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J M Mercader

Publications and source records attributed to J M Mercader.

At least 37 records · Page 2Linked to original sources
PubMed1996

The "target sign": is it a specific sign of CNS tuberculoma?

In brain lesions, the target sign has been defined as a central nidus of calcification or central enhancement surrounded by a ring of enhancement. It has been considered a pathognomonic finding of central nervous system (CNS) tuberculoma. The purpose of this report is to demonstrate that the target sign related to central enhancement is a nonspecific finding and may lead to erroneous diagnosis of CNS tuberculoma.

AIDS-Related Opportunistic Infections↗
PubMed1995

Magnetic resonance imaging of paraganglioma of the cauda equina.

The authors describe atypical magnetic resonance imaging (MRI) findings for pathologically proven paraganglioma of the filum terminale in a 27-year-old man. MRI showed an intradural tumour, which enhanced after administration of gadolinium and which showed evidence of cystic areas. Hemosiderin rings and vessels were not observed.

Adult↗
PubMed1994

An unusual frontal ganglioglioma: CT and MRI.

We describe a ganglioglioma with atypical radiological appearances, in an uncommon location. CT showed a nonenhancing low-density lesion without calcification. On MRI the lesion gave nonspecific low signal on T1-weighted images and high signal on T2-weighted images. The tumour was in the right frontal lobe, producing bulging and thinning of the calvarium.

Adolescent↗
PubMed1994

Correlation of MRI hippocampal volume analysis, video/EEG monitoring and inter- and postictal single photon emission tomography in refractory focal epilepsy.

The effectiveness of surgery in patients with refractory complex partial seizures depends on accurate localisation of the epileptogenic zone. To assess the correlation between magnetic resonance imaging (MRI) hippocampal volume measurements. Tc 99m-hexamethyl-propyleneamineoxime inter- and postictal single photon emission computed tomography (SPECT) and clinico-electrophysiological (video/EEG) localisation of the epileptogenic zone we prospectively studied 16 consecutive patients with refractory complex partial seizures and no significant abnormality on standard MRI. Each test was interpreted blindly by independent observers. Eight patients (50%) had asymmetrical hippocampal volumes indicative of unilateral atrophy; correlation with the video/EEG and postical SPECT changes was very high (100% with definitive video/EEG localisation, 75% with interictal EEG and 83% with postictal SPECT). Moreover, the left/right hippocampal ratio was able to differentiate temporal from extratemporal video/EEG localisations. Postictal SPECT showed regional lateralised changes in 9 (64%) of 14 technically satisfactory studies. Disagreement between the video/EEG and postictal SPECT was seen with two extratemporal and one bitemporal foci.

Adolescent↗
PubMed1993

[Surgical treatment combined with radiotherapy and chemotherapy in an unselected population of patients with malignant glioma].

BACKGROUND: Malignant gliomas are tumors of bad prognosis with a mean survival of 12 months. In the present report 74 patients diagnosed of malignant glioma were studied with the following aims: 1) evaluate how many could receive combined radiotherapy (RT) and chemotherapy (BCNU) treatment following surgery and 2) analyze whether the patients treated presented a survival similar to that described in the literature. METHODS: The records of 74 patients operated on for malignant glioma between 1987-1990 and consecutively included in a protocol of treatment with RT and BCNU were reviewed. RESULTS: Out of the total of 74 patients, 29 (39%) were considered evaluable. The medians of progression free interval and survival were of 10 and 16 months, respectively in these patients. Forty-five (61%) patients could not fulfill the protocol mainly because of tumoral progression prior to completion of RT and severe post surgical complications. The evaluable patients were significantly younger (p = 0.004) and tumoral exeresis wider (p = 0.0003) than in those who were not evaluable. CONCLUSIONS: Most of the patients operated on for malignant glioma may not receive treatment considered as standard, principally due to tumor progression in the first weeks following surgery and the presence of severe post surgical complications.

Adult↗
PubMed1993

Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure.

Hyperintense globus pallidus on T1-weighted MRI is present in most patients with advanced liver disease. We evaluated the relationship between the signal intensity of the globus pallidus and clinical or laboratory data of 77 patients eligible for liver transplantation. There was a significant correlation between the intensity of the signal and the Child-Pugh score (as indication of severity of liver disease), presence of postural tremor, previous episodes of variceal bleeding or hepatic encephalopathy, prothrombin activity, serum aspartate and alanine aminotransferase, bilirubin, and the indocyanine green (ICG) hepatic clearance, a very sensitive marker of liver function. The multivariate analysis disclosed that the ICG hepatic clearance and previous episodes of variceal bleeding were independently associated with the signal intensity in the globus pallidus. MRI repeated in 21 patients 10 to 20 months after transplant showed a disappearance of the lesion in all cases. We conclude that the hyperintense globus pallidus is secondary to the severity of the liver disease, and is reversible when liver function returns to normal.

Adult↗
PubMed1992

[Primary cerebral lymphoma in 10 patients with AIDS. Comparative clinico-radiologic study with cerebral toxoplasmosis, cerebral tuberculoma and primary cerebral lymphoma in non-immunodepressed patients].

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is the second cause of cerebral masses in patients with the acquired immunodeficiency syndrome (AIDS). The present study evaluated the possible presence of clinical or radiologic signs permitting differentiation of AIDS patients and PCNSL from those with cerebral masses of other etiologies. METHODS: Clinical history and cranial computerized tomography (CT) of patients with PCNSL and AIDS from the Hospital Clinic i Provincial in Barcelona were reviewed. Results were compared with those of patients with PCNSL without evidence of immunosuppression and with those with AIDS and cerebral toxoplasmosis or tuberculoma diagnosed during the same period. RESULTS: Of 685 patients with AIDS, 10 were identified with PCNSL. The clinical picture was not different to that observed in patients with AIDS and cerebral toxoplasmosis or tuberculomas. In contrast to PCNSL in non immunodepressed patients, the cerebral CT in patients with PCNSL and AIDS demonstrated hyperdense lesions in only 44% and contrast enhancement was not homogeneous in any case. These characteristics were similar to those observed in the CT of patients with cerebral toxoplasmosis or tuberculoma with the exception that only 8% of the lesions by toxoplasmosis were spontaneously hyperdense. CONCLUSIONS: The clinical-radiological data of primary central nervous system lymphoma in patients with the acquired immunodeficiency syndrome are similar to those observed in other etiologies. However, the presence of a sole spontaneously hyperdense region in cranial computerized tomography is more suggestive of primary central nervous system lymphoma than cerebral toxoplasmosis.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Postherpetic vasculopathy. A study of 3 cases in immunosuppressed patients].

We report three cases of postherpetic vasculopathy in immunologically compromised patients. Two had ophthalmic herpes zoster, contralateral to the physical signs, and the third case developed after disseminated herpes zoster. The initial CT images consisted of small ischemic infarcts in capsular regions and basal ganglia. The arteriography showed images consistent with vasculitis or thrombosis of great vessels of the Willis' polygon, which were ipsilateral to the herpetic lesion in two cases. In one patient the neurological defect remained stable, while the other two developed new ischemic episodes, all in the same cerebral hemisphere. It can be assumed from the delayed development of neurologic disease after cutaneous lesions that some cases go unnoticed if the zoster infection is not specifically looked for in retrospect.

Adult↗
PubMed1990

[Encephalic toxoplasmosis in patients with the acquired immunodeficiency syndrome. A clinico-radiological study and the therapeutic results in 78 cases].

During a 40-month period 78 episodes of encephalic toxoplasmosis (ET) were diagnosed in 57 patients among 394 with acquired immunodeficiency syndrome (AIDS) (based on CDC criteria) in the Hospital Clinic from Barcelona. 38 patients were parenteral drug abusers (66.7%), 17 were homosexual males (29.8%) and 2 were heterosexual females (3.5%). ET was the first opportunistic infection in 28 patients (49.1%). The most common symptoms at the time of diagnosis were focal neurological signs (62.8%) and fever (52.6%). Usually, computed tomography showed single or multiple hypodense lesions (70.3%) with ring-like (46.1%) or nodular (28.3%) uptake. Serology (indirect immunofluorescence) was diagnostic in only 24 cases (42.1%). The acute episodes were treated with the combination pyrimethamine/sulfadiazine (P/S) during 3-6 weeks, and folinic acid was associated. If the patient had previous allergy to sulfonamides or allergy developed during the acute phase, clindamycin (C) was given instead of S. The patients surviving the acute episode (49, 86, 0%) underwent, if they consented, maintenance therapy with P/S two days per week (15 patients) or with C if sulfonamide allergy was present (10 patients). No relapse was observed in those receiving P/S, but 40% of those treated with P/C relapsed. It was concluded that ET is a common opportunistic infection in the AIDS patients, that the treatment of the acute phase with P/S or with P/C is satisfactory, and that maintenance therapy with P/S two days per week may be effective to prevent relapses.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Central nervous system toxoplasmosis in AIDS patients: efficacy of an intermittent maintenance therapy.

Fifty-five episodes of central nervous system (CNS) toxoplasmosis developing in 43 of the 329 AIDS cases seen at our institution were diagnosed during a 34-month period and were prospectively studied. Acute episodes were treated with a pyrimethamine/sulfadiazine (P/S) combination for a mean of 21 days. Because of a previously known major allergy to sulfonamides, three episodes were treated with clindamycin instead of sulphadiazine. In those patients who accepted maintenance therapy, a combination of P/S or pyrimethamine and clindamycin (P/C) was administered 2 days per week. Thirty-six patients (83.7%) survived the first episode. Four of these 36 were lost to further study. Six of the 12 (50%) who decided not to undergo maintenance therapy relapsed (mean follow-up: 12 months). Fourteen patients were given P/S and none relapsed while they were on maintenance therapy (mean follow-up: 10.3 months). Six patients received an intermittent maintenance treatment with P/C and one relapsed 2 months after starting the maintenance therapy (mean follow-up: 13.7 months). We conclude that an intermittent (2 days per week) maintenance treatment for CNS toxoplasmosis with P/S was effective in preventing relapses, although prospective randomized studies remain to be done.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Spinal cord metastasis of carcinoma of the lung: evaluation of magnetic resonance and computed tomography in its diagnosis].

A patient with lung adenocarcinoma had progressive myelopathy. Computed tomography of spinal cord with intravenous contrast and magnetic resonance scan were negative. At autopsy, a spinal cord metastasis was found. In patients with cancer and clinical suspicion of spinal cord metastasis, palliative treatment with radiotherapy is indicated in spite of negative radiological investigations, so as to prevent the progression of myelopathy.

Adenocarcinoma↗
PubMed1989

[Hemangioma of the vertebrae: contribution of magnetic resonance to its study].

Vertebral hemangioma is a benign vascular tumor predominantly involving the dorsolumbar spine. Although most of these tumors are asymptomatic, they may result in radiculopathy and/or compressive myelopathy. Plain X-ray films and computed tomography (CT) generally permit the diagnosis by showing characteristic images with hypertrophic bone trabeculation in the vertebral body. We report three patients with vertebral hemangioma in which CT was diagnostic. Magnetic resonance (MR) with low intensity field was inferior to CT for the suggestion of the diagnosis of hemangioma, but had a better definition for subarachnoid space obliteration and spinal cord compression.

Adult↗
PubMed1979

Angiographic diagnosis of cerebral oedema.

Cerebral oedema is usually associated with brain vascular lesions, such as infarction, neoplasms, angiitis, thrombophlebitis, etc. and we consider that angiographic examination is essential for the diagnosis. In this paper we analyse the angiographic signs of cerebral oedema and the differential diagnosis between oedema and any associated lesions. We also consider that it is very important to establish a diagnosis between primary oedema and hydrocephalus with a view to establishing the correct treatment in each case.

Brain Edema↗