Cases reported "Headache"

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1/10. Persistent bilateral hearing loss after shunt placement for hydrocephalus. Case report.

    Transient hearing decrease following loss of cerebrospinal fluid (CSF) has been reported in patients undergoing lumbar puncture, spinal anesthesia, myelography, and/or different neurosurgical interventions. The authors present the first well-documented case of a patient with persistent bilateral low-frequency sensorineural hearing loss after shunt placement for hydrocephalus and discuss the possible pathophysiological mechanisms including the role of the cochlear aqueduct. These findings challenge the opinion that hearing decreases after loss of CSF are always transient. The authors provide a suggestion for treatment.
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ranking = 1
keywords = aqueduct
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2/10. Dysembryoplastic neuroepithelial tumor of the midbrain tectum: a case report.

    Dysembryoplastic neuroepithelial tumor (DNT) is a relatively new nosologic entity. First described in 1988, it is now included in the "neuronal and mixed neuronal-glial tumours" category in the revised 2000 world health organization (WHO) classification of Tumours of the Nervous System. The collective experience of more than 300 reported cases indicates that, with only rare exceptions, DNTs are cerebral cortical lesions. At present, the actual incidence of extracortical DNT is unknown. We describe, the clinicopathologic features of the first tectal DNT. The patient was a 51-year-old man with a 2-month history of pulsatile headaches. On neurologic examination, the only abnormality was gait ataxia. magnetic resonance imaging (MRI) demonstrated a midbrain tumor involving the tectum. It was hypointense on T1-weighted images and featured an iso- to hyperintense nodule at its center. The nodule showed enhancement upon contrast administration. No aqueductal obstruction or intraventricular extension of tumor was detected. The tumor was approached supratentorially and removed completely. The mucoid tumor was well demarcated from neural tissue. Histopathologically, it was a typical DNT, exhibiting a nodular pattern of growth with a "specific glioneuronal component." This case report documents the first DNT to arise in the midbrain tectum and focuses on the problem of diagnosing this uncommon tumor at extracortical sites.
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ranking = 1
keywords = aqueduct
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3/10. 14 mmHg: a case of raised intracranial pressure?

    A 40-year-old woman presented with chronic headaches. She had undergone ventriculo-peritoneal (VP) shunt 7 years previously for treatment of hydrocephalus secondary to aqueduct stenosis. intracranial pressure (ICP) monitoring revealed a resting ICP of less than 5 mmHg. Headaches were thought to be due to low ICP and the shunt tubing was ligated. Over the next 4 h there was an increase in ICP to 14 mmHg, decrease in GCS to 13 and ventriculomegaly on CT. These changes were reversed by the removal of the ligature. This unusual case highlights the fact that, in some shunted patients with over drainage of ventricles and a low resting ICP, small increases in ICP are poorly tolerated. This may be due to altered visco-elastic properties of the ventricles and the brain parenchyma.
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ranking = 1
keywords = aqueduct
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4/10. Quadrigeminal cistern lipoma.

    Intracranial lipomas are rare benign congenital neoplasms accounting for 0.1 to 0.5% of all primary brain tumours. Approximately 50% are associated with other cerebral developmental disorders. These slow growing benign lesions are usually asymptomatic and rarely require surgery. We report the case of a 37 year old woman presented with signs of raised intracranial pressure. Computerized tomography and magnetic resonance imaging demonstrated a quadrigeminal cistern lipoma compressing the aqueduct of Sylvius. The patient underwent surgery and a distinct plane of cleavage between the lipoma and the adjacent neural structures was found, allowing total removal of the lesion. Postoperatively, the patient was relieved of her original symptoms but developed akinetic mutism which lasted for two weeks. Intracranial lipomas rarely become symptomatic and surgery is seldom required. If the lesion progresses and causes symptoms of raised intracranial pressure or compression of neural structures, surgical intervention is indicated. Total removal should not be attempted unless a plain of cleavage between the lesion and adjacent neural structures is present. Surgical manipulation should be minimised to avoid complications.
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ranking = 1
keywords = aqueduct
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5/10. Acute obstructive hydrocephalus associated with infratentorial subdural hygromas complicating Chiari malformation Type I decompression. Report of two cases and literature review.

    Obstructive hydrocephalus complicating foramen magnum decompression (FMD) for a Chiari malformation (CM) Type I is rare. Two female patients (17 and 55 years old) presented with strain-related headaches. In both cases magnetic resonance (MR) imaging studies confirmed a CM Type I, which was accompanied by syringomyelia in one case. Both patients underwent uncomplicated FMD with good initial recovery. Unfortunately, conditions in both patients deteriorated, with severe headaches occurring between Days 5 and 6 post-FMD. Decreased consciousness occurred in one case. In both patients, computerized tomography scanning demonstrated an acute obstructive hydrocephalus associated with bilateral infratentorial extraaxial fluid collections (EAFCs). In addition, left parafalcine and convexity EAFCs were present in one case. An emergency external ventricular drain was required in one patient, with delayed conversion to a ventriculo-peritoneal shunt. Spontaneous resolution occurred in the other patient without neurosurgical intervention. In both cases, MR imaging confirmed that each EAFC was subdural, resembled cerebrospinal fluid (CSF), and had distorted the superior cerebellum anteroinferiorly. Despite upper fourth ventricle/aqueduct compromise in one case, normal aqueduct flow artifacts were apparent on examination. All EAFCs resolved spontaneously. Obstructive hydrocephalus complicating FMD is rare but invariably associated with infratentorial EAFCs, which were confirmed to be subdural hygromas in this report. The authors assert that hydrocephalus results from upper fourth ventricle/aqueduct compromise as a result of CSF subdural dissection following a pinhole arachnoid tear on durotomy. Because such hygromas spontaneously resolve, permanent shunt insertion should be avoided.
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ranking = 3
keywords = aqueduct
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6/10. deep brain stimulation for neuropathic cephalalgia.

    The aim of this study was to determine the efficacy of deep brain stimulation (DBS) in the treatment of various types of intractable head and facial pains. Seven patients underwent the insertion of DBS electrodes into the periventricular/periaqueductal grey region and/or the ventroposteromedial nucleus of the thalamus. We have shown statistically significant improvement in pain scores (visual analogue and McGill's) as well as health-related quality of life (SF-36v2) following surgery. There is wide variability in patient outcomes but, overall, DBS can be an effective treatment. Our results are compared with the published literature and electrode position for effective analgesia is discussed.
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ranking = 1
keywords = aqueduct
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7/10. Symptomatic subependymoma--a case report.

    Subependymoma is a rare, slow-growing, benign noninvasive tumor of the central nervous system that may be located in the fourth ventricle, the septum pellucidum, the third and the lateral ventricles, the aqueduct, and the proximal spinal cord. Symptoms, if any, usually result either from direct compression of the brain stem or from acute hydrocephalus due to occlusion of the foramen of Monro or aqueduct of Sylvius. In this report, we describe a case of subependymoma of the lateral ventricle with headache in a young female patient. This is the first reported case subependymoma in korea that was documented along with Magnetic resonance image.
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ranking = 2
keywords = aqueduct
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8/10. headache caused by a single lesion of multiple sclerosis in the periaqueductal gray area.

    We report a severe acute headache that occurred in conjunction with a solitary fresh lesion of multiple sclerosis in the periaqueductal gray region of a 16-year-old girl. This unique natural event supports the recent proposition, based on observations of patients with implanted electrodes, that perturbations of the periaqueductal gray region can produce headache. It also suggests that headaches accompanying attacks of multiple sclerosis are due to disturbances in particular regions of the brain.
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ranking = 6
keywords = aqueduct
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9/10. Transient hydrocephalus due to movement of a clot plugging the aqueduct.

    A rare case of transient hydrocephalus is reported. A 64-year-old woman presented with headache. Computerized tomography (CT) scan revealed hydrocephalus with tiny blood clots in the left foramen of Monro and in the aqueduct. Six hours after the onset, the signs and symptoms disappeared spontaneously. The second CT showed improvement of the hydrocephalus with migration of the clot into the i.v. ventricle. Aqueductal trapping and releasing of the clot formed by bleeding from the choroid plexus located in the left foramen of Monro was suspected for the origin of the transient hydrocephalus.
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ranking = 5
keywords = aqueduct
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10/10. Spontaneous recovery of an aqueductal stenosis.

    The case of a 17-year-old male with hydrocephalus caused by aqueductal obstruction is presented. A ventriculo-peritoneal shunt was implanted and later removed due to an infection. In the clinical follow-up no deterioration was observed. No further surgery was necessary. The repeat-MRI showed spontaneous resolution of the hydrocephalus with a normal aqueduct.
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ranking = 6
keywords = aqueduct
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