Cases reported "Headache"

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1/72. Nonaneurysmal thunderclap headache with diffuse, multifocal, segmental, and reversible vasospasm.

    OBJECTIVE: To highlight the clinical profiles and angiographic findings of two patients with recurrent thunderclap headache (TCH) without subarachnoid hemorrhage (SAH) and to present modified diagnostic criteria for this unusual syndrome. BACKGROUND: TCH may be a benign recurrent headache disorder or it may represent a serious underlying process such as SAH or venous sinus thrombosis. The pathophysiology of this disorder in the absence of underlying pathology is not well understood and its potential angiographic features are not well appreciated. methods: Two case descriptions with illustrative angiography. RESULTS: Both cases demonstrated the potential for reversible intracranial vasospasm without intracranial aneurysm or SAH and a benign clinical outcome. CONCLUSIONS: Primary TCH has a distinctive clinical and angiographic profile and must be distinguished from central nervous system vasculitis and SAH.
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keywords = nervous system
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2/72. Rosai-Dorfman disease presenting multiple intracranial lesions with unique findings on magnetic resonance imaging. Case report.

    Rosai-Dorfman disease (RDD) is a rare idiopathic histoproliferative disease affecting the systemic lymph nodes. Although an extranodal lesion has also been recognized, central nervous system involvement is extremely rare. To the authors' knowledge, only 20 cases of intracranial lesions have been reported previously. Intracranial RDD is clinically and radiologically difficult to distinguish from meningioma, and histological examination is essential for a definitive diagnosis. The authors treated a large frontal lobe tumor associated with multiple meningeal nodules in a 67-year-old patient presenting with diplopia and headache. Radiological examination indicated that the mass was an inflammatory lesion rather than a meningioma. Microscopically the lesion consisted of mixed inflammatory infiltrate with marked emperipolesis, which is characteristic of RDD. A review of the literature and a discussion of the differential diagnosis of this rare lesion are also presented.
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keywords = nervous system
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3/72. headache in ehlers-danlos syndrome.

    OBJECTIVE: ehlers-danlos syndrome (EDS) is a complex hereditary connective tissue disorder with neurologic manifestations that include cerebrovascular disorders and chronic pain. The clinical data collected on 18 patients with EDS and chronic headaches is reported. PROCEDURE: Clinical history, neurologic examination, computerized tomography of the head, magnetic resonance imaging (MRI) of the brain, and electroencephalogram (EEG). Headaches were classified according to the International headache Society and the patients were followed by the author for a minimum of 2 years. FINDINGS: Four patients had migraine with aura, four had migraine without aura, four had tension headaches, four had a combination of migraine and tension headaches, and two had post-traumatic headaches. Nine patients exhibited blepharoclonus but none had history of seizures and their EEGs were normal, ruling out eye closure epilepsy. Although one patient had a small right frontal angioma, a second had Arnold Chiari malformation type I, and a third had an old stroke, headaches did not clinically correlate with their central nervous system (CNS) lesions. CONCLUSION: Chronic recurrent headaches may constitute the neurologic presentation of EDS in the absence of structural, congenital, or acquired CNS lesions that correlate with their symptoms. Individuals with EDS may be prone to migraine due to an inherent disorder of cerebrovascular reactivity or cortical excitability. Additional studies are needed to elucidate the pathogenesis of headaches in EDS.
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keywords = nervous system
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4/72. Primary CNS lymphoma associated with streptococcal abscess: an autopsy case.

    This report describes a case of streptococcal abscess in the nodules of a primary central nervous system (CNS) lymphoma. magnetic resonance imaging (MRI) of the brain revealed multiple lesions with ringlike enhancement over the bilateral frontal, right temporal, and left parietal lobes. On admission, acute brain edema occurred following angiography, which resulted in respiratory arrest. autopsy findings showed that the ringlike enhanced lesions on MRI were streptococcal abscesses localized in the lymphoma nodules. The lymphoma was classified as non-Hodgkin, diffuse large cells of B-cell lineage. No other lymphoma mass was found extracranially. An immunohistochemical study showed that the lymphoma cells were positive for leukocyte common antigen, Epstein-Barr virus, bax. and bcl-XL, and negative for L-26 and bcl-2. This case demonstrated that an opportunistic streptococcal abscess developed in primary CNS lymphoma in a patient without acquired immunodeficiency syndrome (AIDS), though a few similar cases have been reported in patients with AIDS.
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keywords = nervous system
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5/72. Scleroderma en coup de sabre with central nervous system involvement.

    We describe a patient with scleroderma en coup de sabre and central nervous system symptoms. She presented with a linear scleroderma on her left paramedian forehead and scalp and suffered from headaches and dizziness. Axial T2-weighted MRI showed a 1 cm, high intense signal abnormality in the medial aspect of the left frontal lobe.
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ranking = 5
keywords = nervous system
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6/72. Somnolence syndrome in a child following 1200-cGy total body irradiation in an unrelated bone marrow transplantation.

    Neurological complications may occur following intensive chemotherapy and hematopoietic cell transplantation. Postirradiation somnolence syndrome has been observed in children with acute lymphoblastic leukemia who received central nervous system preventive therapy with 1800-2400 cGy cranial irradiation. The authors report a 16-year-old boy with chronic myelogenous leukemia in chronic phase, who developed symptoms compatible with the somnolence syndrome (SS) 6 weeks following HLA-matched unrelated bone marrow transplantation (BMT). The preparative regimen consisted of 1200 cGy total body irradiation (TBI), cytosine arabinoside and cyclophosphamide. The patient developed lethargy and low-grade fever, with intermittent rhythmical delta activity in electroencephalograph. He recovered spontaneously without specific therapy 3 weeks after developing symptoms. This is the first report describing that as low as 1200 cGy TBI can induce SS in a child. After allogeneic BMT, some patients develop neurological symptoms. The authors suggest that somnolence syndrome should be included in differential diagnosis in these patients.
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ranking = 1
keywords = nervous system
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7/72. 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.
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ranking = 2
keywords = nervous system
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8/72. central nervous system superficial siderosis, headache, and epilepsy.

    Almost 95 cases of superficial siderosis of the central nervous system have been reported in the literature. These patients showed a clinical syndrome characterized by ataxia, deafness, pyramidal system involvement, and mental deterioration with xanthochromic cerebrospinal fluid and neuroradiological findings of hemosiderin deposits. About 30% of the patients had headache as an accompanying symptom. In the present case report, we describe a 33-year-old man with the typical clinical features of superficial siderosis, who complained, since aged 8, of a severe recurrent frontal headache often associated with loss of consciousness occurring after at least 2 hours of pain. The MRI and CSF findings were consistent with subarachnoid bleeding. In our patient, headache due to meningeal irritation by subarachnoid blood induced seizures as a probable reflex of extreme pain. carbamazepine and nimodipine prophylaxis dramatically reduced the frequency of headaches and seizures.
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ranking = 5
keywords = nervous system
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9/72. Neurobrucellosis.

    brucellosis, which is endemic in saudi arabia, can present as a disease with multisystem involvement. Occasionally the organisms invade the central nervous system producing varied neurological manifestations. Often the clinical diagnosis of neurobrucellosis is not straight forward and is obscure. Certain criteria have to be fulfilled for the definitive diagnosis of neurobrucellosis. We report 2 cases of neurobrucellosis which were encountered for the first time during the past 10 years at this hospital.
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ranking = 1
keywords = nervous system
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10/72. Acute disseminated encephalomyelitis associated with hepatitis c virus infection.

    BACKGROUND: Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of the central nervous system that is frequently preceded by an acute viral infection. This is the first reported case of ADEM associated with hepatitis c virus (HCV) infection. CASE DESCRIPTION: A 46-year-old woman underwent a surgical procedure and received multiple blood transfusions, at which time serologic testing for HCV was negative. Fifty days later, she suddenly developed seizures, alteration of consciousness, right hemiparesis, hemianopsia, and urinary retention. magnetic resonance imaging revealed symmetric multifocal changes on T2-weighted images in the cerebral gray and white matter and in the cerebellar white matter with some lesion enhancement after gadolinium administration. blood testing showed a recent HCV infection with high titer of IgM early antigens and a strongly positive reaction for HCV rna. All other microbiological and virological test results were negative both in serum and in cerebrospinal fluid. Treatment with high-dose dexamethasone was followed by a dramatic improvement of the clinical and magnetic resonance picture. Within a few months the patient recovered completely and there were no relapses during 2 years of follow-up. CONCLUSIONS: infection with HCV is associated with several autoimmune neurological manifestations. It is recommended the patients with ADEM be screened for HCV.
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ranking = 1
keywords = nervous system
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