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Headache
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Use of computed tomography (CT) and MRI (Figures 6.5–6.8) depends on the type of headache and any associated features. For example, sudden-onset headache associated with loss of consciousness suggests probable SAH or pituitary apoplexy, in which case CT brain scanning is the initial investigation of choice. Headache coming on over several weeks that is worse in the morning and on coughing suggests raised intracranial pressure, in which case a contrast-enhanced CT scan (possible brain tumor) or MRI scan (possible venous sinus thrombosis), perhaps followed by angiography, would be appropriate. If an Arnold–Chiari malformation is suspected, then the craniocervical junction and brain need to be imaged by high-resolution CT or MRI scan. Arnold–Chiari can be seen in low CSF pressure headaches. The imaging requirements of headache with localizing features require a little more thought; for example, pituitary disease (MRI), ear disease (MRI for internal auditory meatus, CT for middle and external ear problems), or sinus disease (CT to diagnose plus look at the ostia), but in any case it is essential to state all the relevant history on the request, or the investigation may not answer the problem.
The spine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Arnold-Chiari malformation occurs when the medulla oblongata and the cerebellar tonsils extend through the foramen magnum into the cervical spinal canal, causing pressure on the lower medulla. Hydrocephalus and impaired neurological function are common, and there is a strong association with spina bifida and syringomyelia. Symptoms may include headache, vomiting, visual disturbances, mental impairment, cerebellar ataxia, sensory disturbances or paralysis. Management consists of decompressing the foramen magnum and, usually, the posterior arch of the atlas to restore normal cerebrospinal fluid flow.
Epidemiology of the neurogenic bladder
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Patrick B. Leu, Ananias C. Diokno
Myelodysplasia, also known as spina bifida, is the most common cause of neuropathic bladder in children. It occurs in approximately 1 in 1000 births in the United States. It can involve all levels of the spinal column, including the lumbar 26%, lumbosacral 47%, sacral 20%, thoracic 5%, and cervical spine 2%. Eighty-five percent of children have an associated Arnold–Chiari malformation.
Clinical characteristics and aetiology of acute acquired comitant esotropia
Published in Clinical and Experimental Optometry, 2022
Yanfang Meng, Xuemin Hu, Xiaoqi Huang, Yijia Zhao, Meihong Ye, Beixi Yi, Lianhong Zhou
Previous studies have found that brain tumours, such as astrocytoma of the corpus callosum, brain stem or cerebellum tumours, etc., can cause AACE.17,18 Arnold-Chiari malformation has been associated with AACE in several studies, and esotropia might be an early manifestation or even the only symptom.19,20 Liu et al.21 reported that AACE is associated with meningitis and basilar artery aneurysm. Among the comitant esotropia patients (51 patients), two had psychosis treated with antipsychotic drugs, and one had systemic lupus erythematosus treated with glucocorticoids. AACE onset may be related to long-term near work but also may be associated with mental illness, systemic lupus erythematosus, or their associated drugs. Parentin et al.22 reported that a nine-year-old girl developed acute common esotropia after receiving recombinant human growth hormone. The development of esotropia may be related to idiopathic intracranial hypertension.
Neurological and neuropsychiatric manifestations of porphyria
Published in International Journal of Neuroscience, 2019
Yiji Suh, Jason Gandhi, Omar Seyam, Wendy Jiang, Gunjan Joshi, Noel L. Smith, Sardar Ali Khan
Acute porphyria may have an insidious onset with symptoms that are nonspecific. For this reason, diagnosis of acute porphyria may be difficult, especially among patients who have comorbidities. A woman who had Arnold Chiari malformation was treated with trimethoprim/sulfamethoxazole for neurogenic bladder and recurrent urinary tract infections. However, after receiving metronidazole to treat C. difficile colitis, the patient presented with additional symptoms, including ascending paralysis, metabolic difficulties, and psychosis [28]. Due to the similarities of symptoms, porphyria is frequently misdiagnosed as Guillain-Barré syndrome [18]. Thus, it is essential to consider acute porphyria as a possible diagnosis to prevent disability and improve the prognoses of patients.
Use of cyanoacrylate to prevent cerebrospinal fluid fistulas after cranial surgery
Published in British Journal of Neurosurgery, 2018
The mean age of the cases was 43,7 and 9 cases had otorrhea and/or rhinorrhoea symptoms detected with a trauma-related epidural haematoma. 84 cases were operated due to supratentorial intra-axial pathologies, 13 cases due to Arnold Chiari malformation, 11 cases due to posterior fossa pathologies, and 11 cases due to a glial tumour or haematoma extending to the lateral ventricle. The gap between the dural leaves was large in 18 cases who received posterior fossa surgery; therefore muscle was thinned, and patches were made. Galea was also used for duraplasty in cases where supratentorial surgery was administered. Artificial dura material was not used in any case