Acute Onset Of Headache Research Articles

Comparison of neurological clinical manifestation in patients with hemorrhagic and ischemic stroke

Cerebrovascular accident (CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't significant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients. A descriptive hospital-based study of the neurological symptoms and signs of 503 patients with ischemic stroke, including severe headache, seizure, eye movement disorder, pupil size, Glasgow Coma Scale (GCS), agitation were analyzed in this study. In the current study, dilated pupils, agitation, acute onset headache, lower GCS score, seizure, and eye gaze impairment had significantly higher prevalence in hemorrhagic stroke patients (P<0.001). However, the rate of gradual progressive headache is significantly higher in ischemic stroke patients (P<0.001). Although this result provides reliable indicators for discrimination of stroke types, imaging studies are still the gold standard modality for diagnosis.

Influenza in Children.

In children, influenza is one among the commonest causes of acute respiratory illness and loss of school days. Influenza A, B, and C are 3 types of viruses responsible for illness. Type A virus has many subtypes based on antigens but Type B and Type C viruses have no known subtypes. Currently, influenza A/H1N1, A/H3N2, and influenza type B viruses are circulating in humans. Transmission of influenza occurs through droplets from infected person or through direct contact with person or fomites. Clinically, influenza is characterized by acute onset fever, chills, running nose, cough, sore throat, headache and myalgia. Mostly, febrile illness lasts for 3-4 d with resolution of disease in 7-10 d. Confirmation of influenza can be done either by virus culture, RT-PCR or specific neutralizing antibodies in blood. Basic principles of management include prompt institution of infection control measures, early identification of children at higher risk, supportive care and antiviral drugs. Vaccine and chemoprophylaxis are two commonly used methods for prevention of influenza. Currently, inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) are available for use with good efficacy. Cough etiquette, use of face masks and hand hygiene are the most important measures to reduce the risk of infection transmission from person to person.

Clinically significant intratumoral hemorrhage in patients with vestibular schwannoma.

The frequency of intratumoral hemorrhage (ITH) in vestibular schwannoma (VS) remains undefined. Retrospective case series of all patients diagnosed with hemorrhagic VS between 2003 and 2015 at a single tertiary academic skull base center. Five patients with ITH were evaluated, representing 0.4% of all newly diagnosed VS evaluated at the authors' center during this time. The median age at time of diagnosis was 66 years (range 39-83), four of five cases occurred in men, and all had sporadic unilateral tumors. The frequency of ITH among patients receiving anticoagulation was 5.6% (2 of 36), compared to only 0.2% (3 of 1356) in non-anticoagulated patients (P = 0.006), representing a 25-fold increase. At time of hemorrhage, all patients had acute onset of headache, disequilibrium, and progression of hearing loss; three reported trigeminal symptoms, and two exhibited acute moderate facial paresis. The median tumor size at diagnosis of hemorrhage was 3.1 cm (range 2.4-4.2 cm), and three patients had radiological evidence of hydrocephalus. All patients underwent microsurgical resection. There were no perioperative deaths. At a median follow-up of 25 months (3-70 months), no patient has experienced tumor recurrence. Tumor-associated hemorrhage in VS occurs in 0.4% of cases and commonly presents with acute neurological change. The risk of clinically significant hemorrhage is greater in patients receiving anticoagulation compared to the general VS population. Prompt microsurgical resection should be pursued when possible since tumor removal may improve neurological symptoms, relieve brainstem compression, and reduce the risk of repeat hemorrhage. 4. Laryngoscope, 127:1420-1426, 2017.

Posterior reversible encephalopathy syndrome and association with systemic lupus erythematosus.

Posterior reversible encephalopathy syndrome (PRES) is a neurological complex disorder with many clinical associations and causative factors. It is important to recognize this condition because early diagnosis and treatment usually result in its complete resolution, radiological imaging becoming the key for the correct diagnosis. We retrospectively reviewed charts and magnetic resonance imaging findings in the University of Campinas from January 2005 to July 2015, selecting three cases of patients with systemic lupus erythematosus syndrome who developed PRES, for whom risk factors, characteristics, magnetic resonance imaging findings and neurological resolution were analyzed. We also conducted a review of the English-language literature. The three cases had neurological symptoms like acute onset of headache, altered mental status, cortical blindness and seizures. Brain magnetic resonance imaging demonstrated posterior cortical and white matter alterations involving posterior brain territories, which were more conspicuous on T2-weighted and fluid-attenuated inversion recovery. Spectroscopy, diffusion-weighted imaging and susceptibility-weighted imaging were also important for neuroradiological evaluation. Immunosuppressive drugs were taken in all cases. Partial clinical and radiological recovery was observed in two cases, and complete resolution was observed in the third patient. We found 52 cases of PRES in systemic lupus erythematosus patients. Almost all patients were women 94%, ranging from 8 to 62 years old. Posterior brain territory involvements were found in 98% of patients. Hemorrhagic complications involved 26% of patients, becoming a risk factor for clinical sequels. The total percentage of patients with no complete resolution of radiological findings on follow-up images was 27.5%. In patients with autoimmune disorders, endothelial dysfunction may occur secondary to autoimmunity and the use of cytotoxic drugs, supposedly facilitating the occurrence of more severe PRES. The hypothesis that patients with autoimmune diseases have a propensity to develop non-reversible lesions has been raised.

Case 3: Acute Onset of Headache, Fever, and Right Arm Weakness in 12-year-old Boy

Case 3: Acute Onset of Headache, Fever, and Right Arm Weakness in 12-year-old Boy

Orbital Compartment Syndrome as the Presenting Sign of Disseminated Intravascular Coagulation From Metastatic Prostatic Cancer to the Orbit

A 70-year-old man with castrate-resistant metastatic prostate cancer to the lumbar spine presented with sudden onset of left orbital compartment syndrome. Hematologic workup revealed disseminated intravascular coagulation with isolated left orbital hemorrhage. A canthotomy and blood product transfusions failed to control the bleeding and restore vision. Operative intervention found a new left orbital roof metastasis from primary prostatic carcinoma. Acute onset of headache or ocular pain in patients with metastatic prostate cancer warrants further workup to rule out orbital and intracranial metastases, rare but significant clinical entities that can lead to severe complications.

PP04.4 – 2897: SMART syndrome: A rare complication of cranial radiotherapy

Objective SMART syndrome (stroke-like migraine attacks after radiation therapy) is a rare complication of cranial radiotherapy characterized by migraine-like headache and transient neurological deficits with typical gyriform enhancement on magnetic resonance imaging (MRI). Little is known about the pathophysiology of this condition. Potential underlying mechanisms are endothelial damage or dysfunction, vascular instability, vasospasm and, neuronal dysfunction. Patients We report an 11-year-old girl with primary diagnosis of medulloblastoma presented with acute-onset severe headache and left sided weakness 20 months after completion of cranial radiotherapy. MRI demonstrated unilateral cortical swelling and concomitant leptomeningeal, gyral contrast enhancement, and increased cortical perfusion in the right temporoparietooccipital region. Her symptoms resolved spontaneously over several days. Conclusion SMART syndrome appears to be a reversible and long-term complication of cranial radiotherapy. Up to now, a limited number of pediatric patients with SMART syndrome have been reported. Awareness and recognition of clinical signs and radiological imaging of SMART syndrome is important for preventing unnecessary interventions, appropriate diagnostic workup and management.

Temporoparietal Headache as the Initial Presenting Symptom of a Massive Aortic Dissection.

Aortic dissection is a life-threatening medical emergency often presenting with severe chest pain and acute hemodynamic compromise. The presentation of aortic dissection can sometimes be different thus leading to a challenge in prompt diagnosis and treatment as demonstrated by the following presentation and discussion. We present a case of a 71-year-old male who presented to the emergency department with complaints of left sided temporoparietal headache and was eventually diagnosed with a thoracic aortic dissection involving the ascending aorta and descending aorta, with an intramural hematoma in the descending aorta. This case illustrates the importance of keeping in mind aortic dissection as a differential diagnosis in patients with acute onset headaches in which any intracranial source of headache is not found.

Rapid aneurysm growth and rupture in systemic lupus erythematosus

Background:Subarachnoid hemorrhage (SAH) due to intracranial aneurysm rupture is a major neurosurgical emergency associated with significant morbidity and mortality. Rapid aneurysm growth is associated with rupture. Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder whose complications can include cerebral vasculitis and vasculopathy. Intracranial aneurysms are not known to occur more frequently in SLE patients than the general population; however, aneurysm growth rates have not been studied in SLE.Case Description:We present a 43-year-old female with SLE on prednisone, hydroxychloroquine, and azathioprine with moderate disease activity who presented with severe, acute-onset headache and was found to have Hunt and Hess grade II SAH due to rupture of an 8 mm saccular anterior communicating artery (ACoA) aneurysm. The patient developed severe vasospasm, re-ruptured, and was taken for angiography and embolization, which was challenging due to a high degree of vasospasm and arterial stenosis. Review of imaging from less than 2 years prior demonstrated a normal ACoA complex without evidence of an aneurysm.Conclusion:We review the literature and discuss the risk factors and pathophysiology of rapid aneurysm growth and rupture, as well as the pathologic vascular changes associated with SLE. Although SLE patients do not develop intracranial aneurysm at an increased rate, these changes may predispose them to higher incidence of growth and rupture. This possibility-coupled with increased morbidity and mortality of SAH in SLE-suggests that SAH should be considered in SLE patients presenting with headache, and advocates for more aggressive treatment of SLE patients with unruptured aneurysms.

Pediatric cerebral ganglioneuroblastoma

We describe a 4-year-old girl with acute onset headaches and transient blindness who underwent surgical intervention, chemotherapy, and radiotherapy for an intracranial mass. This mass was pathologically confirmed as a primary intracranial ganglioneuroblastoma, a rare finding in the pediatric population. The literature on pediatric primary intracranial ganglioneuroblastoma is reviewed.

Spontaneous Dural Tear Presenting as an Acute-Onset Headache After a Minor Fall: A Case Report.

Osler, Polina MS1; Herzog, Tyler L. BS1; Mulroy, Sarah1; Grottkau, Brian E. MD1 Author Information

Optic Nerve Sheath Fenestration for the Treatment of Papilledema Secondary to Cerebral Venous Thrombosis

A 16-year-old adolescent girl with multiple risk factors for thrombosis presented with acute onset of headache, decreased vision, and papilledema. Evaluation demonstrated cerebral venous thrombosis (CVT) involving the left transverse and sigmoid sinuses and left internal jugular vein. Following bilateral optic nerve sheath fenestration (ONSF), she experienced improvement in vision and resolution of papilledema. In selected cases, ONSF is an effective surgical option for the treatment of papilledema due to CVT after medical treatment has failed.

Lactococcus garvieaeendocarditis presenting with subdural haematoma

BackgroundLactococcus garvieae is a rare cause of infective endocarditis (IE) in humans and the bacterium can easily be misidentified. Intracranial haemorrhage often occurs in conjunction with IE, but subdural haemorrhage (SDH) is very rarely encountered.Case presentationThe patient was an 81-year-old male with a history of cardiovascular disease and a prosthetic biologic aortic valve. He presented with fatigue and an acute onset of headache. Computed tomography (CT) revealed a left-sided fronto-temporal subdural haematoma. Low-grade fever was noted and blood cultures yielded growth of L. garvieae. Transesophageal echocardiography (TEE) revealed small vegetations on the native mitral valve and on the prosthetic aortic valve. Treatment with penicillin and tobramycin was initiated and the recovery was slow but uneventful.ConclusionThis is the first report of a case where SDH was the sole presenting neurological sign of IE. The case demonstrates that IE should be considered in patients with SDH where a history of trauma is absent, especially if the patient has fever or predisposing conditions such as a prosthetic heart valve.

Noninvasive diagnosis and management of spontaneous intracranial hypotension in patients with marfan syndrome: Case Report and Review of the Literature

Background:Spontaneous intracranial hypotension is an uncommon clinical entity. Heritable connective tissue disorders (HCTD), such as Marfan syndrome, are frequently implicated as an underlying cause, due to dural structural weaknesses that predispose patients to spontaneous cerebrospinal fluid (CSF) leak. Due to the high prevalence of multi-system disease in HCTD, diagnosis and treatment are often complicated.Case Description:We present a 58-year-old female with Marfan syndrome on anticoagulation for a mechanical aortic valve replacement who came to medical attention with severe, acute-onset headache following a straining episode. Noninvasive magnetic resonance (MR) myelography confirmed thoracic CSF extravasations and multiple lumbar diverticula. The patient was treated conservatively and her symptoms resolved.Conclusion:We discuss the common presentation, diagnostic tools, and treatment options for spontaneous CSF leaks in patients with Marfan syndrome or related HCTD with an emphasis on noninvasive modalities and a review of the major radiographic criteria used to diagnose dural abnormalities, such as dural ectasia.

MCA Dissection Presenting with Intracerebral and Subarachnoid Hemorrhage

Dissecting aneurysm of the intracranial arteries is uncommon and isolated dissection of middle cerebral artery (MCA) is much rarer. Cerebral infarction is the usual presentation of MCA dissection in first two decades, hemorrhagic manifestation being much rare. We describe a young male patient who presented with acute onset headache and left sided hemiparesis due to acute intra-parenchymal hemorrhage. Digital subtraction angiography finally revealed dissection involving M2 segment of right MCA as the possible cause of intracerebral hemorrhage in this patient. This type of uncommon presentation of MCA dissection is rarely reported before.

Toxoplasma encephalitis in an HIV-infected patient on highly active antiretroviral therapy despite sustained immune response

Toxoplasma encephalitis (TE) is usually diagnosed in advanced stages of HIV infection when the CD4+ count is <100-200 cells/µl. A 55-year-old woman with HIV/AIDS, well controlled on antiretroviral therapy (ART), CD4+ count in the 300 cells/μl range for >1 year presented with acute onset of headache, nausea and vomiting. She had been on her current ART regimen consisting of raltegravir, co-formulated emtricitabine/tenofovir and etravirine for three years and had been off Pneumocystis prophylaxis for 10 months (trimethoprim-sulfamethoxazole). Brain MRI showed multiple ring-enhancing, supratentorial and infra-tentorial parenchymal lesions suspicious for metastases. She had no other evidence of metastatic disease in her body. The possibilities of TE and primary CNS lymphoma were considered but deemed unlikely given the high CD4+ count. A brain biopsy demonstrated Toxoplasma tachyzoites. There was no evidence of lymphoma or carcinoma. Anti-toxoplasma treatment yielded good initial clinical and radiographic responses. While on TE maintenance therapy, she developed similar symptoms. Repeat MRI showed progression of lesions. Further work-up including CSF Epstein-Barr virus PCR and SPECT Th 201 imaging was not conclusive for CNS lymphoma. The patient's clinical condition deteriorated and she died. We postulate that functional immunological dysfunction is a possible mechanism by which our patient developed TE despite demonstrating sustained immune response on ART.

Predominant intraventricular hemorrhage from a ruptured posterior communicating artery aneurysm.

A 45-year-old woman presented with acute onset of headache and confusion. A computed tomography (CT) of the brain showed predominant intraventricular hemorrhage (IVH) without significant subarachnoid hemorrhage (Figure 1A and B). A CT angiography showed a laterally oriented, left posterior communicating artery (PCOM) aneurysm (Figure 1C). This aneurysm, confirmed by cerebral angiography (Figure 1D), was successfully coil embolized. The ventriculostomy was placed in the right lateral ventricle to treat the obstructive hydrocephalus. The patient survived without major neurological deficits. Although ruptured cerebral aneurysms rarely present as isolated IVH, laterally oriented PCOM aneurysms can rupture through the medial temporal lobe, causing predominant IVH without subarachnoid hemorrhage. This case highlights the importance of urgent vascular imaging for optimal IVH evaluation and management.

Isolated Sinusitis of Lateral Recesses of Sphenoid Sinus

To the Editor: An 11-y-old boy presented with acute onset headache, eye pain and fever. There was no sinus tenderness, and symptoms did not resolve with oral antibiotics and antihistaminics. The CTscan of paranasal sinuses was done which revealed acute sinusitis with fluid only within lateral recesses of bilateral sphenoid sinuses (Fig. 1). This finding was also confirmed on MRI (Fig. 2). Rests of the sinuses, particularly bilateral frontal sinuses were clear (Fig. 3). No neurological complications were seen. The child was managed with intravenous antibiotics and endoscopic sphenoidotomy. Intraoperatively, hypertrophied inflamed polypoidal mucosa was seen involving the lateral recesses of sphenoid sinuses which were excised and curetted. On histopathological examination of the excised tissue, the lamina propria and epithelial layer showed extensive edema with infiltration of neutrophils and mononuclear cells, thrombophlebitis and necrotic foci suggestive of acute inflammatory pathology. Follow-up after one month showed near complete resolution with minimal soft tissue in right lateral recess (Fig. 4). Imaging finding of an isolated acute sinusitis of lateral recess of sphenoid sinus in a child is very uncommon and has not been described in the literature. The diagnosis is often delayed until there is a neurological complication. An important differential diagnoses with similar imaging findings that should be kept in mind while treating these cases is meningocele/meningoencephalocele of the lateral recesses, due to persistence of Sternberg’s canal. These patients usually present with spontaneous cerebrospinal fluid leaks and clinical meningitis. The anatomical location of Sternberg’s canal is medial to the superior orbital fissure Fig. 1 a Axial and b Coronal non-contrast CT scan of paranasal sinuses showing fluid within bilateral lateral recesses (arrow) of the sphenoid sinus (arrowhead) and clear bilateral ethmoid sinuses (asterisk)

Posterior reversible encephalopathy syndrome (PRES) in an HIV-1 infected patient with disseminated varicella zoster virus: a case report

BackgroundPosterior reversible encephalopathy syndrome (PRES) is an uncommon pathology characterized by the acute onset of headache, vomiting, altered consciousness, seizures and focal neurological deficits. It was initially described in the setting of hypertension, uremia and immunosuppression. In the last decade there have been emerging reports of PRES in patients with advanced human immunodeficiency virus (HIV)-infection in the presence of hypertension, dialysis, hypercalcaemia and two opportunistic infections: blastomycosis and tuberculosis (TB).Case presentationHere we present the case of a 54 year old male being treated for disseminated varicella zoster virus (VZV) and vasculopathy in the setting of HIV infection who acutely deteriorated to the point of requiring intubation. His clinicoradiological diagnosis was of PRES and he subsequently improved within 72 h with supportive management. Serial neuroimaging correlated with the clinical findings. The pathogenesis of PRES is poorly understood but is thought to stem from vasogenic oedema either as a result of loss of endothelial integrity and transudate of fluid across the blood–brain barrier, or secondary to vasospasm resulting in tissue oedema in the absence of infarction. How HIV infection impacts on this model is unclear. It is possible the HIV infection causes endothelial dysfunction and disruption of the blood–brain barrier that may be further exacerbated by infections in the central nervous system.ConclusionThe phenomenon of PRES in advanced HIV is an important clinical entity for both physicians and critical care doctors to recognize firstly given its potential mortality but also because of its favourable prognosis and reversibility with supportive care and treatment of underlying causes.

Acute Onset Headache and Left Eye Swelling

A 21-year-old male search and rescue swimmer presented with a 1-day history of acute onset headache and left eye swelling. He denied any trauma but reported blowing his nose in the shower prior to the onset. The patient reported 2 similar headache episodes without eye swelling 3 months prior. The first was also triggered by blowing his nose, and the second occurred while exercising. Both previous headaches resolved over 2 days and were associated with a self-described audible “water trickling” sound in the left side of his head. The patient denied any weakness, paresthesias, or alteredmental status. On examination, the patient was neurologically intact. He had marked periorbital edema with associated crepitus. His ophthalmologic examination was grossly unremarkable except for diplopia during right lateral gaze. Noncontrast computed tomographic (CT) imaging of the sinuses showed a 1.8 × 1.2 × 2.3-cm, well-delineated, hyperdense lesion centered within the left anterior ethmoid air cells that partially protruded into the medial orbit without significant mass effect on the medial rectus or globe (Figure, A). An extensive left-sided pneumocephalus was identified with possible dehiscences in the posterior margin of the frontal sinus, lamina papyracea, and/or cribiform plate (Figure, B and C). What is your diagnosis? A