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Biomedical subjects

M Feinsod

Publications and source records attributed to M Feinsod.

At least 91 records · Page 5Linked to original sources

Cerebellar astrocytoma presenting as deterioration of handwriting in a child.

Deterioration of handwriting in an 11-year-old boy over a 2 month period was found to be caused by a cerebellar astrocytoma. The clinical picture was characterised by a lack of the classic symptoms of increased intracranial pressure. The only positive neurological findings pointed to an isolated right cerebellar symptomatology expressed by mild intention tremor and decreased tone of the right hand. Progressive deterioration of handwriting can be an ominous sign and it should be known to all professionals, as a lack of awareness can cause delay in expert referral and diagnosis.

Astrocytoma↗

Delayed onset of traumatic extradural hematoma.

During a 4 1/2-year period, seven patients with delayed onset of an extradural hematoma were seen among 80 consecutively treated cases of extradural hematoma for a frequency of 8.75%. The hematomas were insignificant or not present on initial computerized tomography (CT) scanning. Repeat CT scans within 24 hours of admission showed sizeable hemorrhages. Six hematomas were evacuated, and one was reabsorbed spontaneously. In only one patient did neurological deterioration herald the onset of the extradural hematoma, four patients remained unchanged, and two improved before diagnosis. Intracranial pressure (ICP) was monitored in five patients, four of whom showed intermittent rise in pressure despite preventive treatment. Intracranial hypotension and rapid recovery from peripheral vascular collapse seemed to be contributory factors in the delayed onset of an extradural hematoma. Awareness of this entity, a high degree of vigilance, ICP monitoring, and repeat CT scanning within 24 hours of injury are strongly recommended in these cases, especially after decompression by either surgical or medical means, recovery from shock, or whenever there is evidence of even minimal bleeding under a skull fracture on the initial CT scan.

Adult↗

Paraganglioma of cauda equina. A report of a case and review of the literature.

A case of a cauda equina paraganglioma in a 13-year-old boy is described. A review of literature revealed six similar reported cases. All were intradural extramedullarly tumors located in the cauda equina-filum terminale region. In all, the presenting and dominant symptom was low back pain, while neurologic deficit was mild or absent. Excessive CSF protein levels appeared to be a characteristic feature of the disease. Histologically, the tumor displayed the typical "Zellballen" pattern, however mild nuclear pleomorphism and some mitotic figures were noted. As it is impossible to predict the biological behaviour of paragangliomas from the histologic appearance, complete surgical resection with close follow-up is indicated in such cases.

Adolescent↗

Visual evoked potentials in experimental allergic encephalomyelitis.

We have compared the clinical signs, brain pathology and visually evoked responses (VEP) of guinea pigs with experimental allergic encephalomyelitis (EAE). Animals immunized with myelin basic protein had a milder disease, both from the clinical and histological points of views, compared to those immunized with crude white matter extract. However, VEP findings were quite similar in both groups. The VEP of the majority of animals from both groups showed changes before or at the same time that neurological signs appeared. Electrophysiological responses were usually characterized by abnormal wave shapes and prolonged latencies. Recovery of the VEP usually preceded the recovery from clinical signs. In contrast, the severity and incidence of brain tissue pathology was not correlated to either clinical signs or VEP changes. Possible explanations of the electrophysiological, clinical and histopathological changes and their time-course are discussed.

Animals↗

Trigeminal neurinoma with unusual presentation. Report of a case with trigeminal somatosensory-evoked response.

A patient with trigeminal neurinoma, presenting unusual symptoms, is described. There was no trigeminal sensory or motor deficit. The only presenting symptoms were unilateral abducens nerve paresis and alternating hemiplegic episodes. The trigeminal somatosensory-evoked response was normal before surgery. After complete removal of the tumor from both the posterior and middle cranial fossae, severe trigeminal sensory deficit ensued, accompanied by impairment of the evoked response. Improvement of the trigeminal nerve function could be predicted by significant changes in a repeat trigeminal sensory-evoked response obtained 2 months after the operation.

Adult↗

Long-term barbiturate infusion to reduce intracranial pressure.

We report two cases of children, 7 and 14 yr old, in whom prolonged infusion of thiopental sodium (TS) was used to control intracranial hypertension previously unresponsive to conventional therapy. Intracranial hypertension followed removal of a large tumor in 1 case, and trauma in the other. TS was administered at a rate of up to 7 mg/kg . h for 8 days in 1 patient, and up to 12 mg/kg . h for 10 days in the other. Both children regained consciousness and made significant recovery of neurological function. The advantage and the side-effects of the prolonged use of TS for intracranial hypertension are discussed.

Adolescent↗

Delayed visual maturation.

Three infants, recognised as blind during the first 4 months of life, were found to be normal on neurological and ophthalmological examinations. Visual electro-diagnostic studies showed normal retinal responses, but delayed conduction velocities and impaired visually-evoked responses over the occipital cortex. After age 6 months, normal vision developed gradually and all abnormalities disappeared.

Developmental Disabilities↗

Transient global amnesia associated with a single metastasis in the non-dominant hemisphere. Case report.

A patient in whom transient global amnesia (TGA) led to the diagnosis of a metastasis of a transition-cell carcinoma of the bladder to the non-dominant hemisphere is described. In previously reported cases of TGA associated with brain tumors, the tumors involved either the dominant or both hemispheres. The etiology of TGA associated with a brain tumor is most likely vascular, as suggested by the sudden development and the transitory character of the event. In contrast to the "common" form of TGA (where both temporal lobes suffer temporary ischemia), in these patients only one side of the limbic system is affected, because a brain tumor has already compromised the other limbic area. Therefore, the dominance of the hemisphere with the tumor is of no consequence, as both hemispheres have been involved. It is concluded that the TGA in these patients is not due to, but is rather associated with, a unilateral brain tumor.

Aged↗

Electrophysiologic tests in assessment of senile macular degeneration.

Twelve patients with macular disease were studied. Mean age at the beginning stages of the disease was 61.75 years. They were examined by biomicroscopy, fluorescein angiography, and electrophysiological tests (ERG, EOG, VEP). No relevant correlation could be found between the routinely administered and evaluated ERG and EOG tests and the clinical stage of the disease. The VEP proved a more sensitive means of evaluating macular function in our patients. The possibility of the VEP's being of prognostic importance is raised.

Aged↗

Visual defects in the uninjured eye of patients with unilateral eye injury.

We have examined the electroretinographic responses, the psychophysically determined course of dark adaptation and/or the scotopic and photopic (static) perimetric profile of the uninjured eyes of 11 patients with unilateral intraocular foreign bodies. Most of the patients showed subnormal ERG amplitudes over a range of light intensities, and subnormal light sensitivity in isolated retinal areas. The data suggest that eyes not directly injured by a unilateral traumatic ocular episode may show visual defects.

Adolescent↗

Trigeminal somatosensory evoked responses in patients with facial anaesthesia dolorosa.

The TSER of six patients with facial anaesthesia dolorosa showed shorter latencies and higher amplitudes of the late waves, which are believed to represent the processing of somatosensory input in the higher subcortical and cortical centres. Shorter latencies and higher amplitudes may reflect abnormal facilitation or decreased inhibition by these centres. The TSER also supplied an objective means of pain measurement, as the stimulating impulse at the affected side had to be reduced from 20 mA (the usual intensity used in patients without evoking pain or an unpleasant sensation) down to 9-12 mA, to avoid unbearable pain.

Adult↗

Increased intracranial pressure in post-traumatic rhinorrhoea.

Increased intracranial pressure coexistent with cerebrospinal fluid (CSF) rhinorrhoea was encountered in five out of 46 patients with a persistent CSF leak. In four patients, hypertension was due to malabsorption of CSF. One patient had a post-traumatic intracerebral cyst. The various degrees of intracranial hypertension, their effects on the clinical course and modes of treatment are demonstrated by the cases reported. Many failures in repairing the fistulous tracts may not stem from lack of technique, but could be the result of treatment of only one of the two concomitant conditions.

Adult↗

Somatosensory evoked potential to peroneal nerve stimulation in patients with herniated lumbar discs.

The somatosensory evoked potential (SEP) to peroneal nerve stimulation was recorded from 76 patients with myelographically proven herniated lumbar disc and was compared with normative data obtained from 65 healthy subjects. All patients with disc herniation had an abnormal SEP even when examination failed to disclose sensory deficits. In the patients with distortion of a root sleeve, the SEP abnormality was confined to the involved side. When myelography demonstrated large defects in the dural sac, there was electrophysiological evidence of disturbed conduction from the asymptomatic leg also. SEP changes in postoperative examinations correlated well with improvement or worsening of the patient's condition and enabled objective evaluation of the dynamics of sensory conduction along the involved structures.

Adolescent↗

Sensory evoked response to electrical stimulation of the trigeminal nerve in humans.

Electrical stimulation of the upper and lower lips of normal subjects evoked a consistent response recorded from over the face area of the ipsi- and contralateral hemispheres. This response consisted of seven discrete waves. Peak latencies ranged from as early as 8 msec to 115 msec. Stimulation of the lower lip evoked a response of lower amplitude and reversed polarity, as compared to te upper lip stimulation response. The data support the validity of the trigeminal sensory evoked response in the evaluation of the trigeminal pathways. Previously reported methods are reviewed and compared.

Adolescent↗

Reversible facial pain due to hydrocephalus with trigeminal somatosensory evoked response changes. Case report.

A patient with hydrocephalus due to aqueductal stenosis suffered facial pain which was relieved after the insertion of a ventriculoperitoneal shunt. The trigeminal somatosensory evoked response (TSER) of the affected side showed lower amplitudes and longer latencies as compared to the unaffected side. Following surgery, the waves regained higher amplitudes and shorter latencies. An episode of shunt malfunction was accompanied by recurrent facial pain and impairment of the TSER. Both improved after revision of the shunt. The possible etiology of facial pain in patients with hydrocephalus is discussed.

Adult↗