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Source: Neurology
Condition: Headache

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Total 267 results found since Jan 2013.

Teaching NeuroImages: Multicompartmental intracranial hemorrhage in a pediatric patient
A previously healthy 9-year-old girl presented with sudden-onset headache followed by confusion. In the emergency department, she was hypertensive, bradycardic, and no longer responsive to any stimuli. An emergent head CT scan demonstrated a left frontal intraparenchymal hematoma with intraventricular and subarachnoid extension as well as subfalcine herniation (figure). She underwent decompressive hemicraniectomy, and digital subtraction angiography confirmed a 7-mm left middle cerebral artery aneurysm (figure).
Source: Neurology - December 4, 2016 Category: Neurology Authors: Siegler, J. E., Ichord, R. N. Tags: Childhood stroke, Intracerebral hemorrhage, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

Three-dimensional modeling of Eagle syndrome
A 63-year-old man presented with transient episodes of left-hand weakness and right-eye vision loss following a lengthy airplane trip. The patient had reported right neck pain after sleeping awkwardly on the flight. Carotid dissection, paradoxical embolism, atherosclerotic occlusion, and thrombotic occlusion were considered possible etiologies of the associated carotid occlusion. Following a period of anticoagulation, a subsequent CT angiography (figure 1, A–C) revealed findings consistent with the styloid-carotid artery, or Eagle, syndrome.1 A 3-dimensional model was subsequently created (figure 2, A and B) utilizin...
Source: Neurology - November 20, 2016 Category: Neurology Authors: Shah, K., Miller, D. J. Tags: All Headache, All Clinical Neurology, All Cerebrovascular disease/Stroke, All Education NEUROIMAGES Source Type: research

Teaching NeuroImages: Swirl sign and spot sign in intraparenchymal hematoma
A 10-year-old-girl was admitted with headache and vomiting. Nonenhanced CT showed hyperdense intraparenchymal hematoma with a hypodense area, consistent with swirl sign, a classic sign of active bleeding (figure 1).
Source: Neurology - October 30, 2016 Category: Neurology Authors: Wagemans, B. A. J. M., Klinkenberg, S., Postma, A. A. Tags: CT, Prognosis, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke, Intracerebral hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

Role of atherosclerosis, clot extent, and penumbra volume in headache during ischemic stroke
Conclusions: Headache in the early phase of ischemic stroke tends to occur less often in patients with atherosclerosis than in patients without atherosclerosis in the large cerebral arteries. This finding lends support to the hypothesis that vessel wall elasticity is a necessary contributing factor in the occurrence of headache during acute ischemic stroke.
Source: Neurology - September 11, 2016 Category: Neurology Authors: van Os, H. J. A., Mulder, I. A., van der Schaaf, I. C., Kappelle, L. J., Velthuis, B. K., Broersen, A., Vos, J. A., Terwindt, G. M., Schonewille, W., Ferrari, M. D., Algra, A., van Walderveen, M. A. A., Wermer, M. J. H. Tags: All Headache, CT, All Clinical Neurology, All Cerebrovascular disease/Stroke, Infarction ARTICLE Source Type: research

Teaching NeuroImages: Carotid cavernous fistula in a patient with Ehlers-Danlos syndrome
A 25-year-old woman with Ehlers-Danlos syndrome type IV and history of spontaneous right petrous internal carotid artery dissection presents with severe headache, right eye pain with extraocular movements, proptosis, and chemosis of the right eye. She reported hearing her heartbeat in her right ear. CT angiogram (figure) revealed an engorged right ophthalmic vein. Subsequent digital subtraction angiography confirmed a carotid cavernous fistula along a previously dissected carotid artery.
Source: Neurology - August 28, 2016 Category: Neurology Authors: Liang, J. W., Horowitz, D. Tags: CT, Other cerebrovascular disease/ Stroke, Arteriovenous malformation, Carotid artery dissection RESIDENT AND FELLOW SECTION Source Type: research

Clinical Reasoning: An unusual case of blurry vision in a young woman after ovarian induction
A 38-year-old woman presented to our emergency department with blurry vision and headache. She developed her symptoms insidiously 8 days into ovarian induction for in vitro fertilization (IVF), consisting of recombinant follicular stimulating hormone, gonadotropin, and a gonadotropin-releasing hormone antagonist. The headache was mild, constant, diffuse, nonpositional, and minimally alleviated with ibuprofen. She described binocular difficulty "focusing her vision" but denied a field cut or diplopia. A community ophthalmologist reported a normal dilated funduscopic examination but noted a subtle right homonymous hemianopia...
Source: Neurology - July 31, 2016 Category: Neurology Authors: Parikh, N. S., Khazanova, D., Moya, A., Kaunzner, U. W., Allen, B. B., Navi, B. B. Tags: Stroke in young adults, Visual fields, All Cerebrovascular disease/Stroke, Embolism, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Neurologic and neuroimaging manifestations of Cantu syndrome: A case series
Conclusions: Cantú syndrome is associated with various neurologic manifestations, particularly cerebrovascular findings including dilated and tortuous cerebral vessels, white matter changes, and persistent fetal circulation. Involvement of the KATP SUR2/Kir6.1 subtype potentially plays an important role in the neurologic manifestations of Cantú syndrome.
Source: Neurology - July 17, 2016 Category: Neurology Authors: Leon Guerrero, C. R., Pathak, S., Grange, D. K., Singh, G. K., Nichols, C. G., Lee, J.-M., Vo, K. D. Tags: Migraine, Other cerebrovascular disease/ Stroke, Developmental disorders, All Genetics, Ion channel gene defects ARTICLE Source Type: research

Rupture of vertebral artery dissection aneurysm during 3D DSA
A 60-year-old man with a history of headache and vomiting had a subarachnoid hemorrhage on CT scan. On 2-dimensional (2D) digital subtraction angiography (DSA), a possible dissection aneurysm of the vertebral artery was seen (video 1 on the Neurology® Web site at Neurology.org). During 3D DSA, the aneurysm suddenly ruptured (video 2), with intracranial hemorrhage. The pressure of contrast was 200 psi, the rate was 2 mL/s, with a total volume of 12 mL. The patient was transferred to the intensive care unit but died of brain herniation and vasospasm. Few dissection aneurysms rupture during 3D DSA, but the risk is likely ...
Source: Neurology - July 10, 2016 Category: Neurology Authors: Xu, D., Wang, C., Zhang, C., Xiang, S., Xie, X. Tags: All Imaging, All Clinical Neurology, All Cerebrovascular disease/Stroke, Critical care, All Education VIDEO NEUROIMAGES Source Type: research

Clinical Reasoning: Myriad manifestations of a global infectious disease
A 21-year-old right-handed Cambodian woman with no history of headache presented with 2 weeks of progressive bifrontal headache. She had no sick contacts or recent travel. She moved to the United States at age 3 years. She had no fever, nuchal rigidity, photophobia, phonophobia, nausea, or vomiting. She had a recent history of weight loss and palpitations. There was no tobacco or illicit drug use or high-risk sexual behavior. She was not pregnant and denied contraception use.
Source: Neurology - June 5, 2016 Category: Neurology Authors: Prabhu, A. M., Raghupathi, R., Dissin, J. Tags: Stroke in young adults, Vasculitis, Meningitis RESIDENT AND FELLOW SECTION Source Type: research

Teaching NeuroImages: Posterior reversible encephalopathy syndrome resulting in hydrocephalus
A woman with prior lung transplantation presented with headaches, seizure, and obtundation. Head MRI (figure) revealed obstructive hydrocephalus and hyperintensity on T2-weighted imaging in the bilateral thalami and brainstem. Management included antiepileptic medications, ventriculostomy placement, and cessation of tacrolimus for concern of atypical posterior reversible encephalopathy syndrome (PRES). Infectious and paraneoplastic etiologies were ruled out. An autoimmune process was unlikely due to immunosuppression. There was rapid clinical improvement with repeat MRI revealing resolution of hydrocephalus and T2 changes....
Source: Neurology - June 5, 2016 Category: Neurology Authors: Paolini, S., Jadhav, A. P. Tags: Hydrocephalus, Secondary headache disorders, Other cerebrovascular disease/ Stroke RESIDENT AND FELLOW SECTION Source Type: research

Performance of bedside stroke recognition tools in discriminating childhood stroke from mimics
Conclusions: Adult stroke recognition tools perform poorly in children and require modification to be useful for pediatric stroke identification. Classification of evidence: This study provides Class II evidence that, for children presenting to the ED with brain attack symptoms, the CPSS and ROSIER tools do not accurately distinguish strokes from mimics.
Source: Neurology - June 5, 2016 Category: Neurology Authors: Mackay, M. T., Churilov, L., Donnan, G. A., Babl, F. E., Monagle, P. Tags: All Clinical Neurology, All Cerebrovascular disease/Stroke, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke ARTICLE Source Type: research

Pearls & Oy-sters: Looking up the anatomy of looking up
A 46-year-old Chinese man with diabetes mellitus, hypertension, and hyperlipidemia, developed sudden onset of vertiginous dizziness and diplopia that was worse on looking up. His symptoms were not preceded by any antecedent infections, neither was there any headache. Blood pressure on arrival in the Emergency Department was 145/95 mm Hg and his neurologic examination revealed bilateral upward gaze restriction (video on the Neurology® Web site at Neurology.org). There was voluntary lid retraction by the patient. The pupils were 3 mm bilaterally and reactive to light and accommodation, there was no ptosis or nystagmus, a...
Source: Neurology - May 1, 2016 Category: Neurology Authors: Abid, M. B., Soon, D., Rathakrishnan, R., Zhao, P., Tan, C., Yeo, L. L. L. Tags: MRI, Clinical neurology examination, Ocular motility, Diplopia (double vision), All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Systemic right-to-left shunts, ischemic brain lesions, and persistent migraine activity
Conclusions: RLS are more prevalent in migraineurs with aura but do not explain the increased prevalence of silent posterior circulation infarcts or white matter lesions in migraineurs. Spontaneous RLS are associated with persistent migraine.
Source: Neurology - May 1, 2016 Category: Neurology Authors: Koppen, H., Palm-Meinders, I. H., Mess, W. H., Keunen, R. W., Terwindt, G. M., Launer, L. J., van Buchem, M. A., Kruit, M. C., Ferrari, M. D. Tags: Migraine, MRI, All Cerebrovascular disease/Stroke, Embolism ARTICLE Source Type: research

Clinical Reasoning: Proptosis, headache, and fever in a healthy young woman
A 23-year-old healthy woman presented to the emergency department with a week-long history of intense, pulsatile, right-sided headache, accompanied by fever, diplopia, and right eye pain and decreased visual acuity. She reported partial relief with nonsteroidal anti-inflammatory drugs.
Source: Neurology - April 17, 2016 Category: Neurology Authors: Orquera, J., Godoy, D. A., Behrouz, R., Rabinstein, A., Di Napoli, M. Tags: All Infections, Bacterial infections, All Cerebrovascular disease/Stroke, Subarachnoid hemorrhage RESIDENT AND FELLOW SECTION Source Type: research

Clinical Reasoning: A 76-year-old man with acute-onset left-sided weakness and numbness
A 76-year-old right-handed man with no known medical problems presented 2 hours after falling at work due to the acute onset of left-sided weakness and numbness. He had experienced left knee pain the previous day, but denied vertigo, headache, neck pain, chest pain, abdominal pain, or back pain. On examination, his blood pressure was 230/118 mm Hg; pulse and respiratory rate were normal. He was anxious with normal mentation, no carotid bruits, normal cardiac rate and rhythm, clear lung fields, normal cranial nerves including facial strength, weakness in his left leg (2/5 power) and arm (4/5 power), sensory loss to painful ...
Source: Neurology - April 10, 2016 Category: Neurology Authors: Renthal, W., Alberts, M., Shang, T. Tags: All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research