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

The modern contrast agents used today in myelography cause far fewer complications than earlier. This development has opened up the prospect of undertaking myelography as an outpatient procedure. The complications that can occur after the myelography are, for the great majority known, benign, and disappear within a few days, mainly headache. The frequency of minor complications can be minimised by the use of a smaller gauge and/or a rounded needle tip. When the procedure is done by experienced personnel with non-toxic antiseptic preparation, the complications seem to be similar in frequency, magnitude, and type to a simple diagnostic spinal tap. Positioning of the patients after the examination does not affect the frequency or seriousness of the complications. Our study of the patients' attitude towards outpatient myelography shows great satisfaction with the procedure. We therefore conclude that there is no added risk in performing outpatient myelography; the only noticeable complication is headache, which seldom needs intervention, and there are considerable benefits for both patients and hospital in an outpatient procedure.
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PMID:[Myelography, can it be performed as an outpatient procedure?]. 1221 84

Alterations in cerebrospinal fluid (CSF) pressure lead to neurologic symptoms, the most common clinical manifestation of which is headache. Typically, the headache is orthostatic and related to traction on pain-sensitive intracranial and meningeal structures, distention on periventricular pain-sensitive areas, and direct pressure on pain conveying cranial nerves. Low CSF headache is a distinct and familiar syndrome that is seen most frequently following lumbar puncture. In this clinical scenario, the diagnosis and proposed plan of treatment are obvious. Over the past decade, however, an emerging syndrome of spontaneous intracranial hypotension (SIH) is being recognized with increasing frequency. Most of these patients are found to have spontaneous CSF leaks and have unique, clinically distinct imaging findings, which confirm the diagnosis leading to appropriate treatment. Spontaneous intracranial hypotension is a relatively benign and usually self-limiting syndrome of orthostatic headache in association with one or more of numerous symptoms including nausea, vomiting, horizontal diplopia, unsteadiness or vertigo, altered hearing, neck pain/stiffness, interscapular pain, and occasionally visual field cuts. The headache itself, while often orthostatic, may initially be non-positional, may lose its orthostatic features, or rarely or never be orthostatic. It may be gradual, subacute, or thunderclap in onset. There may be a history of minor, antecedent trauma. By very definition, the opening CSF pressure is low, below 60 mm H(2)O, and often a "dry" tap is encountered. However, the pressure may be normal, especially with intermittent leaks and may vary tap to tap. Fluid analysis is normal. Brain (and occasionally spinal) MRI studies, with gadolinium enhancement should be undertaken. In patients with SIH, studies typically reveal diffuse pachymeningeal enhancement, frequently in association with "sagging"of the brain, tonsilar descent, and posterior fossa crowding. Spinal MRI is an up and coming investigational technique, which may be helpful even in the case of a normal brain MRI. Computed tomography myelography is the diagnostic study of choice and may follow radiocisternography, which often shows absence of activity over the convexities and early appearance of activity in the renal/urinary tract. Although conservative measures are often undertaken first, epidural blood patch (EBP) is the treatment of choice. For those who fail EBP, surgery may need to be undertaken in those cases with clearly identified leaks.
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PMID:Low Cerebrospinal Fluid Pressure Headache. 1216 24

Slit ventricle syndrome, known to occur from malfunction of the shunt procedure for hydrocephalus, is reported after cyst-peritoneal shunt for temporal arachnoid cyst. Two children aged 12 and 10 years, who underwent cyst-peritoneal shunting for a large temporal arachnoid cyst at the age of 10 and 5 years, respectively, recently experienced several episodes of severe headache. Prior to admission, repeated CT scans did not reveal any morphological change in either of these two patients. Evidence of high intracranial pressure by lumbar tap revealed shunt malfunction. Both patients became free of neurological complaints and deficits after shunt revision. Despite elevated intracranial pressure due to shunt malfunction, neuroimaging studies showed no morphological changes in slit ventricle syndrome. Delay in both the diagnosis and prompt treatment may result in complete loss of visual acuity and even death. It is important to suspect this complication in patients with persistent elevated intracranial pressure symptoms and signs after any shunting procedure, regardless of unchanged neuroimaging studies. Once this is suspected, lumbar tap may be necessary and the choice of treatment is shunt revision.
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PMID:Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children--a clinical entity difficult to detect on neuroimaging study. 1245 2

Granulocytic sarcoma is a tumor composed of proliferating myeloblastic cells, generally found in the orbit. A brain localization is rare. We report the case of a 11-year-old boy treated in our unit for acute myeloblastic leukemia (AML 4 Eo. FAB). After 21 months of complete remission, he developed headache and facial palsy. The CT scan visualized the presence of two frontal and occipital masses. The spinal tap revealed blastic cells in the CSF. The study of the bone morrow showed medullar relapse. A new medullar and cerebro-meningeal remission was obtained with chemotherapy and radiotherapy. CSF and the bone marrow studies can help avoid stereotaxic biopsy can be avoided in this type of tumor
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PMID:[Intracerebral granulocytic sarcoma. A case report]. 1274 29

Forty-three consecutive cases of acute aseptic meningitis (AAM) presenting within a 24-months period were retrospectively analysed with respect to clinical symptomatology, cerebrospinal fluid (CSF) findings, clinical course, treatment and outcome. Nineteen of the 43 AAM cases (44%) were caused by enterovirus, one by HIV (2%), two by Varicella zoster virus (5%), three due to herpes simplex virus I (7%), two due to herpes simplex virus II (5%), one due to Central European encephalitis virus (2%), and in 15 patients (35%) the aetiology of AAM remained unknown. Headache (100%) and fever (93%) were the presenting symptoms in the majority of cases. Signs of preceding infection were predominantly gastrointestinal in the enterovirus subgroup, but were inconsistently observed in the other subgroups. CSF findings at the first lumbar tap on admission generally revealed lymphomonocytic pleocytosis of less than 500 cells per micro l, mild to moderately elevated protein and normal lactate and glucose levels. Initial therapy consisted of an empirical antiviral and antibiotic regimen until a serological diagnosis was available. Acyclovir, effective only in herpes family viruses, was initially administered to all AAM cases. Effective therapy for other viral pathogens are not broadly available and treating AAM of unknown aetiology imposes a particular problem. The average hospitalization time ranged from 16 to 31 days. Patients were either discharged home (72%) or transferred to a rehabilitation centre (28%). The outcome was good (40%) to fair (51%) in the majority of cases.
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PMID:A retrospective clinical, laboratory and outcome analysis in 43 cases of acute aseptic meningitis. 1275 1

We report a rare case of posterior communicating artery occlusion mimicking a cerebral aneurysm. A 62-year-old man was admitted to Towakai Hospital with sudden onset of left motor weakness. He had developed thunderclap headache five days before. Computed tomographic scan and lumbar tap were negative for subarachnoid hemorrhage (SAH). Digital subtraction angiography and three-dimensional computed angiography showed aneurysmal protrusion at the junction of the right internal carotid (IC) artery and posterior communicating artery (PcomA). Because minor bleeding from IC-PcomA junction aneurysm was strongly suspected, a pterional craniotomy was performed. At surgery, there was no evidence of SAH but the PcomA was occluded at the peripheral portion. Several perforators arose from the proximal portion of the PcomA. An aneurysmal protrusion especially without a prominent PcomA does not always indicate an IC-PcomA aneurysm. In diagnosing protruding vascular lesions at the bifurcation between the IC-PcomA, not only infundibular dilatation but also occlusion of the PcomA should be considered if the PcomA is not visualized.
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PMID:Occlusion of the posterior communicating artery mimicking cerebral aneurysm: case report. 1286 6

Headache is one of the most frequent reasons for presenting to Neuropaediatric units. Although in most cases the patient is not suffering from any serious disease, the parents and even the paediatrician do tend to fear that this is indeed the case. Evaluating a patient with headache requires a detailed interview, as well as a careful clinico-neurological examination. From these elements it is basically possible to sort headaches into four large groups: acute, acute-recurrent, chronic non-progressive and chronic progressive. Acute headaches are an emergency and it is therefore necessary to have an algorithm available which can be used regardless of the degree of complexity of the clinical environment in which the patient is being treated. Invasive studies such as a spinal tap and/or neuroradiological studies are often needed. The International Headache Society criteria have been adapted to the juvenile population for the diagnosis of patients suffering from acute-recurrent headaches (migraine). Chronic non-progressive headaches are a group in which prevalence increases with age and is the most frequently observed form of headache in adolescents. Emotional factors, situations involving family and/or social conflict, either alone or in combination, are usually predisposing or triggering factors in this type of headache. Chronic progressive headache is a consequence of some organic disorder. In the search for and treatment of headache we must not forget to calm the pain experienced by the patient.
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PMID:[Headaches in children and adolescents. An etiopathogenic classification]. 1453 14

Cerebral venous thrombosis is a clinical condition of difficult diagnosis, and poor prognosis when treatment is not started early. There is a long list of causes, and hereby we describe a case associated to prothrombin G20210 mutation. A 53-year-old man, white, was admitted with status epilepticus. After seizures control, he developed intracranial hypertension, with headache and vomiting, and bilateral papilledema. His past medical and familial history were unremarkable. He was a nonsmoker, no drug and alcohol user. CT scan and MRI showed right temporal and parietal infarct with hemorrhagic transformation. Spinal tap with opening pressure of 500 mmH2O showed normal CSF examination. MRI angiography disclosed superior sinus, right transverse and sigmoid sinus complete thrombosis. He was started with heparin and oral warfarin. In spite of anticoagulation, two months later he developed deep right inferior limb thrombosis. All the initial tests were normal, and test for prothrombin G20210 mutation was positive. He needed a much higher than conventional daily dose of warfarin to keep him asymptomatic.
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PMID:[Cerebral and systemic venous thrombosis associated to prothrombin G20210 mutation: case report]. 1476 16

A 70-year-old man presented to us in 1994 with a three-year history of worsening dementia. With the exceptions of a Mini-Mental State exam score of 20 and an inability to tandem walk, his physical and neurological examinations were normal. His past medical history revealed that in 1992 he had been evaluated at another institution for memory impairment and bifrontal headaches. A spinal tap had been done in 1992 showing elevated protein, reduced glucose, and a pleocytosis; his CSF fungal culture and cryptococcal antigen test were negative. He subsequently was lost to follow-up, and although his headaches had resolved, his mental status had continued to worsen. In 1994 his CSF cryptococcal antigen was positive, and his CSF fungal culture grew C. neoformans. He gradually improved with treatment for cryptococcal meningitis (CM). With the exception of mild memory impairment, in 2003 he and his family thought that his mental status had returned to normal. This case emphasizes that: 1) CM should always be kept in the differential diagnosis of dementia; 2) CM may be extremely insidious and difficult to diagnose; and 3) if one is to rule out unequivocally all possible reversible causes of dementia, one should perform a spinal tap.
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PMID:Reversible dementia: a case of cryptococcal meningitis masquerading as Alzheimer's disease. 1585 46

Patients with subarachnoid haemorrhage (SAH) frequently describe the occurrence of an underestimated or even ignored severe headache in the days or weeks preceding the bleeding. If recognised early, this warning headache might lead to specific investigations and, if indicated, a surgical approach might avoid a dramatic haemorrhagic event. In a recent and exhaustive systematic review, the incidence of a sentinel headache (SH) was evaluated in a range of 10-43% of SAH patients. SH seems to be due to a minor bleeding from a leak of a berry aneurysm and usually occurs in the preceding two weeks. Such a period is similar to the one for rebleeding in SAH and supports the hypothesis of the warning leak. Nevertheless, a warning headache can precede a SAH in unruptured aneurysm even without a minor bleeding. Underestimation or misdiagnosis of SH depends on incorrect evaluation of the headache characteristics (unusual, severe, abrupt, thunderclap), overestimation of cranial CT sensitivity (false negative increasing over the elapsing time), failure to perform lumbar puncture (LP) in patients with negative CT, incorrect evaluation of CSF findings (xanthochromia may be absent in the first 12 h) and failure to differentiate traumatic tap from true SAH. Considering the diagnosis of SH in all cases of a severe, sudden-onset (thunderclap) headache, and performing all the appropriate diagnostic exams, including LP if necessary, could prevent subsequent massive bleeding and its invalidating or fatal consequences.
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PMID:Sentinel headache. 1554 40


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