1/8. Spontaneous cerebrospinal fluid rhinorrhoea and pneumocephalus following temporal lobectomy for epilepsy.A 30-year-old female presented with headache, CSF rhinorrhoea, mild right facial weakness, 2 months following temporal lobectomy for epilepsy. CT revealed marked intraventricular pneumocephalus with breached air cells in the pneumatized lower part of temporal bone. The dural and bony defects repaired successfully with complete resolution of the pneumocephalus.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
2/8. Spontaneous cerebrospinal fluid rhinorrhea associated with chronic renal failure--case report.A 39-year-old woman was admitted with complaints of headache and nasal discharge on the left for 3 months which was later on proved to be cerebrospinal fluid (CSF). Neurological examination found no abnormalities except bilateral papilledema. neuroimaging demonstrated enlargement of the lamina cribrosa foramina through which the olfactory nerves pass, as well as empty sella and cerebral cortical atrophy. Bone mineral densitometry showed osteopenia. CSF Ca and blood parathyroid hormone levels were elevated. CSF pressure was 280 mmH2O. Bilateral frontal craniotomy was performed to expose the anterior fossa. Foraminal enlargement at the lamina cribrosa was confirmed, and islands of extra-osseous calcifications on the arachnoid membrane were identified. The base of the anterior fossa was repaired intradurally with fascial graft and fibrin glue on both sides. No CSF leakage was noted at 1-year follow up. Spontaneous CSF leakage probably resulted from enlargement of the foramina at the lamina cribrosa due to Ca mobilization from bones and pseudotumor cerebri not to the extent of hydrocephalus caused by poor CSF absorption at the arachnoid granulations obliterated by extra-osseous calcareous accumulation.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
3/8. Endonasal endoscopic treatment of parasellar arachnoid cyst: report of a case.A 40-year-old man presented with intractable headache of 5-year duration and a 1-month history of intermittent cerebrospinal fluid (CSF) rhinorrhea. magnetic resonance imaging showed a cystic lesion with signal characteristics similar to that of CSF. The patient underwent endonasal endoscopic surgery of the sphenoid sinus and the fistula was reinforced with facia, muscle cartilage, and posterior septal flap while performing cystocisternostomy. The postoperative course was uneventfiul CSF leakage stopped, and headache improved. Postoperative imaging revealed total collapse of the cyst cavity. Based on our findings, endonasal endoscopic treatment of the sellar and parasellar arachnoid cysts, if presenting into the sphenoid sinus, could be an acceptable minimally invasive alternative to the conventional modalities.- - - - - - - - - - ranking = 2keywords = headache (Clic here for more details about this article) |
4/8. Intrasphenoidal encephalocele associated with cerebrospinal fluid fistula and subdural hematomas: technical case report.OBJECTIVE AND IMPORTANCE: Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported. CLINICAL PRESENTATION: A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele. INTERVENTION: A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure. CONCLUSION: The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
5/8. Pseudotumour cerebri, CSF rhinorrhoea and the role of venous sinus stenting in treatment.We present a case of pseudotumour cerebri (PTC), which is important as it illustrates the effects of chronically raised CSF pressure, the relationship between PTC and venous sinus obstruction and the successful treatment of PTC using a venous sinus stent. A 38-year-old woman, previously diagnosed with PTC and unsuccessfully treated 10 years previously re-presented with spontaneous CSF rhinorrhoea. Imaging revealed dramatic changes of chronically raised CSF pressure and a defect in the anterior cranial fossa. The CSF leak was corrected surgically and a lumbo-peritoneal shunt inserted to correct a large postoperative subgaleal CSF collection. Direct retrograde cerebral venography (DRCV) demonstrated venous sinus obstruction due to a filling defect. This was associated with a pressure gradient and a high superior sagittal sinus pressure. The venous sinus obstruction was successfully treated with a venous sinus stent and the lumbo-peritoneal shunt was removed. Chronically raised CSF pressure in untreated cases of PTC may cause widespread changes in the skull, which in this case, culminated in a spontaneous CSF leak despite relatively mild headache and visual symptoms. Furthermore, cases of PTC secondary to venous sinus obstruction may be successfully treated using venous sinus stenting. The index of suspicion for venous sinus stenosis or obstruction should be raised in the investigation of patients with PTC.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
6/8. Giant intracranial mucocele.A 21-year-old man was admitted to hospital because of recent anosmia and liquorrhoea. He also complained of moderate headache and concentration problems in the past few years. On CT scan and MRI scans a big subfrontal process was seen, partially solid and partially cystic. Neurosurgical and histological findings proved that the lesion was an osteoma of the anterior skull base, concomitant with an intradurally extending mucocele.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
7/8. Vascular malformation of the cerebellopontine angle associated with "SUNCT" syndrome.A 70-year-old man complained of two distinct types of unilateral headache during the past fifteen years. When the illness began, the pain was intermittent and short-lasting. In successive years, the crises appeared in clusters and lasted weeks to months. At present, the pain occurs daily, and is located on the right side, from the forehead supraorbitally to the temporal region. Some attacks last 30 sec and are accompanied by tearing, conjunctival injection, rhinorrhea and a subjective need to micturate. Other headaches last 1/2-1 h and are occasionally accompanied by local ipsilateral dysautonomic symptoms. Attacks of pain are provoked by movements of the trunk and neck. A vascular malformation in the right cerebellopontine angle was demonstrated on cranial CT and MRI, and by angiography.- - - - - - - - - - ranking = 2keywords = headache (Clic here for more details about this article) |
8/8. pneumocephalus due to nasopharyngeal carcinoma: case report.A 55-year-old man with recurrent nasopharyngeal carcinoma presented with intractable headaches and intermittent rhinorrhoea for 2 weeks. CT showed severe destruction of the skull base by the tumour. The headache persisted despite intraventricular morphine. On the 29th hospital day, sudden onset of neurological deterioration led to coma, and CT revealed tension pneumocephalus due to nasopharyngeal carcinoma breaking through the skull base. The literature on pneumocephalus is reviewed and the aetiology discussed.- - - - - - - - - - ranking = 2keywords = headache (Clic here for more details about this article) |