Biomedical subjects
Publications and source records attributed to B Azar-Kia.
We report a case of transient neurologic toxicity secondary to tacrolimus. The clinical and imaging findings are reported and their subsequent regression after interruption of therapy in the patient following a bone-marrow transplant is also described. The etiology of the neurotoxicity and its analogy with other immunosuppressant agents are discussed.
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OBJECTIVE: To determine any factors that could improve the early detection and management of congenital inner ear malformations. STUDY DESIGN: A retrospective review was performed of all patients with a diagnosis of inner ear malformation at Loyola University Medical Center (LUMC) and the Hospital for Sick Children (HSC) between 1987 and 1995. Clinical records and audiometric data were accumulated. One neuroradiologist reviewed every temporal bone computed tomography (CT) scan. METHODS: Forty-six pediatric patients with congenital inner ear anomalies evaluated at two tertiary care hospitals. RESULTS: The average patient age at initial assessment was 25.7 months. A family history of hearing loss was noted in only five patients (12.8%). A major nonotological deformity was seen in 41% of patients. The average hearing threshold was 88 dB. All three patients with sudden hearing loss had vestibular aqueduct enlargement. Two of the three patients with common cavity anomalies had a history of recurrent meningitis. Twenty-seven patients had a vestibular aqueduct deformity, the most frequent radiographic abnormality in the series. CONCLUSIONS: Because inner ear malformation was diagnosed after 24 months of age in a significant percentage of patients, we recommend increased parental education and vigilance by primary care practitioners. Universal newborn screening may be the key to earlier detection of these infants. For children with idiopathic sensorineural hearing loss, we recommend a temporal bone CT scan. Patients with vestibular aqueduct enlargement must be counseled about the risk of progressive sensorineural hearing loss, meningitis, and the need to avoid contact sports. Patients with common cavity abnormalities should be considered for exploratory tympanotomy and also educated about the risk for meningitis.
BACKGROUND: The actual incidence of residual aneurysm after clipping is unknown. The natural history of residual aneurysm can be regrowth and hemorrhage. Intraoperative angiography offers a cost-effective, safe interdiction to the problem of residual aneurysm and parent vessel stenosis. METHODS/RESULTS: Forty consecutive patients harboring 54 aneurysms underwent 42 operative procedures to clip 52 aneurysms, during which 220 intraoperative angiographic runs were performed. Ninety-three percent of the procedures were performed on patients with acute subarachnoid hemorrhage. There were 4 giant (>2.5 cm, 4/52 = 8%, all anterior circulation), 21 large (1.0-2.5 cm, 21/52 = 40%, 16/ 21 = 76% anterior circulation, 6/21 = 28% posterior circulation), and 27 small (<1.0 cm, 27/52-52%, 22/27 = 81% anterior circulation, 5/27 = 18% posterior circulation) aneurysms. Intraoperative angiography led to clip adjustment in 18/52 = 34% of aneurysms (4/18 = 22% for parent artery stenosis, 8/18 = 44% for residual aneurysm and 6/18 = 33% for both). Of the 18 adjustments made, 16 = 88% were made on giant or large aneurysms and two were small (one was a complex anterior communicating and one was a vertebral junction aneurysm). Follow-up angiography was performed on 26/42 = 62% of operative cases. Postoperative angiography confirmed intraoperative angiography in all cases. Two complications occurred during 220 angiographic runs: one embolic stroke and one incident of equipment failure. CONCLUSION: A grading scale was applied to test the relationship between anatomical site and size as they relate to the necessity for clip adjustment for complete aneurysm obliteration and/or parent artery compromise. Significance was related to site (basilar bifurcation, anterior communicating, middle cerebral bifurcation, and ophthalmic) and size (>1.0 cm), both as independent and codependent variables. An analysis of the cost-effectiveness of intraoperative angiography was demonstrated.
This paper assesses the radiographic findings seen on early postoperative CT following acoustic neuroma resection. CT head scans were routinely obtained from 86 patients within 24 hours of tumor resection via a translabyrinthine or retrosigmoid approach. Repeat CT scans were performed in those patients with abnormal clinical symptoms. The abnormalities seen on postoperative CT included cerebellar hematoma (nine patients), cerebral and/or cerebellar infarction (six patients), CSF leak at the incision (two patients), subdural hematoma (two patients), hydrocephalus (one patient), and residual acoustic neuroma (two patients). An unexpected CT finding was ipsilateral temporal lobe lucency, suggesting venous edema, ischemia, and/or infarction in 16% (14/86) of patients. Overall, the clinical complication rate was 8%, and subclinical CT abnormalities were seen in 17% of patients. Temporal lobe venous edema, ischemia, or infarction is a complication of translabyrinthine resection of acoustic neuroma and is thought to be due to obstruction of an inferior temporal lobe draining vein. Some cases may be related to intraoperative interruption of the superior petrosal sinus or petrosal vein, and/or coagulation of the sigmoid sinus dural margins, interruption of an inferior temporal vein, or venous hypotension. Care in dealing with the superior petrosal and sigmoid sinuses at surgery is needed.
The purpose of this study was to examine the utility of the Water's view in the diagnosis of acute sinusitis in children. The records of all pediatric (less than 18 years old) patients who underwent sinus radiography for suspected acute sinusitis between February 1991 and November 1992 were reviewed. All radiographs were reviewed by an attending radiologist and the interpretation of the Water's (occipitomental) view alone was compared to that of a three-view (anterior/posterior, lateral, Water's) series. Fifty-two three-view sinus series were obtained on pediatric patients during the study period. Twenty-eight patients were diagnosed with acute sinusitis based on the three-view series. When compared to the three-view series, the single Water's view had a sensitivity of 89%, specificity of 83%, positive predictive value of 87%, and negative predictive value of 87%. The overall accuracy of the Water's view in diagnosing childhood acute sinusitis was 87%. The authors conclude that the Water's view is usually sufficient in the evaluation of suspected acute sinusitis in children.
PURPOSE: To review the CT and MR characteristics of temporal bone malignancy, and to evaluate the relationship between malignancies of the temporal bone and parotid gland. METHODS: A group of 15 surgical patients with diagnosis of temporal bone malignancy were retrospectively reviewed. These included 11 cases of primary temporal bone malignancy and four cases of secondary carcinoma of the temporal bone from a primary tumor of the parotid gland. Three primary temporal bone malignancies were recurrences, and two secondary tumors were parotid recurrences. RESULTS: Five of the 11 patients with primary temporal bone malignancy had parotid infiltration (45%). All four patients with secondary temporal bone destruction caused by parotid carcinoma had erosion of the mastoid, two with erosion of the external auditory canal, and one of the middle ear. CONCLUSIONS: It is important radiographically to recognize the close relationship between malignancies of the temporal bone and parotid gland, because either may secondarily invade the other. Suspicion of malignancy in either the temporal bone or parotid gland necessitates complete imaging of the other structure. Temporal bone or skull base erosion were best seen on CT at bone algorithm. MR with and without infusion provided excellent delineation of soft-tissue tumor margins, muscle infiltration, intracranial extension, and vascular encasement.
This study investigated the effects of MRI on receptor-mediated activation of pineal gland indole biosynthesis. Exposure of rats to MRI reduced the effects of isoproterenol on pineal serotonin and N-acetylserotonin levels suggesting that strong magnetic fields and/or radio-frequency pulsing used in MRI inhibited beta-adrenergic activation of the gland. There was no effect of MRI on saline controls.
Traumatic intracavernous aneurysms are a distinctly uncommon lesion in children. They usually present with compressive symptoms of the III, IV, V, or VI cranial nerves rather than epistaxis. Epistaxis is rare and usually minor and brief in duration. A child with severe head injury and basal skull fracture, who did not have any preceding symptoms or signs of ophthalmoplegia or exophthalmus, developed massive epistaxis as a leading symptom of the ruptured intracavernous aneurysm. Since there are no reported pediatric cases with fatal epistaxis as a presenting sign, we would like to share our experience.
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Discussion of the anatomy of the parasellar region focuses on the optic chiasm and its relationship to surrounding structures. CT and MRI are valuable tools in the imaging of these regions. This article provides a brief review of the technique of CT and MRI with visualized anatomic structures of these areas. A closer look at how CT and MRI are used to delineate the different pathologic processes of the sellar and parasellar regions then follows.
Localization and pathologic diagnosis of optic nerve tumors have been greatly improved by high resolution computed tomography and magnetic resonance imaging. Radiologic differentiation of the most common tumors of the optic nerve (meningioma and glioma) can be made by using these new imaging modalities. Early diagnosis of optic nerve lesions has resulted in better prognosis and surgical outcome.
We have studied three patients with angiographically documented cerebellar venous angioma (CVA). One patient had a subacute cerebellar hematoma and underwent posterior fossa craniotomy for evacuation of the hematoma and excision of the malformation. A hemorrhagic venous infarction of the brain stem and cerebellum occurred, and the patient died three weeks postoperatively. A second patient with an unruptured CVA had a history of headaches, tinnitus, and vertigo. Conservative treatment was elected, and the patient's condition remains unchanged after 11 months of follow-up. The third patient, recently diagnosed as having an unruptured CVA had episodic vertigo and disequilibrium. Conservative treatment was chosen, and he is asymptomatic after six months of follow-up. Based on a review of 24 other cases of CVA plus our experience we could not conclude any definite trend regarding natural history or treatment. However, conservative treatment seems the logical choice in patients with unruptured CVA.
We analyzed the clinical and cranial computerized tomographic (CT) features of 10 patients with cerebellar infarction. Among patients with recent cerebellar infarction, the initial CT often failed to demonstrate any recognizable abnormality. Because early neurological deterioration may arise despite normal CT studies, a high level of clinical awareness is critical for appropriate intervention.
Isolated facial myokymia with contracture can be the earliest manifestation of intrinsic lesions of the brainstem. We report a case of facial myokymia with contracture occurring as the result of a pontine glioma, as depicted on cranial computed tomography and magnetic resonance imaging studies. The rostral location of the tumor supports the supranuclear disinhibition hypothesis of facial myokymia.
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