Search PubMed⌕ Search

Biomedical subjects

J F Toole

Publications and source records attributed to J F Toole.

At least 91 records · Page 5Linked to original sources
PubMed1984

The transient global amnesia-migraine connection.

Twelve patients with transient global amnesia (TGA) were studied. Seven (58%) of the 12 had a headache during their attack; five (42%) of the 12 were migraineurs. Measurement of regional cerebral blood flow (rCBF) by the xenon Xe 133 inhalation method showed similar patterns of flow in five of the seven patients tested. The rCBF abnormalities were impaired vasomotor response in the watershed area between the middle cerebral artery and posterior cerebral artery territories, and/or focal ischemia in the inferior part of the temporal lobe. These rCBF abnormalities differed from those seen in patients with carotid transient ischemic attacks (TIAs) and vertebrobasilar TIAs. We speculate that the vasomotor phenomena in migraine may play a major role in the cause of TGA.

Aged↗
PubMed1984

Bilateral brachial paralysis from watershed infarction after coronary artery bypass. A report of two cases and review of the predisposing anatomic and physiological mechanisms.

Bilateral brachial paralysis and bilateral visual field defects developed after coronary artery bypass in two patients. These deficits, caused by cerebral watershed infarctions, probably resulted from global cerebral hypoperfusion during cardiopulmonary bypass, although bypass had been maintained with high perfusion flows (2.0 to 3.0 L/min/m2) and perfusion pressures from 50 to 90 mm Hg. No systemic hypoperfusion or hypotension occurred before or after cardiopulmonary bypass. Cerebral watershed infarctions occur predominantly in the boundary zones between the anterior, middle, and posterior cerebral arteries. In previous reports, watershed infarctions most often occurred as preterminal events in patients after sustained episodes of obvious hypoperfusion. The occurrence of such major neurological deficits in two patients without systemic hypoperfusion suggests that traditionally accepted flows and perfusion pressures do not assure adequate cerebral blood flow during cardiopulmonary bypass.

Angina Pectoris↗
PubMed1982

Nonbacterial thrombotic endocarditis. A neurologic perspective of clinicopathologic correlations of 99 patients.

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.

Adolescent↗
PubMed1982

Extracranial carotid artery arteriosclerosis. Diagnosis with continuous-wave Doppler and real-time ultrasound studies.

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.

Adult↗
PubMed1982

Position-dependent hemifacial spasm.

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.

Adult↗
PubMed1982

Cranial computerized tomography in carotid artery transient ischemic attacks.

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.

Aged↗
PubMed1981

Physician attitudes. Management of asymptomatic carotid artery murmur and transient ischemic attacks.

We polled 582 physicians to determine what their approach would be to management of an asymptomatic murmur at the carotid bifurcation and to carotid-distribution transient ischemic attack. We discovered a great disparity in attitudes attributable to location and type of practice. However, there was no difference attributable to age, and few differences were found with respect to measures of the physician's awareness of his own health. Physicians' attitudes and practices do not necessarily parallel scientific literature or recommendations of experts in the field.

Adult↗
PubMed1981

Monocular blindness in nasopharyngeal cancer.

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.

Aged↗
PubMed1981

Cephalic fibromuscular dysplasia in 32 patients: clinical findings and radiologic features.

The clinical and angiographic features of 32 patients with cephalic fibromuscular dysplasia (FMD) are reported. All of our patients were women, 78% of whom were between 41 and 70 years of age. At examination, 18 (56%) patients had the sudden onset of focal ischemic neurologic deficits. Seven (22%) patients had intracranial berry aneurysms, which ruptured in five patients but were asymptomatic in two. The most common angiographic pattern was the "string of beads" deformity, which involved both extracranial internal carotid arteries at or distal to the third cervical vertebral level. The vertebral artery was affected in six cases, while three cases had intracranial involvement. Less common angiographic findings in this series consisted of segmental fusiform dilation of the artery, and lesions in the form of a septum that extended across the lumen. Twelve patients were followed up for an average of four years. Progression of FMD lesions was shown in two of the six patients who had repeated angiograms. The literature contains reports of only nine cases of cephalic FMD with repeated angiograms, three of which demonstrated progression. Our experience suggests a beneficial role for surgery in patients with specific symptoms in the distribution of the affected vessel, when coexistent disease is negligible or absent.

Adult↗
PubMed1981

Clinical technique for identification of external carotid bruits.

A 66-year-old woman had an asymptomatic bruit over the right carotid bifurcation. Carotid Doppler and real-time ultrasound studies demonstrated an isolated 50 to 75% stenosis of the right external carotid artery. We devised a simple maneuver to determine which artery, internal or external carotid, caused the bruit.

Aged↗
PubMed1980

Transient global amnesia.

Transient global amnesia (TGA) was found in 41 of 76 patients admitted to the North Carolina Baptist Hospital with temporary disturbances of memory. Risk factors for stroke were present in 26 (63%) of these 41 patients, and additional risk factors developed in 9 (27%) of the 33 patients available for follow-up. Follow-up evaluation in 33 patients (80%) for periods ranging from 1 to 17 years (mean, 60.3 months) revealed a low rate of recurrence (18%) and a still lower rate of progression to stroke (6%). No transient ischemic attacks were reported during this period. In 2 patients, multiple recurrences of TGA ceased after treatment of the underlying condition (polycythemia in 1 case and myxomatous degeneration of the mitral valve in the other.

Adult↗