Hemodialysis-related amyloidomas of bone

Lytic bone lesions secondary to amyloid deposition are a recently described complication of long-term hemodialysis. The authors refer to these tumorlike deposits as amyloidomas in a review of the subject and four proved cases. This entity typically appears as multiple well-defined, juxta-articular lytic lesions without matrix calcification. The duration of hemodialysis is probably the greatest risk factor for development of these intraosseous amyloidomas. Ultrastructurally, this new type of amyloid originates from beta 2-microglobulin, a low-molecular-weight serum protein that is not filtered by standard dialysis membranes.     

Hemodialysis-related amyloidosis of the sternoclavicular joint

 Amyloid deposition is an important cause of morbidity in long-term hemodialysis patients, but it has rarely been reported in the sternoclavicular joint, where the clinical picture may be consistent with an infection. The imaging features of one case are discussed. Biopsy with specific staining for the β-2 microglobulin component of amyloid should be considered in the work up of a lesion of this joint in this clinical setting.     

Hemodialysis-related venous stenosis: treatment with ultrahigh-pressure angioplasty balloons

The authors retrospectively reviewed the use of ultrahigh-pressure angioplasty balloons at atmospheric pressures at or above the manufacturer recommended burst pressure (30 atm) for the treatment of resistant hemodialysis-related venous stenosis at their institution. In seven of 87 procedures, high-pressure angioplasty (up to 27 atm) was unsuccessful. By coupling new balloon technology with aggressive inflation pressures, 100% technical success was achieved in the treatment of stenoses that were resistant to high-pressure angioplasty in these seven procedures. This approach could potentially offer cost savings compared with the costs of other previously described treatment methods for resistant lesions, such as atherectomy devices and cutting balloons.     

Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results

Purpose  

To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions.     

Exertional headaches with multiple triggers

Vascular headaches may occur in up to 20% of the population aged 17-40. One subgroup, exertional headaches, has many specific and nonspecific clinical presentations. Knowing the background events preceding the headache and the exact circumstances of the headache can help make a specific diagnosis. Three cases are presented to illustrate the diversity of triggers and their effect on aeromedical decision-making. The headaches are presented within the recently revised nomenclature for head and facial pain by the Headache Classification Committee of the International Headache Society.     

Prevalence of headaches in football players

BACKGROUND: Football coaches and team physicians rely heavily on players' reports of symptoms in deciding whether a player may return to the game after sustaining head trauma. The decision is made difficult by the wide variety of associated symptoms, some of which (e.g., headache is among the most common) may or may not be associated with serious head injury. More information is needed about the clinical significance of football-related headache. METHODS: To assess the frequency of headache associated with playing football, we analyzed responses to our questionnaire asking about incidence, frequency, and outcome of football-related headache from 443 football players (320 from college, 123 from high school). RESULTS: Eighty-five percent of respondents reported previous headache related to hitting in football. Asked specifically about their most recent game, 21% of respondents reported having had headache during that game. Of players who had headache, only 19% informed the team physician, trainer, or coach, and only 6% were removed from the game. Twenty-seven percent of respondents reported previous diagnosis of cerebral concussion by medical personnel. Defensive backs (25%), defensive linemen (19%), and offensive linemen (18%) were most likely to have headache, related to hitting. CONCLUSIONS: Our data confirm that posttraumatic headache is commonly associated with football participation and often goes unreported. Given that the most serious complications of head injuries (e.g., second-impact syndrome) occur infrequently, headache as an isolated symptom lacks specificity in predicting such complications in football players. Therefore, unless it persists or is accompanied by additional symptoms, headache alone may not reliably suggest the need to remove players from the game.     

Migraine headaches and cerebrovascular accident secondary to patent foramen ovale

Atrial septal defects are a frequent finding in young persons with strokes. New research now suggests migraines with aura may also be associated with these types of cardiac defects and that surgical treatment may result in a decrease or resolution of migraines. This case emphasizes the importance of a thorough evaluation of airmen with migraines, particularly migraines with aura.     

MR imaging of the brain in patients with migraine headaches

Forty-one patients with migraine headaches were referred for MR imaging of the brain. Intermediate and T2-weighted images were obtained to determine the frequency of areas of high intensity within the white matter. The average age of these patients was 29.8 years; only five were over 40 years old. Each patient was evaluated in the axial plane with long TR/short and long TE images. Twenty-three patients also had T1-weighted short TR/short TE MR scans; enhancement with gadopentetate dimeglumine was used in three patients. Intracranial abnormalities were seen in only six patients: foci or white matter high intensity on intermediate and T2-weighted images in five and a venous angioma in one. Prior studies have indicated that parenchymal brain abnormalities may be found in up to 46% of patients with migraines. The current study demonstrated parenchymal brain lesions in only 12%. This study suggests that the frequency of foci of high intensity seen on long TR sequences in the migraine patient is much lower than previously reported, especially in patients under 40 years old (5.5% in our series).     

Emergent headaches during pregnancy: correlation between neurologic examination and neuroimaging

BACKGROUND AND PURPOSE: Emergent evaluation of the pregnant headache patient requires rational selection of acute neuroimaging studies, yet guidelines do not exist. We investigated the demographic and clinical features that are predictive of intracranial pathologic lesions on neuroimaging studies in pregnant women with emergent headaches.MATERIALS AND METHODS: We conducted a retrospective review of demographic factors, clinical features, and radiologic findings in a consecutive case series of 63 pregnant women emergently evaluated with a chief complaint of headache, including those with previous headache histories. Clinical data were abstracted from emergency department records, hospital course, and discharge summaries. Multivariate logistic regression analysis examined predictors of intracranial pathologic lesions on emergent neuroimaging studies.RESULTS: Multiparous African American women constituted 63% of the case subjects. Headaches were frequently accompanied by photophobia (59%), nausea (52%), vomiting (37%), and occasionally with fever (11%), meningismus (9%), or seizures (7%). A total of 43% of case subjects had abnormal neurologic examination findings. Emergent neuroimaging, including noncontrast head CT and MR imaging, revealed an underlying headache etiology in 27%, including cerebral venous thrombosis, reversible posterior leukoencephalopathy, pseudotumor, and intracranial hemorrhage. The odds of having intracranial pathologic lesions on neuroimaging were 2.7 times higher in patients with abnormal results on neurologic examination (P = .085).CONCLUSIONS: Emergent neuroimaging studies may reveal an underlying headache etiology in 27% of pregnant women. Further research with a larger sample size is needed to determine what clinical factors are predictive of a pathologic condition on neuroimaging studies.

Headache is a common neurologic complaint among women of childbearing age.¹ The prevalence of headaches during pregnancy has been reported to be as high as 35%.² Although most headaches are unrelated to an intracranial pathologic lesion, some headaches may herald ominous diagnoses, including eclampsia, stroke, tumor, subarachnoid hemorrhage, or cerebral venous thrombosis. Emergent evaluation of headache in the pregnant patient requires rational selection of acute neuroimaging studies, yet guidelines do not exist. Often, the decision to investigate a headache in a pregnant patient through neuroimaging is based on the presence or absence of focal neurologic findings; however, there are no data to support this practice. We investigated the demographic factors, clinical presentations, and examination findings of pregnant women with headaches presenting to an emergency department in an academic center. Our hypothesis was that abnormal findings on neurologic examination would be predictive of an intracranial pathologic condition on acute neuroimaging studies.     

Posterior reversible encephalopathy syndrome after intravenous caffeine for post-lumbar puncture headaches

A 33-year-old woman developed severe post-lumbar puncture headaches in the course of work-up for multiple sclerosis. Immediately after receiving treatment with intravenous caffeine, she became blind and experienced a generalized tonic-clonic seizure. Brain MR imaging then showed vasogenic parieto-occipital edema. She recovered clinically and radiologically within 72 hours. After 1 year of follow-up, there was no recurrence of symptoms or radiologic changes.     

Headache after lumbar iohexol myelography: the influence of a history of headaches and early ambulation

Whether a history of headache or early versus late ambulation (no bed rest or bed rest for 24 h) influence the occurrence of headache after lumbar iohexol myelography was studied by blinded interviews in 158 consecutive patients referred for elective lumbar myelography (LM) because of suspected lumbar disc prolapse or spinal stenosis. Headache after LM occurred more often in patients with a history of headache (57%) than in patients without such a history (29%),P<0.001. Patients with normal myelographic findings complained of headache after LM more often (55%) than patients with abnormal normal myelographams (31%),P<0.008. No difference in the incidence of headache after LM was demonstrated in early versus late ambulation.Died 27 July 1991     

Incidental discovery of subtle-variant septooptic dysplasia in an adult with headaches: a novel case with pathophysiologic implications

Septooptic dysplasia (SOD) is a congenital central nervous system malformation syndrome classically associated with the triad of agenesis of the septum pellucidum, optic nerve hypoplasia, and pituitary abnormalities. It has been suggested that SOD may result from in utero vascular insults. We present the case of an adult male with personal and family histories of intracranial vascular pathology in whom SOD was incidentally discovered, and we describe how the specific abnormalities in this case could be related to vascular pathology.