1/10. 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 = physical (Clic here for more details about this article) |
2/10. Unilateral orbital bruit in an adolescent with daily persistent headache.The presence of an orbital bruit in a patient with daily headache suggests an underlying secondary cause. A case is presented in which a unilateral orbital bruit appeared to be the only physical sign of a dural venous sinus thrombosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. headache with unilateral pulsatile tinnitus in women can signal dural sinus thrombosis.OBJECTIVES: Dural sinus thrombosis commonly presents with headache, and rarely with tinnitus. These thromboses can progress to neurologic impairment and death. We are sharing recent clinical experiences with these thromboses as they present to the otologist. methods: We report the presentation, physical examination, and imaging studies of 4 patients. RESULTS: Four women had thrombotic occlusion of the sigmoid sinus. Their only symptoms were focal headache in all 4 patients, and unilateral pulsatile tinnitus in 2 of them. Imaging studies had to be repeated or alternative testing performed in order to conclusively identify the problem. CONCLUSIONS: It is important to be vigilant for the possibility of sigmoid sinus thrombosis in women who complain of unilateral head pain or unilateral pulsatile tinnitus. Appropriate imaging must be performed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. Cerebral dural sinus thrombosis.Cerebral dural sinus thrombosis is an unusual syndrome in which a patient presents with a severe headache that may be associated with diverse neurologic and physical findings. The case of a 31-year-old woman with headache, vomiting, generalized tonic-clonic seizure, and subsequent dense hemiplegia is presented. The patient was diagnosed as having a cerebral dural sinus thrombosis, but only after the diagnosis was missed initially. The syndrome may be difficult to detect because it can mimic several other entities. There are several known or suspected predisposing factors. The syndrome, diagnostic modalities, and therapeutic options are reviewed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. fever of unknown origin following traumatic brain injury.Fever is a common complication of a traumatic brain injury, occurring during both the acute-care phase and the rehabilitation phase of recovery. The aetiology of fever in this population may remain obscure because of the presence of cognitive confusion associated with post-traumatic amnesia interfering with history taking and the difficult physical examination. We present a case where recovery from a traumatic brain injury was complicated by a fever of unknown origin that proved to be secondary to lateral sinus thrombophlebitis. This case emphasises the importance of a thorough knowledge of the differential diagnosis for fever that is unique to the traumatic brain injury population.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Cerebral vein thrombosis shown by MRI.A 46 year old man with a short history of left facial pain and numbness, and subsequently headaches, had a normal physical examination and a normal CT scan of head. Lumbar puncture yielded normal CSF under increased pressure. MRI showed thrombosis of the superior sagittal sinus, subsequently confirmed by angiography. MRI is a sensitive test for detecting intracranial venous thrombosis, and may be the investigation of choice when this disorder is suspected.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. hypopituitarism after aseptic cavernous sinus thrombosis.A 44-year-old man developed aseptic thrombosis of the cavernous sinuses. He recovered but 3 months later presented a clinical and laboratory picture of pituitary insufficiency. After 3 years of hormonal replacement therapy, he was in good physical condition.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. Cerebral dural sinus thrombosis. A case report.Cerebral dural sinus thrombosis is an uncommon syndrome that a patient presents with severe headache, which may be associated with complex physical and neurologic findings. The authors present a thirty-two-year-old woman with severe headache, focal motor seizures, and subsequent hemiparesis when she was ten weeks pregnant, diagnosed as having a dural sinus thrombosis by magnetic resonance imaging and magnetic resonance angiography. In this report, the application of magnetic resonance techniques, including angiography to diagnose and monitor therapy for dural sinus thrombosis, is presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Perinatal superior sagittal sinus venous thrombosis.The initial clinical findings that form the basis for the diagnosis of puerperal SSSVT are frequently quite subtle. It is essential to a favorable outcome that clinicians maintain a high index of suspicion in relation to physical complaints of puerperal women. Meticulous, comprehensive, multisystem assessment is indicated to explore fully the presentation of headache, weakness, or other subjective data when discovered. Headaches can easily be attributed to a multitude of factors associated with birth. These include fatigue, stress, complications of anesthesia, fluid and electrolyte imbalances, and muscle tension and strain. It is imperative that clinicians not assume a benign etiology for headache. Rather, ongoing assessment focused on describing the problem in its entirety is indicated. Irritability, too, can easily be attributed to stress and exhaustion. Ongoing evaluation of responses to medication, nutrition, and rest will prevent overlooking a fulminant process such as SSSVT. patients frequently need advocates when symptoms are vague and inconsistent. Careful documentation of findings as well as open, ongoing communication with members of the clinical team will best serve the patient. Retrospective analysis of vague complaints and subtle clinical findings frequently forms the basis for diagnosis of SSSVT and for clinical management to follow. In the face of cost constraints and restrictive third party reimbursement, there is significant incentive for early discharge. For this reason, identifying fulminant processes is an increasingly significant role of the perinatal nurse. Data collected in routine assessments and then verified and aggregated by the members of the health care team will be critical to prevent a rise in morbidity and mortality in the early days following discharge. In a more hopeful tone, detecting and resolving complications will help to set up the newly established family for a positive start. Quite simply put, a healthy woman has more energy to take on the new role of mother and maintain her present roles of wife, mother, worker, member of a family, and member of a community.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Septic thrombosis of orbital vessels due to cutaneous nasal infection.The authors describe two cases of cutaneous nose infection that quickly spread and extended to the orbital venous complex. At first glance, the clinical presentation could be mistaken for a complicated sinusal infection; therefore, the evaluation of the sinuses, by means of physical examination and radiological investigation, was of great concern, showing that there was no important pathology in the sinuses. The CT scan and the color Doppler imaging (orbital ultrasound with Doppler) demonstrated, throughout the development of the disease, that the superior ophthalmic vein was affected in both patients and the cavernous sinus in one of them. On physical examination, chemosis of the conjunctiva, proptosis, and edema of the eyelids were prominent. patients improved only after appropriate intravenous antibiotic therapy against staphylococcus (clindamycin) and corticosteroids, making one conclude that treatment of this disease should be initiated as soon as possible in order to decrease morbidity and mortality.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
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