Search PubMed⌕ Search

Biomedical subjects

N W Dorsch

Publications and source records attributed to N W Dorsch.

At least 37 records · Page 2Linked to original sources
PubMed1992

Ectasia and fenestration of the anterior cerebral artery associated with persistent trigeminal artery: case report.

Multiple vascular anomalies in a 22-year-old patient who had signs and symptoms of vestibulocochlear dysfunction are reported. Angiography revealed a fenestration of the proximal segment of the left anterior cerebral artery, an ectasia of the left anterior and posterior cerebral arteries, and a persistence of the right trigeminal artery. The rarity of the association is documented, and the clinical significance is discussed.

Adult↗
PubMed1991

Delayed diagnosis in subarachnoid haemorrhage.

OBJECTIVE: To determine the outcome in patients with subarachnoid haemorrhage from a ruptured aneurysm, particularly in those in whom the diagnosis was delayed. DESIGN: A two-year retrospective study of medical records of patients admitted to Westmead Hospital between July 1988 and June 1989. SETTING: A tertiary level teaching hospital. PATIENTS: Ninety-four patients treated for subarachnoid haemorrhage. In 15 cases the diagnosis was delayed. MAIN OUTCOME MEASURES: Death, disability, or functional recovery. RESULTS: Overall, 40 (42.5%) patients died, 14 (15%) were disabled, and 40 made a functional recovery. Of the 62 patients who were treated surgically 38 (61%) made a functional recovery compared with two of the 32 (6%) who were not. Of the 15 in whom the diagnosis was delayed seven (47%) made a functional recovery. Confirmation of the diagnosis was delayed in four of the latter group because a cranial computed tomography scan showed no abnormalities. CONCLUSIONS: Earlier diagnosis, allowing early definitive surgical treatment, may improve the outcome in aneurysmal subarachnoid haemorrhage. The results of a computed tomography scan are diagnostic only if they are positive--a negative result must be interpreted in conjunction with the clinical picture.

Acute Disease↗
PubMed1989

Timing of surgery for cerebral aneurysms: a plea for early referral.

Two groups of patients with aneurysmal subarachnoid haemorrhages--111 patients who underwent surgery within three days of haemorrhage, and 203 patients who underwent operations four or more days after the haemorrhage--were compared. No significant differences were found in outcome between the two groups. This indicates that early operation, which has the advantage of minimizing the risk of recurrent haemorrhage, is safe. The importance of the early diagnosis of subarachnoid haemorrhage and of an urgent referral for neurosurgical management is stressed.

Emergencies↗
PubMed1989

An experimental study of the effect of nimodipine in primate subarachnoid haemorrhage.

Acute subarachnoid haemorrhage was produced in baboons by a transorbital vessel avulsion technique. Half the animals were pretreated with an intravenous infusion of the calcium antagonistic nimodipine, in a dosage comparable with clinical levels. The severity of the haemorrhage, as measured by changes in intracranial pressure, cerebral perfusion pressure, cerebral blood flow and reactivity, and evoked potentials, was not greater in the group receiving nimodipine. Changes in extracellular K+ and pH were much less marked in animals receiving nimodipine. It is suggested that nimodipine (a) has a protective effect at a cellular level against the ionic changes of ischaemia, (b) does not alter the mechanical severity of subarachnoid haemorrhage.

Acute Disease↗
PubMed1988

Management of cerebral abscess in adolescents and adults. Experience in the CT-scan era.

Thirty-seven patients with non-traumatic intracerebral abscesses are presented. Two were not diagnosed during life. Where the possible cause could not ascertained, a metastatic origin was the commonest, followed by otogenic. A variety of causative organisms, including especially Streptococci, Staphylococci and Bacteroides were isolated. It is possible that the most effective treatment was primary excision of the abscess plus antibiotics, but the numbers were too small for a statistically significant difference to be shown. The reasons for recent improvements in outcome of brain abscesses, including more use of CT scanning and refinements in isolation of organisms and in antibiotic treatment, are discussed, along with possible steps towards more improvement in future.

Adolescent↗
PubMed1988

Outcome prediction in extradural haematomas.

Extradural haematoma (EDH) is generally a condition of young adult males. It represents only a small percentage of the total number of head injuries admitted to a neurosurgical service, but it must be differentiated from simple concussion, and this means that it is considered in a large number of patients. EDH has the potential for a low mortality rate because of its extraaxial location, but in practice it is approximately 10%. Our results show that about 40% of EDH present with vomiting or nausea and no focal neurological signs. Skull X-ray does not aid in the diagnosis as approximately 35% are reported as being normal. There is a place for conservative treatment of EDH but only if the shift of the midline is minimal (less than 5 mm). A score has been developed to predict accurately a patient's outcome after suffering an EDH. This score includes the Glasgow Coma Scale, pupillary reaction and initial CT scan appearance, and has an accuracy of 88%.

Adolescent↗
PubMed1987

Moyamoya disease causing recurrent cerebrovascular episodes in a young adult.

A case of moyamoya disease in a young white adult is described. The patient presented at the age of 27 years with a cerebrovascular accident and over subsequent years has suffered several cerebrovascular accidents and, more recently, transient ischaemic attacks. Serial angiographic studies have demonstrated the development of the classical radiological findings of moyamoya disease. This case illustrates a rare cause of cerebrovascular disease in a non-Japanese individual.

Adult↗
PubMed1986

Cerebral aneurysms and the 'missed' hemorrhage.

Eleven patients are described in whom a warning subarachnoid hemorrhage, preceding severe or fatal rupture of an intracranial aneurysm, was misdiagnosed; a 12th had a successful outcome from surgery after a single hemorrhage. Erroneous labels included meningitis, migraine, hysteria, tension, and head and neck injury. The vital importance of diagnosing an aneurysm before a major rupture occurs is emphasised. Apart from the 'warning leak', other signs may be due to the location or expansion of an aneurysm, which should alert doctors to the diagnosis.

Adult↗
PubMed1986

Clinical course and outcome of severe head injury in Australia.

The records of 159 severely head-injured patients (all in coma for longer than 6 hours) from Sydney, Australia, were studied. The clinical course, charted over a 2-week period, indicated that 60% of deaths occur by Day 3 and that 12% of patients remain in coma (Glagow Coma Scale (GCS) score less than 7) for more than 2 weeks. Overall, at long-term follow-up review more than 2 years after injury, 51% of patients were dead, 7% were severely disabled or vegetative, and 42% had a good to moderate recovery. Outcome of the patients in prolonged coma was assessed separately, with only one-third making a good or moderate recovery; two-thirds of the severely disabled patients came from this group. The high proportion of poor outcomes associated with prolonged coma suggests that this group of patients should be specifically targeted in research. One appropriate intervention with this group would be the restructuring and intensification of early rehabilitation. However, the GCS score lacks the precision needed for this type of study, and a better measure of recovery should be developed.

Adult↗
PubMed1984

Surgery for cerebral aneurysms. An eight-year experience.

The results of operation have been analysed in 182 patients with 219 intracranial arterial aneurysms. One hundred and sixty of the aneurysms had ruptured; for 150 "typical" supratentorial aneurysms, the operative case fatality rate was 10%, and a satisfactory outcome was obtained in 85%. There were no deaths and little morbidity in 108 operations on grade 0 or 1 patients. Among a number of factors influencing outcome, the most obvious were age, hypertension, cerebral arterial spasm, and the clinical condition of the patient at the time of operation. The timing of surgery had no effect on results.

Adolescent↗
PubMed1984

Giant intracranial aneurysms: diagnosis, management, and outcome.

The diagnosis, management, and outcome of a consecutive series of 25 patients with giant intracranial aneurysms are presented. Symptoms and signs directly or indirectly attributable to the intracranial mass effect accounted for presentation in 16 (64%) patients of whom seven had no focal neurological deficits. Nine patients (36%) presented after subarachnoid hemorrhage. Subarachnoid hemorrhage was frequently associated with intraventricular or intracerebral hemorrhage, a poor clinical grading at admission, and a high mortality (67%). Computed tomographic features of the giant aneurysms were usually characteristic; however, angiography was particularly useful in those in close proximity to the skull base. Nineteen patients had a surgical procedure directly or indirectly aimed at obliteration, isolation, or reinforcement of the giant aneurysm. Successful surgical obliteration or occlusion was obtained in 12 (63%) patients, while seven (37%) had only reinforcement or exploration of the aneurysm. The mortality associated with definitive surgical treatment was 5.6%, and major morbidity occurred in 17%. The good long-term outcome in 75% of the patients after occlusion of the giant aneurysm contrasted with the continuing mortality (43%) and morbidity (43%) in those patients in whom surgical obliteration of the aneurysm was not attained. Although advances in microsurgical instrumentation, anesthetic techniques, and innovative revascularization procedures have facilitated the surgical management of giant aneurysms, significant improvement in the high overall mortality associated with these aneurysms (36% in this series) will probably only be attained by diagnosis of giant intracranial aneurysms before they bleed.

Adult↗
PubMed1984

Intradural extramedullary tuberculoma of the cervical spine. Case report.

A case is reported of a 45-year-old man who developed quadriplegia following a trivial motor-vehicle accident. Investigation including computerized tomography (CT) of the cervical spine revealed a large calcified lesion displacing the spinal cord and nerve roots, which proved to be a tuberculoma. The case is unusual in regard to the age of the patient, the size, location, and nature of the lesion, the mode of presentation, and the delineation of the lesion by CT scanning.

Cervical Vertebrae↗