摘要:

The pathophysiology of brain injury in patients undergoing cardiopulmonary bypass remains unclear despite several decades of inquiry. The advent cit noninvasive high‐resolution brain and cerebrovascular imaging by magnetic resonance, computed tomography, and pulsed Doppler ultrasonography now permits in vivo assessment of pathophysiological mechanisms. Neuroradiographic and carotid duplex studies were performed in patients who developed neurological deficits following cardiopulmonary bypass. Among 30 symptomatic patients undergoing magnetic resonance or computed tomography brain scans, 18 (60%) had findings of acute ischemic injury. Embolic infarction was evident in 14 (78%) of these 18 patients. Watershed injury was the predominant finding in a single patient, while findings consistent with global anoxia were present in another patient. Carotid atheroemboli were excluded as a possible source of embolism in 11 patients whose carotid duplex studies were unremarkable preoperatively as well as in 3 further patients whose neuroradiographic findings did not correspond with their moderate carotid disease. It is concluded that infarction due to noncarotid embolism is the primary pathophysiology of neurological deterioration following cardiopulmonary bypass.

ISSN:1051-2284    

DOI:10.1111/jon1993311

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Serial positron emission tomography scans with [18F]fluorodeoxyglucose (FDG) were acquired from 3 patients with malignant gliomas before and after 24 hours of dexamethasone administration (a total of 40 mg administered intravenously over 24 hours). Peak FDG uptake by the tumor decreased 10 to 20% in the posttreatment scans. The data suggest that at least some of the beneficial effects of dexamethasone on the signs and symptoms of tumor‐related increased intracranial pressure might relate to a direct acute effect on glucose metabolism.

ISSN:1051-2284    

DOI:10.1111/jon1993316

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Three patients with headaches in erect but not recumbent positions had barely measurable cerebrospinal fluid (CSF) pressures and aseptic but abnormal CSF findings with variable pleocytosis and elevated protein content. The CSF glucose level was normal and there were no blasts or malignant cells. Gadolinium‐enhanced magnetic resonance imaging (MRI) in all 3 showed diffuse meningeal enhancement. In 2, headaches and MRI abnormalities completely resolved spontaneously. The third patient, who had a prior ventriculoperitoneal shunt, improved after shunt revision.

ISSN:1051-2284    

DOI:10.1111/jon19933111

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Post‐carotid endarterectomy seizures have been previously described. They may be secondary to increased blood flow in the territory supplied by the carotid vessel. This paper reports a patient with post‐carotid endarterectomy in status epilepticus with abnormally high cerebral blood flow velocities as measured by transcranial Doppler criteria. She was treated successfully with a removable, adjustable carotid clamp until cerebral blood flow velocities were maintained in the normal range independent of the clamp.

ISSN:1051-2284    

DOI:10.1111/jon19933116

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

In 5 patients, electroencephalographic (EEG) topography (Fourier analysis and topographic display of EEG data) demonstrated clinically significant acute brain lesions not seen by magnetic resonance imaging or computed tomography. EEG topography contributed to patient management more than standard EEG. Additional, carefully designed, prospective studies may indicate how frequently and in which settings EEG topography is a valuable diagnostic test.

ISSN:1051-2284    

DOI:10.1111/jon19933120

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Magnetic resonance imaging (MRI) findings in a group of 60 ambulatory elderly individuals (average age, 75.8 yr) were characterized as normal (grade 0), periventricular changes only (grade 1 ). small punctate lesions (grade 2), and confluent or large (>2 mm) punctate lesions (grade 3). Patients were characterized by stroke risk factors, cardiolipin antibodies, coagulation factors (fibrinogen and plasminogen activator inhibitor‐1 ). and Doppler ultrasound findings in the carotid and middle cerebral arteries. Subcortical signal abnormalities were present in 62% (37 /60), relatively evenly distributed between grade 1 (18%), grade 2 (25%), and grade 3 (18%). There was no significant association between variables and MRI grade. These findings suggest that ischemia is not a major cause of MRI signal abnormalities in neurologically asymptomatic elderly individuals.

ISSN:1051-2284    

DOI:10.1111/jon19933128

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Over a 3‐year period, a 31‐year‐old man developed multiple cranial nerve palsies consisting of diplopia, left‐sided facial numbness and weakness, and loss of the left corneal reflex. Fifteen years prior to presentation, he had undergone curative therapy for a prolactin‐secreting pituitary macroadenoma. The imaging studies were helpful in localizing the disease process, which correlated well with the clinical examination, and for focusing the differential diagnosis.

ISSN:1051-2284    

DOI:10.1111/jon19933133

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Transcranial color‐coded real‐time sonography was applied to 20 patients with ischemic stroke and 28 patients with spontaneous intracerebral hemorrhage. In all patients the sonographic diagnosis corresponded closely to cranial computed tomography findings. Recent hemorrhages were visualized as a hyperechodense mass. The high contrast to minor echodense adjacent parenchyma led to a clear sonographic distinction. Older clots were characterized by a continuous decrease of echodensity and subsequently were interspersed by hypoechodense zones. In the acute stage of ischemic infarction, the vessel occlusion (17/20) and collateral vascular supply (1 0/20) could be depicted in the color‐B‐mode in two perpendicular planes and further verified by the Doppler mode. Brain edema was not visualized. Although in the acute stage no change of echo texture was observed within the infarction, hyperechodense regions (7/11) could be observed in some patients during the time course. Complications of intracerebral hemorrhage and ischemic stroke, such as disturbance of cerebrospinal fluid circulation, midline shift, and compression of adjacent territories, were depicted by transcranial color‐coded sonography. These preliminary results illustrate that transcranial color‐coded realtime sonography may be helpful in the early noninvasive differential diagnosis as well as long‐term follow‐up in patients with cerebrovascular disorders.

ISSN:1051-2284    

DOI:10.1111/jon19933141

出版商:Wiley    

年代:2016

数据来源: WILEY

ISSN:1051-2284    

DOI:10.1111/jon19933148

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

A patient with cauda equina syndrome from long‐standing ankylosing spondylitis exhibited erosive cystic defects of the thecal sac on lumbosacral magnetic resonance imaging. This report confirms the presence of nerve root clumping described previously, documents contrast enhancement of the leptomeninges for the first time, and suggests that arachnoiditis has a role in the evolution of this disorder.

ISSN:1051-2284    

DOI:10.1111/jon19933155

出版商:Wiley    

年代:2016

数据来源: WILEY