Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Granulocytic sarcoma of the parenchyma of the brain present in a patient with acute monocytic leukemia, and its unusual course during treatment, is described. Four years after diagnosis of acute monocytic leukemia, a 24-year-old man developed severe headache during its remission period. The CT scan showed large intraparencymal mass in the right frontal lobe, which was partially removed and diagnosed as granulocytic sarcoma. Following the operation, radiation in total dose of 35.5 Gy was given to the whole brain, and there was also left intraventricular administration of methotrexate (MTX) and cytosine arabinoside (ara-C). The treatment resulted in the complete disappearance of the intraparenchymal mass apart from small calcifications. Five months later, the patient redeveloped severe headache with consciousness disturbance. CT scan revealed marked swelling in the left cerebral hemisphere with irregular contrast-enhanced areas. The patient died of brain herniation in spite of conservative therapy. Photomicroscopic findings of the left cerebral hemisphere proved the presence of "disseminated leukoencephalopathy" and the absence of tumor cells. On the other hand, the right frontal lesion consisted of no tumor cells but scar tissues. This unusual feature of the CT scan in the terminal stage might be caused by combination with the effect of highly concentrated MTX in the left cerebral hemisphere because of the increased permeability of the ependym and the relatively high radiosensitivity in the non-affected left cerebral hemisphere.
 ...
PMID:[Intraparenchymal granulocytic sarcoma in acute monocytic leukemia; case report]. 160 77

A 64-year-old man was admitted to our hospital with leukopenia. On admission, leukocyte count in the peripheral blood was 1,600/microliters, containing 24.5% blasts of lymphoid appearance, which were negative for myeloperoxidase. A bone marrow aspiration showed hypoplasia with increased blasts (31.6%). The blasts were ultrastructurally positive for platelet peroxidase (PPO) and positive for platelet membrane glycoprotein IIb/IIIa complex. A diagnosis of acute megakaryoblastic leukemia was made. Chemotherapy with behenoyl-ara C (BH-AC) (150 mg/day) was transiently effective. However, after three months, numerous nodules without itching appeared over the entire body, particularly on the anterior chest. A biopsy of the skin lesion revealed a diffuse fibrosis with infiltrations of the blasts. Bone marrow aspirations were dry tap, and a bone marrow biopsy showed marked myelofibrosis. Then, severe headache, vomiting, and loss of consciousness developed, and a lumbar puncture revealed infiltrations of blasts. Although methotrexate was intrathecally injected, he died due to the respiratory failure. As far as we know, a case of acute megakaryoblastic leukemia with leukemia cutis and meningeal leukemia is quite rare. In addition, it is interesting that megakaryoblastic leukemia was accompanied with both the fibrosis of skin and the myelofibrosis.
 ...
PMID:[Acute megakaryoblastic leukemia with leukemia cutis, meningeal leukemia, and myelofibrosis]. 175 56

We report two cases of cytomegalovirus (CMV) encephalitis in immunologically normal adults. Patient 1, a 53-year-old man: onset was acute with headache and pyrexia, followed by moderate disturbance of consciousness with meningeal signs. Repeated lumbar puncture revealed 58 CSF cells per microliters and 96 mg protein per dl. On the 11th day after onset, we started treatment with adenine arabinoside (ara-A). He recovered completely. With IgG-ELISA methods, antibody to CMV turned into positive on the third week, and into negative again on the fifth week, and these conversions were concomitant with the symptomatic aggravation and amelioration, respectively. Patient 2, a 78-year-old woman: onset was acute with general fatigue and pyrexia, followed by meningeal signs and mild disturbance of consciousness. Consciousness level was worsened and two courses of acyclovir (Acv) treatment were started on the 59th and on the 93rd day after onset, but consciousness level went down to coma and she died. Repeated lumbar puncture revealed 787 CSF cells per microliters and 229 mg protein per dl. CMV antibody titer (CF) in CSF was 1:32 and antibody index was 58 or more, suggesting antibody production in central nervous system. CMV encephalitis in immunologically normal adults is very rare, only 10 cases having been reported so far. Most patients recover spontaneously, but some may be fatal. In our view ara-A treatment should be taken in consideration in case of acute encephalitis unresponsive to Acv.
 ...
PMID:[Cytomegalovirus encephalitis in immunologically normal adults]. 216 21

Twenty-seven patients with acute leukemia have been treated by sequential 6-day courses of thymidine (30 g/m2 by i.v. continuous infusion, days 1 and 4) and 1-beta-D-arabinofuranosylcytosine (ara-C) (200 mg/m2 by i.v. continuous infusion, days 2,3,5, and 6). Of 25 evaluable patients 4 achieved a complete remission: one of 9 for acute myelogenous leukemia; and 3 of 14 in the blastic crisis of chronic myelocytic leukemia. Six minor responses were also observed. Toxicity was mainly hematological and did not appear to be higher than that expected from ara-C alone. However, thymidine infusions gave rise to headache and somnolence. The clinical benefit of such treatment seems to be limited to the blastic crisis of chronic myelocytic leukemia. Parallel cytokinetic and biochemical studies were performed in order to assess the cytokinetic and metabolic changes induced by both drugs and to correlate them with the clinical response. Recruitment of cells into the S-phase fraction was observed following the first thymidine infusion in the two complete responders and in three of the five nonresponders studied. In contrast to this high pretherapeutic levels of S-phase fraction were observed in most minor responders and in some nonresponders with further decrease following the thymidine infusion. Recruitment of cells into S phase therefore appeared to be an important but not sufficient factor for prediction of complete response to ara-C. Responders in contrast to most nonresponders were characterized by a higher intracellular level of ara-C and its metabolites following the first 24-h infusion of the drug. Deoxythymidine triphosphate and deoxycytidine triphosphate pools were also measured before and during treatment in order to assess if nucleotide pool variations induced by the administration of thymidine can in fact correlate with the intracellular alteration in ara-C metabolism and with clinical response. The level of deoxycytidine triphosphate pools before treatment showed marked interpatient variations but did not correlate with response. As expected, thymidine infusion induced a rise in the deoxythymidine triphosphate pool and a decrease in deoxycytidine triphosphate. The pools, however, generally returned promptly to the pretherapeutic level 24 h after the end of the infusion of thymidine. There were no significant differences between responders and nonresponders in the modulation of these pools.
 ...
PMID:Modulation of 1-beta-D-arabinofuranosylcytosine metabolism by thymidine in human acute leukemia. 402 95

We report a case of a 5-year-old girl with herpes simplex encephalitis (HSE) who was treated with adenine arabinoside (ara-A). The characteristic symptoms consisted of headache and vomiting followed by progressive disturbance of consciousness. CT scan revealed a translucent area in the left temporal lobe. Seven days after the onset vigorous treatment including ara-A was initiated. She recovered without apparent toxicity or sequelae except for mild motor aphasia. Our experience suggests that ara-A is effective in the treatment of HSE if given early enough.
 ...
PMID:Herpes simplex encephalitis treated with adenine arabinoside. 630 4

We examined the serial MRI diffusion weighted images (DWIs) in two patients with acute viral encephalitis similar to herpes simplex encephalitis (HSE). Patient 1. A 27-year-old woman was admitted to the psychiatry ward for her confusional state and convulsions. Because of abnormal CSF findings she was transferred to the neurology ward, and the infusion of acyclovir was started. On disease day 5. MRI demonstrated high signal intensity in the left lateral lobe both on T2 weighted images (T2WIs) and DWIs. On day 18, MRI showed progression of the lesions, so acyclovir was changed to ara-A. On day 26, no improvement was seen clinically or radiologically. Then, combination therapy with acyclovir, ara-A and gamma-globulin was began. On day 36, she recovered completely, and abnormal intensity in MRI disappeared both on T2WIs and DWIs. Therefore, antiviral agent therapy was discontinued. Patient 2. A 31-year-old man was admitted for headache, fever and aphasia. On the next day, acyclovir was started and both DWIs and T2WIs of MRI demonstrated a high signal intensity in the left temporal lobe. Ten days later, he became perfectly well, and the increased signal intensity disappeared on DWIs, but not on T2WIs. Treatment was therefore discontinued. No relapse was in either patient. We concluded that serial MRI DWIs may be useful to determine when to discontinue the treatment in encephalitis.
 ...
PMID:[The clinical usefulness of MRI diffusion weighted images in herpes simplex encephalitis-like cases]. 1065 72

A 71-year-old woman with hypertension and hypothyroidism was transferred to our hospital from a nearby hospital because of right thalamic hemorrhage evident on CT. She had been suffered from fever and headache for five days. Neurological examination on admission revealed somnolence, rigidity in the neck and extremities, and bilateral Babinski signs. Then she developed decorticate rigidity in a day. On brain MRI four hours after admission, T2-hyperintese lesions were demonstrated in the bilateral thalamus in addition to hemorrhagic change of the right thalamus on the initial CT. No pleocytosis was evident on cerebrospinal fluid examination at admission. Follow-up MRI on the fifth hospital day, however, revealed expansion of the lesions bilaterally to the medial temporal lobes including amygdala, hippocampus and insular cortex. The diagnosis of herpes simplex encephalitis was established by PCR of cerebrospinal fluid on the same day. After immediate treatment with acyclovir and ara-A, she gradually became conscious and could respond to simple conversation. This was an unusual case of herpes simplex encephalitis originating from bilateral thalamic lesions on brain imaging. We should consider thalamus as a primary lesion in herpes simplex encephalitis.
 ...
PMID:[Herpes simplex encephalitis originating from bilateral thalamic lesions with hemorrhagic component]. 1596 Jan 74

A Phase II study of combined modality therapy of leptomeningeal metastases (LM) in melanoma was carried out. Central nervous system (CNS) metastases occur commonly in patients with clinically advanced melanoma. 16 patients (median age 47; range 32-62 years) with LM due to metastatic melanoma were treated. Neurologic presentation included: headache (9 patients); cranial neuropathies (6); cauda equina syndrome (4); gait ataxia (3); hemiparesis (2); radiculopathy (2); myelopathy (1); and seizure (1). All patients underwent CNS staging followed by radiotherapy (14 patients) and intraventricular chemotherapy (methotrexate 16 patients; ara-C 13 patients; thio-TEPA 7 patients). CNS imaging demonstrated: interrupted CSF flow (9 patients); parenchymal brain metastases (7); spinal cord subarachnoid nodules (5); hydrocephalus (3); and epidural spinal cord compression (2). CSF cytologic responses were seen in 4 patients to first-, 6 to second-, and 3 to third-line chemotherapy. Treatment-related toxicity included 13 patients with meningitis (12 chemical; 1 bacterial) and 12 patients (18 episodes) with myelosupression (4 episodes secondary to intraventricular chemotherapy). Median survival was 4 months (range: 2-8). Twelve patients (75%) died of progressive LM or combined LM and systemic disease progression. LM in patients with metastatic melanoma may be palliated with combined modality therapy, however, median survival is quite short suggesting a re-evaluation of such an approach in similarly affected patients.
 ...
PMID:Leptomeningeal metastases due to melanoma. 2154 42