (mannitol, glycerol, dexamethason), ICP and serial CT monitoring; in alert patients with hydrocephalus or mass effect: medical treatment and monitoring as mentioned before; ventricular drainage if ICP surpasses 350 mm H2O; in patients with impaired consciousness and hydrocephalus or mass effect: immediate ventricular drainage. If it is not followed by prompt improvement of the level of consciousness, an emergency suboccipital craniectomy with removal of the infarcted tissue should be done.
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PMID:Surgical management of acute cerebellar infarction. 398 89

Desmopressin is used for the treatment of nocturnal enuresis. Side effects reported with intranasal desmopressin are transient headache, nausea, abdominal cramps and water intoxication with hyponatremia and grand mal seizure. We report a case of water intoxication with low serum sodium and grand mal seizure in a healthy child treated for enuresis with desmopressin. The child experienced abdominal cramps and nausea prior to the convulsions. A computerised tomography scan of the brain gave the suspicion of increased intracranial pressure ICP. The child recovered fully. We therefore recommend that parents and child are fully informed about the administration and the risk of desmopressin. If a child on desmopressin treatment experiences abdominal cramps, nausea or headache the drug should be discontinued and a physician contacted for control of serum sodium. Temporary withdrawal of desmopressin should also be considered in cases of acute illness influencing water balance.
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PMID:[Acute water intoxication caused by intranasal desmopression--Minirin]. 919 Jul 22

Head trauma (HT) and whiplash injury (WI) is followed by a posttraumatic headache (PH) in approx. 90% of patients. The PH due to common WI is located occipitally (67%), is of dull-pressing or dragging character (77%) and lasts on average 3 weeks. Tension headache is the most frequent type of PH (85%). Besides posttraumatic cervicogenic headache or symptomatic, secondary headache due to SDH, SAB, ICB or increased ICP, migraine- or cluster-like headache can be observed in rare cases. Prolonged application of analgetics (> 4 weeks) can cause a drug induced headache. In 80% of patients PH following HT shows remission within 6 months. Chronic PH lasting at least 4 years occurs in 20%. Unfavorouble prognostic factors include an age higher than 40 yrs, a low intellectual, educational and socio-economic level, previous HT or a history of alcohol abuse. A prolonged PH due to WI can be expected in patients with initially severe headache, with an extensive decrease of mobility of the cervical spine, with subjective impediment, with depressive mood, with somatic-vegetative complaints, with a history of pretraumatic headache and with increased age. Acute PH is treated with analgesics, antiphlogistics and/or muscle relaxants; chronic PH with thymoleptics (e.g. Amitryptiline or Amitryptiline oxide). Additional physical therapy (e.g. wearing a cervical collar for a short time, hydrocollator pack), physiotherapy incl. muscle relaxation techniques (Jacobson) and psychotherapy can be performed. Medico-legal issues should be solved as soon as possible.
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PMID:[Post-traumatic headache]. 944 Dec 48

The aim of the present study was to report on the utility of continuous Pcsf monitoring in establishing the diagnosis of idiopathic intracranial hypertension without papilledema (IIHWOP) in chronic daily headache (CDH) patients. We report a series of patients (n = 10) with refractory headaches and suspected IIHWOP referred to us for continuous Pcsf monitoring between 1991 and 2000. Pcsf was measured via a lumbar catheter and analysed for mean, peak, highest pulse amplitude and abnormal waveforms. A 1-2 day trial of continuous controlled CSF drainage (10 cc/ h) followed Pcsf monitoring. Response to CSF drainage was defined as improvement in headache symptoms. Patients with abnormal waveforms underwent a ventriculoperitoneal (VPS) or lumboperitoneal (LPS) shunt insertion. All patients had normal resting Pcsf (8 +/- 1 mmHg) defined as ICP < 15 mmHg. During sleep, all patients had B-waves and 90% had plateau waves or near plateau waves. All patients underwent either a VPS or LPS procedure. All reported improvement of their headache after surgery. Demonstration of pathological Pcsf patterns by continuous Pcsf monitoring was essential in confirming the diagnosis of IIHWOP, and provided objective evidence to support the decision for shunt surgery. Increased Pcsf was seen mostly during sleep and was intermittent, suggesting that Pcsf elevation may be missed by a single spot-check LP measurement. The similarity between IIHWOP and CDH suggests that continuous Pcsf monitoring in CDH patients may have an important diagnostic role that should be further investigated.
Cephalalgia 2004 Jun
PMID:Utility of CSF pressure monitoring to identify idiopathic intracranial hypertension without papilledema in patients with chronic daily headache. 1515 60


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