Treatment of orthostatic headache without intracranial hypotension: A case report

Cephalalgia ◽  
2013 ◽  
Vol 33 (11) ◽  
pp. 948-950 ◽  
Author(s):  
Raquel Gil-Gouveia
Keyword(s):  
Case Report ◽  
Vitamin A ◽  
Intracranial Hypotension ◽  
Brain Mri ◽  
Symptomatic Treatment ◽  
Good Prognosis ◽  
Orthostatic Headache ◽  
Pathophysiological Mechanism ◽  
Vitamin A Supplementation

Introduction: Orthostatic headache is very suggestive of intracranial hypotension. It has a good prognosis as it usually responds to conservative treatment or epidural blood patches. Case report: A 36-year-old female presented with severe and prolonged orthostatic headache starting after a seizure. No stigma of intracranial hypotension was detected on brain MRI, and intracranial pressure was within normal range. No imaging evidence of a fistula was found. She was refractory to symptomatic treatment including five epidural blood patches. Progressive improvement occurred simultaneously to the introduction of vitamin A supplementation. Discussion: A series of six similar patients is discussed, in which five patients remained severely symptomatic and workdisabled at an average follow-up of four years. It is proposed that the pathophysiological mechanism producing orthostatic headache might not be dependent on intracranial hypotension and could respond to vitamin A.

scholarly journals Adjuvant hypofractionated partial-brain radiation therapy for pediatric Ewing sarcoma brain metastases: case report

2016 ◽  
Vol 17 (4) ◽  
pp. 434-438 ◽  
Author(s):  
Ritchell van Dams ◽  
Henry S. Park ◽  
Ahmed K. Alomari ◽  
Adele S. Ricciardi ◽  
Harini Rao ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Case Report ◽  
Ewing Sarcoma ◽  
Tumor Resection ◽  
Symptomatic Treatment ◽  
Reasonable Approach ◽  
Inflammatory Changes ◽  
Brain Radiation ◽  
The Brain

This case report demonstrates that hypofractionated partial-brain radiation therapy with limited margins is a reasonable approach following gross tumor resection of Ewing sarcoma metastases to the brain. The patient presented with 2 intracranial metastases treated with gross-total resection followed by radiation therapy to 30 Gy in 5 fractions. The patient experienced symptomatic treatment-related inflammatory changes with resolution after receiving dexamethasone. He remains alive at 21 months of follow-up with no evidence of disease.

scholarly journals Resolution of Bitot's spots following mega-dose vitamin A supplementation in children between 1 and 5 years of age

2013 ◽  
Vol 17 (7) ◽  
pp. 1614-1619 ◽  
Author(s):  
Umesh Kapil ◽  
Shraddha Dwivedi ◽  
Harshpal S Sachdev ◽  
SN Dwivedi ◽  
RM Pandey ◽  
...  
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Indian Subcontinent ◽  
Uttar Pradesh ◽  
Clinical Predictors ◽  
Vitamin A Supplementation ◽  
Public Health Burden ◽  
Predictors Of Response ◽  
Before And After

AbstractObjectiveThe prevalence of Bitot's spots (BS) is often used to quantify vitamin A deficiency burden in India, both before and after mega-dose vitamin A supplementation (MVAS) programmes. However, the proportion of BS cured following this intervention is unclear in contemporary times. The current study evaluated the responsiveness of BS over 1 year to MVAS administered as per the national programme in rural India.DesignProspective, community-based, 1-year follow-up of a cohort.SettingRural Uttar Pradesh, India.SubjectsTwo hundred and sixty-two children with BS, aged between 1 and 5 years, administered 60 mg (retinol equivalent) of vitamin A on diagnosis and after 1 month. Cure or resolution was defined if there was no discernible BS in either eye.ResultsDuring 1 year, only three children were lost to follow-up. At 6 months of follow-up (MVAS at baseline and 1 month later), 51·1 (95% CI 45·3, 57·3) % were classified as cured. The corresponding figure at 1 year (additional MVAS at 6 months) was 59·9 (95% CI 54·1, 65·9) %. Among those cured at 6 months, about half and three-quarters had resolved at 2 and 3 months, respectively. Apart from male gender, there were no significant sociodemographic or clinical predictors of response.ConclusionsSubstantial non-response to MVAS at 6 months (49%) and 1 year (40%) of follow-up suggests that presently in the Indian subcontinent, BS is a relatively crude indicator of severe current vitamin A deficiency. For programmatic decisions and evaluation, the public health burden of vitamin A deficiency should not be assessed solely through BS.

scholarly journals Case Report: A Case of Perifoveal Exudative Vascular Anomalous Complex With a Good Prognosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Min Fu ◽  
Pan Hu ◽  
Gang Zhang ◽  
Ludonghan Huang ◽  
Huan Xu ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Case Report ◽  
Optical Coherence Tomography Angiography ◽  
Case Reports ◽  
Good Prognosis ◽  
Optical Coherence ◽  
Irreversible Damage ◽  
Micropulse Laser ◽  
History Of

Significance: Perifoveal exudative vascular anomalous complex (PEVAC) is a unique clinical lesion. It manifests as isolated lesions and is easily misdiagnosed. Thus far, few PEVAC case reports have been published. PEVAC is typically inconsistent with other reported macular lesions.Purpose: To report our 24-month follow-up experience on the treatment of PEVAC with a micropulse laser (MPL).Case Report: A 56-year-old Chinese woman with no history of other diseases complained of decreased vision in her left eye that had persisted for more than 1 year. Comprehensive ophthalmic examinations were performed, including a vision test, slit lamp fundus exam, optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A), fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA). Intravitreal injection of ranibizumab was ineffective, and bleeding, exudation and visual acuity were not improved. After two rounds of micropulse laser (MPL) treatment, the patient was followed up, and the prognosis was good.Conclusion: PEVAC is very rare, and early diagnosis is important, as the lesions readily cause irreversible damage. Our results indicate that an MPL can be used as an alternative treatment for PEVAC patients.

Torcular dural sinus malformation

2022 ◽  
Author(s):  
Zeferino Demartini Jr. ◽  
Adriano Keijiro Maeda ◽  
Gelson Luis Koppe ◽  
Ricardo Munhoz da Rocha Guimarães ◽  
Luana A.Maranha Gatto ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Treatment Options ◽  
Brain Mri ◽  
Jugular Bulb ◽  
Good Prognosis ◽  
Dural Sinus ◽  
Third Ventriculostomy ◽  
Arteriovenous Shunts ◽  
Dural Sinus Malformation

The dural sinus malformation (DSM) are rare congenital vascular anomalies with variable anatomic features, clinical conditions, and outcomes. There are two forms of disease: a lateral subtype, affecting the jugular bulb with associated high flow arteriovenous fistula; and a midline subtype, called torcular DSM. The torcular subtype is more common and characterized by a giant dural sinus lake involving the confluens sinuum (torcular Herophili). We present a case of a 28-year-old woman with an ultrasound at 32 weeks’ gestation showing a fetal intracranial thrombosed lesion, measuring 6x4 cm. An elective c-section was performed at 38 weeks’ gestation, and a male neonate was born. He remained asymptomatic, and a brain MRI performed 9 days later showed a thrombosed midline mass due to a torcular DSM. The outcome with conservative treatment was favorable, and further development was unremarkable. The 2-year follow-up imaging demonstrated spontaneous involution of the clot. The torcular DSM is frequently diagnosed prenatally as an intraluminar lake thrombosis, and differential diagnosis include tumors, subdural collections, vein of Galen aneurysmal malformations, pial malformations, arachnoid and dermoid cysts. A literature review involving 126 patients with torcular DSM found an overall mortality of 22.1%. Torcular DSM seems to have better prognosis than those having dural arteriovenous shunts, and the worst outcomes were associated to brain damage and patent feeders. In addition, antenatal diagnosis and thrombosis of pouch have good prognosis, possibly because the clot may spontaneously obliterate the fistulas. Treatment options must be individualized, and include conservative, embolization, ventriculoperitoneal shunt and endoscopic third ventriculostomy. Although systemic anticoagulation is controverse in infants, it should be considered for patients with sinovenous thrombosis affecting outflow pathways, especially those aggravated by venous congestion. Intervention is recommended for grade III patients because they progress to grade IV, and endovascular treatment is the gold standard therapy due to the risk of fatal intraoperative exsanguination. Whenever possible, embolization should be prioritized over hydrocephalus treatment because it may avoid ventriculoperitoneal shunt. Close follow-up imaging is recommended to detect any changes, with lesion reduction indicating favorable outcome.

Update on “Treatment of orthostatic headache without intracranial hypotension: A case report” – nine years later

Cephalalgia ◽  
2021 ◽  
pp. 033310242110386
Author(s):  
Gonçalo V Bonifácio ◽  
Raquel Gil-Gouveia
Keyword(s):  
Vitamin A ◽  
Intracranial Hypotension ◽  
Treatment Options ◽  
Medication Management ◽  
Cerebrospinal Fluid Leak ◽  
Orthostatic Headache ◽  
Drug Induced ◽  
Nerve Blocks ◽  
Obstructive Sleep ◽  
Greater Occipital Nerve

Background In 2013, one of the authors described a 36-year-old female with orthostatic headache without documented intracranial hypotension or evidence of cerebrospinal fluid leak, despite extensive workup. Headache was unresponsive to conservative treatment since 2010, showed only transient benefit after repeated epidural blood patches while vitamin A supplementation resulted in progressive improvement. Case Since 2013, the patient followed a relapsing and remitting course yet relapse control became difficult after a drug induced liver injury required vitamin A discontinuation in 2017, when her headache became chronic. Greater occipital nerve blocks provided pain relief as alternative but were stopped due to the pandemic and her latest severe relapse, in late 2020, required not only restarting anaesthetic blocks and aggressive medication management, but also reassessing and treating comorbidities (obstructive sleep apnoea and major depressive disorder) with modest benefit. Conclusion Orthostatic headache without intracranial hypotension is rare, with only 28 cases reported so far, all treated empirically and all treatment options revealing to be mostly ineffective. Vitamin A anecdotally appeared to be useful in our case but had to be stopped for severe side effects, so unfavourable long-term prognosis, in ours and 2/3 of the reported cases, seems to be the rule in this intriguing entity.

scholarly journals Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Yilmaz Yozgat ◽  
Ayhan Kilic ◽  
Cem Karadeniz ◽  
Rahmi Ozdemir ◽  
Onder Doksoz ◽  
...  
Keyword(s):  
Case Report ◽  
Sinus Node ◽  
Good Prognosis ◽  
Atrial Septal Aneurysm ◽  
Fetal Bradycardia ◽  
Hemodynamic Impairment ◽  
Fetal Tachycardia

Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA) on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA.

scholarly journals Olfactory bulb - gateway for COVID-19?

2021 ◽  
pp. 103-103
Author(s):  
Aleksandar Jovanovic ◽  
Jelena Nikovic ◽  
Nikola Boban ◽  
Radoslav Pejin ◽  
Filip Samardzic
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Case Report ◽  
Mr Imaging ◽  
Olfactory Bulb ◽  
Female Patient ◽  
Brain Mri ◽  
Neurological Complications ◽  
To Come

Introduction: Anosmia and ageusia are one of the most common and characteristic symptoms of SARS-Cov-2 infection, with frequency of almost 50% in patients in Western countries. There are more and more hypotheses of potential central nervous system (CNS) affection by the virus. It is supposed that virus enters via nasal mucosa, and then via cribriform plate enters olfactory bulb, with further dissemination to the CNS. Case report: A 34-year old female patient experienced loss of smell and taste in July 2020, about two months before testing Covid-19 positive. Covid-19 presented with minor pneumonia, and worsening of anosmia and ageusia. After treatment, the patient recovered well, but anosmia and ageusia appeared again, varying in intensity, and since January 2021 became persistent. The case was evaluated by otorinolaryngologist, pulmologist, and finally neurologist. In the meantime, patient was tested Covid-19 negative and received two doses of Sputnik V vaccine. Brain MRI was performed and it clearly shows severe bilateral olfactory bulb atrophy. Thre patient has anosmia and ageusia up to this day, and future MRI follow-up is planned. Conclusion: Loss of smell and taste may be a predictor of further central nervous system dissemination of the virus, and possible neurological complications (which is still a subject of consideration). Olfactory bulb could be a gateway to Covid-19 intrusion into CNS, and its atrophy could be an indicator of that. Further investigation on this topic is required, including wide application of MR imaging in order to come to definite conclusions.

Spontaneous intracranial hypotension combined with subarachnoid hemorrhage: report of 2 cases

2020 ◽  
Author(s):  
Ya Cao ◽  
Weinan Na ◽  
Hui Su ◽  
Xiaolin Wang ◽  
Zhao Dong ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Brain Mri ◽  
Intrathecal Injection ◽  
Spontaneous Intracranial Hypotension ◽  
Orthostatic Headache ◽  
Csf Pressure ◽  
Brain Ct ◽  
Blood Patch

Abstract Background: Spontaneous intracranial hypotension (SIH) combined with subarachnoid hemorrhage (SAH) has rarely been reported. Herein, we report two patients with SIH who suffered from diffuse non-aneurysmal SAH and expanded the symptom spectrum of SIH.Case report: ① A 55-year-old male was diagnosed with SIH based on orthostatic headache and diffuse pachymeningeal enhancement on brain MRI. One more month later, his headache was exacerbated, and brain CT showed diffuse SAH. Lumber puncture showed bloody CSF with a low CSF pressure of 20 mmH2O after a 30 ml intrathecal injection of saline. The patient was treated with a lumbar epidural blood patch and recovered. ② A 41-year-old male presented with orthostatic headache and nuchal pain. The brain CT scan confirmed the diagnosis of SAH. Brain MRI revealed diffuse dural thickening and bilateral frontoparietal subdural fluid collection. Lumber puncture showed bloody CSF with low CSF pressure. Then, an epidural blood patch was performed with satisfactory results.Conclusion: Dilation and rupture of intracranial venous structures might play significant roles in SIH combined with SAH. We should be alert to SIH patients who develop a new persistent severe headache without relief after lying down or a suddenly changed state of consciousness.

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