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Biomedical subjects

G Mohr

Publications and source records attributed to G Mohr.

At least 91 records · Page 5Linked to original sources

Extracranial and intracranial meningiomas.

Meningiomas constitute about 18% of primary intracranial tumors, and they are rarely observed in patients under 30 years of age. In this study, we present the case of a 17-year-old patient who was first seen for a right cervical mass. Further investigation revealed that a meningioma of the posterior cranial fossa had invaded the temporal bone, the infratemporal fossa and the right parapharyngeal region and was at the origin of that cervical mass. This intra- and extracranial meningioma was completely resected in two stages with very satisfactory results. We have reviewed the literature pertaining to the extracranial extensions of meningiomas originating in the posterior fossa.

Adolescent↗

Chiasmal apoplexy due to ruptured cavernous hemangioma of the optic chiasm.

A 30-year-old obese patient with a rapidly progressing chiasmal syndrome presented with acute bitemporal hemianopia, severe bilateral amblyopia, mental confusion, and lethargy. X-ray films of the skull showed a normal sella turcica and computed tomography scan as well as angiography revealed a vascular mass within the chiasmatic cistern. At operation, via left subfrontal approach, an intrachiasmal hematoma was evacuated and biopsies of the hematoma cavity revealed a cavernous hemangioma. Visual symptoms improved markedly postoperatively. This rare association of chiasmal apoplexy and intrachiasmal cavernoma is discussed.

Adult↗

Management of acute subdural hematomas from aneurysmal rupture.

Subdural hematomas (SDH) from ruptured aneurysm (RA) are much less common than intracerebral (ICH) hematomas or subarachnoid (SAH) or intraventricular hemorrhage (IVH). With computerized tomography, preoperative diagnosis is now made more often. The authors have collected 18 such cases from a review of 897 cases of RA admitted to eleven medical centers in 1980 and 1981. Nine (50%) of these patients died prior to discharge from hospital. Four (22%) had surgery and died postoperatively and 9 (50%) were operated upon and survived. Thirteen (72%) of the patients showed anisocoria, decreased consciousness and unilateral weakness prior to surgery. Eight (89%) of the fatalities had shown preoperative herniation as opposed to only 5 (56%) of the survivors. The overall incidence of delayed ischemia due to vasospasm was 11% (2 cases). Those who died had greater midline shift and larger SDH on the admission CT scan. Sixteen (89%) of these patients were female. Thirteen (72%) had ruptured aneurysms on the internal carotid artery. All of these hematomas were unilateral and uniformly hyperdense, and the convexity hematomas were crescentic in shape. Seventeen (94%) had evidence of blood in locations other than the subdural space. If the patient is potentially salvageable and has a midline shift, the SDH should probably be evacuated immediately and the aneurysm clipped at the same operation since the development of a tentorial herniation has such an adverse effect on outcome.

Acute Disease↗

Unusual dural fistulae.

The authors present seven cases of dural fistulae selected because of their difficulty in diagnosis or in the approach to treatment. The first case had a "delayed traumatic" CSF rhinorrhea and the diagnosis remained, to the end, presumptive. The second and the third were either "spontaneous" or "delayed traumatic" in origin. One of these fistulae was localized in a lateral recess of the sphenoid sinus. Both were approached through the ethmoid, and one of these had to be re-operated intracranially because of recurrence. The fourth had a congenital meningo-encephalocele. The fifth and sixth had fistulae secondary to fronto-ethmoidal osteomas, one presenting with an intracranial mucocele, the other with a cerebral abscess. The last one, a traumatic fistula had to be treated extracranially after two unsuccessful intracranial approaches.

Adult↗

Intracranial aneurysms: a report of a large pedigree.

We report on the occurrence of intracranial aneurysms in several individuals of a large French-Canadian family. Recurrence risk from 22 previously reported families (each with at least two affected first degree relatives) and the present family does not allow any firm conclusion about the mode of inheritance of the trait.

Adult↗

Intraventricular hemorrhage from ruptured aneurysm. Retrospective analysis of 91 cases.

Intraventricular hemorrhage (IVH) from aneurysm rupture is generally considered to be of grave prognostic significance. Ninety-one cases have been studied retrospectively from seven medical centers. The overall mortality rate was 64%. The dramatically poor condition of these patients leads to their rapid admission to the hospital. Eighty-seven percent were admitted on Day 0 or 1, and more than half were classified neurologically as Grade 4 or 5. A multiple regression analysis explained 56% of the variance in survival, using the variables of ventriculocranial ratio (VCR), day of admission, diastolic blood pressure, location of aneurysm, associated intracerebral hematoma, age, grade on admission, sex, and systolic blood pressure. No patient with a VCR of more than 0.25, as calculated from the initial computerized tomography (CT) scan, survived. No patient whose smallest VCR was 0.23 or more survived. This ratio can be simply measured with a millimeter ruler from the CT scan. Patients with IVH usually had enlarged ventricles, even initially. The overall results suggest that early management of intracranial hypertension should be more generally considered, although even when this was done the prognosis was still guarded. The timing of surgery was not an important determinant of outcome, although a significant number of patients died awaiting surgery.

Adolescent↗

Clinical - radiological correlates in intracerebral hematomas due to aneurysmal rupture.

In this series of intracerebral hematomas from aneurysmal rupture, gathered from several neurosurgical services, certain morphological features were studied in detail. Patients with very large hematomas tended to have poor neurological grades on admission to hospital and their immediate discharge outlook was correspondingly poor. Ruptured middle cerebral and pericallosal artery aneurysms were relatively common causes of intracerebral hematomas. Patients with temporal lobe hematoma did relatively well; those with parietal hematoma did poorly. The larger the hematoma the less chance there was of developing cerebral vasospasm but the more likely was pre-operative brain herniation. The survival was more closely linked to size and location of the hematoma than to the location of aneurysm or the degree of midline shift.

Cerebral Hemorrhage↗

Bilateral trigeminal neuralgia.

A 56-year-old woman previously treated by a retrogasserian neurectomy for a right tic douloureux was rendered free of pain, but complete anaesthesia of the right half of her face remained. Seven years later, she developed a typical left trigeminal neuralgia. Contralateral rhizotomy was refused because of the patient's concern about having bilateral facial anaesthesia. Through a suboccipital craniectomy, the trigeminal nerve was decompressed from a thickened arachnoid membrane and a large bridging vein near the root entry zone. After eighteen months, the patient was free of pain with intact facial sensations on the left side. Therapeutic considerations in cases of bilateral trigeminal neuralgia are discussed.

Denervation↗

Calcifications in pituitary adenomas.

In a surgical series of 755 pituitary adenomas, 51 cases (6.75%) showed intratumoral calcifications on microscopic examination and 13 of these were visible on roentgenographic examination (1.72%). Thirty-eight of these 51 cases were prolactinomas, the highest incidence being in male patients. There was no correlation between age, sex, levels of hormone, size of the tumor, and the presence of calcifications. Four patterns of radiological calcifications were encountered. Histologically, the calcifications were most frequently found within the tumor masses. Their rare occurrence within fibrous or degenerative areas speaks against their dystrophic nature. Previously reported calcified bodies in fetal and newborn pituitaries and the recently described physiological hyperprolactinemia in early infancy suggest a possible hormonal influence in the genesis of calcifications in prolactinomas.

Adenoma↗