Biomedical subjects
Publications and source records attributed to J Biller.
A 53-year-old man with oat cell carcinoma of the lung developed a bilateral internuclear ophthalmoplegia in association with carcinomatous meningitis. While bilateral internuclear ophthalmoplegia has been described in one case of cryptococcal meningitis, this is the first reported case occurring in association with carcinomatous meningitis.
Of 13,913 patients examined at autopsy between 1939 and 1980, the diagnosis of nonbacterial thrombotic endocarditis (NBTE) was made in 99 instances. There were 53 males and 46 females ranging in age from 4 to 89 years. Vegetations were found on the aortic valve in 39; the mitral in 37; the tricuspid in nine; and the mitral in 37; the tricuspid in nine; and the pulmonic in two. Two-valve involvement was present in 12 cases. Malignant neoplasms were found in 42 autopsies. Embolism to the brain was found in 33 cases and to other organs in 62. Coagulation abnormalities were documented in 22 cases, and a distinct picture of disseminated intravascular coagulation of thrombophlebitis elsewhere in the body should arouse suspicion of NBTE. The high incidence of multiple emboli and its association with malignant neoplasms and with a variety of cardiovascular, pulmonary, renal, and gastrointestinal disorders should provide clues for recognition of this serious disorder.
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To determine the predictive accuracy of Doppler and real-time ultrasound studies, continuous-wave Doppler (CWD) and B-mode real-time ultrasound (RTU) studies of the carotid bifurcation were compared in 50 consecutive patients before cervicocranial arteriography. Four categories of CWD results were formed according to the severity of stenosis. Except for mild to moderate stenosis, there was a high degree of agreement (87.5% to 98.1%) between CWD results and arteriographic diagnosis. Of the arteries classified as normal on RTU study, 95.5% were arteriographically normal; of those classified as abnormal, 94.9% were abnormal on arteriography. In 94.7% of the cases in which RTU demonstrated a possible ulcer, the diagnosis was confirmed by arteriography.
The case of a 40-year-old patient with Dejerine-Sottas disease, who developed spinal cord compression from hypertrophic nerve roots, is presented. Six previously reported cases are reviewed. We discuss the characteristic myelographic changes seen in Dejerine-Sottas disease.
Hemifacial spasm developed in a 32-year-old man following a brain stem stroke. This stroke followed a self-induced head movement, which is a rare cause of such events. The clonic movements were often related entirely to the position of the head. Carbamazepine was successful in treating the spasm and may be indicated in the medical treatment of this disorder. The differential diagnosis and treatment of hemifacial spasm are discussed.
32 of 45 (71.1%) patients with carotid artery distribution transient ischemic attacks had normal cranial computerized tomography (CCT). 9 (20%) had cerebral atrophy. Incidental abnormalities were found in 3 (6.6%) patients, while a hypodense lesion corresponding to the site of neurological dysfunction was seen in only 1 (2.2%) patient. The latter showed a persistent abnormality in follow-up studies on the 8th and the 23rd day after the initial event. Our clinical CCT correlation did not demonstrate the frequency of hypodense lesions reported by some authors. Furthermore an increased incidence of cerebral atrophy was found compared to the one reported previously.
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Migraine can be associated with hemiplegia, ophthalmoplegia, retinal and vertebrobasilar insufficiency, amnesia, confusion, altered perception, stupor and even death. Migrainous complications must be differentiated from structural lesions, metabolic disorders, convulsive states are cerebrovascular thromboembolism. Treatment of complicated migraine is directed toward prophylaxis of vasoconstriction. Agents that produce vasoconstriction, such as ergot preparations, and known migraine precipitants should be avoided in migraineurs.
A 62-year-old man with progressive cerebellar degeneration, corticospinal tract dysfunction, and mild dementia was found to have Hodgkin's disease. Serial computed tomographic studies revealed progressive cerebellar atrophy. The clinical features and neuroradiologic studies in nine previous cases are reviewed. A thorough search for lymphadenopathy should be made in patients with unexplained cerebellar degeneration.
The sudden onset of painless monocular blindness was the initial manifestation of a nasopharyngeal cancer in a 78-year-old woman. Computerized cranial tomography demonstrated encasement of the optic nerve by tumor. Examination of the nasopharynx and paranasal sinuses is important in patients with primary neuro-ophthalmologic complaints.
A patient with oculomotor palsy with pupillary sparing was shown angiographically to have an aneurysm of the internal carotid artery, which proved at operation to arise distal to the origin of the ophthalmic artery. It did not impinge on the oculomotor nerve at any point. The oculomotor palsy persisted postoperatively, and complete intrinsic and extrinsic ophthalmoplegia developed. Cytological studies of cerebrospinal fluid were then made and were positive for malignant lymphocytic leukemic cells. Despite the fact that an aneurysm causing oculomotor palsy with pupillary sparing has been reported, we recommend that nonaneurysmal causes be considered first in patients presenting with that neurological sign.
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Four cases of nasopharyngeal tumors are presented. The neurological complications of these lesions are discussed. The importance of the neuroradiological examination in different stages of these processes, particularly computed tomography, is emphasized.
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