Headache caused by intracranial space-occupying lesions
Introduction
Introduction to headache caused by intracranial space-occupying lesions Brain tumors, subdural hematoma, brain abscesses and other headaches caused by space-occupying lesions are mainly caused by the pain-sensitive structures adjacent to the lesions being displaced, displaced or directly compressed by sensory nerves. In the later stage, the cerebrospinal fluid circulation pathway is blocked, resulting in an increase in intracranial pressure, causing headache-induced pain-sensitive structures to be pulled, twisted, and displaced. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: nausea and vomiting, edema, optic atrophy
Cause
Causes of headache caused by intracranial space-occupying lesions
Increased intracranial pressure is a mass-like lesion that occupies a certain spatial position in the cranial cavity. Such as brain tumors, brain abscesses and cerebral hematoma. As the volume of the lesion increases, the intracranial pressure is physiologically decompensated, and the intracranial pressure exceeds the normal value (80-180 mmH2O), often accompanied by brain dysfunction. headache. When the intracranial pressure is increased, the meninges and important vascular nerves are caused by pulling. It is not typical at the beginning of the onset, and it can be persistent and even unbearable when it is heavy. Vomiting. It is the brainstem shift and traction or tumor directly stimulates the vomiting center of the medulla, vomiting is jetting, without other gastrointestinal symptoms, often occurs when the headache is severe, and the headache is slightly relieved after vomiting. Children often occur in the posterior cranial fossa due to tumors, vomiting can occur in the early stage, and it is easy to be misdiagnosed as visceral papillary edema. Increased intracranial pressure, obstructed ocular venous return.
Prevention
Headache prevention caused by intracranial space-occupying lesions
1, the disease and effective preventive measures, early detection and early treatment is the key to the prevention and treatment of this disease. Avoiding harmful substances (promoting factors) can help us avoid or minimize exposure to harmful substances.
Some related factors of tumorigenesis are prevented before onset. Many cancers are preventable before they are formed. A US report in 1988 compared the international malignant tumors in detail, suggesting that many of the known malignancies are preventable in principle, that is, about 80% of malignant tumors can be changed through simple lifestyles. prevention. Continuing with the retrospective, a study by Dr. Higginson in 1969 concluded that 90% of malignant tumors are caused by environmental factors. Environmental factors and lifestyle refer to the air we breathe, the water we drink, the food we choose to make, the habits of activities, and social relationships.
2, improve the body's immunity against tumors can help improve and strengthen the body's immune system and cancer.
The focus of our current cancer prevention efforts should first focus on and improve those factors that are closely related to our lives, such as smoking cessation, proper diet, regular exercise, and weight loss. Anyone who follows these simple and reasonable lifestyles can reduce their chances of developing cancer.
Promote the body's immunity against cancer: The most important thing to improve the function of the immune system is: diet, exercise and control troubles, healthy lifestyle choices can help us stay away from cancer. Maintaining a good emotional state and proper physical exercise can keep your body's immune system at its best, and it is also good for preventing tumors and preventing other diseases. In addition, studies have shown that appropriate activities not only enhance the body's immune system, but also reduce the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here we mainly understand some of the problems of diet in preventing tumorigenesis.
Complication
Headache complications caused by intracranial space-occupying lesions Complications nausea and vomiting edema optic atrophy
Severe headache can be accompanied by nausea, vomiting and papilledema, and finally due to secondary optic atrophy, vision loss or blindness.
Symptom
Headache symptoms caused by intracranial space-occupying lesions Common symptoms Local headaches Intracranial headaches with a curse like head nipple edema Secondary optic atrophy Head occipital chronic pain
About 30% of patients with brain tumors have headaches as the main complaint. The initial headache is often located on the same side of the lesion. When the intracranial pressure is increased, it is persistent and persistent. It is heavier in the morning, coughing and exerting stool. Or headaches worsen when snoring, generally not as severe as migraine or cerebral vascular rupture, most do not affect sleep, with increased lesions and increased intracranial pressure, patients with vomiting and papilledema, and finally secondary Optic atrophy causes vision loss or blindness.
According to headache, vomiting and papilledema, combined with localized signs of progressive exacerbation and corresponding neuroimaging examination can confirm the diagnosis.
Examine
Examination of headache caused by intracranial space-occupying lesions
Do a head CT or MRI to understand the location, size, and metastasis of the lesion.
Contrast: The premise of intracranial lesion treatment is accurate diagnosis and precise positioning. Cerebral angiography (DSA) and magnetic resonance (MR) examinations are the main methods for diagnosing intracranial lesions. The skull MR image can accurately reveal the structure of the intracranial anatomy, but because some lesions such as small arteriovenous malformations are not clear enough on MR, it is impossible to determine whether the lesion exists, and DSA cerebral angiography can clearly show intracranial blood vessels, which is considered It is the "gold standard" for diagnosing intracranial vascular abnormalities. The blood supply of the lesion can be understood by the image, but it is difficult to accurately locate it. MR and DSA image fusion technology can perform DSA cerebral angiography and three-dimensional reconstruction for patients with suspected intracranial lesions, and find lesions or suspicious lesions, and then reveal MR enhancement scans. The two inspected images are transmitted to the image workstation, and the images of the two images are matched by pixel size and layer thickness by the application of the DSA/MRFUSION software, and the image space alignment and registration are added, overlapped, and merged. , to form a new image, so that different pre-operative preparation images complement each other and complement each other, increase the amount of information, form a new image data, effectively avoid misdiagnosis and missed diagnosis, and accurately locate, provide a reliable basis for further treatment. Generally, the patient is fasted for 12 hours before surgery, and the contrast agent is tested for allergy. If necessary, sedation and antiemetic can be given.
Diagnosis
Diagnosis and diagnosis of headache caused by intracranial space-occupying lesions
Different from the headache caused by other causes, the head CT showed a space-occupying lesion, which can be identified.
Cluster headache, also known as histamine headache, is rare in the clinic. It manifests itself as a series of intensive, transient, severe unilateral pains. The headache area is limited and fixed on one side of the eyelid, the back of the ball and the frontal forehead. The onset is sudden and without aura, and the onset time is fixed, lasting 15 minutes to 3 hours, and the attack is from once every other day to 8 times a day. Severe pain, often painful, and facial flushing, conjunctival congestion, tearing, salivation, nasal congestion, more often without nausea, vomiting, a few patients may have Horner's sign in headache. The age of onset is often later than migraine, with an average age of 25 years, and the ratio of male to female is about 4:1.
Tension-type headache: also known as muscle contraction headache. The headache area is more diffuse, and it can be placed on the forehead, eyes, top, pillow and neck. The nature of headache is often dull and painful, and the head feels tight and tight. Headaches are often persistent, and some cases can also present with paroxysmal, pulsatile headaches. Very rarely accompanied by nausea and vomiting. Most patients have tender points on the scalp and neck. Massage the head and neck to relieve headaches. More common in young and middle-aged women, emotional disorders or psychological factors can aggravate headache symptoms.
Painful ophthalmoplegia: An inflammatory disease characterized by headache and ophthalmoplegia that involves idiopathic eyelids and cavernous sinus. For intractable pain, tingling or tear-like pain after paroxysmal eyeballs and periorbital weeks, accompanied by eye movement, trochlear and/or nerve palsy, ophthalmoplegia can occur simultaneously with pain or two weeks after pain onset Inside, MRI or biopsy can be found in the cavernous sinus, supracondylar fissure or granulomatous lesions in the eyelids. The disease can relieve itself after several weeks, but it is prone to recurrence. Proper glucocorticoid treatment can relieve pain and ophthalmoplegia.
Symptomatic migraine: headaches due to vascular lesions in the head and neck such as ischemic cerebrovascular disease, cerebral hemorrhage, unruptured saccular aneurysm and arteriovenous malformations; due to non-vascular intracranial disease Headaches such as intracranial tumors; headaches due to intracranial infections such as brain abscesses, meningitis, etc. These secondary headaches can also be clinically similar to migraine-like headaches, which can be accompanied by nausea and vomiting, but no typical migraine attacks, most cases have focal neurological deficit or irritation, brain Imaging studies can show lesions. Headaches due to internal environment disorders such as hypertensive crisis, hypertensive encephalopathy, eclampsia or pre-eclampsia can be expressed as bilateral pulsatile headaches. The time of headache is closely related to the increase of blood pressure, and some cases are neuroimaging. Examination can show reversible white matter damage performance.
