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Biomedical subjects

A H Ropper

Publications and source records attributed to A H Ropper.

At least 109 records · Page 6Linked to original sources
PubMed1984

Intracranial pressure monitoring in comatose patients with cerebral hemorrhage.

Intracranial pressure (ICP) was measured continuously in ten consecutive comatose patients with intracerebral hemorrhage. Eight hemorrhages were ganglionic, one was thalamic, and one was lobar. The ICP at the time of insertion of the monitoring device was below 20 mm Hg in four patients, 20 to 30 mm Hg in four, and above 30 mm Hg in two. Of the seven patients whose ICP remained above 20 mm Hg despite aggressive medical therapy, three had the clot removed surgically and all three survived, although one died of sepsis a month later. The remaining four patients with uncontrolled ICP all died of the syndrome of brain death. Of tht three patients whose ICP was persistently below 20 mm Hg, one survived and two subsequently died of sepsis after improving neurologically for the first week. Intracranial pressure monitoring did not cause any morbidity. Raised ICP is related to mortality in comatose patients with cerebral hemorrhage, and ICP monitoring may be useful in guiding therapy, especially the timing and selection of patients for surgery.

Adult↗
PubMed1984

Unusual spontaneous movements in brain-dead patients.

Striking arm movements are described in five brain-dead patients. The arms flex quickly to the chest from the patient's side, the shoulders adduct, and in some patients, the hands cross or oppose just below the chin. The limbs then return to the patient's side, sometimes asymmetrically. These movements are precipitated after several minutes by hypoxia or ischemia when the ventilator is removed terminally, or during apnea testing. Families of brain-dead patients should be dissuaded from remaining in the room with the patient after the ventilator is turned off.

Arm↗
PubMed1984

Outcome 1 year after SAH from cerebral aneurysm. Management morbidity, mortality, and functional status in 112 consecutive good-risk patients.

A group of 112 consecutive patients who initially had no neurological deficits after subarachnoid hemorrhage (SAH) was followed intensively for at least 1 year. Ninety-four were in neurological Grade I or II (Hunt and Hess classification) on arrival. A hundred patients underwent late surgery but, despite excellent surgical results, major morbidity and mortality rates were observed related to preoperative complications. In the preoperative period, 14 (13%) rebled, 41 (37%) had symptomatic cerebral vasospasm, and 24 (21%) had hydrocephalus that required treatment. Of the 100 surgical patients, 73 were in Grade I or II, 26 in Grade III, and one in Grade IV. Six patients had intraoperative neurological complications, and two had delayed postoperative cerebral infarction. Six patients died during hospitalization, but only one as a result of operation. Six others died during the year following discharge of causes unrelated to the operation. The ultimate functional outcome at 1 year of these initially good-risk patients was poor. Only 46% were fully recovered, and 25% reported emotional or psychological disturbances that interfered with their daily lives. Forty-four percent could return to their previous jobs or a comparable position, and 20% obtained lesser employment. Management mortality at 1 year was 11%, and morbidity related to persistent neurological deficits (mainly strokes from vasospasm) was 20%. Thus, management mortality and morbidity at 1 year was 31%, and the number of patients returning to useful life was disappointing. The authors support the suggestion by previous workers that an analysis of at least the 6-month and perhaps the 1-year outcome (especially management mortality for all patients) provides the most important parameter for judging outcome and comparing different management protocols for SAH.

Activities of Daily Living↗
PubMed1984

Spontaneous spinal subarachnoid hemorrhage and subdural hematoma. Report of two cases.

Two patients with spontaneous spinal subarachnoid hemorrhage are presented to emphasize the clinical and radiological features of this uncommon illness. Both had severe back pain at the onset. One patient had a subdural hematoma that compressed the conus medullaris and cauda equina, and was drained percutaneously; the other had clots in the subarachnoid space. The cerebrospinal fluid showed a polymorphonuclear pleocytosis that simulated septic meningitis. Complete spinal angiography failed to reveal a cause for the hemorrhages.

Aged↗
PubMed1984

An approach to the care of patients with Guillain-Barré syndrome.

Sophisticated nursing management is an integral part of treatment in GBS. Many difficulties are overcome if nurses have a sound basis of knowledge of the disease and can anticipate complications and explain the illness to patient and family. Most efforts are directed toward preventing the secondary medical complications of quadriparesis, bulbar paresis, and general disability. Plasma exchange is an important recent innovation in the therapy of GBS.

Electromyography↗
PubMed1983

Proposed mechanism of ataxia in Fisher's syndrome.

A patient with Fisher's variant of Guillain-Barré syndrome had severe limb ataxia. Joint position sense was diminished proximally but normal distally. In contrast, muscle proprioceptive function, studied electrophysiologically by recording silent periods in proximal muscles, appeared to be normal. A disparity between proprioceptive information from muscle spindles and kinesthetic information from joints and other proprioceptors may be a mechanism of ataxia, based solely on abnormalities of peripheral nerve function. A CNS lesion is, therefore, not necessary to explain cerebellar ataxia in Fisher's syndrome.

Adult↗
PubMed1983

Illusion of tilting of the visual environment. Report of five cases.

The symptom of sudden tilting of the visual surroundings is described in detail based on experience with five patients. Patients perceive the visual fields as suddenly turning through a variable arc, most frequently 90-180 degrees, usually associated with dizziness. In three patients with vertebral-basilar artery disease, visual tilting was more closely related to local pontomedullary ischemia than to posterior cortical ischemia. It is suggested that most instances of this illusion are due to disorders of the vestibular-otolithic apparatus or its central connections, most frequently from vertebral-basilar ischemia.

Adult↗
PubMed1983

Initial results of a clinical trial of Fluosol-DA 20 percent in acute cerebral ischemia.

We present three patients in whom Fluosol-DA 20 percent was administered in the presence of ischemic cerebral vascular disease. While transient improvement observed in two cases may have been related to Fluosol-DA administration it is premature to use these results to comment on the potential protective or therapeutic efficacy of Fluosol-DA in ischemic cerebral vascular disease. One patient progressively deteriorated neurologically during and after the infusion. Our initial impressions are limited to the observations that Fluosol-DA in doses of 20 ml/kg can be administered easily and without major effects on hemodynamic or pulmonary function. One patient had a transient leukopenia.

Acute Disease↗
PubMed1983

Pentobarbital in refractory status epilepticus.

Tonic-clinic status epilepticus, which is refractory to phenobarbital, phenytoin, and diazepam, may respond readily to a continuous infusion of pentobarbital. The efficacy of pentobarbital can be monitored at the bedside by electroencephalography. We report the clinical and electroencephalographic findings of two children who developed refractory tonic-clonic status epilepticus and responded to pentobarbital.

Child↗
PubMed1982

Cerebral blood flow after experimental basal ganglia hemorrhage.

The effect of cerebral hemorrhage on regional cerebral blood flow (RCBF) in awake, unrestrained rats was studied by comparing intracaudate injections of whole blood (N = 14), centrifuged blood (N = 2), and inert plastic (N = 1). RCBF was measured by the polarographic hydrogen clearance technique using chronically implanted electrodes in the cortex and caudate bilaterally. After hemorrhage, animals became comatose and flows diminished 23 to 30% (p less than 0.01) below baseline values. Recovery of RCBF to prehemorrhage values was accompanied by awakening and survival while persistently low RCBF in all regions occurred only in the 2 animals died, suggesting that physiological changes which lower RCBF in after hemorrhage may be harmful. Transient hyperperfusion of the contralateral cortex occurred in 6 of 10 animals during the first 10 minutes after hemorrhage. In all 8 animals tested daily there was significant hyperperfusion of one or both cortical regions during the second or third day after hemorrhage (mean increase in right cortex RCBF, 30%, p less than 0.05; left, 45%, p less than 0.01). Injection of an identical volume of plastic was not accompanied by hyperperfusion, suggesting that destruction of the caudate or addition of an intracerebral mass was not responsible for the increase in blood flow. However, injection of centrifuged blood components caused immediate hyperperfusion, which persisted in some cortical regions on the following day. A substance in cerebral hemorrhage clot may cause increased cortical RCBF.

Animals↗
PubMed1982

Self-grasping: a focal neurological sign.

A physical sign is described in patients with typical bilateral grasp responses, whereby one hand grasps the contralateral forearm (self-grasping). Of 37 patients with strong bilateral grasp responses, unilateral self-grasping occurred in 8; of these 8 patients, 7 were hemiparetic and 5 showed extinction of double simultaneous stimulation. Two patients had bilateral self-grasping, and 27 avoided self-grasping. In contrast, only 4 of the 27 patients without self-grasping were hemiparetic and 1 had associated sensory extinction. In 2 confused, uncooperative patients, unilateral self-grasping was the most easily demonstrable focal or asymmetrical sign. The sign indicates a contralateral frontal or parietal lobe lesion. It may be related to the inability to recognize oneself.

Brain Diseases↗
PubMed1982

Absence of evoked potential abnormalities in acute transverse myelopathy.

We studied 12 consecutive patients with inflammatory acute transverse myelopathy (ATM) and no prior history of neurologic disease. All had normal pattern shift visual and brainstem auditory evoked potentials. All of nine patients tested also had normal median nerve short-latency somatosensory evoked potentials. None developed new neurologic signs in 18 months' mean follow-up. In contrast, 72% of 50 patients with definite, probable, or possible multiple sclerosis (MS) had abnormalities in at least one evoked potential test. When defined as a virtually or completely transverse inflammatory lesion, acute transverse myelopathy differs from MS.

Adolescent↗
PubMed1982

Head position, intracranial pressure, and compliance.

The effect of head position on intracranial pressure (ICP) and intracranial compliance was determined in 19 consecutive ICU patients. Ten had lower ICPs with the head raised 60 degrees, two were lower at 0 degrees, and seven were unchanged. Compliance improved with head elevation in five patients, improved with head lowering in four, and was unchanged in 10. The use of subarachnoid screw devices for compliance measurements was validated by simultaneously recording intraventricular and subarachnoid pressures in four patients. Optimal head positioning for patients with raised ICP should be established individually rather than routinely caring for patients with the head elevated.

Adolescent↗