Computerised axial tomography in patients with severe migraine: a preliminary report.

Hungerford, G D; Boulay, G. H. du; Zilkha, K. J.

doi:10.1136/jnnp.39.10.990

Cited by 93 publications

(46 citation statements)

References 6 publications

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“…2,8,[15][16][17][18][19][20][21][22][23] The populations in these studies were reasonably similar. Results from these studies were combined in a meta-analysis to yield a summary prevalence of 0.0018 (approximately 0.2%), with an upper 95% confidence limit of 0.0059 (approximately 0.6%).…”

Section: Nonacute Headache and Normal Neurological Examinationmentioning

confidence: 61%

Endoscopic resection of incidental colloid cysts

Margetis

Christos

Souweidane

2014

JNS

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Object Incidental colloid cysts are frequently managed with surveillance imaging rather than surgical excision. This approach is born out of their purported indolent growth pattern and the surgical morbidity associated with microsurgical removal. The advent of endoscopic colloid cyst removal may offer renewed assessment of these patients who carry a risk of acute neurological deterioration. An evidence-based recommendation should weigh the risks of operative treatment. Thus far, there has been no concentrated assessment of cyst removal in patients with incidental colloid cysts. The major objective in this study was to define the risks associated with the endoscopic surgical removal of incidentally diagnosed colloid cysts Methods A retrospective review of the medical records was performed to search for patients evaluated for a colloid cyst between the years 1996 and 2012. Eighty-seven patients underwent colloid cyst resection, and 34 were managed with nonoperative surveillance imaging. Microsurgical resections, endoscopic resections of residual or recurrent colloid cysts, and cases with unknown preoperative symptomatic status were excluded from further analysis. Seventy-seven cases of primary endoscopic resections were identified. Twenty resections were performed in patients with an incidental diagnosis and 57 in symptomatic individuals. Presenting characteristics and surgical outcomes were compared between the incidental and symptomatic groups. Results The mean age at surgery was 39.65 years for the incidental and 43.31 years for the symptomatic group (p = 0.36). The median maximal cyst diameter was 9.7 mm (range 3–31 mm) for the incidental and 12 mm (range 5–34 mm) for the symptomatic group. The mean frontal and occipital horn ratio was 0.3928 for the incidental and 0.4445 for the symptomatic group (p = 0.002). Total resection was achieved in 90% of the incidental and 82.3% of the symptomatic cases (p = 0.49). The median hospital stay was 1 day for incidental and 2 days for symptomatic cases (p = 0.006). There were no deaths. There was one case of aseptic meningitis in the incidental group. In the symptomatic group there were 3 complications: one patient with subjective memory impairment, one with transient short-term memory deterioration, and another with a superficial wound infection treated with operative debridement. Two patients from the symptomatic group needed a CSF diversion procedure, and no shunting was needed in the incidental group. There were two recurrences in the symptomatic group (78 and 133 months postoperatively) and none in the incidental group (p = 1). Conclusions Age and cyst diameter were not correlated with the absence or presence of symptoms in patients with a colloid cyst of the third ventricle. Operative results were highly favorable in both groups and did not reveal a higher risk of morbidity in the patient presenting with an incidental lesion. The results support endoscopic resection as a legitimate therapeutic option for patients with incidental colloid cysts. Generalization of the operative results should be cautiously made, since this is a limited series and the results may depend on the degree of neuroendoscopic experience.

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Section: Nonacute Headache and Normal Neurological Examinationmentioning

confidence: 61%

Endoscopic resection of incidental colloid cysts

Margetis

Christos

Souweidane

2014

JNS

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“…Prensky [16] has postulated that the per sistent focal activity on EEG between episodes in migraine patients is indi cative of permanent brain damage, and both Verret and Steele [15] and Hosking et al [9] reported persistent EEG changes in their patients with resi dual neurologic deficits. In support of the concept of permanent CNS injury following migraine, Hungerford et al [14] performed CT scans in 53 patients with long-standing migraine and demonstrated generalized or focal atrophy in 14 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Connor [13] reported on 18 patients, in cluding several teenaged patients with permanent neurologic deficits follow ing complicated migraine attacks. More recently, Hungerford et al [14] de tected abnormalities on neurologic exam in 13 of 30 patients with long histo ries of complicated migraine..…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Complicated Migraine in Childhood

Ment¹,

Duncan²,

Parcells³

et al. 1980

Pediatr Neurosurg

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We report on 3 patients with complicated migraine of childhood. Family history was positive for migraine in each case, and all experienced the acute onset of neurologic deficits in association with throbbing hemicranium. Abnormalities of cerebral blood flow determinations, electroencephalograms and cerebral arteriograms in addition to persistent neurologic sequelae were demonstrated. We propose that complicated migtaine of childhood is not an entirely benign symptom complex.

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“…2 ' 6 Angiography is usually normal, but some cases show occlusion of one of the major cerebral arteries, most commonly the P.C.A. 4 ' 5 7 However, given the high prevalence of migraine, 15 to 30% of all stroke patients would be expected to have a past history of migraine. Therefore, to causally link cerebral infarcts to migraine itself, three criteria are thought to be essential.…”

Section: Discussionmentioning

confidence: 99%

Stroke, migraine and intracranial aneurysm: a case report.

Mas¹,

Baron²,

Bousser³

et al. 1986

Stroke

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1019SUMMARY A man had since childhood recurrent attacks typical of ophthalmic migraine. After an otherwise unremarkable attack, he was left with a permanent quadrantanopsia due to a right occipital infarct. The remarkable pattern of progression, which characterized the visual phenomenon of subsequent attacks, favours a primary neuronal phenomenon. The first angiography revealed an occlusion of the posterior cerebral artery (PCA) but the second one, performed two years later, disclosed a PCA aneurysm. Such a finding emphasizes the need of thorough and repeated evaluations of patients with so-called "migrainous Infarcts." Stroke Vol 17, No 5, 1986 THE PRECISE MECHANISMS of the transient neurological disturbances that characterize classic migraine, and of the events that lead to permanent deficits in complicated migraine remain unknown. The following case report may add further information on these questions.Case Report A 44 year old man had suffered from ophthalmic migraine since the age of 5. His attacks always started with a brilliant and scintillating visual disturbance in the central part of vision, followed by a left homonymous hemianopsia which lasted about 10 minutes. Then a diffuse headache appeared, worsening over 30 minutes, lasting about 5 hours and accompanied by vomiting. Attacks remained infrequent until he was 40, when their frequency increased from twice a year to twice a month.At 42, the patient had an attack starting as an usual one, but, a few minutes after the onset of the left visual field defect, he complained of weakness of the left lower limb and of numbness of the left side of the tongue, lip and palate and of the first three fingers of the left hand. He also had a severe headache which lasted several hours. The other neurological symptoms lasted about one week and then disappeared except for a left upper homonymous quadrantanopsia and a persistent numbness of the left side of the palate. Brain CT scan performed two days later showed, without contrast infusion, an area of decreased density compatible with an infarct in the right posterior cerebral artery (PCA) territory (fig. 1); at the antero-intemal edge of the hypodensity, there was a small round hyperdensity. These lesions did not enhance after contrast infusion. Right vertebral selective angiography performed the next day disclosed an occlusion of the right PCA ( fig. 2). No treatment was given acutely and the visual field defect persisted. Afterwards, the patient was given methysergide, but continued to have weekly attacks which, however, had a different pattern: they began From the Clinique des Maladies du Systeme Nerveux (Pr. Laplane),* and Service de Neuro-radiologie (Pr. Bones) H6pital de la Salp4triere 47, Bd d l'Hopital 75641 -Paris CEDEX 13, France.t

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Computerised axial tomography in patients with severe migraine: a preliminary report.

Cited by 93 publications

References 6 publications

Endoscopic resection of incidental colloid cysts

Endoscopic resection of incidental colloid cysts

Evaluation of Complicated Migraine in Childhood

Stroke, migraine and intracranial aneurysm: a case report.

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