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Biomedical subjects

T Tartaglione

Publications and source records attributed to T Tartaglione.

At least 19 recordsLinked to original sources
PubMed2004

Craniopagus: the Thessaloniki-Rome experience.

OBJECT: A case of two female Greek twins conjoined at the left frontal and orbital regions is described. These conjoined twins were transferred to the Pediatric Neurosurgical Unit of the Gemelli Hospital, Catholic University Medical School, at the age of 4 months for possible surgical division. METHOD: Multiple diagnostic investigations, which included in particular advanced imaging techniques, demonstrated an independent cerebral vascularization of the two babies and excluded significant intracranial malformations. Such an accurate evaluation of the anatomy of the craniopagus at the level of the cranial junction allowed the feasibility of the surgical correction to be established. CONCLUSIONS: The operation was carried out by a multidisciplinary team in a single stage. The operating team included two distinct teams of neurosurgeons and anesthesiologists as well as a plastic surgeons' team. Both babies survived the operation. The postoperative course was uneventful. Both twins were discharged in good clinical and neurological condition after a 3-week period of hospitalization.

Brain↗
PubMed2004

Observation of continuous spike-waves during slow sleep in children with myelomeningocele.

CASES: Two patients with myelomeningoceles (MMC) and shunt-treated hydrocephalus are reported. At 5 and 7 years respectively, when they began presenting mental deterioration and behavioural disorders, sleep EEG showed continuous spike-waves during slow sleep (CSWS). DISCUSSION: These are the first cases of CSWS described in patients with MMC. The mechanisms of CSWS are considered. The role of hydrocephalus and the thalamic injuries found in one of the patients is discussed in detail. The usefulness of monitoring sleep EEG in patients with hydrocephalus or thalamic lesions is stressed, considering the effects of CSWS on the cognitive competencies and the soft or subclinical course that epilepsy complicated with CSWS may follow.

Cerebrospinal Fluid Shunts↗
PubMed2004

The role of brain infarcts and hippocampal atrophy in subcortical ischaemic vascular dementia.

We investigated if, in patients with vascular lesions, the variable that best discriminated demented from non-demented patients was the severity of the vascular pathology or the degree of hippocampal atrophy. A total of 39 patients multiple subcortical infarcts, who could be considered as possible vascular dementia with small vessel pathology, with underwent a neuropsychological study and brain magnetic resonance imaging (MRI) DSM IV criteria supported by neuropsychological data were used to distinguish demented from non-demented patients. The MRI study took into account the degree of hippocampal atrophy (hippocampal height and interuncal distance) and the severity of vascular pathology (number of brain infarcts). The distribution of lesions and a factor analysis showed that hippocampal atrophy is a better predictor of dementia than the number of brain infarcts. Multiple subcortical infarcts alone are probably not able to cause clinical dementia but the presence of vascular lesions increases the expression of concomitant Alzheimer's disease.

Aged↗
PubMed2003

Adenovirus meningoencephalitis in a patient with large B-cell lymphoma.

We report a case of a 58-year-old female with neuromeningeal relapse of a large B-cell lymphoma which developed a meningoencephalitis due to adenovirus (ADV). Diagnosis of suspected viral meningoencephalitis was based on computed tomography (CT) scan radiological pictures, which were atypical for CNS neoplastic infiltrations, and it was confirmed by direct immunofluorescence performed on cerebrospinal fluid. Cultural exams identified adenovirus type 7. The ADV infection resolved after treatment with total four doses of cidofovir. Unfortunately, the hematological disease progressed and the patient died 2 months later from disseminated lymphoma.

Adenovirus Infections, Human↗
PubMed2001

Spinal cord stimulation prevents the effects of combined experimental ischemic and traumatic brain injury. An MR study.

Spinal cord stimulation (SCS) interferes with cerebral blood flow (CBF). In this paper we try to evaluate the possible preventing effect of SCS in an animal model of combined ischemic and traumatic injury. We studied 20 New Zealand rabbits undergoing ligature of both carotid arteries and a right hemispheric craniectomy and about 3 h mechanical injury (200 mg) over the dura. In 10 animals (control group) SCS was not delivered; in 10 (SCS group) cervical SCS was started 20 min after arterial ligation and before the craniectomy and the mechanical injury. MR examination was performed in all the animals at the end of the experiments. Compared to the control group none but one of the SCS showed lesional pattern far from the craniectomy suggesting a 'preventing' effect of SCS on the secondary damage associated with our model combined ischemic and traumatic brain injury.

Animals↗
PubMed2000

Concomitant post-traumatic craniocervical junction epidural hematoma and pontomedullary junction infarction: clinical, neurophysiologic, and neuroradiologic features.

STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a case of post-traumatic epidural hematoma of the craniocervical junction with concomitant brain stem infarction. SUMMARY OF BACKGROUND DATA: Post-traumatic epidural hematoma of the cervical spine and brain stem post-traumatic infarction are very rare disorders. Post-traumatic epidural hematoma is usually located dorsally in the epidural space. METHODS: The clinical, neuroradiologic, and neurophysiologic findings in one patient with post-traumatic epidural hematoma located ventrally at the cervicomedullary junction and associated with medial infarction at the pontomedullary junction are reported. RESULTS: The main clinical finding in this patient was bilateral corticospinal and corticobulbar tract involvement. A magnetic resonance image showed displacement and flattening of the medulla oblongata and of the most cranial portion of cervical cord, which were caused by the epidural hematoma associated with an ischemic lesion of the pontomedullary junction. Results of central motor conduction studies indicated that the abnormality of the central motor pathways was localized at brain stem level, and that there was normal conduction from the cervicomedullary junction to spinal cord. CONCLUSION: This is the first reported case of spinal epidural hematoma located ventrally in the cervical spine at the cervicomedullary junction level and concomitant infarction at the pontomedullary junction resulting from whiplash injury.

Aged↗
PubMed1999

Value of combined approach with thallium-201 single-photon emission computed tomography and Epstein-Barr virus DNA polymerase chain reaction in CSF for the diagnosis of AIDS-related primary CNS lymphoma.

PURPOSE: To determine the diagnostic capability of thallium-201 (201Tl) single-photon emission computed tomography (SPECT) combined with Epstein-Barr virus DNA (EBV-DNA) in CSF for the diagnosis of AIDS-related primary CNS lymphoma (PCNSL). PATIENTS AND METHODS: All human immunodeficiency virus (HIV)-infected patients with focal brain lesions observed between June 1996 and March 1998 underwent lumbar puncture and 201Tl SPECT. Each CSF sample was tested with polymerase chain reaction (PCR) for EBV-DNA. RESULTS: Thirty-one patients were included, 13 with PCNSL and 18 with nontumor disorders. In 11 PCNSL patients, EBV-DNA was positive. Thallium-201 uptake ranged from 1.90 to 4.07 in PCNSL cases (mean, 2.77; 95% confidence interval [CI], 2.35 to 3.19) and from 0.91 to 3.38 in nontumor patients (mean, 1.62; 95% CI, 1.30 to 1.94) (P<.0002). Using a lesion/background ratio of 1.95 as cutoff, a negative SPECT was found in one PCNSL case and 16 nonneoplastic cases. A cryptococcoma and a tuberculoma showed highly increased 201Tl uptake. Epstein-Barr virus DNA was never detected in nonneoplastic patients. For PCNSL diagnosis, hyperactive lesions showed 92% sensitivity and 94% negative predictive value (NPV), whereas positive EBV-DNA had 100% specificity and 100% positive predictive value. The presence of increased uptake and/or positive EBV-DNA had 100% sensitivity and 100% NPV. CONCLUSION: Combined SPECT and EBV-DNA showed a very high diagnostic accuracy for AIDS-related PCNSL. Because PCNSL likelihood is extremely high in patients with hyperactive lesions and positive EBV-DNA, brain biopsy could be avoided, and patients could promptly undergo radiotherapy or multimodal therapy. On the contrary, in patients showing hypoactive lesions with negative EBV-DNA, empiric anti-Toxoplasma therapy is indicated. In patients with discordant SPECT/PCR results, brain biopsy seems to be advisable.

Adult↗
PubMed1999

Acute hemorrhagic leukoencephalitis in patients with acute myeloid leukemia in hematologic complete remission.

The authors describe the cases of three patients affected by acute myeloid leukemia, in complete remission, who rapidly developed neurologic symptoms leading to death. Neither clinical characteristics, nor radiological or microbiological procedures, allowed an etiological diagnosis of the neurologic syndrome. Post-mortem examination of the brain showed both macroscopic and microscopic findings compatible with acute hemorrhagic leukoencephalitis. The difficulty in distinguishing this entity from other CNS disease-related complications (e.g. leukemia infiltration, drug toxicity, hemorrhages) should not lead to an underestimation of the true incidence of this complication. We believe that with more attention to the possibility of this complication there would probably be both a greater possibility of collecting clinical informations about the real impact of this dramatic disease and a stronger hope of finding the right treatment for it.

Acute Disease↗
PubMed1999

Inconsistent MRI findings in acute pre-Willisian brain ischemia in rabbit: a useful model?

BACKGROUND: We have investigated a model of "preterminal ischemia" in order A) to assess the MRI findings and the repeatability of the anatomical changes as showed by MRI, and B) to compare the data so obtained with the humans. METHODS: Twenty rabbits were used. Under general anesthesia, the occlusion of 1) the two common carotid arteries (from 2 hours up to 24 hours) was performed in 8 cases, and of 2) the epi-aortic vessels at the aortic arch (from 2 hours up to 4 hours) was performed in 4 cases in general anesthesia. RESULTS: In the vessels occlusion group MRI study showed inconsistent, inconstant, predominantly ill defined, linear and/or spotlike hyperintense deep cerebral alterations, variable in location, unilateral and bilateral in 8 cases. Although in carotid occlusion the damage was already evident within the first two hours, aortic arch occlusion was unable to produce global brain lesional pattern even up to 4 hours. MRI study of the sham operated animals was negative. CONCLUSIONS: The selective vulnerability of mesial deep cerebral structures to hypoxia, different in location from the human's, and the more effective pre-Willisian compensation, suggests to look for different animals when dealing with preterminal ischemic models comparable to the humans' as studied with MRI.

Animals↗
PubMed1997

Contrast enhancement issues in the MR evaluation of the central nervous system.

Because of its high intrinsic contrast resolution, magnetic resonance imaging (MRI) has largely replaced computed tomography (CT) in the diagnosis of central nervous system (CNS) diseases, and the use of contrast media in MRI of the CNS has increased progressively, gadolinium chelates being, by far, the most used ones. Our paper will focus on the current indications for contrast-enhanced MR imaging of the CNS and will outline the current role and the future trends in contrast medium (CM) administration in the diagnosis of CNS disease. Gadolinium chelates are now routinely employed in MRI of the brain and spine and have been shown to be relatively safe and well tolerated at standard doses of 0.1 mmol/kg b. w. Although there is general consensus on the usefulness of CM administration in MRI of the CNS, some controversy still persists on the type of CM to be used, on the administration scheme, and on the imaging protocol. The current trend is toward selective employment of CM, the effect of which can be enhanced by Magnetization Transfer (MT) techniques, to increase the sensitivity of the procedure. Double or triple doses of CM can be useful in the detection of small parenchymal lesions with faint enhancement, in functional/dynamic studies of the brain parenchyma and in MR angiography. Gadoteridol (ProHance(R)) closely resembles the features of an optimal CM, because it is non-ionic, has a low osmolality and a low viscosity, and may be particularly efficacious when high doses are required.

Central Nervous System↗
PubMed1997

Ischaemic myelopathy associated with cocaine: clinical, neurophysiological, and neuroradiological features.

Two patients with spinal infarction and one patient with the previously unreported complication of spinal transient ischaemic attack associated with cocaine misuse are reported. Spinal MRI documented an infarction in the territory of the anterior spinal artery in the first two patients and was completely normal in the patient with a transient ischaemic attack. Motor evoked potentials were abnormal in all three patients.

Adult↗
PubMed1997

Diagnosis of AIDS-related focal brain lesions: a decision-making analysis based on clinical and neuroradiologic characteristics combined with polymerase chain reaction assays in CSF.

OBJECTIVE: To identify disease patterns in AIDS-related focal brain lesions (FBL) and to design a decision-making strategy for differential diagnosis. DESIGN: Prospective study. Probabilities of CNS disorders were calculated using Bayes' theorem according to clinical variables (mass effect at CT or MRI, Toxoplasma serology, anti-Toxoplasma prophylaxis) and to the results of polymerase chain reaction (PCR) assays. PATIENTS: 136 consecutive HIV-infected patients with a definitive diagnosis of FBL-causing disorder observed from 1991 to 1995 in a single clinical setting. INTERVENTIONS: Patients underwent empiric anti-Toxoplasma therapy. After 3 weeks, patients with progressive/stable disease underwent brain biopsy. In 66 patients Epstein-Barr virus (EBV)-DNA, JC virus (JCV)-DNA, and T gondii-DNA amplification was performed by PCR in CSF. Diagnostic criteria were histopathologic examination of bioptic or autoptic tissue specimens for all disorders and complete/partial resolution of FBL after empiric therapy for toxoplasmic encephalitis (TE). RESULTS: Neuroradiologic characteristics did not discriminate between TE and primary CNS lymphoma (PCNSL). Probability of TE was 0.87 in Toxoplasma-seropositive patients with mass effect who were not receiving anti-Toxoplasma prophylaxis, but only 0.59 if prophylaxis was performed. In seronegative patients with mass effect, the likelihood of PCNSL was 0.74. If EBV-DNA or T gondii-DNA tests were positive, the probability of PCNSL or TE increased to more than 0.96. The absence of T gondii-DNA did not exclude the possibility of a TE diagnosis. Among FBL without mass effect, the probability of progressive multifocal leukoencephalopathy (PML) was 0.81; this increased to 0.99 if JCV-DNA testing was positive. Sensitivity of brain biopsy was 93%, with a perioperative morbidity of 12% and a mortality of 2%. CONCLUSIONS: Due to the low diagnostic capability of clinical variables, PCR amplifications in CSF, especially for EBV-DNA and for JCV-DNA, represent, in most cases, an essential step in the differential diagnosis of AIDS-related FBL. This is particularly true in patients with FBL without mass effect or with mass effect and who are either seronegative or undergoing anti-Toxoplasma prophylaxis. Brain biopsy remains a necessary procedure in EBV-DNA-positive cases and in seronegative patients with FBL displaying a mass effect. Positive JCV-DNA testing may obviate the need for brain biopsy in patients with FBL without mass effect. An advanced diagnostic strategy based on combined clinical criteria and PCR tests may allow rapid and accurate identification of patients for prompt brain biopsy or specific therapy.

AIDS Dementia Complex↗
PubMed1996

Preliminary clinical observations on a new trigeminal reflex: the trigemino-cervical reflex.

Short latency trigemino-cervical reflexes can be recorded from sternocleidomastoid muscle after stimulation of the infraorbital branch of the trigeminal nerve. We studied the trigemino-cervical reflexes and the conventional blink reflex in three patients with an isolated lesion in the medulla oblongata, eight patients with multiple sclerosis, and two patients with supratentorial ischemic lesion. The trigemino-cervical response was abnormal in the patients with an isolated lesion in the medulla oblongata and in all multiple sclerosis patients, whereas both components of the blink reflex were preserved in the patients with a lesion in the medulla oblongata and in half of the patients with multiple sclerosis. The trigemino-cervical reflex was preserved in patients with supratentorial lesions, whereas the late component of the blink reflex was abnormal. These findings suggest that central pathways generating the trigemino-cervical reflex are confined to the medulla oblongata and that they are independent from those generating the long latency (R2) component of the blink reflex. The trigemino-cervical reflex may help in disclosing and localizing brainstem lesions.

Adult↗
PubMed1996

[T2-dependent sequences in the study of hepatic focal lesions: comparison of the conventional spin echo sequence and the 0.5 T fast spin echo].

T2-weighted spin echo MR images are widely used in the detection and characterization of focal liver lesions. The main pitfall of this technique is its relatively long acquisition time. Fast spin echo sequences can provide the same contrast as conventional T2-weighted SE images in a shorter scanning time. Our study prospectively compared the effectiveness of T2-weighted conventional spin echo (CSE) versus fast spin echo (FSE) sequences in MRI of focal liver lesions. We examined 24 patients with this condition. All lesions were submitted to percutaneous biopsy and to the diagnostic gold standard technique, which was intraoperative US (13 patients), Lipiodol CT (10 patients) or 6-month follow-up (1 patient). MR images were analyzed from both a quantitative (signal-to-noise and contrast-to-noise ratios) and a qualitative viewpoints (overall image quality, lesion detection rate, number of lesions as compared with the gold standard, lesion conspicuity, internal features and the absence of artifacts). There was no statistically significant difference in contrast-to-noise ratio between the two sequences (p = 0.713). In the qualitative analysis, CSE sequences were superior to FSE for overall image quality in 50% of cases, for lesion conspicuity in 41.5% of cases and for internal features and the absence of artifacts in 46% of cases, FSE sequences had a higher detection rate in 17% of cases, even though both types of sequences underestimated the number of lesions in 29% of cases, as compared with the gold standard. To conclude, FSE sequences were inferior to CSE for image quality, lesion conspicuity, internal features and the absence of artifacts. FSE sequences were superior in the detection and characterization of fluid and nearly fluid lesions.

Adult↗