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Biomedical subjects

J van Gijn

Publications and source records attributed to J van Gijn.

At least 325 records · Page 18Linked to original sources
PubMed1982

The time course of aneurysmal haemorrhage on computed tomograms.

We performed serial CT scans in a prospective series of 100 patients with a ruptured aneurysm who were first scanned within 2 days of the haemorrhage. In all patients the early CT scan showed evidence of extravasated blood. In 96 patients the source of bleeding was clearly at the base of the brain, and 32 of these had a haematoma. We estimated from the results of 139 repeat scans that the probability of recognizing an aneurysmal haemorrhage on CT is 85% after 5 days, 50% after 1 week, 30% after 2 weeks (mostly patients with haematomas), and almost nil after 3 weeks.

Hematoma↗
PubMed1982

Horner's syndrome. Criteria for oculosympathetic denervation.

The darkness reflex of the pupil was examined by taking photographs under standard bright lighting conditions, and after 5 and 10 s of uninterrupted darkness. The study involved 40 control subjects and 12 patients with a presumed Horner's syndrome. No control subject showed a dilatation lag (compared with the other eye) of 0.5 mm or more in the first 5 s of darkness. This criterion allows exclusion of a fortuitous combination of "physiological anisocoria" and "physiological ptosis".

Adolescent↗
PubMed1982

Blood pressure does no predict lacunar infarction.

We studied the relation between blood pressure and type of cerebral infarction (large or lacunar) in 134 patients with acute hemispheral infarcts that were detectable by computed tomography and that could not be attributed to causes other than atherothrombotic arterial disease. Lacunae were present in 26 patients, and systolic blood pressures were higher in this group than in the 108 patients with large infarcts. The overlap was so wide, however, that large infarcts predominated at every level of blood pressure. The presence of a lacune can be inferred only from the combination of clinical signs and, most important, computed tomography.

Blood Pressure↗
PubMed1980

Computed tomography in the diagnosis of subarachnoid haemorrhage and ruptured aneurysm.

One hundred consecutive patients with subarachnoid haemorrhage were investigated by computed tomography (CT) within five days of the bleeding. In 19 cases CT indicated other sources than a ruptured aneurysm, most often a cerebellar haematoma. The other 81 patients did not all undergo angiography. It could be estimated by extrapolation that an aneurysm would be demonstrated in 66 of the 68 patients in whom CST showed extravasated blood in the basal cisterns, and in only five of the remaining 13 patients. In a consecutive series of 50 patients with bleeding from a verified aneurysm, CT showed some extravasated blood in all cases and a haematoma in half of these. In 74% the site of the haemorrhage correctly predicted the site of the ruptured aneurysm. Intravenous contrast medium visualized the aneurysm on CT in 15 of 25 cases; this can improve the identification of the bleeding aneurysm to 88%. Rebleeding occurred in 21 patients, and was obvious in Ct in 19. If available, CT should be the first investigation in patients with first and recurrent subarachnoid haemorrhage.

Hematoma↗
PubMed1980

Computerized tomography in subarachnoid hemorrhage: difference between patients with and without an aneurysm on angiography.

Fifty patients with spontaneous subarachnoid hemorrhage were investigated by both computerized tomography (CT), within 5 days of onset, and complete cerebral angiography. CT showed blood in the basal cisterns in 38 of the 42 patients with a demonstrable aneurysm, but in only 1 of 8 patients with a negative angiogram (p less than 0.001). This means that: (1) blood in the basal cisterns on CT almost certainly indicates a ruptured aneurysm, and (2) unexplained subarachnoid hemorrhages are unlikely to be caused by occult basal aneurysms.

Cerebral Angiography↗
PubMedDate not supplied

Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study.

BACKGROUND: Determinants of survival and of risk of vascular events after transient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patients after TIA or minor ischaemic stroke (Rankin grade< or =3), after 10 years or more. METHODS: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial (recruitment in 1986-89; arterial cause of cerebral ischaemia). We included 24 hospitals in the Netherlands that recruited at least 50 patients. Primary outcomes were all-cause mortality and the composite event of death from all vascular causes, non-fatal stroke, and non-fatal myocardial infarction. We assessed cumulative risks by Kaplan-Meier analysis and prognostic factors with Cox univariate and multivariate analysis. FINDINGS: Follow-up was complete in 2447 (99%) patients. After a mean follow-up of 10.1 years, 1489 (60%) patients had died and 1336 (54%) had had at least one vascular event. 10-year risk of death was 42.7% (95% CI 40.8-44.7). Age and sex-adjusted hazard ratios were 3.33 (2.97-3.73) for age over 65 years, 2.10 (1.79-2.48) for diabetes, 1.77 (1.45-2.15) for claudication, 1.94 (1.42-2.65) for previous peripheral vascular surgery, and 1.50 (1.31-1.71) for pathological Q waves on baseline electrocardiogram. 10-year risk of a vascular event was 44.1% (42.0-46.1). After falling in the first 3 years, yearly risk of a vascular event increased over time. Predictive factors for risk of vascular events were similar to those for risk of death. INTERPRETATION: Long-term secondary prevention in patients with cerebral ischaemia still has room for further improvement.

Aged↗
PubMedDate not supplied

A new type of extracranial/intracranial bypass for recurrent haemodynamic transient ischaemic attacks.

Since the completion of the international extracranial/intracranial (EC/IC) bypass study in 1985, no treatment of proven value has become available for patients with symptomatic carotid artery occlusion other than treatment with antithrombotic medication. However, in this trial the causal factors of cerebral ischaemia were not part of the inclusion criteria and also patients with single episodes only were included. We report successful Excimer laser-assisted high flow EC/IC bypass surgery in a patient with frequent transient ischaemic attacks associated with a low flow state of the cerebral circulation. In the 1.5 years after the operation the patient has never again experienced any symptoms of cerebral ischaemia. In addition there was improvement in cerebral blood flow, measured by magnetic resonance spectroscopy and hexamethylpropyleneamine oxime single photon emission computed tomography. Certain patients with occlusion of the internal carotid artery may benefit from EC/IC bypass surgery, in particular the Excimer laser-assisted high-flow bypass, that is, if recurrent (transient) ischaemic attacks are associated with compromised cerebral perfusion.

Aged↗
PubMedDate not supplied

Interobserver agreement for the diagnosis of transient ischemic attacks.

The interobserver agreement for the diagnosis of a cerebral transient ischemic attack (TIA) was investigated in a pool of eight senior and interested neurologists from the same department. They interviewed 56 patients in alternating pairs. The diagnosis was based on internationally accepted criteria. The agreement rates were corrected for chance (kappa statistics). Both neurologists agreed that 36 patients had a TIA and 12 had not, but they disagreed about 8 patients (kappa = 0.65; for perfect agreement kappa would be 1.0). The vascular territory (carotid or vertebrobasilar) was agreed upon in only 24 of the 36 patients in whom both diagnosed TIA's (kappa = 0.31). We concluded that currently the diagnosis of a TIA, made by a single neurologist, is a poorly defined entity.

Female↗
PubMedDate not supplied

Holter monitoring in patients with transient and focal ischemic attacks of the brain.

The results of Holter monitoring in 100 patients with transient and focal cerebral ischemia were studied retrospectively. Atrial fibrillation (AF) was found in five patients compared with two from a group of 100 age and sex-matched control patients. Four of these had a previous history of AF or showed AF on the standard electrocardiogram. Episodic forms of sick sinus syndrome, which have also been related to cerebral embolism, were found in 32 of the TIA patients against 13 of the controls (p less than 0.0025). Sick sinus syndrome was of the bradyarrhythmia-tachyarrhythmia type in 14 of the TIA patients and in three of the controls (p less than 0.01). The relationship between TIAs and transient sinus node dysfunction could not be explained by concomitant heart disease. It is not yet clear whether the relationship is causal or indirect.

Adult↗
PubMedDate not supplied

Diagnosis of transient ischemic attacks: improvement of interobserver agreement by a check-list in ordinary language.

To try and improve the interobserver agreement for the diagnosis of TIA, we used a checklist in which the symptoms were recorded in plain language, instead of in abstract diagnostic terms such as amaurosis fugax. Criteria for a diagnosis of TIA were similarly phrased and recommended to all observers. Eight senior neurologists and ten neurology residents interviewed 72 patients in random pairs. In 64 cases the observers agreed on the diagnosis (kappa value = 0.77). After a short discussion between the two observers the agreement increased to a maximum (kappa = 1.0). However, in 29 of the 144 interviews the diagnosis would have been different, had the recommended criteria been fully applied. In 28 of these the observer had diagnosed TIA on insufficient evidence. Six "misinterpretations" led to disagreement for the diagnosis and only these were corrected by the observers during their discussion. The present design has led to a maximal agreement for the diagnosis of TIA between two observers, but the agreement between such a pair and the common diagnostic criteria was not yet ideal. The precision of the diagnosis could be improved if details of the required symptoms are discussed in general as well as for each patient.

Adult↗
PubMedDate not supplied

Aneurysmal subarachnoid hemorrhage. Complications and outcome in a hospital population.

We describe total management results in a prospective series of 264 patients with aneurysmal subarachnoid hemorrhage (SAH) admitted to a neurologic unit. Referrals were actively solicited from general physicians as well as neurologists in the area. The diagnosis was based on computed tomography (CT). Secondary deteriorations were analyzed clinically and with serial CT scanning. Outcome was assessed 3 months after SAH. There were no relevant differences between the analyses of patients with and without an aneurysm confirmed by angiography or autopsy. One third of the patients either died within 1 day (12%) or remained in a poor clinical condition that precluded surgery (22%). One third were in good clinical condition, but contraindications to surgery were judged present or serious complications occurred before surgery could be performed. One third of all patients underwent surgery. Overall mortality in our series was 52%; only 26% made a good recovery. The risk of rebleeding was not related to the patients' initial clinical condition, but all other intracranial complications occurred significantly more often in patients graded poor compared with patients in good clinical condition. The most important causes of death and severe disability were hemorrhage (16%), recurrent hemorrhage (18%), and delayed cerebral ischemia (15%). The most important surgical complication was delayed deterioration caused by ischemia (20% of operated patients). We estimated that recognition of 'warning leaks,' surgery in patients over 65, and improvement of our surgical technique could decrease mortality from 52% to approximately 41%.

Brain Ischemia↗