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D H Unwin

Publications and source records attributed to D H Unwin.

9 recordsLinked to original sources
PubMed2001

Quantitative cerebral blood flow imaging in a patient with the Heidenhain variant of Creutzfeldt-Jakob disease.

PURPOSE: This report describes quantitative SPECT cerebral blood flow (CBF) changes in a patient with the confirmed Heidenhain variant of Creutzfeldt-Jakob disease. MATERIALS AND METHODS: A 60-year-old man reported visual disturbances, including left hemianopsia. An electroencephalogram, magnetic resonance imaging, cerebral arteriogram, and quantitative SPECT CBF imaging with Xe-133, with and without acetazolamide, were performed. After the patient's death, an autopsy was performed. RESULTS: The electroencephalographic findings were nonspecific, those of magnetic resonance imaging were normal, and the cerebral arteriogram showed minimal atherosclerosis. However, the SPECT scan revealed marked depression of perfusion in the parietal and occipital cortices that did not change with the administration of acetazolamide. Autopsy results were consistent with CJD. CONCLUSIONS: Although there is no consistent pattern of CBF changes that is characteristic of Creutzfeldt-Jakob disease, the Heidenhain variant of that disease may be an exception. Clinical symptoms include profound changes in vision, and the pattern of CBF changes in the patient described here included depression of perfusion in areas of primary and associated visual cortex. Also of interest is the finding that although other imaging did not reveal an abnormality, the CBF changes were marked. In addition, vasoreactivity is poor in response to acetazolamide, a finding that occurs only late in other neuronal degenerative conditions such as Alzheimer's disease.

Acetazolamide↗
PubMed2001

A double-blind, placebo-controlled study of the use of amphetamine in the treatment of aphasia.

BACKGROUND AND PURPOSE: A number of studies suggest that drugs which increase the release of norepinephrine promote recovery when administered late (days to weeks) after brain injury in animals. A small number of clinical studies have investigated the effects of the noradrenergic agonist dextroamphetamine in patients recovering from motor deficits following stroke. To determine whether these findings extend to communication deficits subsequent to stroke, we administered dextroamphetamine, paired with speech/language therapy, to patients with aphasia. METHODS: In a prospective, double-blind study, 21 aphasic patients with an acute nonhemorrhagic infarction were randomly assigned to receive either 10 mg dextroamphetamine or a placebo. Patients were entered between days 16 and 45 after onset and were treated on a 3-day/4-day schedule for 10 sessions. Thirty minutes after drug/placebo administration, subjects received a 1-hour session of speech/language therapy. The Porch Index of Communicative Ability was used at baseline, at 1 week off the drug, and at 6 months after onset as the dependent language measure. RESULTS: Although there were no differences between the drug and placebo groups before treatment (P=0.807), by 1 week after the 10 drug treatments ended there was a significant difference in gain scores between the groups (P=0.0153), with the greater gain in the dextroamphetamine group. The difference was still significant when corrected for initial aphasia severity and age. At the 6-month follow-up, the difference in gain scores between the groups had increased; however, the difference was not significant (P=0.0482) after correction for multiple comparisons. CONCLUSIONS: Administration of dextroamphetamine paired with 10 1-hour sessions of speech/language therapy facilitated recovery from aphasia in a small group of patients in the subacute period after stroke. Neuromodulation with dextroamphetamine, and perhaps other drugs that increase central nervous system noradrenaline levels, may facilitate recovery when paired with focused behavioral treatment.

Adrenergic Uptake Inhibitors↗
PubMed2001

Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis.

BACKGROUND AND PURPOSE: We sought to compare the safety and efficacy of direct urokinase thrombolysis with systemic heparin anticoagulation for superior sagittal sinus thrombosis (SSST). METHODS: At University at Buffalo (NY) and University of Texas (Dallas, Houston), we reviewed 40 consecutive patients with SSST, treated with local urokinase (thrombolysis group) or systemic heparin anticoagulation (heparin group). The thrombolysis group (n=20) received local urokinase into the SSS followed by systemic heparin anticoagulation. The heparin group (n=20) received systemic heparin anticoagulation only. Neurological dysfunction was rated as follows: 0, normal; 1, mild (but able to ambulate and communicate); 2, moderate (unable to ambulate, normal mentation); and 3, severe (unable to ambulate, altered mentation). RESULTS: Age (P=0.49), sex (P=0.20), baseline venous infarction (P=0.73), and predisposing illnesses (P=0.52) were similar between the thrombolysis and heparin groups. Pretreatment neurological function was worse in the thrombolysis group (normal, n=5; mild, n=8; moderate, n=4; severe, n=3) than in the heparin group (normal, n=8; mild, n=8; moderate, n=3; severe, n=1) (P=NS). Discharge neurological function was better in the thrombolysis group (normal, n=16; mild, n=3; moderate, n=1; severe, n=0) than in the heparin group (normal, n=9; mild, n=6; moderate, n=5; severe, n=0) (P=0.019, Mann-Whitney U test). Hemorrhagic complications were 10% (n=2) in the thrombolysis group (subdural hematoma, retroperitoneal hemorrhage) and none in the heparin group (P=0.49). Three of the heparin group patients developed complications of the underlying disease (status epilepticus, hydrocephalus, refractory papilledema). No deaths occurred. Length of hospital stay was similar between the groups (P=0.79). CONCLUSIONS: Local thrombolysis with urokinase is fairly well tolerated and may be more effective than systemic heparin anticoagulation alone in treating SSST. A randomized, prospective study comparing these 2 treatments for SSST is warranted.

Adult↗
PubMed1996

Response of primary leptomeningeal melanoma to intrathecal recombinant interleukin-2. A case report.

BACKGROUND: Primary leptomeningeal melanomas are rare tumors that originate in the leptomeninges and are associated with a poor prognosis and no response to radiation and chemotherapy. These tumors rarely metastasize outside the central nervous system. Recombinant interleukin-2-(rIL-2) is a cytokine that activates natural killer cells and lymphokine-activated killer cells, augments their antitumor effects, and recruits and activates cytotoxic T lymphocytes. We have hypothesized that rIL-2 may prolong disease free survival in a patient with primary leptomeningeal melanoma. METHODS: The patient was treated with intrathecal rIL-2 via lumbar puncture daily for 5 days, the weekly for 5 weeks. To investigate whether rIL-2 induced a favorable clinical response, the following parameters were monitored: survival, neurologic status, cerebrospinal fluid (CSF) analysis, visual fields, and magnetic resonance imaging (MRI) of the lumbosacral spine. RESULTS: The patient is still alive and disease free 15 months after receiving rIL-2, and his neurologic status remains unchanged. The CFS glucose concentration, undetectable prior to therapy, has become normal. Repeated cytologic examinations of CSF were negative for malignant cells. The visual field examinations have remained unchanged. MRI scans of the lumbosacral spine have shown the development of arachnoiditis, but no recurrence of the mass lesion. CONCLUSIONS: The tumor response in this patient, as measured by remarkable disease free survival and normalization of the CSF glucose concentration, illustrates the potential benefits of intrathecal rIL-2 in the treatment of patients with this otherwise rapidly fatal disease.

Animals↗
PubMed1993

Prophylactic drug therapy in cerebrovascular disease.

Aspirin in doses of 325 mg to 1,300 mg per day is the drug of choice for prophylactic therapy in cerebrovascular disease. Ticlopidine, a platelet antagonist, is available for use in patients who cannot tolerate aspirin or who have not had success with aspirin therapy. Although ticlopidine is more effective than aspirin in preventing stroke, its use may be somewhat limited due to cost and the uncommon but serious side effect of neutropenia. Low-dose warfarin remains the drug of choice for the prevention of cardioembolic stroke. The role of warfarin in ischemic cerebrovascular disease is unknown.

Aspirin↗
PubMed1992

Management controversy. Medical versus surgical therapy for spontaneous intracerebral hemorrhage.

The controversy surrounding the management of intracranial hemorrhage seems to have been quieted by a large group of recent studies. Future efforts must focus on expansion of the current population screening projects for early detection of hypertension. Whereas some potential exists for new innovative surgical techniques to offer some benefit, it should be kept in mind that most of these patients suffer from end-stage cardiovascular, cerebrovascular, and peripheral vascular disease.

Cerebral Hemorrhage↗
PubMed1991

Central nervous system monitoring. What helps, what does not.

The ICU monitoring of CNS function can make a difference in the clinical outcome. No single technique addresses the multiple issues that arise in the ICU setting, especially for the polytrauma patient. Multimodality approaches combining assessment of cerebral blood flow, electrophysiologic parameters, and intracranial pressure, when appropriate, with cardiac and respiratory monitors are being developed at a number of traumatology centers world wide. Experience needs to be gained to establish the best combination of these modalities. Pending this, selected use of intracranial pressure monitoring combined with EEG and transcranial Doppler ultrasound provides reliable immediate assessment and ongoing monitoring of CNS structures.

Arterial Occlusive Diseases↗