1/107. prognosis of children with malignant pheochromocytoma. Report of 2 cases and review of the literature.Malignant pheochromocytomas are rare in childhood and the prognosis of children with this tumor is not well known. We present 2 pediatric observations of malignant pelvic pheochromocytoma. Symptoms in both cases were headache and hypertension. The tumor invaded the sacral bone. Angiogram helped to localize the tumor and metastases, and allowed preoperative embolization of the tumor in 1 case. The first child underwent incomplete surgical resection, (131)I-MIBG therapy and radiotherapy, and is still alive 2 years after diagnosis. The second child died from metastatic invasion a few weeks after discovery of the tumor. We reviewed previous reports of children with malignant pheochromocytomas (30 cases). Primary tumor was extraadrenal in 50% of cases. The 3-year survival rate was 73 /- 9% (mean /- SD). Apart from surgical resection, no particular treatment appeared to be more effective than others in reducing mortality.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
2/107. Spinal dural arteriovenous fistula with perimesencephalic subarachnoid haemorrhage.A case is reported of a 66 year old woman presenting with perimesencephalic subarachnoid haemorrhage (SAH) which was caused by a spinal dural arteriovenous fistula at the C1 level. The fistula drained into the venous system of the posterior cranial fossa through a perimedullary vein. The bleeding was thought to result from venous hypertension induced by the fistula. This case may support the hypothesis that perimesencephalic non-aneurysmal SAH can be ascribed to venous bleeding and that venous hypertension is the key to its pathology.- - - - - - - - - - ranking = 2keywords = hypertension (Clic here for more details about this article) |
3/107. Recurrent short-lasting headache associated with paroxysmal hypertension: a clonidine-responsive syndrome.The clinical syndrome of hypertension, headache, palpitation, diaphoresis, flushing, and emotional lability is classically associated with pheochromocytoma. Two patients are presented with this constellation of symptoms in whom investigations for pheochromocytoma were unrevealing. headache was the presenting and most prominent complaint, with daily episodes of short-lasting, intermittent, and paroxysmal attacks. Each paroxysm of headache was associated with a dramatic increase in systolic and diastolic blood pressure. After failure to control the labile fluctuations in blood pressure and headache with several classes of anti-hypertensive medications used in combination, a prompt and persistent response occurred after the administration of clonidine. The pathophysiology of this syndrome and the mechanism of clonidine action are reviewed in the context of a possible failure of the baroreceptor reflex.- - - - - - - - - - ranking = 5keywords = hypertension (Clic here for more details about this article) |
4/107. Trigeminal autonomic cephalgia with periorbital ecchymosis, ocular hemorrhage, hypertension and behavioral alterations.We describe a 38-year-old male in whom severe unilateral headache was associated with marked palpebral edema, periorbital ecchymosis, lacrimation, conjunctival injection, nasal congestion and rhinorrhea. A second, less severe headache form developed subsequently. The patient often presented severe labile hypertension and behavioral disturbances during the crises, and there was an episode of intra-ocular hemorrhage. General, neurological and ophthalmological examinations revealed nothing remarkable. We discuss possible pathogenetic mechanisms and the nosology of this case within the trigeminal autonomic cephalgias.- - - - - - - - - - ranking = 5keywords = hypertension (Clic here for more details about this article) |
5/107. Neurologic symptoms in children with systemic lupus erythematosus.Neurologic complications of systemic lupus cerebritis are not as well known in children as in adults. Twenty-five children with neurologic complications were identified after reviewing the hospital medical records of 86 children with systemic lupus erythematosus. Seven children (28%) had neurologic symptoms at the time of initial diagnosis of systemic lupus erythematosus; median time between diagnosis of systemic lupus erythematosus and onset of neurologic complications was 1 month (range 0-5 years). seizures were the most common neurologic symptoms overall, but headaches were the most frequent neurologic manifestation in children without a previous diagnosis of systemic lupus erythematosus. Sixteen children had seizures, and 12 children had seizures as the initial central nervous system involvement. Almost all children who developed seizures had an established diagnosis of systemic lupus erythematosus; only one child had seizures that led to the diagnosis of systemic lupus erythematosus. No patient had status epilepticus, and, in general, seizures were not difficult to control. In six children, headache was the initial symptom of central nervous system involvement. Five children had lupus cerebritis, three children had stroke, and two had isolated cranial neuropathies. chorea was seen in only two cases, and three children had pseudotumor cerebri. Treatment with high-dose intravenous methylprednisolone led to a good response in 18 children; cyclophosphamide was required in 6 patients and plasmapheresis in 1 child. Outcome was generally good, although one child developed fulminant cerebritis with intracranial hypertension and died.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
6/107. hypertensive encephalopathy presenting with thunderclap headache.A 68-year-old woman presented with thunderclap headache, which led to a search for subarachnoid hemorrhage. Both computerized tomography of the head and cerebrospinal fluid examination were normal. magnetic resonance imaging revealed abnormalities in the white matter in the parieto-occipital regions. There was no aneurysm on magnetic resonance angiography. Treatment of hypertension led to resolution of the posterior leukoencephalopathy. hypertensive encephalopathy with reversible posterior leukoencephalopathy can present as a thunderclap headache.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
7/107. headache as only symptom in multiple cervical artery dissection.We describe a patient with atypical headache as the only presenting symptom of spontaneous triple cervical artery dissection. As the patient suffered from arterial hypertension, a causative relation between headache and arterial hypertension was initially taken into consideration. However, four-vessel arteriography disclosed a dissection of both internal carotid arteries and the right vertebral artery. This unique case highlights the value of conventional arteriography for diagnosing cervical artery dissection. Since multiple cervical artery dissections are not rare, all cervical arteries should be examined by means of conventional arteriography when a dissection is suspected.- - - - - - - - - - ranking = 2keywords = hypertension (Clic here for more details about this article) |
8/107. Idiopathic intracranial hypertension and hemophilia a.OBJECTIVE: A patient with hemophilia a and long-standing recurrent symptoms of idiopathic intracranial hypertension is described. During his relapses, he experienced headache, and attention and language disturbance, but no visual symptoms. BACKGROUND: hemophilia a is a rare inherited coagulation disorder secondary to factor viii deficiency. Idiopathic intracranial hypertension has been reported in association with prothrombotic conditions and iron deficiency anemia, but not in patients with hemophilia a. Recurrent or chronic headache is not a typical symptom of hemophilia, but headache is a presenting sign of intracranial bleed in persons with hemophilia. methods: Medical history review, clinical neurologic examination, brain magnetic resonance imaging, computed head tomography, and electroencephalogram were performed. RESULTS: neurologic examination revealed bilateral papilledema during relapses of idiopathic intracranial hypertension. Multiple lumbar punctures preceded by the intravenous administration of factor viii early in the course of the illness confirmed the presence of elevated cerebrospinal fluid pressures and absence of subarachnoid blood. He had no complications from lumbar punctures. Initial electroencephalograms showed background slowing but later normalized. magnetic resonance imaging of the brain and computerized tomography of the head were normal. Relapses of idiopathic intracranial hypertension were eventually controlled with the administration of acetazolamide. CONCLUSION: Idiopathic intracranial hypertension may develop in patients with hemophilia a in the absence of visual symptoms. Therapeutic and diagnostic lumbar punctures were safe to perform on this patient, following the administration of factor viii.- - - - - - - - - - ranking = 9keywords = hypertension (Clic here for more details about this article) |
9/107. Idiopathic "benign" intracranial hypertension: case series and review.Idiopathic "benign" intracranial hypertension is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken to review our experience in the diagnosis and management of idiopathic intracranial hypertension, giving special attention to treatments used. A retrospective chart review was conducted on 32 patients diagnosed with idiopathic intracranial hypertension between 1984 and 1995. Subjects included 23 females and ranged in age from 2 to 17.5 years. headache was the most common symptom, followed by nausea and vomiting, double vision, and visual loss. papilledema was the most common sign. Others were VIth cranial nerve palsy and compromised visual acuity at or within 3 months of presentation. Management included administration of acetazolamide or corticosteroids, lumboperitoneal shunt, optic nerve fenestration, and repeat lumbar puncture. Treatment combinations were used in 40% of cases. During follow-up, headache, papilledema, and decreased visual acuity persisted for longer than 10 months in a significant number of patients. We conclude that idiopathic intracranial hypertension causes significant short- and long-term morbidity with no proven effective treatment available. A prospective study is needed to establish the indications for treatment and the efficacy of the treatments used.- - - - - - - - - - ranking = 8keywords = hypertension (Clic here for more details about this article) |
10/107. intraocular pressure elevation in a child due to the use of inhalation steroids--a case report.inhalation steroid therapy can cause ocular hypertension or open angle glaucoma. The authors describe the case of a young girl who presented with raised intraocular pressure and headaches due to the prolonged administration of nasal and inhalation steroids. The ophthalmologist should monitor the intraocular pressure in patients who use inhalation or nasal steroid therapy on a regular base. The physician or paediatrician should be aware of this complication in children with headaches or diminished visual acuity.- - - - - - - - - - ranking = 1keywords = hypertension (Clic here for more details about this article) |
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