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Biomedical subjects

L Schut

Publications and source records attributed to L Schut.

At least 127 records · Page 7Linked to original sources
PubMed1980

Global rostral midbrain dysfunction secondary to shunt malfunction in hydrocephalus.

Two cases of congenital hydrocephalus with shunt malfunction are described. Both patients presented with clinical syndromes suggestive of global rostral mesencephalic dysfunction, including the sylvian aqueduct syndrome, a parkinsonian-like state, and quadriparesis. Each had computed tomographic findings that showed marked dilatation of the lateral and 3rd ventricles, and both improved with revision of their shunts. The anatomical substrates of the clinical findings are reviewed. A discussion of the probable mechanism proposes that dilatation of the 3rd ventricle and rostral aqueduct sufficiently explains the entire syndrome. (Neurosurgery, 7: 322-325, 1980).

Adolescent↗
PubMed1980

Rapid neurologic assessment and initial management for the patient with traumatic dental injuries.

The authors believe that a dental practitioner can be adept at observing insidious signs of neurologic impairment secondary to trauma of the head and neck. If approached logically in a systematic order, the course of neurologic assessment of a patient with traumatic dental injuries can be achieved in a short time. If neurologic damage is suspected, immediate medical referral is indicated, as impending neuropathologic crises of secondary injury may be prevented with definitive early care. Medical personnel will benefit in their diagnostic course from information gathered by the initial provider of health care. The dentist also provides a service to the patient by ruling out definite signs of neurologic deficit before directing complete attention to emergency dental procedures.

Brain Injuries↗
PubMed1980

Hydranencephaly versus maximal hydrocephalus: an important clinical distinction.

To define better the syndromes of hydranencephaly and maximal hydrocephalus, we followed 10 neonates demonstrating (by computerized tomography) virtual absence of the cerebral substance with serial computerized tomographic (CT) scans, electroencephalograms (EEGs), and developmental evaluations. The follow-up period ranged from 4 to 23 months. Two well-defined syndromes emerged. Five patients showed absence of cortical activity on EEG and a CT picture of minimal occipital brain parenchyma connected by a thin bridge of tissue to intact basal ganglia. These patients were shunted and showed no improvement with time, either neurologically or radiologically. Five patients showed minimal frontal cerebral mantle on CT and the presence of electrical activity on EEG. These patients required bilateral shunts to control head size and showed remarkable progress with time. Serial CT scans demonstrated the appearance of considerable brain substance, and neurological development was either normal or slightly delayed. We believe that the former pattern of only minimal occipital brain and absent EEG activity defines true hydranencephaly, whereas the presence of small amounts of frontal brain tissue associated with EEG activity seems to represent maximal hydrocephalus. The differences in CT pattern, EEG, and clinical progress all suggest a different pathophysiology for these two conditions. (Neurosurgery, 6: 35--38, 1980).

Anencephaly↗
PubMed1979

Computed tomography of craniocerebral injury in the abused child.

Computed tomography (CT) was performed in 26 infants and children with craniocerebral trauma related to abuse during a 41-month period. The pattern of brain injury differed from that seen in the nonabused traumatized infant or child. Parieto-occipital acute interhemispheric subdural hematoma (AIHSH) with associated parenchymal injury was the most frequent finding (58%). Follow-up by CT in patients with AIHSH demonstrated infarction in half and cerebral atrophy in all.

Brain Injuries↗
PubMed1979

Problems of diagnosis and treatment in the Dandy-Walker syndrome.

10 children with Dandy-Walker syndrome are presented to discuss their clinical assessment and therapy. The presence on physical examination of a large posterior fossa was the most reliable clinical finding and was diagnostic in 9 out of the 10 patients. The different diagnostic confirmatory studies are discussed. The most satisfactory treatment in this series was the combination of a shunt from the lateral ventricle and the posterior fossa to the peritoneum.

Cerebrospinal Fluid Shunts↗
PubMed1979

Teratocarcinoma of the brain -- a treatable disease?

Teratocarcinoma of the brain is a rare teratoid tumor. Less than 100 cases have been previously reported and only 4 were patients with tumors in the lateral ventricular system. At the Children's Hospital of Philadelphia, 2 patients with teratocarcinoma of the lateral ventricle of the brain have been treated in the past 5 years and both are long-term survivors. A third patient with a recurrence at University Hospital is now receiving chemotherapy. Our experience suggests that a combination of radical surgery, supervoltage radiotherapy and chemotherapy may be successful in controlling these neoplasms. Furthermore, since there is increasing evidence that they have a strong histologic relationship to the embryonal carcinomas that arise in the testes and elsewhere, it appears logical to apply chemotherapeutic strategies to these intracranial neoplasms based on experience with such tumors located in other regions of the body.

Adolescent↗
PubMed1979

Pathophysiology, treatment and outcome following severe head injury in children.

The pathophysiology and outcome following severe head injury in 85 children are presented. The commonest initial CT diagnosis was of acute brain swelling. This swelling was associated with an increased white matter density on the CT scan which decreased to normal concomitant with recovery and increased ventricular size. CBF measurements in 6 of these patients revealed an increased blood flow despite a decreased CMRO2 and clinical coma. This CT pattern of diffuse swelling is believed to be due to acute cerebrovascular congestion and hyperemia and not to edema. Because of this, all children were treated with endotracheal intubation and controlled hyperventilation as part of the initial management. Mass lesions were uncommon, 20%. ICP was monitored in 40 children. The ICP rose above 20 Torr despite therapy in 80% of children with decerebrate or flaccid coma and in only 20% of children with spontaneous motor function. The ICP was at its highest between the second and fifth day. Aggressive therapy to control the ICP, with barbiturates if necessary, was successful in 80% of the patients. The overall results were useful recovery in 87.5% of the children, 3.5% were left vegetative or severely disabled and 9% died.

Adolescent↗
PubMed1979

Spinal lipomas in infancy and childhood.

The clinical course of 42 children with lipomatous lesions of the lower spine is reviewed. Good neurological exam, IVP and myelography are considered essential components of the preoperative studies. The surgical aim is to free all intra- to extradural adhesions with dural grafting, if necessary. The results suggest that early corrective surgery within the first few weeks to months of life is the most satisfactory approach to preserving normal neurological and urological function in these children. 88% of children not operated on early developed progressive loss of neurological function and while delayed surgery frequently stopped progression of the disease it rarely returned the children to a normal state.

Adolescent↗
PubMed1979

Hydrocephalus in myelomeningocele.

156 children born with myelomeningocele were studied over a 3- to 10-year follow-up period. The appearance, type and rate of development of hydrocephalus were noted and correlated with the findings on neonatal and follow-up physical examination. 80% of the children developed overt hydrocephalus; 73.4% of these cases were secondary to aqueductal stenosis. Only 15.3% of the cases showed physical evidence of hydrocephalus at birth. Another 64.8% of the children developed clinical signs of hydrocephalus during the follow-up period, most during the first few weeks but some as late as the third year of life. The neonatal examination is unable to predict the subsequent appearance of hydrocephalus or its rate of development, and even serial determinations of head circumference are often of limited value. The authors conclude that the early diagnosis of hydrocephalus in children with myelomeningocele cannot reliably be made on physical examination alone and that other means of assessing ventricular size should be employed.

Age Factors↗
PubMed1979

Localized primary intracranial Ewing's sarcoma of the orbital roof. Case report.

A rare case of a primary Ewing's sarcoma arising from the intracranial portion of the right orbital roof is presented. Clinical presentation was that of a rapidly growing tender exostosis, associated with headaches. History indicated that the tumor may have been present for more than 1 year. Skull x-rays showed marked diastasis of the coronal suture and a "mottled" appearance on the right frontal bone suggestive of a sarcoma. Bone scan further confirmed the presence of a malignant bone tumor. Computerized tomography scan showed the intracranial extension of the tumor and a follow-up scan allowed us to see the response of the tumor to therapy. Only two other cases with details as to intracranial localization were found in the literature.

Child↗
PubMed1978

Interhemispheric acute subdural hematoma: a computed tomographic manifestation of child abuse by shaking.

Parieto-occipital interhemispheric acute subdural hematomas (IASH) were found in 17 (61%) of 28 abused children examined by computed tomography, presenting with neurologic symptoms. CT demonstration of IASH correlated with injury due to severe shaking, the presence of retinal hemorrhages, and the absence of the stigmata of battering. Subsequent computed tomographic examination in these patients demonstrated infarction in 50%, and cerebral atrophy in 100%.

Acute Disease↗
PubMed1978

Pitfalls in the diagnosis of arrested hydrocephalus.

Arrested hydrocephalus probably results from improvement of CSF circulation during growth. Although a generally accepted condition, its mode of onset, its presence in a given patient, and time required to establish the absence of progressive hydrocephalus have not been defined. Five patients are presented with ostensibly arrested hydrocephalus due to: aqueductal stenosis, communicating hydrocephalus, and Dandy-Walker malformation. In a period ranging from 4 to 13 years, they presented clinical signs of decompensation with intracranial hypertension. One had never had a shunt procedure. Another two were performing well in school until they suddenly deteriorated. The diagnosis of arrested hydrocephalus requires close follow-up well into adolescence, with periodical neurological and psychomotor evaluations. Sequential observation of the ventricular size with computed tomography (CT) is recommended.

Cerebrospinal Fluid Shunts↗
PubMed1978

Outcome following severe head injuries in children.

The outcome in 53 children following severe head injury is presented. All children were graded using the Glasgow Coma Scale; 90% made a good recovery or were moderately disabled, and 8% died or were left vegetative. All patients were treated with controlled ventilation and steroids; mannitol, and, if necessary, Nembutal (pentobarbital) were used to maintain the intracranial pressure below 20 torr. With this regimen, only one death occurred due to uncontrollable intracranial hypertension. All patients with a coma scale of 5 or greater recovered well. The worst prognostic sign was the presence of flaccidity: 33% of these patients died or were vegetative. Five of seven patients who were decerebrate or flaccid with bilateral fixed pupils and absent caloric responses made a good recovery or were moderately disabled. The relatively low incidence of mass lesions (23%) and high incidence of diffuse cerebral swelling (34%) suggest a different pathophysiological response of the child's brain to injury, which may play a role in the improved survival of children following severe head injury when compared to adults.

Adolescent↗
PubMed1977

Optic nerve compression due to aneurysmal bone cyst.

A 10-year-old boy developed loss of central vision in both eyes due to compression of the optic nerves by a mass arising from the sphenoid and ethmoid sinuses. Histopathologic examination of biopsy specimens showed a fibrous matrix composed of spindle-shaped cells interspersed with small and large channels, characteristic of an aneurysmal bons cyst. One year after partial excision of the intracranial and extracranial portions fo the lesions, vision had returned to nearly normal levels. Aneurysmal bone cysts rarely involve the orbits or other cranial bones to produce ocular signs and symptoms. However, since this lesion probably represents reactive proliferation of bony tissues, rather than neoplasia, the prognosis for vision and life is good.

Bone Cysts↗