Cases reported "Headache"

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1/155. Pituitary macroadenoma manifesting as an isolated fourth nerve palsy.

    PURPOSE: To describe an unusual ophthalmic manifestation of a pituitary adenoma. methods: Case report. RESULTS: A 32-year-old man had left supraorbital and frontal headaches and new-onset vertical diplopia. Examination showed a left fourth nerve palsy and increased vertical fusional amplitudes. magnetic resonance imaging disclosed a sellar mass consistent with a pituitary macroadenoma. CONCLUSION: A pituitary adenoma may rarely manifest with an isolated fourth nerve palsy.
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2/155. Compression of the visual pathway by anterior cerebral artery aneurysm.

    Visual failure is an uncommon presenting symptom of an intracranial aneurysm. It is even more uncommon in aneurysms arising from the anterior cerebral artery (ACA). We presented 2 patients with an aneurysm of the A1 segment of the anterior cerebral artery causing visual field defects. One patient presented with a complete homonymous hemianopia due to compression of the optic tract by a giant aneurysm of the proximal left A1 segment. The second patient had an almost complete unilateral anopia caused by compression of the optic nerve and chiasm by an aneurysm of the distal part of the A1 segment with a small chiasmatic hemorrhage and ventricular rupture.
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3/155. Resolution of third nerve paresis after endovascular management of aneurysms of the posterior communicating artery.

    The effect of endovascular treatment on the recovery of neural function in patients with third nerve palsy caused by an aneurysm of the posterior communicating artery is poorly documented. We report three cases in which third nerve paresis resolved completely within 2 to 3 weeks of endovascular occlusion of a posterior communicating artery aneurysm.
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4/155. Pseudo Chiari type I malformation secondary to cerebrospinal fluid leakage.

    cerebrospinal fluid (CSF) leakage may occur spontaneously, iatrogenically or from spinal trauma. Postural headache is the cardinal symptom; dizziness, diminished hearing, nausea and vomiting are additional symptoms. In neurological examinations cranial nerve palsies may be found. Due to low CSF pressure neuroimaging studies may reveal dural enhancement and vertical displacement of the brain. We describe a patient with the history of an uncomplicated lumbar discectomy at the level L4-5 and the typical clinical symptoms of intracranial hypotension. MRI of the craniocervical junction showed typical features of a Chiari type-I malformation. After neurosurgical ligation of a CSF leak at L4-5 caused by lumbar disc surgery, the patient was free of orthostatic headache. A repeated MRI showed a striking reduction of the previous downward displacement of the cerebellar tonsils and pons.
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5/155. Is sphenoid sinus opacity significant in patients with optic neuritis?

    PURPOSE: optic neuritis secondary to sinus disease is an infrequent but well-documented association. When a patient presents with signs of optic nerve dysfunction and orbital inflammation the significance of widespread sinus disease on radiology is clear and the management is straightforward. We present a group of patients with isolated optic neuritis and radiological evidence of spheno-ethmoiditis and discuss the clinical relevance of this finding. methods: We reviewed the notes of 11 patients with optic neuritis who, because of atypical headache, underwent neuroimaging revealing sphenoid sinus opacity. Six patients had endoscopic drainage of the sphenoid sinus; 4 were treated medically. RESULTS: Sinus contents included fungal infection (2), mucopurulent material (5), polyps (1) and necrotic tumour (1). Narrowing of the optic canal due to chronic osteomyelitis was found in 1 patient with irreversible optic atrophy. Visual loss was reversible in 6 patients. Four patients had normal radiological findings after treatment. Two patients had recurrent optic neuritis with sphenoid sinusitis on MRI scan, resolving on treatment, during the 4 year follow-up period. CONCLUSIONS: Possible mechanisms of nerve damage in this situation include direct spread of infection, occlusive vasculitis and bony deficiency in the wall of the sinus. patients presenting with isolated optic neuritis and atypical headache should be scanned; an opaque sphenoid sinus in the context of visual loss should not be dismissed as coincidental but assumed to be pathological and the patient referred for drainage. sphenoid sinusitis is an uncommon but treatable cause of optic neuritis.
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6/155. The criteria of the International headache Society for tolosa-hunt syndrome need to be revised.

    In 1988 the International headache Society defined the diagnostic criteria of tolosa-hunt syndrome (THS) to include episode(s) of unilateral orbital pain for an average of 8 weeks if untreated, with associated paresis of one or more of the third, fourth, and sixth cranial nerves. Cranial nerve paresis may coincide with the onset of pain or follow it within a period of up to 2 weeks, and the pain must be relieved within 72 h after the initiation of corticosteroid therapy. Other causative lesions must be excluded by neuroimaging. On the basis of the history and neuroradiological findings of six patients we show the pitfalls in diagnosing THS with these criteria. We propose a revision of the criteria: Other causative lesions must be excluded by neuroimaging, especially of the region of the cavernous sinus and the orbita, and by blood and CSF examinations. Since imaging techniques have dramatically improved, it is now possible to visualize the inflammatory tissue in THS. Positive magnetic resonance imaging or computed tomography findings compatible with inflammatory tissue neither exclude nor confirm THS and remain suspect until a malignant tumor or inflammation other than THS is excluded. Clinical and radiological follow-up examinations must be performed for at least 2 years, even in patients with negative findings on magnetic resonance imaging at onset.
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7/155. Reversible neuropraxic visual loss induced by allergic aspergillus flavus sinomycosis.

    This work reports a patient with visual loss treated successfully with surgical removal of the aspergillus flavus sinomycosis. Vision was partially reversed within hours after surgery before starting planned corticosteroid therapy. The patient's visual acuity continued to improve steadily until it became equal to that of the other eye. The immediate gain in vision and continued improvement without corticosteroid therapy suggest a new hypothesis for visual loss induced by allergic sinonasal aspergillosis. Simple mechanical pressure alone of the aspergillus mass over the nerve can produce visual loss, and this loss is reversed by removing the mass without corticosteroid therapy.
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8/155. Cervicogenic headache: long-term postoperative follow-up.

    The patient, a 50-year old female had been suffering from right-sided head- and neck pain since she was 31 years of age. It started in connection with an indirect neck trauma. analgesics were of little or no avail and operative procedures, including liberation of the greater occipital nerve (GON) (n = 2) and decompression of the C2 ganglion/root, had only a transitory effect. At 42, a magnetic resonance scan of the cervical spine demonstrated a degenerated disk C5-C6, with encroachment on the foramina and the cord. At 42 years of age, a stabilization operation at C5-C6 (Robinson-Smith) alleviated her discomfort--only some motor complaints in the ipsilateral upper extremity remaining and only in the first 12-18 months.
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9/155. Successful epidural blood patch in a patient with headache for 6 months after lumbar root decompression.

    Prolonged headache following dural puncture is an uncommon problem that may occur after a spinal tap, often as a complication of epidural anaesthesia. This problem has also been described after long-term epidural or spinal anaesthesia, myelography or spinal surgery. A case of prolonged postdural puncture headache following lumbar nerve root decompression is described in a healthy young man. No other cause could be found either clinically or with the aid of scanning by computerized tomography or magnetic resonance imaging techniques at the spinal level involved. The symptoms were successfully treated with an epidural blood patch performed seven months following the original surgical operation.
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10/155. A bruital headache and double vision.

    A 44-year-old woman presented with a painful abducens nerve palsy in the left eye. Examination revealed a white, quiet eye and an orbital bruit without proptosis. magnetic resonance imaging demonstrated abnormal ipsilateral dural-based enhancement. angiography confirmed a posterior draining carotid-cavernous fistula. Symptoms resolved spontaneously in approximately 8 months. The classification and treatment options for carotid-cavernous fistula are discussed.
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