Search PubMed⌕ Search

Biomedical subjects

A Uske

Publications and source records attributed to A Uske.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Traumatic dissection of the internal carotid artery].

Two patients with posttraumatic dissection of the internal carotid artery were referred to the neurosurgical department with secondary neurological deterioration following a minor head injury with concussion. Both developed aphasia and right hemiparesis during the first few hours after the accident; one patient also had right focal seizures. On admission, both were only mildly lethargic, which contrasted with the severity of the focal neurological signs. Early CT scan was normal in both cases, whereas cerebral blood flow (CBF) studies by single photon emission computerized tomography (SPECT) with Tc-HMPAO (Ceretec) showed perfusion defects in the region supplied by the left middle cerebral artery (MCA), correlating with the clinical picture. Doppler sonography disclosed pathologic flow patterns, and carotid angiography demonstrated dissection of the internal carotid artery, in one patient on the left only and in the other bilaterally, with embolic occlusion of a branch of the left MCA in the latter case. Clinical features, pathogenesis, diagnostic workup and possible treatment (medical, as in our two cases, versus surgical) of this rare pathology are briefly reviewed.

Adult↗
PubMed1990

Loose bodies of the temporomandibular joint: arthrographic and CT findings in five patients.

We report a series of five patients with symptoms of internal derangements of the temporomandibular joint (TMJ), in whom intraarticular loose bodies were found. Three patients with a single loose body had osteochondrosis dissecans of the temporal part of the joint; one trauma patient had two loose bodies (including a bony and a meniscal fragment). The fifth patient presented with a loose meniscal fragment and a complete meniscal rupture, complicating a long-lasting TMJ dysfunction due to non-reducible anterior meniscus displacement. The diagnosis was made by arthrotomography (3 cases), CT (one case) and by CT and arthrotomography (one case). Surgical confirmation was obtained in all patients. Arthrography and CT are accurate in diagnosing TMJ loose bodies; characteristic findings disclosed in both examinations are described.

Adult↗
PubMed1989

Pancreatic insuloma causing Cushing's syndrome.

The advent of new diagnostic procedures such as petrosal venous sampling and CRF testing has improved the possibilities of precise location of the site of hormonal overproduction in Cushing's syndrome. We report on a case of ectopic ACTH-dependent Cushing's syndrome in which the use of such techniques helped to locate the tumor. A 45-year-old woman with definite ACTH-dependent Cushing's syndrome was referred to our clinic for evaluation. ACTH, cortisol and urinary 17OHCS failed to suppress on high dose dexamethasone oral administration. Computerized tomography showed bilateral adrenal hyperplasia and an empty sella turcica. ACTH and cortisol did not increase after CRF administration. Staged caval system catheterism via both femoral veins up to the inferior petrosal sinuses, including after CRF administration, demonstrated no ACTH gradient between staged samples and simultaneous peripheral venous blood. This suggested a tumor drained by the portal system. An abdominal ultrasonography demonstrated a pancreatic mass, that was surgically excised and appeared as a benign islet cell tumor. Portal vein ACTH promptly decreased after tumor excision and postoperative peripheral cortisol and ACTH were normal. On immunostaining the tumor cells proved to be positive for ACTH.

ACTH Syndrome, Ectopic↗
PubMed1989

[Menkes disease. Report of a case with pronounced involvement of connective tissues and changes in epidermal desmosomes].

The authors describe a patient who presented from birth on a severe involvement of connective tissues with pathological fractures, lack of auricular cartilage, hyperlaxity of fingers and cutis laxa with deep folds, all suggestive of derangements of collagen and elastin. Hypothermia at 24 hours of age should have already indicated the possibility of Menkes' syndrome. From the 3rd month on, the patient presents a neurological deterioration and a myoclonic epilepsy which is resistant to treatment. Craniocerebral tomodensitometry revealed, with time, a cerebral atrophy and subdural hematomas. Angiodysplasia of a coronary artery was seen at cardiac echocardiography. Undetectable levels of serum copper and ceruloplasmin, and an increased uptake of copper by fibroblasts in vitro confirmed the diagnosis of Menkes' syndrome. Electron microscopy of a skin biopsy disclosed a desmosomal anomaly in the epidermis. Desmosomes stay apart suggesting an alteration of the interdesmosomal cement.

Brain↗
PubMed1988

Migraine stroke.

Because the cause of stroke during migraine is not known, we studied 22 (17 females, 5 males; mean age, 32.7 years) classic migraine sufferers who had an ischemic stroke during an attack of migraine, with CT, Doppler ultrasound, cerebral angiography, and two-dimensional echocardiography. We found no cardiac or arterial lesion in 91% of the patients, as compared with 9% of age- and sex-matched migraineurs with stroke remote from a migraine attack and 18% of age- and sex-matched nonmigraineurs with stroke (p less than 0.00001). Mitral valve prolapse, arterial dissection, and vasospasm were not significant causes of stroke during migraine. These patients had longer previous attacks of migraine and their infarct was more frequently in the territory involved during the attacks than the controls, supporting the hypothesis that a prolongation of the migrainous process beyond usual limits may explain most migraine strokes.

Adult↗
PubMed1988

Thalamic infarcts: clinical syndromes, etiology, and prognosis.

We studied forty patients with CT-proven thalamic infarcts without involvement of the superficial territory of the posterior cerebral artery. The delineation into four arterial thalamic territories (inferolateral, tuberothalamic, posterior choroidal, paramedian) corresponded clinically to four different syndromes. The most common etiologies were lacunar infarction, large artery atherosclerosis with presumed artery-to-artery embolism, cardioembolism, and migrainous stroke. We found no risk factor other than age or oral contraceptive use in six patients. One patient died in the acute phase. During follow-up (45.6 months), the stroke or death rate was 7.4% per year. Delayed pain developed in three patients and abnormal movements in three. Late disability was mainly secondary to persisting neuropsychological dysfunction (thalamic dementia).

Adult↗
PubMed1987

Optico-cerebral syndrome: simultaneous hemodynamic infarction of optic nerve and brain.

Three (0.5%) of 612 patients with an acute ischemic stroke in the carotid territory also had ipsilateral optic nerve infarction. They had unilateral or bilateral internal carotid artery occlusion and reversed flow in the ophthalmic artery. Hemodynamic infarction was suggested by triggering by a drop in blood pressure, decreased ophthalmic artery flow and perfusion pressure, and cerebral infarction in a watershed area. The "optico-cerebral syndrome" suggests internal carotid artery occlusion with hemodynamic disturbances. In carotid disease, monocular blindness may be due to an optic nerve lesion sparing the retina.

Arterial Occlusive Diseases↗
PubMed1986

[Cerebellar infarct. Clinical presentation and x-ray computed tomography of the brain].

A series of 12 patients with cerebellar infarcts diagnosed by computerized tomography are reviewed. The clinical features of cerebellar infarctions cover a wide spectrum, mimicking symptoms and signs from an acute labyrinthitis to a rapidly expanding posterior fossa mass lesion with brain stem and cerebral dysfunction. Two patients were asymptomatic and three showed signs of cerebellar dysfunction only. Three patients had evidence of brain stem dysfunction with cranial nerve palsies accompanying the cerebellar deficit. Two presented a pseudovestibular form with sudden onset of nausea, vomiting, rotary dizziness and ataxia. A pseudotumoral form with intracranial hypertension was found in two cases, in which softening tissue acts as a rapidly expanding posterior foss mass lesion. It is difficult to identify the exact artery involved in a cerebellar infarct because of the collateral circulation and connections between the three major arteries. Atherosclerosis and general decrease in blood flow can be regarded as the most likely factors precipitating focal cerebellar infarction. Surveillance is necessary during the first days with anti-edematous therapy. Rapid deterioration of consciousness should be considered a sign of increasing intracranial pressure progressing with the development of hydrocephalus. If necessary, surgical decompression by external drainage or by direct access to the posterior fossa can be carried out.

Cerebellar Ataxia↗
PubMed1986

Spin-echo MR imaging of intracranial hemorrhage.

This retrospective study was performed to describe the appearance of intracranial hemorrhagic lesions on magnetic resonance (MR) imaging at 0.35 tesla using the spin-echo technique, and define the present clinical role of MRI in this particular pathology. Forty-eight examinations of forty-three patients with forty-seven intracranial hemorrhagic lesions (39 true hematomas and 8 hemorrhagic lesions mixed with other tissues) were reviewed for this study. Comparative CT studies were available for all the patients. In our limited experience with acute hematomas (less than 3 days old), low or isointense signal was seen with a short TR (0.5 s), but a relative increase in signal intensity was observed with a long TR (2.0 s). This appearance of acute hematoma was not specific. Chronic hematomas (more than 3 days old) were imaged as foci of bright signal intensity on both short and long TR. This pattern was characteristic of chronic hematoma. With a short TR (0.5 s), two hemorrhagic lesions (5 and 7 days old) were displayed as an isointense signal surrounded by a rim of high intensity signal. This peripheral zone most likely represented liquefaction at the clot's periphery and the initial formation of methemoglobin. T1 and T2 relaxation times were found to be very long for acute hematomas (first two days). T1 values of chronic hematomas (more than 3 days old) were comparatively short and in the same range as T1 of white matter. T2 values of chronic hematomas decreased also but remained very long.

Acute Disease↗
PubMed1986

MRI of angiographically occult vascular malformations.

Eleven patients with 15 angiographically occult arteriovenous malformations were studied by magnetic resonance (MR) imaging and computed tomography (CT). Five patients had biopsy proof; six were clinically diagnosed from the long-term clinical follow-up (more than 3 years) and imaging features. Of the 15 lesions, 11 were recognized by both CT and MR. Each method was falsely negative for two lesions. The most useful contribution of MR in the characterization of angiographically occult arteriovenous malformations was the depiction of hemorrhagic foci in 12 of 13 lesions seen on MR. High-attenuation foci indicative of hematomas were seen in only five lesions on CT; the rest were iso- or hypoattenuating. CT detected two very small lesions, in one case as punctate foci of enhancement and in the other as punctate calcification, that were not seen with MR. MR complements CT in characterizing angiographically occult arteriovenous malformations and in distinguishing them from similar-appearing lesions, in particular, small neoplasms. However, when such lesions are seen with only focal calcification and subtle enhancement on CT, routine MR may miss them.

Adolescent↗
PubMed1986

[Cerebellar infarcts and hemorrhages: differential diagnosis].

Seventeen adults with cerebellar stroke confirmed by computerized tomography were reviewed, and divided into two groups: the first group consisted of 10 patients with cerebellar softening, and the second one included 7 cases with cerebellar hemorrhage. The diagnostic rests primarily upon the symptoms and clinical signs. They consist of acute onset of vertigo, headache, nausea or vomiting, ataxia-disequilibrium, then progressing signs of brain stem compression with gaze palsy, cranial nerve palsies and a decreasing level of consciousness. The computerized tomography is the diagnostic test of choice. The interpretation of the scan and of the brain stem and its surrounding cisterns gives decisive help in accessing the indications for surgical treatment.

Adult↗
PubMed1986

[Hemiataxia and ipsilateral sensory deficit. Infarct in the area of the anterior choroidal artery. Crossed cerebellar diaschisis].

A 58 year old hypertensive man suffered an acute right-sided hemiataxia associated with painful hypoesthesia. CT showed an infarct in the territory of the left anterior choroidal artery. The sensory defect involved all the elementary modes, but predominated on pain sensation. The ataxia suggested a cerebellar type of dysfunction, with hypermetria, intentional tremor, dysdiadochokinesia and a positive rebound phenomenon. There was no hemiparesis, no hemianopia, no neuropsychological dysfunction and no oculomotor abnormality. Hemiataxia with hemisensory defect has not been reported in stroke, and it constitutes a new clinical form of lacunar syndrome. The hemiataxia may be related to the finding on single-photon emission computed tomography (SPECT) using 123 I-amphetamine of a crossed cerebellar diaschisis, which may suggest a transneuronal deactivation. This metabolic depression may have been due to involvement of the temporo-parieto-pontine bundle of Türck in the retro and sub-lenticular portion of the internal capsule. The finding of a normal cortical blood flow may explain why no neuropsychological impairment was present, because of the absence of functional deactivation of the cortex by the underlying deep infarct.

Arteries↗
PubMed1986

MR imaging of extracranial hematomas: comparison with CT.

Thirty MR examinations of twenty-five patients with extracranial hemorrhagic lesions were reviewed. Comparative CT studies were available in 11 patients. The acute hematomas (less than 3 days old) showed intermediate intensity on the short TR (0.5 sec.) and increased in signal intensity on the long TR (2.0 sec.). The MR appearance of acute hematoma was not specific. Clot (more than 3 days old) demonstrated an intermediate intensity on the short TR and increased markedly in signal intensity on the long TR equaling the signal intensity of fat. Serum (more than 3 days old) was imaged as a high intensity lesion on both short and long TR. It is concluded that MR can be very useful for the differential diagnosis of subacute and chronic hemorrhagic lesions from other lesions.

Acute Disease↗
PubMed1986

Direct coronal computed tomography of the lumbar spine: a new technical approach in supine position.

Computed tomography (CT) was carried out on 46 subjects with L5-S1 disk hernia. All the patients had a L5-S1 angle equal or greater than 40 degrees. Coronal sections of the disk were obtained with a rostral angulation of the gantry, having placed the lumbar spine in a hyperlordotic position. Results are discussed and compared with those obtained from para-axial transverse sections and multidirectional reformated images.

Adult↗