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Biomedical subjects

P Anslow

Publications and source records attributed to P Anslow.

At least 37 records · Page 2Linked to original sources
PubMed1999

Is sphenoid sinus opacity significant in patients with optic neuritis?

PURPOSE: Optic neuritis secondary to sinus disease is an infrequent but well-documented association. When a patient presents with signs of optic nerve dysfunction and orbital inflammation the significance of widespread sinus disease on radiology is clear and the management is straightforward. We present a group of patients with isolated optic neuritis and radiological evidence of spheno-ethmoiditis and discuss the clinical relevance of this finding. METHODS: We reviewed the notes of 11 patients with optic neuritis who, because of atypical headache, underwent neuroimaging revealing sphenoid sinus opacity. Six patients had endoscopic drainage of the sphenoid sinus; 4 were treated medically. RESULTS: Sinus contents included fungal infection (2), mucopurulent material (5), polyps (1) and necrotic tumour (1). Narrowing of the optic canal due to chronic osteomyelitis was found in 1 patient with irreversible optic atrophy. Visual loss was reversible in 6 patients. Four patients had normal radiological findings after treatment. Two patients had recurrent optic neuritis with sphenoid sinusitis on MRI scan, resolving on treatment, during the 4 year follow-up period. CONCLUSIONS: Possible mechanisms of nerve damage in this situation include direct spread of infection, occlusive vasculitis and bony deficiency in the wall of the sinus. Patients presenting with isolated optic neuritis and atypical headache should be scanned; an opaque sphenoid sinus in the context of visual loss should not be dismissed as coincidental but assumed to be pathological and the patient referred for drainage. Sphenoid sinusitis is an uncommon but treatable cause of optic neuritis.

Adult↗
PubMed1998

Birth asphyxia.

The term Birth asphyxia covers a number of clinical and physiological definitions. Birth asphyxia is a relatively common clinical event. In the majority of cases the outcome in terms of brain damage and future development of the child is excellent. However, a small number of children go on to develop patterns of brain damage which are then associated with disability. The article seeks to provide a basic understanding of the various mechanisms involved in producing injury.

Asphyxia Neonatorum↗
PubMed1998

Brain imaging in neonatal hypoglycaemia.

Magnetic resonance imaging studies in two cases of neonatal hypoglycaemia showed cortical and white matter cerebral damage that was most obvious in the occipital lobes. Both cases showed oedema in the parieto-occipital cortex and underlying white matter in the acute phase, with profound atrophy of these regions in the chronic phase. These findings support those of pathological studies which suggest that hypoglycaemia induces cerebral damage by a mechanism separate from the effects of cerebral hypoxia-ischaemia caused by secondary seizures.

Brain↗
PubMed1996

Pictorial review: MR imaging of neuronal migration anomalies.

Neuronal migration anomalies form a spectrum of congenital brain malformations with a variety of clinical manifestations. The widespread use of MRI in the investigation of neurological symptoms, and particularly in the imaging of epilepsy, has made the correct recognition and interpretation of these disorders important. This pictorial summary describes the typical clinical features and the MR appearances of this group of conditions. For a more detailed review which includes pathological correlation, the reader should refer to an excellent article by Barkovitch and colleagues (Barkovitch A.J., Gressens P, Evrard P. Formation, maturation and disorders of brain neocortex.

Brain↗
PubMed1996

MRI in the detection of acoustic neuromas--a suggested protocol for screening.

Magnetic resonance imaging (MRI) is the definitive investigation in the detection of an acoustic neuroma and its use is becoming increasingly widespread for this purpose. In the Oxford region, this facility has been available for 3 years, resulting in the scanning of the internal auditory meati and cerebellopontine angles of 892 patients and the detection of 38 acoustic neuromas. Based on our use of this investigation over this time period, we have attempted to rationalize our entry protocol for screening by limiting the availability of the test to those patients up to 70 years of age presenting with unilateral audiovestibular symptoms in the absence of significant neurological symptoms or signs, with an average difference in hearing threshold of 15 dB between normal and symptomatic ears or unilateral tinnitus with normal hearing. By following these entry criteria, we would hope to maximize the available resources.

Adult↗
PubMed1995

Correlation of fornix damage with memory impairment in six cases of colloid cyst removal.

We studied six patients in whom colloid cysts had been removed surgically from the third ventricle. The patients were selected simply by availability for the study, not on grounds of clinically diagnosed amnesia or its absence. The outcomes of operation ranged from one patient who had postoperatively resumed a normal life without complaint of memory disorder at any stage, through four who complained of memory disorder since operation, to one who was so severely amnesic as to require constant supervision. Each patient was given psychometric tests of memory, and was also scanned by magnetic-resonance imaging. One of us examined the six scans and assessed the extent of damage to the fornix, and any other brain damage, in ignorance of the outcomes of the psychometric tests. The fornix in the right hemisphere had been destroyed in all six cases, and all showed evidence of moderate or severe impairment in nonverbal memory. The fornix in the left hemisphere was intact in only one patient; this was the patient who had resumed a normal life without complaint of memory disorder. The left fornix was damaged with some sparing in one further patient, and the remaining four patients showed destruction of the fornix in the left as well as in the right hemisphere. The severity of impairment in verbal memory in these six cases was related to the severity of the damage to the left fornix. No other evidence of brain damage appeared to be systematically related to memory ability. These results add to the evidence that bilateral fornix damage produces amnesia, and that sparing of the left fornix alone is sufficient to ensure a more favourable outcome.

Adult↗
PubMed1995

Damage to cerebellocortical pathways after closed head injury: a behavioural and magnetic resonance imaging study.

The objective was to investigate the anatomical substrate of ataxia seen after severe head injury. Five patients were recruited from present and former inpatients at Rivermead Rehabilitation Centre. All patients had had a closed head injury and all had cerebellar type ataxia. Four normal controls were also studied. Brain MRI, clinical examination, computer based recording, and analysis of visuomotor tracking were carried out. Focal damage was found in the superior cerebellar peduncle in all five ataxic patients. The patients' tracking movements showed profound tremor, and unusual reliance on visual feedback. Ataxia seen after severe head injury can arise from damage to the superior cerebellar peduncle, which may interfere with the cerebellocortical circuits involved in coordinated movement.

Adult↗
PubMed1995

Selective amygdalohippocampectomy for hippocampal sclerosis: postoperative MR appearance.

PURPOSE: To analyze the anatomic consequences of selective amygdalohippocampectomy (AH) in patients with hippocampal sclerosis and to correlate the clinical outcome with the MR appearance. METHODS: Seventeen patients were examined with clinical and neuropsychologic examination and cranial MR after AH (7 transcortical AH, 10 trans-Sylvian AH). The clinical and neuropsychologic outcomes after AH were compared with those of anterior lobectomy (ATL). RESULTS: There was no significant difference in seizure cure between transcortical or trans-Sylvian AH and ATL. However, patients with left AH fared significantly better in terms of verbal IQ and nonverbal memory when compared with those with left ATL. Verbal memory and cognition were not significantly different in the two AH groups. Variable amounts of hippocampal and amygdala remnants were found in both AH groups and did not correlate with seizure cure. White matter change consistent with gliosis probably secondary to wallerian degeneration was demonstrated in the anterior temporal lobe to a mean distance of 4.5 cm after transcortical AH and to a lesser degree as a consequence of trans-Sylvian AH. Nine patients (53%) (4 transcortical All, 5 trans-Sylvian AH) demonstrated wallerian degeneration in the optic radiations after surgery. All had incomplete contralateral quadrantanopia. CONCLUSIONS: There is more secondary damage to the temporal lobe after AH than was previously recognized. The extent of hippocampal and amygdala resection in AH do not seem to be directly related to seizure cure. Visual field defects are common in AH because of the anterior but variable course of the optic radiations

Adolescent↗
PubMed1994

The value of MRI in angiogram-negative intracranial haemorrhage.

In one year, cerebral angiograms were performed for intracranial haemorrhage (ICH) on 334 patients. No cause for haemorrhage could be identified in 41 (12%), 30 of whom had predominantly subarachnoid (SAH) and 11 predominantly parenchymal haemorrhage (PH). These patients were prospectively examined by cranial MRI 1-6 weeks after the ictus. The MRI studies were positive in 7 patients (17%). In the 30 patients examined after SAH, 2 studies were positive, showing an aneurysm in one case and a brain stem lesion of uncertain aetiology in the other. In those examined after PH, cavernous angiomas were shown in 2, a tumour in 1 and a vascular malformation in another; useful diagnostic information was thus obtained in 36% of this group.

Adult↗
PubMed1993

The effective use of magnetic resonance imaging in the diagnosis of acoustic neuromas.

The diagnostic approach to acoustic neuromas is complex but these tumours are infrequent in patients even with a suggestive clinical picture. Easy access to an efficient, reliable and cost effective investigation is desirable. Magnetic resonance imaging is now the imaging modality of choice and this paper shows that it may be used effectively as the sole investigation. T2-weighted (T2W) fast spin echo axial images taking 1 min 37 s to acquire were compared with T1-weighted (T1W) gadolinium-enhanced axial images, taking 5 min 11 s to acquire, in 157 patients. The T2W images were satisfactory alone in 43% of patients and allowed confident diagnosis of seven of the nine acoustic neuromas. Partial volume artefact and CSF flow artefact resulted in equivocal examinations in the remaining patients. Using both sequences in every patient, imaging time was 7 min 41 s and at least 40 patients could be examined in 1 day, thus ensuring efficient patient throughput. We suggest that T2W fast spin echo axial images be routinely obtained and that only when they are equivocal should T1W gadolinium-enhanced axial sequences be employed.

Adolescent↗
PubMed1993

The role of CT imaging in the management of chronic suppurative otitis media.

CT imaging of the temporal bone is highly predictive of the presence of cholesteatoma but its value in the routine management of cholesteatoma has not been assessed. We aimed to establish the indications for CT imaging in CSOM by a prospective study of patients suspected of having cholesteatoma. The patients were assessed clinically and a management plan chosen; this was later adjusted, if indicated, on the basis of radiological findings. Surgical findings were recorded and correlation with CT appearances evaluated. Twenty patients completed the study. CT altered the management plan in 10 and was considered helpful in a further 6. We recommend its routine use in children, medically unfit patients, only or better hearing ears, patients in whom the tympanic membrane cannot be adequately visualized, patients who have had previous mastoid surgery whose operative records are available and patients with intratemporal or intracranial complications of disease.

Adolescent↗
PubMed1993

CT-dacryocystography for nasolacrimal duct obstruction following paranasal sinus surgery.

Nasolacrimal duct obstruction and consequent epiphora is a complication that may develop in some patients following paranasal sinus surgery. We describe the technique of CT-dacryocystography which entails contrast injection of the lacrimal system and simultaneous computed tomography (CT) scanning of the facial structures. This technique provides concurrent information regarding obstruction of the nasolacrimal duct and the presence of disease recurrence or persistence in the adjacent paranasal sinuses. The role of CT-dacryocystography prior to endoscopic dacryocystorhinostomy is discussed briefly.

Aged↗
PubMed1993

MRI as a single screening procedure for acoustic neuroma: a cost effective protocol.

Magnetic resonance imaging (MRI) is accepted as the 'gold standard' in diagnosing acoustic neuromas. Limited availability and perceived high costs have prevented clinicians from using it as a first-line investigation. A prospective study was set up in a specially designated screening session to audit the cost effectiveness and accuracy of audiovestibular investigations compared to MRI. Ninety-nine patients with asymmetrical audiovestibular symptoms or signs were investigated. Of these 54 evoked response audiometry tests, and 39 calorics were either not performed or were inconclusive. One patient refused to enter the MRI machine. All others received an unequivocal report after MRI and four tumours (three intracanalicular) were detected. The total cost of the audiovestibular protocol was 12,545 pounds compared to 12,900 pounds for the MRI protocol, which is a diagnostic and well-tolerated procedure. This study shows that MRI can be cost effective, as well as accurate, when used as a single screening procedure for acoustic neuromas.

Adult↗
PubMed1991

Post-myelogram headache--physiological or psychological?

Psychological aspects of post-lumbar puncture headache have hitherto received little attention. A hundred consecutive patients admitted for elective myelography were studied. Post-myelogram headache was assessed by an independent observer and found to be strongly associated with normality of the test (P less than 0.001). Psychological testing showed a trend between Hospital Anxiety Depression score and normality of myelogram as well as development of headache, although this did not achieve statistical significance. This study suggested that there is a large psychological as well as organic component to post-myelogram headache.

Adolescent↗
PubMed1990

Effect of a new computed tomographic image transfer system on management of referrals to a regional neurosurgical service.

A computed tomographic image transfer system ('Image Link') was used to link scanners within the Oxford region, UK, to the regional neurosurgical service. 100 consecutive neurosurgical referrals were examined by this system; 43% of the emergency referrals did not require transfer, 31% were transferred electively, and 26% urgently. Most of the patients defined as potentially hazardous for transfer (10/11) did not require neurosurgical intervention. The delay by the use of the system was negligible and early detection of intracranial haematoma contributed to good outcome in some head injured patients. Overall, 3,170 miles of ambulance journey were avoided. Use of image link has led to substantial improvements in management of neurosurgical emergency referrals, cost-effectiveness of neurosurgical and ambulance facilities, and interhospital communication between doctors.

Adolescent↗
PubMed1990

Neuroradiology including magnetic resonance.

The radiological assessment of drug resistant temporal lobe epilepsy has changed dramatically over the last few years. New CT scan techniques and the increasing application of MRI have meant that ever more subtle lesions can now be regularly identified. The major challenge now lies in the accurate identification of atrophic lesions such as Ammon's horn sclerosis.

Brain↗
PubMed1990

Heterotopic brain tissue: a rare cause of adult recurrent meningitis.

Heterotopic brain tissue is a rare cause of symptoms in neonates in whom it may present with respiratory obstruction. In infants it may produce unilateral nasal obstruction due to a nasal 'polyp' or cerebrospinal fluid rhinorrhoea with an associated risk of meningitis. It is exceedingly rare in adults but may nevertheless be a cause of significant morbidity as this case demonstrates.

Brain↗