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Biomedical subjects

M Limburg

Publications and source records attributed to M Limburg.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Dissection of cervical arteries as a cause of cerebral ischemia or cranial nerve dysfunction].

Nine patients with dissections of the cervical arteries are presented. Dissections cause approximately three per cent of non-haemorrhagic stroke and are usually observed in young and middle-aged patients. Dissections very often give rise to head or neck pain. Carotid artery dissection may lead to lower cranial nerve dysfunction and an incomplete Horner's syndrome in case of subadventitial dissection, and to cerebral ischaemia in case of subintimal spread. Vertebral artery dissection may cause brain stem ischaemia (subintimal dissection) or in rare cases a subarachnoid haemorrhage (subadventitial spread). The history frequently reveals a (trivial) traumatic event. Diagnosis is usually established by angiography or MRI. The prognosis is good and recurrences are rare. Treatment with anticoagulants or acetylsalicylic acid seems recommendable, though scientifically unproven.

Adult↗
PubMed1990

Progressive fatal dementia (Creutzfeldt-Jakob disease) in a patient who received homograft tissue for tympanic membrane closure.

We report the case history of a 54-year-old man who developed a fatal neurological disorder 4 years after a successful tympanoplasty with homograft pericardium. The final diagnosis of this case was Creutzfeldt-Jakob disease. This infectious spongiform encephalopathy is probably caused by a slow virus that can be transmitted by transplantation materials. The possible accidental transmission of Creutzfeldt-Jacob disease by the use of homograft materials in otologic surgery is discussed.

Cerebral Cortex↗
PubMed1990

SPET brain imaging with 201 diethyldithiocarbamate in acute ischaemic stroke.

Thirty-five patients with acute ischaemic stroke were studied within 24 h after hospital admission with thallium 201 diethyldithiocarbamate single photon emission tomography (201Tl-DDC SPET) and X-ray computed tomography (CT). 201Tl-DDC is a non-redistributing agent that allows postponed imaging after early administration and early therapeutic intervention. In 16 patients both investigations were performed within 24 h after stroke onset. The sensitivity of SPET was 94% and of CT 81% in the first 24 h, when hypodensity and obliteration of sulci were used as CT reading criteria. When only hypodensity was used as a criterion, the sensitivity of CT was 50% in this group. Sensitivity of CT compared with SPET became increasingly better in patients with older infarcts (1-18 days). In two-thirds of patients, the lesion demonstrated on SPET was larger than that on CT, and this was especially so with older infarcts. Crossed cerebellar diaschisis occurred in 69% of patients. The high sensitivity of 201Tl-DDC SPET in the first 24 h after ischaemic stroke and the favourable properties of this radiopharmaceutical make it a method of interest in the assessment of initial perfusion defects in early experimental stroke therapies.

Aged↗
PubMed1990

Flunarizine in acute ischemic stroke: a pilot study.

Twenty-six patients with acute supratentorial brain infarction were randomly allocated to double-blind intravenous treatment with the calcium entry blocker flunarizine (12 patients) or placebo (14 patients) within 24 h. CT scan excluded other significant pathology. Impaired consciousness and gaze deviation were more common in the placebo group. Three patients in the treated group (25%) were either dead or severely disabled after 6 months, whereas this occurred in 8 of the 14 (57%) control patients, a difference of 32%. This difference is not statistically significant and there is an uneven distribution of important prognostic variables, however, the confidence limits of the difference (-4% and +68%) suggest that there may be a clinically important effect.

Aged↗
PubMed1990

Cerebrovascular disease in Ehlers-Danlos syndrome type IV.

We describe two patients with cerebrovascular complications of Ehlers-Danlos syndrome type IV. A 16-year-old girl with spontaneous internal carotid artery dissection and a 46-year-old woman with aneurysmal subarachnoid hemorrhage and multiple aortic dissections were both deficient in collagen type III, analyzed in cultured skin fibroblasts. To our knowledge, spontaneous carotid artery dissection associated with collagen type III deficiency has not been reported previously. Early clinical recognition of this syndrome is of great importance in view of the hazards of angiography and surgery. Collagen type III deficiency plays a role in the pathogenesis of intracranial saccular aneurysms and may also be involved in the pathogenesis of carotid cavernous fistulas and dissections of the cervical arteries.

Adolescent↗
PubMed1990

Single-photon emission computed tomography and early death in acute ischemic stroke.

Single-photon emission computed tomography with thallium-201-labeled diethyldithiocarbamate was performed in 26 consecutive patients less than or equal to 24 hours after a supratentorial brain infarction. Computed tomography excluded other relevant pathology. Two observers assessed the initial regional cerebral blood flow deficit using a semiquantitative visual method. The size of the initial flow deficit correlated negatively with the Barthel Index score (performance of the activities of daily living) after 6 months but not with the motricity index score (a measure of severity of the hemiparesis) after 6 months. The initial flow deficit was strongly correlated with early death from tentorial herniation; all five patients with the largest initial flow deficits died less than or equal to 6 days after the stroke, but among the 21 patients with smaller initial flow deficits only one died early (p = 0.00018, Fisher's exact two-tailed test). Although depressed level of consciousness, conjugate gaze deviation, and severe hemiparesis were more prevalent in the group of six patients who died early, the differences in prevalence between this group and the 20 patients who survived were not significant. Single-photon emission computed tomography is a relatively simple method to semiquantitatively measure a blood flow disturbance immediately after its occurrence. The magnitude of this blood flow disturbance is strongly related to early death from tentorial herniation. Because of these properties, single-photon emission computed tomography to measure regional cerebral blood flow can be of great use in acute stroke research.

Acute Disease↗
PubMed1987

Cerebral blood flow imaging with thallium-201 diethyldithiocarbamate SPECT.

Thallium-201 diethyldithiocarbamate ([201TI]DDC) was studied in humans as an agent for cerebral blood flow imaging. Brain uptake proved to be complete 90 sec after injection with no appreciable washout or redistribution for hours. Intracarotid injection suggested an almost 100% extraction during the first passage. Whole-body distribution studies demonstrated a brain uptake of 4.3% of the dose compared with 0.9% for [201TI]chloride. No differences were found in the distribution of [201TI]DDC versus [201TI]chloride in other organs. After the injection of 3 mCi 201TI, good quality single photon emission computed tomographic (SPECT) images of the brain were obtained with both a rotating gamma camera and a multidetector system. In ischemic brain disease, perfusion defects were easily demonstrated. We conclude that [201TI]DDC is a suitable radiopharmaceutical for SPECT studies of cerebral blood flow.

Aged↗
PubMed1986

Functional brain imaging with I123-amphetamine. First experience in the Netherlands.

Single Photon Emission Computed Tomography (SPECT) has been used in the last five years as a method for cerebral bloodflow imaging, especially in cerebral infarction. In this study the first experiences in the Netherlands are presented. In 57.6% of our patients lesions, defined by SPECT were larger than those found by CT. This was not only seen in patients with cerebral infarction but also in hematoma. In 33.3% the size of the lesions were comparable. In 10 out of 14 patients with a solitary lesion in one hemisphere a decreased perfusion was seen in the contralateral cerebellar hemisphere. This phenomenon is called crossed cerebellar diaschisis. One patient with probably Alzheimer disease, showing a specific flow pattern, is discussed.

Aged↗
PubMed1985

Mollaret's meningitis responding to phenylbutazonum. A case report.

A patient with Mollaret's meningitis is presented, with some unusual features. Criteria for the diagnosis are discussed. Many therapies for this recurrent aseptic meningitis have been suggested. In our patient there was a good response to phenylbutazonum, which to our knowledge has not been reported before.

Body Temperature↗
PubMed1984

[The triad: mediastinal chemodectoma, chondroma of the lung and esophageal leiomyoma].

In 1958 a mediastinal tumor was discovered in an asymptomatic patient. The tumor was resected and diagnosed as a nonchromaffin chemodectoma. Additionally an oesophageal abnormality was discovered but not treated. At subsequent follow-ups the mediastinum never appeared normal and the heart size progressively increased. In 1974 a small opacity appeared in the left lung. In 1975 the patient was operated: a pulmonary osteochondroma, a pericarditis and an intrapericardial aortopulmonary chemodectoma were discovered. The oesophagus was not explored. In july 1979 an inoperable epidermoid carcinoma of the main bronchus of the left lung was discovered and the patient died in september 1979. There was no hypertension and no catecholamine excess. A post-mortem section was refused. After the recent description by Carney of the triad: extra-adrenal paraganglioma, lung chondroma and gastro-intestinal leiomyo(sarco)ma, we feel that our patient could present this syndrome and that the oesophageal tumor could be a benign leiomyoma. However the exact diagnosis of the oesophageal lesion is still unknown.

Adult↗
PubMed1977

Intrathoracic chemodectoma with multiple localisations.

In 1958 a mediastinal tumour was discovered in an asymptomatic woman with a history of vomiting and an oesophageal anomaly which had not been treated. A tumour of the anterosuperior mediastinum in relation to the aortic arch was extirpated and proved to be a chemodectoma or non-chromaffin paraganglioma. At subsequent follow-ups the mediastinum was never normal and the heart size progressively increased, the oesophageal anomaly remaining unchanged. A small opacity appeared in the left lung in 1974. An operation performed in 1975 revealed an osteochondroma in the lung, pericarditis, and an intrapericardial chemodectoma. The oesophagus was not explored. An intrathoracic chemodectoma is rare. The importance of angiography in its diagnosis is emphasised. Malignant degeneration is seldom observed. Therapy is surgical, the tumour being radioresistant. The possibility to be considered in our patient was either relapse of the tumour with degeneration or multiple localisations of the tumour.

Adult↗