Subject(s)
Adenoma/physiopathology , Blepharoptosis/etiology , Diplopia/etiology , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/physiopathology , Adenoma/surgery , Aged , Facial Paralysis/etiology , Facial Paralysis/physiopathology , Headache/etiology , Headache/physiopathology , Humans , Magnetic Resonance Imaging , Male , Nausea/etiology , Oculomotor Nerve Diseases/etiology , Oculomotor Nerve Diseases/physiopathology , Pituitary Apoplexy/etiology , Pituitary Apoplexy/physiopathology , Pituitary Apoplexy/surgery , Pituitary Neoplasms/surgery , Severity of Illness Index , Tomography, X-Ray Computed , Treatment Outcome , Vomiting/etiologyABSTRACT
In the present study we describe the cases of two patients with cluster-like headache related to intracranial carotid artery aneurysm. One of these patients responded to verapamil prescription with headache resolution. In both cases the surgical clipping of the aneurysm resolved the cluster pain. These findings strongly suggest a pathophysiological link between the two conditions. The authors discuss the potential pathophysiological mechanisms underlying cluster-like headache due to intracranial carotid artery aneurysm.
Subject(s)
Cluster Headache/diagnosis , Cluster Headache/etiology , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnosis , Oculomotor Nerve Diseases/etiology , Subarachnoid Hemorrhage/etiology , Afferent Pathways , Calcium Channel Blockers/therapeutic use , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Artery, Internal/surgery , Cerebral Angiography , Cluster Headache/physiopathology , Diagnosis, Differential , Humans , Intracranial Aneurysm/physiopathology , Magnetic Resonance Imaging , Male , Middle Aged , Mydriasis/etiology , Neurosurgical Procedures , Oculomotor Nerve Diseases/diagnosis , Oculomotor Nerve Diseases/physiopathology , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/surgery , Surgical Instruments , Treatment Outcome , Vascular Surgical Procedures , Verapamil/therapeutic useABSTRACT
BACKGROUND: To review the preoperative signs of bilateral superior oblique paresis and to analyze their presence. METHODS: The proposed preoperative signs of bilateral superior oblique (SO) muscle paresis were separated into "certain signs" and "suspicious signs." The signs were analyzed for accuracy using case examples and statistics. RESULTS: A strong preoperative sign of bilateral SO muscle paresis was reversal of the hypertropia in the ipsilateral (and/or ipsi-supralateral) position and/or in the contralateral head tilt position. In such cases, the addition of a light contralateral weakening procedure to the operation aimed at the elimination of the hypertropia caused by the more affected SO muscle prevented development of the clinical picture of a contralateral SO muscle paresis. A suggestive preoperative sign of bilateral SO muscle weakness was marked reduction of the hypertropia in the ipsilateral (and ipsi-supralateral) position, as well as in the contralateral head tilt position. In these cases, a contralateral inferior oblique muscle weakening was deferred until after motility could be reassessed postoperatively. An additional sign of possible bilateral SO muscle weakness was the presence of a large V pattern. CONCLUSIONS: When planning surgery for apparent unilateral SO muscle paresis, the surgeon should be aware of the often subtle preoperative signs of bilateral SO muscle paresis. Early diagnosis allows the surgeon to avoid the reversal of the clinical picture or to advise the patient of the possibility of a bilateral problem.