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Biomedical subjects

A D Firlik

Publications and source records attributed to A D Firlik.

33 records · Page 2Linked to original sources
PubMed1997

Effect of transluminal angioplasty on cerebral blood flow in the management of symptomatic vasospasm following aneurysmal subarachnoid hemorrhage.

In this study the authors have examined the effects of transluminal angioplasty on cerebral blood flow (CBF) in the management of intractable vasospasm following aneurysmal subarachnoid hemorrhage (SAH). Fourteen consecutively enrolled patients underwent attempted angioplasty with or without intraarterial infusion of papaverine. Twelve patients underwent pre- and postangioplasty xenon-enhanced computerized tomography (Xe-CT) scanning to measure regional CBF in 55 to 65 regions of interest (ROIs) per patient. Angioplasty was possible in 13 (93%) of 14 patients, with angiographically demonstrated improvement in all 13. Twelve (92%) of the 13 patients were neurologically improved following angioplasty; seven (58%) of the 12 patients who improved had a complete reversal of all delayed ischemic deficits. Angioplasty significantly decreased the mean number of ROIs at risk (11.4 ROIs pre- and 0.9 ROIs postangioplasty) (p < 0.00005, t-test). All patients had a reduction in the number of ROIs at risk after angioplasty; six (50%) of 12 no longer had any ROIs remaining at risk after angioplasty. Angioplasty significantly increased the mean CBF within at-risk ROIs (13 ml/100 g/minute pre- and 44 ml/100 g/minute postangioplasty) (p < 0.00005, t-test). All patients experienced an improvement in mean CBF in at-risk ROIs after angioplasty, with the mean CBF improving to above 20 ml/100 g/minute in all cases. No differences in the degree of improvement were found in patients who received intraarterial papaverine compared with those who did not. In the majority of patients with refractory vasospasm following SAH, angioplasty effectively dilated spastic arteries, reversed delayed neurological deficits, and significantly improved CBF in areas of brain at risk of infarction.

Adult↗
PubMed1996

A meningeal cyst of the thoracic spine presenting as prolonged paresis after ankle injury: case report.

A case of a thoracic meningeal cyst causing right lower extremity weakness in a fifteen-year-old girl is presented. The diagnosis was delayed due to a history of ankle injury which was initially used to explain her symptoms. The authors explain the difficulty in diagnosing intraspinal meningeal cysts and stress the importance of surgical excision before spinal cord injury progresses.

Adolescent↗
PubMed1996

Physiological diagnosis and surgical treatment of recurrent limb shaking: case report.

OBJECTIVE AND IMPORTANCE: Although recurrent limb shaking has been observed in patients with carotid occlusion, its cause, method of diagnosis, and definitive treatment have yet to be fully elucidated. This report examines the cerebrovascular physiology of a patient with recurrent limb shaking by means of xenon-enhanced computed tomographic (XeCT) scanning. By measuring cerebral blood flow (CBF) and cerebrovascular reserve capacity, we were able to confirm both the clinical diagnosis and the response to treatment on physiological grounds. CLINICAL PRESENTATION: The patient is a 49-year-old man who presented with frequent brief attacks of left arm and leg shaking that occurred at standing or coughing. After cervical radiation therapy for a laryngeal carcinoma, he was found to have bilateral carotid occlusion with minimal collateral development. XeCT scans revealed borderline ischemic perfusion and lack of cerebrovascular reserve in response to an acetazolamide vasodilatory challenge. INTERVENTION: The patient underwent a right superficial temporal artery to middle cerebral artery bypass to augment cerebral perfusion. CONCLUSION: After the procedure, the patient's limb shaking attacks ceased. The postoperative XeCT scan showed improved CBF and a return of cerebrovascular reserve capacity. Recurrent limb shaking is a manifestation of decreased CBF. Quantitative XeCT CBF studies coupled with vasodilatory challenge is an important way to assess patients with cerebrovascular disorders and thus identify individuals who will benefit from cerebral revascularization.

Arm↗
PubMed1996

Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage. Case report.

Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented to the authors' service with symptomatic vasospasm 10 days after experiencing an SAH. The ruptured anterior communicating artery aneurysm was surgically obliterated the following day, and thereafter maximum hypervolemic and hypertensive therapies were used. However, the patient remained lethargic, and a stable xenon-computerized tomography (CT) cerebral blood flow (CBF) study revealed CBF to be 15 cc/100 g/minute in the left anterior cerebral artery (ACA) and 25 cc/100 g/minute in the right ACA territories. Cerebral arteriography demonstrated diffuse severe left ACA and mild left middle cerebral artery (MCA) vasospasm. In response intraarterial papaverine was infused into the internal carotid artery just proximal to the ophthalmic artery. During the infusion the patient became aphasic and exhibited right hemiplegia. Arteriography performed immediately after the intraarterial papaverine infusion revealed diffuse exacerbation of vasospasm in the distal ACA and MCA territories. A repeat xenon-CT CBF study showed that CBF in the left ACA and the MCA had drastically decreased (2 cc/100 g/minute and 10 cc/100 g/minute, respectively). Despite aggressive management, infarction ultimately developed. This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH. The possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.

Cerebral Angiography↗
PubMed1995

Harvey Cushing, M.D.: a Clevelander.

Harvey Cushing was born, raised, wedded, and buried in Cleveland, OH. Many of his family members lived in Cleveland. Cushing frequently visited the city and maintained close personal and professional relationships with Clevelanders throughout his life. Presented are artifacts, photographs, and excerpts from his and others' works that document Cushing's connection with his home town.

History, 19th Century↗
PubMed1993

Contribution of increased cerebral blood volume to posttraumatic intracranial hypertension.

Cerebrovascular dysfunction following acute brain injury (BI) may be the critical mediator of excess morbidity and mortality after BI. Despite aggressive therapy, death often is caused by refractory intracranial hypertension (IH). An understanding of the contributions of cerebrospinal fluid (CSF) and vascular factors to IH after BI is essential for management of intracranial pressure (ICP). Marmarou et al. showed that CSF accounted for only one third of the ICP rise after BI. We hypothesized that a vascular mechanism is predominant. Cerebral cortical reflectance photoplethysmography (IP) and radioactively labeled red blood cells were employed to study cerebral blood volume (CBV) changes associated with increased ICP after BI in miniature swine. Immediate posttraumatic IH could be attributed almost entirely to increased CBV. An early elevation in ICP immediately after BI (t = 0) was accompanied by a large increase in CBV compared with pre-BI levels (19.2 +/- 4.9 vs. 8.9 +/- 2.7 mL/100 g tissue, p < 0.05). Decreased CBV corresponded to lower ICP within 1 hour, followed by a slow rise that paralleled the increase in ICP. The CBV (16.1 +/- 3.3 vs. 8.9 +/- 2.7, p < 0.05) and ICP (23 +/- 2.2 vs. 9 +/- 0.6, p < 0.05) were higher at 6 hours than at baseline. Based on compartmental analysis, the data indicate that ICP changes immediately after BI and within 6 hours are predominantly caused by increased CBV.

Acute Disease↗
PubMedDate not supplied

Remote effects of acute ischemic stroke: A xenon CT cerebral blood flow study.

OBJECTIVE: The purpose of this study was to verify transhemispheric diaschisis in the early hours after an ischemic event. METHODS: XeCT cerebral blood flow (CBF) studies within 8 h of stroke were studied in 23 patients. Mean CBF was evaluated in the ischemic area, contralateral hemisphere and ipsilateral cerebellum. RESULTS: A severe CBF reduction was found in the ischemic area (mean 9 +/- 3 ml/100 g/min). The mean CBF in the unaffected hemisphere (33 +/- 10 ml/100 g/min) was 35% less compared to the normal mean value. CBF was decreased in the cerebellum ipsilateral to the stroke (mean 31 +/- 12 ml/100 g/min) suggesting a blood flow depression of the whole brain. CONCLUSIONS: During the initial hours of cerebral ischemia, the asymptomatic hemisphere demonstrated CBF depression that was part of the global flow reduction.

Adult↗
PubMedDate not supplied

Relationship between cerebral blood flow and clinical outcome in acute stroke.

OBJECTIVE: The purpose of this study was to determine the relationship between cerebral blood flow (CBF) measurements in acute stroke and early clinical outcome. MATERIAL AND METHODS: The xenon-enhanced computed tomography (XeCT) CBF studies performed in 50 patients in the acute stage (within 8 h) of a hemispheric stroke were retrospectively analyzed. The mean CBF of the symptomatic vascular territory was compared to the corresponding territory in the contralateral hemisphere. Clinical assessment on admission and discharge was performed using the National Institutes of Health stroke scale (NIHSS). RESULTS: Three groups were defined according to the degree of CBF asymmetry between the symptomatic and the contralateral asymptomatic vascular region. The CBF asymmetry was mild in group A (< or =20%), moderate in group B (>20% and <60%) and severe in group C (> or =60%). Patients in group A (n = 18) had a good outcome with a mean NIHSS score of 2 +/- 2 at discharge. In group B, the patients (n = 22) had intermediate but variable outcomes: 2 patients died and the mean NIHSS score for the survivors was variable (mean NIHSS score: 9 +/- 6). The patients in group C (n = 10) had a very poor outcome: 4 patients died and the survivors had a mean NIHSS score of 15 +/- 1. CONCLUSIONS: Quantitative XeCT CBF measurements may be useful for selecting subgroups of stroke patients with different clinical outcomes. The possibility of predicting patient prognosis as early as in the first hours after the ischemic event may help to identify the appropriate target population that will benefit from aggressive stroke therapy.

Acute Disease↗