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

It is known well that acute subdural hematoma develops most frequently after head injury, and secondly from pathological lesions such as intracranial ruptured aneurysm or AVM. A case of ruptured middle cerebral artery aneurysm which was clipped nine years before resulting in acute subdural hematoma is reported. At 6 pm on July 21, 1988, a 53-year-old woman with severe headache starting at 4:20 pm was transferred to our hospital. She suffered from herniated signs; Conscious disturbance; anisocoria; positive OCR; decerebrate posture. An emergency CT showed right acute subdural hematoma with severe midline shift. Following a decompressing craniotomy at 9 pm, the subdural clot was evacuated. It measured 90g in volume and the underlying cortex was normal. There was no evidence of SAH. Right carotid angiography three weeks after the first operation showed a middle cerebral artery aneurysm at the site of a clip which had been applied nine years ago. A second operation was performed on August 30, 1988. Via the right pterional route, the middle cerebral artery aneurysm was clipped successfully with a Sugita's clip replacing the first clip. We concluded that the regrowth and rebleeding of the middle cerebral artery aneurysm which had been clipped nine years before was most probable. She was discharged with slightly decreased consciousness and right motor weakness, on November 13, 1988.
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PMID:[A case of ruptured middle cerebral artery aneurysm with acute subdural hematoma after clipping of the aneurysm nine years previously]. 269 86

Two cases of dissecting aneurysm of the vertebral artery are reported and the 70 cases reported previously are reviewed. Case 1 showed Wallenberg's syndrome following sudden headache on the right side without SAH. Angiograms demonstrated the "pearl and string sign" on the right vertebral artery, characteristic of a dissecting aneurysm. Through a right suboccipital craniectomy, the right vertebral artery was found to be discolored purplish-red and swollen, so the proximal vertebral artery was clipped. The postoperative course was uneventful. Case 2 showed Wallenberg's syndrome with antecedent headache. CT scan was normal and lumber puncture revealed xanthochromic CSF, which was attributed to a SAH several days before. Angiograms disclosed the "pearl and string sign" on the right vertebral artery, and right vertebral artery clipping was performed. Postoperatively it was uneventful. Intracranial dissecting aneurysms of the vertebrobasilar system are not as rare as previously thought. They can often be overlooked as fusiform aneurysms or as thrombosis associated with SAH and/or ischemic attacks. The difficulty in diagnosis, leads to a high morbidity and mortality rate. Recently many cases have been reported in sequence. These cases involving SAH were successfully treated by surgical procedure. However in addition to our cases, only two cases of successful surgical treatment after ischemic stroke, have been reported. We emphasize that surgical intervention should be carried out for dissecting aneurysms of the vertebro-basilar system, even without SAH, to prevent further dissection which could cause SAH or/and further brainstem infarction. Proximal vertebral artery occlusion is the most beneficial treatment of choice.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dissecting aneurysm of the vertebral artery--report of two cases and review of the literature]. 306 7

Despite its efficacy in preventing rebleeding, the anticipated strong trend in favor of early intracranial surgery has not been achieved. Early intracranial operation remains a useful choice in the management of recent SAH in good-risk patients, but patients must be carefully selected on an individual basis. Many patients will undoubtedly benefit from early surgery but it is not a panacea. Further investigation of surgical treatment in combination with improved preoperative and postoperative medical therapy will be required to ameliorate the outcome of SAH. In particular, the prevention and treatment of cerebral infarction deserves attention. The results of the antifibrinolytic and timing of intracranial surgery studies point to the need for an effective prevention treatment regimen for vasospasm. Further studies about the efficacy of calcium channel blocking drugs in prevention of ischemia after SAH are needed among patients given antifibrinolytic drugs or having early operation. All the advances in treatment are predicated on prompt diagnosis of SAH in good-condition patients. The medical community needs to maintain a high degree of vigilance for the diagnosis of SAH in all patients complaining of a new, unusual or severe headache. Early referral to properly equipped and staffed medical facilities remains a keystone to effective treatment of SAH.
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PMID:Early management of the patient with recent aneurysmal subarachnoid hemorrhage. 381 Jul 3

We reviewed cerebral angiograms studied between May 1985 and December 1992 focusing on unruptured incidental intracranial aneurysms. In a total of 605 cases of cerebral angiograms except for patients with SAH, 43 patients (7.1%) were found to have unruptured aneurysms. In the 72 patients with headache, 11 patients (15.3%) were found to have unruptured aneurysms. This high frequency of unruptured aneurysms in headache patients is significant as a factor showing that headache may be due to unruptured aneurysms. The result of this observation is that as a screening study for headache patients, cerebral angiography may be required in spite of the invasive and high-risk method. But we think that MR angiography is, at present, a useful screening study only for detecting cerebral aneurysms with a diameter of over 5mm, and which are considered to need an operation.
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PMID:[Angiographical frequency of unruptured incidental intracranial aneurysms]. 819 28

Headaches are one of the most common symptoms that neurologists evaluate. Although most are caused by primary disorders, the list differential diagnoses is one of the longest in all of medicine, with over 300 different types and causes. The cause or type of most headaches can be determined by a careful history supplemented by a general and neurologic examination. Reasons for obtaining neuroimaging include medical indications as well as anxiety of patients and families and medico-legal concerns. In the era of managed care, concerns over deselection and negative capitation may dissuade the physician from ordering even a medically indicated scan. The yield of neuroimaging in the evaluation of patients with headache and a normal neurologic examination is quite low. Combining the results of multiple studies performed since 1977 for a total of 3026 scans reveals the overall percentages of various pathologies as: brain tumors, 0.8%; arteriovenous malformations, 0.2%; hydrocephalus, 0.3%; aneurysm, 0.1%; subdural hematoma, 0.2%; and strokes, including chronic ischemic processes, 1.2%. EEG is not useful in the routine evaluation of patients with headache. Similarly, the yield of neuroimaging in the evaluation of migraine is quite low. Combining the results of multiple studies performed since 1976 for a total of 1440 scans of patients with various types of migraine, the overall percentages of various pathologies are: brain tumor, 0.3%; arteriovenous malformation, 0.07%; and saccular aneurysm, 0.07%. WMA have been reported on MRI studies of patients with all types of migraine, with a range from 12% to 46%. The cause of WMA in migraine is not certain. Cerebral atrophy has been variable reported as more frequent and no more frequent in migraineurs compared with controls. The "first or worst" headache has a long list of possible causes and always includes the possibility of acute subarachnoid hemorrhage. Headaches--especially the sentinel type caused by SAH--often are misdiagnosed. The probability of detecting an aneurysmal hemorrhage of CT scans performed at various intervals after the ictus is: day 0.95%; day 3, 74%; 1 week, 50%; 2 weeks, 30%; and 3 weeks, almost nil. The location of a ruptured saccular aneurysm often is suggested by the predominant site of the SAH. The probability of detecting xanthochromia with spectrophotometry in the CSF at various times after a subarachnoid hemorrhage is: 12 hours, 100%; 1 week, 100%; 2 weeks, 100%; 3 weeks, more than 70%; and 4 weeks, more than 40%. The management of thunderclap headaches with normal CT scan and CSF examinations is controversial. Most patients have a benign course but an unruptured saccular aneurysm occasionally may be responsible for the headache. MR angiography may be a reasonable test to obtain instead of a cerebral arteriogram in many of these cases. About 30% to 90% of patients have headaches of various types and causes after mild head injury. Although most headaches are relatively benign, perhaps 1% to 3% of these patients have life-threatening pathology, including subdural and epidural hematomas, that are detected on CT and MRI scans. Headaches caused by subdural hematomas can be nonspecific. When new-onset headaches begin in patients over the age of 50 years, the physician always should consider whether it may be a secondary headache disorder requiring specific diagnostic testing and treatment. Up to 15% of patients 65 years and over who present to neurologists with new-onset headaches may have serious pathology such as stroke, TA, neoplasm, and subdural hematoma. Headaches are the most common symptom of TA, reported by 60% to 90%. The only over the temple. The diagnosis of TA is based on a high index of clinical suspicion that usually but not always is confirmed by laboratory testing. The erythrocyte sedimentation rate can be normal in 10% to 36% of patients with TA. A superficial temporal artery biopsy can give a false-negative result in 5% to 44% of patients.
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PMID:Diagnostic testing for the evaluation of headaches. 867 38

This is a case report of a patient with unruptured dissecting aneurysm in the vertebral artery that bled after being treated by proximal clipping. A 53-year-old male was admitted to our hospital due to transient right hemiparesis which occurred 20 days prior to his admission. He had been medicated for hypertension for the previous 33 years. CT scan and MRI showed lacunar infarction in the left corona radiata, and an aneurysm was accompanied with clot in the prepontine cistern. Angiography revealed a dissecting aneurysm in the right intracranial vertebral artery. His right hemiparesis was derived from infarction in the left corona radiata. It was likely that the dissecting aneurysm might rupture in the future. Proximal clip ping was performed to prevent rupture of the aneurysm. After clipping of the right vertebral artery distal to the PICA, the wall of the aneurysm appeared to be drawn toward the clip blades and to be tensed by the blades. Four hours after the operation, he complained of severe headache, and experienced a sudden loss of consciousness and the immediate development of a deep comatose state. CT scan disclosed massive SAH in the right cerebellopontine and basal cistern. Repeat angiography demonstrated that the aneurysm was not visualized and the right vertebral artery distal to the aneurysms was opacified through the left vertebral artery. Ventricular drainage was performed, but the patient died on the 20th day after bleeding. It was suspected that the aneurysmal clip might have produced shear force on the weak adventitia of the dissecting aneurysms and that the intra-aneurysmal pressure might have increased because of blood back-flow via the contralateral vertebral artery after the proximal clipping.
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PMID:[Bleeding from unruptured dissecting aneurysm in the vertebral artery after proximal clipping]. 892 23

A case of a ruptured aneurysm located in the P3 portion of the posterior cerebral artery (PCA), which was not accessible through a subtemporal approach, was reported. In addition to the case presented here, alternative operative approaches to the distal P3 portion or higher ambient cistern were reviewed and discussed. A 64-year-old man was admitted because of sudden onset of headache. CT scan disclosed SAH which was recognized mainly in the left ambient cistern with intraventricular bleeding (Fisher Group 4, Hunt and Kosnik Grade 2). A left vertebral angiogram disclosed a small saccular aneurysm in the distal P3 portion of the left PCA, which was located as highly as the plexal point of the anterior choroidal artery. On day 4, neck clipping was tried via the left subtemporal approach. The distal P3 aneurysm, however, could not be reached by this approach, in spite of aspiration of the parahypocampal gyrus. On day 7, the patient died of massive bleeding from a Cushing ulcer. It was considered that an occipital interhemispheric approach might have been more suitable in the present case.
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PMID:[A case report of a distal posterior cerebral artery (P3) aneurysm, not accessible through a subtemporal approach]. 893 69

Migraine and tension-type headache are primary headache disorders that occur during pregnancy. Migraine sometimes occurs for the first time with pregnancy. Most migraineurs improve while pregnant; however, migraine often recurs postpartum. Some disorders that produce headache, such as stroke, cerebral venous thrombosis, eclampsia, and SAH, occur more frequently during pregnancy. Diagnostic testing serves to exclude organic causes of headache, to confirm the diagnosis, and to establish a baseline before treatment. If neurodiagnostic testing is indicated, the study that provides the most information with the least fetal risk is the study of choice. Although drugs are used commonly during pregnancy, there is insufficient knowledge about their effects on the growing fetus. Most drugs are not teratogenic. Adverse effects, such as spontaneous abortion, development defects, and various postnatal effects, depend on the dose and route of administration and the timing of the exposure relative to the period of fetal development. Although medication use should be limited, it is not absolutely contraindicated in pregnancy. In migraine, the risk of status migrainosus may be greater than the potential risk of the medication use to treat the pregnant patient. Nonpharmacologic treatment is the ideal solution; however, analgesics, such as acetaminophen and narcotics, can be used on a limited basis. Preventive therapy is a last resort.
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PMID:Migraine and pregnancy. 905 7

A P4 segment aneurysm of the posterior cerebral artery has rarely been described. A case of ruptured P4 segment aneurysm, which re-ruptured after clipping procedure for unruptured internal carotid artery aneurysm, was reported. A 57-old-man had sudden onset of severe headache and vomiting and was transferred to our hospital. CT scan on admission showed diffuse subarachnoid hemorrhage dominantly extending to the tentorial surface and the occipital interhemispheric tissue. Four-vessel angiography demonstrated a right internal carotid-posterior communicating artery junction aneurysm, and its neck clipping was performed on day 5. Intraoperative inspection of the whole appearance of the aneurysm was difficult because of the aneurysm existing on the ventral portion of the internal carotid artery and definite diagnosis of the bleeding source was not obtained. On day 23, he complained of severe headache and restricted vision and CT scan showed intracerebral hematoma in the left occipital lobe with intraventricular hemorrhage. The angiograms and CT scan on admission were reexamined, and another aneurysm on the left parieto-occipital artery (P4 segment) was retrospectively identified. The ruptured P4 segment aneurysm was obliterated via the interhemispheric approach and the patient enjoyed an uneventful postoperative course. When a thick subarachnoid hemorrhage distributed in the occipital interhemispheric fissure, quadrigeminal cistern, and ambient cistern is encountered, the existence of a possible P4 segment aneurysm should be suspected. Correct initial diagnosis and definite treatment of the ruptured lesion in the acute stage is essential in dealing with SAH-patient with multiple aneurysms. When they are unruptured lesions at a common aneurysm site, the existence of an unusually located aneurysm should not be overlooked as the possible source responsible for symptoms.
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PMID:[A case of ruptured P4 segment aneurysm of the posteior cerebral artery: therapeutic pitfalls encountered when dealing with the multiple intracranial aneurysms]. 966 99

In patients with strong suspicion of SAH, CT is the initial diagnostic procedure of choice. A lumbar puncture (LP) should be done if a CT is not available. If the patient has no focal deficit or papilloedema there is a little risk in LP. When a CT is negative there can be indication to do a LP: small leaks can be overlooked by CT, and they are often important premonitory events preceding larger and severe haemorrhages. The accuracy of CT in documenting SAH diminishes after 24 hours: thereafter, diagnosis is often dependent on LP. In some cases LP can be useful because the procedure may alleviate headache and remove some blood. LP can also quantify cerebro-spinal fluid (CSF) pressure, provide a baseline for future CSF determination, and allow the study of some parameters like arachidonate metabolites, lactic acid, fibrinogen degradation products (FDP) and thrombin-antithrombin complex (TAT).
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PMID:[Reasons in favor of lumbar puncture diagnosis (or lavage)]. 977 40


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