History Of Severe Headache Research Articles

Association of dietary vitamin C consumption with severe headache or migraine among adults: a cross-sectional study of NHANES 1999-2004.

An antioxidant-rich diet has been shown to protect against migraines in previous research. However, little has been discovered regarding the association between migraines and vitamin C (an essential dietary antioxidant). This study assessed the dietary vitamin C intake among adult migraineurs in the United States to determine if there is a correlation between migraine incidence and vitamin C consumption in adults. This cross-sectional research encompassed adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004, providing detailed information on their dietary vitamin C intake as well as their history of severe headaches or migraines. The study used weighted multivariable and logistic regression analyses to find an independent connection between vitamin C consumption and severe headache or migraine. Tests of interactions and subgroup analysis were conducted. Among the 13,445 individuals in the sample, 20.42% had a severe headache or migraine. In fully adjusted models, dietary vitamin C consumption was substantially linked negatively with severe headache or migraine (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.91-0.98, p = 0.0007). Compared to quartile 1, quartile 4 had 22% fewer odds of having a severe headache or migraine (OR = 0.78, 95% CI = 0.69-0.89, p = 0.0002). Subgroup analyses showed a significant difference between vitamin C intake and severe headaches or migraines by gender (p for interaction < 0.01). Reduced risk of severe headaches or migraines may be associated with increased consumption of vitamin C.

Intracerebral Haemorrhage after Illicit Use of Sildenafil: A Case Report

Sildenafil(viagra) has become one of the top selling over the counter product for the treatment of male erectile dysfunction.(1) We report a case of 34year male patient admitted in our ICU with history of severe headache followed by sudden loss of consciousness after ingestion of two tablets of sildenafil(50mg) land up intracerebral bleed and died. There are many cases in the literature reporting intracerebral or subarachnoid haemorrhage associated with use of sildenafil while sexual contact.

Ruptured Intracranial Vascular Aneurysm with Subarachnoid Haemorrhage: Autopsy Case Series and Literature Review

Background: Subarachnoid haemorrhage (SAH) is a severe condition where bleeding occurs in the subarachnoid space surrounding the brain. SAH can be caused by a ruptured aneurysm or head injury leading to a stroke (with associated disability or death). Common symptoms include severe (thunderclap) headache, neck pain, nausea, vomiting, and sensitivity to light. Case Presentations: Firstly, a 58-year-old man presented with a history of severe headaches and inability to use the left side of his body, with a possible hemorrhagic right-sided hemispheric stroke diagnosis. Following death, an autopsy revealed a ruptured intracranial Charcot Bouchard aneurysm, with SAH as the cause. Secondly, a 35-year-old woman presented with a sudden loss of consciousness and three episodes of generalised tonic-clonic convulsion during a coital activity at a guest house. Following death, an autopsy revealed a ruptured middle cerebral artery’s saccular (berry) aneurysm, causing SAH with bilateral tonsillar herniation as the cause. These case series highlight the importance of autopsy in diagnosing SAH.

Rare case of double seronegative ocular myasthenia gravis and non-functional pituitary macroadenoma

Chronic autoimmune neuromuscular disorder known as Myasthenia Gravis (MG). The relationship of myasthenia gravis with pituitary adenomas is relatively uncommon, despite the fact that it is widely known that people with the condition have a higher prevalence of other autoimmune diseases. Here, we describe the case of a 45-year-old Indian man who had complained of severe cephalgia, associated with ocular pain, dizziness, diplopia, ptosis of the unilateral right eye. Although he has a history of severe headaches that started prior to 3 months, his complaints became more obvious at the end of the day. An MRI of the brain revealed an increased pituitary gland that measured 13.7 × 15.5 x 16. 9 mm. Furthermore, post admission histological examinations supported the diagnosis of a double seronegative ocular myasthenia gravis and non-functional pituitary macroadenoma. Following treatment, it was discovered that Pyridostigmin and Prednisolone considerably reduced his myasthenia symptoms. Finally, it should be noted that pituitary tumours are one potential underlying cause of headache in myasthenic patients.

The Radiological Appearances Of Rhino-Cerebral Mucormycosis (Black Fungus) In Brain and Nose - A Case Study

Background: Rhino cerebral Mucormycosis is life-threatening contamination as a result of saprophytic fungi visible nearly solely in immuno-compromised sufferers. The goal of this observes changed to explain the imaging findings in sufferers with rhinocerebral mucormycosis. The following motive was to present not unusual place radiographic styles that can be beneficial in concluding the prognosis of rhinocerebral mucormycosis. We retrospectively evaluated the imaging and scientific records of 1 adult male, 46 years old, with rhinocerebral mucormycosis.Case presentation: We herein present an interesting case of a 46-year-old male patient of the department of ENT (Ear, Nose and Throat). A patient came on an outpatient basis with a clinical history of severe headache in the last 20 days, blurring of vision in bilateral eyes, diplopia and fainting in the previous 8-10 days, fever (on &amp; off) in the past 8 days. Swelling on forehead, eyes and overall face diagnosis was done with the help of MRI scan imaging and treated with excision of black fungus. Mucormycosis is a rare disease, but it is more frequent in persons with health issues or who use medications such decrease the body's ability to fight infections and illness. As a result, other specific groups of people are more likely to get Mucormycosis.

Efficacy of Physiotherapy Rehabilitation for Hemiparesis following Cerebral Venous Sinus Thrombosis: A Rare Case Report

Background: In Cerebral Vascular Disease when one or more arteries are thrombosed it results in Cerebral Venous Sinus Thrombosis (CVST) and affects in all ages. This condition is very challenging as it is not diagnosed early due to diverse signs and symptoms and involvement of extensive collateral circulation. Superior sagittal sinus is a large sinus which is commonly affected. Usually, patient comes with clinical presentation of headache with papilledema, to focal deficit, seizures and coma. &#x0D; Aim: To investigate the efficacy of Physiotherapy Rehabilitation for Hemiparesis following Cerebral Venous Sinus Thrombosis.&#x0D; Presentation of Case: A 18-year-old male patient presented with a history of severe headache, weakness in his right arm and leg, dizziness upon rising from bed, and a unilateral headache. On investigation CT scan and MRI brain was done. The physiotherapy has started from 2 days after admission in AVBRH.&#x0D; Discussion: In the cases of cerebral venous sinus thrombosis the management of hemiparesis is shown to enhance the ADL and quality of life of patients.&#x0D; Conclusion: The rehabilitation protocol planned will help in improving the range of motion and ADL of patient when started as early as possible.

CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele

A 45-year-old female with medical background significant for bronchial asthma, hypothyroidism, polycystic kidney disease and obesity presented to the emergency department in December 2020 with one week history of severe headache, unilateral rhinorrhea and metallic taste. Her symptoms started two days after she had nasopharyngeal swab as post travel screening routine. Radiological investigations revealed features of increased intracranial pressure and a suspicious skull base defect for which patient undergone endoscopic transnasal skull base repair. Intraoperative findings were positive for CSF leak from a skull base defect and an incidental finding of Meningiocle. Patient was seen after three weeks with no more CSF rhinorrhea, but was complaining of persistent mild headache, for which she was referred to neurology for further management. Conclusion: CSF leak is one of the rare, yet serious complications of nasopharyngeal swab especially in patients with previous skull base surgery, trauma, patients with pre-existing skull base defects or with elevated intracranial pressure. Meningocele found in this case report was presumed to be a predisposing factor for CSF leak post nasopharyngeal swab. Education about safe administration of nasopharyngeal swabs as well as understanding the nose anatomy is important to reduce the overall risk profile of nasopharyngeal sampling. Moreover, an alternative method of testing such as oropharyngeal specimen should be considered in populations with increased risk of CSF leak.

Recurrent Cerebellar Hemangioblastoma with Obstructive Hydrocephalus in Pregnancy: Challenges in Management—a Case Report

Hemangioblastoma is a rare brain tumor seen in pregnancy. Its management can be challenging due to the physiological changes of pregnancy. We discuss the challenges of managing such patients during pregnancy and review the literature regarding the management of cerebellar hemangioblastoma during pregnancy. We report a case of recurrent cerebellar hemangioblastoma who presented in pregnancy with a repeated history of severe headache and papilledema at 36 weeks. She was diagnosed to have obstructive hydrocephalus which did not respond to conservative management. Cesarean delivery along with cerebrospinal fluid diversion, ventriculoperitoneal shunt procedure, and excision of posterior fossa cyst was done, which resulted in good maternal and neonatal outcome. The risk of newborn and maternal mortality can be minimized by knowing the challenges and their appropriate management.

Rare Case of a Disappearing Pituitary Adenoma During the Coronavirus Disease 2019 (COVID-19) Pandemic

We present a case of a 28-year-old woman with a history of severe headaches and pituitary insufficiency. She was found to have a large, enhancing, sellar mass consistent with a pituitary adenoma. The patient's surgical care was delayed due to the coronavirus disease 2019 (COVID-19) pandemic, and follow-up imaging revealed spontaneous involution of the sellar mass. Spontaneous involution of pituitary masses has been described but not often encountered in clinical practice. This case highlights that follow-up imaging is necessary when scheduling elective surgeries during the COVID-19 pandemic.

Posterior Reversible Leukpoencephaopthy Syndrome Associated with SARS-CoV-2 Antibodies

A 60-year-old caucasian woman was transferred from an outside hospital with one week history of severe headache, intermittent nausea, vomiting, and a one day history of episodes of dizziness, ataxia, and falls. An initial non-contrast computed tomographic of head demonstrated diffuse cerebral edema prompting transfer to our institution for further evaluation and management.

Beware of cryptococcomas when treating Cryptococcal meningitis

Introduction: The authors describe a rare presentation of central nervous system cryptococcosis in an immunocompromised patient. Case description: An HIV-positive patient, with poor adherence to the treatment, presented with a seventeen days history of severe headache. On the neurological exam there was only evidence of neck stiffness, he had a CD4 count of 23 cells/μl and plasma HIV RNA viral loads of 364,000 copies/ml. Lumbar puncture revealed positive for cryptococcal antigen virus and so treatment with amphotericin B was started. During his admission the patient developed an expressive aphasia with visual hallucinations and the brain MRI revealed cerebral cryptococcomas. After 98 days of treatment general and neurological examination was normal and the patient was discharged home. Conclusion: This case highlights a rare and severe complication of Cryptococcus neoformans infection in immunocompromised patients.

Spontaneous parieto-occipital haematoma: lessons for the primary care clinician.

This case is intended to serve as a learning tool for all clinicians working in primary care. Headache is a commonly encountered problem in primary care and most cases do not mandate urgent transfer to secondary care. However, in this particular patient, there was focal neurology as well as a coital history of headache, both of which collectively mandated further investigation. She was diagnosed with a spontaneous parieto-occipital haemorrhage. On reflection, it is important to note that, despite this haemorrhage, the patient remained well enough to present to primary care and was still able to maintain a Glasgow Coma Scale score of 15/15. This case highlights two important areas of learning which could be useful to all healthcare professionals evaluating headaches. Firstly, any new focal neurology such as blurring of vision should prompt further investigation. Secondly, all healthcare professionals evaluating a sudden-onset headache should ask about whether the headache was coital or not, as this is very easy to ask and may prove to be very diagnostically useful. ### Presenting complaint A 44 year old woman presented to her GP on a morning walk-in clinic, complaining of an 18-hour history of severe headache which was spreading from the posterior to the anterior aspect of her head. She mentioned that this …

Pachymeningeal en Plaque Tuberculoma in Children: A Case Report

Pachymeningeal en plaque tuberculoma is a rare manifestation of tuberculosis and has a poor prognosis if not diagnosed early and treated adequately. The aim of the present paper is to collect the reported clinical and radiological signs in the literature and compare it with a personal observation to evaluate the possibility of a presumptive diagnosis. A 4-year-old boy presented at the pediatric emergency department with 7 days history of severe headache, vomiting blurred vision and had one partial seizure. His neurologic examination was notable for decreased visual acuity with bilateral papilledema and intact extra-ocular muscles. His neck was rigid. Neuroimaging revealed a multifocal dural-based mass on the fronto-parietal convexity with dense heterogeneous contrast enhancement and hydrocephalus. He has undergone a Ventriculoperitoneal shunt and surgical excision of the mass the next day. Outcome was favorable with antituberculosis therapy and corticosteroids. The clinical presentation and outcome were similar to the reported cases in the literature.

Cerebral venous thrombosis due to hereditary anti Thrombin III deficiency

Hereditary anti thrombin III (AT III) deficiency is usually associated with increased risk of venous thrombosis and pulmonary embolism. Cerebral venous thrombosis (CVT) is a rare manifestation. We report a case of hereditary AT III deficiency causing cerebral vein thrombosis in 3 members of a family. A 29 year old unmarried lady presented with 1 week history of severe headache and neck pain. Examination was unremarkable except for mild papilloedma. A contrast MRI and MRV revealed acute thrombosis involving left transverse, sigmoid sinuses and internal jugular veins. All relevant blood investigations were normal except for low antithrombin III activity --46% {normal: 80-120}. Her mother had 2 thrombotic events, one episode of cerebral vein thrombosis and one episode of probable renal artery thrombosis and she is asymptomatic now. Her AT III level was low-51%. Her sister had an episode of cerebral vein thrombosis during post-partum period and her AT III level was also low – 56%. Genetic study done in the index patient showed compound heterozygous mutation of SERPINC1 gene confirming the diagnosis of hereditary AT III deficiency. She recovered well with anticoagulation and was advised to continue it lifelong. Evaluation for hereditary thrombophilia should be done in patients with cerebral venous thrombosis especially if there is a family history of venous thromboembolism or unprovoked CVT. Diagnosing these conditions is important in planning anticoagulation and proper counselling of asymptomatic family members regarding prophylaxis for VTE in high risk situations.

076 A rare case of anti-glutamate decarboxylase antibody syndrome presenting with recurrent vomiting

IntroductionAnti-glutamte decarboxylase antibody (anti-GAD) has been linked with various neurological syndromes including stiff-person syndrome, limbic encephalopathy, cerebellar ataxia, eye movement disorders and epilepsy (collectively known as ‘anti-GAD positive neurological syndromes’).1 We describe a very atypical phenotypic presentation of anti-GAD syndrome with unexplained vomiting and weight loss.CaseA 46 years old lady with no past medical or family history of note, presented with 6 months history of severe headaches and recurrent attacks of episodic vomiting (4–6 episodes of multiple vomiting daily) with no identified precipitant and complete normality in between the episodes with no other associated symptoms. She reported 15 kg of unintentional weight loss. Neurological examination and investigations including MRI brain, CT angiogram and liver enzymes, immunoglobulins, thyroid function, vasculitic screen were normal. Upper GI endoscopy, gastric emptying studies, CT imaging of chest, abdomen and pelvis and whole body PET scan were unremarkable. Serum autoimmune antibody screen was positive with high titre of anti-GAD antibody (1200 kU/liter). The cerebrospinal fluid anti-GAD antibody titre was raised at 103.7 kU/liter with otherwise normal parameters including negative oligoclonal bands. The nerve conduction studies did not show continuous motor activity or spasmodic reflex myoclonus (seen in stiff-person syndrome).2 A therapeutic trial of immunosuppression was introduced with moderate improvement in symptoms.ConclusionAnti-GAD neurological syndromes are rare and this is a unique presentation of the same. It is not completely understood why the presence of one antibody causes varied syndromes. The hypothesis is that the recurrent vomiting is possibly due to diaphragmatic spasms.ReferencesSaiz A, Blanco Y, Sabater L, et al. Spectrum of neurological syndromes associated with glutamic acid decarboxylase antibodies: diagnostic clues for this association. Brain 2008;131:2553–2563.Buechner S, Florio I, Capone L. Stiff person syndrome: A rare neurological disorder, heterogeneous in clinical presentation and not easy to treat. Case Rep Neurol Med2015; 2015:278065.

Case 5: Headache, Vomiting, and Elevated Blood Pressure while Voiding in an 8-year-old Girl

1. Ara Healey, MD*,† 2. Liam Fardy, MD*,‡ 3. Kevin Chan, MD, MPH*,† 1. *Department of Pediatrics, Memorial University of Newfoundland Faculty of Medicine, St John's, Newfoundland and Labrador, Canada 2. †Children and Women's Health Program, Eastern Health, St John's, Newfoundland and Labrador, Canada 3. ‡Children’s Health, Central Health, Gander, Newfoundland and Labrador, Canada An 8-year-old girl from South Sudan presents to the emergency department with a history of severe headache and vomiting with urination. She describes the headache as being present “all over” her head and rates the pain “15/10.” There is no history of morning or positional headache. She has had a history of vomiting with urination and defecation since she was 1 year old. From 1 to 6 years of age, the vomiting occurred sporadically, but during the 2 years before the emergency department visit, vomiting was occurring 4 to 5 times daily with voiding and defecation. Initial vital signs reveal a heart rate of 114 beats/min, a respiratory rate of 24 breaths/min, a temperature of 97.0°F (36.1°C), and blood pressure (BP) of 122/88 mm Hg. Funduscopic examination results are normal. Results of cardiovascular, respiratory, abdominal, and central nervous system examinations are normal. In the emergency department, we observe the child screaming with a headache and vomiting after 3 separate voids. Her BP increases to 143/94 mm Hg during these episodes. Between voids, she does not complain of headache and does not vomit. Her headache is treated with intravenous morphine. After treatment with morphine, the BP returns to 120/84 mm Hg. We provide no further …

Orbital Pseudotumor Initially Presented as Chronic Sinusitis: A Case Report

Idiopathic orbital pseudotumor, is defined as a benign, non-infective lesion characterized by orbital inflammatory process. A 73-year-old man, with a 1 year history of severe headache and unilateral left-sided chronic pan-sinusitis without orbital involvement underwent functional endoscopic sinus surgery (FESS) surgery due to sinusitis recurrence. Also Dacryocystorhinostomy (DCR) surgery and re-surgery of sphenoid sinus and middle turbinecomy were conducted. About 5 months later, patient presented with ocular pain, diplopia and reduced left eye movements. He underwent surgery and biopsy was conducted for histopathology and immunohistochemistry (IHC) and their reports confirmed the diagnosis of orbital pseudotumor. The initial symptoms did not start from orbit, interestingly. Notably, one of the differential diagnoses of unilateral chronic sinusitis can be orbital pseudotumor.

Successful perinatal management of a ruptured brain arteriovenous malformation in a pregnant patient by endovascular embolization followed by elective cesarean section: a single-case experience.

BackgroundAlthough brain arteriovenous malformations (AVM) usually remain asymptomatic during pregnancy, they can cause intracranial hemorrhage and lead to serious neurological deficits. Nowadays, it is accepted that treatment of a ruptured brain AVM during pregnancy should be based on neurologic, not obstetric, indications.Recently, endovascular treatment has been recognized as a treatment option associated in pregnant patients with brain AVMs.Case presentationA 34-year-old woman presented at 25 weeks of gestation with a history of severe headache followed by severe consciousness disturbance. Brain CT showed a subcortical hematoma in the right occipital lobe along with bilateral intraventricular hematomas. A cerebral angiogram was performed to confirm the diagnosis, which revealed right occipital AVM. At 27 weeks of gestation, endovascular embolization of the AVM was attempted under general anesthesia. The feeding artery and the nidus were simultaneously obliterated by injection of 50 % n-butyl-cyanoacrylate. As a result, the blood flow into the nidus was drastically decreased and the risk of re-bleeding was substantially reduced. At 38 weeks of gestation, elective cesarean section was performed to deliver the baby under combined spinal-epidural anesthesia (CSEA). An infant weighing 3665 g was delivered, with Apgar scores of 8 and 9 at 1 and 5 min, respectively.Postoperative analgesia was provided by a continuous infusion of ropivacaine via the epidural catheter. The infant was confirmed as not having any congenital anomalies.On POD 5, both of the patient and the infant were discharged home without any medical problems. The mother has shown no evidence of re-bleeding from the intracranial lesion since, and the infant is thriving well.ConclusionsEndovascular treatment in pregnant women is associated with various unique concerns. However, it can be carried out safely and effectively and is useful not only for saving the mother’s life but also for allowing the pregnancy to continue to term.

Cerebellar cryptococcoma due to Cryptococcus gattii VGI; a rare and first report from India

Introduction: Cryptococcus gattii is an emerging global pathogen. Recent reports suggest that C. gattii cryptococcosis is more common in immunocompetent as well as HIV-infected patients than earlier estimated. We report the first case of cerebellar cryptococcoma from India due to C. gattii in an immunocompetent individual. Case Presentation: A 73-year-old immunocompetent male, presented with a 3 month history of severe headache, neck stiffness, walking difficulty, bilateral papilloedema and slight cerebellar signs including gait imbalance and giddiness. Magnetic resonance imaging (MRI) revealed a well-defined enhancing lesion in the cerebellum, suggestive of abscess and mild hydrocephalus. Blood parameters and liver function tests were within normal limits. The patient underwent paramedian suboccipital craniotomy, and the aspirated purulent material grew Cryptococcus neoformans. Histologically, the lesion was a cryptococcoma. The isolate was further identified as C. gattii VGI, serotype C, mating type alpha, and produced extracellular phospholipase enzyme. It was sensitive to amphotericin B, 5-flucytosine and azoles. The patient was treated with intravenous amphotericin B (0.7 mg kg–1 day–1) for 15 days along with a maintenance dose of oral fluconazole (400 mg day–1) for 6 months. The patient's symptoms recovered while on treatment but he was lost to follow up. Conclusion: Cryptococcus gattii is an emerging pathogen in India that affects otherwise healthy, immunocompetent individuals and requires rapid identification and treatment in order to prevent severe neurological sequelae.

PP04.2 – 2598: The varicella-zoster virus vasculopathy: Case report

Objectives Varicella zoster virus (VZV) is a common childhood infection. Reactivation may cause various neurological complications, including infection of cerebral arteries, resulting in vascular remodeling and stroke. We are presenting an unusual pediatric case of VZV vasculopathy. Case report A six years old boy, with no history of immunologic or neurologic disorder, was admitted to our hospital due to two episodes of diplopia and gait unsteadiness. No history of severe headaches was noted. He had chickenpox 20 months earlier and no history of zoster rash. Physical examination revealed only mild torticollis. Ophthalmological examination was unremarkable. On magnetic resonance imaging (MRI) multiple T2/FLAIR hyperintensities were seen, most pronounced was in the ventral part of the right thalamus, and an old ischemic lesion in the left postcentral cortex, suggesting ischemic lesions of different ages. MR angiography was unremarkable. Cerebrospinal fluid (CSF) pleocytosis was present and it tested positive for VZV DNA; specific anti-VZV antibodies were not detected. Thrombophilia screening revealed he was homozygous for methylenetetrahydrofolate (MTHFR) gene mutation. Fourteen day treatment with intravenous acyclovir was applied. After three months the follow-up MRI showed two old lacunar ischemic lesions and multiple T2/FLAIR hyperintensities at the same locations, new lesions were not found. Symptoms have not reoccurred. Conclusion Our patient had an atypical clinical presentation of multifocal, probably small artery vasculopathy and subsequent ischemic strokes presumably after VZV reactivation wihout the preceding rash.