Headache and vomiting

Introduction A headache accompanied by severe vomiting suggests an increase in intracranial pressure. Headaches can be seen in migraine after vomiting. Generally, increased intracranial pressure is one of the common factors that stimulate the vomiting center. Another manifestation of increased intracranial pressure is headache. Headache with nausea, vomiting, diarrhea, fever, can be seen in acute gastroenteritis. Headache with severe jet vomiting is common in intracranial hypertension. Headache with vomiting, but vomiting is not severe and headache relief after vomiting is a feature of migraine.

Cause

(1) Causes of the disease

The causes may include endocrine and metabolic disorders, intracranial venous sinus thrombosis, drugs and toxins, as well as primary benign intracranial hypertension, which is unknown.

(two) pathogenesis

The pathogenesis of this disease is still unclear, and it is an intracranial hypertension that develops within weeks or months. As for the direct cause of increased intracranial pressure, it is due to the swelling of the brain parenchyma itself, or the change of cerebrospinal fluid is still inconclusive. Most people think that it is caused by cerebrospinal fluid absorption disorder, but the evidence is not much.

Karahalios et al (1996) found that all patients with benign intracranial hypertension have increased cerebral venous pressure. In this case, cerebrospinal fluid absorption is blocked, which can cause increased intracranial pressure, but elevated cerebral venous pressure is increased intracranial pressure. The reason or the result is not clear. In the continuous cerebrospinal fluid monitoring of patients with benign intracranial hypertension, it is found that the pressure of cerebrospinal fluid is uninterrupted and irregularly fluctuating. When the pressure rises in a plateau for 20-30 minutes, it will suddenly drop to normal level. It is like draining the increased CSF (Johnston and Paterson, 1974). A considerable number of patients are reported to have irregular menstruation or amenorrhea, some are pregnant women, some have endocrine system dysfunction, and others have taken tetracycline, indomethacin, oral contraceptives or other hormones, and have also been reported to be associated with vitamin A poisoning. . It is inferred that the above conditions are related to the increase of benign intracranial pressure, but there is no substantive evidence.

an examination

Related inspection

Blood pressure brain CT examination of intracranial pressure monitoring

The diagnostic criteria are as follows:

1. There are symptoms and signs of increased intracranial pressure.

2. There is no local localization sign in the nerve examination.

3. Neurological diagnostic examination has no abnormalities other than increased cerebrospinal fluid pressure (no deformation, displacement or obstruction of the ventricular system).

4. The patient is conscious.

5. There is no other cause of increased intracranial pressure.

6. If the cerebrospinal fluid is abnormal, the diagnosis is not established.

Differential diagnosis

Mainly have dural sinus recessive embolism, diffuse glioma, cancerous meningitis, granulomatous meningitis and microcephalic malformations. The main features of the above lesions can cause headache, optic disc edema, and severe intracranial pressure, but no imaging lesions can be seen in imaging examination, and there are no other localized signs in neurological examination. Cerebral dural sinus embolism (including cerebral large vein thrombosis) and benign intracranial hypertension are sometimes almost indistinguishable in clinical practice. However, the onset of cerebral dural venous sinus is urgent, the headache is mostly at the top, and there may be epilepsy. Note that the shape of the superior sagittal sinus during MRI or contrast-enhanced CT is helpful in differential diagnosis.

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