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Biomedical subjects

W C Hanigan

Publications and source records attributed to W C Hanigan.

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

Children with cerebral venous thrombosis diagnosed with magnetic resonance imaging and magnetic resonance angiography.

From 1985 to 1991, 13 children were diagnosed at the University of Illinois College of Medicine at Peoria, Saint Francis Medical Center, with cerebral venous thrombosis (CVT) by magnetic resonance imaging scan. Ages ranged from newborn to 5 years. Six children were premature neonates, five were term neonates and two were 5 years old. In the premature neonates, thrombosis was usually associated with other problems. All the term neonates had seizures. In all neonates, thrombosis resolved without any specific treatment. In the two older children, one presented with pseudotumor cerebri and one with coma. These children required neurosurgical intervention. Follow-up magnetic resonance imaging scans were obtained in 9 of 13 children and showed thrombus resolution in each case. Three children were studied in the acute and convalescent stages by magnetic resonance angiography using time-of-flight techniques. Each follow-up magnetic resonance angiogram showed improvement in venous flow consistent with their clinical course and other imaging studies. We conclude that 1) CVT in children encompasses a range of clinical conditions which may or may not require neurosurgical intervention; 2) magnetic resonance imaging is superior to other modalities for the diagnosis of CVT; and 3) magnetic resonance angiography is an alternative means to monitor the evolution of CVT and efficacy of therapeutic intervention.

Cerebral Angiography↗
PubMed1992

Neurological surgery in the nineteenth century: the principles and techniques of Ernst von Bergmann.

Born in Latvia in 1836, Ernst von Bergmann received his medical education and first academic position at the University of Dorpat in Russia. In 1866, he served as a military surgeon in the Prusso-Austrian War, followed by duty in the Franco-Prussian War of 1870. He was appointed to the faculty of the University of Würzburg in 1878 and 4 years later moved to the University Clinic in Berlin. As a professor and chairman of surgery, he taught until his death in 1907. Von Bergmann practiced general surgery but devoted a large part of his career to the treatment of neurological diseases. Known for his development of aseptic technique, his early military experiences directed his attention to cranial trauma and, ultimately, neurosurgery. In 1880, he authored his first textbook, which described missile ballistics and animal experiments first demonstrating the physiological response later known as "the Cushing reflex" and advocated meticulous intracranial debridement with thorough closure after trauma. Twenty years later, as senior editor of the massive System of Practical Surgery, his contributions included pediatric neurosurgery, successful treatment of abscesses and tumors, diagnostic radiography, and cerebral localization using external landmarks and the neurological examination. Revered by his students and honored by his colleagues, von Bergmann became a proponent for aggressive neurosurgical treatment. His skilled techniques, developed in parallel with accurate experimental physiology, advanced 19th century surgical progression and formed a solid framework for the advances of neurosurgical specialists.

Germany↗
PubMed1991

Surgical treatment and long-term neurodevelopmental outcome for infants with idiopathic aqueductal stenosis.

Evaluation of in utero shunting for fetal ventriculomegaly requires an analysis of the ex utero treatment of a comparison population of infants with idiopathic aqueductal stenosis (IAS). In this study, 14 neonates with IAS were followed with detailed developmental assessment profiles for 18 months or longer. Using magnetic resonance imaging, the preoperative and postoperative frontal cortical mantle widths (FCMW) were determined for each patient. Four of 14 children demonstrated normal outcomes while 5 of 14 children showed abnormal outcomes. The remaining 5 children demonstrated minimally impaired outcomes. No child with a postoperative FCMW below 30 mm showed normal development on any scale, while all children with abnormal development demonstrated a postoperative FCMW of 21 mm or less. In conclusion, the prognosis for normal long-term neurodevelopment in infants with IAS, despite prompt ex utero treatment, is guarded; the majority of such children will show developmental delays of varying degrees. The FCMW serves as a reasonable prognostic indicator in this patient population.

Cerebral Aqueduct↗
PubMed1991

Incidence and neurodevelopmental outcome of periventricular hemorrhage and hydrocephalus in a regional population of very low birth weight infants.

During the years 1984 to 1987, 459 very low birth weight (VLBW) infants were admitted to a state-designated Level III Neonatal Intensive Care Unit. Cerebral sonography performed in a standardized sequence and graded with the Papile scale diagnosed 97 (21.1%) children with periventricular hemorrhage (PVH). The incidence of PVH declined from a peak of 26.6% in 1985 to 16.4% in 1987, associated with an increase in the incidence of inborn admissions (including maternal transport) from 62.0% in 1984 to 80.4% in 1987. During initial hospitalization, the occurrence of both low-grade (Grades I and II) and high-grade PVH was associated with a significantly higher incidence of perinatal risk factors compared with a concurrent population of VLBW infants without PVH. Developmental follow-up was achieved in 93.3% of VLBW infants without PVH and 95.7% of VLBW infants with PVH who survived their initial hospitalization. The incidence of abnormal outcome ranged from 7 of 37 infants with Grade I PVH to 7 of 8 VLBW infants with Grade IV PVH. Only 1 of 16 VLBW infants with high-grade PVH demonstrated normal motor and cognitive development. Active hydrocephalus developed in 12 infants; 11 sustained a high-grade PVH. Appropriate treatment of intracranial hypertension did not modify the neurodevelopmental outcome. In conclusion, this regional population of VLBW infants demonstrated a decline in the incidence of PVH during the years 1984 to 1987 associated with an increase in the incidence of inborn admissions. The risk of abnormal neurodevelopmental outcome was elevated for all grades of PVH. A 12.0% incidence of hydrocephalus was associated with high-grade PVH, and appropriate treatment did not alter the poor prognosis.

Cerebral Hemorrhage↗
PubMed1991

Intestinal injury after lumbar discectomy.

In a review of 5,200 lumbar discectomies performed from 1974 to 1989, two patients sustained a ventral perforation of the disc space followed by isolated small intestinal injury. Both patients underwent lumbar discectomy at the lumbosacral junction and presented with signs and symptoms of acute abdominal distress within three days after the operation. At surgical laparotomy, small tears were noted in the ileum, which were closed primarily. The patients had an uneventful recovery. The results of a review of 11 instances reported in the literature suggest that isolated intestinal injuries usually occur postoperatively at the lumbosacral junction and involve the small intestine. Factors, such as body habitus, surgical experience, patient positioning and types of instruments, as well as the use of a surgical microscope, do not appear to modify the risk of intestinal injury. After discectomy, patients may present with acute abdominal signs and symptoms or chronic wound infections. Work-up studies include evaluation of vascular structures and ureters either roentgenographically or at abdominal exploration. A high index of suspicion and adequate disc space visualization during discectomy may reduce the incidence of this complication.

Abdomen, Acute↗
PubMed1990

The use of magnetic resonance imaging for the diagnosis of fetal intracranial anomalies.

While fetal cranial sonography has been used for the sensitive detection of ventriculomegaly, ancillary imaging techniques may be needed for precise delineation of structural abnormalities. This report outlines the radiologic and clinical results using maternal magnetic resonance imaging (MRI) in ten patients with suspected fetal intracranial anomalies. Imaging was accomplished at 17-39 weeks gestational age, using spin-echo, a multislice technique with intramuscular morphine sulfate for sedation. In four cases, MRI significantly clarified the sonographic diagnosis, while in two cases the scan agreed with the sonographic findings. In one patient, MRI failed to image a lumbar meningomyelocele associated with the Chiari II malformation. In two patients with the Chiari II malformation, both sonography and MRI failed to delineate the anatomic pathology completely. Optimal imaging resolution was achieved in the third trimester. Four patients died in the perinatal period. All the surviving patients required shunting to treat intracranial hypertension: only two patients were meeting cognitive milestones. We conclude that due to the high incidence of multiple anomalies in the fetus with ventriculomegaly, precision in neuroradiological diagnosis is essential. MRI can be a useful adjunct to cranial sonography for the specific delineation of abnormalities of the fetal central nervous system.

Brain↗
PubMed1990

Magnetic resonance imaging and the nonoperative treatment of spinal epidural abscess.

This report describes three patients with spinal epidural abscess diagnosed by magnetic resonance imaging and treated nonoperatively. Prior to treatment, one patient was neurologically intact, one patient demonstrated a moderate neurological deficit, and one patient was severely paraparetic with loss of bladder and bowel control. Following identification of the pathogenic organism, antibiotic therapy was continued until the patients demonstrated clinical improvement and radiological resolution of the abscess. All patients remained stable or improved neurologically. Analysis of 33 previously reported patients treated with antibiotics suggests that nonoperative treatment may be a reasonable alternative therapy under certain clinical conditions. These include (1) identification of the pathogenic organism, (2) a stable neurological condition, (3) access to magnetic resonance imaging or computed tomography for potentially rapid reevaluation, and (4) appropriate neurosurgical consultation and nursing care. Nonoperative treatment may also be considered as a reasonable alternative for patients who have severe concurrent medical illness.

Adult↗
PubMed1990

Dryander of Marburg and the first textbook of neuroanatomy.

Born in Wetter, Germany, in 1500, Johannes Eichmann (Dryander) studied medicine and anatomy at the University of Paris from 1528 to 1534. In 1535, he was appointed professor of medicine at the University of Marburg. During the next year he held two public dissections, and in 1536 he was the author of the first text illustrating a Galenic dissection of the human brain. An expanded edition of this early book, the Anatomiae pars prior, was published in 1537. These texts represented an important transition from the dogma of medieval scholasticism to the precise observations of Vesalius. The books depicted the brain in eight figures, with four additional plates describing the skull, skull base, and cranial sutures. Detailed illustrations of the dura mater, cerebral cortex, and posterior fossa structures with clear, but inaccurate, relationship to the cranial nerves demonstrated Dryander's reliance on his own dissections. In 1542, he published a translated edition of Mundinus' anatomy. As was common at that time, the text plagiarized a portion of Vesalius' Tabulae sex, which resulted in the famous anatomist's anger. Despite this, Dryander continued to write on medical subjects as well as mathematics and astrology until his death in 1560. Because he was a progenitor of rational scientific thought, his earlier books represented an important advance in the progression to modern anatomic description and illustration.

Anatomy, Artistic↗
PubMed1990

Spinal dysraphism: use of magnetic resonance imaging in evaluation.

Three cases of children with spinal dysraphism are reported. Magnetic resonance imaging (MRI) was used as a primary diagnostic examination. The ages of the patients were 2 days, 4 years, and 16 years. In all instances the scan gave a precise diagnosis as well as well as an accurate delineation of the structural abnormalities before surgical treatment. Plain radiographs and ultrasound analysis may not be helpful, and invasive procedures can be associated with morbidity. Technical ease, safety, and anatomic precision suggest that MRI should be performed as a primary radiologic examination in the diagnostic workup of spinal dysraphism.

Adolescent↗
PubMed1990

Spontaneous regression of giant arteriovenous fistulae during the perinatal period. Case report.

A unique case of spontaneous regression of giant arteriovenous fistulae during infancy is described in this report. A female infant, the product of normal labor and delivery, demonstrated severe ventriculomegaly and an intracranial hemorrhage at birth. Cerebral angiography at 5 days of age revealed several large fistulae fed by the anterior and middle cerebral arteries draining into the deep venous system through a dilated internal cerebral vein and ectatic vein of Galen. Two days following the angiogram, a second intracranial hemorrhage occurred. Active hydrocephalus developed over the next 6 months and was treated with ventriculoperitoneal shunting. When the child was 8 months of age, angiography failed to demonstrate the fistulae. It was postulated that pressure effects from the intracranial hematoma and long-standing intracranial hypertension as well as stenosis in the anomalous venous outflow resulted in vascular stasis, venous thrombosis, and selective arterial occlusion. Hydrocephalus was a result of the compression of the intraventricular foramina by dilated embryonic vessels. This anomaly, predominantly involving the anterior circulation, may be homologous to the vein of Galen aneurysm in the posterior circulation.

Arteriovenous Fistula↗
PubMed1990

Tentorial hemorrhage associated with vacuum extraction.

The clinical and radiologic descriptions of three neonates with tentorial hemorrhage after vacuum extraction are reported. All patients were full term, with Apgar scores of 8 or more; one patient experienced fetal distress during delivery. Within 36 hours after birth, the neonates had multiple generalized seizures; computed tomography or magnetic resonance imaging outlined distinctive tentorial hemorrhages with extension over the superior surface of the cerebellum or inferior surface of the occipital lobe. One patient had diffuse hypoxic-ischemic injury, and another had bilateral temporal lobe infarcts. Treatment included medical control of seizures and intracranial hypertension; one patient had surgical evacuation of bilateral subdural hematomas. Follow-up from 1 to 5 years showed significant developmental delays in two patients. These cases demonstrate that the forces generated on the fetal cranium by vacuum extraction are similar to those produced by forceps and result in tentorial laceration, venous rupture, and subdural hemorrhage. Because these hemorrhages may be associated with significant ischemic injury, serial radiologic evaluation is recommended for the detection of persistent structural abnormalities.

Birth Injuries↗
PubMed1989

Magnetic resonance imaging of spinal injury.

Magnetic resonance imaging (MRI) was performed on 30 patients following spinal injury (SI). Spin-echo sequences and surface coils were used for all patients. Plain radiographs, high-resolution computed tomography (CT), and MRI were compared for the delineation of bone, disc, and ligament injury, measurement of sagittal spinal canal diameter and subluxation, epidural hematoma, and spinal cord structure. Myelography or intrathecal contrast-enhanced CT were not performed on any of these patients. Magnetic resonance imaging accurately delineated intraspinal pathology in two of four patients with acute penetrating SI, and was normal in the other two patients. In 16 patients with acute nonpenetrating SI, MRI was superior to CT for visualizing injuries to discs, ligaments, and the spinal cord, while CT was superior to MRI in characterizing bony injury. Computed tomography and MRI provided similar measurements of subluxation in six of six patients and of sagittal spinal canal diameter in three of four patients. In ten patients with chronic SI, MRI demonstrated post-traumatic cysts, myelomalacia, spinal cord edema, and the presence or absence of spinal cord compression. In patients with acute penetrating SI and chronic SI, MRI provided comprehensive clinical information. In patients with acute nonpenetrating SI, the information obtained by MRI complemented the data given by plain radiographs and CT, allowing clinical decisions to be made without the need of invasive imaging modalities.

Adolescent↗
PubMed1988

Administration of indomethacin for the prevention of periventricular-intraventricular hemorrhage in high-risk neonates.

One hundred twenty-two preterm infants were enrolled in a placebo-controlled, double-blind trial using intravenous indomethacin for the prevention of periventricular-intraventricular hemorrhage (PVH-IVH). Before random assignment, data on the infants were stratified according to low-weight (500 to 999 g) or high-weight (1000 to 1500 g) subgroups. Cranial sonography was used to document the absence of PVH-IVH before enrollment and the occurrence of PVH-IVH during the 7-day protocol. Indomethacin, 0.1 mg/kg, or placebo was administered before 12 hours of age and at 24, 48, and 72 hours of age. Five patients receiving indomethacin and six receiving placebo were withdrawn before completion of the study. In the remaining 111 patients, the indomethacin and placebo groups were comparable with respect to gestational ages, maternal complications, Apgar scores, ventilatory requirements, complications of prematurity, and mortality rate. PVH-IVH developed in six of 56 infants who received indomethacin and 11 of 55 infants who received placebo (P = 0.174). Analysis of the individual strata showed that the indomethacin-treated infants in the low-weight subgroup sustained a higher mortality rate (11/17 vs 3/16; P = 0.008) without a reduction in the incidence of PVH-IVH. Infants in the indomethacin-treated high-weight subgroup demonstrated a significantly lower incidence of PVH-IVH (2/39 vs 8/39; P = 0.04), but the frequency of high-grade hemorrhages was comparable for both indomethacin- and placebo-treated groups. In summary, the prophylactic administration of intravenous indomethacin for the prevention of PVH-IVH cannot be recommended for infants less than 1000 g. In preterm infants between 1000 and 1500 g birth weight, indomethacin significantly reduced the incidence of PVH-IVH.

Birth Weight↗
PubMed1988

Neonatal cerebral venous thrombosis.

Five cases of neonatal cerebral venous thrombosis (NCVT) diagnosed by magnetic resonance imaging (MRI) are presented in this report. MRI was specific for the anatomic diagnosis, demonstrating involvement of the superior sagittal sinus in 3 infants or deep venous system in the remaining 2. Four cases were associated with perinatal hypoxia or cranial trauma. Three of these children show significant developmental delays. The increased use of MRI may add significant information on the association of cerebral venous thrombosis with the common systemic illnesses of newborns.

Child, Preschool↗
PubMed1988

Neurological surgery during the Great War: the influence of Colonel Cushing.

Despite von Bergmann's work in the Franco-Prussian War and Makins' experiences in the Boer conflict, military surgeons in World War I were unprepared for the nature and extent of intracranial injuries. Poor triage, disorganized transportation, incomplete surgery, and sepsis resulted in a mortality of over 50%. In 1915, as a volunteer to the Ambulance Américaine near Paris, Harvey Cushing spent 5 weeks observing the Allied medical system. He quickly recognized the technical importance of early, definitive intracranial surgery and the logistical requirements for a unified triage system located along the main lines of traffic. Cushing returned to France in 1917 as director of Base Hospital #5, known as the Harvard Unit. Immediately detached to the British Expeditionary Force, he operated at a smaller casualty clearing station close to the Belgian front. The patients treated during the third battle of Ypres (Passchendaele) formed the basis of his technical reports. He standardized intracranial injuries into nine categories with separate mortality rates. In addition, he recommended the surgical techniques of en bloc bone resection under local anesthesia with suction debridement and primary two-layer closure. Shell fragments were removed by magnets when possible; dichloramine-T was used as an antiseptic. By reducing infection and secondary complications, Cushing halved the earlier mortality rates. In September 1918, as senior consultant to the American Expeditionary Force, Cushing was in charge of organizing the neurosurgical care for the St. Mihiel and Meuse-Argonne offensives. His instruction of individual surgeons in operative techniques and the creation of identified hospital centers with suitable equipment and trained personnel helped to establish neurological surgery as a military specialty.

Brain Injuries↗
PubMed1987

Surgical results in obese patients with sciatica.

A prospective study was done to determine the effect of obesity on the surgical results in patients with intractable sciatica. One hundred ten patients entered the study over an 8-month period. Five patients (1 obese) were excluded. Seventeen patients were included in the obese group. The two populations did not differ in age, sex, occupation, level of disc herniation, involvement of compensation, length of hospitalization, duration of disability, or incidence of surgical complications. At the 6-month follow-up assessment, 14 obese patients vs. 80 nonobese patients rated their surgical results good or excellent. Patients with postoperative weight loss were equally distributed between the groups. The data demonstrate that obesity should not be considered a prognostic factor when patients are eligible for surgical therapy.

Female↗
PubMed1987

Tin ear syndrome: rotational acceleration in pediatric head injuries.

An array of signs pathognomonic of child abuse is described for three young children. The eponym "tin ear syndrome" describes distinct unilateral ear bruising, radiographic evidence of ipisilateral cerebral edema with obliteration of the basilar cisterns, and hemorrhagic retinopathy. Rotational acceleration produced by blunt trauma to the ear is shown to be a necessary and sufficient cause for the production of this syndrome. An approximate value of 4,670 radians/s2 produced by a force of 309 to 347 N (70 to 80 lb) results in shear stress and tearing of the subdural veins, loss of cortical vasomotor tone, cerebral hyperemia, herniation, and death. Past history and environmental circumstances implicated child abuse in every case.

Battered Child Syndrome↗