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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 48-year-old female suffered from severe headache, vomiting, and disturbance of consciousness. On admission, she was somnolent with mild paresis of the left leg. Precontrast computed tomography (CT) scans showed a high-density area in the left sylvian fissure and the posterior horn of the left lateral ventricle. Angiographically, a right middle cerebral artery aneurysm and a basilar artery aneurysm were recognized. Furthermore, on the venous phase of bilateral carotid angiograms, superior sagittal sinus (SSS) thrombosis was recognized. Subarachnoid hemorrhage (SAH) was probably induced by rupture of a dilated vein associated with SSS thrombosis, because high-density area on CT scan and location of the aneurysms were different. The patient was initially treated conservatively. Two months later, craniotomy was performed which did not disclose any trace of hemorrhage around the aneurysms and aneurysms themselves. Postoperatively, acute brain swelling and generalized convulsion were induced. The patient became ambulatory 5 months after surgery. In SAH cases, the venous phase should be examined at least in one side of the carotid arteries. In such a SAH case induced by venous thrombosis complicated by aneurysms it is very difficult to decide the timing of surgery for aneurysms.
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PMID:[Superior sagittal sinus thrombosis complicated with multiple aneurysms presenting as subarachnoid hemorrhage. Case report]. 172 64

The authors present three cases of non-traumatic acute subdural hematoma showing interesting clinical features and operative findings. Case 1: A-50-year-old male was admitted because of sudden headache and epileptic seizure. Computed tomographic (CT) scan showed a right thin subdural hematoma, but cerebral angiography demonstrated no pathological findings, that might cause acute subdural hematoma on the follow-up CT scans. The hematoma changed to a chronic one within only 15 days, which was proved by the operation. Case 2: A 52-year-old male was hospitalized because of loss of consciousness. CT scan revealed a right subdural hematoma without subarachnoid hemorrhage and cerebral angiography demonstrated a right middle cerebral artery aneurysm. The hematoma was surgically proved to be due to rupture of the aneurysm. Case 3: A 52-year-old male was admitted because of headache, vomiting and left motor weakness. CT scan showed a thick right subdural hematoma and right carotid angiography revealed two internal carotid artery aneurysms. It was surgically certified that the subdural hematoma was caused by a tear in a cortical artery attached to the dura, not by the rupture of the aneurysms. Clinical cause and pathogenesis of so-called "non-traumatic" or "spontaneous" acute subdural hematomas were discussed, and the importance of emergency angiography for this condition is stressed.
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PMID:[Three cases of non-traumatic acute subdural hematoma]. 176 56

A case is reported of ruptured dissecting aneurysm of the intracranial vertebral artery (VA) operated on with VA trapping and bilateral posterior inferior cerebellar artery (PICA) side-to-side anastomosis. A 42-year-old male suddenly developed severe headache and vomiting. On admission, 3 hours later, he was in a state of moderate confusion (Japan Coma Scale 3) and had neck stiffness. Computed tomography (CT) revealed diffuse subarachnoid hemorrhage, especially thick in the posterior fossa with right side dominance. Right vertebral angiography disclosed a fusiform dilatation with proximal narrowing of the right VA which originated just proximal to the VA-PICA junction. Lateral suboccipital craniectomy was undertaken with the patient in a left park bench position. Right VA was dilated and discolored black, and right PICA arose from the proximal portion of this aneurysmal dilatation. Since it was impossible to clip the VA distal to the PICA for the proximal clip-occlusion, the VA including the VA-PICA junction was trapped. Considering the risk of developing infarction at the PICA territory, bilateral PICA was anastomosed at their posterior medullary segment in a side-to-side fashion because the occipital artery (OA) had been cut at the skin incision and could not be used for the OA-PICA anastomosis. The postoperative course was benign, but a mild lateral medullary syndrome developed. CT revealed no abnormal low density area and left vertebral angiography demonstrated the patency of the bypass. Thereafter, the deficit subsided gradually and the patient was discharged. He is presently working without neurological deficit.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Vertebral dissecting aneurysm treated with trapping and bilateral posterior inferior cerebellar artery side-to side anastomosis; case report]. 188 26

A 45-year-old woman with prosthetic valves replacement, was admitted with severe headache and vomiting one month after starting danazol treatment at 300 mg per day. She was receiving long-term anticoagulation with warfarin and dipyridamole, taking 3.5 mg and 300 mg per day respectively. The patient's thrombotest value was less than 6% at the time of admission. Cranial CT revealed subarachnoid hemorrhage. Warfarin and danazol treatment ware discontinued with replenishment of vitamin K. Recovery was uneventful. Danazol is 2, 3 isoxazol derivative of 17-alpha-ethinyl testosterone. As such, it shares the property of C 17 alkylated steroids in potentiating the action of coumarin. It is suggested that danazol affects the turnover of vitamin-K-dependent clotting factors, an impairment of synthesis being a likely mechanism. The possible hazard of the potentiating effect of danazol on warfarin should be widely appreciated.
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PMID:[Subarachnoid hemorrhage following commencement of danazol treatment in a patient well controlled on warfarin anticoagulation]. 188 15

A case of ruptured aneurysm in the hypoplastic proximal anterior cerebral artery (A1 portion) is reported. This 25-years old man complained of the sudden onset of severe headache and vomiting on January 11, 1989. He was referred to our hospital on the same day, and CT scan revealed subarachnoid hemorrhage. Cerebral angiography on the next day revealed an aneurysm in the hypoplastic A1 portion of the right anterior cerebral artery, and no branch was present at the site of the aneurysmal neck. He was operated on using the right pterional approach. The A1 portion was trapped and the aneurysm was removed successfully. The histology of the aneurysm was that of the usual type of the saccular aneurysm. The post-operative course was uneventful. He was discharged with no neurological deficit two months after the operation. As far as we know, there has been no report on a ruptured aneurysm in the hypoplastic A1 portion. We also reviewed the 55 aneurysms in the A1 portion that have been reported in the literature.
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PMID:[A ruptured aneurysm in the hypoplastic proximal anterior cerebral artery (A1 portion); case report]. 189 24

In the Danish Aneurysm Study 1076 patients (pts.) were admitted with an aneurysmal subarachnoid hemorrhage in the 5-year period 1978-83. A warning leak (WL), defined as a sudden episode of headache, vomiting, nuchal pain, dizziness or drowsiness, was identified in 166 pts. (15.4%). In 99 of these the episode was evaluated by a physician but misdiagnosed. A 2-year follow-up examination of the 99 pts. showed that 30 pts. had a normal mental outcome and 43 pts. were dead. If these patients were correctly diagnosed after the WL, when they were in Hunt grade 1-2, the outcome-figures would probably have been significantly better. A theoretical transfer of the outcome-probabilities for pts. in Hunt grade 1-2 to the above mentioned 99 pts. would result in 66 pts. with a normal mental outcome and 25 dead pts. This shows the importance of recognition of a WL episode.
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PMID:Importance of the recognition of a warning leak as a sign of a ruptured intracranial aneurysm. 201 46

About half of the aneurysm patients admitted to neurosurgical departments experience warning symptoms in the form of minor bleeding episodes days or even several months before a major haemorrhage occurs. Headache is the most common symptom of this warning leak, occurring in 9 out of 10 patients. The onset of headache is sudden and is unusual in severity and location, being unlike any headache the patient has otherwise experienced. It is frequently accompanied by transient nausea, vomiting, visual disturbances or meningism. Medical advice may be sought by the patient but all too often the diagnostic importance of a warning headache is missed. It is misinterpreted as attacks of migraine, tension headache, the 'flu, sinusitis, or a "sprained neck". A more vigilant attention to the presence of a warning headache probably offers the greatest opportunity for altering the otherwise serious natural history of aneurysmal subarachnoid haemorrhage. If a warning headache is suspected, lumbar puncture is the examination of choice, once CT scanning has ruled out an intracranial mass lesion.
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PMID:Headache as a warning symptom of impending aneurysmal subarachnoid haemorrhage. 203 71

Two cases treating aneurysms of the distal PICA were reported, and 36 cases with 39 aneurysms in the literatures in Japan were reviewed concerning the distribution of aneurysms and their findings on CT. Case 1; a 68-year-old female suffered from sudden onset of severe headache and nausea. On admission, it was found she was lethargic. However, her consciousness deteriorated down to semicoma with tetraparetic condition soon after. CT revealed subarachnoid hemorrhage in the basal, quadrigeminal and supravermian cisterns and blood clots in the entire ventricle. Cerebral angiography demonstrated an aneurysm located at the distal segment of the left PICA. She was initially treated conservatively because of being in Hunt and Kosnik Grade 5, and then, 3 weeks after onset, suboccipital craniectomy was performed and the aneurysm was clipped successfully. Case 2; a 60-year-old, female, suddenly experienced severe suboccipitalgia and vomiting. CT revealed subarachnoid hemorrhage in the entire subarachnoid space and intraventricular hemorrhages in the 4th, 3rd and lateral ventricles. Subsequently cerebral angiography was performed and left VAG demonstrated an aneurysm at the left A2-A3 junction. She underwent bifrontal craniotomy and the aneurysm was clipped via the interhemispheric approach. Her postoperative course was uneventful. Postoperative left CAG showed successful clipping of the aneurysm. However, left VAG suggested an aneurysm-like shadow in the right PICA. Right BAG carried out one week later demonstrated an aneurysm at the distal segment of the right PICA. This aneurysm was then clipped successfully under suboccipital craniectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Distal aneurysm of posterior inferior cerebellar artery: report of two cases--pitfall in diagnosis]. 228 Aug 14

The pathophysiology and treatment of acute subarachnoid hemorrhage (SAH) are reviewed. SAH occurs when blood is released into the subarachnoid space, which surrounds the brain and spinal cord. Symptoms of SAH include severe headache, nausea, vomiting, neck pain, nuchal rigidity, and photophobia. The initial hemorrhage is fatal in 20-30% of patients. Complications of SAH include rebleeding, hydrocephalus, delayed cerebral ischemia associated with cerebral vasospasm, and seizures. The likelihood of rebleeding is increased by measures that rapidly lower intracranial pressure. The risk of developing hydrocephalus is associated with the volume of blood within the subarachnoid space and ventricular system. Cerebral vasospasm develops in 20-40% of patients, and up to 50% of affected patients die or suffer permanent neurological damage. Seizures occur in 5-15% of patients with SAH. Radiologic procedures form the foundation for the diagnosis of SAH. The most commonly used rating scale classifies the severity of SAH based on the clinical presentation of the patient. Surgery is the definitive treatment for the prevention of rebleeding. Hydrocephalus can only be treated surgically, most commonly by insertion of a drain. The only measures proved to be effective for treatment of delayed cerebral ischemia are volume expansion and the induction of hypertension. The calcium-channel blocker nimodipine was recently approved for treatment of arterial spasm in SAH. Intravenous nicardipine is also being studied for the same indication. These agents may improve clinical outcome substantially by limiting fixed neurological deficits. To prevent seizures, prophylactic antiepileptic therapy with phenytoin sodium is generally accepted. The SAH complications of rebleeding, hydrocephalus, delayed cerebral ischemia, and seizures are managed by surgical, drug, and fluid therapy.
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PMID:Pathophysiology and treatment of subarachnoid hemorrhage. 240 1

The authors describe a case of persistent primitive hypoglossal artery aneurysm in a 42-year-old woman who had complained of headache, mainly in the occiput, for 5 days prior to admission. Because of a sudden exacerbation of the headache associated with vomiting, she was hospitalized on July 31, 1988. On admission, a cranial computed tomography scan demonstrated a high density lesion in the basal cisterns which suggested subarachnoid hemorrhage (SAH). Right carotid angiography revealed a persistent primitive hypoglossal artery and an aneurysm arising from this artery at the junction of the posterior inferior cerebellar artery. Bilateral vertebral arteries were shown to be hypoplastic. This was followed by a right suboccipital craniectomy on the 6th hospital day at which time a neck clipping was made. Her postoperative course was uneventful. On discharge on August 22, she was ambulatory and had no neurological deficit except for a mild hoarseness which developed after surgery. Well over one hundred cases of persistent primitive hypoglossal artery aneurysm have been reported. However, as far as we could discern, there have been only 9 cases of persistent primitive hypoglossal artery aneurysm including this present case. Most of the cases had SAH due to the rupture of these aneurysms with favorable outcome after the surgery. In addition, some embryological considerations were made.
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PMID:[A case report: persistent primitive hypoglossal artery aneurysm]. 240 42


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