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Biomedical subjects

C Jungreis

Publications and source records attributed to C Jungreis.

11 recordsLinked to original sources
PubMed2003

Aneurysm rupture during endovascular coiling: effects on cerebral transit time and neurophysiologic monitoring and the benefits of early ventriculostomy: case report.

OBJECTIVE AND IMPORTANCE: We report a case of intra-operative aneurysm rupture during endovascular therapy and document the effects of rupture on cerebral transit times and neurophysiologic monitoring. The effects of early ventriculostomy are clearly documented. CLINICAL PRESENTATION: A 42-year-old man with Hunt and Hess grade 1, Fisher grade 3 subarachnoid hemorrhage secondary to a 5 mm anterior communicating artery aneurysm underwent coil embolization. INTERVENTION: Endovascular therapy was complicated by intraprocedural aneurysm rupture. Changes in cerebral transit time and electroencephalography along with somatosensory evoked potentials were documented as were improvement in these parameters following aneurysm obliteration and ventriculostomy placement. The patient awoke without deficit and was discharged 2 weeks later with a grossly normal examination. CONCLUSION: Early recognition of aneurysm rupture during coil embolization and prompt aneurysm obliteration and reduction in intracranial hypertension can lead to acceptable patient outcomes. Use of neurophysiologic monitoring in the intubated patient can help the neurosurgeon determine the need for cerebrospinal fluid drainage in such situations.

Adult↗
PubMed2001

Endovascular management of a basilar artery false aneurysm secondary to endoscopic third ventriculostomy: case report.

OBJECTIVE AND IMPORTANCE: Third ventriculostomy for the management of noncommunicating hydrocephalus is a commonly performed procedure with a 5% complication rate. One of the known complications is basilar artery injury. CLINICAL PRESENTATION: We report a case of basilar artery injury, intraventricular hemorrhage, and false aneurysm formation in a 30-month-old boy after third ventricle floor fenestration. INTERVENTION: The false aneurysm was managed with endovascular trapping by use of Guglielmi detachable coils without morbidity. CONCLUSION: Endovascular therapy can be used successfully to manage vascular injury after third ventriculostomy.

Aneurysm, False↗
PubMed1994

Management of a giant middle cerebral artery fusiform serpentine aneurysm with distal clip application and retrograde thrombosis: case report and review of the literature.

Giant fusiform aneurysms are rare vascular anomalies that due to their size are often difficult to manage. We describe one such aneurysm that was managed with a superficial temporal to middle cerebral artery bypass followed by the application of a single clip just distal to the vascular dilation. Follow-up angiography has shown aneurysm obliteration by the process of retrograde thrombosis.

Adult↗
PubMed1994

Pituitary carcinoma.

The presence of distant metastases may be asymptomatic in patients who present with symptoms and signs due to the local mass effects of an invasive pituitary adenoma. A case of pituitary carcinoma in a 54-year-old man who presented with widespread asymptomatic distant metastases 12 years after initial diagnosis is reviewed. The long course and asymptomatic metastases suggested a relatively slow-growing malignancy. The factors that played a role in the pathogenesis of the metastasis are unknown. A review of the literature on pituitary carcinoma suggests that accurate diagnosis and a multidisciplinary approach to management of such lesions emphasizing surgery, radiotherapy, and hormonal manipulation may provide these patients with the longest and best quality of survival.

Journal Article↗
PubMed1994

A method for using MR to evaluate the effects of cardiovascular disease on the brain: the cardiovascular health study.

PURPOSE: To do a pilot study for the Cardiovascular Health Study (a population-based, longitudinal study of coronary heart disease and stroke in adults 65 years of age and older designed to identify risk factors related to cerebrovascular disease, particularly stroke): (a) to determine the feasibility of adding brain MR to the full-scale study; (b) to evaluate the reliability of standardized MR image interpretation in a multicenter study; and (c) to compare the prevalence of stroke determined by MR with that by clinical history. METHODS: Protocol-defined MR studies were performed in 100 subjects with clinical histories of stroke and 203 subjects without reported histories of stroke. MR scans were independently evaluated by two trained neuroradiologists for the presence of small (< or = 3 mm) and large (> 3 mm) "infarctlike" lesions. The sizes of the cerebral sulci and lateral ventricles and the extent of white matter disease were graded on a scale of 0 to 9. RESULTS: Eighty percent of the Cardiovascular Health Study participants who were invited to undergo MR studies agreed to do so; 95% of those agreeing to the procedure successfully completed the exams. Intrareader and interreader reliability of infarctlike lesion identification was high for large lesions (kappa, 0.71 and 0.78, respectively) but not for small lesions (kappa, 0.71 and 0.32, respectively). Relaxed intrareader and interreader kappa scores for sulcal and ventricular sizes and extent of white matter disease were greater than 0.8 MR evidence of infarctlike lesions was present in 77% of the participants with histories of stroke but was also present in 23% of the participants without clinical histories of stroke. Seventy-nine percent of the infarctlike lesions were larger than 3 mm. CONCLUSIONS: This preliminary study indicates that a large, prospective, epidemiologic study of elderly subjects using MR scans of the brain for identification of cerebrovascular disease is feasible and that the interpretative results are reproducible, and suggests that MR evidence of stroke is more prevalent than reported clinical history of stroke.

Aged↗
PubMed1994

Cerebral blood flow response pattern during balloon test occlusion of the internal carotid artery.

PURPOSE: To evaluate the risk of temporary or permanent internal carotid artery occlusion. METHODS: In 156 patients intraarterial balloon test occlusion in combination with a stable xenon-enhanced CT cerebral blood flow study was performed before radiologic or surgical treatment. All 156 patients passed the clinical balloon test occlusion and underwent a xenon study in combination with a second balloon test. Quantitative flow data were analyzed for absolute changes as well as changes in symmetry. RESULTS: Fourteen patients exhibited reduced flow values between 20 and 30 mL/100 g per minute, an absolute decrease in flow, and significant asymmetry in the middle cerebral artery territory during balloon test occlusion. These patients would be considered at high risk for cerebral infarction if internal carotid artery occlusion were to be performed. With one exception they belonged to a group (class I) of 61 patients who showed bilateral or ipsilateral flow decrease and significant asymmetry with lower flow on the side of occlusion. The other 95 patients, who showed a variety of cerebral blood flow response patterns including ipsilateral or bilateral flow increase, were at moderate (class II) or low (class III) stroke risk. In contrast to these findings, exclusively qualitative flow analysis failed to identify the patients at high risk: a threshold with an asymmetry index of 10% revealed only 16% specificity whereas an asymmetry index of 45% showed only 61% sensitivity for detection of low flow areas (< 30 mL/100 g per minute). CONCLUSION: For achieving a minimal hemodynamic related-stroke rate associated with permanent clinical internal carotid artery occlusion we suggest integration of a thorough analysis of quantitative cerebral blood flow data before and during balloon test occlusion.

Adolescent↗
PubMed1991

Mapping of motor cortex gyral sites non-invasively by transcranial magnetic stimulation in normal subjects and patients.

Transcranial stimulation offers the opportunity to replace a standard clinical method of invasive brain cortical mapping. A figure '8' magnetic coil with a 1-3-cm area of stimulation is combined with a new method of creating magnetic resonance imaging (MRI) scans which represent the cortical surface (mapping cuts) and thus establishing common landmarks between the MRI and the scalp for cortical mapping. This assigns gyral sights to scalp sites of transcranial stimulation. We report the development and evaluation of these techniques in 6 normals and 10 patients. Cortical maps were shown to enlarge during voluntary contraction. They were variable between individuals, as reported for direct cortical mapping. Maps showed a degree of short and longer term consistency within an individual. The maps were influenced by lesions. They also provided clinical information of the relation of functioning cortex to brain tumors that could influence clinical management including surgical decisions. A consideration of safety of the method in comparison to direct brain stimulation indicates that it falls within existing parameters for electrical stimulation of the brain, and could reduce the risks of the present standard by lowering charge density and the need for invasive methods. Broader application could lead to development of functional imaging methods, which would be a useful preoperative planning tool and investigative method.

Action Potentials↗
PubMedDate not supplied

Hemobilia complicating transhepatic catheter drainage in liver transplant recipients: management with selective embolization.

Two liver transplantation patients are reported who experienced severe hemobilia following percutaneous placement of a transhepatic biliary drainage catheter. In both, hepatic angiography demonstrated the source of bleeding from a traumatic pseudoaneurysm of a right hepatic artery branch. Hemobilia in both patients was successfully treated using selective embolization techniques. Follow-up computed tomography of the liver showed no evidence of allograft necrosis or abscess formation. One patient developed an intrahepatic biliary stricture adjacent to the embolized branch artery nine months following the procedure. Hepatic artery embolization techniques are effective in the treatment of life-threatening hemobilia posttransplantation.

Aneurysm↗