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

The objective of this study was to investigate the outcome of neurosurgical treated children with suppurative intracranial complications (SIC) of sinusitis over the past 28 years in our hospital. We reviewed the cases notes of a series of 11 consecutive paediatric patients, who were subjected to surgery for sinusitis-induced SIC, retrospectively. Eleven children (10 males and only one female) were underwent neurosurgical procedure in our hospital between 1978 and 2006. Their age at the time of diagnosis ranging from 13 to 17 years (mean 15.27 years, SD 1.737). The commonest presenting symptoms were headaches (81.8%) followed by vomiting (45.5%) and swelling of the forehead (45.5%). The most often involved sinus was the frontal sinus (63.6%) and sinus surgery was performed in eight (72.72%) of 11 cases. The neurosurgical procedures carried out included burr hole drainage or aspiration of abscess in five cases, craniotomy and evacuation of empyema in seven cases and craniectomy in two cases. Four (36.4%) of 11 patients had more than one neurosurgical operation due to re-accumulation of pus and worsening of their clinical status. Most common pathogen was Streptococcus species (81.9%), and anaerobes were isolated in three (27.3%) cases. Postoperative antibiotic treatment lasted from 26 to 70 days (mean 45.45 days, SD 15.280). Epilepsy was diagnosed in two patients, postoperatively. During the follow-up period, persistent focal neurological deficits were present in five (45.5%) of 11 patients. Interestingly, five (45.45%) cases occurred over the last 2 years (2005-2006) and the other six over the previous 16 years (1978-2006). Prompt and aggressive medical and neurosurgical intervention is required, aiming to minimize the morbidity and mortality and also to maximize the favourable outcome of those children.
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PMID:Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. 1807 89

Rosai-Dorfman disease (RDD) is a rare idiopathic histiocytic disorder that only occasionally involves the central nervous system (CNS). Previous cases of RDD involving the CNS were generally seen in adults. Pediatric cases of RDD are rare, and the disease in these cases typically has an indolent clinical course. In this report, the authors describe a pediatric case of intracranial RDD with rapid clinical and radiological progression. A previously healthy 13-year-old girl presented with a 15-day history of progressive left-sided headaches, vomiting, and fever. On examination she was pyrexial but otherwise normal. Neuroimaging results demonstrated an extraaxial left frontal lesion with peripheral enhancement. A bur hole was drilled over the lesion to obtain a tissue sample and de-bulk the lesion. The initial histological results showed a nonspecific inflammatory lesion. Postoperatively, the patient was asymptomatic, and neuroimaging results confirmed a significant reduction in the size of the lesion. Repeated neuroimaging 3 months later, however, revealed a large recurrence of the lesion, which was removed macroscopically by a craniotomy. Histological analysis of the tissue confirmed the RDD diagnosis. At the latest follow-up (12 months) the patient had remained asymptomatic with no evidence of recurrence on neuroimaging. This is the first reported case of intracranial RDD with an aggressive clinical course.
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PMID:Cerebral localization of Rosai-Dorfman disease in a child. Case report. 1845 87

A case of chronic subdural hematoma with multiple rapid recurrences is reported. A 41-year-old woman was admitted to hospital because of a traumatic subarachnoid hemorrhage and an intracerebral hematoma in the left frontal lobe. Both regions were conservatively treated, and she was discharged with no neurological deficit. Four months after this injury, she was readmitted to our clinic with complaints of severe headache and mild left hemiparesis. A CT scan showed a right chronic subdural hematoma. A burr hole and irrigation was performed, and the hematoma cavity disappeared on the following day. However, a deterioration of consciousness and left hemiparesis appeared ten days after the first operation. A second CT scan showed the recurrence of a left chronic subdural hematoma, so a second operation was performed. The patient showed a good postoperative course, and once again the hematoma cavity disappeared on the day following the operation. Nevertheless, a deterioration of consciousness and left hemiparesis appeared eight days after the second operation. A CT scan showed a second recurrence with low-density findings. Intraoperative findings during the third operation showed an almost water-like subdural fluid, and entrapment of cerebrospinal fluid by the inner membrane was suspected. A craniotomy and the removal of the outer and inner membranes were performed. Macroscopically, the inner membrane was intact and showed no signs of injury. No further recurrences occurred after the craniotomy. The suspected cause of the multiple subdural hematomas was the flow and entrapment of cerebrospinal fluid in some area of the inner membrane.
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PMID:[Rapid recurrence of chronic subdural hematoma by CSF entrapment]. 1952 84

A 62-year-old man had a new onset of severe, orthostatic headache which eventually progressed to a stupor and a coma 3 weeks later. A computed tomography (CT) scan showed bilateral chronic subdural haematoma and magnetic resonance imaging (MRI) of the brain showed the typical findings of spontaneous intracranial hypotension (SIH). After pre-medication with acetazolamide, he was treated with three lumbar autologous epidural blood patches (EBPs) and kept in the Trendelenburg position, with full recovery. The first lumbar autologous EBP was ineffective and the second was only partially effective because of incorrect execution of the procedure as shown by spinal neuroimaging examination post-EBP. A spinal neuroimaging examination post-EBP is therefore to be recommended in order to confirm the correct execution of procedure. Pre-medication with acetazolamide and keeping the patient in the Trendelenburg position could reduce the flow of spinal cerebrospinal (CSF) leak favouring sealing of the hole.
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PMID:Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in the Trendelenburg position pre-medicated with acetazolamide. 1957 56

A fifty-year-old man who had a history of minor head injury a month previously presented with headache, visual disturbance and papilloedema. Brain MR imaging showed bilateral subdural effusion and fat saturated orbital MR imaging demonstrated dilated subarachnoid space around the optic nerve. The diameter of the subarachnoid space behind the globe was 7.0 mm and that of the optic nerve was 3.5 mm. Bilateral simple drainage was performed to prevent deterioration of the visual disturbance. Light bloody fluid with a subdural pressure of 10.5 cmH2O was drained from the burr hole at the left side, and colorless fluid was drained from the right. Orbital MR imaging during continuous drainage revealed shrinkage of the subarachnoid space around the optic nerve. However, follow-up MR imaging 5 months after drainage showed disappearance of the subdural effusion and the reappearance of the subarachnoid space around the optic nerve, even though the size was smaller than before surgery. These findings suggest that the diameter of the optic subarachnoid space co-relates with the intracranial pressure, and may be an indication for increased intracranial pressure.
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PMID:[Dilation of subarachnoid space around the optic nerve in a patient with subdural effusion: a case report]. 1976 22

The major invasive procedure of the neurologist is the spinal tap. Its most frequent complication is post-lumbar puncture syndrome/headache. The syndrome's leading symptom is posture-dependent headache, which is caused by the prolonged escape of CSF from a dural leak. Its frequency lies between 1 and 30%, depending on the technique used for lumbar puncture. An important measure for reducing the risk of its occurrence is the use of a small (22-gauge), atraumatic Sprotte or Whitacre needle. The treatment of choice for the syndrome is caffeine, and if ineffective, then an epidural blood patch (at least 20 ml of the patient's own blood). Spontaneous low CSF pressure is due to a dural tear; it has the same symptoms as post-dural puncture headache, and on MRI there is a contrast enhancement of the meninges. In most cases the spontaneous low CSF pressure syndrome only is diagnosed after weeks to months. For this reason one should consider this syndrome in all cases of chronic headache. It is also treated with caffeine and an epidural blood patch. If it persists, the leak must be localized by means of radioisotope cisternography, thin-layer MRI, or CT myelography, and then the hole is closed either surgically or by CT-assisted application of fibrin glue.
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PMID:[Post-lumbar puncture syndrome and spontaneous low CSF pressure syndrome]. 1992 3

Spontaneous Intracranial Hypotension (SIH) is an uncommon headache syndrome. Patients classically present with orthostatic headache, tinnitus, and diplopia. The authors reported a 43 year-old man who presented with orthostatic headache, tinnitus, and hearing impairment for 3 months. Physical examination was unremarkable except for auditory impairment. The audiogram revealed minimal low-frequency neurosensori hearing loss suggesting a cochlear lesion. Computed tomography of the brain revealed bilateral thin chronic subdural hematomas. He underwent burr-hole surgery. Headache and auditory symptoms persisted and reevaluation of this syndrome was performed MRI of the brain showed diffuse smooth enhanced dura mater low lying position of midbrain, pons, medullar and cerebellar tonsil, as well as enlarged pituitary gland compatible with low CSF pressure syndrome. MRI of the whole spine could not demonstrate the site of CSF leakage. The patient was much improved after conservative treatments with hydration and bed rest. One year after treatment, he had no headache and only mild tinnitus was reported.
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PMID:Bilateral subdural hematomas and hearing disturbances caused by spontaneous intracranial hypotension. 1993 48

Intracranial infections, especially subdural empyema, due to salmonella are rare. Subdural empyema caused by Salmonella paratyphi A has been documented only once earlier in the literature. Hence, we report a case of subdural empyema and osteomyelitis of cranial vault due to S. paratyphi A. A 42- year-old male presented with headache and purulent discharge from right parietal burr hole wound site. Patient gave a history of head injury two years ago. He underwent burr hole evacuation of chronic subdural haematoma, excision of outer membrane and right parietal craniectomy. The cultures grew S. paratyphi A. Recovery was uneventful following surgical intervention and antibiotic therapy.
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PMID:Chronic subdural empyema and cranial vault osteomyelitis due to Salmonella paratyphi A. 2006 68

A 76-year-old man presented with a 4-day history of bilateral leg pain. Magnetic resonance imaging (MRI) of the lumbosacral spine revealed a spinal subarachnoid and spinal epidural haematomas. MRI of the brain revealed a chronic intracranial subdural haematoma with a midline shift. On further questioning, the patient reported a history of a fall 6 weeks earlier and had no evidence of coagulopathy. He underwent a burr-hole decompression of the intracranial subdural haematoma. At the one-year follow-up, the patient was symptom free with no leg pain or headache. The concomitant occurrence of an intracranial subdural haematoma with spinal epidural and spinal subarachnoid haematomas is rare. MRI of the brain and the entire spine is essential in the presence of a spontaneous spinal haematoma.
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PMID:Cranial subdural haematoma with concomitant spinal epidural and spinal subarachnoid haematomas: a case report. 2006 80

Despite advances in imaging and antibiotic treatment, brain abscess is still encountered occasionally. Various aerobic and anaerobic bacteria have been reported as causative agents of brain abscess but only a few cases of enterococcal brain abscesses have been reported. Here we report a case of brain abscess in a 12-year-old female patient, who presented with a history of fever, chills, headache, convulsions since seven days and history of altered sensorium and aphasia since the last two days. The patient had chronic suppurative otitis media of both ears following trauma and presented with ear discharge. The diagnosis of brain abscess was done by computerized tomography scan and the pus was aspirated by left suboccipital burr hole operation. Enterococcus species was cultured from the aspirated pus sample. The patient responded to surgical drainage and antibiotic treatment.
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PMID:Enterococcal Cerebellopontine Angle Abscess in a 12-year-old Female. 2030 Apr 22


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