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Biomedical subjects

L F Hirsh

Publications and source records attributed to L F Hirsh.

At least 37 records · Page 2Linked to original sources
PubMed1981

Cerebral vasospasm in aneurysmal subarachnoid hemorrhage.

Cerebral vasospasm is a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage. With improvement in surgical techniques and perioperative care, the results in neurologically intact patients are generally satisfactory. However, cerebral vasospasm remains a major problem in the successful management of neurologically deteriorating patients. Until the pathophysiology of cerebral vasospasm is clarified, a reliable treatment regimen will remain elusive and the overall outlook for patients with aneurysmal subarachnoid hemorrhage will remain limited.

Humans↗
PubMed1981

Chronic encapsulated intracerebral hematoma.

Intracerebral hematomas producing chronic neurological disability are reported rarely. Two cases of chronic intracerebral hematoma are described. Each case was associated with a thick, fibrous capsule found histologically to arise from an occult vascular malformation. When such encapsulation is discovered surgically, a vascular anomaly must be suspected.

Aged↗
PubMed1980

Modern treatment of intracranial aneurysms.

The initial physical and neurologic examinations usually allow a presumptive diagnosis of intracranial aneurysm, but confirmation may require computed tomography (CT) and selective angiography. Medical management of the patient necessitates close observation, supportive care, and use of drugs to reduce intracranial pressure and to prevent dissolution of clot at the aneurysmal fundus to prevent rebleeding. The age of the patient may be a deciding factor in selection of surgical candidates. The surgical procedure of choice is direct obliteration of the aneurysm by clipping or ligation, unless such a procedure would compromise the patency of major intracranial vessels or not be possible because of the shape of the aneurysm. With aggressive medical management and modern surgical techniques, many more of these patients may be saved and returned to productive life.

Aminocaproates↗
PubMed1980

Chronic epidural hematomas.

Epidural hematomas generally become manifested within hours after trauma because of progressive obtundation and later transtentorial herniation. However, epidural hematomas located outside the temporal fossa may produce vague neurological symptoms of delayed onset. Emergency operation may not adequately expose those blood clots located in unexpected positions. Computed tomographic (CT) brain scans will reveal the full extent and location of these hematomas. Seven cases of chronic epidural hematoma in various extratemporal locations are reported to emphasize their misleading clinical courses, their demonstration by CT scanning, and the underlying pathophysiology.

Adolescent↗
PubMed1980

Paroxysmal facial neuralgia secondary to a posterior communicating artery aneurysm.

Paroxysmal facial neuralgia, typified by classical tic douloureux, may be secondary to intermittent compression of the trigeminal nerve by pulsating vascular structures. The critical area of compression, at least for producing true trigeminal neuralgia, is felt to be the dorsal root entry zone. One case of paroxysmal facial neuralgia, secondary to more distal compression of the trigeminal nerve by a large posterior communicating artery aneurysm, is reported here. The location of the compression may be important in producing the atypical characteristics of paroxysmal facial neuralgia that is not classical tic douloureux. The pain was relieved by clipping the aneurysm without excision or rupture of the sack.

Facial Neuralgia↗
PubMed1979

Delayed traumatic intracerebral hematomas after surgical decompression.

Delayed traumatic intracerebral hematomas found after an initially unrevealing computerized tomographic scan have been reported occasionally. Such hemorrhage may occur in an area of brain contusion with cerebral vessel injury. Four cases of intracerebral hematoma appearing after evacuation of a different traumatic intracranial mass lesion are reported. This suggests that an intracranial mass lesion may tamponade cerebral venous oozing in an area of brain contusion and delay the accumulation of intracerebral blood, accounting for the late discovery of a parenchymal hematoma. (Neurosurgery, 5: 653--655, 1979).

Adult↗
PubMed1978

Giant meningiomas of the posterior fossa.

Posterior fossa meningiomas ordinarily produce clinical signs appropriate to their location. Four cases of huge infratentorial meningiomas were associated with minimal clinical manifestations.

Age Factors↗
PubMed1978

Panhypopituitarism resulting from Hodgkin's disease of the nasopharynx.

Nasopharyngeal involvement by Hodgkin's Disease is rare and may result in deafness, headaches, nasal obstructions and other symptoms. Compression of the pituitary gland with resultant panhypopituitarism has not been reported in nasopharyngeal Hodgkin's Disease. This paper documents a patient in whom Hodgkin's Disease of the nasopharynx eroded the bony sella turcica and compressed the pituitary gland causing anterior pituitary insufficiency. The patient presented with a skull x-ray and history compatible with a pituitary neoplasm. The diagnosis was established only by surgical exploration.

Bone Diseases↗
PubMed1978

Intracranial tuberculomas and the CAT scan.

Tuberculomas of the brain are rare in the United States. Although CAT (computerized axial tomography) scanning cannot distinguish these infections from other intracranial mass lesions, it provides a non-invasive technique with which to follow the course of presumptive lesions during medical therapy, and with which to search for clinically unsuspected infections. The necessity for and timing of surgery can be considered more easily with this technique. Two cases are presented with their CAT scans, including one example of the disappearance of a presumptive tuberculoma, during appropriate medical therapy.

Adult↗
PubMed1978

Spinofacial anastomosis.

Removal of large acoustic neuromas may still be followed by facial nerve palsy. The results of fourteen cases of spinofacial nerve anastomosis have been studied and compared with the results of spinofacial and hypoglossal-facial anastomoses reported in the literature. Other standard treatments of facial palsy have been briefly reviewed and criteria developed by which the most appropriate therapy for facial paralysis may be selected.

Accessory Nerve↗
PubMed1978

Intradural sacral nerve root metastasis mimicking herniated disc. Case report.

Spinal tumors may mimic herniated discs but the neurological findings and radiographs usually indicate the correct diagnosis. A case of metastasis to the S-1 intradural nerve rootlets is reported, with symptoms closely simulating a herniated disc. The correct diagnosis could not be made preoperatively in spite of clinical suspicion of a tumor.

Adenocarcinoma↗
PubMed1977

Unusual cause of relapsing hydrocephalus. Congenital intracranial teratoma.

We add clinical and pathological details of one male and one female infant with congenital pineal teratomas who died before reaching 3 months of age to the small number in the world literature. Each had a nonresectable, enormous neoplasm at the time of diagnosis, and shunting procedures were of no significant value. The pathological features of the tumors conformed in all respects to those classically described as true teratomas. An epidermal cyst, possibly metastatic, was found in the spinal subarachnoid space in one patient. There is currently no effective therapy for these neoplasms, although both were diagnosed during life. Whenever recurrent shunt insufficiency occurs in a hydrocephalic neonate, the possibility of a congenital brain tumor should be considered.

Brain Neoplasms↗
PubMed1977

Decompressive laminectomies with clinical improvement but persistent myelographic blocks.

Surgical decompression for spinal cord compression secondary to metastatic epidural neoplasms is a common procedure. Preoperative myelography is nearly always done, and clinical improvement postoperatively is assumed to be correlated with relief of the radiologically demonstrated subarachnoid block. Three cases with postoperative clinical improvement but persistent subarachnoid blocks are reported. The recognition of this is important to avoid unnecessary secondary surgery.

Female↗