Biomedical subjects
D F Cohn
Publications and source records attributed to D F Cohn.
MRI demonstration and CT correlation of the brain in patients with idiopathic intracerebral calcification.
Twenty-two patients aged 36-63 years were diagnosed as having Fahr's syndrome on the basis of the presence on CT of unexpected extensive calcification of the basal ganglia. Even when associated with calcification of other brain areas, the main diagnostic criterion remained basal ganglia calcification larger than 800 mm2. Normal values of parathormone, serum calcium and phosphorus excluded hypercalcaemia and hypoparathyroidism. Mitochondrial CNS disease was excluded clinically. MRI and repeated CT and neurological examination were performed in all of the patients. The patients were divided into two groups: neurologically asymptomatic (group 1) and neurologically symptomatic (group 2). T2-weighted sequences demonstrated hyperintense areas in all of the patients involving the white and the grey matter of the brain. In group 1 the hyperintense lesions were significantly smaller than in group 2. The neurological symptoms correlated better with the hyperintensities on T2-weighted MR images than with the calcification demonstrated on CT. Hyperintensities in T2-weighted MRI and the areas shown by CT to have calcification had different locations. In 15 patients with dementia, the white matter of the entire centrum semiovale was bilaterally hyperintense. In another 3 patients with hemiparesis, hyperintense areas in the internal capsule, contralateral to the side of hemiparesis, were demonstrated in the T2-weighted sequence. The hyperintense T2 signals may reflect a slowly progressive, metabolic or inflammatory process in the brain which subsequently calcifies and are probably responsible for the neurological deficit observed.
Stress and epilepsy: the Gulf war experience.
Stress is commonly believed to precipitate seizures in some patients with epilepsy, but direct examination of this assumption is problematic because of the difficulty in defining vague factors such as 'emotional stress'. Using a questionnaire, we have recorded seizure frequency during the 1991 Persian Gulf war, when Israelis were under stress from the threat of Scud missile attacks, in 100 consecutive adult patients with epilepsy. Increased frequency of seizures was reported by eight patients. These were younger than the other patients, the majority showed generalized epileptic EEG activity and all had generalized seizures (secondarily generalized in four). Only four had seizures directly related to the sounding of an alarm and in the others, non-compliance, being off medication at the time and disturbed sleep were probable contributory factors. We conclude that, in this series, epilepsy control was only weakly affected by an acute external emotional stress factor.
Semen parameters among epileptic males treated with carbamazepine.
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Electrophysiologic features in patients with chronic neurolathyrism.
Neurolathyrism is a toxic nutritional disorder induced by the ingestion of the chick-pea "lathyrus sativus" and characterized by a pure motor spastic paraparesis. Eight patients with long-standing disease underwent nerve conduction and electromyographic studies. Two of them (25%) showed electrophysiological signs of lower motor neuron disease in their lower limbs. Subclinical affection of the anterior horn cells occurs probably more frequently than expected in chronic neurolathyrism.
Magnetic resonance imaging in patients with progressive myelopathy following spinal surgery.
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Epilepsy in patients with brain metastases triggered by intravenous contrast medium.
187 patients with histologically proven primary neoplasms underwent computed tomography (CT) of the brain following intravenous administration of contrast medium. Eight developed focal epileptic seizures 2 to 4 minutes after the start of the injection. In three of these patients, in whom there was CT evidence of bilateral mass lesions of the brain, this epileptic activity became generalised into grand mal seizures, and two died in status epilepticus. In the other five patients with unilateral deposits in the brain, the focal fits corresponded to the site of the lesion shown by CT. Three of the patients had follow-up electroencephalography (EEG) examinations which showed unilateral focal activity, and their EEG foci correlated with the CT findings.
Magnetic resonance imaging in patients with progressive myelopathy following spinal surgery.
Thirty one patients with insidious progressive myelopathy 2 to 8 years following surgery of the cervical spine were subjected to magnetic resonance imaging (MRI). In 15 patients operated on for vascular malformations or intramedullary tumours, syringomyelia and cystic lesions of the spinal cord were shown. Seven of these patients also showed a combination of a recurrent tumour and spinal atrophy. Out of 16 patients who had surgery for herniated disc or spinal stenosis of the cervical spine, four had syringomyelia and 12 had spinal cord atrophy. There was no syringomyelia in the 12 patients submitted to MRI prior to surgery.
Generalized epileptic seizures as the presenting symptom of lacunar infarction in the brain.
Five elderly hypertensive patients presented with grand mal seizures and had computed tomographic (CT) findings consistent with lacunar infarction. Three of them had also a recent hemiparesis, contralateral to the side of the CT findings. Follow-up CT scans supported the diagnosis of lacunar infarction. Contrary to the accepted opinion, generalized epileptic seizures may be the presenting symptom of lacunar brain infarction.
Magnetic resonance imaging (MRI) in patients with complex partial seizures and normal computerized tomography (CT) scan.
Magnetic resonance imaging (MRI) examination was performed in 18 patients with complex partial seizures (CPS) of long duration, who had normal computerized tomographic (CT) scans of the brain. Small MRI abnormalities correlating with the location of the epileptogenic focus in the EEG were demonstrated in 4 cases. The findings with strong signals were better demonstrated in the coronal view with longer time to echo (TE). In one patient, a lower signal lesion was documented, which was better visualized in the axial view with shorter TE. Patients with CPS should be subjected to MRI examinations with coronal and sagittal planes, using short and long TE in each slice. This method minimizes the chance for missing pathology.
Focal epileptic activity following intravenous contrast material injection in patients with metastatic brain disease.
Four patients with metastatic brain disease were referred for computed tomographic (CT) examination with contrast material injection. Within 2 to 4 minutes after the intravenous administration of water soluble contrast agent, focal epileptic activity occurred. The seizures became generalised in two of the patients who later died following status epilepticus. In the other two patients the focal seizures correlated with the localisation of the metastatic mass lesions. None of the patients had a previous history of epilepsy.
Magnetic resonance imaging of syringomyelia occurring after operation on spinal intramedullary tumors by Cavitron ultrasonic aspirator.
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[Near-drowning and epilepsy during swimming].
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[Computerized tomography in epilepsy].
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Computerized tomography, clinical and X-ray correlations in the hemisacralized fifth lumbar vertebra.
One hundred and twenty patients with hemisacralization of the L5 vertebra associated with LBP underwent clinical, conventional X-ray and CT examinations. More than 50% of the patients had scoliosis. One third of the patients had disc lesions. Sacroiliac joint sclerosis was noted in two thirds of the cases. Almost all patients had an articulation between the hemisacralized side of L5 and the sacrum, which usually showed degenerative changes. Clinical symptoms are correlated to the CT and X-ray findings.
Sphenoidal EEG recording in complex partial seizures.
A prospective study was performed to evaluate the usefulness of sphenoidal EEG recording during wakefulness, as compared to routine tracings awake and asleep, for recognizing epileptic electroencephalographic foci in patients with complex partial seizures. Fifty patients were investigated. Following sleep deprivation a routine waking EEG, a sleep tracing and an awake recording with sphenoidal needles were obtained. In nine patients temporal epileptiform activity was apparent in all three conditions (wakefulness, sleep and with sphenoidal electrodes). In 21 patients temporal epileptiform activity was seen during sleep only, while the sphenoidal leads were non-contributory. In 20 patients epileptiform activity was not recorded under any of the above conditions. This study indicates that sphenoidal recording during wakefulness does not contribute to the detection of epileptic discharges in patients with complex partial seizures.
Computerized tomographic demonstration of intraorbital bone fragments caused by penetrating trauma.
Three patients with fragments of bones lodged in the orbit from apparently non-penetrating trauma, associated with cranio-cerebral injury, are reported. In all three cases the initial symptoms and signs of intraorbital or retrobulbar injury were minimal. The bone fragments were not demonstrable on plain x-ray films of the skull but were clearly shown on computerized tomographic (CT) scans of the orbit. They could easily have been overlooked had reliance been placed on plain x-ray films alone. In patients with suspected non-penetrating orbital trauma, axial and coronal CT views of the orbit are recommended.