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Biomedical subjects

J Brismar

Publications and source records attributed to J Brismar.

At least 55 records · Page 3Linked to original sources

Subarachnoid hemorrhage of unknown origin: prognosis and prognostic factors.

The cases of 127 consecutive patients with subarachnoid hemorrhage (SAH), in whom cerebral panangiography revealed no cause for the bleeding nor any sign of an intraparenchymatous hemorrhage, were reviewed in a study of the long-term prognosis and the possible prognostic factors in this condition. Data for all 127 patients in the study were obtained, with an average follow-up period of 5.4 years. After the 1st week post-SAH, only three rebleeds had occurred. In all, 80% of the patients had returned to full activity, 91% to at least part-time work; if the patients with hypertension were excluded, these figures rose to 86% and 95%, respectively. Decreased wakefulness on admission related to a slightly poorer prognosis, whereas age and red blood cell count in the cerebrospinal fluid had no prognostic significance. Of those patients who, at the end of the 2nd week following the SAH, were fully awake and had not developed any symptoms of delayed cerebral ischemia (87% of all patients admitted), 88% returned to full activity, 97% to at least part-time work. The survival rate for this group, as well as causes of death, seem to be within the range for normal individuals. It should thus be possible to inform these patients (at least the normotensive ones) of the benignity of their condition, directly after normal angiography. Even among the patients who were able to return to full activity, symptoms attributable to the SAH were common: 22% experienced problems such as frequent headaches, vertigo, irritability, and increased fatigability.

Adolescent↗

Diagnosis of brain abscesses with indium-111-labeled leukocytes.

Sixteen patients with intracerebral mass lesions where computed tomography (CT) was not fully conclusive with respect to the differential diagnosis between brain tumor and abscess were examined with leukocyte brain scintigraphy (LBS). Autologous leukocytes were labeled with indium-111 oxinate and were reinjected intravenously; registration with a gamma camera was performed after 24 and 48 hours. In 10 of 11 patients with the final diagnosis of a brain tumor, no accumulation of radiolabeled leukocytes could be detected in the brain. In 4 of 5 patients with the final diagnosis of brain abscess, scintigraphy showed a pronounced increase of focal activity corresponding to the lesion demonstrated with CT. The reasons for the one false-positive and the one false-negative result are discussed, and it is concluded that LBS (a) can be used to detect intracranial infection and (b) may be a useful diagnostic tool for distinguishing between brain abscess and brain tumor.

Adult↗

Clinical comparison of bone scintigraphy with 99Tcm-DPD, 99Tcm-HDP and 99Tcm-MDP.

The bone-imaging agents MDP, DPD and HDP were compared radiochemically (only minor differences were found) in 12 patients with prostatic and 12 patients with breast carcinoma. Each patient received both MDP and either DPD or HDP. The scintigraphic examinations were compared visually and quantitatively. The uptake ratio normal bone/soft tissue was higher for DPD and HDP than for MDP. The ratio pathologic bone/normal bone was highest for MDP, particularly for prostatic carcinoma. The differences in this ratio for breast carcinoma were in general non-significant. The observed differences were minor and of little practical importance.

Aged↗

External and biopsy determination of preoperative Tc-99m MDP femoral-head labeling in fracture of the femoral neck: concise communication.

In 30 fresh fractures of the femoral neck, the preoperative femoral-head tracer uptake in Tc-99m MDP scintimetry was compared with the uptake of peroperatively obtained femoral-head biopsies and correlated to intravital bone staining by tetracycline, infused concurrently. Bone uptakes of Tc-99m MDP and tetracycline were shown to correlate well. Total absence of Tc-99m MDP uptake in the femoral-head biopsy corresponded to a scintigraphic uptake ratio of 0.7 (fractured over contralateral head), whereas a normal Tc-99m MDP biopsy uptake corresponded to a ratio of 1.5. This suggests that in Tc-99m MDP scintimetry of a normal hip, less than half of the emission ascribed to the femoral head is derived from the femoral head itself.

Adult↗

Late cerebral arterial spasm: the cerebrovascular response to hypercapnia, induced hypertension and the effect of nimodipine on blood flow autoregulation in experimental subarachnoid hemorrhage in primates.

1. Late cerebral arterial spasm was induced by repeated injections of autologous blood in a total amount of 14-33 ml into the basal cisterns of baboons to mimick subarachnoid hemorrhage (SAH). Regional cerebral blood flow (CBF), sagittal sinus pressure, cerebral arterial caliber from angiograms, and cerebral metabolic rate of oxygen (CMRO2) were measured before and after the experimental SAH to determine responses to hypercapnia and induced hypertension. The effect of the calcium antagonist, Nimodipine, on CBF autoregulation pre- and post-SAH was tested. 2. One week after the blood injections were started there was about 10-20% reduction, depending on territory measured, in the arterial diameter of the carotid and vertebral systems. This was associated with an 18% reduction in CBF and 9% decrease in the brain metabolism. 3. During hypercapnia before and after experimental SAH the flow increased with a mean of 3.7 and 1.8 ml, respectively, for each mm Hg elevation of PaCO2. In control animals, graded angiotensin-induced hypertension did not overtly affect CBF. Following SAH, the CBF autoregulation was impaired in 5 of 6 animals tested. 4. I.v. infusion of Nimodipine markedly curtailed the CBF autoregulation in pre-SAH animals and, to a somewhat slighter extent, also in post-SAH animals.

Animals↗

Carotid fibromuscular dysplasia and paresis of lower cranial nerves (Collect-Sicard syndrome). Case report.

A patient suffered the acute onset of unilateral pareses of the ninth through 12th cranial nerves (Collet-Sicard syndrome). Ipsilateral retrograde jugular phlebography and carotid angiography revealed irregular aneurysmal changes of the internal carotid artery at the base of the skull, causing compression of the internal jugular vein below the jugular foramen. This finding is discussed in relation to the clinical symptoms and signs, and possible mechanisms are examined. Family history as well as the clinical and roentgenological findings were compatible with a diagnosis of fibromuscular dysplasia.

Adult↗

Computer tomography in superior sagittal sinus thrombosis.

Three angiographically confirmed cases and one possible case of aseptic superior sagittal sinus thrombosis had CT findings ranging from apparently normal to single or even bilateral multiple intracerebral hemorrhages surrounded by low-attenuation regions. The latter finding, in particular, suggests a possible superior sagittal sinus thrombosis.

Adult↗

Angiography of chemodectomas of the neck.

In 18 chemodectomas of the neck (6 carotid body tumours, 1 vagal body tumour and 11 tympanojugular tumours) the arterial supply and circulatory characteristics were evaluated at angiography. The arterial supply of the carotid body tumours was derived from all adjacent vessels including direct carotid body branches of the proximal external carotid artery. The arterial supply in tympanojugular tumours constantly came from both the ascending pharyngeal and retroauricular arteries and often also from the anterior tympanic artery. Other branches contributed less constantly and only to a minor degree, except for the vertebral artery in cases with tumour extension intracranially. The circulatory characteristics were constant in the series: a short arterial phase was rapidly followed by a phase of relatively long duration with marked, somewhat granular accumulation of contrast medium and also by an early filling of draining veins. The planning of the angiographic procedure in cases of chemodectoma is discussed.

Adult↗

Benign brainstem hematoma.

Brainstem hematoma is generally considered a very rare condition with a grave prognosis. This report presents two patients with extensive brainstem hematomas who both recovered without major sequele. A brainstem hematoma is often impossible to differentiate from an infarction despite angiographic and cerebrospinal fluid examinations, but is readily disclosed by computerized tomography. It is suggested that the seriousness of the prognosis in brainstem hematoma may earlier have been exaggerated as there may have been a tendency to classify cases exhibiting a good recovery as infarcts, while the diagnosis hematoma was reserved for cases verified at autopsy.

Adult↗

Computer tomography as the primary radiologic procedure in acute subarachnoid hemorrhage.

CT was performed in 149 patients with acute subarachnoid hemorrhage and clinical findings consistent with an aneurysm rupture, and was found informative in most cases when performed within one week after the hemorrhage. CT disclosed in 29 per cent of cases other causes for the hemorrhage than a ruptured aneurysm (intracerebral hemorrhage, tumor, trauma, infarct) and an extensive angiographic evaluation could be omitted. In those patients where the hemorrhage was caused by an aneurysm rupture, the distribution of extravasated blood in the subarachnoid space and the brain parenchyma usually indicated the aneurysm location--angiography could thus be restricted to the proper vessel. These capabilities of CT are sufficient to economically motivate its routine use as the primary investigation in cases with an acute subarachnoid hemorrhage.

Acute Disease↗

Intra-arterial chemotherapy of malignant head and neck tumours with superselective angiographic technique.

A technique is described for repeated superselective angiographic infusion of anticancer drugs into advanced malignant tumours of the head and neck region. The technique allows for a high concentration of the drug in the tumour and, furthermore, it is possible to ensure that the infused anticancer drug adequately reaches the tumour. Mitomycin C was given to 15 patients with advanced malignant tumours of the head and neck region. In 16 patients a partial remission was seen, and in another 5 patients a subjective improvement was reported. No complications were observed.

Adult↗

Pulsatile tinnitus and therapeutic embolization.

Fifteen patients with disabling pulse-synchronous tinnitus were investigated with super-selective angiography demonstrating an arteriovenous malformation in 8 cases, chemodectoma of the jugular bulb in 3, and a local arterial stenosis in one case. In 12 of these cases the murmur could be registered objectively, while in the 3 cases with a negative angiographic finding no such murmur could be heard, an observation which may be of importance when selecting patients for further angiographic examination. The cases with a tumour and those with an arteriovenous malformation were all treated with gelatin sponge embolizatioected cases embolization is recommended alone or in combination with surgery.

Adult↗

Selective intra-arterial cytotostatic injections in malignant head and neck tumors.

Regional intra-arterial drug administration has been advocated in order to reduce the risks of systemic complications in conjunction with systemic tumor chemotherapy. We have been using superselective angiographic techniques to administer the antitumor drug mitomycin C directly into the feeding arteries of the tumor in 15 patients with advanced malignant head and neck tumors. No complications were observed. In five patients the tumor decreased significantly in size, in four patients, tumor cell necrosis was found. A marked decrease in pain was reported by nine of the 15 patients.

Adult↗

Impact of CT in the neurosurgical management of intracranial tumors.

A total of 103 brain tumor patients examined with CT, radionuclide brain scan, and angiography or pneumoencephalography, and all surgically verified, were studied to evaluate the impact of CT on the neurosurgical handling of brain tumors. CT alone was usually sufficient for optimal handling of astrocytoma patients, angiography in most meningioma cases, and pneumoencephalography in cases with sellar, suprasellar, and some other midline tumors. Information obtained only through CT sometimes altered the therapy. Sometimes it led to biopsy instead of a meaningless attempt at a 'radical' excision: in other cases it permitted a 'radical' excision otherwise not possible.

Adolescent↗

Recurrent cavernous branches of the ophthalmic artery.

Two arteries arising from the orbit, coursing through the superior orbital fissure to supply the cavernous region and the tentorium, may be identified at angiography. The radiologic and anatomic appearances of these arteries are discussed on the basis of the embryologic development.

Animals↗