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

We described a case of cerebellar hemorrhage after trapping of a vertebral artery dissecting aneurysm. A forty-eight-year-old man had suffered from severe headache, vomiting and disturbance of consciousness. He was transferred to our hospital in an ambulance. Emergency CT scan showed subarachnoid hemorrhage in the posterior fossa predominantly, intraventricular hemorrhage and hydrocephalus change. Chest X-ray showed radiological evidence of pulmonary edema. The initial blood-gas determinations demonstrated a marked reduction in PaO2 and increased PaCO2. Five days after admission, the patient's condition was improving. Cerebral angiography was performed using the Seldinger method. It revealed a right vertebral artery dissecting aneurysm just distal to the posterior inferior cerebellar artery. We performed an operation to trap the VA dissecting aneurysm. Blood pressure was well controlled under 140 mmHg during the operation and he recovered from anesthesia completely. On the day after the operation, suddenly the patient's consciousness began to deteriorate. Emergency CT scan was performed and it showed SAH, cerebellar hemorrhage and diffuse swelling of the cerebellum on the same side as the operation. We suspected rebleeding of the aneurysm due to a clip's having slipped. Reoperation was performed, but the clip was not displaced and there were no definite bleeding vessels on the operative field. Consequently only external decompression and resection of the right cerebellum were performed. We discuss pathogenesis of the occurrence of hemorrhage in this particular case after trapping. We also review the relevant literature.
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PMID:[Postoperative hemorrhage due to normal pressure hyperperfusion breakthrough after a trapping of VA-PICA dissecting aneurysm]. 1072 26

Little is known about the long-term cognitive-functional outcome of patients with perimesencephalic subarachnoid haemorrhage (PM SAH). We investigated the neurological, cognitive and emotional consequences of perimesencephalic subarachnoid haemorrhage in eighteen PM SAH patients admitted between November 1990 and July 1997 to the Neurology/Neurosurgery services of a University Hospital. The follow-up study consisted of a face-to-face interview, a neurological examination, an headache questionnaire, a neuropsychological evaluation (Mini-Mental State and a complementary battery to assess specific cognitive domains), the Hamilton Depression Rating Scale (HDRS) and the Blessed Dementia Scale. Thirteen patients performed below the 10th percentile in at least one cognitive domain. Six patients scored more than 12 points on the HDRS. Mini-Mental State and HDRS scores were moderately correlated (r = 0.55). Only three patients left their previous occupation. Minor cognitive deficits and high scores on a depression scale were frequent findings in this cohort of PM SAH patients. Reassurance and treatment of depressive symptoms could be important to improve the long-term outcome of PM SAH patients.
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PMID:Cognitive and emotional consequences of perimesencephalic subarachnoid hemorrhage. 1115 19

We report a SAH case of a ruptured dissecting aneurysm of the middle cerebral artery following parietooccipital subcortical hemorrhage. A 68-year-old woman was admitted to our hospital, complaining of headache. On admission she was alert with left homonymous hemianopsia. A CT scan disclosed subcortical hemorrhage in the right parieto-occipital lobe. An angiogram revealed no abnormal vessels. Seven days after admission, she suddenly lapsed into unconsciousness with left hemiparesis. A CT scan demonstrated subarachnoid hemorrhage with a right sylvian hematoma. A second angiogram revealed fusiform dilatation of the M2 branches and aneurysmal dilatation at the M1-M2 bifurcation. Following conservative therapy, she died 21 days after admission. The relationship between subcortical hemorrhage and the subsequent subarachnoid hemorrhage was not certain. We discuss and review the treatment of a dissecting aneurysm of the middle cerebral artery.
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PMID:[Dissecting aneurysm of the middle cerebral artery (M1-2 portion) with subarachnoid hemorrhage: a case report]. 1134 15

A careful and complete headache history supplemented by a neurologic and general physical examination, as appropriate, enables the astute physician to diagnose most headaches correctly without diagnostic testing. When indications are present (see Box 1), some headache patients with a normal physical examination require testing even though the yield may be low. Failure to test may result in misdiagnosis of potentially serious and life-threatening causes of headaches, such as brain tumors, chronic meningitis, SAH, and temporal arteritis.
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PMID:Diagnostic testing for headache. 1148 Feb 62

To decide which patients with headache ought to be evaluated for SAH, physicians should focus on specific elements of the patient history, such as onset, severity, and quality of the headache and associated symptoms. These questions should be asked and the responses documented for every patient with a headache. The physical examination should be compulsive with regard to vital signs, HEENT. and neurologic signs. Then, the physician should form an explicit differential diagnosis and have reasons for diagnosing migraine, tension, or sinus headache and other benign causes. If there is no clear-cut alternative hypothesis, the patient should be evaluated by CT and LP (if the CT is negative, equivocal, or technically inadequate). Physicians should understand the limitations of this diagnostic algorithm. In addition, the CSF should be carefully analyzed, including measuring the opening pressure. In patients whose CT scans and CSF analyses are normal, further testing is rarely indicated.
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PMID:Diagnosis of subarachnoid hemorrhage in the emergency department. 1263 Jul 32

Headache represents one of the most common complaints in the outpatient and emergency room setting [1]. Most causes of headache are benign and do not require emergent imaging or intervention. The authors' review of the diagnostic tests does not offer absolute indications for neuroimaging because most of the evidence is based on studies that are not randomized controlled trials. Imaging guidelines for adults and children, however, have emerged based on the available level 2 and 3 literature. CT imaging remains the initial test of choice for new-onset headache in adults and headache suggestive of SAH. Most of the available literature also recommends performing lumbar puncture when CT is equivocal in ruling out SAH [1]. The sensitivity of MR imaging appears to be less than CT for SAH [1]. Newer MR imaging techniques need to be tested and developed to determine if they have higher sensitivity than CT or lumbar puncture in the detection of SAH. In adults with suspected brain metastatic disease, contrast-enhanced MR imaging is the imaging study of choice [38,39]. Contrast-enhanced MR imaging is the examination of choice for brain metastatic lesions less than 2 cm [39]. CT angiography and MR angiography have sensitivities greater than 85% for brain aneurysms larger than 5 mm [43]. If clinically warranted, aneurysms smaller than 5 mm may require digitally subtracted angiography because of the low sensitivity of MR and CT angiography. In children, the choice of diagnostic test strategy depends on the risk group. In high-risk patients, MR imaging is the test of choice whereas in low-risk patients, close clinical observation with periodic reassessment is the best strategy [44]. Clinical diagnosis will always play a key role in the evaluation of headache disorders; however, for the small subset of patients who present with headache secondary to an intracranial space-occupying lesion, bleeding, or SAH, making the diagnosis is crucial to decreasing morbidity and mortality. CT, MR imaging, and lumbar puncture play important roles in the assessment of headache disorders, but their future roles will continue to evolve as the technology becomes more sophisticated and robust, and physicians become more expert with their use [1].
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PMID:Adults and children with headache: evidence-based diagnostic evaluation. 1367 3

Migraine and TTH are primary headache disorders that occur commonly during pregnancy. Migraine sometimes occurs for the first time with pregnancy. The majority of migraineurs improve while pregnant; however, migraine often recurs post partum. 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. Drugs commonly are used during pregnancy despite insufficient knowledge about their effects on the growing fetus. Most drugs are not teratogenic. Adverse effects, such as spontaneous abortion, developmental defects, and various postnatal effects, depend on the dosage 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 for status migrainosus may be greater than the potential risk of the medication used to treat the pregnant patient. Nonpharmacologic treatment is the ideal solution; however, analgesics, such as acetaminophen and narcotics, can be used ona limited basis. Preventive therapy is a last resort.
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PMID:Headaches in pregnancy. 1547 64

We report 3 cases with reversible posterior leukoencephalopathy syndrome (RPLS) accompanied by eclampsia or hypertensive encephalopathy. RPLS may develop in patients who have eclampsia or hypertensive encephalopathy or who are immunosuppressed. The findings on neuroimaging are characteristic of subcortical edema without infarction. A 27-year-old primigravida developed eclampsia at 37 weeks of gestation. MRI was performed 4 hours after the onset. The FLAIR sequence delineated extensive hyperintense lesions in the temporal and occipital lobe bilaterally. MR angiography(MRA) performed 6 days after the onset of symptoms clearly demonstrated intracranial vasospasm. Follow up MRI and MRA were performed 3 weeks after the onset. The MRI showed slight residual hyperintensity in the occipital lobe. The MRA showed the disappearance of the vasospasm. A 39-year-old woman on the 8th postpartum day presented with thunderclap headache, which led to a search for SAH. She visited our hospital, whose high arterial blood pressure (220/110 mmHg) was observed. Both CT and MRA were normal. MRI revealed abnormalities in the parieto-occipital regions bilaterally. Treatment of hypertension led to resolution of the posterior leukoencephalopathy. A 38-year-old woman on the 11th postpartum day suddenly developed vertigo, visual disturbance and generalized convulsion. MRI was performed 7 days after the onset. The FLAIR sequence delineated extensive hyperintense lesions in the occipital lobe bilaterally. MRA clearly demonstrated diffuse intracranial vasospasm. MRA performed 3 weeks after the onset showed the disappearance of the vasospasm. In conclusion, our experience suggests that the MRI and MRA noninvasively provide valuable findings which are complementary in the diagnosis and follow-up examination of a brain edema and vasospasm in RPLS.
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PMID:[Reversible posterior leukoencephalopathy syndrome: experience in 3 cases]. 1572 81

Arachnoid cysts represent benign cysts that occur in the cerebrospinal axis in relation to the arachnoid membrane and do not communicate with the ventricular system. We report a case of a years right handed lady, who presented to the emergency department with the complaints of headache and vomiting for one week CT scan showed extraaxial cystic lesion in the left fronto-parietal region. On the fifth day of admission, patient had sudden onset of severe headache associated with loss of consciousness for about 3-4 minutes with neck rigidity. A CT scan of head was repeated, which showed left fronto-parietal cystic lesion with intracystic bleed and SAH. Intraoperatively, there was intradural cystic lesion containing xanthochromic fluid with normal brain surface and there were no evidence of any vascular malformations. Marsupilization of the cystic lesion was carried out and she improved. The literature regarding arachnoid cyst with spontaneous intracranial haemorrhage is reviewed.
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PMID:Spontaneous intracystic hemorrhage of the arachnoid cyst: a case report and review of literature. 1907 1

A pseudo-subarachnoid hemorrhage (pseudo-SAH) is a brain computed tomography (CT) finding that is seen as high-density areas along the basal cisterns, the sylvian vallecula/fissure, the tentorium cerebella, or the cortical sulci, although no SAH is found upon lumbar puncture or at autopsy. There is one report of cryptococcal meningitis presenting as pseudo-SAH, but the explanatory pathology is unknown. A 68-year-old woman with headache, fever, decreased hearing, and decreased vision was admitted to our hospital. Cerebrospinal fluid India ink staining was positive, and culture yielded Cryptococcus neoformans. Cryptococcus meningitis was diagnosed. Head CT and magnetic resonance imaging (MRI) showed no abnormality upon admission, but 1 month later, head CT showed iso- to high-density areas within the sulci, and fluid-attenuated inversion recovery MRI showed high signal intensity within the convexity sulci resembling an SAH. These areas were enhanced by gadolinium on T1-weighted images. Lumber puncture produced no evidence of bleeding. Biopsy of the left frontal lobe sulci was performed, and histopathological study revealed inflammation and granulation with capsules of C. neoformans. The inflammation and granulation at the convexity sulci induced by the C. neoformans infection explained the pseudo-SAH in this case. Physicians should be aware that cryptococcal meningitis-induced inflammation and granulation at the sulci can present as pseudo-SAH on CT and MRI.
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PMID:Pseudo-subarachnoid hemorrhage in cryptococcal meningitis: MRI findings and pathological study. 2370 98


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