Search PubMed⌕ Search

Biomedical subjects

F Vinuela

Publications and source records attributed to F Vinuela.

At least 37 records · Page 2Linked to original sources
PubMed1995

Two concurrent spinal dural arteriovenous fistulae in a patient with rapidly progressive myelopathy. A case report.

A rare case of two separate spinal dural arteriovenous fistulae (DAVFs) occurring concurrently in a patient with a rapidly progressive myelopathy is reported. Although concurrent spinal DAVFs may be "well known," their occurrence has been only anecdotally reported. To the authors' knowledge, this well documented case of a presumably rare variant of spinal DAVFs is the first to appear in the literature and is instructive for reconsidering approaches to optimal diagnosis and evaluation of posttherapeutic efficacy of these lesions.

Angiography↗
PubMed1994

Localization of motor areas adjacent to arteriovenous malformations. A positron emission tomographic study.

Motor cortex activity was localized with positron emission tomography (PET) in 4 patients with large arteriovenous malformations adjacent to or undercutting the left primary motor cortex. Relative cerebral blood flow responses were measured during execution of a visually guided motor tracking task performed with the right index finger, hand, great toe, tongue, or eyes alone (control) and mapped onto each patient's corresponding magnetic resonance imaging (MRI) scan. The relative cerebral blood flow responses in the contralateral precentral gyrus, adjacent to each arteriovenous malformation, demonstrated a normal somatotopic distribution, similar to that in a control population. In the 3 patients with preserved motor function, responses were also present in the ipsilateral primary motor cortex, bilateral supplementary motor area, and ipsilateral anterior cerebellum, similar in location to those of a control population. In the fourth patient with a hemiparesis, responses were attenuated in the primary motor cortex, increased in the supplementary motor area, and absent in the cerebellum. The results demonstrate that PET cerebral blood flow mapping can localize motor cortex despite the presence of significant blood flow abnormalities in adjacent arteriovenous malformations. The method, particularly when combined with MRI, may be used in the planning of surgical, radiation, or embolization therapy.

Adult↗
PubMed1993

Monitoring carotid test occlusions with continuous EEG and clinical examination.

We routinely monitor invasive neuroradiologic carotid balloon test occlusions with continuous polygraph and quantitative EEG along with repeated detailed clinical examinations. Four of 17 consecutive cases showed changes during carotid occlusion. In one instance, an immediate delta increase was accompanied by slurred speech and aphasia. Another showed alpha attenuation without clinical change. A third patient had significant clinical change without EEG change. Nine of the 17 cases underwent permanent therapeutic carotid occlusion as treatment of an intracerebral vascular abnormality. Seven of these nine had no EEG or clinical changes during monitoring and have had no functional abnormalities on follow-up. The patient with focal alpha attenuation had an accidental balloon detachment but has had no functional or structural neurologic abnormalities. The patient with minor regional increased delta received a permanent carotid occlusion and went on to develop clinical signs 24 h later. We believe that continuous EEG monitoring and repeated clinical examinations provide useful ways of evaluating cerebral circulation during carotid test occlusions.

Adult↗
PubMed1990

Ischemic brain rescue by transvenous perfusion in baboons with venous sinus occlusion.

We studied brain retroperfusion in nine adult baboons. Experiments in four baboons determined techniques and the safety of retroperfusion, and experiments in three baboons determined the ability of retroperfusion to reverse cerebral ischemia. Two baboons died before retroperfusion. Arterial blood was continuously circulated by an external pumping system from one femoral artery into the intracranial sinuses through specially designed balloon-tipped catheters placed percutaneously into the sigmoid sinuses bilaterally. The balloons intermittently occluded the sinuses. Ischemia was produced by occluding the left middle cerebral artery. Standard and computed electroencephalography with topographic mapping monitored the onset and reversal of ischemia. Retroperfusion rate exceeded 50 ml/min with a mean intrasinus pressure increase of 27 (0-149) mm Hg in all seven experiments. Venograms demonstrated complete or partial filling of the superior sagittal sinus in each experiment. Four experiments without ischemia established maximal balloon occlusion cycles, retroperfusion rates, and sinus pressure changes. These four baboons were neurologically normal after retroperfusion; two had normal magnetic resonance imaging scans. Ischemic changes, detected by electroencephalography following middle cerebral artery occlusion, were reversed with retroperfusion in all three ischemia experiments. Autopsies in the seven baboons demonstrated no parenchymal hemorrhage or edema. Our results suggest that further investigation of retroperfusion, and possibly retroinfusion of agents for cerebral protection, is warranted.

Animals↗
PubMed1988

Embolization: an adjunctive measure for removal of carotid body tumors.

Small carotid body tumors that do not encircle the internal carotid artery are excised with relative ease and minimal risk by the conventional subadventicial approach. Large carotid body tumors frequently encircle the internal and external carotid arteries, and extensive bleeding often complicates the resection, increasing the risk of carotid artery rupture and damage to major cranial nerves. Recent improvements in surgical techniques and selective embolization have lessened the risks of surgical excision, decreased the blood loss, and diminished the time required for resection. Experiences in the resection of carotid tumors with and without embolization are compared. Early resection of carotid body tumors, before involvement of the internal carotid artery and carotid bulb, is advocated.

Adult↗
PubMed1987

Interobserver variation in computed tomography of the brain.

As part of the University of Western Ontario Dementia Study, the computed tomographic brain scans of 16 patients were reviewed by three neuroradiologists. The size of the ventricles and sulci were rated using a six-point scale. Infarction and white matter changes were assessed in accordance with specified criteria. The interobserver correlations in this small series were statistically significant in 17 of 20 items, and good or acceptable for infarction, leuko-araiosis, and ventricular size. It is suggested that the use of rigid criteria for the definition of abnormality helps to promote interobserver agreement.

Brain↗
PubMed1987

MR imaging of the nasopharynx and floor of the middle cranial fossa. Part I. Normal anatomy.

The normal anatomy of the nasopharynx and floor of the middle cranial fossa was analyzed with magnetic resonance (MR) imaging. MR images from five healthy volunteers were correlated with whole-organ cryomicrotome sections from three cadavers. Anatomic connections exist between the paranasopharyngeal spaces and the surface structures of the skull base. These anatomic connections include the intimate relationship between the eustachian tube and the pharyngobasilar fascia, the attachment of the muscles of mastication and deglutition to the skull base, and vascular and nervous structures in the foramina. The inherent contrast between the soft tissues of the nasopharynx and related structures and the bone of the floor of the middle cranial fossa allowed excellent visualization of these anatomic connections.

Cadaver↗
PubMed1987

MR imaging of the nasopharynx and floor of the middle cranial fossa. Part II. Malignant tumors.

The intracranial extension of tumors of the nasopharynx and related spaces presents a difficult imaging problem. Unlike computed tomography (CT) scans, magnetic resonance (MR) images are not limited by beam-hardening artifacts from bone or dental amalgam. Forty-six patients with malignant tumors of the nasopharynx and related spaces affecting the skull base underwent MR imaging. MR images were obtained with a 0.3-T permanent-magnet imaging system in axial, sagittal, and coronal planes. MR findings were compared with clinical records, plain radiographs, CT scans, and pathologic correlates when available. MR imaging could demonstrate neoplastic invasion of the bone of the floor of the middle cranial fossa and the vital soft-tissue structures related to it as well as or better than CT. Tumor extension was viewed directly as a continuous mass or indirectly by marrow replacement or displacement of normal structures. Specific anatomic routes through which tumors extend from the nasopharynx to the middle cranial fossa were inferred from MR findings.

Eustachian Tube↗
PubMed1987

Percutaneous embolization for control of nasal blood circulation.

Percutaneous embolization to control the nasal blood circulation was used in 19 patients with vascular nasal disorders. Embolization was the initial treatment for intractable posterior epistaxis in 11 patients, 9 (82%) of whom were controlled without further treatment. Used as an adjunct to surgery on vascular nasal tumors, embolization reduced intraoperative blood loss in four patients to an average of 800 cc. In four patients with Osler-Weber-Rendu disease, treatment with embolization did not significantly alter the course of their disease. Overall, however, this relatively new technique enhances successful management of difficult epistaxis cases.

Embolization, Therapeutic↗
PubMed1986

Intraluminal thrombus of the internal carotid arteries: angiographic demonstration of resolution with anticoagulant therapy alone.

Fourteen patients with angiographically demonstrated thrombus in the cerebral vessels were treated immediately with anticoagulant or antiplatelet medication. Follow-up angiograms, obtained in eight cases, showed resolution of the thrombus in seven. In no patient did the thrombus progress to occlude the vessel completely, and no new distal emboli were identified on the follow-up angiograms. There were no new permanent neurologic events in these 14 patients while they were undergoing medical therapy. Six patients subsequently underwent delayed endarterectomy to treat underlying stenoses. Our experience indicates that the presence of intraluminal thrombus may not be a surgical emergency.

Adult↗
PubMed1986

Increased density of tentorium and falx: a false positive CT sign of subarachnoid hemorrhage.

Noncontrast computed tomographic (CT) findings in 10 patients with profound brain swelling or a mass effect revealed a high density of the falx and tentorium and thus suggested subarachnoid hemorrhage. Postmortem examinations performed shortly after the CT scans demonstrated no subarachnoid blood. A review of 100 CT scans drawn at random was carried out to assess the frequency of a hyperdense, noncalcified falx in the same population and failed to demonstrate this finding. Therefore, in the presence of profound brain swelling or a mass effect, factors other than subarachnoid hemorrhage may be responsible for increased density of the falx and tentorium on cranial CT head scans.

Adult↗
PubMed1985

Subependymal metastases of an extracranial malignancy.

We report a patient in whom subependymal metastases from a primary lung cancer were demonstrated by computed tomography of the head and in whom tissue correlation became available. To our knowledge, no such patient has previously been reported.

Aged↗
PubMed1985

Oblique positioning for intravenous digital subtraction angiography images of the neck and head.

Oblique intravenous digital subtraction arteriography (IV-DSA) images of the neck were centered high to include the carotid bifurcations and siphons on one view in 80 consecutive patients being investigated for cerebral vascular atherosclerosis. Using a 27 cm image intensifier, these two important areas for atherosclerotic involvement were seen together on 68.1% of the images. In 25.6% of the images, the centering was too low to include the siphons on the film due to incorrect interpretation of facial anatomy on the oblique scout view. Careful attention to anatomic detail will allow correct centering in most patients. This will allow the bifurcations and siphons to be seen in profile together, thereby decreasing the number of film runs needed and the contrast volume given.

Arteriosclerosis↗
PubMed1984

Computed tomography in temporal lobe epilepsy.

Forty patients who had intractable temporal lobe epilepsy had surgery for treatment of their seizures following study by computed tomography (CT). Fifteen of 19 patients with tumors had good correlation between CT and pathological findings. Another group of patients had macroscopic changes that were demonstrated on CT and verified at surgery. Sixteen patients had microscopic pathological diagnoses including cytoarchitectural abnormalities, Chaslin gliosis, and ectopic neurons. Six of these had enlarged temporal horns on the ipsilateral and five on the contralateral side to the electroencephalographic-pathological abnormality. In the investigation of temporal lobe epilepsy we believe that CT, especially with the newer generation scanners, records tumors and other larger macroscopic changes but that temporal horn size is unreliable in predicting the abnormal side if only microscopic changes are present.

Adolescent↗
PubMed1984

Revisited old and new CT findings in unruptured larger arteriovenous malformations of the brain.

Several papers have already described the computed tomographic (CT) findings in arteriovenous malformations (AVMs) of the brain. In a population of larger and unruptured AVMs, however, improved resolution CT has made it possible to demonstrate findings not previously appreciated: (a) major and minor mass effects in the absence of rupture of an AVM (33 of 60 cases); (b) cisternal enlargement secondary to vessel ectasia and tortuosity; (c) extensive edema of white matter; (d) the detailed features of finer and coarser calcifications of the malformation; (e) gray matter changes, disturbances in the gray-white matter interface, and intrinsic hypodense regions within the AVM; and (f) visualization of small vessels on intravenous enhancement.

Brain↗
PubMed1983

Intraoperative embolization of cerebral arteriovenous malformations in the awake patient.

Fourteen cases of relatively large AVMs within important functional cortical areas, the majority in the dominant hemisphere, are discussed; these AVMs have undergone varying degrees of obliteration by intravascular embolization with IBC in the operating room, under neuroleptanalgesia and local anesthesia. Our belief is that while there have been complications these can hopefully be avoided in the future and that with the evolution of the present technology there will be further refinements in the technique which will eventually allow predictable and definitive treatment of such AVMs.

Adolescent↗