Medulloblastoma Presenting as Severe Headache during Pregnancy: A Case Report and Review of the Literature

Headache is a common complaint during pregnancy and the puerperium. The differentiation between a benign headache and a headache that has an underlying more endangering cause, such as an intracranial tumor, can be difficult and often requires diagnostic procedures and brain imaging techniques. We report the case of an 18-year-old female patient who developed clinical symptoms—persistent headache followed by neurological deficit—in the last part of her pregnancy. A medulloblastoma (MB) was diagnosed and treated after delivery. We review 11 other cases of MB in pregnancy reported in the literature. The most common clinical manifestation at diagnosis was headache followed by neurological deficits. We discuss the association of brain tumor growth with physiological changes during pregnancy. We conclude that clinical features of intracranial tumors can be misinterpreted as pregnancy-related symptoms and should not be dismissed.

Case Report: Primary Pulmonary Angiosarcoma With Brain Metastasis

Primary pulmonary angiosarcoma (PPA) is a rare malignant vascular tumor, of which early diagnosis is challenging due to lack of specific clinical manifestations and a low level of suspicion. Here, we report a case of PPA presented with advanced brain metastasis. A 21-year-old patient with 1 week history of headache and mild cough was hospitalized for a head injury. Head MRI showed multiple intracranial lesions with brain edema. Chest CT displayed bilateral pulmonary infiltrates with mediastinal lymph node enlargement. After 2 months of anti-tuberculosis treatment, the patient was readmitted for persistent headache and cough with occasional hemosputum along with worsening pulmonary and intracranial lesions. Despite seizure prophylaxis and control of intracranial pressure and brain edema, his symptoms progressively aggravated, accompanied by cough with bloody sputum, frequent epileptic seizures, and hypotension. He eventually developed coma and died within 3 months of onset of symptoms. An autopsy confirmed PPA with brain metastasis.

Persistent Headache Caused by Post-Traumatic External Nasal Neuralgia: A Case Report

A 50-year-old female patient presented with a severe headache characterized by sharp pain localized in the right frontal area above the right eye. The patient’s right nostril was cauterized to stop a nosebleed one year prior to the start of the pain. Physical examinations revealed that the pain was aggravated by touch of the right lateral side of the nose and in severe attacks radiated to the maxillary frontal teeth. Blood tests, magnetic resonance image (MRI) and computer scanning (CT) scan images were all normal. The patient was diagnosed with post-traumatic external nasal neuralgia and symptoms were relieved and nearly resolved completely using a nasal cleanse and lubrication of the nose.

Headaches in the context of the COVID-19 pandemic: preliminary results of a national survey

Headache in the context of the COVID-19 pandemic is a current topic, being divided into pre-infection headache, headache attributed to COVID-19 infection and post-COVID-19 headaches. The aim of the research was to analyze the peculiarities of the evolution and treatment of headache during the COVID-19 pandemic in the cohort of patients from the Republic of Moldova. The study was an online survey. People with COVID-19 infection and headaches were asked to complete a structured, validated and approved questionnaire, which included questions on: demographics, comorbidities, clinical signs of COVID-19 infection, headache before, during and after COVID-19 infection, screening for anxiety, depression and sleep disorders. The data collected for 3 months from the launch are presented (January - March 2021). The study showed that half (58.3%) of the respondents had different forms of headache before COVID-19 infection. During the infection period - 91% of the respondents had bouts of headache attributed to COVID-19, which were of high intensity, holocranial localization, being associated with such signs as vertigo, nausea, peripheral vegetative signs, pronounced asthenia (80%) and pain with another location (85.5%). Persistent headache after COVID-19 was reported by 62.7% of respondents, it being severe for 16.7% of them. Preliminary results show that headache during COVID-19 is prevalent and persists after COVID-19 causing disability and increased costs. Further studies are needed to validate these results.

Brain paracoccidioidomycosis in an immunosuppressed patient with systemic lupus erythematosus

Background: Brain paracoccidioidomycosis (PCM) or neuroparacoccidioidomycosis (NPCM) is a fungal infection of the central nervous system (CNS) caused by Paracoccidioides brasiliensis, a dimorphic fungus. The CNS involvement is through bloodstream dissemination. The association between NPCM and systemic lupus erythematous (SLE) is rare. However, SLE patients are under risk of opportunistic infections given their immunosuppression status. Case Description: The aim of this case report is to present a 37-year-old female with diagnosis of SLE who presented with progressive and persistent headache in the past 4 months accompanied by the right arm weakness with general and neurologic examination unremarkable. The computerized tomography of the head showed left extra-axial parietooccipital focal hypoattenuation with adjacent bone erosion. The brain magnetic resonance imaging reported left parietooccipital subdural collection associated with focal leptomeningeal thickening with restriction to diffusion and peripheral contrast enhancement. The patient underwent a left craniotomy and dura mater biopsy showed noncaseous granulomatosis with multinucleated giant cells with rounded birefringent structures positive for silver stain, consistent with PCM. Management with itraconazole 200 mg daily was started with a total of 12 months of treatment, with patient presenting resolution of headache and right arm weakness. Conclusion: The diagnosis of NPCM is challenging and a high degree of suspicious should be considered in patients with persistent headache and immunosuppression.

Case Report: Take a Second Look: Covid-19 Vaccination-Related Cerebral Venous Thrombosis and Thrombotic Thrombocytopenia Syndrome

We present two cases of ChAdOx1 nCov-19 (AstraZeneca)-associated thrombotic thrombocytopenia syndrome (TTS) and cerebral venous sinus thrombosis (CVST). At the time of emergency room presentation due to persistent headache, blood serum levels revealed reduced platelet counts. Yet, 1 or 4 days after the onset of the symptom, the first MR-angiography provided no evidence of CVST. Follow-up imaging, performed upon headache refractory to nonsteroidal pain medication verified CVST 2–10 days after initial negative MRI. Both the patients received combined treatment with intravenous immunoglobulins and parenteral anticoagulation leading to an increase of platelet concentration in both the individuals and resolution of the occluded cerebral sinus in one patient.

Case study of thrombosis and thrombocytopenia syndrome following administration of the AstraZeneca COVID-19 vaccine

Cerebral venous sinus thrombosis is a complication of the ChAdOx1 nCoV-19 vaccine that should elicit a high index of suspicion when patients present with persistent headache post vaccination.

Adenocarcinoma lung presenting with meningeal carcinomatosis

Meningeal infiltration by malignant metastasis process without brain parenchymal involvement is very unusual event in patients with bronchogenic carcinoma. This manuscript describes a case of adenocarcinoma right lung in a 48-year old male having persistent headache. The cerebrospinal fluid cytology revealed the presence of metastatic deposits of adenocarcinoma lung that confirmed the diagnosis of meningeal carcinomatosis.