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Biomedical subjects

J B Posner

Publications and source records attributed to J B Posner.

At least 127 records · Page 7Linked to original sources
PubMed1988

Paraneoplastic cerebellar degeneration: clinical-immunological correlations.

Four different antineuronal autoantibodies have been identified in 23 of 47 patients with paraneoplastic cerebellar degeneration (PCD). The most common, an antibody against 34- to 38-kDa and 62- to 64-kDa protein antigens in the cytoplasm of Purkinje cells, was found in 18 patients. It is a highly specific marker for a severe stereotypical subacute pancerebellar syndrome of truncal and appendicular ataxia, dysarthria, and nystagmus in women with cancer (usually ovarian or breast carcinoma). Different anti-Purkinje cell antibodies (APCA) were found in 2 other patients with PCD. With two possible exceptions, an APCA was not found in patients with other neurological diseases, with cancer not associated with neurological symptoms, or in normal subjects. Antibodies reactive with neuronal nucleoproteins were identified in 3 other patients with PCD: an antibody that recognized 35- to 40-kDa neuronal antigens was found in 2 women with small-cell lung carcinoma, while an antibody in a woman with breast carcinoma identified 53- to 61-kDa and 79- to 84-kDa antigens. Detection of an antineuronal antibody in a patient without known cancer should prompt a careful search for a tumor at a site appropriate to the antibody type.

Adult↗
PubMed1988

Cerebral herniation in patients receiving cisplatin.

5 Patients with intracranial mass lesions are described who experienced cerebral herniation and coma following intravenous cisplatin therapy. Although the pathogenesis of the acute cerebral swelling is unknown, it is most likely multifactorial. Possible contributing factors include pre-existing cerebral edema, acute hypo-osmolality with fluid shifts into an already swollen brain, seizures and possible direct neurotoxicity of cisplatin.

Brain Neoplasms↗
PubMed1988

Leukoencephalopathy complicating intraventricular catheters: clinical, radiographic and pathologic study of 10 cases.

Ten patients with implanted Ommaya devices developed pericatheter white matter lesions, apparent as focal lucenaries on computed tomographic scan sometimes with contrast enhancement and/or mass effect. Some of the patients had significant neurological signs that related to the lesion. Three of the patients had not received cytotoxic drugs through the reservoir, and two had received neither intrathecal chemotherapy nor cranial radiation therapy. The process appears to be related to back flow of cerebrospinal fluid, with or without contained cytotoxic drugs into the periventricular white matter. Patients with elevated intracranial pressure are at particular risk. Removal of the catheter relieves the condition.

Adult↗
PubMed1988

Cerebral necrosis following neutron radiation of an extracranial tumor.

Radiation necrosis of the brain is a rare complication of irradiation for extracranial tumors. We present a patient who emphasizes the potential hazard of neutron therapy, the sensitivity of magnetic resonance imaging (MRI) which may detect white matter changes prior to the development of clinical symptoms, the potential diagnostic value of 18F-fluorodeoxyglucose/positron emission tomography, and the importance of a combined surgical and medical approach for proper treatment.

Brain↗
PubMed1988

Central nervous system metastases from non-Hodgkin's lymphoma: treatment and prophylaxis.

Central nervous system (CNS) lymphoma was identified in 96 patients treated for non-Hodgkin's lymphoma at Memorial Sloan-Kettering Cancer Center between 1975 and 1981. During the same period, 68 other patients with non-Hodgkin's lymphoma but no CNS disease received prophylactic CNS chemotherapy. In the 156 total patients, the lymphomas were diffuse in 96 percent, and 67 percent were stage IV at diagnosis. CNS involvement was present at initial diagnosis in 27 percent, at relapse in 26 percent, and during the course of progressive systemic disease in 47 percent. CNS involvement was asymptomatic in 10 percent. Cytologic study of the cerebrospinal fluid was the most sensitive and specific laboratory test, but often (22 percent) more than one lumbar puncture was required to identify malignant cells. CNS lymphoma was treated in 85 patients, 46 by intracerebroventricular cannulae; 81 percent improved. Although median survival after the diagnosis of CNS disease was four months, there were seven long-term disease-free survivors and the CNS disease contributed to death in only 14 percent. In 52 percent of treated patients, there was no CNS lymphoma at autopsy. CNS prophylaxis was with methotrexate or cytosine arabinoside, usually by lumbar puncture; an intraventricular cannula was used in seven patients. Although this group of high-risk patients with non-Hodgkin's lymphoma had a high systemic response rate and the median projected survival was greater than five years, CNS lymphoma developed in eight patients (12 percent). In five, CNS lymphoma occurred as an apparently isolated relapse site. The role of CNS chemoprophylaxis in high-risk patients with non-Hodgkin's lymphoma is still uncertain.

Adult↗
PubMed1988

A model of radiation myelopathy in the rat. Pathology, regional capillary permeability changes and treatment with dexamethasone.

In order to identify the effects of x-irradiation on spinal cord histology and capillary permeability, we irradiated the upper thoracic spinal cord of adult rats with 3500 cGy to a single lateral field. After 165 +/- 14 (SD) days the rats became paraplegic over 4 to 8 days. Quantitative autoradiography using 14C-amino-isobutyric acid demonstrated a biphasic curve of regional capillary permeability changes (K1). K1 first increased 70 to 85% in all regions of the cord at 30 days, then normalized at 60 days. From 60-151 +/- 8 days in asymptomatic animals there was an apparently exponential increase of K1 in all spinal cord regions progressing at varying rates among regions, most rapidly in the posterior columns and least rapidly in grey matter. K1 continued to rise when the animals became paraplegic. Morphologically, the asymptomatic period was characterized by myelin pallor and vacuolation evident at 30 days, maximal at 60 days, without progression until 151 +/- 8 days when microscopic foci of necrosis appeared in the posterior columns of some clinically normal ('preparetic') animals. The paretic period was characterized by extensive posterior and lateral column necrosis with preservation of grey matter. High dose dexamethasone or indomethacin had no preventative effect when administered just prior to irradiation. Dexamethasone transiently improved motor strength in symptomatic rats and reduced K1 in nonnecrotic portions of the cord. This study suggests that, after a transient peak of 'early delayed' changes in regional capillary permeability, there is progressive damage to the endothelium that may play a primary role in delayed radionecrosis.

Angiography↗
PubMed1988

Opsoclonus, myoclonus, ataxia, and encephalopathy in adults with cancer: a distinct paraneoplastic syndrome.

The clinical and pathological findings in 4 adults with cancer and opsoclonus were compared with those of 15 other patients described elsewhere. The clinical syndrome of paraneoplastic opsoclonus is characterized by the acute onset of opsoclonus and truncal ataxia, often accompanied by encephalopathy, myoclonus and a cerebrospinal fluid pleocytosis. Unlike most other paraneoplastic syndromes, the course is often remitting and relapsing. Neuropathological examination in 3 of our patients showed lymphocytic cuffing of occasional blood vessels throughout the central nervous system, associated with a mild, diffuse proliferation of microglia in 1 patient. Apart from a mild, patchy loss of Purkinje cells in 1 patient, there was no loss of neurons from the cerebellum, brainstem, cerebral hemispheres, or spinal cord. These patients differ from those with the more common paraneoplastic cerebellar degeneration by the predominance of truncal over limb ataxia, the presence of myoclonus, the absence of severe dysarthria, a tendency for remission, and the preservation of Purkinje cells.

Ataxia↗
PubMed1988

Erythema multiforme and Stevens-Johnson syndrome in patients receiving cranial irradiation and phenytoin.

In 15 months we encountered eight patients with intracranial tumors who developed erythema multiforme (EM) or erythema multiforme bullosa (Stevens-Johnson syndrome). All occurred shortly after use of phenytoin (DPH) and brain radiation therapy (WBRT). The clinical picture differed from the classic form of EM in that the erythema began on the scalp and spread to the extremities, progressing in three cases to extensive bullous formation. There were no cases of EM among patients who received either DPH or radiotherapy alone. The combination of DPH, WBRT, and tapering of steroids seems to predispose to EM. The pathogenesis of the disorder is probably immunologic. In the absence of seizures, anticonvulsants should not be given routinely to patients with brain tumors. When anticonvulsants are necessary in patients scheduled for WBRT, DPH may not be the drug of choice.

Adult↗
PubMed1988

Perforation of the gastrointestinal tract in patients receiving steroids for neurologic disease.

Between 1980 and 1984, of 107 patients receiving 16 mg/d of dexamethasone for spinal cord compression, three (2.8%) developed gastrointestinal (GI) perforation and two (1.9%) GI bleeding; of 226 being tapered from 100 mg/d of dexamethasone, perforation occurred in six (2.7%) and GI bleeding in eight (3.5%). Of 125 patients with GI perforations treated between 1979 and 1986, 41 (33%) were on steroids, 24 for neurologic disease. Median duration of steroid therapy was 24 days; 20 (91%) of the neurologic patients perforated within 30 days. The steroid group had more free peritoneal involvement (p less than 0.00001), but fewer signs and symptoms of peritonitis (p less than 0.000001) than the nonsteroid group. Seventeen patients were receiving steroids for cord compression; they had significantly more rectosigmoid perforations (p less than 0.014) and associated constipation (p less than 0.000001) than the 108 remaining patients. GI perforation is a less well-recognized complication of steroid therapy in neurologic patients than is GI bleeding though it occurs as frequently, is more difficult to diagnose, and far more serious. In steroid-treated patients, prevention of constipation might avert this serious complication, while early diagnosis will improve the outcome.

Adolescent↗
PubMed1988

MRI demonstrates descending transtentorial herniation.

Descending cerebral transtentorial herniation (DTH) is a serious and often fatal complication of intracranial mass lesions. The condition can be inferred from clinical neurologic signs, but has not been visualized during life. Using midsagittal magnetic resonance images (MRIs), we compared vertical brainstem position on 50 images from normals and 21 images from 15 clinically stable patients with large supratentorial tumors. The length of Twining's line (T), the perpendicular distance from T to the pontomesencephalic junction (T-PMJ), and from T to the apex of the midbrain aqueduct (T-A) were measured. We also measured lateral shifts of the diencephalon and midbrain on axial images. T-PMJ decreased from 2.04 +/- 0.06 mm in normals to 0.94 +/- 0.2 mm in patients with large cerebral tumors (p less than 0.0001). Similarly, T-A decreased from 6.35 +/- 0.13 mm in normals to 4.83 +/- 0.35 mm in patients (p = 0.001). Lateral diencephalic-midbrain shifts often accompanied DTH but to an unpredictable degree. Either lateral or downward brainstem shift could occur alone and did not necessarily produce specific neurologic signs or an altered state of consciousness. Anatomic DTH occurs in life, it can be quantified with MRI, and in slowly developing cerebral mass lesions the process can precede the appearance of neurologic signs and symptoms that indicate lower-diencephalic or midbrain dysfunction.

Brain Diseases↗
PubMed1988

A variant of the anti-Purkinje cell antibody in a patient with paraneoplastic cerebellar degeneration.

An anti-Purkinje cell antibody was found in the serum and CSF of a man with adenocarcinoma of the lung and paraneoplastic cerebellar degeneration (PCD). This antibody differed from the autoantibodies found in patients with gynecologic cancer and PCD in that it produced a different pattern of Purkinje cell cytoplasmic staining, did not react with PCD antigens in Purkinje cell Western blots, and the antigen had a different species distribution. Unlike the antinuclear antibody found in patients with PCD and small-cell lung carcinoma, the antigen was restricted to the cytoplasm of Purkinje cells. If autoantibodies are important in the pathogenesis of PCD, this case illustrates that they can recognize different antigenic epitopes in the nervous system, but cause similar clinicopathologic syndromes.

Adenocarcinoma↗
PubMed1988

Morbidity and mortality of craniotomy for excision of supratentorial gliomas.

Extensive surgical resection of supratentorial gliomas increases survival. However, some reports suggest that the perioperative morbidity and mortality outweigh the potential benefit of the procedure. We examined prospectively morbidity and mortality in 104 consecutive patients who underwent surgery for supratentorial glioma, as well as other factors that might affect the short-term outcome. To determine if our experience was unusual, we compared these results with those obtained from another academic neurosurgical center by a review of the records of 109 patients also treated surgically for supratentorial glioma. Mortality was 3.3% and the medical plus neurologic morbidity was 31.7%. Functionally significant neurologic worsening occurred in 42 (19.7%) patients. Complications were more frequent in patients with moderate or severe preoperative disabilities than those with mild or no preoperative disability. Patients with complete resection had fewer acute neurologic complications, and no greater risk of being neurologically impaired at 1 week, than patients with biopsy or less extensive procedures. Morbidity and mortality correlated with location: deep-midline lesions had a higher overall rate of perioperative complications (p = 0.032) and mortality (p = 0.019) and bilateral lesions a higher rate of hemorrhage (p = 0.017) and hydrocephalus (p = 0.010). Older patients (greater than 55 years) and those receiving high daily dose of preoperative dexamethasone (greater than or equal to 24 mg) had a significantly higher risk of surgical mortality. Reoperation for recurrent tumor carried no greater risk of mortality, neurologic deterioration, and infection than a first operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Autoantibodies in paraneoplastic syndromes associated with small-cell lung cancer.

An antineuronal autoantibody has been identified in serum from 14 patients, 8 women and 6 men, with small-cell lung carcinoma (SCLC) and a neurologic disorder. Neurologic symptoms began prior to diagnosis of the SCLC in 12 patients. The dominant neurologic disorder was a subacute sensory neuronopathy (SSN) in eight patients, SSN plus lower motor neuron weakness (2 patients), SSN plus autonomic neuropathy (1 patient), cerebellar ataxia (1 patient), myelopathy (1 patient), and multifocal nervous system disease (encephalomyelitis) in one patient. The presence of the same autoantibody in patients with SSN, encephalomyelitis, and autonomic neuropathy suggests that these diseases are different manifestations of the same nosologic process. With one exception, treatment of the tumor, immunosuppressive drugs, and plasmapheresis did not influence the course of the neurologic illness. The autoantibody was not identified in sera from more than 400 controls subjects, including patients with SSN associated with other tumors, SSN without malignancy, other paraneoplastic syndromes, and SCLC without neurologic symptoms. The autoantibody is a highly specific marker of the paraneoplastic syndromes associated with SCLC and its detection in a patient not known to have cancer should prompt a careful search for SCLC.

Aged↗
PubMed1988

High dose versus low dose dexamethasone in experimental epidural spinal cord compression.

A compound of methylcellulose-silicone expanding progressively over a 1-week period by moisture absorption was implanted in the midthoracic epidural space of 17 Sprague Dawley adult rats. When the animals became paraplegic 6.3 +/- 1.6 days later, they were randomized into three groups: untreated control (n = 5), high dose dexamethasone (HD, 1.25 mg/kg intramuscularly, twice daily, n = 5), and low dose dexamethasone (LD, 0.125 mg/kg intramuscularly, twice daily, n = 7). Motor strength was evaluated daily by an observer unaware of the treatment given to the rats. Animals treated with dexamethasone (HD or LD) improved faster than untreated control animals. No significant difference in the rate of recovery or degree of motor improvement was noted between the HD and LD groups. Mortality was higher in the HD group because of infections and gastrointestinal perforation/bleeding.

Animals↗
PubMed1987

Cerebral infarction from non-bacterial thrombotic endocarditis. Clinical and pathological study including the effects of anticoagulation.

The clinical and pathologic findings in 42 autopsy proved cases of cerebral infarction from cancer-associated non-bacterial thrombotic endocarditis were reviewed. Carcinoma of the lung was the most common malignancy. Most patients had disseminated cancer, but in six patients, the condition was stable or in remission, and six patients had localized cancer; two patients were not known to have cancer until neurologic symptoms developed. Neurologic symptoms were focal, suggesting stroke in 18; diffuse, suggesting metabolic encephalopathy in nine; and mixed in five. Neurologic signs were often the only evidence of thromboembolism. The definitive diagnostic test was cerebral angiography showing multiple arterial occlusions. Anticoagulation with heparin appeared to help some patients and did not promote brain hemorrhage. Early diagnosis and vigorous treatment of non-bacterial endocarditis may prevent severe neurologic disability.

Adenocarcinoma↗