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

Low spinal fluid pressure syndrome is characterized by orthostatic headache aggravated in upright position. It is classified into two from etiological standpoint i.e. primary and secondary (most often seen after lumbar puncture). On the other hand, low spinal fluid pressure is one of the promoting factors of chronic subdural hematoma. We report 2 cases of primary low spinal fluid pressure syndrome (primary intracranial hypotension) associated with chronic subdural hematoma. Case 1 is a 47-year-old man who was admitted with disorientation following 2 week history of orthostatic headache. Spinal fluid pressure was 7mmH2O in the lateral recumbent position. CT scan revealed bilateral isodense chronic subdural hematoma. The subdural hematoma reaccumulated 17 days after the first operation. Case 2 is a 31-year-old woman who was admitted with 4 week history of progressive orthostatic headache accompanied by nausea and vomiting. Spinal fluid pressure was 0 mmH2O. CT scan and cerebral angiography showed bilateral chronic subdural hematoma. The hematoma reaccumulated 20 days after the first operation. Six cases including our two cases of primary intracranial hypotention associated with chronic subdural hematoma have been reported. When changes of characters of headache, especially mental symptoms and disturbances of consciousness occurred in patients with chronic orthostatic headache, association of chronic subdural hematoma should be suspected. In cases with chronic subdural hematoma associated with low spinal fluid pressure syndrome, the reaccumulation of hematoma tends to occur after burr hole opening and irrigation of hematoma.
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PMID:[Primary intracranial hypotension associated with chronic subdural hematoma--report of 2 cases]. 650 58

Isotope studies have related chronic headache after myelography to persistent leakage of normal cerebrospinal fluid (CSF) through an unsealed puncture hole in the dura and arachnoid. Although a technique well known to anesthesiologists, the use of an epidural blood patch (EBP) as a means to seal the dural opening is not known to many radiologists. We have used this technique successfully in three patients and believe it should be performed on all those still suffering from typical postural headaches three weeks after myelography if conservative treatment has failed and if there are no contraindications.
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PMID:Epidural blood patch for the treatment of chronic headache after myelography. 716 2

In this paper a case of acute spontaneous subdural hematoma is reported with a review of fifteen cases in the literature. A 48-year-old left handed man suffered from severe headache on a motor cycle but he arrived at his brother's office immediately after. Three hours later he was found unconscious and soon he was brought to our hospital. On admission he was semicomatose with left hemiparesis. There was no evidences of head injury and the x-rays were normal. CT scan disclosed a high density mass in the left temporal extra-axial region with a remarkable shift of midline structures. His bleeding and clotting time were normal. Emergent left craniotomy was performed and a subdural clot without a membrane was evacuated. Neither cortical lacerations nor vascular malformations were seen on the cortical surface. But two spurting cortical arteries with a lateral pin-hole were seen and coagulated. Postoperative angiograms also revealed no vascular anomalies. He discharged one month later and he is now free from any neurological deficits. In the review several characteristic points of acute spontaneous subdural hematoma were discussed.
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PMID:[Acute spontaneous subdural hematoma--a case report (author's transl)]. 729 Mar 25

We report two patients with solitary thalamic abscesses, occurring among 91 consecutive patients (2.2%) with computed tomography (CT)-diagnosed and surgically-verified brain abscess experienced in our college during 1975 to 1991. A 9-year-old girl with congenital heart disease experienced frequent vomiting followed by left hemiparesis and deterioration of consciousness. CT demonstrated a right thalamic ring-enhanced lesion. Purulent material was aspirated via a burr hole. She died of heart failure on the 5th postoperative day. Autopsy disclosed diffuse brain swelling and an encapsulated abscess in the right thalamus, which had ruptured into the third ventricle. A 30-year-old female experienced headache, nausea, and vomiting, which progressed to somnolence and right hemiparesis. CT demonstrated a left thalamic ring-enhanced lesion. Purulent material was aspirated by stereotactic procedures. All symptoms had resolved by the end of the 2nd postoperative week.
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PMID:Solitary pyogenic thalamic abscess--two case reports. 750 3

An analysis of 19 confirmed cases of subdural empyema treated in our unit during a 29-month period ending in May 1990 revealed that this was a disease of young males (mean age 19.6 yrs: male:female ratio 5:1) that was frequently associated with paranasal sinusitis. We have identified a characteristic symptom complex which when present together with focal neurological deficits makes the diagnosis highly probable. This consists of fever, headache, altered level of consciousness and frontal scalp swelling. In a practice setting where neuroradiological confirmation of the diagnosis is not always practicable, this clinical syndrome is helpful and should prompt early burr hole exploration of the subdural space. The only deaths (2 patients; 11%) occurred in patients who presented in coma. The remaining were either normal (6 patients) or continued to improve after treatment, which consisted of multiple burr hole drainage, broad spectrum antimicrobial treatment and eradication of the source of infection.
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PMID:Intracranial subdural empyema: burr hole exploration for diagnosis and treatment. 783 22

The authors report a case of intracranial chronic subdural hematoma after spinal anesthesia for a perianal abscess. The chronic subdural hematoma was successfully treated by burr hole drainage. This complication should be suspected in patients who complain of prolonged headache, or who develop signs of increased intracranial pressure or neurologic deficits after spinal anesthesia.
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PMID:Intracranial chronic subdural hematoma following spinal anesthesia: report of a case. 790 8

The clinical usefulness of combined spinal-epidural needles, Portex Spinal/Epidural set (Pencil point tip type and Lancet point tip type), was evaluated on 30 patients undergoing orthopedic lower limb surgeries, hysterectomies or transurethral surgeries. In all the patients, the spinal-epidural needles were successfully inserted with paramedian approach without any problem. The time to appearance of cerebrospinal fluid in the spinal needle hub after removal of the stylet was 15-40 seconds, and no patient in both groups had postspinal headache. Following spinal anesthesia, the local anesthetics injected through the epidural catheter extended the analgesia in the range of 1-2 dermatomes higher in the Lancet point type group in comparison with Pencil point type group. It is possible that the hole in the dura may allow a transfer of local anesthetics into the subarachnoid space. The present study shows that combined spinal-epidural block is clinically useful, and the Pencil point type is safer than the Lancet point type.
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PMID:[The clinical usefulness and problem of combined spinal epidural needle]. 854 92

Subdural empyema, a collection of pus in the space between the dura and arachnoid, is a rare type of intracranial infection. We report on 23 patients, aged 8 months to 70 years, with subdural empyema who were treated in our clinic between 1989 and 1994. The sources of subdural empyemas were meningitis in five patients, middle ear in five, trauma in four, paranasal sinus in three, complications of surgery and subdural tap in four, and unknown in two patients. The common presentations were headache, focal neurologic deficit, fever, vomiting, seizures, and neck stiffness. Diagnosis was achieved by computerized tomography and neurologic examinations in all cases. Treatment was effected by burr hole or small craniotomy with catheter drainage, and antibiotics were administered to all patients. The mortality rate was 8.7%; the remaining patients made a good recovery without sequelae. We therefore recommend burr hole with catheter drainage plus antibiotics as a method of treating subdural empyema.
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PMID:Treatment of subdural empyema by burr hole. 875 81

Sixty-seven patients with brain abscess were managed over 19 years (1975-1993). Our series had a 2.5 to 1 male predominance; the age distribution was from 3 days to 81 years. The underlying conditions of hematogenic brain abscesses (n = 33; 49%) included lung infections (n = 16), heart disease (n = 4), sepsis (n = 10), and other foci (n = 3). Otolaryngologic infections led to the abscess in 10 cases; there were 9 traumatic abscesses. The causes remained unknown in 15 cases. There were 47 solitary abscesses (70%) and 20 multiple abscesses. The most frequent presenting signs and symptoms were neurologic deficits (n = 17), disturbances of consciousness (n = 14), seizures (n = 6), and headaches, meningism and vomiting (n = 13). Causative organisms were isolated in 39 cases (58%) and included staphylococci (n = 6), streptococci (n = 6), enterobacteriae (n = 2), and anaerobic pathogens (n = 9). The most reliable laboratory sign of inflammation was an elevated ESR (52/59 patients). With the advent of computed tomography, burr hole aspiration of the abscess with or without drainage was possible in 30 cases; the mortality in this subgroup was 9%. All 4 patients with surgical excision in the pre CT-era died. The mortality of patients treated with antibiotics only was 62% (18/29). Overall mortality was 37% (25/67), including 5 cases with post mortem-diagnosis of brain abscess. Good recovery was achieved in 29/42 survivors. Predictors of a poor outcome were the patient's age, the level of consciousness, multiple abscesses, polybacterial cultures, and a hematogenic etiology, but not the size of the abscess.
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PMID:[Bacterial brain abscess--experiences with 67 patients]. 880 80

A 35-year-old male was admitted with headache, nausea, and vomiting persisting for 2 days. Computed tomography (CT) revealed a left chronic subdural hematoma. Cerebral angiography demonstrated cerebral venous sinus thrombosis (CVST). He had presented with a subcutaneous mass involving the neck at age 2 years, which was shown to be a cavernous angioma, and thereafter shown signs of consumptive coagulopathy with systemic multiple hemangiomas. Burr hole aspiration of the hematoma was performed. Seventy-two-hours later, he developed clouding of consciousness and right hemiparesis. CT revealed a fresh hematoma in the operated subdural cavity and hemorrhagic diathesis manifested. A frontotemporoparietal large craniotomy was performed to remove the hematoma. Extensive electrocauterization was required. He had a satisfactory postoperative course. Collateral venous pathways, resulting from the CVST due to systemic multiple hemangiomas, may have caused hemodynamic stress in the bridging veins which subsequently induced chronic subdural hematoma.
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PMID:Cerebral venous sinus thrombosis associated with systemic multiple hemangiomas manifesting as chronic subdural hematoma--case report. 891 83


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