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Biomedical subjects

A H Ropper

Publications and source records attributed to A H Ropper.

At least 127 records · Page 7Linked to original sources
PubMed1981

Ocular dipping in anoxic coma.

Patients with anoxic coma had a cyclic, downward dipping motion of the eyes. The sign is different from ocular bobbing, seizure-related eye deviation, oculogyric crisis, and roving eye movement. Its distinguishing characteristics are slow downward with rapid upward movement, a nadir at the extreme of downgaze, and spontaneous roving horizontal eye movements. Based on necropsy findings in one case and lesions of the basal ganglia evident on computerized tomographic scan in another, it is proposed that cortical dysfunction with damage to the basal ganglia may cause ocular dipping.

Adolescent↗
PubMed1981

Apnea testing in the diagnosis of brain death. Clinical and physiological observations.

The absence of spontaneous respiration is a crucial determinant in the diagnosis of brain death, but standardized criteria for apnea testing have not been established. Guidelines are proposed based on the results of 51 apnea tests and associated physiological measurements. In patients who fulfilled all other conventional criteria for brain death, three exhibited non-repetitive back arching and shoulder shrugging when CO2 pressures reached 41 to 51 mm Hg during apnea testing. These respiratory-like movements were ineffective for ventilation and were not reproducible on the following day at the same of higher pCO2. The nature of these movements, evoked potential testing, and autopsy results suggest that they were not triggered by normal medullary centers, and that these patients were, in fact, brain-dead. In four other patients with severe brain damage sparing only the medulla, normal spontaneous ventilation resumed at CO2 pressures of 30 to 39 mm Hg (mean 34 mm Hg). High arterial oxygen tension raised this apnea point slightly, but spontaneous breathing always began at CO2 pressures lower than 40 mm Hg. This level is therefore adequate to stimulate medullary respiration in patients with severe brain damage who are not brain-dead. In brain-dead patients, pCO2 rises slowly during apnea (2.58 +/- 0.85 mm Hg/min), in part because CO2 production is diminished (1.8 +/- 0.23 ml/min/kg). These data allow estimation of a desired length of an apnea test and standardized interpretation of results.

Adolescent↗
PubMed1980

Lobar cerebral hemorrhages: acute clinical syndromes in 26 cases.

The acute syndromes and CT findings are described in 26 cases of spontaneous cerebral hemorrhage. Occipital hemorrhage (11 cases) caused severe pain around the ipsilateral eye and dense hemianopia. Left temporal hemorrhage (7 cases) began with mild pain in or just anterior to the ear, fluent dysphasia with poor auditory comprehension but relatively good repetition, and a visual deficit subtending less than a hemianopia. Frontal hemorrhage (4 cases) caused a distinctive syndrome beginning with severe contralateral arm weakness, minimal leg and face weakness, and frontal headache. Parietal hemorrhage (3 cases) began with anterior temporal ("temple") headache and hemisensory deficit, sometimes involving the trunk to the midline. One patient had a right temporal hemorrhage. Spontaneous lobar hemorrhage and branch artery embolism in the same region produce similar clinical syndromes. Headache is a first and prominent symptom. A rapid but not instantaneous onset over several minutes, when combined with one of the typical syndromes, suggests lobar hemorrhage rather than other types of stroke. Ancillary investigations (including CT scanning, angiography in 11 patients, and autopsy in 4) disclosed 2 patients with bleeding diatheses due to warfarin, 2 with arteriovenous malformations, and 1 with metastatic tumor. Only 8 of the 26 patients had chronic hypertension (blood pressure greater than 130/85 mm Hg), suggesting that hypertension is not an etiological factor in most lobar hemorrhages.

Acute Disease↗
PubMed1980

Relationship between plaques, tangles, and dementia in Down syndrome.

In patients with Down syndrome, senile plaques and neurofibrillary tangles accumulate in the cortex at an earlier age than in persons of normal karyotype. We studied 20 Down syndrome patients dying after age 30 (average age, 49); all had neocortical plaques and tangles, but only 3 of 20 had been demented. In 12 cases (average age, 53), tissue was available for quantitative study of plaque and tangle densities and estimation of cell loss in the hippocampus. Although at least 8 of these 12 cases had plaque and tangle densities comparable to those previously reported in demented old people, only 1 had dementia. The regional distribution of plaques and tangles in the hippocampus of these Down cases differed from the pattern in senile dementia. Although Alzheimer-like dementia occurs in Down disease, it is less prevalent than the plethoric plaques and tangles in the cortex.

Adult↗
PubMed1979

A rational approach to dementia.

Dementia is a common problem facing all medical practitioners and it frequently results in hospitalization and death. This review provides a framework for dealing with dementia in clinical practice that is based on both traditional concepts and recent advances in the understanding of the problem. Distinguishing at the bedside between dementia and other disorders of intellect is emphasized. The main causes of dementia and their clinical characteristics are reviewed and a rational approach to definitive diagnosis is developed. Simple, effective symptomatic forms of therapy are described.

Aged↗
PubMed1979

Clinical and radiologic remission in reticulum cell sarcoma of the brain.

Two patients with cerebral reticulum cell sarcoma (CRCS) are reported in whom neurologic abnormalities and radiologic (computerized tomographic [CT] scan) evidence of tumor remitted. In one patient, remission followed craniectomy and corticosteroid therapy and lasted for eight months. In the other patient, at least four remissions occurred over a span of seven years, each in conjunction with the administration of corticosteroids. Corticosteroids may favorably alter the biologic activity of tumor tissue in some cases of CRCS, predisposing to clinical remission and disappearance of tumor on CT scan.

Adult↗
PubMed1979

The effect of metrizamide on the electroencephalogram: a prospective study in 61 patients.

A prospective study was made of changes in the electroencephalogram after the use of metrizamide for myelography and posterior fossa cisternography in 61 patients (62 studies). The EEG changed in 21 patients (34%); 3 of these had had previously abnormal records, and the abnormalities were accentuated on the second recording. Eight developed paroxysmal activity, including spike and wave in 1. EEG changes appeared 24 to 48 hours after the use of metrizamide in 6 patients whose intervening EEGs were normal. The percentage of records that changed tended to increase as metrizamide was brought to more rostral levels. Symptoms following the use of metrizamide were reviewed in 58 patients. Although there were no seizures in the present series, seizures did occur with subsequent use of metrizamide in 3 other patients at our institution. Previous reports may have underestimated the frequency of EEG changes after metrizamide since these may require 24 to 48 hours to develop. The appearance of such activity suggests that the use of metrizamide in patients with known seizure disorders, the anatomical level to which metrizamide is brought during radiography, removal of contrast medium, and further investigation of premedication with anticonvulsants all require careful consideration when use of metrizamide is being contemplated.

Adult↗
PubMed1979

Pyramidal infarction in the medulla: a cause of pure motor hemiplegia sparing the face.

We present a case with an infarct limited to the right pyramidal tract in the medulla. The lesion lay approximately 1 cm below the pontomedullary junction. On the basis of this case and three previously reported cases of medullary pyramidal infarction, there is defined a syndrome of severe hemiplegia with relative sparing of the face, tongue and articulation, minimal sensory loss, and good recovery. The hemiplegia is initially flaccid and later spastic. Transient symptoms, referable to the tegmentum of the medulla, occur at the onset, and reflect ischemia in the deeper territory of a paramedian penetrating vessel.

Brain↗
PubMed1978

The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms.

Fifty-two patients with acute and subacute transverse myelopathy (TM) were evaluated at the Massachusetts General Hospital between 1955 and 1975 and followed for 1 to 23 years (average, 5). Nineteen had symptoms of a recent acute infectious illness, 3 had cancer, and 1 had undergone a recent operation. There were four types of initial symptom. Twenty-four patients had paresthesias at the onset of the illness, 18 had pain, usually interscapular, 7 had leg weakness, and 3 had urine retention. Prognosis depended on the nature of the onset of TM. An acute catastrophic onset was generally associated with back pain and led to a poor outcome in 7 and a good outcome in only 1 of 11 patients. A subacute progressive onset over several days to four weeks, generally with ascending paresthesias or leg weakness, was associated with a good outcome in 15 and fair outcome in 17 of 37 patients. Preceding febrile illness, treatment with corticosteroids, and the nature of CSF abnormalities had no effect on outcome. Multiple sclerosis evolved in 7 patients during the follow-up period. Because of the frequency with which mass lesions were missed, the need for myelography in the diagnosis of TM is emphasized. The distinguishing clinical characteristics of TM provide guidelines for diagnosis and prognosis.

Acute Disease↗
PubMed1978

Cerebellar hemangioblastoma: computed tomographic, angiographic and clinical correlation in seven cases.

Seven patients with histologically confirmed cerebellar hemangioblastomas are reviewed in order to establish computed tomographic (CT), angiographic and clinical characteristics and correlations. Noncontrast CT scans demonstrated most cystic lesions but did not always depict nodules on the cyst wall and small solid tumors. Contrast-enhanced CT scans demonstrated the solid and cystic types of tumors but in some cases angiography better delineated them and the presence of nodules. The CT appearance reflected the pathologic characteristics, which included vascular channels, cyst formation and nodules. Solid tumors enhanced homogeneously and could not be definitively distinguished from other cerebellar neoplasms by CT alone. One atypical undifferentiated tumor appeared as a solid mass with a necrotic center. The CT appearance of associated retinal angiomatosis is also described. Hydrocephalus, gait or appendicular ataxia was the initial clinical presentation in these patients.

Adolescent↗
PubMedDate not supplied

High dose barbiturates in non-traumatic brain swelling: ICP reduction and effect on outcome.

High dose barbiturates were used to treat intracranial hypertension in 15 patients with nontraumatic brain lesions; (3 hypertensive hemorrhage, 4 subarachnoid hemorrhage, 5 infarction, 2 global anoxia-ischemia and 2 encephalitis). All had persistently raised intracranial pressure (ICP) while being treated with aggressive conventional therapy. The addition of barbiturates caused an initial lowering of ICP in 11 patients, but only 5 of these had sustained ICP reductions. Survival of the 5 patients with persistently lowered ICP and death of the remaining 10 may indicate an improvement in outcome attributable to the addition of high dose barbiturates to conventional therapy in non-traumatic brain swelling. Because of the resources required for their prolonged use, randomized studied in patients with intracranial hypertension are required to determine the effect of barbiturates on outcome.

Adolescent↗
PubMedDate not supplied

Contrast enhancement CT scan and post-endarterectomy hemorrhage.

Cerebral hemorrhage, an unusual complication of endarterectomy, is often attributed to postoperative hypertension. A patient with a middle cerebral artery stroke had a hemorrhage without hypertension, 2 days postoperatively. Pronounced contrast enhancement of the infarction during the 7 weeks prior to surgery reflected severe disruption of the blood-brain barrier. Contrast CT scans may detect patients at risk for post-endarterectomy hemorrhage even 2 months after a stroke or TIA.

Aged↗