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Biomedical subjects

E C Raps

Publications and source records attributed to E C Raps.

At least 37 records · Page 2Linked to original sources
PubMed1997

Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage.

Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is correlated with the thickness of blood within the basal cisterns on the initial computerized tomography (CT) scan. To identify additional risk factors for symptomatic vasospasm, the authors performed a prospective analysis of 75 consecutively admitted patients who were treated for aneurysmal SAH. Five patients who died before treatment or were comatose postoperatively were excluded from the study. Of the remaining 70 patients, demographic (age, gender, and race) and clinical (hypertension, diabetes, coronary artery disease, smoking, alcohol abuse, illicit drug use, sentinel headache, Fisher grade, Hunt and Hess grade, World Federation of Neurological Surgeons grade, and ruptured aneurysm location) parameters were evaluated using multivariate logistic regression to determine factors independently associated with cerebral vasospasm. All patients were treated with hypervolemic therapy and administration of nimodipine as prophylaxis for vasospasm. Cerebral vasospasm was suspected in cases that exhibited (by elevation of transcranial Doppler velocities) neurological deterioration 3 to 14 days after SAH with no other explanation and was confirmed either by clinical improvement in response to induced hypertension or by cerebral angiography. The mean age of the patients was 50 years. Sixty-three percent of the patients were women, 74% were white, 64% were cigarette smokers, and 46% were hypertensive. Ten percent of the patients suffered from alcohol abuse, 19% from sentinel bleed, and 49% had a Fisher Grade 3 SAH. Twenty-nine percent of the patients developed symptomatic vasospasm. Multivariate analysis demonstrated that cigarette smoking (p = 0.033; odds ratio 4.7, 95% confidence interval [CI] 2.4-8.9) and Fisher Grade 3, that is, thick subarachnoid clot (p = 0.008; odds ratio 5.1, 95% CI 2-13.1), were independent predictors of symptomatic vasospasm. The authors make the novel observation that cigarette smoking increases the risk of symptomatic vasospasm after aneurysmal SAH, independent of Fisher grade.

Adolescent↗
PubMed1997

Clinical evaluation and management of aneurysmal subarachnoid hemorrhage.

As neuroradiologic techniques become more critical to the care of patients suffering from aneurysmal subarachnoid hemorrhage, a thorough understanding of the natural history and medical management of this disorder by neuroradiologists is required to insure appropriate diagnosis and therapy. This article addresses the medical and perioperative management of subarachnoid hemorrhage, with an emphasis on features relevant to neuroradiologic diagnosis and treatment.

Aneurysm, Ruptured↗
PubMed1996

Severe sudden visual loss caused by pseudotumor cerebri and lumboperitoneal shunt failure.

PURPOSE: Severe vistral acuity loss associated with pseudotumor cerebri is usually caused by chronic optic disk edema or a retinal abnormality. METHODS: We treated a women, with known pseudotumor cerebri treated with a lumboperitoneal shunt, who developed acute pallied optic disk swelling and visual acuity of R.E.: no light perception and L.E.: 20/70 in association with lumboperitoneal shunt failure. There were no contributory retinal lesions. RESULTS: The patient underwent optic nerve sheath fenestration and lumboperitoneal shunt revision. Visual acuity improved to 20/20 in both eyes. The papilledema resolved. CONCLUSION: The severe sudden visual loss was attributed to axoplasmic stasis and optic nerve ischemia associated with a sudden rise in intracranial pressure.

Adult↗
PubMed1996

Muscle is electrically inexcitable in acute quadriplegic myopathy.

We directly stimulated muscle in three patients with acute quadriplegic myopathy to determine whether paralyzed muscle in this syndrome is electrically excitable. Two of the patients had been treated with neuromuscular blocking agents and corticosteroids, and one patient had been treated with corticosteroids alone. We found that paralyzed muscle is electrically inexcitable in affected patients. Muscle regained electrical excitability over weeks to months. The recovery of muscle excitability paralleled the clinical recovery of patients, suggesting that paralysis in this syndrome is secondary to electrical inexcitability of muscle membrane.

Acute Disease↗
PubMed1996

Central neurogenic hyperventilation in an awake patient with a pontine glioma.

A 57-year-old awake man developed central neurogenic hyperventilation associated with a pontine mass. Serum pH reached as high as 7.72 with serum carbon dioxide of 6 torr. Examination of CSF during overbreathing showed that CSF pH was markedly alkaline. Pathologic study showed a well-differentiated pontine astrocytoma. The combination of alkaline CSF and an infiltrating pontine lesion supports a structural, rather than chemical, mechanism for central hyperventilation.

Astrocytoma↗
PubMed1996

Eyelid lag without eyelid retraction in pretectal disease.

We report a patient with pretectal eyelid lag without retraction. MRI showed high signal abnormality dorsal to the right red nucleus in a region thought responsible for premotor eyelid control. The dissociation of eyelid lag from eyelid retraction in this patient would suggest that these lid signs may have separate neural mechanisms or pathways. We propose that the lesion interrupts inhibitory connections between the vertical gaze center and the central caudal nucleus.

Adult↗
PubMed1996

Clinicopathologic study of paraneoplastic brainstem encephalitis and ophthalmoparesis.

We report three patients who exhibited ophthalmoparesis as an early manifestation of progressive paraneoplastic brainstem encephalitis. In two patients, anti-Hu antibodies were detected, whereas in a third, found at postmortem to have thyroid cancer, no antibodies were identified. Postmortem examination of two patients disclosed extensive gliosis, perivascular inflammation, and cell loss in the midbrain and pontine tegmentum. In one of these patients, there was selective neuronal loss within the third, fourth, and sixth nerve nuclei. We conclude that supranuclear or nuclear ophthalmoparesis may be the initial manifestation of paraneoplastic brainstem encephalitis. Our pathologic data suggest that the ophthalmoparesis may result from selective neuronal death within the brainstem tegmentum and ocular motor nuclei.

Brain Stem↗
PubMed1995

Core temperature control in the management of CNS lesions.

Renewed interest in the regulation of core temperature as a means of treating central nervous system disease has been fueled by a wealth of literature describing the physiology of lowered core temperature. Hypothermia is now recognized for its anesthetic and cerebroprotective effects and is being applied in an increasing number of clinical paradigms.

Body Temperature↗
PubMed1995

Spinal dural arteriovenous fistula: the pathology of venous hypertensive myelopathy.

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal vascular malformation. The arteriovenous shunts, located entirely outside the spinal cord, cause a clinical picture of chronic progressive myelopathy believed to arise from the effects of increased venous pressure and impaired venous drainage on the spinal cord. Despite their well-described clinical and angiographic features, no reports have documented the spinal cord pathology in a case of angiographically or pathologically proven SDAVF. We report such a patient in whom a spinal cord biopsy supported increased venous pressure as a mechanism of neurologic dysfunction.

Aged↗
PubMed1995

Critical neurologic illness in the immunocompromised patient.

Immunocompromised patients are vulnerable to a host of neurologic problems that may complicate their clinical course and necessitate intensive care. Atypical and opportunistic infections represent the primary concern in such patients and can cause a variety of neurologic complications. In addition, these patients are susceptible to neurologic dysfunction induced by drugs or underlying disease states. This article emphasizes the diagnostic approach to selected clinical syndromes in the immunocompromised patient, such as encephalopathy, seizures, and stroke.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Stroke prevention therapies and management of patient subgroups.

Stroke is the third leading cause of death in the United States. Efforts directed at reversing acute cerebral ischemia are promising but are hampered by multiple logistic and physiologic barriers. Prevention of stroke, therefore, remains of critical importance. Primary prevention is accomplished through reduction of risk factors and the appropriate use of warfarin or aspirin in patients with cardiac sources of emboli such as atrial fibrillation. Secondary prevention is designed to reduce the risk of stroke in patients with known stroke precursors, including transient ischemia, reversible ischemic deficits, and completed stroke. Aspirin and ticlopidine are two antiplatelet agents with an established role in secondary stroke prevention. In a major North American clinical trial, ticlopidine demonstrated superior efficacy to aspirin for the prevention of recurrent stroke, particularly in the first year following a stroke. Dipyridamole has not been shown to be useful for stroke prevention. The role of warfarin in the prevention of recurrent noncardiogenic stroke remains controversial and is currently under investigation. Stroke prevention remains an important challenge, and therapy should be individualized to achieve optimal results.

Cerebrovascular Disorders↗
PubMed1994

Cyclodeviation in skew deviation.

We examined four patients with dorsolateral pontomedullary lesions and skew deviation, with ocular torsion of varying symmetry. In three patients, the hypotropic eye was excyclodeviated relative to the fellow eye. Observations of these patients, combined with recent evidence, suggest that cyclodeviation is a frequent component of skew deviation and may result from variable involvement of utricular, semicircular canal, and cerebelloocular pathways. Although cyclodeviation is a feature of trochlear-nerve palsies, its presence does not exclude skew deviation and underlying brainstem lesions.

Adult↗
PubMed1994

Intensive care neurology.

Critical care neurology is a rapidly developing subspecialty of neurology. The neuro-intensivist is called upon to manage critically ill patients with stroke, neuromuscular disease, traumatic injury, increased intracranial pressure, and other disorders. Therapeutic and technologic advances are rapidly being incorporated into practice and will improve patient care and outcome.

Brain Diseases↗