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Biomedical subjects

J van Gijn

Publications and source records attributed to J van Gijn.

At least 271 records · Page 15Linked to original sources
PubMed1988

Long-term follow-up of 71 patients with thunderclap headache mimicking subarachnoid haemorrhage.

Seventy-one patients with sudden, severe, and unusual headache, but with normal computerised tomographic scan and cerebrospinal fluid, were followed for an average of 3.3 years. Twelve patients (17%) had identical recurrences, but again without evidence of subarachnoid haemorrhage. Findings on cerebral angiography, performed in four patients after the first attack and in two patients after recurrent episodes, were normal. Thirty-one (44%) of the seventy-one patients subsequently had regular episodes of tension headache or common migraine. If the computerised tomographic scan and cerebrospinal fluid findings are normal, this type of headache can be regarded as a benign symptom, and cerebral angiography is not indicated.

Adolescent↗
PubMed1988

Cerebellar stroke.

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Cerebellar Diseases↗
PubMed1988

Warning headache in aneurysmal subarachnoid hemorrhage. A case-control study.

Thirty consecutive patients with aneurysmal subarachnoid hemorrhage (SAH), 20 patients with ischemic stroke, and 100 controls were extensively interviewed about previous episodes of sudden headache, according to a standard pro forma. Thirteen patients with SAH (43%) had a history of a forewarning headache, compared with only one of the patients with ischemic stroke and none of the controls. The interval from the warning headache to the admission rupture was between one week and two months in all patients but one with SAH. Only half of the 13 patients with a warning headache consulted their physician. The outcome was slightly worse in patients with a warning headache, but the differences did not reach statistical significance. These data emphasize the frequent occurrence of warning headaches in SAH. Measures to increase the recognition of sudden headaches should be considered.

Diagnostic Errors↗
PubMed1988

Histological investigations of muscle atrophy and end plates in two critically ill patients with generalized weakness.

We describe pathological alterations at the light microscopical and ultrastructural level of motor end plates and muscle fibres in 2 critically ill patients with generalized muscular atrophy and weakness. Axonal degeneration of intramuscular nerve fibres was not conspicuous. The sural nerve in one patient showed only minor abnormalities. There was a marked atrophy of type 1 and especially type 2 muscle fibres. Nodal and ultraterminal nerve sprouts were seen in both biopsies. Motor end plates showed features of regeneration. They were enlarged in one patient. This patient was treated for a prolonged period with vecuronium bromide. Pharmacological denervation may explain the presence of fibrillation potentials, and, partially, of the histological abnormalities. Another factor which must be considered is inhibition of neuromuscular transmission by antibiotics. In addition to disuse atrophy and a minor degree of axonal neuropathy, the production of muscle proteolytic factors may be involved in the rapidly occurring massive loss of muscle fibre size in critically ill patients.

Atrophy↗
PubMed1988

Cerebellar hemorrhage: diagnosis and treatment.

We have reviewed the records of 22 patients with spontaneous cerebellar hemorrhage. One question that we considered was whether the increased recognition of this disorder, since the introduction of computed tomography (CT) scanning, had brought about a change in the associated signs and symptoms, as compared with previous series. No such change was found. Nine patients died, four after operation (ventricular shunting in one, clot evacuation in one, both procedures in two patients). The five other patients were considered inoperable, because they showed signs of compression of the caudal brainstem. It is improbable that any of these five could have been saved by immediate ventricular drainage, advocated by some as the only treatment. Thirteen patients were treated conservatively and recovered, although four had a hematoma larger than 3 cm. All these patients had a Glasgow coma scale score of 11 points or more. The level of consciousness may be a better guide in management than the size of the clot.

Adult↗
PubMed1988

Outcome of aneurysmal subarachnoid hemorrhage in patients 66 years of age and older.

The outcome at three months after aneurysmal SAH in a group of older patients and a group of younger patients is compared. The patients were admitted within 72 hours of their SAH. Of 61 patients 66 years of age and older, comprising 13% of the whole patient group, 52% died, 12% remained dependent and 36% became independent. In the younger group, 55% had an independent outcome (p less than 0.01). In contrast to what we expected in the older patient group, not extracranial, but intracranial events (re-bleeds, infarcts, hydrocephalus) were by far the most frequent cause of deterioration.

Age Factors↗
PubMed1988

The effect of fludrocortisone acetate on plasma volume and natriuresis in patients with aneurysmal subarachnoid hemorrhage.

In order to prevent hypovolemia fludrocortisone acetate treatment was started on admission in 39 consecutive patients with CT evidence of subarachnoid hemorrhage. In 28 patients an aneurysm was proven or probable, and in 21 of these the effects of fludrocortisone acetate on sodium balance and on plasma volume could be studied. In the first five days plasma volume decreased more than 10% in four patients, decreased less than 10% in five and increased in 12. The cumulative sodium balance measured over five days was negative in seven of the 21 patients. Plasma renin values were measured in 15 of the 21 patients and also in stored samples of 18 patients who were not treated with fludrocortisone acetate. Plasma renin values were less high in patients treated with fludrocortisone acetate, regardless of the presence of a negative sodium balance. In three of the 39 patients signs of pulmonary edema developed, and low serum potassium values were observed in four of the 21 patients. In comparison with previous studies, these findings suggest that fludrocortisone acetate is an effective method of decreasing the incidence of volume depletion and negative sodium balance.

Blood Volume↗
PubMed1988

The diagnosis of Horner's syndrome.

We studied the accuracy of the clinical diagnosis of Horner's syndrome in 62 patients. The final criterion was serial photography of the darkness reflex of the pupil. This technique confirmed oculosympathetic dysfunction in only 50%. The positive predictive value of the clinical diagnosis could be increased to more than 80% by measuring the degree of miosis and ptosis on single photographs, or by assuming independent confirmation of the clinical diagnosis by a second observer. However, the chance that a patient who is judged normal in this way does still have oculosympathetic dysfunction remains 25% (photographs) to 40% (second observer). Testing with cocaine is more specific and slightly more sensitive than estimating or measuring the degree of miosis and ptosis.

Dark Adaptation↗
PubMed1988

Cerebral infarction does not occur typically at night.

In a hospital-based series of 66 consecutive patients with non-progressive cerebral infarction, the time of onset and the type of infarction on computed tomography were studied retrospectively. Forty-six (78%) patients suffered cerebral infarction between 6 am and 6 pm. Only five patients (8%) had their infarct between midnight and 6 am. Only three patients had a watershed-infarct, and these occurred during the daytime. Our results do not support the belief that atherothrombotic brain infarction is largely determined by haemodynamic factors.

Cerebral Arteries↗
PubMed1988

Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage.

Using logistic regression, we analyzed the predictive value of a number of entry variables with respect to the outcome variables delayed cerebral ischemia, rebleeding, and poor outcome (death or severe disability) in patients with aneurysmal subarachnoid hemorrhage. The entry variables were clinical condition on admission (grades on the Glasgow Coma Scale, Hunt and Hess system), the amount of subarachnoid and intraventricular blood and the presence of hydrocephalus on the admission computed tomogram, and antifibrinolytic treatment with tranexamic acid. We used data from a prospectively studied population of 176 patients admitted within 72 hours after subarachnoid hemorrhage. The risk of delayed cerebral ischemia was best predicted by the amount of subarachnoid blood, intraventricular blood, and antifibrinolytic treatment irrespective of clinical condition and hydrocephalus. The site of delayed cerebral ischemia was not related to the location of the subarachnoid hemorrhage. Antifibrinolytic treatment was the only entry variable (negatively) predicting the risk of rebleeding. Death or severe disability after 3 months was best predicted by the amount of subarachnoid blood and the initial clinical condition reflected by the grade on the Glasgow Coma Scale.

Blood↗
PubMed1988

Interobserver agreement for the assessment of handicap in stroke patients.

Interobserver agreement for the assessment of handicap in stroke patients was investigated in a group of 10 senior neurologists and 24 residents from two centers. One hundred patients were separately interviewed by two physicians in different combinations. The degree of handicap was recorded by each observer on the modified Rankin scale, which has six grades (0-5). The agreement rates were corrected for chance (kappa statistics). Both physicians agreed on the degree of handicap in 65 patients; they differed by one grade in 32 patients and by two grades in 3 patients. Kappa for all pairwise observations was 0.56; the value for weighted kappa (with quadratic disagreement weights) was 0.91. Our results confirm the value of the modified Rankin scale in the assessment of handicap in stroke patients; nevertheless, further improvements are possible.

Activities of Daily Living↗
PubMed1988

Carotid angiography in patients with lacunar infarction. A prospective study.

We prospectively studied the results of carotid angiography in 45 patients with transient or nondisabling neurologic deficits caused by lacunar infarction in the internal capsule or corona radiata and demonstrated by computed tomography. An ipsilateral stenosis at the bifurcation of the internal carotid artery was found in 14 patients (31%, 95% confidence limits 18-47%), seven of whom also had stenosis of the contralateral internal carotid artery. In previous studies an average of 65% of patients with transient hemispheric deficit had internal carotid artery stenosis or occlusion. Hypertension and hypertensive retinal vasculopathy assessed by fundus photographs were found in most patients, but not significantly more often in the patients without internal carotid artery stenosis. Our findings support the notion that small vessel disease rather than emboli from the carotid bifurcation is the most common cause of lacunar infarction.

Adult↗
PubMed1988

Treatment of intact familial intracranial aneurysms: a decision-analytical approach.

Clinical decision analysis is applied to the treatment decisions for four patients with unruptured familial aneurysms. The surgical treatment was uneventful in all patients except one with mild mixed aphasia and facial weakness postoperatively; these deficits disappeared in less than 2 years. In the decision analysis, discounted Quality Adjusted Life Years are used as an outcome measure. Probability estimates are extracted from the literature when available. It is concluded that the decision to treat the aneurysm neurosurgically in three of the four patients was correct. In two of these three patients, the decision cannot be altered by plausible changes in estimated data. For the third patient, only the combination of a low probability of rupture, a high surgical mortality and morbidity, and high discount favors conservative treatment. In the fourth patient, a toss-up situation exists. More knowledge of the probability of rupture, the probability of the development of other aneurysms, and the results of operation on intact intracranial aneurysms would have made the analysis more accurate. Clinical research should address these issues.

Adult↗