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E Kirsch

Publications and source records attributed to E Kirsch.

At least 19 recordsLinked to original sources
PubMed2005

Dynamics of Saturn's magnetosphere from MIMI during Cassini's orbital insertion.

The Magnetospheric Imaging Instrument (MIMI) onboard the Cassini spacecraft observed the saturnian magnetosphere from January 2004 until Saturn orbit insertion (SOI) on 1 July 2004. The MIMI sensors observed frequent energetic particle activity in interplanetary space for several months before SOI. When the imaging sensor was switched to its energetic neutral atom (ENA) operating mode on 20 February 2004, at approximately 10(3) times Saturn's radius RS (0.43 astronomical units), a weak but persistent signal was observed from the magnetosphere. About 10 days before SOI, the magnetosphere exhibited a day-night asymmetry that varied with an approximately 11-hour periodicity. Once Cassini entered the magnetosphere, in situ measurements showed high concentrations of H+, H2+, O+, OH+, and H2O+ and low concentrations of N+. The radial dependence of ion intensity profiles implies neutral gas densities sufficient to produce high loss rates of trapped ions from the middle and inner magnetosphere. ENA imaging has revealed a radiation belt that resides inward of the D ring and is probably the result of double charge exchange between the main radiation belt and the upper layers of Saturn's exosphere.

Atmosphere↗
PubMed2003

Migraine and asthma in childhood: evidence for specific asymmetric parent-child interactions in migraine and asthma families.

In spite of the fact that migraine often manifests as a familial disorder, the role of the family in migraine has not been adequately explored. In this study parent-child interactions in 20 families with a child suffering from migraine were analysed and compared with 20 healthy families and 20 families with an asthma child. The families had to solve a puzzle within a limited time. Parent-child interactions within migraine and asthma families were asymmetric, revealing a disease-specific interpersonal context in the family. Communication with the affected child in migraine families was significantly more directive, with more specific instructions and less help, towards migraineurs than with the healthy siblings. Dominance of parents and submissive behaviour of children were the main features of interactions. In asthma families interactions were more conflicting and less cooperative. This study demonstrated a specific, asymmetric, pattern of family interactions predisposing children either to migraine or asthma.

Adolescent↗
PubMed2001

Coagulopathy induced spinal intradural extramedullary haematoma: report of three cases and review of the literature.

In a retrospective review of patients operated for coagulopathy induced spinal intradural-extramedullary haematoma the literature regarding coagulopathy induced spinal haemorrhage is reviewed and the etiology of these rare spinal subdural and subarachnoid haemorrhages is discussed. Spinal intradural haematomas are usually related to trauma or a previous lumbar puncture. A review of the literature revealed only a handful cases of spinal intradural haemorrhages occurring secondary to an underlying haematological disorder or an iatrogenic coagulopathy. Coagulopathy induced spinal haemorrhage should be included in the differential diagnosis of acute paraparesis in patients with co-existent haematological disorders or undergoing anticoagulation therapy. Due to the often mixed subdural and subarachnoid bleeding patterns we have termed this entity spinal intradural-extramedullary haematoma.

Adult↗
PubMed2000

Slow cortical potentials in migraine families.

Amplitude and habituation of event-related potentials are abnormal in migraine. We investigated 43 migraine and 41 healthy families to evaluate the influences of age, sex and familial contribution on the variance of amplitude and habituation of the contingent negative variation (CNV). Analysis of individual differences in relation to the CNV habituation was performed. The study demonstrated that habituation of the early CNV component characterizes migraine considerably better than the CNV amplitudes. Habituation, however, is strongly influenced by age. Migraine adults and children generally showed reduced habituation. Surprisingly, more than 30% of the healthy adults demonstrated a marked loss of habituation. The reduced CNV habituation represented a high sensitivity but low specificity to migraine, especially in children. CNV amplitude and habituation parameters revealed a considerable familial contribution associated with migraine. No familial influence on either morphology or habituation of the CNV in healthy families or between healthy members of migraine families was observed. The low specificity and familial transmission of CNV parameters in members of migraine families suggest that increased amplitudes and reduced habituation of CNV do not constitute a primary risk factor for migraine, but rather represent a predisposition. Genetic components probably affect variation of the CNV amplitude and habituation.

Adolescent↗
PubMed2000

Moyamoya disease.

Explore the source record for details and available documents.

Angiography, Digital Subtraction↗
PubMed2000

Ganglioglioma of the optic chiasm: case report and review of the literature.

We report a case of a hypothalamic chiasmatic ganglioglioma in a 21-year-old woman who presented with hyperprolactinemia and developed visual field defects. This circumscribed cystic lesion with an enhancing mural nodule was radiologically indistinguishable from a pilocytic astrocytoma. Although rare, gangliogliomas should be included in the differential diagnosis of lesions occurring in this area of the brain.

Adult↗
PubMed1999

Cerebral veins: comparative study of CT venography with intraarterial digital subtraction angiography.

BACKGROUND AND PURPOSE: Our objective was to compare the reliability of CT venography with intraarterial digital subtraction angiography (DSA) in imaging cerebral venous anatomy and pathology. METHODS: In 25 consecutive patients, 426 venous structures were determined as present, partially present, or absent by three observers evaluating CT multiplanar reformatted (MPR) and maximum intensity projection (MIP) images. These results were compared with the results from intraarterial DSA and, in a second step, with the results of an intraobserver consensus. In addition, pathologic conditions were described. RESULTS: Using DSA as the standard of reference, MPR images had an overall sensitivity of 95% (specificity, 19%) and MIP images a sensitivity of 80% (specificity, 44%) in depicting the cerebral venous anatomy. On the basis of an intraobserver consensus including DSA, MPR, and MIP images (415 vessels present), the sensitivity/specificity was 95%/91% for MPR, 90%/100% for DSA, and 79%/91% for MIP images. MPR images were superior to DSA images in showing the cavernous sinus, the inferior sagittal sinus, and the basal vein of Rosenthal. Venous occlusive diseases were correctly recognized on both MPR and MIP images. Only DSA images provided reliable information of invasion of a sinus by an adjacent meningioma. CONCLUSION: CT venography proved to be a reliable method to depict the cerebral venous structures. MPR images were superior to MIP images.

Adult↗
PubMed1998

MR angiography in internal carotid artery dissection: improvement of diagnosis by selective demonstration of the intramural haematoma.

We studied eight consecutive patients with clinical and intra-arterial angiographic (DSA) diagnosis of internal carotid artery (ICA) dissection to analyse the accuracy of MRA in dissections, using a new technique with presaturation pulses. Spin-echo images of the head were followed by three-dimensional time-of-flight (TOF) MRA at the site of the dissection, with and without a special caudal saturation pulse in addition to the cranial one. The accuracy of MRA was assessed in 64 segments of 16 ICA, all examined with DSA and MRA. High-signal intramural haematoma in the ICA at the level of the dissection was observed in all patients either on the maximal-intensity projection (MIP) reconstructions or on the partitions with this presaturation pulse technique. MRA had a sensitivity to detect dissected vessels of 100%. Specificity for vessels correctly identified as not having a lesion was also 100%. There was good correlation between DSA and MRA in demonstrating the site of the dissected ICA segment and the degree of stenosis. In only two cases was there overestimation of the degree of stenosis on the MIP reconstructions of the 3-D MRA.

Adult↗
PubMed1998

Diameter of the common bile duct in the elderly patient: measurement by ultrasound.

We wanted to assess the width of the common bile duct (CBD) in an asymptomatic elderly (> 75 years) population, since no previous report has particularly considered the important age-related increase in CBD diameter for this patient group. CBD width of 92 asymptomatic people over 75 years of age (mean 84.7 years, range 75-96 years) without clinical or laboratory evidence for biliary, hepatocellular or pancreatic disease was measured by real-time high-resolution ultrasound of the upper abdomen. All examinations were performed by one experienced radiologist. Mean values were calculated for three groups: patients with and without cholecystolithiasis and after cholecystectomy. Statistical analysis was carried out by analysis of variance. Considering the measurements of all patients, the mean width (+/- SD) of the CBD was calculated as 6.5 +/- 2.5 mm. The difference between patients without cholecystolithiasis (6.2 +/- 2.3 mm) and patients after cholecystectomy (8.7 +/- 2.9 mm) was statistically significant (P < 0.0001). Cholecystolithiasis (6.0 +/- 1.6 mm) proves not to be an additional factor for CBD widening in comparison with patients without stone disease. The CBD of these very elderly subjects shows a considerable increase in comparison with the recommended borderline values in the ultrasound literature. An upper limit of 10 mm seems reasonable for patients with and without cholecystolithiasis. A significant increase in CBD width after cholecystectomy was found and measurements up to 14 mm may occur. Measurements have to be correlated with clinical and laboratory findings.

Aged↗
PubMed1998

Prostate-specific antigen in the cerebrospinal fluid leads to diagnosis of solitary cauda equina metastasis: a unique case report and review of the literature.

A 79-year-old male patient presented with a subacute cauda syndrome caused by an intradural metastasis of the lumbosacral caudate fibres from an adenocarcinoma of the prostate, which had been treated 5 years earlier with external beam radiation therapy. Diagnosis could not be established by repeated magnetic resonance images (MRIs) during a 2-year period of increasingly severe radicular pain. Eventually, a small tumour mass could be visualized on the fourth MRI. Repeated normal serum prostate-specific antigen (PSA) did not hint at a prostate cancer metastasis (range 2.4-5.1 ng ml(-1)); however, PSA in the cerebrospinal fluid was found to be elevated (29.1 ng ml(-1)). Empirical radiation therapy of the caudate region did not improve radicular pain. Therefore, an exploratory surgical procedure was conducted, which confirmed the suspicion of an intradural prostate cancer metastasis. In conclusion, PSA in the cerebrospinal fluid provides a useful diagnostic tool for detecting intradural prostate cancer metastasis.

Adenocarcinoma↗
PubMed1998

Symptomatic granular cell tumor of the pituitary gland: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: The posterior pituitary lobe is rarely the site of symptomatic primary tumors. The most common lesions arising from the neurohypophysis and the pituitary stalk seem to be granular cell tumors (GCTs), of which only 42 symptomatic cases have been reported. Here we present an unusually well-documented case of a GCT, which has implications for the differential diagnosis of sellar masses. CLINICAL PRESENTATION: A 75-year-old woman presented with decreased visual acuity, visual field loss, and a 2-year history of progressive vertigo and headaches. Neuroradiological studies showed a supra- and intrasellar, 25 x 20-mm mass, containing calcifications, that compressed the optic chiasm and extended into the third ventricle. INTERVENTION: The tumor was subtotally resected through a transsphenoidal approach. The tumor was tough and vascular and could not be suctioned. Histological examination revealed a typical GCT. The postoperative course was uneventful. Residual tumor was treated with fractionated radiation therapy. Ophthalmological testing 10 months after surgery showed a slight improvement in the visual symptoms. CONCLUSION: Tumor calcifications in computed tomographic scans do not exclude a GCT. The diagnosis requires histological confirmation. Surgical removal by the transsphenoidal approach is the therapy of choice, as for other sellar tumors. Radiation therapy may be advisable after subtotal resection. Our literature review suggests the possibility of gender-related tumor biology in GCTs.

Aged↗
PubMed1997

[Bilateral glomus tumors with a blood pressure regulation disorder due to baroreceptor dysfunction].

HISTORY AND CLINICAL FINDINGS: A 73-year-old woman was admitted because of vertigo of recent onset with a tendency to fall down and progressive hearing impairment with tinnitus over the last 2 years. Neurological examination also revealed right recurrent nerve paresis, facial hemispasm and lingual atrophy, pointing to a lesion involving cranial nerves VII, VIII, IX, X and XII. She was found to have spontaneous nystagmus to the left, due to peripheral vestibular function deficit, without otoscopic abnormalities. She was in atrial fibrillation with a blood pressure of 140/80 mm Hg. The suspected cause was a hormonally active glomus jugulare tumour with intermittent hypertension and involvement of several cranial nerves. INVESTIGATIONS: Repeatedly measured plasma and urinary catecholamine concentration was normal. Neuroradiology showed a contrast-rich lesion close to the jugular vein and the hypoglossal nerve, as well as a tumour in the left retromandibular fossa with displacement of the left internal carotid artery. The suspected cause of these findings was a neurologically asymptomatic left carotid body tumour with multiple cranial nerve deficits (VII, VIII, IX and XII) due to their compression at the base of the skull. No abnormal catecholamine activity could be demonstrated. TREATMENT AND COURSE: After complete excision of the right carotid body there were no further hypertensive crises. Later on the left carotid body tumour was embolised because it had continued to grow. CONCLUSION: The repeated hypertensive crises were probably caused by absent blood pressure regulation, the result of destruction of the afferent fibres. This destruction was due to compression of the hypoglossal nerve by the right jugular glomus, at the same time as the contralateral carotid body had been destroyed by tumour.

Aged↗
PubMed1997

Chronic complicated osteomyelitis of the appendicular skeleton: diagnosis with technetium-99m labelled monoclonal antigranulocyte antibody-immunoscintigraphy.

Chronic post-traumatic osteomyelitis (OM) represents a particular challenge for nuclear medicine and radiology since clinical and biochemical parameters are frequently unreliable. The aim of this study was to investigate the value of combined bone scan (BS) and immunoscintigraphy (IS) with technetium-99m labelled monoclonal antigranulocyte antibody (MAB) in patients with suspected chronic OM of the appendicular skeleton. Twenty-four patients (17 females and 7 males) with suspected chronic post-traumatic OM were evaluated with three-phase BS/99mTc-MAB-IS. The final diagnosis was established by means of bone culture and histology in 19 cases and clinical follow-up in five cases. The studies were reviewed by two independent and experienced observers; the interobserver agreement was calculated by kappa statistics. The sensitivity, specificity and accuracy of BS alone were 92%, 18% and 58%, respectively. Combined BS/99mTc-MAB-IS had a sensitivity, specificity and accuracy of 84%, 72% and 79%, respectively. Of 24 studies, 11 were true-positive, two false-negative, eight true-negative and three false-positive. Two patients presented with unexpected ectopic haematopoietic bone marrow in the appendicular skeleton that caused false-positive results. A high degree of interobserver agreement was found (kappa=0. 85). It is concluded that combined BS/99mTc-MAB-IS represents a very sensitive and reproducible method with an acceptable specificity for the investigation of chronic OM. Problems may occur in the differentiation of low-grade OM from aseptic inflammation. Another problem is ectopic marrow that may occur in the appendicular skeleton due to a chronic inflammatory stimulus. A former intramedullary intervention in the femur with displacement of haematopoietic marrow may also lead to an ectopic location.

Bone and Bones↗
PubMed1997

Foramen of Monro mass: MRI appearances permit diagnosis of cavernous haemangioma.

Cavernous haemangiomas are most commonly found in the subcortical white matter, the pons and the external capsule. We present a case of a cavernous haemangioma that appeared as an intraventricular mass at the foramen of Monro. Despite the unusual location the diagnosis was established by MRI because of the typical appearance. The differential diagnosis included primary and secondary neoplasms at the foramen of Monro.

Cerebral Ventricle Neoplasms↗
PubMed1996

Magnetic resonance imaging of vertebrobasilar ectasia in trigeminal neuralgia.

Vertebrobasilar ectasia is a rare cause of typical trigeminal neualgia. In a recently published large series only thirty-one (2%) of 1404 consecutive patients with vascularly determined neuralgia were found to have vertebrobasilar compression. We present three patients with trigeminal neuralgia caused by vertebrobasilar ectasia, who were evaluated with high resolution magnetic resonance imaging (MRI). MRI studies provided accurate information on the anatomical location and course of the ectatic vessel in the cerebellopontine angle and the caused mass effect on the brainstem. With gadolinium-enhancement vascular compression of the trigeminal nerve was demonstrated clearly. Surgery confirmed compression of the fifth nerve by an ectatic and tortuous vertebrobasilar artery in two cases. Following microvascular decompression neither patient experienced further pain. The third patient was treated with a ventriculoperitoneal shunt, as he developed occlusive hydrocephalus caused by the vertebrobasilar dolicho-ectasia. MRI is useful in the evaluation of trigeminal neuralgia as it excludes other aetiologies such as tumour or arteriovenous malformation, but also demonstrates cranial nerve compression by ectatic vertebral arteries.

Basilar Artery↗