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T Jaspan

Publications and source records attributed to T Jaspan.

At least 55 records · Page 3Linked to original sources
PubMed1994

A simple simulation for the visualisation of CSF flow in infants with hydrocephalus.

Cerebrospinal fluid (CSF) flow was demonstrated incidentally in our unit during the routine cranial colour Doppler examination of infants with hydrocephalus. Pulsed Doppler analysis of the flow jets within CSF has shown that for each CSF flow jet there is a characteristic sinusoidal wave pattern that decreases in amplitude at the end of each jet episode. Any activity that transiently elevates the intracranial pressure, such as crying, increased the intensity of this signal. A study was subsequently carried out to investigate the origin of these clinical observations of CSF flow. Using a simple flow phantom, experiments with degassed water demonstrated the transient production of a Doppler signal at a stenosis in an otherwise uniform bore tube. We postulate that in infants with obstructive hydrocephalus, high CSF velocities in excess of 25 cm/s are produced as a result of the pressure caused by the excess cerebrospinal fluid. In some instances fluid jets may give rise to the production of microbubbles that act as transient but extremely efficient reflectors for the ultrasound, thus enabling the visualisation of CSF flow in these patients.

Cerebrospinal Fluid↗
PubMed1994

The outcome of fetal ventriculomegaly.

Over a 5 year period 38 cases of fetal ventriculomegaly were diagnosed at Queen's Medical Centre, Nottingham. There were 12 cases of spina bifida and all patients opted for a termination of pregnancy. There were 15 cases of isolated ventriculomegaly comprising seven cases of aqueduct stenosis, four abnormalities of the corpus callosum, one cavum septum pellucidum cyst, one case of porencephaly and two cases of mild lateral ventricular dilatation. The fetuses in this group had a relatively good outcome with five babies showing normal development, three with mild development delay and one with moderate developmental delay. There was one stillbirth and five patients opted for a termination of pregnancy. Associated abnormalities were seen in seven cases and these carried a poor prognosis with one fetus stillborn, one neonatal death, and three patients opted for a termination of pregnancy. Two babies were liveborn, one has severe developmental delay and the other one is normal. The four remaining cases included two Dandy Walker syndrome, one brain tumour and one case of subdural haemorrhage. There were three terminations of pregnancy and one stillbirth in this group. The outcome of fetal ventriculomegaly depends on the presence of associated abnormalities which carry a poor prognosis. It also depends on the timing of the diagnosis as most patients will opt for a termination of pregnancy if the diagnosis is made before 24 weeks gestation. A review of the literature reveals that, excluding terminations, fetuses with isolated ventriculomegaly have an 80% chance of survival and a 50% chance of normal development.

Abnormalities, Multiple↗
PubMed1994

Review article: computed tomography and magnetic resonance in the diagnosis of intraventricular cerebral masses.

We describe a series of 60 cases of patients with masses arising within the cerebral ventricles. The site and relative frequency is noted for each histological type. The differential diagnosis depends on patient age and sex, site, morphology and number of masses, presence and type of hydrocephalus and the characteristics of the mass on computed tomography (CT) and magnetic resonance (MR) images. A review of the literature has been performed and this information collated with our own experience to give detailed descriptions of the typical features of each intraventricular mass. Attention is drawn to intraventricular neurocytoma, a recently described tumour that may be mistaken histologically for intraventricular oligodendroglioma or ependymoma. A comparison is made of the value of CT and MR in the diagnosis of intraventricular masses.

Adolescent↗
PubMed1993

Migraine angiitis precipitated by sex headache and leading to watershed infarction.

Vasospasm is a rare cause of cerebrovascular disease except following subarachnoid haemorrhage. We describe a woman who developed an explosive-type sex headache, followed by a series of severe migrainous headaches associated with fully reversible segmental cerebral arterial narrowing and dilatation, resulting in widespread infarction in cerebral arterial border zones. This led to transient loss of consciousness and multiple focal cortical deficits including blindness. She had a past history of migraine and a family history of both migraine and sex headaches. Similar cases have been reported in the literature under a variety of rubrics. We suggest that this newly recognized clinico-radiological syndrome is a migraine variant.

Adult↗
PubMed1992

Cerebral contusional tears as a marker of child abuse--detection by cranial sonography.

A series of 6 infants subjected to child abuse is presented in whom contusional tears of subcortical white matter were detected during life by intracranial sonography. The sonographic appearances of this highly pathognomonic marker of shaking injury are described for the first time and their significance discussed. On the basis of our experience we suggest that high resolution cranial sonography is an extremely valuable part of the diagnostic work up in cases of suspected non-accidental injury.

Brain Concussion↗
PubMed1992

Management and outcome of severe head injuries in the Trent region 1985-90.

In a five year period, 39 children (29 boys, 10 girls) aged 2 months to 13 years (mean 7.8 years) were studied who had suffered a major head injury (29 road traffic accidents, six falls, and four non-accidental injury). The injury had been assessed clinically and by cranial computed tomography or cranial ultrasound (in a single baby of 2 months). Initial Glasgow coma scores for all subjects ranged from 3-11 (mean 5.5), intact survivors 5-11 (7.4), minor handicap 4-11 (6.1), major handicap 3-6 (4.3), fatalities 3-6 (4.1). All were treated with sedation, paralysis, hyperventilation (arterial carbon dioxide tension 3.0-3.5 kPa), intracranial pressure monitoring and moderate body surface hypothermia to 32 degrees C. Nine children died and 30 survived (nine intact, 13 minor disability, and eight major disability). The worst cerebral perfusion pressure was over 40 mm Hg in all but one survivor, and less than 40 mm Hg in seven of nine fatalities. Severe hypocapnia both in the first 24 hours and overall was correlated with poor outcomes (dead or major disability), as were bilateral contusions or diffuse axonal injury.

Adolescent↗
PubMed1991

Magnetic resonance imaging of spinal trauma.

A retrospective series of 118 magnetic resonance examinations of 110 patients who had sustained previous spinal trauma is reported. Examinations performed within 3 weeks of trauma showed extraspinal soft tissue (including ligamentous) injury in 48% and intraspinal lesions in 61% (mostly consisting of extradural haematoma and spinal cord contusion). In examinations performed more than 3 weeks after injury intraspinal abnormalities were shown in 51% and these represented spinal cord compression, atrophy, myelomalacia and syringohydromyelia. Magnetic resonance imaging has the unique capability of displaying non-invasively the late sequelae of spinal trauma permitting simultaneous evaluation of the extra-spinal soft tissues, vertebral column and spinal cord. It is therefore recommended as the technique of choice in the investigation of patients who have sustained previous spinal injury, particularly those with neurological deficit. In the acute phase potentially remediable causes of neurological impairment such as disc herniation or extradural haematoma can be identified. Signal changes in the cord may allow the prognosis for neurological recovery to be established. In the later stages sequelae such as cord atrophy, myelomalacia and syringohydromyelia are accurately identified and surgical therapy may be guided, where appropriate.

Acute Disease↗
PubMed1990

Thoracic spinal cord compression caused by diffuse idiopathic skeletal hyperostosis (DISH).

Diffuse idiopathic skeletal hyperostosis (DISH) is now recognized with increasing frequency in the elderly population. Whilst usually a relatively asymptomatic process, serious neurological sequelae have been reported. A previously unreported complication, severe focal thoracic canal stenosis, is presented. Attention is drawn to the need for full assessment of the whole spine by CT myelography in patients presenting with evidence of myelopathy.

Aged↗
PubMed1990

The impact of the M1 air crash on the radiological services at the Queen's Medical Centre, Nottingham.

Following the M1 air crash on 8 January 1989, 39 casualties were taken to the Queen's Medical Centre, Nottingham. A team of 31 radiographers and four radiologists used all five X-ray rooms adjacent to the Accident and Emergency Department. Patients with head and spinal injuries were further assessed in the CT suite by four radiographers and a neuroradiologist. The volume of work in the first few hours and in the subsequent days is described. All radiological examinations have been reviewed and the injuries, including those missed at initial assessment, are discussed. The role of the radiologists was to issue immediate reports, manage examinations so as to minimize any delay and assess the need for further specialized investigation. Important problems were identified, specifically: the call-out system; patient deterioration and lack of resuscitation equipment; patient flow; documentation; radiology equipment; and missed injuries. These problems are discussed and recommendations are made for X-ray Departments in dealing with disasters.

Accidents, Aviation↗
PubMed1990

Magnetic resonance imaging in neurological disorders.

To investigate the role of magnetic resonance imaging (MRI) in neurological disorders, 115 children were studied in two groups. Group A (78 patients) was studied by paired computed tomography and MRI cranial scans. Group B (37 patients) was studied by paired computed tomography assisted myelography (CTM) and MRI spinal scans. In group A, the scans were generally equivalent for supratentorial tumours and for investigating fits, hydrocephalus, benign intracranial hypertension, and cerebral atrophies, but MRI scanning was superior for posterior fossa tumours and cysts. In group B, MRI scans were superior for intramedullary spinal tumours, spinal dysraphic problems with tethering or syrinx, and were complementary to CTM in diastematomyelia.

Adolescent↗
PubMed1990

Intraventricular neurocytoma: a clinical and pathological study of three cases and review of the literature.

Three patients with a recently described tumor of neuronal origin, intraventricular neurocytoma, are presented. These tumors occur as intraventricular lesions in young patients, and the prognosis after surgical treatment is favorable. The initial pathological diagnosis of intraventricular neurocytoma may be difficult because of the striking resemblance of these tumors to oligodendroglioma and, to a lesser extent, ependymoma on light microscopic examination. Despite the use of wide-ranging panels of monoclonal antibodies, previous authors have not found any characteristic immunohistochemical staining patterns, but in our three patients, the use of synaptophysin, glial fibrillary acidic protein, and Leu-7 demonstrated staining patterns that may be useful in the diagnosis of this tumor. The monoclonal antibody Ki-67 was used to stain one tumor and showed a low cell proliferation rate. We have reviewed the clinical, radiological, and pathological features of these 3 patients and 17 previously described patients in an attempt to determine the important diagnostic features of intraventricular neurocytoma. Intraventricular neurocytoma should be considered in any young patient with symptoms of raised intracranial pressure and radiological evidence of an intraventricular lesion. Pathological diagnosis requires the use of electron microscopy to show features of neuronal differentiation; however, immunohistochemical demonstration of a neuronal phenotype is also a useful adjunct to diagnosis. Failure to use specialized techniques for pathological diagnosis will lead to misdiagnosis of these lesions as oligodendrogliomas, as was the initial diagnosis in 2 of our patients before review.

Adolescent↗
PubMed1989

Multiple cerebral aneurysms--a reappraisal.

254 consecutive cases of angiographically demonstrated intracranial cerebral aneurysms occurring over a three year period were reviewed with specific reference to aneurysm multiplicity, site, patient age and the presence of infundibular abnormalities. The overall incidence of multiple aneurysms was 44.9%. Female patients accounted for 66.5% of all aneurysm cases. The incidence of multiplicity was higher in women (51.5%) than men (31.7%) and overall was higher in patients over 40 years of age (52.8%) compared to those under this age (26.3%). Infundibula occurred in 27.2% of all patients and 9.45% of all patients demonstrated infundibular dilatation of the origin of the posterior communicating artery.

Adolescent↗
PubMed1989

Gadolinium-enhanced magnetic resonance imaging of spinal tumours.

The use of gadolinium diethylenetriamine-penta-acetic acid (Gd-DTPA) (Magnevist) enhanced magnetic resonance imaging (0.15 T) in the assessment of spinal tumours is described. Thirty-five patients were entered into the study and a total of 39 examinations were performed. The information obtained from unenhanced T1- and T2-weighted spin-echo sequences was compared with the Gd-DTPA-enhanced T1 images. Thirty patients had intradural lesions and five had extradural lesions. A variable pattern of enhancement of intramedullary tumours was found, which in part reflected differences in the cystic component of the lesions. Extramedullary intra- and extradural lesions generally showed marked enhancement. The greatest contribution to management decisions was in the evaluation of intramedullary tumours where the use of contrast enhancement facilitated the precise localization of active tumour, differentiation of cystic and solid components of tumour, separation of tumour from peritumoral oedema and, in cases of suspected recurrence, aided distinction between tumour and both post-operative scarring and radiation damage.

Adolescent↗
PubMed1988

Magnetic resonance imaging with even-echo rephasing sequences in the assessment and management of giant intracranial aneurysms.

The role of magnetic resonance imaging in the assessment of giant intracranial aneurysms was compared with angiography and contrast-enhanced computed tomography (CT) in 18 patients. The use of T1- and T2-weighted spin-echo (SE) sequences demonstrated both the presence and the evolution of thrombus within these lesions. High-velocity flow within the parent vessels and still-patent lumen could be defined as an area of absent signal. The use of even-echo rephasing (EER) sequences provided a rapid technique for demonstrating and confirming the presence of luminal flow, which is shown as areas of high signal. The combination of SE and EER techniques proved superior to CT in the assessment of thrombus and flow patterns in these lesions, as well as enabling superior demonstration of the patency of the parent vessel following surgical ligation. Computed tomography remains the most accurate method of defining the presence and location of associated calcification.

Adult↗