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In this article, we present a 31-year-old female who presented with intermittent headache and oligomenorrhea of over 10 years’ duration. Imaging revealed a large suprasellar mass with sellar extension. The patient underwent an endoscopic endonasal trans-sphenoidal surgery to resection of the mass. Clinical, radiological, and operative findings from this patient were initially considered to be Rathke’s cleft cyst (RCC). However, postoperative histological examinations revealed a mature cystic teratoma. No radiotherapy was performed after surgery. At the most recent follow-up, approximately 1 year later, the patient is doing well with no headache and no recurrence of the teratoma.

A case of Sluder's syndrome in a female patient, aged 56 years old, suffered from intermittent headache for over 20 years. The therapeutic methods include acupuncture with filiform needle mainly applied to the acupoints on governor vessel, foot-shaoyang meridian and foot-yangming meridian, the external application of Wuzhūyu (吴茱萸 Fructus Evodiae) on Yŏngquan (涌泉 KI1), as well as the pricking and bleeding method with the three-edge needle on Touwei (头维 ST8). The alliance of these three therapies co-act on promoting the circulation of shaoyang and yangming meridians and governor vessel and have obtained an satisfactory clinical effect. After treated for 5 weeks, the symptoms all disappeared completely, such as headache, vertigo and discomfort on eyes and they were not recurred in 1-year follow-up.

This is a case of carotid body tumour at right side of neck region with initially diagnosed as paraganglioma. A 22 year old female patient with an history of pain and swelling at right side of neck region with intermittent headache difficulty during deglutination. Patient has taken medication for pulmonary kochs for 8 months. Now presented with the mentioned complaints with a swelling at right side swelling at neck region. The features and the correlation with MRI report diagnosed as paraganglioma and then on Histopathologic examination showed a tumour mass composed of two different areas admixed with each other either alternatively or diffusely. The final pathological impression was Neurilemmoma (Schwannoma).The diagnosis was definitive with no evidence of paraganglioma.

To study the cognitive profile and scholastic performance of children with parenchymal neurocysticercosis. A total of 500 children with a diagnosis of neurocysticercosis and epilepsy registered in our pediatric neurocysticercosis clinic between January 1996 and December 2002 were enrolled. Patients were evaluated for their scholastic performance using their school grades. Cognitive assessment was done using Parental interview and the “Draw-a-Man” test. Poor scholastic performance was seen in 22.2% (111) children. Draw-a-Man test was done in 148 children; 18.2% (27/148) had scores equivalent to IQ

Background Pituitary ependymoma is exceptionally rare. Its etiology, clinical presentation, radiologic feature, and treatment strategy are still a matter of debate. Only 7 human cases with limited data were reported in the English literature, and now we described another case of pituitary ependymoma. We also systematically reviewed previously reported cases and described its potential etiology, clinical presentation, radiologic features, pathology, immunohistochemical analysis, and ultrastructural examinations. Case Description A lesion in pituitary fossa was discovered in a 40-year-old man after suffering a progressive deterioration of vision in his right eye for >1 year with intermittent headache. The lesion was microsurgically resected and proved to be ependymoma upon pathologic and histologic examination. The patient made a fully recovery after surgery. Conclusions To our knowledge, only 7 patients with ependymoma in the sellar region have been described in the English literature. We reported 1 more case of pituitary ependymoma and discussed the potential etiology, clinical presentation, radiologic features, pathology, immunohistochemical analysis, ultrastructural examinations, treatment, surgery, radiotherapy, chemotherapy, and prognosis of pituitary ependymoma. The case report may serve as a helpful reference for clinicians and radiologists.

Chronic overdrainage affects shunted patients producing a variety of symptoms that may be misdiagnosed. The best known symptoms are so-called shunt-related headaches. There is mounting evidence that changes in cerebrospinal venous system dynamics are a key factor to the pathophysiology of chronic overdrainage syndrome. We report the case of a 29-year-old woman with a shunt since the postnatal period suffering from chronic but the most severe intermittent headache attacks, despite an open shunt and with unchanged ventricular width during attacks. Intracranial pressure (ICP) recordings were performed during headache attacks and thereafter. Massively increased ICPs, a continuous B wave “storm,” and severely compromised intracranial compliance despite an open shunt were found, a scenario that was always self-limiting with the resolution of symptoms after several hours. When mobilized to the upright position, her ICPs dropped to − 17 mm Hg, proving shunt overdrainage. Symptomatology can only be explained by sudden venous entrapment following chronic venous distention as a result of chronic overdrainage. Subsequent therapeutic management with an overdrainage preventing shunt and satisfying clinical outcome with complete ceasing of headache attacks adds insight into the pathophysiology of chronic overdrainage syndrome.

Keywords: cerebral herniation; giant arachnoid granulation; advanced MR imaging; headache

A reading of the letters of Charlotte Bronte shows that she suffered an intermittent headache disorder throughout her adult life, with many of the features of headache being compatible with a diagnosis of migraine. Although such headaches interrupted her social and occupational functions including on occasion her writing, they do not seem to have informed her fictional characterizations, since reports of headache occur rarely in her novels.

A young adult male was referred by his optometrist for suspected papilloedema. He complained of a 4-week history of intermittent headache and a 2-day history of blurred vision in his right eye. There were no postural variation in symptom intensity, pulsatile tinnitus or additional neurological symptoms. A recent CT scan of the head (arranged by his general practitioner) had shown no intracranial space-occupying lesions. On examination, Snellen visual acuities were 20/30 on the right and 20/20 on the left. There was no relative afferent pupillary defect, and examinations of colour vision, cranial nerve and anterior ocular segments were normal. Funduscopy showed bilateral optic nerve head …

We present 2 cases, one adult and one pediatric, of acute migraine headache promptly relieved by intravenous oxytocin. Both cases were typical flares of a chronic intermittent headache pattern with classic vascular symptoms. Pain relief in both cases was rapid and temporally related to oxytocin administration. Vascular headache pathophysiology and possible oxytocin mechanisms of action are discussed.

Pituitary hyperplasia with hyperprolactinemia has been described as a rare presentation of primary hypothyroidism. A 12-y-old child presented with intermittent headache, easy fatigability, coarseness of facial features, and hoarseness of voice for 6 mo duration. Brain imaging findings showed pituitary hyperplasia; hormonal assessment revealed primary hypothyroidism and hyperprolactinemia. Pituitary hyperplasia regressed with thyroid hormone replacement therapy. This report describes an unusual case of pituitary hyperplasia with hyperprolactinemia secondary to primary hypothyroidism.

Background: The orbital varix is a rare congenital disorder. Men and women are equally affected. The disease becomes usually apparent during the third decade of life. Patient: A 66-year old women presented with a history of progressive enophthalmos for the last 45 years and complained of intermittent headache and visual deterioration in the left eye. Results: Visual acuity was markedly reduced in the left eye and optic atrophy was present. The enopthalmos was less apparent after bending forward of the upper part of the body. A concentric visual field defect was noted during perimetry, CT revealed severe changes in the orbital walls. Conclusion: Enophthalmos in association with an orbital varix is a rare condition and is usually caused by atrophy of the orbital fatty tissue; changes in the orbital walls are less common.

Angle closure is usually associated with older patients, as it typically manifests in middle to later life, being associated with an age-related increased lens volume. However, angle closure can occur in any age group if there is an anatomical predisposition that promotes pupillary block or an anterior pulling of the iris. During an acute angle closure, patients generally experience ocular pain, headache, nausea, vomiting and conjunctival hyperaemia. These attacks can be misinterpreted as migraine, particularly if subacute or chronic and the demographic characteristics of the patient do not suggest a primary angle closure event. Diagnosing a headache as ocular related is of paramount importance, since there is an effective treatment. We report a case of a child with intermittent headache which revealed a subacute angle closure in both eyes.

A 27-year-old woman presented with a six-month history of intermittent headache and a 2-week history of blurring of vision. Subsequently a 4 cm large enhancing lesion in the left frontal parafalcine region with a small extension into the nasoethmoid sinus was found. This was thought to be either an anterior cranial fossa meningioma or an esthesioblastoma. However after uneventful gross total excision of this lesion via a frontal craniotomy, the histology came back as a schwannoma. Only seven cases of nasoethmoid schwannoma with intracranial extension have been reported before and this case is unique in that almost all of the tumour was intracranial. We review the literature and discuss the origin of these tumours.

Septum pellucidum cysts are rare clinical findings. Although their optimal treatment remains controversial, large cysts causing hydrocephalus or neural compression should be treated surgically. However, spontaneous resolution can also occur. Herein, the authors present a case of a 38-year-old woman suffering from intermittent headache associated with an expanding cyst of the septum pellucidum. No surgical intervention was performed as hydrocephalus was not observed. After 16 months follow-up, both her symptom and the cyst (assessed by magnetic resonance imaging) had disappeared. To the best of the authors' knowledge, this is only the third reported case of spontaneous resolution of a septum pellucidum cyst. This case suggests that a symptomatic septum pellucidum cyst is not an absolute indication for surgical treatment. A conservative approach with close follow-up with computerized tomography or magnetic resonance imaging is strongly recommended unless the cyst causes obvious hydrocephalus or progressive neurological deterioration.

The falcine sinus is an abnormal anatomic structure located in the falx cerebri that is closed after birth and is rarely observed. We describe two cases of persistent falcine sinus. A 60-year-old woman presented with headache. An 11-year-old girl presented with intermittent headache and a palpable scalp mass in the middle of the high parietal area. The straight sinuses were absent in both patients. In both patients, drainage of the galenic system took place through a sinus within the falx, also known as a falcine sinus. Suspicious dysplastic tentorium cerebelli was observed in one patient. It can be concluded that a mesenchymal disorder can be the primary cause for a persistent falcine sinus.

DURING the past years, approximately 30 cases of eosinophilic granuloma of bone have been reported in the medical literature. Since it has been noted that this condition is confined to the skeleton, often involving only a single bone, it has also been called "solitary granuloma of bone." 1 The case herein reported has been under observation for almost three years since the diagnosis was established and is considered noteworthy because of the presence of multiple skeletal lesions and a coexistent pulmonary infiltration. The latter may well be an instance of visceral involvement. REPORT OF A CASE The patient was a 31 year old lawyer who was admitted to the Medical Service of Vanderbilt University Hospital on Jan. 6, 1943, complaining of an intermittent headache in the left occipital region, of about seven months' duration, and backache in the lower region, which he had first noticed three months before his admission.

We report the details of a patient with an intracisternal schwannoma that developed from the spinal accessory nerve. The patient, a 70-year-old women, presented with a 5-year history of intermittent headache and neck pain. A 3.2 x 2.5 cm partially cystic mass was found in the right cervicomedullary cistern. It was removed through a far-lateral inferior suboccipital craniotomy using image-guidance. The tumor arose from one rootlet of the right accessory nerve and histological examination confirmed the diagnosis of a schwannoma. Removal of the schwannoma did not result in a significant neurological deficit.

Migraine is an intermittent headache syndrome whose pattern is generally easily recognized. It is comprised of a combination of signs and symptoms no one of which (other than headache) is absolutely required for diagnosis. Attacks can occur almost daily or very rarely, indicating that the threshold for experiencing an attack may vary from person to person. In an effort to standardize diagnosis, the International Headache Society has devised diagnostic criteria [1]. These have been useful for research purposes but perform less well in the clinical setting. Nonetheless, these criteria are widely accepted and used. They are summarized in Table 1.

Headache is one of the chief complaints among patients visiting primary care physicians. The aim of the current study is to report on a case of daily intermittent headaches in a patient with idiopathic cyclic edema. Over three years the patient suffered from headaches that started and improved at specific times. They began at about 5 to 6 o’clock in the morning and spontaneously disappeared 3 to 4 hours after getting up and thus were directly associated to sleep. The patient complained of generalized edema and had weight differences of about two kilograms between 7 a.m. and 5 p.m. A hypothesis of idiopathic cyclic edema was reached and the patient was prescribed aminaphtone which cured the headaches within two days after initiating treatment.

SUMMARY: A 50-year-old woman presented with intermittent headache for the past few years. A paranasal sinus CT scan showed a diffusely calcified lesion at the roof of the sphenoid sinus and sella turcica, with the sellar floor bony cortex involved. Empty sella was noted. MR imaging revealed a soft-tissue lesion with low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and heterogeneous enhancement on postgadolinium images. Histologic examination revealed an osteoma composed of mature lamellar bone.

A 32-year old female patient was referred to our hospital for evaluation of headache. A preliminary diagnosis of possible temporal arteritits in young patient was made in the referral letter. She had been complaining of episodes of left sided headache for the last 2 years. The headache occurred mainly in the horning; it is mild to moderate in severity, associated with feeing of fullness in the left temple. The episodes were coming at no regular time, was not related to menstruation and was not accompanied by nausea, vomiting or photophobia. It lasts for few hours and then subsides, and she noticed that the sensation of fullness also disappears. She had no history of trauma. She denied any fever, weight loss, morning stiffness, or any sinuses, ear or eye complaints. She was diagnosed at one time as migraine headache and was given treatment for that. Clinical examination at the time of headache revealed afebrile patient with normal blood pressure and pulse. The left temple showed fullness compared to the right side but there was no redness or warmth of the overlying skin. There was an ill-defined slightly raised 5 × 4cm soft swelling in the left temple. There was no palpable thrill or audible bruit. The temporal artery was pulsating without any tenderness.

A 14-year-old boy presented to our emergency department with status epilepticus of 1-h duration. He also had multiple episodes of generalised tonic-clonic seizures and intermittent headache for the past 1 month. He was a school dropout and belonged to a poor socioeconomic background. On examination, he was deeply comatose. Initial investigations included an axial contrast-enhanced CT of the brain subsequently followed by MRI of the brain. CT brain demonstrated diffuse cerebral oedema with multiple small cystic lesions scattered bilaterally (figure 1). MR images revealed innumerable well-defined small-sized cystic lesions (low signal on T1 and increased intensity on T2) …

A 42-year-old, unmarried, white male, native to New York, was admitted to the hospital complaining of severe intermittent headache of 4 weeks duration, stiff neck, dizziness, and intermittent lethargy. He reported an approximate 30lb weight loss over the previous year associated with almost constant diarrhea.

To the Editor.— The recent discovery of unexpected increased lead absorption in children of female battery workers strikingly reflects the impact on clinical practice of the increased participation by women in the work force. This experience illustrates other epidemiologic principles that we believe need wider appreciation. We have detailed these points to pediatricians 1 and wish now to reiterate them for a more general medical audience. Report of a Case.— A 24-year-old woman had intermittent headache, dizziness, and amnesia. Results of neurological evaluation were normal, but anemia with basophilic stippling was found. Her work involved burning lead battery terminals, but the importance of this information was not appreciated until her 20-month-old son showed a high blood lead level on routine screening. Subsequently, increased lead absorption was disclosed in the woman, and chelation therapy produced clinical and biochemical improvement. Three of her children, and children in the families of five other