Biomedical subjects
Publications and source records attributed to A J Drapkin.
A case is reported which questions the absolute significance of the "double-lumen sign" in the diagnosis of arterial dissection. I suggest that when demonstrated in isolation, this sign should be interpreted with caution, giving consideration to the possibility of arterial fenestration, and appropriate diagnostic measures implemented.
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A severe left-sided cervical radiculopathy that developed after a work-related injury is reported. Because this involved the upper limb opposite to a long-standing postpolio sequela, it is suggestive of postpolio syndrome. Work-up showed left-sided multilevel acquired foraminal stenosis. These unilateral degenerative changes were very likely the result of overuse of the cervical apophyseal joints, the consequence of the muscle imbalance created by the poliomyelitis. It was successfully treated by appropriate surgical decompression.
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Our experience in Monmouth County with surgical resection of single brain metastases followed by whole brain radiotherapy confirms the findings of a recent prospective randomized controlled study of this problem and demonstrates that patients treated with surgical resection followed by whole brain radiation live longer and have a better quality of life than those patients treated with radiotherapy alone. Best results are attainable if there is no evidence of disease activity at the primary site or systemically at the time the brain metastasis is diagnosed.
A case demonstrating the serial development of "de novo" aneurysms following common carotid ligation is presented. Persistence of the hemodynamic changes caused by carotid ligation, proven by ophthalmodynamometry performed twenty-five years later, might be the underlying basis for the serial formation of de novo aneurysms. The need for a program of routine neuroradiological follow-up in patients undergoing carotid ligation is discussed.
Fifty-three consecutive adult patients treated surgically for chronic subdural hematoma are reviewed. The current understanding of the pathogenesis of chronic subdural hematoma is discussed. In the current neurosurgical literature, wide discrepancies exist, in patients treated by burr-hole evacuation, regarding the rate of subdural recollection. Possible factors responsible for these discrepancies include (1) failure to recognize and properly treat multiloculated chronic subdural hematomas, (2) too aggressive a surgical approach toward persistent CT-demonstrated but asymptomatic subdural residual or recurrent collections, and (3) failure to use corticosteroids in the post-operative management of patients with persistent or recurrent symptoms as a step prior to re-operation. A prospective controlled clinical trial of glucocorticoids in chronic subdural hematoma is needed to establish their place in the management of this condition.
Three cases of the so-called rudimentary cranial meningocele/encephalocele are presented. A review of the literature yielded a number of similar cases which were tabulated and analyzed. It is suggested that this group of lesions represents neural crest remnants for which there is a good prognosis, distinct from the true meningocele/encephalocele complex.
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A 4th ventricular mature teratoma that became symptomatic in an adult man is reported. The literature on teratomas located in the posterior fossa midline is reviewed, and previously reported cases are tabulated. The differential diagnosis of posterior fossa midline mass lesions is discussed.
A case of Chiari type I malformation associated with a cervical intramedullary schwannoma is presented. A review of the literature concerning intramedullary schwannomas revealed their most frequent location to be in the cervical region. Their optimal treatment seems to be total removal as early in the course as is feasible. Emphasis is given to the need for actual demonstration of the cystic nature of the swollen spinal cord when dealing with Chiari type I malformation.
A case of epidural hematoma associated with Paget's disease of the skull, following minimal head trauma, is presented. Review of the literature yielded only one previously reported case of this association. Factors of relevance in the development of epidural hematoma in patients with Paget's disease of the skull are discussed, and steps to consider in that situation are recommended. In view of the steady increase in the elderly population of this country, this association is likely to become more frequently seen.
Ventriculo-subgaleal shunting was used for temporary decompression of hypertensive hydrocephalus. Pre- and post-shunt computed tomography was utilized in five cases as a method for detecting complications and determining shunt function. A clear-cut clinical improvement and stabilization followed the subgaleal diversion, but nevertheless usually only a mild decrease in ventricular size was demonstrated after shunting.
Adult craniectomized cats, rendered hydrocephalic by intracisternal kaolin injection, were repeatedly studied as to parameters pertaining to cerebrospinal fluid (CSF) dynamics and ventricular size. Intraventricular pressure was up to 8-fold of normal (mean 17.1 cm H2O) initially after induction of hydrocephalus and then went gradually down after 1 month. Ventricular volumes attained their maximum volume of approximately 4.5 ml at the very earliest study. The absorptive reserve (excess of absorption over formation rate of CSF) increased with time, thereby theoretically enabling the 'arrest' of the hydrocephalic process. Ventricular distensibility also increased with time, thus even the low ventricular pressure maintains the larger ventricular volume.
A patient with a mobile schwannoma of the cauda equina is described. The wide discrepancy between the myelographic and surgical locations of the tumor is most unusual. Awareness of the possibility of such an extreme degree of motility is important when dealing with cauda equina tumors.
Two cases of subarachnoid hemorrhage complicating intranasal ethmoidectomy are presented. In both, the bleeding was initally considered coincidental to the rupture of a congenital aneurysm or an arteriovenous malformation. A direct relationship between the surgical procedure and the subarachnoid hemorrhage only became evident after extensive studies or after delayed development of CSF rhinorrhea, pneumocephalus and meningitis.