tailieunhanh - Chapter 015. Headache (Part 3)

Intracranial Hemorrhage Acute, severe headache with stiff neck but without fever suggests subarachnoid hemorrhage. A ruptured aneurysm, arteriovenous malformation, or intraparenchymal hemorrhage may also present with headache alone. Rarely, if the hemorrhage is small or below the foramen magnum, the head CT scan can be normal. Therefore, LP may be required to definitively diagnose subarachnoid hemorrhage. Intracranial hemorrhage is discussed in Chap. 269. Brain Tumor Approximately 30% of patients with brain tumors consider headache to be their chief complaint. The head pain is usually nondescript—an intermittent deep, dull aching of moderate intensity, which may worsen with exertion or change in position and may. | Chapter 015. Headache Part 3 Intracranial Hemorrhage Acute severe headache with stiff neck but without fever suggests subarachnoid hemorrhage. A ruptured aneurysm arteriovenous malformation or intraparenchymal hemorrhage may also present with headache alone. Rarely if the hemorrhage is small or below the foramen magnum the head CT scan can be normal. Therefore LP may be required to definitively diagnose subarachnoid hemorrhage. Intracranial hemorrhage is discussed in Chap. 269. Brain Tumor Approximately 30 of patients with brain tumors consider headache to be their chief complaint. The head pain is usually nondescript an intermittent deep dull aching of moderate intensity which may worsen with exertion or change in position and may be associated with nausea and vomiting. This pattern of symptoms results from migraine far more often than from brain tumor. The headache of brain tumor disturbs sleep in about 10 of patients. Vomiting that precedes the appearance of headache by weeks is highly characteristic of posterior fossa brain tumors. A history of amenorrhea or galactorrhea should lead one to question whether a prolactin-secreting pituitary adenoma or the polycystic ovary syndrome is the source of headache. Headache arising de novo in a patient with known malignancy suggests either cerebral metastases or carcinomatous meningitis or both. Head pain appearing abruptly after bending lifting or coughing can be due to a posterior fossa mass or a Chiari malformation . Brain tumors are discussed in Chap. 374. Temporal Arteritis See also Chaps. 29 and 319 Temporal giant cell arteritis is an inflammatory disorder of arteries that frequently involves the extracranial carotid circulation. It is a common disorder of the elderly its annual incidence is 77 per 100 000 individuals ages 50 and older. The average age of onset is 70 years and women account for 65 of cases. About half of patients with untreated temporal arteritis develop blindness due to involvement of the .