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Eelco F M Wijdicks - One of the best experts on this subject based on the ideXlab platform.

  • hypertensive encephalopathy presenting with thunderclap headache
    Headache, 2001
    Co-Authors: David F Tangwai, Thanh G. Phan, Eelco F M Wijdicks
    Abstract:

    A 68-year-old woman presented with thunderclap headache, which led to a search for subarachnoid hemorrhage. Both computerized tomography of the head and Cerebrospinal Fluid Examination were normal. Magnetic resonance imaging revealed abnormalities in the white matter in the parieto-occipital regions. There was no aneurysm on magnetic resonance angiography. Treatment of hypertension led to resolution of the posterior leukoencephalopathy. Hypertensive encephalopathy with reversible posterior leukoencephalopathy can present as a thunderclap headache.

David F Tangwai - One of the best experts on this subject based on the ideXlab platform.

  • hypertensive encephalopathy presenting with thunderclap headache
    Headache, 2001
    Co-Authors: David F Tangwai, Thanh G. Phan, Eelco F M Wijdicks
    Abstract:

    A 68-year-old woman presented with thunderclap headache, which led to a search for subarachnoid hemorrhage. Both computerized tomography of the head and Cerebrospinal Fluid Examination were normal. Magnetic resonance imaging revealed abnormalities in the white matter in the parieto-occipital regions. There was no aneurysm on magnetic resonance angiography. Treatment of hypertension led to resolution of the posterior leukoencephalopathy. Hypertensive encephalopathy with reversible posterior leukoencephalopathy can present as a thunderclap headache.

Gert-jan Luijckx - One of the best experts on this subject based on the ideXlab platform.

  • an often unrecognized cause of thunderclap headache reversible cerebral vasoconstriction syndrome
    Journal of Headache and Pain, 2008
    Co-Authors: Karen Koopman, L K Teune, Maarten Uyttenboogaart, Johannes Keyser, Patrick C.a.j. Vroomen, Maris Laan, Gert-jan Luijckx
    Abstract:

    Thunderclap headache (TCH) can have several causes of which subarachnoid hemorrhage (SAH) is most common and well known. A rare cause of TCH is the reversible cerebral vasoconstriction syndrome (RCVS) which is characterized by a reversible segmental vasoconstriction of the intracranial vessels. We describe two patients with TCH due to RCVS and the probable precipitating factor, namely, cannabis and an anti-migraine drug. In RCVS, Cerebrospinal Fluid Examination is (near) normal, in contrast to SAH and (primary) cerebral vasculitis. Brain MRI may be normal or shows infarction. MRA can demonstrate vasoconstriction of the great arteries, but a normal MRA does not rule out the diagnosis. Caliber changes on cerebral angiography cannot adequately differentiate between RCVS and vasculitis. Calcium-channel antagonists may be a good therapy and repeated transcranial Doppler ultrasonography can be a reliable non-invasive investigation to monitor the effect of treatment and demonstrate reversibility of the vasoconstriction.

Adam Gassas - One of the best experts on this subject based on the ideXlab platform.

  • important role of routine Cerebrospinal Fluid Examination in diagnosing central nervous system relapse during maintenance therapy in pediatric acute lymphoblastic leukemia
    Blood, 2005
    Co-Authors: Lani Lieberman, Ronald Grant, Johann Hitzler, Adam Gassas
    Abstract:

    Despite the success of central nervous system (CNS) preventive therapy in reducing the incidence of CNS recurrence in pediatric acute lymphoblastic leukemia (ALL) on therapy, CNS relapse continues to be a significant cause of treatment failure and is observed in 5–10% of patients. While most pediatric ALL treatment protocols mandate periodic lumbar puncture (LP) surveillance for the length of therapy, some centers have stopped collecting routine CSF samples unless there are suggestive signs or symptoms of CNS involvement. Our objective herein was to assess the value of routine Cerebrospinal Fluid (CSF) obtained while performing routine LPs for administration of intrathecal chemotherapy in diagnosing CNS relapse in children with ALL in the maintenance phase. Patients and Methods: All children (0–18 years) with ALL, diagnosed and treated at the Hospital for Sick Children, Toronto, Canada between 1994–2004 were subjected to a retrospective analysis. Original reports for CNS relapse during maintenance therapy were examined to determine whether CNS relapse was diagnosed based on routine CSF sample obtained while administering intrathecal chemotherpy or a CSF sample obtained based on signs and symptoms or after a diagnosis of a bone marrow relapse. Results: Four hundred and ninety four children were diagnosed and treated in our institution during the study period. Children were treated based on the children oncology group (COG), pediatric oncology group (POG) and local protocols where applicable. Thirty-one children (6.3%) suffered CNS relapse while on maintenance therapy. Twenty-one had an isolated CNS relapse and ten had a combined bone marrow and CNS relapse. Seventy-six percent (16/21) isolated CNS relapses were diagnosed base on routine CSF samples obtained from asymptomatic children while administering intratheacal chemotherapy. Conversely, all patients with combined bone marrow and CNS relapse presented with symptoms and signs that warranted CSF Examination. Conclusion: Routine CSF Examinations are important in detecting CNS relapse in children with ALL during maintenance therapy. Furthermore, routine CSF sampling may detect isolated CNS relapse in asymptomatic children with ALL prior to extension into combined relapse where prognosis is less favorable.

Staffan Persson - One of the best experts on this subject based on the ideXlab platform.

  • Polyneuritis cranialis presenting with anti-GQ1b IgG antibody
    Journal of the Neurological Sciences, 2009
    Co-Authors: Bengt Edvardsson, Staffan Persson
    Abstract:

    A 52-year-old man developed diplopia, a nasal voice, dysphagia, hoarseness and slight bilateral facial palsies. There was no ataxia, areflexia, limb weakness or sensory involvement. Serum anti-GQ1b IgG antibody was present. Treatment with intravenous immunoglobulin started, and the patient responded with a rapid resolution of symptoms. The diagnosis is consistent with polyneuritis cranialis which is considered to be a Guillain-Barre syndrome variant, a forme fruste, but very rare. The diagnosis can be difficult and a thorough investigation is required. Electrophysiological Examination, laboratory evaluations, imaging and Cerebrospinal Fluid Examination are often required in the investigations. Cranial neuropathy can be the presentation of many disorders. Determination of anti-ganglioside antibodies as anti-GQ1b is valuable to the diagnosis, and shows the association with the Guillain-Barre syndrome.

  • cerebral infarct presenting with thunderclap headache
    Journal of Headache and Pain, 2009
    Co-Authors: Bengt Edvardsson, Staffan Persson
    Abstract:

    A 73-year-old man presented with a thunderclap headache (TCH), suggesting a subarachnoid haemorrhage. Neurological Examination, computer tomography of the head, and Cerebrospinal Fluid Examination were normal. Magnetic resonance imaging of the brain revealed a supratentorial cerebral infarct. No cerebral aneurysm could be detected. A TCH can be the presenting feature of many conditions. A formula for the diagnostic assessment of TCH should be established. The management of this type of headache is controversial. Articles differ in their conclusions and recommendations. An expansion of routine investigations should be performed in cases where the neurological Examination, Cerebrospinal Fluid analysis, and computer tomography are normal. A TCH can be the primary clinical feature of a supratentorial cerebral infarct.