1/10. Transitional interpersonality thunderclap headache.OBJECTIVE: To report a patient with multiple personality disorder who experienced severe acute headaches without warnings, solely during the transition between her host personality and her pain-prone personality. BACKGROUND: The initial detailed description of headache in multiple personality disorder was made by Packard and Brown and published in this journal 15 years ago. methods: Clinical history, neurologic examination, electroencephalogram, and brain magnetic resonance imaging. RESULTS: A 54-year-old holocaust survivor with an established diagnosis of multiple personality disorder had recurrent, excruciating, acute ("thunderclap") headaches only when switching between her domineering personality and her pain-prone personality, who suffered from chronic back pain. None of her personalities otherwise suffer from headaches. Electroencephalogram and brain magnetic resonance imaging were normal. CONCLUSION: This is an independent and current confirmation of the existence of transitional headaches in a patient with multiple personality disorder. They may occur as an isolated event during the switch process and have features of benign thunderclap headache.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/10. women and traumatic brain injury.women with TBI have been inadequately studied in relation to most aspects of pathophysiology, recovery, health and behavioral issues, and community integration. This is not entirely surprising in light of the preponderance of men with TBI but also reflects the traditional tendency of medical researchers to concentrate their efforts on men. Although most of the residual effects of TBI are gender-neutral, women may present some unique problems in relation to pain and endocrine issues, reproduction, and sexual functioning In addition, a woman's roles as wife, mother, and daughter are likely to result in a different constellation of family dynamics when TBI is introduced. attention to enrollment of women in research studies and the increasing number of multi-institutional studies of TBI may provide enlightenment on these issues in the future.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
3/10. sunct syndrome responsive to lamotrigine.BACKGROUND: Short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection, tearing, rhinorrhea (sunct syndrome) is a headache form generally refractory to drug therapy. Occasional patients with SUNCT have been reported with a successful response to lamotrigine. OBJECTIVE: To report two patients with SUNCT treated with lamotrigine. methods: Clinical history, neurologic examination, and brain magnetic resonance imaging. RESULTS: Both patients with sunct syndrome were successfully treated with lamotrigine. In both cases, when lamotrigine was tapered off, the attacks reappeared, only to disappear when the dose was again increased. In addition, lamotrigine was well tolerated and no undesired side-effects were reported. CONCLUSION: If the positive effect of lamotrigine in patients with SUNCT is confirmed in other cases, lamotrigine could become the first specific treatment for sunct syndrome.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
4/10. Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch.Puerperal women are reported to have a rate of cerebral infarction 13 times greater than non-pregnant females. We report a case of cerebral ischaemia in a 30-yr-old healthy parturient after epidural analgesia for labour, complicated by dural puncture treated with two epidural blood patches. Investigations showed the development of cerebral ischaemia on postpartum day 14. A transcranial Doppler ultrasonography showed vasospasm of the left middle cerebral artery still present at 3-month follow-up. At 1-yr follow-up, the patient had homonymous hemianopsia. We discuss the possible causative mechanism of the cerebral ischaemia in relation to the dural puncture and epidural blood patch.- - - - - - - - - - ranking = 68.574092920598keywords = cerebral (Clic here for more details about this article) |
5/10. New daily persistent headache.New daily persistent headache (NDPH), which is the acute onset of headache within 3 days and is persistent for 15 days or more each month for at least 3 months, is a predominantly female heterogeneous subtype of chronic daily headache, typically with migraine features of unknown etiology. NDPH may be a presentation of other primary headaches such as new onset migraine, tension, or benign thunderclap headache. The headaches can be difficult to treat. The diagnosis is one of excluding the many secondary types or NDPH mimics, which is especially critical early in the course of the disease when a secondary etiology is more likely. NDPH mimics include postmeningitis headache, NDPH with medication rebound, neoplasms, temporal arteritis, chronic meningitis, chronic subdural hematoma, post-traumatic headaches, sphenoid sinusitis, hypertension, subarachnoid hemorrhage, low cerebrospinal fluid pressure syndrome, cervical artery dissections, pseudotumor cerebri without papilledema, and cerebral venous thrombosis.- - - - - - - - - - ranking = 7.6193436578443keywords = cerebral (Clic here for more details about this article) |
6/10. Headaches, shunts, and obstructive sleep apnea: report of two cases.OBJECTIVE: This report describes two shunted patients evaluated with continuous intracranial pressure (ICP) monitors for worsening headaches and subsequently diagnosed with obstructive sleep apnea. CLINICAL PRESENTATION AND INTERVENTION: ICPs were monitored with strain-gauge sensors inserted into the frontal cortex. After the initial diagnosis of sleep apnea, 8-hour attended polysomnography was performed in each patient. Both patients showed apnea-hypopnea indices greater than 15. Consequently, a "split-night study" was performed to evaluate treatment with titrated nasal continuous positive airway pressure. Patient 1 was a 42-year-old woman (body mass index, 34.1) with a 16-year history of idiopathic intracranial hypertension treated with lumboperitoneal and ventriculoperitoneal shunts. Patient 2 was a 20-year-old man (body mass index, 64.4) with the Arnold-Chiari II malformation. The patient had had a low-pressure shunt since birth. Neurological examinations were normal or unchanged before evaluation. Neurophthalmological examinations were normal. Computed tomographic scans failed to show progressive ventriculomegaly. Awake ICPs were less than 15 mm Hg. Nighttime ICPs during rapid eye movement sleep showed multiple Lundberg A waves associated with obstructive sleep apnea and hypoxemia. blood pressure did not change during these episodes. polysomnography showed apnea-hypopnea indices of 31 and 41, respectively. continuous positive airway pressure reduced apnea-hypopnea indices to 17 and 0, respectively; headaches resolved with outpatient therapy. CONCLUSION: These observations suggest adequate shunting with reduced cerebral compliance in both patients. Altered respiratory mechanics associated with hypoxemia may have triggered cerebral vasodilation and increases in cerebral blood volume, particularly during rapid eye movement sleep. In noncompliant systems, these changes precipitated sustained elevations in ICP and intermittent headaches relieved by continuous positive airway pressure. The clinical patterns also suggest that obstructive sleep apnea should be considered in shunted patients with isolated symptoms of increasing headaches.- - - - - - - - - - ranking = 22.858030973533keywords = cerebral (Clic here for more details about this article) |
7/10. deep brain stimulation to relieve drug-resistant SUNCT.The rare primary headache short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is characterized by 3 to 200 attacks per day of severe unilateral orbital pain. Functional magnetic resonance imaging shows increased blood flow in the ipsilateral posterior inferior hypothalamus during attacks, indicating activation. We report the first patient with SUNCT in whom severe intractable pain (70 per day) was well controlled by electrode implant to and continuous stimulation of the posterior inferior hypothalamus. Ann Neurol 2005;57:925-927.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
8/10. Serious neurological disorders in children with chronic headache.AIMS: To determine the prevalence of serious neurological disorders among children with chronic headache. methods: All children presenting to a specialist headache clinic over seven years with headache as their main complaint were assessed by clinical history, physical and neurological examination, neuroimaging where indicated, and by follow up using prospective headache diaries. RESULTS: A total of 815 children and adolescents (1.25-18.75 years of age, mean 10.8 years (SD 2.9); 432 male) were assessed. Mean duration of headache was 21.2 months (SD 21.2). neuroimaging (brain CT or MRI) was carried out on 142 (17.5%) children. The vast majority of patients had idiopathic headache (migraine, tension, or unclassified headaches). Fifty one children (6.3%) had other chronic neurological disorders that were unrelated to the headache. The headache in three children (0.37%, 95% CI 0.08% to 1.1%) was related to active intracranial pathology which was predictable on clinical findings in two children but was unexpected until a later stage in one child (0.12%, 95% CI 0.006% to 0.68%). CONCLUSIONS: Chronic headache in childhood is rarely due to serious intracranial pathology. Careful history and thorough clinical examination will identify most patients with serious underlying brain abnormalities. Change in headache symptomatology or personality change should lower the threshold for imaging.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
9/10. A pediatric case of reversible segmental cerebral vasoconstriction.BACKGROUND: Reversible segmental cerebral vasoconstriction (RSCV) is a recognizable clinical and radiographic syndrome consisting of thunderclap headache with or without focal neurological symptoms combined with reversible segmental vasoconstriction of proximal cerebral blood vessels. methods: We report a case of reversible segmental cerebral vasoconstriction in a child. RESULTS: A healthy 13-year-old boy experienced the sudden onset of a severe, diffuse headache upon surfacing from a deep dive in a swimming pool. Severity was maximal at the onset and improved over several hours. The same headache recurred three times over the next four days and a low baseline headache persisted throughout. vomiting occurred once and mild photo/osmophobia were reported but throbbing, aura, or autonomic symptoms were absent. Focal neurological signs or symptoms were absent and he denied previous history of headaches, medications, drugs, or trauma. Two normal CT scans were performed within hours of separate headaches. Cerebrospinal fluid study on day 5 was bloody with no xanthochromia. MRI/MRA/MRV of the brain and vasculitic work-up were normal. cerebral angiography on day 6 demonstrated smooth narrowing of multiple proximal cerebral vessels including supraclinoid internal carotid artery (ICA), M1, and A1 on the right and M1 on the left. By ten days, the patient's headaches had resolved and repeat angiography was normal. CONCLUSION: RSCV should be considered in a child with thunderclap headache.- - - - - - - - - - ranking = 61.454749262754keywords = cerebral, brain (Clic here for more details about this article) |
10/10. An adult case of leukoencephalopathy with intracranial calcifications and cysts.We describe a 44-year-old woman with progressive headache, ataxia, and seizures in association with multifocal cerebral and cerebellar leukoencephalopathy, intracranial calcifications, and cysts. The cause of death was intracerebellar hemorrhage while taking warfarin. Pathologic features on biopsy included angiomatous-like blood vessels, intense gliosis, and Rosenthal fiber formation in the white matter. Genetic analyses did not identify any significant mutations in two candidate genes.- - - - - - - - - - ranking = 7.6193436578443keywords = cerebral (Clic here for more details about this article) |
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