Biomedical subjects
Publications and source records attributed to D W Dunn.
Peduncular hallucinations are associated with intrinsic lesions of the midbrain. We report transient peduncular hallucinations due to extrinsic compression of the midbrain by a cystic craniopharyngioma. The peduncular hallucinations resolved promptly after drainage of the cyst.
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In an effort to define the value of computed tomographic (CT) scanning in assessment of cerebral involvement in children with severe Haemophilus influenzae meningitis, we studied 12 children who had focal neurologic deficits on admission or within the early days of illness. The CT scan reliably excluded abscess and cerebritis and suggested ischemic cerebrovascular lesions in 11 of 12 children. Scans performed early in the hospital course generally showed low-density lesions occurring in a vascular distribution without detectable mass effect or enhancement. Later in the clinical course there was consistent enhancement of gray matter or diffuse enhancement in the area of the vascular lesion. The duration of symptoms of meningitis ranged from five to 21 days (mean, 13 days) and appeared to predispose to these vascular lesions. A CT scan consistent with infarction of brain parenchyma occurred predictably in patients with persistent focal neurologic deficits and was correlated with poor outcome.
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Thirty-three cases of benign paroxysmal vertigo in childhood have been seen at our institution since the disorder was recognized ten years ago. Progression from paroxysmal torticollis of infancy to paroxysmal vertigo of childhood is documented. Ear infections and allergy appeared causative in a few, but not most, of the cases. The most important consideration for the pediatrician is to rule out epilepsy and brain tumor. Parents should be reassured that the condition is benign, and that the attacks will cease in a few months or years.
The long-term care project of the Iowa Hospital Association has demonstrated the feasibility and utility of a multipurpose data system for nursing homes and related institutions. Important features of the Iowa system are emphasis on the needs and constraints of those providing care and collecting the data; prior establishment of specific criteria for the content of the system; the use of three related forms (admission, evaluation, and discharge) to produce current reports; and ease, flexibility, and transferability. A significant byproduct of the demonstration project was improved record keeping and patient care planning by the 14 participating facilities. Major problems encountered were lack of experience on the part of nursing homes and external regulatory agencies in defining their data needs and using data effectively, and financial support. Contribution to cost by external agencies in return for data and a major commitment to educational programs, both initial and continuing, are seen as essential to the success of long-term care data systems.
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Difficulties in the diagnosis of cerebral thrombosis are due to the nonspecificity of symptoms and signs and the infrequent occurrence on computed tomography (CT) of direct signs of cerebral sinus thrombosis, i.e. the empty delta sign and cord sign. We present two patients, a 2 4/12-year-old girl with nephrotic syndrome, coma, papilledema, and hyperdensity along the sagittal sinus on CT; and a 34-year-old man with headaches, episodic visual loss, papilledema and a normal CT following posterior fossa craniotomy. On MRI, there was increased signal in sagittal and straight sinuses in the first patient, and in the lateral sinus in the second patient. The increased signal from clot, and the absence of signal from flowing blood, make MRI the procedure of choice for the initial diagnosis of cerebral sinus thrombosis.
We discuss the clinical and CT features of certain metabolic brain disorders which cause specific CT abnormalities. These disorders may be divided into those which affect the gray matter, white matter or a combination of both gray and white matter regions. In metabolic disorders which affect the gray matter, there is ventricular enlargement with basal cistern and cortical sulcal space enlargement. In metabolic disorders which affect the white matter, there are symmetrical hypodensities seen throughout the white matter region.
Perinatal hypoxic-ischemic injury is an important cause of neurological deficit in infants. The hypoxic-ischemic process causes symmetrical periventricular and subcortical hypodense lesions which represent ischemic infarcts. It is important to be able to differentiate these hypodense lesions which represent ischemic infarcts from white matter which is not well myelinated. The temporal pattern of the change in the CT findings may be helpful in differentiating hypodensities due to ischemic infarct from immature myelination.
A newborn had a combination of brachial plexus palsy and phrenic nerve palsy associated with a small left arm, deformed ribs on the left, and an area of subcutaneous calcification on the left side of the neck. These lesions represent a deformation syndrome due to uterine constraint in a bicornuate uterus. Appropriate diagnosis can initiate management to avoid problems in subsequent pregnancies.
A nine-year-old girl developed a cerebellar infarct documented by computed tomography. This infarct occurred in association with a typical migrainous attack. Vertebrobasilar occlusive disease has been reported in adult migraineurs but has not been previously reported in children.
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