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Biomedical subjects

B A Sandok

Publications and source records attributed to B A Sandok.

At least 19 recordsLinked to original sources
PubMed1990

Prospective comparison of a cohort with asymptomatic carotid bruit and a population-based cohort without carotid bruit.

This study is a prospective analysis of the predictive value of diffuse and localized carotid bruit. Patients with asymptomatic carotid bruits are compared with a population-based age- and sex-matched control group known not to have carotid bruit, in regard to subsequent transient ischemic attack, stroke, and death. Each person was followed until death or for 5 years. Among the 566 patients with asymptomatic carotid bruit, the annual stroke rate given survival was 1.5%/yr or 7.5% at 5 years by actuarial analysis. The annual stroke rate given survival for the 428 patients in the population-based cohort was 0.5%/yr or 2.4% at 5 years. Patients with localized carotid bruit were not significantly different from those with diffuse carotid bruits in regard to subsequent cerebral ischemic events (p = 0.11). These data indicate that patients with asymptomatic diffuse or localized carotid bruit are approximately three times more likely to have ischemic stroke than an age- and sex-matched population sample known not to have carotid bruit.

Age Factors↗
PubMed1988

Spontaneous dissections of the vertebral arteries.

Clinical and angiographic features and outcome in 25 patients with spontaneous dissections of the vertebral arteries are described. Most patients were in their fourth or fifth decade of life, and women predominated. Forty-eight percent of the patients were hypertensive. Angiographic evidence of fibromuscular dysplasia was noted in one only. Brainstem ischemic symptoms (usually a lateral medullary syndrome) and ipsilateral occipital headache and neck pain (often preceding but sometimes associated with or following the brainstem ischemic event) were the most common clinical findings. The angiographic features in decreasing order of frequency were luminal stenosis (often irregular and tapered), aneurysm, occlusion, and intimal flap. On follow-up, most of the patients (88%) made complete or very good recoveries. Angiographic abnormalities either subsided or improved in 76%. Multivessel dissection (involvement of both vertebral arteries or one or both vertebral arteries and one or both internal carotid arteries) was noted in about two-thirds of the patients. This tendency of vertebral artery dissections to involve multiple cervicocephalic vessels concurrently, if not simultaneously, implies that four-vessel angiography should be attempted if a vertebral artery dissection is visualized. It also raises the possibility of an underlying arteriopathy that predisposes the vessel to dissection.

Adult↗
PubMed1987

Vascular malformations of the posterior fossa. Clinical and radiologic features.

Thirty-one patients with vascular malformations of the posterior fossa were studied to determine their clinical presentation and radiologic diagnosis. The most common clinical presentations were acute hemorrhage (68%, 21/31) and progressive or fluctuating focal neurologic deficits resembling those found in other pathologic processes (19%, 6/31). Trigeminal neuralgia and hemifacial spasm occurred in these patients, but they were rarely initial presenting symptoms. Computed tomography, after infusion of contrast medium, was abnormal in 95% (20/21) of the patients. Angiography established or confirmed the diagnosis in most of the patients; however, a negative angiogram, especially in cases with recent hemorrhage, does not exclude the diagnosis.

Adolescent↗
PubMed1987

Focal encephalitis in a young woman 6 years after the onset of Lyme disease: tertiary Lyme disease?

A 19-year-old woman had severe focal inflammatory encephalitis. Six years previously, she had had classic untreated Lyme disease characterized by erythema chronicum migrans, bilateral facial palsies, and lymphocytic meningitis. During her recent encephalitic illness, Lyme disease serologic tests were positive by indirect immunofluorescence microscopy, enzyme-linked immunosorbent assay, and western blot (immunoblot technique) testing. We hypothesize that the patient's focal inflammatory encephalitis was a result of a persistent spirochetal infection of the central nervous system.

Adolescent↗
PubMed1986

Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits.

Emergency revascularization procedures for patients with acute stroke are controversial. Thirty-four patients with acute internal carotid artery occlusion documented at the time of emergency endarterectomy were analyzed. Before operation, all these patients had profound neurological deficits including hemiplegia and aphasia. There was a 94% success rate in restoring patency. In follow-up, nine patients (26.5%) had a normal neurological exam, four (11.8%) had a minimal deficit, 10 (29.4%) had a moderate hemiparesis, which was improved over their preoperative deficit, 4 (11.8%) remained hemiplegic, and seven (20.6%) died. The natural history of patients with acute carotid occlusion and profound neurological deficits is dismal. In comparison, 13 patients (38%) made a dramatic recovery. The surgical mortality rate compares favorably with the natural history. Good collateral flow was a good prognostic factor, while a simultaneous middle cerebral artery embolus was associated with a poorer prognosis. An emergency carotid endarterectomy may be indicated in selected patients with acute internal carotid artery occlusion with profound neurological deficits. Full preoperative angiography may identify those patients who would benefit from surgical intervention and reduce the operative mortality rate.

Aged↗
PubMed1984

Complications of cerebral angiography: prospective assessment of risk.

A prospective study of 1,517 consecutive cerebral angiographic examinations is reported. The incidence of all complications was 8.5%, and the incidence of all neurologic complications was 2.6%. The overall incidence of permanent neurologic deficit was 0.33%. The incidence of permanent neurologic deficit in patients referred for evaluation of symptomatic cerebrovascular disease was 0.63%. Older age, increased serum creatinine concentration, and the use of more than one catheter all were significantly associated with serious neurologic complications. Although patients with a recent stroke or frequent transient ischemic attacks had a higher incidence of serious neurologic complications, this increase was not statistically significant for this sample.

Adolescent↗
PubMed1978

Guidelines for the management of transient ischemic attacks.

On the basis of a review of the literature on anticoagulant, antiplatelet, and surgical treatment, supplemented by our personal experience, we have developed guidelines for the management of patients with transient ischemic attacks (TIA). 1. The majority of patients with vertebral-basilar TIA are treated medically. 2. If a skilled surgeon and an experienced angiographer are available, patients with typical carotid TIA who are suitable medical risks should have angiography followed by carotid endarterectomy if an appropriate lesion is found. 3. Nonoperated patients with TIA of less than 2 months' duration are treated with 3 months of warfarin therapy (unless contraindicated) before treatment with aspirin is begun. 4. Nonoperated patients with continuing TIA of 2 or more months' duration are treated with aspirin unless there has been a recent increase in the frequency, duration, or severity of TIA. Under these circumstances, warfarin therapy is advised for 3 months before aspirin is started. Aspirin therapy should be continued until the patient has been free of TIA for 1 year. 5. No treatment is advised for nonoperated patients whose last episode of TIA was longer than 12 months ago.

Anticoagulants↗
PubMed1975

Carotid endarterectomy. Complications and preoperative assessment of risk.

A system of grouping patients according to preoperative evaluation of risk of carotid endarterectomy is presented. The primary complications of this surgical procedure were myocardial infarction and residual mild to severe neurologic deficit. Neurologically stable patients without medical or angiographically determined risk factors (group 1, 129 patients) have a risk of 1%. Neurologically stable patients without medical risk but with angiographically determined risk (group 2, 56 patients) have a risk of 2%. Neurologically stable patients with significant medical illness and with or without angiographically determined risks (group 3, 76 patients) have a risk of 7%, primarily related to cardiac disease. Neurologically unstable patients (group 4, 70 patients) have a 10% risk for a neurologic deficit.

Angiography↗
PubMed1975

A distinctive clinical EEG profile in herpes simplex encephalitis.

Two patients with herpes simplex encephalitis had clinical courses consisting of an acute febrile illness with early onset of seizures and rapidly progressive neurologic signs evolving to coma and death within 3 weeks. The electroencephalograms of both patients were similar and showed widespread, periodic, stereotyped sharp-and-slow-wave complexes occurring bilaterally over both hemispheres, as well as transient episodes of electrographic seizure activity occurring unilaterally, with suppression of the periodic activity on that side. Although the electroencephalographic findings are not pathognomonic, when associated with an acute encephalitic process, they would suggest the diagnosis of herpes simplex encephalitis.

Aged↗
PubMed1972

Temporal arteritis.

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Adrenal Cortex Hormones↗