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Biomedical subjects

B E Kendall

Publications and source records attributed to B E Kendall.

At least 145 records · Page 8Linked to original sources
PubMed1987

Intracranial catecholamine secreting paragangliomas.

Three intracranial catecholamine-secreting paragangliomas are described. They involved a glomus jugulare, a sphenopalatine ganglion and the clivus and upper cervical spine respectively. The extent of the tumours was shown by CT and MRI. They were all highly vascular with a substantial blood supply from systemic arteries which was subjected to particulate embolisation, followed in two cases by surgery. The importance of studying any tumour which could possibly be a paraganglioma for hormonal and, especially, for catecholamine secretion prior to any invasive procedure, including angiography and embolisation, is emphasised: all such procedures should be covered with catecholamine blocking agents and, in addition, carefully monitored with resuscitation facilities immediately available.

Adult↗
PubMed1987

Down beating nystagmus: magnetic resonance imaging and neuro-otological findings.

Twenty-four patients with down beating nystagmus (DBN) underwent magnetic resonance imaging (MRI) of the head. MRI provided diagnostic images in Arnold-Chiari malformation (6 cases), cerebellar atrophy (6 cases), 1 case with a prepontine-medullary epidermoid tumour and was helpful in the diagnosis of 2 patients with multiple sclerosis and 1 with a ponto-cerebellar infarct. Multiple cerebral hemisphere lesions were found in 6 patients (5 of them over 60 years of age) in whom no diagnosis was made. All cases of DBN, plus 3 additional patients with Arnold-Chiari malformation and other types of nystagmus, were neuro-otologically assessed. Sensitivity of the nystagmus to head tilt with respect to the gravity vector had no localizing value. Impaired horizontal vestibulo-ocular reflex suppression occurred more frequently in those patients with abnormal posterior fossa MRI. Pure torsional nystagmus, and DBN with a strong torsional component, in patients with Arnold-Chiari malformation was associated with syringomyelia. Magnetic resonance is the imaging method of choice for investigating patients with DBN.

Adolescent↗
PubMed1987

The role of NMR imaging in the assessment of multiple sclerosis and isolated neurological lesions. A quantitative study.

The form and distribution of MRI abnormalities in 114 patients with clinically definite multiple sclerosis (MS) have been compared with observations on 53 apparently healthy individuals, 129 patients with isolated focal neurological lesions with which MS often presents (51 patients with optic neuritis, 44 with isolated brainstem lesions and 34 with isolated spinal cord syndromes) and 105 patients with disorders which may be confused clinically or radiologically with MS. The latter comprised 55 patients with cerebral vascular disease (including 7 cases of dementia with diffuse white matter disease), 24 with degenerative ataxic disorders, 8 with cerebellar tonsillar ectopia, 7 with sarcoidosis and 11 with a variety of other disorders. Periventricular abnormalities were found in all but 2 patients with MS and discrete white matter lesions in all but 12. Characteristically the periventricular changes in MS were irregular in outline. Periventricular abnormalities which were often milder and of smooth outline were seen in 37/55 patients with cerebral vascular disease, 9/24 with cerebellar degeneration, 5/7 with sarcoidosis and in 2/3 apparently healthy individuals over the age of 60. The appearances in the 7 cases of dementia resembled those with advanced MS. Cerebellar and/or brainstem atrophy characteristic of the cerebellar degenerations, in the absence of white matter abnormalities, was helpful in making the distinction from MS. Congenital anomalies and tumours in the region of the brainstem and foramen magnum were readily shown. More than half the patients with symptoms attributable to isolated focal neurological lesions had additional lesions at presentation. MS cannot be diagnosed in these cases at presentation, but repeat scans after 5 to 20 months in 25 patients with optic neuritis and 10 with clinically isolated brainstem lesions have shown new lesions in 7 (20%). The patients with new lesions fulfil the criteria for clinically probable MS (Poser et al., 1983). Measurements of T1 and T2 in vivo permitted the distinction of acute from chronic brainstem lesions. There were quantitative differences in T1 and T2 between the normal appearing white matter in MS and normal brain. Studies of postmortem brains provided convincing evidence that the MRI abnormalities in MS correspond with plaques. Evidence is adduced to support the view that an important source of the abnormal NMR signals in acute lesions is oedema, and in chronic lesions is gliosis; demyelination per se is unlikely to make an important contribution.

Adolescent↗
PubMed1987

Tuberculous meningitis: role of CT in management and prognosis.

Serial computed tomographic scans were performed during the course of tuberculous meningitis in 25 patients aged 1-70 years. Hydrocephalus rarely occurred without other abnormalities. Marked ventricular enlargement was associated with extensive basal enhancement. Basal meningeal enhancement was not a good indicator of the clinical state although marked enhancement was a risk factor for the development of basal ganglia infarction. Infarcts were much more common in children than in adults and were sometimes asymptomatic. Radiological abnormalities sometimes developed during treatment and often did not resolve completely. Many patients had severe residual neurological problems.

Adolescent↗
PubMed1987

Regional cerebral blood flow of patients with focal epilepsy studied using xenon enhanced CT brain scanning.

Stable xenon-enhanced X-ray computed tomography (XeCT) was used to measure the regional cerebral blood flow (rCBF) of 12 patients with drug resistant partial epilepsy and a marked unilateral focus on electroencephalography (EEG). Interictal mean rCBF of fixed regions of interest (ROIs) was reduced by 25% in the cortex of the epileptogenic cerebral lobe compared with the same regions on the contralateral side (p less than 0.02). Six control scans showed a mean side to side cortical difference in rCBF of 14%, whereas the epileptogenic focus was associated with a reduction in the cortical rCBF of greater than 30% in six out of the 12 patients. In an additional patient with partial epilepsy XeCT demonstrated significant focal hypoperfusion when interictal EEGs and conventional CT scans showed no abnormalities.

Adult↗
PubMed1986

Tuberous sclerosis: a clinicoradiological evaluation of 110 cases with particular reference to atypical presentation.

CT scans on 110 children with a diagnosis of tuberous sclerosis have been compared with the clinical features of the disease. Patients with definite radiological as well as definite or suggestive clinical features accounted for only 80% of cases. 16% had positive radiological and negative clinical features and 4% had positive clinical and negative radiological features. There is little relationship between the mental development and the incidence of periventricular tubers or cortical and white matter lesions. In 15 patients older than 7 years the diagnosis was only made at the time of CT. Cerebral atrophy was not a prominent feature. Giant cell astrocytomas were present in 14%, one third of whom presented for the first time.

Adolescent↗
PubMed1986

Computed tomography in cervical spondylotic myelopathy and radiculopathy: visualisation of structures, myelographic comparison, cord measurements and clinical utility.

Sixty-nine patients with cervical spondylotic myelopathy (CSM), radiculopathy (CSR), or both (CSMR) were studied with computed tomography (CT). Computer-assisted myelography (CAM) accurately determines the site and nature of spondylotic protrusions and provides good visualisation of the subarachnoid space and cord deformities even in areas with dilute metrizamide. However, excessive vertebral movement and bulging ligamenta flava with their effects on cord deformity, so easily visualised in myelograms, are completely or partially missed. In the assessment of CSM, metrizamide myelography (MM) followed by CAM should be performed, particularly when the myelographic images are unsatisfactory due to contrast dilution or blockage, when cord compression cannot be ascertained with MM and when cord atrophy is suspected. In CSR, the diagnostic information from MM and CAM is comparable. The diagnostic criteria in CAM are, however, less direct and since MM is adequate in uncomplicated cases, CAM is generally not necessary. The APD, APD/TD ratio, area and circularity are sensitive indices of cord deformity and the first two should be used more often to assist visual assessment of cord deformity. The relation between cord parameters and treatment response is better reflected in CSM cases managed conservatively and the results suggest that the degree of cord deformity is helpful in determining the outcome and hence the choice between surgical and conservative treatment. In plain CT, the osteophytes and calcified discs are adequately visualised and canal dimensions measured with accuracy, but the cervical cord and roots cannot be properly assessed and the diagnosis of CSM or CSR cannot be ascertained. At present, its role in cervical spondylosis is therefore limited.

Humans↗
PubMed1986

Computer-assisted myelography in cervical spondylotic myelopathy and radiculopathy. Clinical correlations and pathogenetic mechanisms.

A total of 53 patients with cervical spondylotic myelopathy and/or radiculopathy were studied with computer-assisted myelography following metrizamide myelography. Cervical cord deformities resulting from spondylotic protrusions were classified into four groups. The A shape (anterior central concavity) is the commonest and is often associated clinically with bilateral anterolateral and posterior column deficits. In the B shape (lateral deformity on one side), unilateral anterolateral column and root signs, usually mild, predominate. The symptomatology of the C shape (lateral deformity on both sides) and the D shape (flattened anterior surface) is bilateral, although not often symmetrical, and includes anterolateral and posterior column disturbances and root signs. Radiculopathy may, however, occur in the absence of cord deformity if the spondylotic lesion is close to or inside the intervertebral foramen. As there is some relationship between cord shapes and symptomatology, the decision as to whether a particular deformity is responsible for the clinical presentation may be made with more confidence. Moreover, the degree of cord deformity correlates well with the severity of symptomatology. Those with mild deformity had relatively few or mild cord signs, whereas in those with severe deformity cord signs were numerous and severe. Certain observations on cord deformity in vivo support the view that compression is an important pathogenetic mechanism in cervical spondylotic myelopathy. Most patients had anterior cord compression and the anterolateral signs were more frequent and marked. Severity of cord signs is associated with the degree of compression. Removal of the compression is followed by re-expansion of the cord and clinical improvement. In a small number of cases where cord compression by osteophytic protrusion was mild, and where clinical improvement followed the removal of the protrusion, the theory of cord traction and friction appears to apply. The contribution of other mechanical factors and of ischaemia to cord damage is also discussed.

Adult↗
PubMed1986

Tall stature: a clinical, endocrinological and radiological study.

We have studied GH secretory dynamics in 38 (25 F, 13 M) children referred for investigation and treatment of tall stature (Height SD score (SDS) greater than 1.8). Five children had elevated basal GH levels (mean 20.4 mU/l) and a further four had abnormal GH responses to exogenous TRH. Two other children had paradoxical GH responses to oral glucose loading. Although one of these was receiving high dose testosterone to limit final height. All these children were pubertal and did not show concordance between peak GH concentration observed after insulin-induced hypoglycaemia and during stage IV sleep. Twenty-four hour GH profiles revealed increased GH pulse amplitude and area under the pulse during puberty. Morning GH secretion was also regularly observed and it is possible that the paradoxical responses seen by us and reported by others reflect this increased physiological secretion. Pituitary radiology revealed morphological abnormalities suggestive of microadenomata in 17 patients but these were all in late puberty and these changes may be related more to the effects of sex hormones than to somatotroph pathology. 'Abnormal' endocrinology and radiology are seen in tall children in puberty and must be interpreted with caution.

Body Height↗
PubMed1986

Disseminated lesions at presentation in patients with optic neuritis.

Thirty five adults and two children with clinically isolated optic neuritis were examined by magnetic resonance imaging (MRI) to determine the presence of disseminated lesions within the brain at presentation and to compare these findings with the results of evoked potential studies. Of the adult patients, 61% showed lesions on the scans whereas the evoked potentials suggested the presence of lesions outside the visual system in 30%. MRI is a sensitive method for the demonstration of clinically unsuspected lesions in patients with uncomplicated optic neuritis.

Adolescent↗
PubMed1986

The spinal cord in rheumatoid arthritis with clinical myelopathy: a computed myelographic study.

Thirty one patients with suspected myelopathy due to rheumatoid arthritis were examined by plain radiography and 27 had computed myelography. Clinical features and radiological findings were compared. Deformity of the spinal cord could occur in the absence of combined anterior and posterior compression and correlated closely with clinical features only when considered in combination with skeletal and adjacent soft tissue abnormalities. The best surgical results were achieved by transoral odontoidectomy.

Adult↗
PubMed1986

Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation.

Cervical myelopathy is an uncommon but potentially fatal complication of rheumatoid atlanto-axial subluxation. Computerised myelotomography with three-dimensional reconstruction shows that rheumatoid pannus, together with the odontoid peg, contributes significantly to anterior cervico-medullary compression. These findings were the basis for treatment by transoral anterior decompression and posterior occipitocervical fusion, which removes both bony and soft-tissue causes of compression and allows early mobilisation without major external fixation. We report encouraging results from this combined approach in 14 patients who had progressive neurological deterioration.

Adult↗
PubMed1986

Radiology of orbital masses in children.

Ninety-three children (103 orbital tumours) have been examined. Typical appearances were noted in one half of the cases. Most of the optic nerve gliomas, rhabdomyosarcomas, metastatic neuroblastomas and all the dermoids were typical. The most variable appearance was seen in vascular malformations which sometimes could be confused with typical lesions of other histologic type.

Child↗
PubMed1985

Aspects of the anatomy of the cerebellum on computed tomography.

The salient features of the normal CT anatomy of the various lobules of the cerebellar hemispheres and vermis are described. The subdivisions of the vermis were found to be most constant. The surface appearance of the hemisphere lobules was also relatively constant; however, at CT these fissures are imaged at depth and this constancy is not reflected in CT images because folia cross the depths of the major sulci from one lobule to the other in a highly variable manner. The flocculus has been confused with the anterior angle of the cerebellum, and the cerebellar tonsils with the biventral lobule.

Cerebellum↗
PubMed1985

Morphology and measurements of the cervical spinal cord in computer-assisted myelography.

Thirty-six control subjects had computer assisted myelography (CAM) using the EMI CT 5005 scanner. The normal cervical cord is elliptical, more circular at the upper and lower ends and flatter in the mid-segments. Asymptomatic cord deformities, usually mild, were present in nine subjects (25%). Four measurements, namely, sagittal diameter (APD), transverse diameter (TD), area (a) and circumference (c) were made and two more parameters calculated i.e. APD/TD ratio and circularity (= 4 pi a/c2). These control values form the basis of qualitative and quantitative assessment of cord deformity. When cord measurements are to be used, control values should be obtained for each scanner and procedures should be standardized.

Adult↗
PubMed1985

Spasticity complicating metrizamide myelography.

Temporary but considerable increase in spasticity following myelography using metrizamide at 300 mgs I/ml concentration occurred in 4 patients. In 3 of the patients the diagnosis is uncertain, but it is likely to be some form of degenerative disease involving motor pathways in two of them; the fourth case has cervical spondylotic myelopathy. The spasticity might be related to the anticholinesterase activity of metrizamide or to competitive inhibition of endogenous glucose metabolism by the deoxyglucose component of the metrizamide molecule.

Female↗