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Sample records for posterior fossa stroke

  1. Mortality Rates After Emergent Posterior Fossa Decompression for Ischemic or Hemorrhagic Stroke in Older Patients.

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    Puffer, Ross C; Graffeo, Christopher; Rabinstein, Alejandro; Van Gompel, Jamie J

    2016-08-01

    Cerebellar stroke causes major morbidity in the aging population. Guidelines from the American Stroke Association recommend emergent decompression in patients who have brainstem compression, hydrocephalus, or clinical deterioration. The objective of this study was to determine 30-day and 1-year mortality rates in patients >60 years old undergoing emergent posterior fossa decompression. Surgical records identified all patients >60 years old who underwent emergent posterior fossa decompression. Mortality rates were calculated at 30 days and 1 year postoperatively, and these rates were compared with patient and procedure characteristics. During 2000-2014, 34 emergent posterior fossa decompressions were performed in patients >60 years old. Mortality rates at 30 days were 0%, 33%, and 25% for age deciles 60-69 years, 70-79 years, and ≥80 years. Increasing age (alive at 30 days 75.2 years ± 1.7 vs. deceased 81.1 years ± 1.7, P = 0.01) and smaller craniectomy dimensions were associated with 30-day mortality. Mortality rates at 1 year were 0%, 50%, and 67% for age deciles 60-69 years, 70-79 years, and ≥80 years. Increasing age was significantly associated with mortality at 1 year (alive at 1 year 72.3 years ± 2.0 vs. deceased 81.1 years ± 1.2, P mortality. Age was independent of admission Glasgow Coma Scale score as a predictor of mortality at 30 days, 90 days, and 1 year postoperatively. Increasing age and smaller craniectomy size were significantly associated with mortality in patients undergoing emergent posterior fossa decompression. Among patients ≥80 years old, one-quarter were dead within 1 month of the operation, and more than two-thirds were dead within 1 year. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Posterior fossa epidural hematoma

    International Nuclear Information System (INIS)

    Kushner, M.J.; Luken, M.G. III

    1983-01-01

    CT demonstrated posterior fossa epidural hematoma in three patients with head trauma in whom this diagnosis was not clinically apparent. No patient was in stupor or coma and no patient experienced a lucid interval. Only one patient had signs referable to the posterior fossa. Two patients had occipital skull fracture disclosed by plain radiographs. CT revealed a unilateral biconvex hematoma in two cases, and a bilateral hematoma with supratentorial extension in the third. All patients underwent suboccipital craniectomy and recovered. Therapeutic success in these cases was facilitated by early CT and the rapid disclosure of the unsuspected posterior fossa lesions. CT showing contiguous hematoma below and above the tentorium cerebelli after posterior head trauma is highly suggestive of epidural hematoma arising from the posterior fossa. (orig.)

  3. Diagnosis of small posterior fossa stroke on brain CT: effect of iterative reconstruction designed for brain CT on detection performance

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    Inoue, Taihei; Yoshida, Morikatsu; Yokoyama, Koichi [Amakusa Medical Center, Department of Radiology, Amakusa, Kumamoto (Japan); Nakaura, Takeshi; Hirata, Kenichiro; Kidoh, Masafumi; Oda, Seitaro; Utsunomiya, Daisuke; Yamashita, Yasuyuki [Kumamoto University, Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto (Japan); Harada, Kazunori [Amakusa Medical Center, Department of Surgery, Kumamoto (Japan)

    2017-09-15

    In this study, we aimed to determine whether iterative model reconstruction designed for brain CT (IMR-neuro) would improve the accuracy of posterior fossa stroke diagnosis on brain CT. We enrolled 37 patients with ischaemic stroke in the posterior fossa and 37 patients without stroke (controls). Using axial images reconstructed using filtered back-projection (FBP) and IMR-neuro, we compared the CT numbers in infarcted areas, image noise in the pons, and contrast-to-noise ratios (CNRs) of infarcted and non-infarcted areas on scans subjected to IMR-neuro and FBP. To analyse the performance of hypo-attenuation detection, we used receiver-operating characteristic (ROC) curve techniques. The image noise was significantly lower (2.2 ± 0.5 vs. 5.1 ± 0.9 Hounsfield units, p < 0.01) and the difference in CNR between the infarcted and non-infarcted areas was significantly higher with IMR-neuro than with FBP (2.2 ± 1.7 vs. 4.0 ± 3.6, p < 0.01). Furthermore, the average area under the ROC curve was significantly higher with IMR-neuro (0.90 vs. 0.86 for FBP, p = 0.04). IMR-neuro yielded better image quality and improved hypo-attenuation detection in patients with ischaemic stroke. (orig.)

  4. Diagnosis of small posterior fossa stroke on brain CT: effect of iterative reconstruction designed for brain CT on detection performance

    International Nuclear Information System (INIS)

    Inoue, Taihei; Yoshida, Morikatsu; Yokoyama, Koichi; Nakaura, Takeshi; Hirata, Kenichiro; Kidoh, Masafumi; Oda, Seitaro; Utsunomiya, Daisuke; Yamashita, Yasuyuki; Harada, Kazunori

    2017-01-01

    In this study, we aimed to determine whether iterative model reconstruction designed for brain CT (IMR-neuro) would improve the accuracy of posterior fossa stroke diagnosis on brain CT. We enrolled 37 patients with ischaemic stroke in the posterior fossa and 37 patients without stroke (controls). Using axial images reconstructed using filtered back-projection (FBP) and IMR-neuro, we compared the CT numbers in infarcted areas, image noise in the pons, and contrast-to-noise ratios (CNRs) of infarcted and non-infarcted areas on scans subjected to IMR-neuro and FBP. To analyse the performance of hypo-attenuation detection, we used receiver-operating characteristic (ROC) curve techniques. The image noise was significantly lower (2.2 ± 0.5 vs. 5.1 ± 0.9 Hounsfield units, p < 0.01) and the difference in CNR between the infarcted and non-infarcted areas was significantly higher with IMR-neuro than with FBP (2.2 ± 1.7 vs. 4.0 ± 3.6, p < 0.01). Furthermore, the average area under the ROC curve was significantly higher with IMR-neuro (0.90 vs. 0.86 for FBP, p = 0.04). IMR-neuro yielded better image quality and improved hypo-attenuation detection in patients with ischaemic stroke. (orig.)

  5. Epidural hematomas of posterior fossa

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    Radulović Danilo

    2004-01-01

    Full Text Available Background. Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. Methods. Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. Results. Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. Conclusion. Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.

  6. Hematomas na fossa craniana posterior Haematomata in the posterior fossa

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    Mário S. Cademartori

    1969-09-01

    Full Text Available São relatados 6 casos de hematomas sub-tentorias (um de hematoma subdural crônico, quatro de hematomas intra-cerebelares, um de hematoma extra-dural. Salientando a pequena freqüência dos hematomas da fossa craniana posterior, o autor mostra a necessidade de vários exames complementares para o diagnóstico exato, indispensável para a aplicação de terapêutica cirúrgica adequada.Six cases of sub-tentorial haematomata (one chronic sub-dural, four intra-cerebellar, one extra-dural are reported. Emphasizing the relative rarity of haematomata in the posterior cranial fossa, the author claims the necessity of complementary examinations for proper diagnosis, indispensable for adequate surgical treatment.

  7. Traumatic posterior fossa epidural hematoma

    International Nuclear Information System (INIS)

    Ikeda, Yukio; Nakazawa, Shozo; Yamakawa, Kazuomi; Kobayashi, Shiro; Tsuji, Yukihide

    1981-01-01

    In this paper three acute cases and two subacute cases are reported. CT findings in acute cases show two different types. ''Type I'' shows crescent or lenticular high density area which is not enhanced after contrast infusion. ''Type II'' shows lenticular low density area with membranous high density region in its medial side after contrast infusion. In subacute cases plain CT scan shows lenticular iso or low density area with membranous high density region in its medial side. Forty five cases of posterior fossa epidural hematoma in the review of literature of this country are discussed. Disturbances of the consciousness are the most predominant symptoms in acute cases, while in subacute cases cerebellar signs, vomiting, headache and choked disc are noted. Angiographical examinations may not always be valuable in collecting the direct information of the existence of the epidural hematoma. Liquor cavity in the posterior fossa which is thought to serve as a buffer action of hematoma is about 20 ml, so we discuss about the volume of hematoma, especially of 20 ml, associated with clinical course and prognosis. Volume of epidural hematoma is one of the most important factors affecting clinical course and prognosis. In summary of these our experiences, we again emphasize the value of CT scan as the rapid, noninvasive, accurate radiological examination in the diagnosis of traumatic posterior fossa epidural hematoma. (author)

  8. Hematomas na fossa craniana posterior

    Directory of Open Access Journals (Sweden)

    Mário S. Cademartori

    1969-09-01

    Full Text Available São relatados 6 casos de hematomas sub-tentorias (um de hematoma subdural crônico, quatro de hematomas intra-cerebelares, um de hematoma extra-dural. Salientando a pequena freqüência dos hematomas da fossa craniana posterior, o autor mostra a necessidade de vários exames complementares para o diagnóstico exato, indispensável para a aplicação de terapêutica cirúrgica adequada.

  9. Cisternography of the posterior fossa with metrizamide

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    Kobayashi, N.; Saito, Y.; Miyashita, T.; Tajika, Y.

    1981-12-01

    Nine patients underwent metrizamide cisternography of the posterior fossa. Excellent opacification of the fourth ventricle resulted when the patient's head was suitably positioned and the contrast material was introduced via a C1-2 puncture. With this technique, a benign aqueductal stenosis can be readily identified and the posterior fossa and fourth ventricle can be studied easily.

  10. Treatment implications of posterior fossa ependymoma subgroups.

    Science.gov (United States)

    Ramaswamy, Vijay; Taylor, Michael D

    2016-11-15

    Posterior fossa ependymoma comprises two distinct molecular entities, ependymoma_posterior fossa A (EPN_PFA) and ependymoma_posterior fossa B (EPN_PFB), with differentiable gene expression profiles. As yet, the response of the two entities to treatment is unclear. To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment, we studied a cohort of 820 patients with molecularly profiled, clinically annotated posterior fossa ependymomas. We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA, which was recently reported in the paper entitled "Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era: a retrospective multicohort analysis" in the Journal of Clinical Oncology. Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy, whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.

  11. Congenital abnormalities of the posterior fossa.

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    Bosemani, Thangamadhan; Orman, Gunes; Boltshauser, Eugen; Tekes, Aylin; Huisman, Thierry A G M; Poretti, Andrea

    2015-01-01

    The frequency and importance of the evaluation of the posterior fossa have increased significantly over the past 20 years owing to advances in neuroimaging. Nowadays, conventional and advanced neuroimaging techniques allow detailed evaluation of the complex anatomic structures within the posterior fossa. A wide spectrum of congenital abnormalities has been demonstrated, including malformations (anomalies due to an alteration of the primary developmental program caused by a genetic defect) and disruptions (anomalies due to the breakdown of a structure that had a normal developmental potential). Familiarity with the spectrum of congenital posterior fossa anomalies and their well-defined diagnostic criteria is crucial for optimal therapy, an accurate prognosis, and correct genetic counseling. The authors discuss the spectrum of posterior fossa malformations and disruptions, with emphasis on neuroimaging findings (including diagnostic criteria), neurologic presentation, systemic involvement, prognosis, and risk of recurrence. RSNA, 2015

  12. Posterior Fossa Tumors and Intellectual Impairment

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    J Gordon Millichap

    2005-01-01

    Full Text Available The effect of cerebellar damage on intellectual function in 76 children treated surgically for malignant posterior fossa tumor was investigated at the Gustave Roussy Institute, Villejuif, and the Department of Pediatric Neurosurgery, Necker Hospital, Paris, France.

  13. Extensive Supratentorial Hemorrhages Following Posterior Fossa ...

    African Journals Online (AJOL)

    Remote supratentorial hematoma soon after posterior fossa surgery for the removal of a space-occupying lesion is a rare but dramatic and dreaded complication, carrying significant morbidity and mortality. A 47-year-old woman presented with headache of 1-year duration that worsened over last 2 months, progressive ...

  14. Vermian agenesis without posterior fossa cyst

    International Nuclear Information System (INIS)

    Adamsbaum, C.; Moreau, V.; Bulteau, C.; Burstyn, J.; Lair Milan, F.; Kalifa, G.

    1994-01-01

    We report 11 cases of vermian partial agenesis without posterior fossa cyst or hemispheric abnormalities. Characteristic MR signs were: absence of the posterior lobe, hypoplasia of the anterior lobe, a narrow sagittal cleft separating the hemispheres (''buttocks sign'') and fourth ventricle deformity. The main clinical signs were complex oculomotor dysfunction and developmental delay. None of the patients had respiratory symptoms. Consideration is given to the relationship between Joubert syndrome and this entity as well as to embroyological data. (orig.)

  15. Posterior fossa meningioma (surgical experiences)

    African Journals Online (AJOL)

    Wael M. Moussa

    2012-08-27

    Aug 27, 2012 ... of the CNS, representing about a third of brain tumors. They arise from the ... subtypes based on cell structure.1–4 In 1979, the World Health. Organization .... anterior or posterior to the internal auditory meatus), petrocli-.

  16. Acute Spontaneous Posterior Fossa Subdural Hematoma

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    Osama Shukir Muhammed Amin

    2014-02-01

    Full Text Available Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient’s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection.

  17. MRI diagnosis of posterior fossa tumors

    International Nuclear Information System (INIS)

    Yamashita, Yasuyuki; Takahashi, Mutsumasa; Sakamoto, Yuuji; Kojima, Ryutarou; Bussaka, Hiromasa; Korogi, Yukunori

    1988-01-01

    Magnetic resonance images (MRI) of 58 patients with posterior fossa tumors were compared with computed tomography (CT). Spin echo (SE) technique and inversion recovery (IR) technique were obtained using 0.22 tesla resistive magnetic resonance unit. MRI was superior to CT in detecting the lesions and showing internal archtecture, hemorrhage, edema of the tumor and displacement of the normal brain. CT was superior to MRI in demonstrating calcification. MRI and CT were comparable in detecting erosions of the skull base, while MRI was superior to CT in showing erosions of the clivus. Most tumors showed hypointensity on T1 weighted images and hyperintensity on T2 weighted images. Meningioma showed equal or almost equal intensity to cerebral gray matter on both SE images. The boundary of intra-axial tumors was unclear in many cases without contrast enhancement using Gd-DTPA, while most extra-axial tumors showed clear margin surrounded by a thin band (rim). In 81.8 % of acoustic neurinomas, signal void rims were demonstrated on both SE images, and they were considered to be vessels around the tumor. The rims of meningioma, on the other hand, were hypointense on T1 weighted images and hyperintense on T2 weighted images. They were considered to be cerebrospinal fluid or capsule around the tumor. It has been concluded that MRI is the most important technique for diagnosis of posterior fossa tumors. (author)

  18. Endoscopic third ventriculostomy and posterior fossa tumors.

    Science.gov (United States)

    Di Rocco, Federico; Jucá, Carlos Eduardo; Zerah, Michel; Sainte-Rose, Christian

    2013-02-01

    The management of hydrocephalus associated with a posterior fossa tumor is debated. Some authors emphasize the advantages of an immediate tumor removal that may normalize the cerebrospinal fluid (CSF) dynamics. However, in clinical practice, the mere excision of the lesion has been demonstrated to be accompanied by a persisting hydrocephalus in about one third of the cases. Preoperative endoscopic third ventriculostomy (ETV) offers several advantages. It may control the intracranial pressure (ICP), avoid the necessity of an emergency procedure, allow appropriate scheduling of the operation for tumor removal, and eliminate the risks related to the presence of an external drainage. The procedure also reduces the incidence of postoperative hydrocephalus. A final advantage, more difficult to weight, but obvious to the neurosurgeon, is the possibility to remove the lesion with a relaxed brain and normal ICP. In the postoperative phase, ETV can be used in case of persisting hydrocephalus, both in patients who underwent only the excision of the tumor and in those whose preoperative ETV failed as a consequence of intraventricular bleeding with secondary closure of the stoma (redoETV). The main advantage of postoperative ETV is that the procedure is carried out only in case of persisting hydrocephalus; its use is consequently more selective than preoperative ETV. The disadvantage consists in the common use of an external CSF drainage in the first few postoperative days, which is necessary to control the pressure and for ruling out those cases that reach a spontaneous cure of the hydrocephalus. The authors review the criteria for patient selection and the results of ETV performed in case of hydrocephalus secondary to a posterior fossa tumor. Preoperative ETV constitutes an effective procedure for controlling the hydrocephalus associated with posterior fossa tumors. It might lower the rate of persistent postoperative hydrocephalus and result in a short hospital stay. Low

  19. MRI of the fetal posterior fossa

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    Adamsbaum, Catherine; Andre, Christine; Merzoug, Valerie; Ferey, Solene [St Vincent de Paul Hospital, Department of Radiology, Paris Cedex 14 (France); Moutard, Marie Laure [St Vincent de Paul Hospital, Department of Neuropaediatrics, Paris (France); Quere, Marie Pierre [CHU, Department of Radiology, Nantes (France); Lewin, Fanny [St Vincent de Paul Hospital, Maternity Department, Paris (France); Fallet-Bianco, Catherine [Ste Anne Hospital, Department of Neuropathology, Paris (France)

    2005-02-01

    MRI is a useful tool to complement US for imaging of the fetal posterior fossa (PF). In France, the discovery of a PF malformation in the fetus frequently leads to termination of pregnancy (80% in a personal series). However, despite improved accuracy in the diagnosis of PF abnormalities, prognosis remains uncertain. The first objective of this review is to document the normal MRI landmarks of the developing fetal PF. Because of their thinness, the visibility of the cerebellar fissures is dramatically delayed on MRI compared to macroscopic data. An important landmark is identification of the primary fissure of the vermis, normally seen at around 25-26 weeks' gestation (WG) on the sagittal slice, separating the larger posterior lobe from the anterior lobe (volume ratio around 2:1). The prepyramidal and secondary fissures are usually only identifiable after 32 WG and the hemispheric fissures are difficult to see until the end of pregnancy. Considering the signal changes, high signal on T2-weighted (T2-W) sequences is seen from 25 WG in the posterior part of the brain stem (tegmentum and ascending sensory tracts) related to myelination. The low signal intensities seen within the cerebellum on T2-W images correspond to high cellularity of grey matter (deep nuclei), as there is no myelination within the white matter before 38 WG. The second objective is to highlight the signs highly predictive of a poor neurological prognosis. Lack of pontine curvature or vermian agenesis without a PF cyst (small volume of PF) is greatly associated with poor neurological status. The third objective is to propose a diagnostic strategy in difficult cases where prognosis is important, e.g. the Dandy Walker continuum. (orig.)

  20. MRI of the fetal posterior fossa

    International Nuclear Information System (INIS)

    Adamsbaum, Catherine; Andre, Christine; Merzoug, Valerie; Ferey, Solene; Moutard, Marie Laure; Quere, Marie Pierre; Lewin, Fanny; Fallet-Bianco, Catherine

    2005-01-01

    MRI is a useful tool to complement US for imaging of the fetal posterior fossa (PF). In France, the discovery of a PF malformation in the fetus frequently leads to termination of pregnancy (80% in a personal series). However, despite improved accuracy in the diagnosis of PF abnormalities, prognosis remains uncertain. The first objective of this review is to document the normal MRI landmarks of the developing fetal PF. Because of their thinness, the visibility of the cerebellar fissures is dramatically delayed on MRI compared to macroscopic data. An important landmark is identification of the primary fissure of the vermis, normally seen at around 25-26 weeks' gestation (WG) on the sagittal slice, separating the larger posterior lobe from the anterior lobe (volume ratio around 2:1). The prepyramidal and secondary fissures are usually only identifiable after 32 WG and the hemispheric fissures are difficult to see until the end of pregnancy. Considering the signal changes, high signal on T2-weighted (T2-W) sequences is seen from 25 WG in the posterior part of the brain stem (tegmentum and ascending sensory tracts) related to myelination. The low signal intensities seen within the cerebellum on T2-W images correspond to high cellularity of grey matter (deep nuclei), as there is no myelination within the white matter before 38 WG. The second objective is to highlight the signs highly predictive of a poor neurological prognosis. Lack of pontine curvature or vermian agenesis without a PF cyst (small volume of PF) is greatly associated with poor neurological status. The third objective is to propose a diagnostic strategy in difficult cases where prognosis is important, e.g. the Dandy Walker continuum. (orig.)

  1. Direct sagittal CT scanning in the diagnosis of pituitary fossa tumours and posterior fossa pathology

    International Nuclear Information System (INIS)

    Podlas, H.

    1981-01-01

    Two independent methods are presented for multidirectional CT scanning of the brain using the Philips Tomoscan 300. The advantages in scanning pituitary fossa tumours and pathology of the posterior fossa are discussed. No additional software or modifications are required. Direct sagittal scanning is particularly advantageous for accurate assessment of the size of pituitary tumours and intrasellar lesions requiring surgical intervention or radiation therapy. (Auth.)

  2. CT findings of posterior fossa venous angiomas

    International Nuclear Information System (INIS)

    Satoh, Toru; Kinugasa, Kazushi; Nishimoto, Akira; Nishimoto, Ken.

    1986-01-01

    Three cases of posterior fossa venous angiomas were reported, with some comments on the CT findings. Case 1: A 53-year-old woman was admitted for the further examination of a viral meningitis which had appeared three months before. Neurological examination revealed no abnormality. Vertebral angiography, however, demonstrated numerous fine medullary veins, with an enlarged intraparenchymal draining vein, in the right cerebellum; they drained into the petrosal vein, which was characteristic of venous angioma. On the plain CT, part of the draining vein was identified as a slightly high-density node. A curvilinear draining vein was demonstrated by the enhanced CT. Case 2: A 29-year-old man was admitted complaining of headache, vomiting, and atxia. Neurological examination disclosed truncal ataxia. The enhanced CT demonstrated two distinct nodules on the anterior border of the hematoma in the deep median cerebellum, probably corresponding to the draining veins. On the angiogram, a venous angioma was found in the bilateral cerebellum; it drained into the precentral cerebellar veins and ultimately joined the straight sinus via the precentro-vermo-rectal vein. Case 3: A 4-year-old boy was admitted suffering from headache, vomiting, and ataxia. Neurological examination disclosed a co-ordination disturbance of the left side. The enhanced CT demonstrated a curvilinear structure inside the hematoma. Angiography showed a venous angioma in the left cerebellum which drained into the petrosal vein. Computerized angiotomography delineated the characteristic venous structure on the angiogram as many fine, high-density lines (medullary veins) converging to a large intraparenchymal linear structure (central medullary vein) and then to a superficial cortical vein. In all cases, large intraparenchymal draining veins were identified by the conventional CT. (J.P.N.)

  3. Subarachnoid pouches of the posterior fossa with syringomyelia

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    Williams, B [Midland Centre for Neurosurgery and Neurology, Smethwick (UK)

    1979-01-01

    Three men are presented, all of whom were born with difficulty and later developed severe syringomyelia with collapsing cords on air myelography. Each had hydrocephalus and a sizable subarachnoid pouch in the posterior fossa. The clinical features and investigations are presented with a discussion of the aetiology and possible mechanisms concerned in pathogenesis and treatment. All three men had posterior fossa exploration over fifty years after birth, and the first two were also treated by valved ventriculo-atrial shunts. Each patient has improved a little since operation, but no certainly that this was due to surgery has been proved in any case; none has progressed since the last operation.

  4. Gliosarcoma of the posterior cranial fossa: MRI findings

    International Nuclear Information System (INIS)

    Nitta, H.; Hayase, H.; Moriyama, Y.; Yamashima, T.; Yamashita, J.

    1993-01-01

    We report the MR findings of a biopsy-proven gliosarcoma of the posterior cranial fossa. Multiple homogeneously enhancing lesions had shaggy margins and broad-based dural attachments, which may reflect the gliomatous and sarcomatous element of this tumour. (orig.)

  5. Tumors of the posterior cranial fossa; Tumoren der hinteren Schaedelgrube

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    Papanagiotou, P.; Politi, M. [Klinikum Bremen-Mitte/Bremen-Ost, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Bremen (Germany)

    2016-11-15

    Various types of brain tumor can occur in the region of the posterior fossa. Brain metastases in adults are the most common malignancies at this localization. Ependymomas, medulloblastomas and pilocytic astrocytomas occur mostly in children and only rarely in adults. Other tumors that occur in the posterior fossa are meningiomas, schwannomas, hemangioblastomas, brain stem gliomas and epidermoid tumors. Due to the fact that the various tumors of the posterior fossa have different treatment approaches and prognoses, an accurate and specific diagnosis is mandatory. This review discusses the imaging aspects by computed tomography (CT) and magnetic resonance imaging (MRI) of the most frequent tumors of the posterior fossa. (orig.) [German] Im Bereich der hinteren Schaedelgrube treten verschiedene Typen von Hirntumoren auf, wobei Hirnmetastasen bei Erwachsenen die haeufigsten Malignitaeten in dieser Region darstellen. Ependymome, Medulloblastome und pilozytische Astrozytome kommen meistens bei Kindern und nur selten bei Erwachsenen vor. Weitere Tumoren der hinteren Schaedelgrube sind Meningeome, Schwannome, Haemangioblastome, Hirnstammgliome und Epidermoide. Da die verschiedenen Tumoren der hinteren Schaedelgrube unterschiedliche Behandlungsansaetze sowie Prognosen haben, ist eine genaue und spezifische Diagnose obligatorisch. Dieser Review diskutiert die bildgebenden CT- und MRT-Aspekte der haeufigsten Tumoren der hinteren Schaedelgrube. (orig.)

  6. Posterior cranial fossa tumours in children at Kenyatta National ...

    African Journals Online (AJOL)

    Background: The management of children with posterior fossa tumours is a challenge to health care professionals worldwide. Difficulties in diagnosis especially in children less than three years is well documented. Limited diagnostic modalities and lack of awareness of the symptoms and signs as well as societal perception ...

  7. Quantitative imaging analysis of posterior fossa ependymoma location in children.

    Science.gov (United States)

    Sabin, Noah D; Merchant, Thomas E; Li, Xingyu; Li, Yimei; Klimo, Paul; Boop, Frederick A; Ellison, David W; Ogg, Robert J

    2016-08-01

    Imaging descriptions of posterior fossa ependymoma in children have focused on magnetic resonance imaging (MRI) signal and local anatomic relationships with imaging location only recently used to classify these neoplasms. We developed a quantitative method for analyzing the location of ependymoma in the posterior fossa, tested its effectiveness in distinguishing groups of tumors, and examined potential associations of distinct tumor groups with treatment and prognostic factors. Pre-operative MRI examinations of the brain for 38 children with histopathologically proven posterior fossa ependymoma were analyzed. Tumor margin contours and anatomic landmarks were manually marked and used to calculate the centroid of each tumor. Landmarks were used to calculate a transformation to align, scale, and rotate each patient's image coordinates to a common coordinate space. Hierarchical cluster analysis of the location and morphological variables was performed to detect multivariate patterns in tumor characteristics. The ependymomas were also characterized as "central" or "lateral" based on published radiological criteria. Therapeutic details and demographic, recurrence, and survival information were obtained from medical records and analyzed with the tumor location and morphology to identify prognostic tumor characteristics. Cluster analysis yielded two distinct tumor groups based on centroid location The cluster groups were associated with differences in PFS (p = .044), "central" vs. "lateral" radiological designation (p = .035), and marginally associated with multiple operative interventions (p = .064). Posterior fossa ependymoma can be objectively classified based on quantitative analysis of tumor location, and these classifications are associated with prognostic and treatment factors.

  8. STUDY OF POSTERIOR FOSSA TUMORS BY HIGH RESOLUTION MRI

    Directory of Open Access Journals (Sweden)

    Sree Hari

    2016-01-01

    Full Text Available INTRODUCTION Magnetic Resonance Imaging (MRI is the imaging modality used for the assessment of infratentorial neoplasms. Although Computed Tomography (CT provides better demonstration of small or subtle calcifications within tumors. OBJECTIVES Study is done to assess the potential of MRI in characterisation of different tumors in posterior fossa by evaluating various unenhanced and gadolinium enhanced sequences and to compare high resolution FSE MRI sequences with routine FSE MRI sequences in diagnosing posterior fossa brain tumors. Also correlate findings on Magnetic Resonance Imaging with Pathological diagnosis. MATERIALS AND METHODS A total of 52 patients were diagnosed by CT brain as having posterior fossa brain for a year of 2 years were included in the study. In all studies MR imaging was performed with a clinical 1.5 T system (General electrical medical systems. A dedicated phased-array coil was used. RESULTS The age group ranged from 1 year to 60 years, majority were between 1 to 20 years (39%. Slight male preponderance was seen (males 29, females 23. Commonest tumor encountered in our study was vestibular schwannoma. DWI alone can differentiate different pediatric posterior fossa brain tumors. One case of pilocytic astrocytoma showed solid lesion instead of typical cystic lesion with mural nodule. One case AT-RT showed 2 lesions one in cerebrum, one in CP angle. Common feature being intra-axial lesion involving cerebellum. MRI was able to predict diagnosis in 50 of the 52 tumors. CONCLUSION Magnetic Resonance Imaging was found to be a highly sensitive imaging procedure and method of choice for posterior fossa brain tumors.

  9. Children's vomiting following posterior fossa surgery: A retrospective study

    Directory of Open Access Journals (Sweden)

    Dundon Belinda

    2009-07-01

    Full Text Available Abstract Background Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated. Methods A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting. Results The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to Conclusion The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

  10. Venous anomalies and abnormalities of the posterior fossa

    International Nuclear Information System (INIS)

    Goulao, A.; Alvarez, H.; Garcia Monaco, R.; Pruvost, P.; Lasjaunias, P.

    1990-01-01

    The authors report a series of 16 patients with venous anomalies or abnormalities of the posterior fossa studied by angiography, CT and/or MRI. We believe that so-called 'venous angioma' are extreme anatomic variants that drain normal territories, and we prefer to call them developmental venous anomalies (DVA). Posterior fossa DVA, like the supra-tentorial ones are classified according to their drainage into deep and superficial type. They are exclusively located in the cerebellum or tectum. In 4 cases DVA was an incidental finding, in 3 an associated cerebral venous malformation (CVM) was found and felt to be the cause of the symptoms and only in one (Trigeminal pain) was a link between both suspected. Cavernous venous malformation (CVM) were found in frequent association with DVA (27%). 4 cases were single and 2 multiple. 5 CVM were located in the brain stem and 3 in the cerebellum. The clinical and radiological files were reviewed and a direct relationship between symptoms and localization was found in all patients with CVM. In 2 cases venous dysplasia was found: 1 Sturge-Weber and 1 First branchial arch syndrome. Both posterior fossa venous abnormalities were incidental findings. (orig.)

  11. CT and MRI diagnosis of posterior fossa atypical ependymoma

    International Nuclear Information System (INIS)

    Yu Bolang; Zhang Ming; Luo Lin; Wang Shijie; Zhu Liping

    2000-01-01

    Objective: To analyse the CT and MRI features of posterior fossa atypical ependymoma. Methods: Sixteen cases of posterior fossa atypical ependymoma proved by surgery and pathology had CT and (or) MRI scanning. There were 11 males and 5 females. The age ranged from 17 to 46 (mean, 31.2). Twelve cases ranged from 20 to 40 years old. the main symptoms of all cases were dizziness, unsteady walking and vomiting. Results: The locations of all cases were cerebellum (12 cases), vermis (3 cases) and cerebellopontile angle (1 cases). Fifteen cases were solid with multiple cystic changes and 1 case in the cerebellopontile angle was cystic. The tumor was usually close to the surface of cerebellum with rather extensive connection with dura mater or tentorium. Calcifications were shown in 3 cases. The tumors revealed inhomogeneous density on CT scan and inhomogeneous intensity on MRI. Mild inhomogeneous enhancement was shown in most cases, while intense irregular enhancement in the others. Conclusions: The characteristic findings of the posterior fossa atypical ependymoma ependymoma were cerebellar intraparenchymatous multiple small cystic changes within solid tumor in most cases and inhomogeneous density and intensity on CT and MRI. The differential diagnosis is meningioma, metastasis and acoustic schwannoma

  12. Posterior Fossa Decompression with Duraplasty in Chiari-1 Malformations

    International Nuclear Information System (INIS)

    Rehman, L.; Akbar, H.; Bokhari, I.; Babar, A. K.; Hahim, A. S. M.; Arain, S. H.

    2015-01-01

    Objective: To evaluate the symptomatic outcome after PFD (Posterior Fossa Decompression) with duraplasty in Chiari-1 malformations. Study Design: Case series. Place and Duration of Study: Department of Neurosurgery, JPMC, Karachi, from July 2008 to September 2012. Methodology: This included 21 patients of Chiari 1 malformations admitted in department through OPD with clinical features of headache, neck pain, numbness, neurological deficit, and syringomyelia. Diagnosis was confirmed by MRI. PFD followed by C1 laminectomy with duraplasty was done in all cases and symptomatic outcome was assessed in follow-up clinic. Results: Among 21 patients, 13 were females and 8 were males. Age ranged from 18 to 40 years. All the patients had neck pain and numbness in hands. Only 3 patients had weakness of all four limbs and 12 with weakness of hands. Symptoms evolved over a mean of 12 months. Syringomyelia was present in all cases. All patients underwent posterior fossa decompression with duraplasty with an additional C1 laminectomy and in 2 cases C2 laminectomy was done. Syringo-subarachnoid shunt was placed in one patient and ventriculo-peritoneal shunt was placed in 2 patients. Pain was relieved in all cases. Weakness was improved in all cases and numbness was improved in 19 cases. Syringomyelia was improved in all cases. Postoperative complications included CSF leak in 2 patients and wound infection in one patient. However, there was no mortality. Conclusion: Posterior fossa decompression with duraplasty is the best treatment option for Chiari-1 malformations because of symptomatic improvement and less chances of complications. (author)

  13. Tratamento cirúrgico da cisticircose da fossa craniana posterior

    Directory of Open Access Journals (Sweden)

    Pedro Garcia Lopes

    1971-03-01

    Full Text Available A cisticercose, um dos mais sérios problemas parasitológicos do sistema nervoso, apresenta, quando localizada na fossa posterior, um quadro clínico dramático, no qual predomina a hipertensão intracraniana. Foram estudados neste trabalho, 70 pacientes com cisticercose de fossa craniana posterior, atendidos no Serviço de Neurocirurgia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo de 1945 a 1968. Considerando-se a grande diversidade existente em torno das técnicas de tratamento cirúrgico, foi objetivo deste trabalho o estudo dos resultados obtidos nestes pacientes, nos quais várias técnicas foram empregadas. As cirurgias paliativas que derivam o trânsito do líquido cefalorraqueano para regiões extracranianas, quando comparadas aos outros tipos de cirurgias utilizados, foram as que proporcionaram maior índice de recuperação, exigiram menos reoperações, além de terem sido acompanhadas de menor número de complicações, bem como de menor mortalidade pós-operatória. Por outro lado, a neurocisticercose geralmente é um processo difuso, encontrando-se parasitas em várias regiões do encéfalo e/ou aracnoidite, conforme comprovou-se, também, entre os casos ora reunidos e que vieram a falecer. Baseando-se nestes fatos, não se justificam as derivações intracranianas e, a não ser eventualmente, a abordagem direta do parasita. Os casos estudados permitem cone- tatar, portanto, que as derivações extracranianas, por sua simplicidade e eficácia, apresentam-se, atualmente, como a terapêutica cirúrgica mais propriada à cisticercose de fossa craniana posterior.

  14. Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H M; Shih, H C; Huang, Y C; Wang, Y H [Dept. of Medical Imaging, National Taiwan University Hospital, Taipei (Taiwan)

    2001-05-01

    We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

  15. Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

    International Nuclear Information System (INIS)

    Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H.

    2001-01-01

    We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

  16. Large intradiploic growing skull fracture of the posterior fossa

    International Nuclear Information System (INIS)

    Hamamcioglu, M. Kemal; Hicdonmez, Tufan; Kilincer, Cumhur; Cobanoglu, Sebahattin

    2006-01-01

    Growing skull fractures (GSFs) are rare complications of head injury and mostly occur in infancy and early childhood. Location in the posterior fossa and intradiploic development of a GSF is very uncommon. We report a 7-year-old boy with a large, 9 x 7 x 4-cm, occipital intradiploic GSF. The lesion developed progressively over a period of 5 years following a documented occipital linear fracture. This case of a GSF developing from a known occipital linear fracture demonstrates that a GSF may reach a considerable size and, although uncommon, intradiploic development and occipital localization of a GSF is possible. (orig.)

  17. Traumatic acute posterior fossa subdural hematoma – A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Jaiswal Manish

    2014-12-01

    Full Text Available Traumatic subdural hematomas of the posterior fossa are rare but dangerous neurosurgical emergencies that require prompt diagnosis and management to avoid the uniformly poor outcome. We present a case of a teenager with severe TBI and acute subdural hematoma of the posterior fossa that deteriorated rapidly before surgery but eventually made a good recovery. We also the review the literature concerning traumatic posterior fossa subdural hematomas [PFSDH].

  18. Tratamento cirúrgico da cisticircose da fossa craniana posterior Surgical treatment of cysticercosis in posterior cranial fossa

    Directory of Open Access Journals (Sweden)

    Pedro Garcia Lopes

    1971-03-01

    Full Text Available A cisticercose, um dos mais sérios problemas parasitológicos do sistema nervoso, apresenta, quando localizada na fossa posterior, um quadro clínico dramático, no qual predomina a hipertensão intracraniana. Foram estudados neste trabalho, 70 pacientes com cisticercose de fossa craniana posterior, atendidos no Serviço de Neurocirurgia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo de 1945 a 1968. Considerando-se a grande diversidade existente em torno das técnicas de tratamento cirúrgico, foi objetivo deste trabalho o estudo dos resultados obtidos nestes pacientes, nos quais várias técnicas foram empregadas. As cirurgias paliativas que derivam o trânsito do líquido cefalorraqueano para regiões extracranianas, quando comparadas aos outros tipos de cirurgias utilizados, foram as que proporcionaram maior índice de recuperação, exigiram menos reoperações, além de terem sido acompanhadas de menor número de complicações, bem como de menor mortalidade pós-operatória. Por outro lado, a neurocisticercose geralmente é um processo difuso, encontrando-se parasitas em várias regiões do encéfalo e/ou aracnoidite, conforme comprovou-se, também, entre os casos ora reunidos e que vieram a falecer. Baseando-se nestes fatos, não se justificam as derivações intracranianas e, a não ser eventualmente, a abordagem direta do parasita. Os casos estudados permitem cone- tatar, portanto, que as derivações extracranianas, por sua simplicidade e eficácia, apresentam-se, atualmente, como a terapêutica cirúrgica mais propriada à cisticercose de fossa craniana posterior.Cysticercosis is one of the most severe parasitic diseases of the nervous system. When located in the posterior fossa, it presents a dramatic picture of intracranial hypertension. Seventy patients of cysticercosis in posterior cranial fossa have been studied, all of them attended at the Neurosurgery Service of the University of São Paulo

  19. Ependymomas of the posterior cranial fossa: CT and MRI findings

    International Nuclear Information System (INIS)

    Tortori-Donati, P.; Fondelli, M.P.; Cama, A.; Garre, M.L.; Rossi, A.; Andreussi, L.

    1995-01-01

    We studied nine children with posterior cranial fossa ependymomas to identify specific neuroradiological features. Patients were studied preoperatively with CT and MRI; T1-, T2- and proton-density (PD)-weighted images were obtained. All children underwent surgery and a definite histopathological diagnosis was made. All the tumours grew into the fourth ventricle and caused dilatation of its upper part, which resembled a cap. All but one were separated from the vermis by a cleavage plane. In eight cases there was desmoplastic development through the foramina of the fourth ventricle, and five were heterogeneous due to necrosis and cystic change; one had a haemorrhagic area. In most cases the solid portion was isointense with grey matter on T1-weighted images, hyperintense on PD weighting, and isointense on T2-weighted images. On CT the tumour was isodense in six cases and calcification was detected in four. The presence of both desmoplastic development and a tumour/vermis cleavage plane in a posterior cranial fossa tumour isodense on CT is highly suggestive of ependymoma. (orig.)

  20. Epidermoid cyst of the posterior fossa: a case report Cisto epidermoide da fossa posterior: relato de caso

    Directory of Open Access Journals (Sweden)

    Eduardo Cambruzzi

    2011-02-01

    Full Text Available Epidermoid cysts of the central nervous system are uncommon conditions, which are frequently located in the cerebellopontine angle and around the pons. They are covered with keratinized squamous epithelium and keratin lamella, which give its contents a soft, white-pearly appearance. Epidermoid cysts are mostly originated from malformations, presumably associated with surface elements of the nervous system ectoderm during the closure of the neural groove or formation of secondary cerebral vesicles. The authors describe a case of epidermoid cyst in the posterior fossa causing hydrocephalus and review morphologic and diagnostic criteria of this lesion.Os cistos epidermoides do sistema nervoso central (SNC são condições incomuns, estando localizados mais frequentemente no ângulo pontocerebelar e ao redor da ponte. Eles são revestidos por epitélio escamoso queratinizado e lamelas de queratina, tornando seu conteúdo branco-perolado e pastoso. Os cistos epidermoides são, na maioria das vezes, originados de malformações, possivelmente associados ao entremeio de elementos superficiais do ectoderma do SNC durante o fechamento da placa neural, ou formação das vesículas cerebrais secundárias. Os autores descrevem um caso de cisto epidermoide da fossa posterior determinando hidrocefalia e revisam critérios morfológicos e diagnósticos dessa lesão.

  1. Cerebellar Mutism Syndrome and Other Complications After Surgery in the Posterior Fossa in Adults

    DEFF Research Database (Denmark)

    Wibroe, Morten; Rochat, Per; Juhler, Marianne

    2018-01-01

    BACKGROUND: Cerebellar mutism syndrome (CMS) is rarely described in adults; however, data on self-assessed linguistic complications after posterior fossa surgery do not exist. METHODS: Through a prospective single-center study, data on 59 tumor operations in the posterior fossa were collected pre...

  2. Posterior fossa malformations: main features and limits in prenatal diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Garel, Catherine [Hopital d' Enfants Armand-Trousseau, Department of Radiology, Paris (France)

    2010-06-15

    Posterior fossa (PF) malformations are commonly observed during prenatal screening. Their understanding requires knowledge of the main steps of PF development and knowledge of normal patterns in US and MR imaging. The vast majority of PF malformations can be strongly suspected by acquiring a midline sagittal slice and a transverse slice and by systematically scrutinizing the elements of the PF: cerebellar vermis, hemispheres, brainstem, fourth ventricle, PF fluid spaces and tentorium. Analysis of cerebellar echogenicity and biometry is also useful. This review explains how to approach the diagnosis of the main PF malformations by performing these two slices and answering six key questions about the elements of the PF. The main imaging characteristics of PF malformations are also reviewed. (orig.)

  3. Radiological imaging detection of tumors localized in fossa cranii posterior.

    Science.gov (United States)

    Kabashi, Serbeze; Muçaj, Sefedin; Ahmetgjekaj, Ilir; Gashi, Sanije; Fazliu, Ilir; Dreshaj, Shemsedin; Shala, Nexhmedin

    2008-01-01

    Intracranial tumors are characterized by a variety imaging aspects and their detection is always a challenge. Clinical application of Magnetic Resonance Imaging (MRI) and Computerized Tomography has provided an earlier detection and treatment of many CNS pathologies. The aim of this study is to estimate the role of CT and MRI in the determination of posterior fossa tumors. During period 2000-2005 in UCCK-Prishtina, 368 patients were diagnosed with intracranial tumors. Fifty-nine of them were found to have tumor localized in fossa crani posterior (FCP) without any significant difference between genders (50.8% female vs. 49.2% male, chi2 test=0.02 p=0.896). The average age of patients with FCP tumors was 33.1 (SD +/- 22.5, rank 1-70). The most of these patients were registered in 2003 (20.3%) whereas the least in 2000 (11.9%). The most affected age-group was 0-9 (25.4%) and 50-59 (23.7%) whereas the incidences was between 30-39 years of age (3.4%). Tumor types that more often were found in young's individuals were: Astrocytomas with a peak incidence in teenagers (average age was 12-year-old SD +/- 7.5, rank 3-23), next was Medulloblastomas (average age was 11-years-old, SD +/- 2.9, rank 6-16 years) and ependymomas (average age was 6.8-years-old, SD +/- 4.6, rank 1-12). Patients with osseous tumors are characterized by older age than median (61.0, SD +/- 4.2, rank 58-64), then metastases (53.0, SD +/- 5.3, rank 45-60) and meningiomas (50.8, SD +/- 7.7, rank 38-63). The overall average mortality was 0.41 cases per 100,000 inhabitants with variations through years from 0.30-0.50/100,000 inhabitants. Comparing with other countries, for some types of FCP tumors, lower morbidity is shown in Kosova, with mean incidence 0.41/100,000. The most frequent tumors in children were medulloblastomas, brainstem gliomas, astrocytomas and ependymomas whereas meningiomas and metastasis were most often found in adults. For FCP tumors detection, MRI had 100% sensitivity, specificity and

  4. Supratentorial Neurometabolic Alterations in Pediatric Survivors of Posterior Fossa Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Rueckriegel, Stefan M., E-mail: rueckriegel.s@nch.uni-wuerzburg.de [Pediatric Neurooncology Program, Department of Pediatric Oncology and Hematology, Charite-Universitaetsmedizin Berlin, Berlin (Germany); Driever, Pablo Hernaiz [Pediatric Neurooncology Program, Department of Pediatric Oncology and Hematology, Charite-Universitaetsmedizin Berlin, Berlin (Germany); Bruhn, Harald [Department of Radiology, Charite-Universitaetsmedizin Berlin, Berlin (Germany); Department of Radiology, Klinikum der Friedrich-Schiller-Universitaet, Erlanger (Germany)

    2012-03-01

    Purpose: Therapy and tumor-related effects such as hypoperfusion, internal hydrocephalus, chemotherapy, and irradiation lead to significant motor and cognitive sequelae in pediatric posterior fossa tumor survivors. A distinct proportion of those factors related to the resulting late effects is hitherto poorly understood. This study aimed at separating the effects of neurotoxic factors on central nervous system metabolism by using H-1 MR spectroscopy to quantify cerebral metabolite concentrations in these patients in comparison to those in age-matched healthy peers. Methods and Materials: Fifteen patients with World Health Organization (WHO) I pilocytic astrocytoma (PA) treated by resection only, 24 patients with WHO IV medulloblastoma (MB), who additionally received chemotherapy and craniospinal irradiation, and 43 healthy peers were investigated using single-volume H-1 MR spectroscopy of parietal white matter and gray matter. Results: Concentrations of N-acetylaspartate (NAA) were significantly decreased in white matter (p < 0.0001) and gray matter (p < 0.0001) of MB patients and in gray matter (p = 0.005) of PA patients, compared to healthy peers. Decreased creatine concentrations in parietal gray matter correlated significantly with older age at diagnosis in both patient groups (MB patients, p = 0.009, r = 0.52; PA patients, p = 0.006, r = 0.7). Longer time periods since diagnosis were associated with lower NAA levels in white matter of PA patients (p = 0.008, r = 0.66). Conclusions: Differently decreased NAA concentrations were observed in both PA and MB groups of posterior fossa tumor patients. We conclude that this reflects a disturbance of the neurometabolic steady state of normal-appearing brain tissue due to the tumor itself and to the impact of surgery in both patient groups. Further incremental decreases of metabolite concentrations in MB patients may point to additional harm caused by irradiation and chemotherapy. The stronger decrease of NAA in MB

  5. Posterior cranial fossa dimensions in the Chiari I malformation: relation to pathogenesis and clinical presentation

    International Nuclear Information System (INIS)

    Stovner, L.J.; Bergan, U.; Nilsen, G.; Sjaastad, O.

    1993-01-01

    Skull dimensions were measured on lateral skull radiographs in 33 adult patients with MRI-verified Chiari I malformations and in 40 controls. The posterior cranial fossa was significantly smaller and shallower in patients than in controls. In the patients, there was a positive correlation between posterior fossa size and the degree of the cerebellar ectopia, which might indicate that a posterior cranial fossa which was originally too small had been expanded by the herniation of hindbrain structures at an early stage. No special clinical presentation was associated with a very small posterior cranial fossa, which may indicate that a small posterior cranial per se has little or no clinical significance, although it may be the primary developmental anomaly. (orig./GD)

  6. Visual attention in posterior stroke

    DEFF Research Database (Denmark)

    Fabricius, Charlotte; Petersen, Anders; Iversen, Helle K

    Objective: Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere. However, attentional effects of more posterior lesions are less clear. The aim of this study was to characterize visual processing speed...... and apprehension span following posterior cerebral artery (PCA) stroke. We also relate these attentional parameters to visual word recognition, as previous studies have suggested that reduced visual speed and span may explain pure alexia. Methods: Nine patients with MR-verified focal lesions in the PCA......-territory (four left PCA; four right PCA; one bilateral, all >1 year post stroke) were compared to 25 controls using single case statistics. Visual attention was characterized by a whole report paradigm allowing for hemifield-specific speed and span measurements. We also characterized visual field defects...

  7. Diagnosis and treatment of trigeminal schwannomas extending into both the middle and posterior cranial fossa

    Institute of Scientific and Technical Information of China (English)

    徐启武; 车晓明; 胡杰; 杨伯捷

    2004-01-01

    @@ Trigeminal schwannomas (TSs) account for 0.1%-0.4% of all intracranial tumors and 1%-8% of intracranial schwannomas.1,2 Yoshida and Kawase3 classified TSs into 6 types according to their locations: M (TS involving the middle cranial fossa), P (TS involving the posterior cranial fossa), E (TS located at extracranial space), MP (TS involving both the middle and the posterior cranial fossa), ME (TS involving the middle cranial fossa and the extracranial space), and MPE (TS involving the the middle and the posterior cranial fossa and the extracranial space). Of these types, MP is the commonest, but is difficult to be totally removed. Between January 1984 and June 2003, we surgically treated 28 patients with TSs of type MP and obtained satisfactory results. To make a correct diagnosis of TS, to select appropriate surgical approach, and to improve surgical outcome of TS of type MP, we analysed the related clinical data and experiences.

  8. Quality of life in children survivors of posterior fossa tumors

    International Nuclear Information System (INIS)

    Martinez-Climent, J.A.; Castel Sanchez, V.; Esquembre Menor, C.; Ferris Tortajada, J.; Verdeguer Miralles, A.

    1994-01-01

    We have created a numerical scale in order to measure the Quality of Life in children survivors of posterior fossa tumors. We evaluated the long-term sequelae in 39 patients seen during a 20 year period, with a medium follow-up of 9 years. They were 25 Cerebelar Astrocytoma (CA), 6 Medulloblastoma (MDB), 5 Brain-Stem Glioma (BSG) and 3 Ependymoma of IV ventricle (EPD). Sixty-six per cent of children showed neurologic and/or visual sequelae (Bloom's levels I-II in 66%). Psychointellectual dysfunctions were identified in 44%, with an IQ<90 in 39%. Endocrine disorders were found in 26%. Quality of Life (QL) was measured with our Scale, finding that 19 patients (49%) have a good or acceptable QL, eight (20%) a moderate QL that can be acceptable with adequate rehabilitation, and the remaining 12 (36%) a bad QL that can be improved slightly. Unfavorable outcomes were related to age less than 4 years at diagnosis, type of tumor (MDB, EPD, BSG), incomplete tumoral resection, and use of radiotherapy and/or chemotherapy. We consider that our scale is complete and adequate to measure the QL of children survivors of CNS tumors. (Author) 55 refs

  9. Comparison of posterior fossa and tumor bed boost in medulloblastoma.

    Science.gov (United States)

    Paulino, A C; Saw, C B; Wen, B C

    2000-10-01

    To quantify the difference between the area of brain irradiated using the posterior fossa boost (PFB) and tumor bed boost (TBB) in medulloblastoma, we studied 15 simulation radiographs of patients treated in our institution from 1990 and 1999. The PFB was compared with the TBB, which was defined as the tumor bed plus 2-cm margin as demonstrated by postoperative magnetic resonance imaging. The PFB field treated a mean area of 9.43 cm2 more brain than the TBB. In 3 patients (20%), the area of the brain in the TBB was larger than the PFB. In 11 patients (73.3%), the PFB field had more than 10% more brain than the TBB. The cochlea was in the PFB and TBB field in all patients. In more than two thirds of patients, the area of brain irradiated with the PFB was at least 10% greater than the TBB. Future studies are needed to determine whether the TBB can replace the PFB in patients with medulloblastoma.

  10. Factors affecting outcome in posterior fossa EDH: an analytical study at tertiary referral hospital

    Directory of Open Access Journals (Sweden)

    Anurag Pateriya

    2016-06-01

    Full Text Available Introduction. Posterior fossa extradural hematomas (PFEDHs are uncommon as compared to supratentorial EDH and these patients can deteriorate very rapidly due to compression over brainstem. Thus early identification and intervention can save the lives of these patients.

  11. MRI tight posterior fossa sign for prenatal diagnosis of Chiari type II malformation

    Energy Technology Data Exchange (ETDEWEB)

    Ando, Kumiko; Ishikura, Reiichi; Ogawa, Masayo; Takada, Yoshihiro; Yamamoto, Satoshi; Fujiwara, Masayuki; Hirota, Shozo [Hyogo College of Medicine, Department of Radiology, Nishinomiya, Hyogo (Japan); Shakudo, Miyuki [Osaka City General Hospital, Department of Radiology, Osaka (Japan); Tanaka, Hiroyuki [Hyogo College of Medicine, Department of Gynecology, Nishinomiya (Japan); Minagawa, Kyoko [Hyogo College of Medicine, Department of Pediatrics, Nishinomiya (Japan)

    2007-12-15

    Chiari type II malformation (CMII) is one of three hindbrain malformations that display hydrocephalus. We have observed that cerebrospinal fluid (CSF) signal in the posterior fossa, which is always apparent on normal fetal MR images, is not visible in a fetus with CMII. We use the term 'tight posterior fossa' for this MR imaging finding, and evaluate the diagnostic value of this finding on fetal MR images. Included in the study were 21 fetuses which underwent brain MR imaging at 1.5 T using two-dimensional balanced turbo-field-echo (2-D balanced-TFE) in the axial and sagittal planes. Postnatal diagnoses were CMII (n=5), CNS abnormalities other than CMII (n=8), and no abnormality (n=8). A tight posterior fossa was defined as an absent or slit-like water signal space around the hindbrain in the posterior fossa on both sagittal and axial MR images. All CMII fetuses displayed a tight posterior fossa on MR images. Hydrocephalus was visualized in all CMII fetuses and myelomeningocele in four fetuses, but hindbrain herniation was visualized only in two of five fetuses. The CSF signal surrounding the hindbrain was clearly visible in all the other 16 fetuses, including five with hydrocephalus not associated with CMII, although it was slightly narrower in a fetus with a cloverleaf skull than in the normal fetuses. Tight posterior fossa in the presence of hydrocephalus is a useful and characteristic finding of CMII on fetal MRI. (orig.)

  12. MRI tight posterior fossa sign for prenatal diagnosis of Chiari type II malformation

    International Nuclear Information System (INIS)

    Ando, Kumiko; Ishikura, Reiichi; Ogawa, Masayo; Takada, Yoshihiro; Yamamoto, Satoshi; Fujiwara, Masayuki; Hirota, Shozo; Shakudo, Miyuki; Tanaka, Hiroyuki; Minagawa, Kyoko

    2007-01-01

    Chiari type II malformation (CMII) is one of three hindbrain malformations that display hydrocephalus. We have observed that cerebrospinal fluid (CSF) signal in the posterior fossa, which is always apparent on normal fetal MR images, is not visible in a fetus with CMII. We use the term 'tight posterior fossa' for this MR imaging finding, and evaluate the diagnostic value of this finding on fetal MR images. Included in the study were 21 fetuses which underwent brain MR imaging at 1.5 T using two-dimensional balanced turbo-field-echo (2-D balanced-TFE) in the axial and sagittal planes. Postnatal diagnoses were CMII (n=5), CNS abnormalities other than CMII (n=8), and no abnormality (n=8). A tight posterior fossa was defined as an absent or slit-like water signal space around the hindbrain in the posterior fossa on both sagittal and axial MR images. All CMII fetuses displayed a tight posterior fossa on MR images. Hydrocephalus was visualized in all CMII fetuses and myelomeningocele in four fetuses, but hindbrain herniation was visualized only in two of five fetuses. The CSF signal surrounding the hindbrain was clearly visible in all the other 16 fetuses, including five with hydrocephalus not associated with CMII, although it was slightly narrower in a fetus with a cloverleaf skull than in the normal fetuses. Tight posterior fossa in the presence of hydrocephalus is a useful and characteristic finding of CMII on fetal MRI. (orig.)

  13. Metrics and textural features of MRI diffusion to improve classification of pediatric posterior fossa tumors.

    Science.gov (United States)

    Rodriguez Gutierrez, D; Awwad, A; Meijer, L; Manita, M; Jaspan, T; Dineen, R A; Grundy, R G; Auer, D P

    2014-05-01

    Qualitative radiologic MR imaging review affords limited differentiation among types of pediatric posterior fossa brain tumors and cannot detect histologic or molecular subtypes, which could help to stratify treatment. This study aimed to improve current posterior fossa discrimination of histologic tumor type by using support vector machine classifiers on quantitative MR imaging features. This retrospective study included preoperative MRI in 40 children with posterior fossa tumors (17 medulloblastomas, 16 pilocytic astrocytomas, and 7 ependymomas). Shape, histogram, and textural features were computed from contrast-enhanced T2WI and T1WI and diffusivity (ADC) maps. Combinations of features were used to train tumor-type-specific classifiers for medulloblastoma, pilocytic astrocytoma, and ependymoma types in separation and as a joint posterior fossa classifier. A tumor-subtype classifier was also produced for classic medulloblastoma. The performance of different classifiers was assessed and compared by using randomly selected subsets of training and test data. ADC histogram features (25th and 75th percentiles and skewness) yielded the best classification of tumor type (on average >95.8% of medulloblastomas, >96.9% of pilocytic astrocytomas, and >94.3% of ependymomas by using 8 training samples). The resulting joint posterior fossa classifier correctly assigned >91.4% of the posterior fossa tumors. For subtype classification, 89.4% of classic medulloblastomas were correctly classified on the basis of ADC texture features extracted from the Gray-Level Co-Occurence Matrix. Support vector machine-based classifiers using ADC histogram features yielded very good discrimination among pediatric posterior fossa tumor types, and ADC textural features show promise for further subtype discrimination. These findings suggest an added diagnostic value of quantitative feature analysis of diffusion MR imaging in pediatric neuro-oncology. © 2014 by American Journal of Neuroradiology.

  14. 3DCRT for posterior fossa: Sparing of surrounding organs at risk

    African Journals Online (AJOL)

    Azza Helal

    2013-06-25

    Jun 25, 2013 ... including non-posterior fossa brain, pituitary, cochlea, eyes, optic nerves, optic chiasm, ... grams; Rt.C, right cochlea; Lt. C, left cochlea; Non P.F, non posterior ... child's cognitive function and quality of life.6 Although the.

  15. Sandwich wound closure reduces the risk of cerebrospinal fluid leaks in posterior fossa surgery

    Directory of Open Access Journals (Sweden)

    Verena Heymanns

    2016-07-01

    Full Text Available Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8% in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark, Gelfoam® (Pfizer Inc., New York, NY, USA and polymethylmethacrylate (osteoclastic craniotomy. The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

  16. Clinical analysis of surgical treatment of traumatic hematomas of the posterior cranial fossa

    International Nuclear Information System (INIS)

    Wang Wenhua; Zhou Youxin; Zhu Fengqing; Zhou Dai

    2000-01-01

    Objective: To discuss the clinical features and surgical outcome of the traumatic hematomas posterior cranial fossa. Methods: Fifteen patients with traumatic hematomas posterior cranial fossa in authors' hospital during the period from 1995 to 1998 were reviewed. Results: Thirteen patients had an occipital skull fracture, 11 pure epidural hematomas among whom 4 had cerebellar contusion and hematomas 4 posterior cranial fossa hematoma with associated cerebral hematoma or contusion, and 5 acute hydrocephalus. Fifteen patients were treated by emergency surgery, 9 had good recovery and 1 had severe disability in GCS between 9 and 15 marking, 1 had good recovery, 1 had severe disability and 3 died in GCS between 3 and 8. Nine patients had good recovery in 11 patient having pure epidural hematoma of posterior cranial fossa. Conclusions: The clinical course of the traumatic hematomas posterior cranial fossa was acute and severe. The GCS value below 9 predicts the poor out-come for patients. Early diagnosis and appropriately and promptly treatment are crucial for achieving good results

  17. Venous hemodynamics of arteriovenous meningeal fistulas in the posterior cranial fossa

    International Nuclear Information System (INIS)

    Brainin, M.; Samec, P.

    1983-01-01

    The etiology of arteriovenous meningeal fistulas (AVMFs) of the posterior fossa often remains unclear. Analyses of three personal cases, however, suggest a change in venous hemodynamics due to a primary lesion, the cases being of sinus thrombosis, intracerebral abcess with oedema and arteriovenous malformation. It is suggested that increase of venous pressure in the posterior fossa leads to increased drainage and, consequently, to dilatation of infratentorial veins and of meningeal branches of the external carotid and vertebral artery. Clinical findings and anatomical facts underlying AVMF lesions tend to confirm the view that the concept of a congenital malformation decompensating with age cannot be upheld for all AVMFs, especially when located in the posterior fossa and when clinical symptoms arise in middle age. It is proposed that a pressure activated mechanism of growth results in widening of normally insignificantly small dural vessels. (orig.)

  18. Magnetic resonance imaging textural evaluation of posterior cranial fossa tumors in childhood; Avaliacao textural por ressonancia magnetica dos tumores da fossa posterior em criancas

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Joelson Alves dos; Costa, Maria Olivia Rodrigues da; Otaduy, Maria Concepcion Garcia; Lacerda, Maria Teresa Carvalho de; Leite, Claudia da Costa [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Dept. de Radiologia]. E-mail: joelson_alves@ig.com.br; Matsushita, Hamilton [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Dept. de Neurologia

    2004-08-01

    Objective: To distinguish healthy from pathological tissues in pediatric patients with posterior cranial fossa tumors using calculated textural parameters from magnetic resonance images. Materials And Methods: We evaluated 14 pediatric patients with posterior cranial fossa tumors using the software MaZda to define the texture parameters in selected regions of interest representing healthy and pathological tissues based on T2-weighted magnetic resonance images. Results: There was a statistically significant difference between normal and tumoral tissues as well as between supposedly normal tissues adjacent and distant from the tumoral lesion. Conclusion: Magnetic resonance textural evaluation is an useful tool for determining differences among various tissues, including tissues that appear apparently normal on visual analysis. (author)

  19. Remote Supratentorial Hemorrhage After Posterior Fossa Surgery: A Brief Case Report

    Directory of Open Access Journals (Sweden)

    Moscote-Salazar Luis Rafael

    2014-10-01

    Full Text Available The supratentorial hemorrhage after posterior fossa surgery is an unusual but delicate complication that carries high mortality and morbidity. A 50 year old woman presented vertigo 6 months of evolution, which worsened in the last 2 months accompanied by ataxia. She showed left cerebellar signs, had no focal motor or sensory deficits. A brain MRI identified cerebellopontine angle lesion with mass effect. The patient was treated on suboccipital craniectomy and resection of right posterior fossa tumor, the histopathological diagnosis was consistent with typical meningioma. (WHO Class I.

  20. Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery.

    Science.gov (United States)

    Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

    2016-03-06

    Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  1. Teratoma of the posterior fossa CT and MR aspects A case

    International Nuclear Information System (INIS)

    Pina, J.I.; Feijoo, R.; Lasierra, R.; Medrano, J.; Benito, J.L. de

    1994-01-01

    The CT and MR findings are reported for a patient diagnosed as having teratoma of the posterior fossa with onset in the form of intracranial hypertension. The objective of this article is to report the detection of the lesion, as well as its origin in the closure defect of the cranial cavity with the formation of a cutaneous fistula, and review the recent literature

  2. Posterior fossa syndrome in a patient with an ornithine transcarbamylase deficiency

    NARCIS (Netherlands)

    Nedermeijer, S. C M; Van Den Hout, J.; Geleijns, C.; De Klerk, H.; Catsman-Berrevoets, C. E.

    2015-01-01

    The posterior fossa syndrome (PFS) is a well-known clinical entity and mainly occurs in children. Ornithine transcarbamylase deficiency (OTC) is the most common urea cycle disorder, which occurs in an estimated 1 per 50.000 live births in Japan. Symptoms are mostly due to hyperammonemia and include

  3. 3DCRT for posterior fossa: Sparing of surrounding organs at risk ...

    African Journals Online (AJOL)

    Introduction: Radiotherapy of the posterior fossa is routinely delivered using 3DCRT parallel-opposed lateral fields. However high incidence of sensorineural hearing loss, hypothalamic– pituitary dysfunction, thyroid and gonadal dysfunction during radiotherapy makes the need for treatment plan which provides adequate ...

  4. Traumatic acute subdural haematomas of the posterior fossa: clinicoradiological analysis of 24 patients

    International Nuclear Information System (INIS)

    Avella, D. d'; Conti, A.; Cardali, S.; Tomasello, F.; Servadei, F.; Scerrati, M.; Tomei, G.; Brambilla, G.; Massaro, F.; Stefini, R.; Cristofori, L.

    2003-01-01

    We report 24 patients with a traumatic acute subdural haematoma of the posterior fossa managed between 1997 and 1999 at 8 Italian neurosurgical centres. Each centre provided data about patients clinico-radiological findings, management, and outcomes, which were retrospectively reviewed. A poor result occurred in 14 patients (58.3 %). Ten patients (41.7 %) had favourable results. Patients were divided into two groups according to their admission Glasgow Coma Scale (GCS) scores. In Group 1 (12/24 cases; GCS score, 8), the outcome was favourable in 75 % of cases. In Group 2 (12/12 cases; GCS score, <8), the outcome was poor in 91.6 % of cases. Nineteen patients underwent posterior fossa surgery. Factors correlating to outcome were GCS score, status of the basal cisterns and the fourth ventricle, and the presence of supratentorial hydrocephalus. Multivariate analysis showed significant independent prognostic effect only for GCS score (P < 0.05). Acute posterior fossa subdural haematomas can be divided into two distinct groups: those patients admitted in a comatose state and those with a moderate/mild head injury on admission. Comatose patients present usually with signs of posterior fossa mass effect and have a high percentage of bad outcomes. On the contrary, patients admitted with a GCS of 8 or higher are expected to recover. In these patients the thickness of the haematoma (< 1 cm) seems to be a guide to indicate surgical evacuation of the haematoma. (author)

  5. Posterior fossa midline cryptococcoma in a patient with idiopathic CD4 lymphocytopenia

    Directory of Open Access Journals (Sweden)

    S Rai

    2012-01-01

    Full Text Available Idiopathic CD4 lymphocytopenia (ICL is a rare disorder which is often diagnosed as HIV-negative AIDS in the light of poor immunity and AIDS-defining illnesses. We present a case of a 50-year-old male who presented with a midline posterior fossa tumour with ICL diagnosed as cerebellar cryptococcoma.

  6. Arterial relationships to the nerves and some rigid structures in the posterior cranial fossa.

    Science.gov (United States)

    Surchev, N

    2008-09-01

    The close relationships between the cranial nerves and the arterial vessels in the posterior cranial fossa are one of the predisposing factors for artery-nerve compression. The aim of this study was to examine the relationships of the vertebral and basilar arteries to some skull and dural structures and the nerves in the posterior cranial fossa. For this purpose, the skull bases and brains of 70 cadavers were studied. The topographic relationships of the vertebral and basilar arteries to the cranial nerves in the posterior cranial fossa were studied and the distances between the arteries and some osseous formations were measured. The most significant variations in arterial position were registered in the lower half of the basilar artery. Direct contact with an artery was established for the hypoglossal canal, jugular tubercle, and jugular foramen. The results reveal additional information about the relationships of the nerves and arteries to the skull and dural formations in the posterior cranial fossa. New quantitative information is given to illustrate them. The conditions for possible artery-nerve compression due to arterial dislocation are discussed and two groups (lines) of compression points are suggested. The medial line comprises of the brain stem points, usually the nerve root entry/exit zone. The lateral line includes the skull eminences, on which the nerves lie, or skull and dural foramina through which they exit the cranial cavity. (c) 2008 Wiley-Liss, Inc.

  7. [Acute epidural hematoma of the posterior fossa caused by forehead impact].

    Science.gov (United States)

    Abe, S; Furukawa, K; Endo, S; Hoshi, S; Kanaya, H

    1988-03-01

    A rare case of acute epidural hematoma of the posterior fossa caused by forehead impact is reported. This 36-year-old man fell from a truck and hit his face. He was conscious and was brought to our center 30 minutes after the injury. On admission, a contused wound of the right forehead was noticed. He was restless and had severe pain in the neck and upper extremities. Skull X-ray showed a linear fracture of the frontal bone and computed tomography (CT) scan was normal. He continued to be restless and sudden respiratory arrest and pupillary dilation occurred 10 hours after the admission. A CT scan revealed a lenticular high density area in the left posterior fossa which extended to the supratentorial region. The 4th ventricle was compressed and displaced to the right and also the quadrigeminal and ambient cisterns were not visualized at all. Immediate surgery disclosed a 30 g epidural hematoma of the left posterior fossa and the supratentorium and the clot was completely evacuated. The source of bleeding could not be identified. Opening of the dura revealed contusion in the occipital lobe. He died on the 17th postoperative day. The possible mechanism in the production of the posterior fossa hematoma in this case is discussed.

  8. PAEDIATRIC POSTERIOR FOSSA TUMORS: A CLIN ICO - PATHOLOGICAL STUDY I N A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Raja Sekhar Kennedy

    2015-09-01

    Full Text Available INTRODUCTION: Tumors of the Central Nervous S ystem , are the second commonest childhood tumors and are the most common solid paediatric tumors comprising 40% - 50% of all tumors . 1 2 Posterior fossa brain tumors are one of the most devastating forms of human illnesses wh ich are more common in children. AIMS AND OBJECTIVES : To study the incidence, clinicopathological features and management of paediatric posterior fossa tumors. MATERIALS AND METHOD S : This is a prospective study done in the Department of Neurosurgery, Ranga raya Medical College, Government General Hospital, Kakinada from 2012 to 2015. It is a Tertiary Care Hospital. A total of 25 paediatric patients ranging from infants to 15 years were included in the study. DISCUSSION AND CONCL USION: Posterior fossa tumors are the commonest solid brain tumors of children with a rate of 2.4 per lakh of children at risk per year. The predominant symptoms are headache and vomiting followed by cerebellar symptoms (gait disturbances. Posterior fossa tumors are predominantly seen in children with peak incidence in first decade. Commonest presenting symptoms are due to raised intracranial pressure with headache and vomiting followed by cerebellar symptoms. Meticulous microsurgical techniques are to be followed in removing these tum ors. The incidence of recurrence is very less after gross total excision. Prognosis is good in patients with total excision

  9. Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery.

    Science.gov (United States)

    Koutourousiou, Maria; Filho, Francisco Vaz Guimaraes; Costacou, Tina; Fernandez-Miranda, Juan C; Wang, Eric W; Snyderman, Carl H; Rothfus, William E; Gardner, Paul A

    2014-08-01

    Transclival endoscopic endonasal surgery (EES) has recently been used for the treatment of posterior fossa tumors. The optimal method of reconstruction of large clival defects following EES has not been established. A morphometric analysis of the posterior fossa was performed in patients who underwent transclival EES to compare those with observed postoperative anatomical changes (study group) to 50 normal individuals (anatomical control group) and 41 matched transclival cases with preserved posterior fossa anatomy (case-control group) using the same parameters. Given the absence of clival bone following transclival EES, the authors used the line between the anterior commissure and the basion as an equivalent to the clival plane to evaluate the location of the pons. Four parameters were studied and compared in the two populations: the pontine location/displacement, the maximum anteroposterior (AP) diameter of the pons, the maximum AP diameter of the fourth ventricle, and the cervicomedullary angle (CMA). All measurements were performed on midsagittal 3-month postoperative MR images in the study group. Among 103 posterior fossa tumors treated with transclival EES, 14 cases (13.6%) with postoperative posterior fossa anatomy changes were identified. The most significant change was anterior displacement of the pons (transclival pontine encephalocele) compared with the normal location in the anatomical control group (p 50% of the clivus) and dura. Nine (64.3%) of the 14 patients were overweight (body mass index [BMI] > 25 kg/m(2)). An association between BMI and the degree of pontine encephalocele was observed, but did not reach statistical significance. The use of a fat graft as part of the reconstruction technique following transclival EES with dural opening was the single significant factor that prevented pontine displacement (p = 0.02), associated with 91% lower odds of pontine encephalocele (OR = 0.09, 95% CI 0.01-0.77). The effect of fat graft reconstruction was

  10. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M. [University of Arkansas for Medical Sciences, Pediatric Radiology, Little Rock, AR (United States)

    2016-01-15

    Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

  11. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

    International Nuclear Information System (INIS)

    Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M.

    2016-01-01

    Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

  12. Magnetic resonance imaging textural evaluation of posterior cranial fossa tumors in childhood

    International Nuclear Information System (INIS)

    Santos, Joelson Alves dos; Costa, Maria Olivia Rodrigues da; Otaduy, Maria Concepcion Garcia; Lacerda, Maria Teresa Carvalho de; Leite, Claudia da Costa; Matsushita, Hamilton

    2004-01-01

    Objective: To distinguish healthy from pathological tissues in pediatric patients with posterior cranial fossa tumors using calculated textural parameters from magnetic resonance images. Materials And Methods: We evaluated 14 pediatric patients with posterior cranial fossa tumors using the software MaZda to define the texture parameters in selected regions of interest representing healthy and pathological tissues based on T2-weighted magnetic resonance images. Results: There was a statistically significant difference between normal and tumoral tissues as well as between supposedly normal tissues adjacent and distant from the tumoral lesion. Conclusion: Magnetic resonance textural evaluation is an useful tool for determining differences among various tissues, including tissues that appear apparently normal on visual analysis. (author)

  13. Progressive multifocal leukoencephalopathy restricted to the posterior fossa in a patient with systemic lupus erythematosus

    Energy Technology Data Exchange (ETDEWEB)

    Goncalves, Fabricio Guimaraes; Lamb, Leslie; Del Carpio-O' Donovan, Raquel, E-mail: goncalves.neuroradio@gmail.com [McGill University Health Center Montreal General Hospital (Canada)

    2011-11-15

    Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyoma virus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppressed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa (author)

  14. Spontaneous bilateral subdural haematomas in the posterior cranial fossa revealed by MRI

    International Nuclear Information System (INIS)

    Pollo, C.; Porchet, F.; Meuli, R.

    2003-01-01

    A 52-year-old woman treated for acute myeloproliferative disease developed progressive stupor. CT showed obstructive hydrocephalus resulting from unexplained mass effect on the fourth ventricle. MRI revealed bilateral extra-axial collections in the posterior cranial fossa, giving high signal on T1- and T2-weighted images, suggesting subacute subdural haematomas. Subdural haematomas can be suspected on CT when there is unexplained mass effect. MRI may be essential to confirm the diagnosis and plan appropriate treatment. (orig.)

  15. A systematic review of neuropsychological outcomes following posterior fossa tumor surgery in children.

    Science.gov (United States)

    Hanzlik, Emily; Woodrome, Stacey E; Abdel-Baki, Mohamed; Geller, Thomas J; Elbabaa, Samer K

    2015-10-01

    Central nervous system tumors are the most common solid tumors in the pediatric population. As children with central nervous system (CNS) tumors are surviving into adolescence and adulthood, more research is being focused on the long-term cognitive outcomes of the survivors. This review examines the literature on different cognitive outcomes of survivors of different childhood posterior fossa CNS tumor types. The authors reviewed the literature for articles published from 2000 to 2012 about long-term neuropsychological outcomes of children diagnosed with posterior fossa brain tumors before the age of 18, which distinguished between histological tumor types, and had a minimum follow-up of 3 years. The literature search returned 13 articles, and a descriptive analysis was performed comparing intelligence quotient (IQ), attention/executive function, and memory components of 456 survivors of childhood posterior fossa tumors. Four articles directly compared astrocytoma and medulloblastoma survivors and showed medulloblastoma survivors fared worse in IQ, attention/executive function, and memory measurements. Five articles reporting medulloblastomas found IQ, attention, and memory scores to be significantly below the standardized means. Articles examining astrocytoma survivors found IQ scores within the normal range for the population. Survivors of ependymomas reported 2/23 survivors impaired on IQ scores, while a second study reported a significant number of ependymoma survivors lower than the expected population norm. Tumor histopathology and the type of postoperative adjuvant therapy seem to have a significant impact on the long-term neuropsychological complications of pediatric posterior fossa CNS tumor survivors. Age at diagnosis and treatment factors are important variables that affect the outcomes of the survivors.

  16. Lateral posterior fossa encephalocele with associated migrational disorder of the cerebellum in an infant.

    Science.gov (United States)

    Hamilton, Kimberly M; Wiens, Andrea L; Fulkerson, Daniel H

    2011-11-01

    Encephaloceles are acquired or congenital defects in which intracranial contents protrude through a defect in the calvaria. The embryogenesis of these lesions is incompletely understood. The vast majority of lesions occur at or near the anatomical midline. The authors present an extremely rare case of a laterally oriented, pathologically proven encephalocele associated with a posterior fossa cyst and cerebellar migrational defect in an infant. The authors review past and current theories of encephalocele formation as it relates to this case.

  17. Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours

    Energy Technology Data Exchange (ETDEWEB)

    Warmuth-Metz, M.; Solymosi, L. [Abteilung fuer Neuroradiologie, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany); Kuehl, J. [Paediatric Oncology, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany); Krauss, J. [Paediatric Neurosurgery, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany)

    2004-03-01

    In malignant brain tumours which may disseminate staging, usually by cranial and spinal MRI is necessary. If MRI is performed in the postoperative period pitfalls should be considered. Nonspecific subdural contrast enhancement on spinal staging MRI is rarely reported after resection of posterior fossa tumours, which may be mistaken for dissemination of malignancy. We investigated the frequency of spinal subdural enhancement after posterior cranial fossa neurosurgery in children. We reviewed 53 postoperative spinal MRI studies performed for staging of paediatric malignant brain tumours, mainly infratentorial primitive neuroectodermal tumours 2-40 days after surgery. There was contrast enhancement in the spinal subdural space in seven cases. This was not seen in any of eight patients who had been operated upon for a supratentorial tumour. After resection of 45 posterior cranial fossa tumours the frequency of subdural enhancement was 15.5%. MRI showing subdural enhancement was obtained up to 25 days postoperatively. No patient with subdural enhancement had cerebrospinal fluid (CSF) examinations positive for tumour cells or developed dissemination of disease in the CSF. Because the characteristic appearances of subdural contrast enhancement, appropriate interpretation is possible; diagnosis of neoplastic meningitis should rarely be impeded. Because of the striking similarity to that in patients with a low CSF-pressure syndrome and in view of the fact that only resection of tumours of the posterior cranial fossa, usually associated with obstructive hydrocephalus, was followed by this type of enhancement one might suggest that rapid changes in CSF pressure are implicated, rather the effects of blood introduced into the spinal canal at surgery. (orig.)

  18. Spontaneous bilateral subdural haematomas in the posterior cranial fossa revealed by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Pollo, C.; Porchet, F. [Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne (Switzerland); Meuli, R. [Department of Radiology, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne (Switzerland)

    2003-08-01

    A 52-year-old woman treated for acute myeloproliferative disease developed progressive stupor. CT showed obstructive hydrocephalus resulting from unexplained mass effect on the fourth ventricle. MRI revealed bilateral extra-axial collections in the posterior cranial fossa, giving high signal on T1- and T2-weighted images, suggesting subacute subdural haematomas. Subdural haematomas can be suspected on CT when there is unexplained mass effect. MRI may be essential to confirm the diagnosis and plan appropriate treatment. (orig.)

  19. Progressive multifocal leukoencephalopathy restricted to the posterior fossa in a patient with systemic lupus erythematosus

    International Nuclear Information System (INIS)

    Goncalves, Fabricio Guimaraes; Lamb, Leslie; Del Carpio-O'Donovan, Raquel

    2011-01-01

    Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyoma virus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppressed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa (author)

  20. Cerebellar mutism syndrome in children with brain tumours of the posterior fossa

    DEFF Research Database (Denmark)

    Wibroe, Morten; Cappelen, Johan; Castor, Charlotte

    2017-01-01

    , the clinical course and strategies for prevention and treatment are yet to be determined.Methods: This observational, prospective, multicentre study will include 500 children with posterior fossa tumours. It opened late 2014 with participation from 20 Nordic and Baltic centres. From 2016, five British centres...... for and the clinical course of CMS - with the ultimate goal of defining strategies for prevention and treatment of this severely disabling condition....

  1. Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours

    International Nuclear Information System (INIS)

    Warmuth-Metz, M.; Solymosi, L.; Kuehl, J.; Krauss, J.

    2004-01-01

    In malignant brain tumours which may disseminate staging, usually by cranial and spinal MRI is necessary. If MRI is performed in the postoperative period pitfalls should be considered. Nonspecific subdural contrast enhancement on spinal staging MRI is rarely reported after resection of posterior fossa tumours, which may be mistaken for dissemination of malignancy. We investigated the frequency of spinal subdural enhancement after posterior cranial fossa neurosurgery in children. We reviewed 53 postoperative spinal MRI studies performed for staging of paediatric malignant brain tumours, mainly infratentorial primitive neuroectodermal tumours 2-40 days after surgery. There was contrast enhancement in the spinal subdural space in seven cases. This was not seen in any of eight patients who had been operated upon for a supratentorial tumour. After resection of 45 posterior cranial fossa tumours the frequency of subdural enhancement was 15.5%. MRI showing subdural enhancement was obtained up to 25 days postoperatively. No patient with subdural enhancement had cerebrospinal fluid (CSF) examinations positive for tumour cells or developed dissemination of disease in the CSF. Because the characteristic appearances of subdural contrast enhancement, appropriate interpretation is possible; diagnosis of neoplastic meningitis should rarely be impeded. Because of the striking similarity to that in patients with a low CSF-pressure syndrome and in view of the fact that only resection of tumours of the posterior cranial fossa, usually associated with obstructive hydrocephalus, was followed by this type of enhancement one might suggest that rapid changes in CSF pressure are implicated, rather the effects of blood introduced into the spinal canal at surgery. (orig.)

  2. Pattern of recurrence in children with midline posterior fossa malignant neoplasms

    Energy Technology Data Exchange (ETDEWEB)

    Wootton-Gorges, S.L.; Foreman, N.K.; Albano, E.A.; Dertina, D.M.; Nein, P.K.; Shukert, B.; Cesario, K.B.; Gage, S.; Rumack, C.M.; Strain, J.D. [Children' s Hospital, Department of Radiology, Denver, CO (United States)

    2000-02-01

    Background. Surveillance imaging of the brain and spinal neuraxis in patients with posterior fossa malignant tumors is commonly performed, with the assumption that early detection of tumor recurrence will improve outcome. However, the benefit of this imaging has not been proven. To evaluate the usefulness of spinal surveillance imaging in children with nonmetastatic (at diagnosis, M0) posterior fossa ependymoma and medulloblastoma. Materials and methods. This retrospective study included 65 children (3 months to 16 years, mean 5.7 years) treated between 1985 and 1997 for ependymoma (22) and medulloblastoma (43). Medical records were reviewed for pathology and treatment data. Serial imaging of the head and spine was reviewed for evidence of tumor recurrence. Results. Twenty-four patients (37 %) had tumor recurrence, including 13 with ependymoma and 11 with medulloblastoma. Of the 17/24 recurrent patients initially diagnosed as M0 (6 medulloblastoma and 11 ependymoma), 13 (76 %) had a cranial recurrence only, and 4 (24 %) presented with concomitant cranial and spinal recurrence. No M0 patient presented solely with spinal metastases at recurrence. Conclusion. This study suggests that spinal surveillance imaging in patients with posterior fossa ependymoma or medulloblastoma initially staged as M0 may not be useful, as these patients initially recur intracranially. Thus, until an intracranial recurrence is detected, these patients may be spared the time, expense and sedation risk necessary for spinal imaging. (orig.)

  3. Pattern of recurrence in children with midline posterior fossa malignant neoplasms

    International Nuclear Information System (INIS)

    Wootton-Gorges, S.L.; Foreman, N.K.; Albano, E.A.; Dertina, D.M.; Nein, P.K.; Shukert, B.; Cesario, K.B.; Gage, S.; Rumack, C.M.; Strain, J.D.

    2000-01-01

    Background. Surveillance imaging of the brain and spinal neuraxis in patients with posterior fossa malignant tumors is commonly performed, with the assumption that early detection of tumor recurrence will improve outcome. However, the benefit of this imaging has not been proven. To evaluate the usefulness of spinal surveillance imaging in children with nonmetastatic (at diagnosis, M0) posterior fossa ependymoma and medulloblastoma. Materials and methods. This retrospective study included 65 children (3 months to 16 years, mean 5.7 years) treated between 1985 and 1997 for ependymoma (22) and medulloblastoma (43). Medical records were reviewed for pathology and treatment data. Serial imaging of the head and spine was reviewed for evidence of tumor recurrence. Results. Twenty-four patients (37 %) had tumor recurrence, including 13 with ependymoma and 11 with medulloblastoma. Of the 17/24 recurrent patients initially diagnosed as M0 (6 medulloblastoma and 11 ependymoma), 13 (76 %) had a cranial recurrence only, and 4 (24 %) presented with concomitant cranial and spinal recurrence. No M0 patient presented solely with spinal metastases at recurrence. Conclusion. This study suggests that spinal surveillance imaging in patients with posterior fossa ependymoma or medulloblastoma initially staged as M0 may not be useful, as these patients initially recur intracranially. Thus, until an intracranial recurrence is detected, these patients may be spared the time, expense and sedation risk necessary for spinal imaging. (orig.)

  4. 3D Super-Resolution Motion-Corrected MRI: Validation of Fetal Posterior Fossa Measurements.

    Science.gov (United States)

    Pier, Danielle B; Gholipour, Ali; Afacan, Onur; Velasco-Annis, Clemente; Clancy, Sean; Kapur, Kush; Estroff, Judy A; Warfield, Simon K

    2016-09-01

    Current diagnosis of fetal posterior fossa anomalies by sonography and conventional MRI is limited by fetal position, motion, and by two-dimensional (2D), rather than three-dimensional (3D), representation. In this study, we aimed to validate the use of a novel magnetic resonance imaging (MRI) technique, 3D super-resolution motion-corrected MRI, to image the fetal posterior fossa. From a database of pregnant women who received fetal MRIs at our institution, images of 49 normal fetal brains were reconstructed. Six measurements of the cerebellum, vermis, and pons were obtained for all cases on 2D conventional and 3D reconstructed MRI, and the agreement between the two methods was determined using concordance correlation coefficients. Concordance of axial and coronal measurements of the transcerebellar diameter was also assessed within each method. Between the two methods, the concordance of measurements was high for all six structures (P fetal motion and orthogonal slice acquisition. This technique will facilitate further study of fetal abnormalities of the posterior fossa. Copyright © 2016 by the American Society of Neuroimaging.

  5. The use of wavelet filters for reducing noise in posterior fossa Computed Tomography images

    International Nuclear Information System (INIS)

    Pita-Machado, Reinado; Perez-Diaz, Marlen; Lorenzo-Ginori, Juan V.; Bravo-Pino, Rolando

    2014-01-01

    Wavelet transform based de-noising like wavelet shrinkage, gives the good results in CT. This procedure affects very little the spatial resolution. Some applications are reconstruction methods, while others are a posteriori de-noising methods. De-noising after reconstruction is very difficult because the noise is non-stationary and has unknown distribution. Therefore, methods which work on the sinogram-space don’t have this problem, because they always work over a known noise distribution at this point. On the other hand, the posterior fossa in a head CT is a very complex region for physicians, because it is commonly affected by artifacts and noise which are not eliminated during the reconstruction procedure. This can leads to some false positive evaluations. The purpose of our present work is to compare different wavelet shrinkage de-noising filters to reduce noise, particularly in images of the posterior fossa within CT scans in the sinogram-space. This work describes an experimental search for the best wavelets, to reduce Poisson noise in Computed Tomography (CT) scans. Results showed that de-noising with wavelet filters improved the quality of posterior fossa region in terms of an increased CNR, without noticeable structural distortions

  6. Presentation and management of lateral sinus thrombosis following posterior fossa surgery.

    Science.gov (United States)

    Apra, Caroline; Kotbi, Owais; Turc, Guillaume; Corns, Robert; Pagès, Mélanie; Souillard-Scémama, Raphaëlle; Dezamis, Edouard; Parraga, Eduardo; Meder, Jean-François; Sauvageon, Xavier; Devaux, Bertrand; Oppenheim, Catherine; Pallud, Johan

    2017-01-01

    OBJECTIVE There are no guidelines for the management of postoperative lateral sinus thrombosis following posterior fossa surgery. Introducing treatment-dose anticoagulant therapy during the immediate postoperative period increases the risk of intracranial bleeding. This study assessed the incidence of and risk factors associated with postoperative lateral sinus thrombosis and the complications related to thrombosis and/or anticoagulation. METHODS This study was a retrospective monocentric analysis of adult patients who underwent surgical removal of a posterior fossa space-occupying lesion with available postoperative imaging. Postoperative lateral sinus thrombosis was defined as a T2 * hypointensity within the venous sinus and/or a filling defect on postcontrast MRI or CT scan. RESULTS Among 180 patients, 12 (6.7%; 95% CI 3.0-10.4) were found to have lateral sinus thrombosis on postoperative imaging, none of whom were symptomatic. Unadjusted risk factors for postoperative lateral sinus thrombosis were a history of deep venous thrombosis (p = 0.016), oral contraceptive pill (p = 0.004), midline surgical approach (p = 0.035), and surgical exposure of the sinus (p < 0.001). Seven of the patients (58.3%) with a postoperative lateral sinus thrombosis received immediate treatment-dose anticoagulant therapy. Lateral sinus recanalization occurred radiologically at a mean time of 272 ± 23 days in 85.7% of patients (6 of 7) undergoing treatment-dose anticoagulant therapy and in 20% of patients (1 of 5) not receiving treatment-dose anticoagulant therapy. Postoperative complications occurred in 56.2% of patients (9 of 16) who received treatment-dose curative anticoagulant therapy and in 27% of patients (45 of 164) who did not. CONCLUSIONS Incidental radiological lateral sinus thrombosis following posterior fossa surgery has an incidence of 6.7%. To further define the benefit-to-risk ratio of a treatment-dose anticoagulant therapy, a prospective trial should be considered.

  7. Postoperative intraspinal subdural collections after pediatric posterior fossa tumor resection: incidence, imaging, and clinical features.

    Science.gov (United States)

    Harreld, J H; Mohammed, N; Goldsberry, G; Li, X; Li, Y; Boop, F; Patay, Z

    2015-05-01

    Postoperative intraspinal subdural collections in children after posterior fossa tumor resection may temporarily hinder metastasis detection by MR imaging or CSF analysis, potentially impacting therapy. We investigated the incidence, imaging and clinical features, predisposing factors, and time course of these collections after posterior fossa tumor resection. Retrospective review of postoperative spine MRI in 243 children (5.5 ± 4.6 years of age) from our clinical data base postresection of posterior fossa tumors from October 1994 to August 2010 yielded 37 (6.0 ± 4.8 years of age) subjects positive for postoperative intraspinal subdural collections. Their extent and signal properties were recorded for postoperative (37/37), preoperative (15/37), and follow-up spine (35/37) MRI. Risk factors were compared with age-matched internal controls (n = 37, 5.9 ± 4.5 years of age). Associations of histology, hydrocephalus and cerebellar tonsillar herniation, and postoperative intracranial subdural collections with postoperative intraspinal subdural collections were assessed by the Fisher exact test or χ(2) test. The association between preoperative tumor volume and postoperative intraspinal subdural collections was assessed by the Wilcoxon rank sum test. The overall incidence of postoperative intraspinal subdural collections was 37/243 (15.2%), greatest ≤7 days postoperatively (36%); 97% were seen 0-41 days postoperatively (12.9 ± 11.0 days). They were T2 hyperintense and isointense to CSF on T1WI, homogeneously enhanced, and resolved on follow-up MR imaging (35/35). None were symptomatic. They were associated with intracranial subdural collections (P = .0011) and preoperative tonsillar herniation (P = .0228). Postoperative intraspinal subdural collections are infrequent and clinically silent, resolve spontaneously, and have a distinctive appearance. Preoperative tonsillar herniation appears to be a predisposing factor. In this series, repeat MR imaging by 4 weeks

  8. Long-term outcomes of gamma knife surgery for posterior fossa arteriovenous malformations

    International Nuclear Information System (INIS)

    Matsunaga, Shigeo; Shuto, Takashi

    2014-01-01

    The long-term outcomes of gamma knife surgery (GKS) in patients with posterior fossa arteriovenous malformations (AVMs) were retrospectively analyzed in 82 patients followed up for more than 5 years to evaluate the efficacy and safety. The median AVM volume at GKS was 0.95 cm 3 . The prescribed dose to the AVM margin was median 18 Gy with 1-18 isocenters. The actual complete AVM obliteration rate was 58.5% at 3 years and 78.0% at 5 years. The significant factors for higher complete obliteration rate were younger patient age and smaller maximum/minimum nidus diameter ratio. Two patients experienced hemorrhage caused by residual AVM rupture at 4 and 49 months. Twenty patients developed peri-nidal edema as an adverse radiation-induced reaction at median 13 months. One patient developed radiation-induced necrosis at 6.8 years. Neurological complication was observed in 12 patients and 6 patients remained with neurological dysfunction permanently. Larger nidus volume and location adjacent to an eloquent area significantly increased the risk of neurological complication. Pittsburgh radiosurgery-based AVM grading scale was significantly correlated with the outcome of neurological symptoms after GKS. GKS achieved acceptable and complete obliteration rate for posterior fossa AVM with relatively low risk of morbidity on neuroimaging and neurological symptoms for the long-term period after treatment. We recommend conformable and selective treatment planning to achieve both obliteration of the AVM nidus and preservation of neurological function. (author)

  9. Pathology, treatment and management of posterior fossa brain tumors in childhood

    International Nuclear Information System (INIS)

    Bonner, K.; Siegel, K.R.

    1988-01-01

    Brain tumors are the second most common childhood malignancy. Between 1975 and 1985, 462 newly diagnosed patients were treated at the Children's Hospital of Philadelphia; 207 (45%) tumors arose in the posterior fossa and 255 (55%) appeared supratentorially. A wide variety of histological subtypes were seen, each requiring tumor-specific treatment approaches. These included primitive neuroectodermal tumor (n = 86, 19%), astrocytoma (n = 135, 30%), brainstem glioma (n = 47, 10%), anaplastic astrocytoma (n = 32, 7%), and ependymoma (n = 30, 6%). Because of advances in diagnostic abilities, surgery, radiotherapy, and chemotherapy, between 60% and 70% of these patients are alive today. Diagnostic tools such as computed tomography and magnetic resonance imaging allow for better perioperative management and follow-up, while the operating microscope, CO 2 laser, cavitron ultrasonic aspirator and neurosurgical microinstrumentation allow for more extensive and safer surgery. Disease specific treatment protocols, utilizing radiotherapy and adjuvant chemotherapy, have made survival common in tumors such as medulloblastoma. As survival rates increase, cognitive, endocrinologic and psychologic sequelae become increasingly important. The optimal management of children with brain tumors demands a multidisciplinary approach, best facilitated by a neuro-oncology team composed of multiple subspecialists. This article addresses incidence, classification and histology, clinical presentation, diagnosis, pre-, intra- and postoperative management, long-term effects and the team approach in posterior fossa tumors in childhood. Management of specific tumor types is included as well. 57 references

  10. Expansion of Chiari I-associated syringomyelia after posterior-fossa decompression.

    Science.gov (United States)

    Gil, Z; Rao, S; Constantini, S

    2000-09-01

    Chiari I malformation (CMI) is an abnormality that involves caudal herniation of the cerebellar tonsils into the foramen magnum. CMI has been shown to be closely associated with the development of syringomyelia (SM). Several theories have emerged to explain the apparent correlation between the existence of CMI with subsequent development of SM. However, the exact mechanism of the evolution of SM is still subject to controversy. We report here the case of a 12-year-old girl admitted to hospital with headache, vomiting, ataxia, and moderate pyramidal signs. Radiological evaluation revealed the presence of CMI, accompanied by a small SM. The patient underwent posterior fossa decompression and improved significantly. She was re-admitted 6 months later with clinical evidence of progressive spinal cord dysfunction. MR revealed gross expansion of the syrinx. This case raises questions regarding the pathophysiology of CMI and its association with SM. The case indicates the need for neurological and radiological follow-up for patients undergoing posterior fossa decompression due to CMI, even for those without an initial syrinx. This is the first report known to us of expansion of a syrinx following decompression of an associated CMI.

  11. Posterior fossa abnormalities in high-risk term infants: comparison of ultrasound and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Steggerda, S.J.; Smits-Wintjens, V.E.H.J.; Verbon, P.; Walther, F.J. [Leiden University Medical Centre, Department of Neonatology, Leiden (Netherlands); Bruine, F.T. de [Leiden University Medical Centre, Department of Radiology, Leiden (Netherlands); Wezel-Meijler, G. van [Leiden University Medical Centre, Department of Radiology, Leiden (Netherlands); Isala Hospital, Department of Neonatology, Zwolle (Netherlands)

    2015-09-15

    We aimed to assess the characteristics of posterior fossa (PF) abnormalities in a cohort of high-risk term neonates, as well as the diagnostic performance of cranial ultrasound (CUS) with additional mastoid fontanelle (MF) views for the detection of these abnormalities, with magnetic resonance imaging (MRI) being the reference standard. In this retrospective study, 113 term neonates with CUS and subsequent MRI were included. Sensitivity, specificity, and predictive values of routine CUS and CUS with MF views were calculated. Posterior fossa abnormalities were diagnosed on CUS in 46 of 113 infants. MRI confirmed these findings in 43 and showed additional abnormalities in 32 infants. The sensitivity and specificity of anterior fontanelle views for major PF abnormalities as seen on MRI were 16 % and 99 %. Adding MF views increased the sensitivity of US to 82 %. The sensitivity and specificity of MF views for the detection of any (major or minor) PF abnormality were 57 % and 95 %. Especially acute hypoxic-ischemic injury and small subdural and punctate cerebellar haemorrhage remained undetected by CUS. PF abnormalities are frequent in high-risk term infants. MF-CUS enables early diagnosis of major PF abnormalities. We therefore advocate to perform MF-CUS in high-risk term neonates. (orig.)

  12. Posterior fossa abnormalities in high-risk term infants: comparison of ultrasound and MRI

    International Nuclear Information System (INIS)

    Steggerda, S.J.; Smits-Wintjens, V.E.H.J.; Verbon, P.; Walther, F.J.; Bruine, F.T. de; Wezel-Meijler, G. van

    2015-01-01

    We aimed to assess the characteristics of posterior fossa (PF) abnormalities in a cohort of high-risk term neonates, as well as the diagnostic performance of cranial ultrasound (CUS) with additional mastoid fontanelle (MF) views for the detection of these abnormalities, with magnetic resonance imaging (MRI) being the reference standard. In this retrospective study, 113 term neonates with CUS and subsequent MRI were included. Sensitivity, specificity, and predictive values of routine CUS and CUS with MF views were calculated. Posterior fossa abnormalities were diagnosed on CUS in 46 of 113 infants. MRI confirmed these findings in 43 and showed additional abnormalities in 32 infants. The sensitivity and specificity of anterior fontanelle views for major PF abnormalities as seen on MRI were 16 % and 99 %. Adding MF views increased the sensitivity of US to 82 %. The sensitivity and specificity of MF views for the detection of any (major or minor) PF abnormality were 57 % and 95 %. Especially acute hypoxic-ischemic injury and small subdural and punctate cerebellar haemorrhage remained undetected by CUS. PF abnormalities are frequent in high-risk term infants. MF-CUS enables early diagnosis of major PF abnormalities. We therefore advocate to perform MF-CUS in high-risk term neonates. (orig.)

  13. A morphometric CT study of Down's syndrome showing small posterior fossa and calcification of basal ganglia

    International Nuclear Information System (INIS)

    Ieshima, A.; Yoshino, K.; Takashima, S.; Takeshita, K.; Kisa, T.

    1984-01-01

    We report characteristic and morphometric changes of cranial computed tomography (CT) with increasing age in 56 patients with Down's syndrome aged from 0 month to 37 years. Patients were compared with 142 normal controls aged 0 to 59 years. Width of ventricles, Sylvian fissures, posterior fossa, pons and cisterna magna were measured on CT. The incidences of the cavum septi pellucidi, cavum vergae and cavum veli interpositi and high density in the basal ganglia were examined. There was high incidence (10.7%) of bilateral calcification of basal ganglia in Down's syndrome, although that of pineal body and choroid plexus calcification was similar in Down's syndrome and controls. Basal ganglia calcification is more frequently seen in young Down's syndrome and may be related to the premature aging characteristic of Down's syndrome. The CT in Down's syndrome showed relatively small posterior fossa, small cerebellum, small brain stem and relatively large Sylvian fissures in those under one year of age. There was a high frequency of midline cava and large cisterna magna. There were no significant atrophic changes on CT except after the fifth decade comparing with controls. (orig.)

  14. Extramedullary Plasmacytoma Presenting as a Solitary Mass in the Intracranial Posterior Fossa

    International Nuclear Information System (INIS)

    Daghighi, Mohammad Hossein; Poureisa, Masoud; Shimia, Mohammad; Mazaheri-Khamene, Ramin; Daghighi, Shadi

    2012-01-01

    A patient with a 3-month history of headache refractory to pain medication was admitted. The CT scan and MRI showed evidence of a posterior fossa mass. This was pathologically confirmed as an extra medullary plasmacytoma (EMP). He had a pathologic fracture of the left humerus 7 years ago while the radiologist was unaware at the time of diagnosis. A solitary bone plasmacytoma (SBP) was the cause of the pathologic fracture. This report includes the first description of MRI findings in a patient with a rare-incidence intracranial solitary extra medullary plasmacytoma (SEP) in Iran. There is a striking similarity between the features of intracranial SEP and meningiomas. Intracranial SEP, although rare, should be included in the differential diagnosis of brain tumors in areas where meningiomas commonly arise. The MRI findings and differential diagnosis of plasmacytoma are reviewed. Before this case report, only few cases have been reported in the literature. Nonetheless, this is the first report of posterior fossa EMP from Iran

  15. Late effects of treatment on the intelligence of children with posterior fossa tumors

    International Nuclear Information System (INIS)

    Duffner, P.K.; Cohen, M.E.; Thomas, P.

    1983-01-01

    This retrospective pilot study was undertaken to evaluate the late effects of treatment on intelligence in a population of children with posterior fossa tumors. Ten children with posterior fossa tumors treated with radiation and chemotherapy received intellectual evaluations at least one year following diagnosis. Six children had medulloblastomas, one child had a fourth ventricular ependymoma, two children had brainstem gliomas, and one child had a recurrent cerebellar astrocytoma. Children with supratentorial tumors were specifically excluded from the study in order to eliminate the possible influence of the tumor on intellectual functioning. Four children had had intelligence testing in school prior to treatment of their tumor. In each case results following treatment revealed a deterioration of full scale IQ of at least 25 points. Six children did not have prior testing; of these, two had IQ's less than 20. Overall, 50% of the patients had IQ's of less than 80 and 20% had IQ's of greater than 100. Furthermore, four children with normal intelligence (IQ greater than 80) have learning problems requiring special classes. Thus, of the ten children evaluated, all have either dementia, learning disabilities, or evidence of intellectual retardation. This study suggests that aggressive treatment of children with brain tumors may improve survivals but may be associated with significant long-term disabilities

  16. Posterior fossa reconstruction using titanium plate for the treatment of cerebellar ptosis after decompression for Chiari malformation.

    Science.gov (United States)

    Udani, Vikram; Holly, Langston T; Chow, Daniel; Batzdorf, Ulrich

    2014-01-01

    We describe our use of a perforated titanium plate to perform a partial posterior fossa cranioplasty in the treatment of cerebellar ptosis and dural ectasia after posterior fossa decompression (PFD). Twelve patients who had undergone PFD underwent posterior fossa reconstruction using a titanium plate. Symptoms were related to either descent of the cerebellum into the decompression or to dural ectasia into the craniectomy defect. Twelve patients who had undergone large suboccipital craniectomies and who presented with persistent headaches and some with neurological symptoms related to syringomyelia, underwent reoperation with placement of a small titanium plate. Ten of 12 patients showed symptomatic improvement after reoperation. Placement of a titanium plate appears to be an effective method of treatment of cerebellar ptosis and dural ectasia after PFD for Chiari malformation. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Fetal MRI for characterising a variety of posterior fossa anomalies suspected on 3rd trimester ultrasound examination – a short series of four cases

    Directory of Open Access Journals (Sweden)

    Amaresh Indravadan Ranchod

    2012-02-01

    Full Text Available Fetal MRI is increasingly being used to more accurately assess abnormalities detected on screening ultrasound. This procedure is more pertinent when the initial ultrasound is done late in the third trimester and when the abnormality involves the posterior fossa of the brain. Four cases with a variety of unusual posterior fossa anomalies are presented.

  18. Acoustic neurinoma and posterior fossa meningioma - clinical and CT radiologic findings

    International Nuclear Information System (INIS)

    Catz, A.; Reider-Groswasser, I.; Ichilov Hospital, Tel Aviv; Tel Aviv Univ.

    1986-01-01

    Clinical and computed tomography (CT) findings of twenty-three patients with acoustig neurinoma (AN) and eleven patients with posterior fossa meningioma (PFM) are described. AN frequently (94%) presents with the complaint of hearing loss, while PFM often (60%) presents with non-specific pains in the head or neck. The CT characteristics of AN and PFM in this series were similar to those found in most previous publications. The maximal measured mean diamter of PFM (40.2 mm) was significantly larger than that of AN (26.4 mm). Hydrocephalus was apparently influenced by tumor location rather than by its size. It is concluded that diagnostic ability has been improved in cases of CPA tumors, but not in those of non-CPA PFM, probably because of the earlier clinical presentation of the former. Clinical efforts are still necessary to detect the smaller tumors. (orig.)

  19. Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia

    Directory of Open Access Journals (Sweden)

    Vijay P Joshi

    2013-01-01

    Full Text Available Acquired cerebellar tonsillar herniation and syringomyelia associated with posterior fossa mass lesions is an exception rather than the rule. In the present article, we describe the neuroimaging findings in a case of 28-year-old female patient presented with a history of paraesthesia involving right upper limb of 8-month duration. Magnetic resonance imaging showed a giant retrocerebellar arachnoid causing tonsillar herniation with cervical syringomyelia. The findings in the present case supports that the one of the primary mechanism for the development of syringomyelia may be the obstruction to the flow of cerebrospinal fluid causing alterations in the passage of extracellular fluid in the spinal cord and leading to syringomyelia.

  20. Posterior fossa decompression with duraplasty in Chiari surgery: A technical note

    Directory of Open Access Journals (Sweden)

    Marcelo Ferreira Sabba

    Full Text Available Summary Chiari malformation (CM is the most common and prevalent symptomatic congenital craniocervical malformation. Radiological diagnosis is established when the cerebellar tonsils are located 5 mm or more below the level of the foramen magnum on magnetic resonance imaging (MRI. Surgical treatment is indicated whenever there is symptomatic tonsillar herniation or syringomyelia/hydrocephalus. The main surgical treatment for CM without craniocervical instability (such as atlantoaxial luxation is posterior fossa decompression, with or without duraplasty. The authors describe in details and in a stepwise fashion the surgical approach of patients with CM as performed at the State University of Campinas, emphasizing technical nuances for minimizing the risks of the procedure and potentially improving patient outcome.

  1. Life-threatening macroglossia after posterior fossa surgery: a surgical positioning problem?

    Science.gov (United States)

    Vermeersch, G; Menovsky, T; De Ridder, D; De Bodt, M; Saldien, V; Van de Heyning, P

    2014-01-01

    A 55-year-old woman was operated in the lateral park bench position with significant neck flexion and oral packing. Macroglossia was noticed immediately postoperatively after endotracheal extubation. The patient was reintubated for 13 days and subsequently required a tracheostoma. After the placement of the tracheostoma and the removal of the endotracheal tube, the congestion of the tongue decreased markedly within 24 hours. Macroglossia is a rare complication following posterior fossa procedures with few cases reported so far. It can cause airway obstruction, which could be a life-threatening complication, and it therefore requires prompt treatment. The aetiology of postoperative macroglossia remains uncertain and has been attributed to arterial, venous and lymphatic compression, mechanical compression, or neurogenic causes. This article describes new insights into aetiology and also describes preventive measures and possible treatment.

  2. Role of Cerebellum in Fine Speech Control in Childhood: Persistent Dysarthria after Surgical Treatment for Posterior Fossa Tumour

    Science.gov (United States)

    Morgan, A. T.; Liegeois, F.; Liederkerke, C.; Vogel, A. P.; Hayward, R.; Harkness, W.; Chong, K.; Vargha-Khadem, F.

    2011-01-01

    Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen…

  3. A method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus: the "mosquito" method.

    Science.gov (United States)

    Lee, Hee Chang; Lee, Ji Yeoun; Ryu, Seul Ki; Lim, Jang Mi; Chong, Sangjoon; Phi, Ji Hoon; Kim, Seung-Ki; Wang, Kyu-Chang

    2016-12-01

    The posterior fossa dural opening requires the ligation of the occipital sinus to gain successful exposure. However, there could be a prominent occipital sinus which is functioning as the main drainage route and is harboring the risk of unpredictable massive hemorrhage during the dural opening. We introduce a safe method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus using four curved hemostat clamps. For the dural incision at the midline part of the posterior cranial fossa, we used four curved hemostat clamps to occlude the prominent occipital sinus: one pair of clamps at the proximal part and the other pair at the distal part to occlude the occipital sinus. Dural incision was made between the two pairs of the curved hemostat clamps. By clamping of the sinus, it allows observation of possible brain swelling after occlusion of the occipital sinus as well as minimizes hemorrhage during incision of the midline dura of the posterior fossa. This method allows observation of brain swelling after occipital sinus occlusion and is an easy and safe incision of the midline dura minimizing hemorrhage in selected cases with a prominent occipital sinus.

  4. Contribution of sup(99m)Tc pertechnetate brain scintigraphy in the diagnosis of tumours of posterior fossa

    International Nuclear Information System (INIS)

    Sergent, Aline.

    1976-01-01

    The present work concerns 38 posterior cranial fossa tumour cases subjected to sup(99m)Tc pertechnetate brain scintigraphy between May 1974 and June 1976. 33 of these patients have undergone an anatomical check while for the remaining 5, the existence of a posterior fossa tumour is established from the conjunction of clinical signs and other paraclinical examinations. The procedure was the same for all these 38 patients: after a 300 μC/kg injection of tracer, an immediate angioscintigraphic period, an early set of pictures (half an hour after the tracer injection) then delayed set (4 to 5 hours later) taken from 4 angles: front, back and two profiles. The examination was performed with an OHIO NUCLEAR SIEMENS gamma camera and sometimes a conventional scanner as well (the latter giving no better a diagnosis than the former). In 75% of the cases a hyperfixation of the injected tracer was observed and its site located quite accurately in the posterior fossa tumour. The etiology of the lesion could be diagnosed in 'most probable' or 'least probable' terms. Examination of work by other authors, who obtained similar results, leads to the conclusion that this method is very helpful in the diagnosis of posterior fossa tumours when used as a means of early detection, before the undertaking of more complex neuroradiological explorations [fr

  5. Correlation of Acute and Late Brainstem Toxicities With Dose-Volume Data for Pediatric Patients With Posterior Fossa Malignancies

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    Nanda, Ronica H., E-mail: rhazari@emory.edu [Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia (United States); Ganju, Rohit G.; Schreibmann, Edward [Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia (United States); Chen, Zhengjia; Zhang, Chao [Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University Rollins School of Public Health, Atlanta, Georgia (United States); Jegadeesh, Naresh; Cassidy, Richard; Deng, Claudia; Eaton, Bree R.; Esiashvili, Natia [Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia (United States)

    2017-06-01

    Purpose: Radiation-induced brainstem toxicity after treatment of pediatric posterior fossa malignancies is incompletely understood, especially in the era of intensity modulated radiation therapy (IMRT). The rates of, and predictive factors for, brainstem toxicity after photon RT for posterior fossa tumors were examined. Methods and Materials: After institutional review board approval, 60 pediatric patients treated at our institution for nonmetastatic infratentorial ependymoma and medulloblastoma with IMRT were included in the present analysis. Dosimetric variables, including the mean and maximum dose to the brainstem, the dose to 10% to 90% of the brainstem (in 10% increments), and the volume of the brainstem receiving 40, 45, 50, and 55 Gy were recorded for each patient. Acute (onset within 3 months) and late (>3 months of RT completion) RT-induced brainstem toxicities with clinical and radiographic correlates were scored using Common Terminology Criteria for Adverse Events, version 4.0. Results: Patients aged 1.4 to 21.8 years underwent IMRT or volumetric arc therapy postoperatively to the posterior fossa or tumor bed. At a median clinical follow-up period of 2.8 years, 14 patients had developed symptomatic brainstem toxicity (crude incidence 23.3%). No correlation was found between the dosimetric variables examined and brainstem toxicity. Vascular injury or ischemia showed a strong trend toward predicting brainstem toxicity (P=.054). Patients with grade 3 to 5 brainstem toxicity had undergone treatment to significant volumes of the posterior fossa. Conclusion: The results of the present series demonstrate a low, but not negligible, risk of brainstem radiation necrosis for pediatric patients with posterior fossa malignancies treated with IMRT. No specific dose-volume correlations were identified; however, modern treatment volumes might help limit the incidence of severe toxicity. Additional work investigating inherent biologic sensitivity might also provide

  6. Emergency department CT screening of patients with nontraumatic neurological symptoms referred to the posterior fossa: comparison of thin versus thick slice images.

    Science.gov (United States)

    Kamalian, Shervin; Atkinson, Wendy L; Florin, Lauren A; Pomerantz, Stuart R; Lev, Michael H; Romero, Javier M

    2014-06-01

    Evaluation of the posterior fossa (PF) on 5-mm-thick helical CT images (current default) has improved diagnostic accuracy compared to 5-mm sequential CT images; however, 5-mm-thick images may not be ideal for PF pathology due to volume averaging of rapid changes in anatomy in the Z-direction. Therefore, we sought to determine if routine review of 1.25-mm-thin helical CT images has superior accuracy in screening for nontraumatic PF pathology. MRI proof of diagnosis was obtained within 6 h of helical CT acquisition for 90 consecutive ED patients with, and 88 without, posterior fossa lesions. Helical CT images were post-processed at 1.25 and 5-mm-axial slice thickness. Two neuroradiologists blinded to the clinical/MRI findings reviewed both image sets. Interobserver agreement and accuracy were rated using Kappa statistics and ROC analysis, respectively. Of the 90/178 (51 %) who were MR positive, 60/90 (66 %) had stroke and 30/90 (33 %) had other etiologies. There was excellent interobserver agreement (κ > 0.97) for both thick and thin slice assessments. The accuracy, sensitivity, and specificity for 1.25-mm images were 65, 44, and 84 %, respectively, and for 5-mm images were 67, 45, and 85 %, respectively. The diagnostic accuracy was not significantly different (p > 0.5). In this cohort of patients with nontraumatic neurological symptoms referred to the posterior fossa, 1.25-mm-thin slice CT reformatted images do not have superior accuracy compared to 5-mm-thick images. This information has implications on optimizing resource utilizations and efficiency in a busy emergency room. Review of 1.25-mm-thin images may help diagnostic accuracy only when review of 5-mm-thick images as current default is inconclusive.

  7. [Efficacies of arthroscopic debridement and olecranon fossa plasty in the treatment of osteoarthritis and posterior elbow impingement].

    Science.gov (United States)

    Liu, Yu-jie; Wang, Jun-liang; Li, Hai-feng; Qi, Wei; Wang, Ning

    2012-07-17

    To evaluate the efficacies of arthroscopic debridement and removal of osteophyma for olecroanon and olecranon fossa plasty for posterior impingement of elbow joint. Between 1999 and 2008, a total of 21 cases were diagnosed with osteoarthritis and posterior elbow impingement. There were 15 males and 6 females. And there were 16 right and 15 left cases. They included volleyball players (n = 7), tennis players (n = 7), golf enthusiasts (n = 4) and fencers (n = 3). The average duration of onset-operation was 3.5 years (range: 2.5 - 8). Arthroscopic exploration revealed synovial hyperplasia hypertrophy, cartilage degeneration and olecranon fossa hyperplasia with deformed olecranon fossa. Debridement and plasty were performed. Loose bodies were removed from elbow joint in 6 patients. Partial resection of posterior olecranon tip was performed and osteophytes or fibrous tissue removed in this area. Dynamic observation showed no posterior elbow impingement. Postoperative follow-up was conducted in 19 cases and 2 cases became lost to follow-up. The average follow-up period was 25.3 months (range: 18 - 42). All patients were evaluated preoperatively and postoperatively with the Hospital for Special Surgery Elbow Assessment Scale. The outcomes were excellent (n = 12), good (n = 7) and fair (n = 2). Postoperative patients elbow swelling and pain relieve, sports and life function returns to normal, elbow flexion and rotating mobility obviously improved. With the elbow radiological films to measure the range of motion, the average range of motion was 90.5° preoperatively and improved to 130° postoperatively. There was significant improvement in all cases. Posterior elbow impingement is caused by hyperextension trauma and elbow overuse during specific sporting activities. Arthroscopic debridement and olecroanon or olecranon fossa plasty demonstrates excellent results for posterior impingement of elbow joint.

  8. Frequency and determinants for hemorrhagic transformation of posterior cerebral stroke : Posterior ischemic stroke and hemorrhagic transformation.

    Science.gov (United States)

    Valentino, Francesca; Gentile, Luana; Terruso, Valeria; Mastrilli, Sergio; Aridon, Paolo; Ragonese, Paolo; Sarno, Caterina; Savettieri, Giovanni; D'Amelio, Marco

    2017-11-13

    hemorrhagic transformation is a threatening ischemic stroke complication. Frequency of hemorrhagic transformation differs greatly among studies, and its risk factors have been usually studied in patients with anterior ischemic stroke who received thrombolytic therapy. We evaluated, in a hospital-based series of patients with posterior ischemic stroke not treated with thrombolysis, frequency and risk factors of hemorrhagic transformation. Patients with posterior circulation stroke were seen in our Department during the period January 2004 to December 2009. Demographic and clinical information were collected. We estimated risk for spontaneous hemorrhagic transformation by means of uni- and multivariate logistic regression analyses. 119 consecutive patients were included (73 males, 61.3%). Hemorrhagic transformation was observed in 7 patients (5.9%). Only clinical worsening was significantly associated with hemorrhagic transformation (OR 6.8, 95% CI 1.3-34.5). Our findings indicate that patients with posterior have a low risk of spontaneous hemorrhagic transformation, suggesting that these patients might have greater advantage from intravenous thrombolysis.

  9. Curative analysis of different surgical treatments for non-solid hemangioblastoma in posterior cranial fossa

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    Yu-xiang MA

    2015-07-01

    Full Text Available Objective  The article analyzed the curative effect of different surgical treatments for non-solid hemangioblastoma in posterior cranial fossa to explore reasonable operation method.  Methods  Clinical data of 61 patients with non-solid hemangioblastoma who underwent surgeries in Tianjin Huanhu Hospital during July 2007 and June 2014 were retrospectively analyzed. According to surgical approaches and the situation of foramen magnum and atlas, these patients were divided into 5 groups: midline approach opening foramen magnum and atlas (Group A, midline approach without opening foramen magnum and atlas (Group B, paramedian approach opening foramen magnum and atlas (Group C, paramedian approach without opening foramen magnum and atlas (Group D, retrosigmoid approach (Group E. By collecting clinical symptoms, imaging findings, surgical records and postoperative complications, the surgical results and occurrence of postoperative complications were summarized and reasonable operation method was discussed.  Results  Among 61 patients, total resection was achieved in 56 cases (91.80%, and partial resection was achieved in 5 cases (8.20% . The postoperative remission rate of 43 cases with hydrocephalus was 79.07% (34/43. Intracranial infection was the most common postoperative complication, accounting for 22.95% (14/61. There was significant difference in occurrence rate of intracranial infection among 4 subgroups: opening or not opening the foramen magnum and atlas with or without restoring bone flap (Z = 16.269, P = 0.001. In the subgroup of not opening foramen magnum and atlas with restoring bone flap, the infection rate, which accounted for 6.90% (2/29, was the lowest.  Conclusions  The surgical treatment options for non-solid hemangioblastoma in posterior fossa should be done according to patients' condition, and performed by a professional group. If conditions allow, not to open the foramen magnum and atlas, as well as intraoperative

  10. Lumbar meningeal enhancement after surgery in the posterior cranial fossa: a normal finding in children?

    International Nuclear Information System (INIS)

    Krampla, W.; Urban, M.; Newrkla, S.; Hruby, W.; Schatzer, R.; Knosp, E.

    2002-01-01

    Purpose: Spinal meningeal Gd-DTPA enhancement after cranial surgery is a known observation of a not well understood underlying mechanism. This paper demonstrates that this MRI finding is a normal meningeal reaction to subarachnoid hemorrhage, which should not be mistaken for metastatic spread. Material and methods: Three pediatric patients were examined by MRI for metastatic spread of malignant infratentorial tumors along the spinal canal two to nine days after the removal of the primary cerebral lesion. The findings were compared with a control group that underwent cranial surgery (cyst resection or fenestration of the posterior cranial fossa) without major bleeding into the subarachnoid space. Unenhanced and enhanced sequences were obtained to prove that the high singal within the CSF is caused by an abnormal Gd-DTPA uptake and not by methemoglobin. Results: Meningeal enhancement was observed in all patients with intraoperative bleeding resembling subarachnoid masses on enhanced T 1 -weighted images. This was not present in any patient of the control group. This finding lasts for approximately two weeks. Conclusion: The meningeal enhancement renders immediate postoperative studies inconclusive for the detection of metastatic spread. Consequently, the obligatory tumor staging along the spinal canal should ideally be done prior to the resection of a cerebral tumor. (orig.) [de

  11. The value of metrizamide CT cisternography in the diagnosis of suprasellar and posterior fossa tumors

    International Nuclear Information System (INIS)

    Takahara, Nobuhiko; Mizuno, Makoto; Suwa, Jun; Yamanouchi, Yasuo; Matsumura, Hiroshi

    1982-01-01

    We have studied the diagnostic value of metrizamide CT cisternography (MCTC) in 22 patients. Six patients received metrizamide for the delineation of suprasellar tumors, 8 for posterior fossa tumors, and 8 for miscellaneous lesions, such as congenital cystic lesions and subdural fluid collections. Metrizamide with a concentration of 170 mgI/ml was used; 10 ml of it was introduced through the lumbar intrathecal route in every case. The patients were kept in a 15-degree Trendelenburg position, and Computed Tomography with an ACTA scanner (ACTA 200FS) was performed in principle one hour after the intrathecal injection and, if necessary, serially thereafter. The morphology of the subarachnoid space was well visualized in detail by CSF enhancement with metrizamide in all cases. The contours of the tumors in and around the basal cisterns were clearly shown; their relationship to the adjacent structures became more evident upon direct coronal section or upon coronal and sagittal reconstruction. It is suggested that the differential diagnosis in the suprasellar tumors and the C-P angle tumors can be made by means of the exact representation of the contours and extension of these tumors. MCTC can delineate the brain-stem glioma more accurately than the conventional CT scan: thus, it offers a definite advantage for the diagnosis and evaluation of those tumors which show isodensity on precontrast and no enhancement on postcontrast conventional CT scan. An arachnoid cyst or a porencephalic cyst can be diagnosed by the evaluation of the CSF-flow pattern. (author)

  12. Posterior Cranial Fossa Crowdedness Is Related to Age and Sex: an Magnetic Resonance Volumetric Study

    International Nuclear Information System (INIS)

    Lirng, J.F.; Fuh, J.L.; Chen, Y.Y.; Wang, S.J.

    2005-01-01

    Purpose: To measure 3-dimensional (3D) posterior cranial fossa (PCF) crowdedness and to evaluate the effect of age, sex, and body height on PCF. Material and Methods: Fifty-two healthy volunteers (24 M and 28 F; mean age 55.4±17.2 years; range 24-82 years) were recruited. Using a semi-automated magnetic resonance technique, we calculated a PCF crowdedness index (CI) as the ratio of hindbrain (HB) volume to PCF volume x100% and correlated this index with age, sex, body height, and other crowdedness parameters. Results: The mean PCF CI was 93.7±2.7%. Women had a more crowded PCF than men (95.0±1.7% versus 92.1±2.7%; P <0.001). PCF CI declined with age for both men ( r = -0.61; P = 0.002) and women ( r = -0.68; P <0.001). The association with age - but not HB volume - was maintained after we controlled for sex and body height. On multiple regression, both age and sex accounted for 57.5% of the PCF CI variance. Conclusion: Our study shows that PCF CI is associated with age and sex, and can therefore be used as a surrogate to assess hindbrain atrophy in a cross-sectional sample. Moreover, sex- and age-specific normal ranges may be needed to evaluate the PCF CI in clinical practice

  13. Indirect computerized tomography sign of chronic subdural hematoma demonstrated in the posterior fossa

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    Machi, Takao; Fukui, Masashi; Maeyama, Ryutaro; Takaki, Tosuke; Yoshiura, Shogo; Kamoi, Itsuma

    1985-03-01

    In cases of chronic subdural hematoma (CSH), brain computerized tomography (CT) scans frequently disclose a low density band in the posterior fossa (LDBP) between the lateral margin of the cerebellum and the adjacent petrous bone/tentorium cerebelli. Out of 121 cases of CSH, 56 (46%) showed the LDBP. The LDBP was mostly ipsilateral to the side of the CSH or bilateral. The frequency of the LDBP had no correlation with the severity of the cerebral midline shift or the thickness of the hematoma. As normal controls, CT scans of 257 cases in which no organic lesions were detected were used. Also 30 cases with dementing diseases, 2 cases with spinocerebellar degeneration and 428 cases of other neurological diseases such as head trauma other than CSH, brain tumor, cerebrovascular disease etc. were studied as disease controls. The incidence of the LDBP in both controls was significantly lower than in CSH. Therefore, the LDBP in cases of CSH was considered to be a significant associated finding of CT scans. The mechanism of the LDBP is discussed.

  14. A report of the anesthesia in posterior fossa operations in the sitting position in 55 patients

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    Jahanguiri B

    1994-04-01

    Full Text Available In this survey, 55 patients were studied in a period of six years for having the anesthesia in the sitting position. In this position, the surgeon will had a better access to the location, whose damages have been sustained, so less damages would be given to the healthy tissues. For the patients, due to their critical general conditions, one week prior to giving anesthesia to the posterior fossa, operation in the sitting position the right ventriculoatiral shunt was placed. For preventing the fall of blood pressure, a bandage was placed in the lower limbs after inducing anesthesia and changing supine position to sitting position. Before the induction, central venous pressure was measured for treating the air embolism. The head of catheter was placed inside the right atrial. Premedications such as atropine, pethidine, and inductive agents like thiopenton, and muscle relaxants, maintained with halothane and nitrous oxide. All of the patients endured this condition without the fall of blood pressure and air embolism

  15. Posterior Cranial Fossa Crowdedness Is Related to Age and Sex: an Magnetic Resonance Volumetric Study

    Energy Technology Data Exchange (ETDEWEB)

    Lirng, J.F.; Fuh, J.L.; Chen, Y.Y.; Wang, S.J. [Taipei Veterans General Hospital, Taiwan (China). Dept. of Radiology and Neurological Inst.

    2005-11-01

    Purpose: To measure 3-dimensional (3D) posterior cranial fossa (PCF) crowdedness and to evaluate the effect of age, sex, and body height on PCF. Material and Methods: Fifty-two healthy volunteers (24 M and 28 F; mean age 55.4{+-}17.2 years; range 24-82 years) were recruited. Using a semi-automated magnetic resonance technique, we calculated a PCF crowdedness index (CI) as the ratio of hindbrain (HB) volume to PCF volume x100% and correlated this index with age, sex, body height, and other crowdedness parameters. Results: The mean PCF CI was 93.7{+-}2.7%. Women had a more crowded PCF than men (95.0{+-}1.7% versus 92.1{+-}2.7%; P <0.001). PCF CI declined with age for both men ( r = -0.61; P = 0.002) and women ( r = -0.68; P <0.001). The association with age - but not HB volume - was maintained after we controlled for sex and body height. On multiple regression, both age and sex accounted for 57.5% of the PCF CI variance. Conclusion: Our study shows that PCF CI is associated with age and sex, and can therefore be used as a surrogate to assess hindbrain atrophy in a cross-sectional sample. Moreover, sex- and age-specific normal ranges may be needed to evaluate the PCF CI in clinical practice.

  16. Declarative and procedural learning in children and adolescents with posterior fossa tumours

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    Casares Encarnación

    2006-03-01

    Full Text Available Abstract Background This quasi-experimental study was designed to assess two important learning types – procedural and declarative – in children and adolescents affected by posterior fossa tumours (astrocytoma vs. medulloblastoma, given that memory has an important impact on the child's academic achievement and personal development. Methods We had three groups: two clinical (eighteen subjects and one control (twelve subjects. The learning types in these groups were assessed by two experimental tasks evaluating procedural-implicit and declarative memory. A Serial Reaction-Time Task was used to measure procedural sequence learning, and the Spanish version 1 of the California Verbal Learning Test-Children's Version- CVLT- 2 to measure declarative-explicit learning. The learning capacity was assessed considering only the blocks that represent learning, and were compared with MANOVA in clinical and normal subjects. The Raven, simple reaction-time, finger-tapping test, and grooved pegboard tests were used to assess the overall functioning of subjects. The results were compared with those from a control group of the same age, and with Spanish norm-referenced tools where available Results The results indicate the absence of procedural-implicit learning in both clinical groups, whereas declarative-explicit learning is maintained in both groups. Conclusion The clinical groups showed a conservation of declarative learning and a clear impairment of procedural learning. The results support the role of the cerebellum in the early phase of procedural learning.

  17. Imaging of lesions in the posterior cranial fossa using single photon emission computed tomography

    International Nuclear Information System (INIS)

    Kawakami, Michiro; Uesugi, Yasuo; Higashikawa, Masahiko; Ochi, Mari; Makimoto, Kazuo; Takahashi, Hiroaki; Shin, Akinori; Utsunomiya, Keita; Akagi, Hiroaki

    1988-01-01

    Lesions in the posterior cranial fossa were visualized by single photon emission computed tomography (SPECT) with 123 I-IMP (N-isopropyl-p- 123 I-iodoamphetamine) and 99m Tc-HM-PAO ( 99m Tc-hexametylpropyleneamine oxime). It is generally held that these radiopharmaceuticals penetrate the walls of cerebral blood vessels and that their accumulations in the brain tissue may reflect the cerebral blood flow. Six patients with lesions in the central nervous system all showed wider areas of abnormality in SPECT than in X-ray CT, indicating a larger lesion of blood flow disturbance. In the next series of 11 patients with vertigo or dizziness of unknown etiology, eight had abnormal findings in the scan with 123 I-IMP as did four of the nine in the scan with 99m Tc-HM-PAO. Thus, most patients with dizziness of unknown etiology may have some vertebral blood flow disorder, which in some cases is not clearly diagnosed by conventional vestibular examinations or even by X-ray CT scan. The accuracy of the diagnostic measures for otoneurological problems awaits further studies of their sensitivity and specificity. (author)

  18. Total spine and posterior fossa MRI screening in adolescent idiopathic scoliosis (177 cases

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    MR Etemadifar

    2005-05-01

    Full Text Available Background: MRI screening for idiopathic scoliosis is controversial. Considering our clinical experiences, the results of MRI in all patients with idiopathic scoliosis were evaluated. Methods: In a prospective clinical study, all neurologically normal patients with idiopathic scoliosis screened by posterior fossa and total spine MRI. Results: After excluding 9 patients for mild neurological findings, in other 177 patients (132 female, 45 male, the average age and curve angle was 15±2 years and 59±17º (30 to 135º, respectively. Convexity was to right in 146 and to left in 31 cases. MRI was positive in 12 cases (6.8%. In 5 cases (2.8%, neurosurgical intervention was necessary prior to scoliosis surgery. There was no relation between age, sex, presence of pain or curve angle and positive MRI findings (P>0.05. Left convexity was significantly related to positive MRI findings (P=0.013. In males with left convex curves, the probability of positive MRI findings was 8.8 folds other patients. Conclusion: Considering our results and other reported articles, it seems that routine MRI screening of all patients presenting as idiopathic scoliosis is necessary for detection of underlying pathologies. Key words: Idiopathic Scoliosis, MRI, Spine Syrinx, Chiari

  19. Chromosomal aneuploidies and copy number variations in posterior fossa abnormalities diagnosed by prenatal ultrasonography.

    Science.gov (United States)

    Lei, Ting; Feng, Jie-Ling; Xie, Ying-Jun; Xie, Hong-Ning; Zheng, Ju; Lin, Mei-Fang

    2017-11-01

    To explore the genetic aetiology of fetal posterior fossa abnormalities (PFAs). This study involved cases of PFAs that were identified by prenatal ultrasonographic screening and confirmed postnatally between January 2012 and January 2016. Conventional cytogenetic analyses and chromosomal microarray analysis were performed, and chromosomal aneuploidies and copy number variations (CNVs) were identified. Among 74 cases included in this study, 8 were of Blake's pouch cyst; 7, Dandy-Walker malformation; 11, vermian hypoplasia; 32, enlarged cisterna magna; and 16, cerebellar hypoplasia. The rates of nonbenign chromosomal aberrations (including chromosomal aneuploidies, pathogenic CNVs, and variants of unknown significance) were 2/8 (25.0%), 2/7 (28.5%), 8/11 (72.7%), 7/32 (21.9%), and 6/16 (37.5%), respectively. Cases were also classified as isolated PFAs (30/74), PFAs with other central nervous system (CNS) abnormalities (13/74), or PFAs with extra-CNS structural abnormalities (31/74). No fetuses with isolated PFAs or PFAs accompanied by other CNS abnormalities exhibited chromosomal aneuploidies or pathogenic CNVs. The rate of pathogenic chromosomal aberrations in the remaining fetuses was 17/31 (22.9%). The combined use of chromosomal microarray analysis and karyotype analysis might assist the prenatal diagnosis and management of PFAs, with extra-CNS structural abnormalities being detected by ultrasonography. © 2017 John Wiley & Sons, Ltd.

  20. High-resolution MRI of cranial nerves in posterior fossa at 3.0 T.

    Science.gov (United States)

    Guo, Zi-Yi; Chen, Jing; Liang, Qi-Zhou; Liao, Hai-Yan; Cheng, Qiong-Yue; Fu, Shui-Xi; Chen, Cai-Xiang; Yu, Dan

    2013-02-01

    To evaluate the influence of high-resolution imaging obtainable with the higher field strength of 3.0 T on the visualization of the brain nerves in the posterior fossa. In total, 20 nerves were investigated on MRI of 12 volunteers each and selected for comparison, respectively, with the FSE sequences with 5 mm and 2 mm section thicknesses and gradient recalled echo (GRE) sequences acquired with a 3.0-T scanner. The MR images were evaluated by three independent readers who rated image quality according to depiction of anatomic detail and contrast with use of a rating scale. In general, decrease of the slice thickness showed a significant increase in the detection of nerves as well as in the image quality characteristics. Comparing FSE and GRE imaging, the course of brain nerves and brainstem vessels was visualized best with use of the three-dimensional (3D) pulse sequence. The comparison revealed the clear advantage of a thin section. The increased resolution enabled immediate identification of all brainstem nerves. GRE sequence most distinctly and confidently depicted pertinent structures and enables 3D reconstruction to illustrate complex relations of the brainstem. Copyright © 2013 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  1. High-resolution MRI of cranial nerves in posterior fossa at 3.0 T

    Institute of Scientific and Technical Information of China (English)

    Zi-Yi Guo; Jing Chen; Qi-Zhou Liang; Hai-Yan Liao; Qiong-Yue Cheng; Shui-Xi Fu; Cai-Xiang Chen; Dan Yu

    2013-01-01

    Objective:To evaluate the influence of high-resolution imaging obtainable with the higher field strength of3.0T on the visualization of the brain nerves in the posterior fossa.Methods:In total,20 nerves were investigated onMRI of12 volunteers each and selected for comparison, respectively, with theFSE sequences with5 mm and2 mm section thicknesses and gradient recalled echo(GRE) sequences acquired with a3.0-T scanner.TheMR images were evaluated by three independent readers who rated image quality according to depiction of anatomic detail and contrast with use of a rating scale.Results:In general, decrease of the slice thickness showed a significant increase in the detection of nerves as well as in the image quality characteristics. ComparingFSE andGRE imaging, the course of brain nerves and brainstem vessels was visualized best with use of the three-dimensional(3D) pulse sequence.Conclusions:The comparison revealed the clear advantage of a thin section.The increased resolution enabled immediate identification of all brainstem nerves.GRE sequence most distinctly and confidently depicted pertinent structures and enables3D reconstruction to illustrate complex relations of the brainstem.

  2. Fluorodeoxyglucose positron emission tomography/computed tomography findings in a patient with cerebellar mutism after operation in posterior fossa

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    Gonca Kara Gedik

    2017-03-01

    Full Text Available Cerebellar mutism is a transient period of speechlessness that evolves after posterior fossa surgery in children. Although direct cerebellar and brain stem injury and supratentorial dysfunction have been implicated in the mediation of mutism, the pathophysiological mechanisms involved in the evolution of this kind of mutism remain unclear. Magnetic resonance imaging revealed dentatothalamocortical tract injuries and single photon emission computed tomography showed cerebellar and cerebral hypoperfusion in patients with cerebellar mutism. However, findings with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT in this group of patients have not been documented previously. In this clinical case, we report a patient who experienced cerebellar mutism after undergoing a posterior fossa surgery. Right cerebellar and left frontal lobe hypometabolism was shown using FDG PET/CT. The FDG metabolism of both the cerebellum and the frontal lobe returned to normal levels after the resolution of the mutism symptoms.

  3. Longitudinal MRI assessment: the identification of relevant features in the development of Posterior Fossa Syndrome in children

    Science.gov (United States)

    Spiteri, M.; Lewis, E.; Windridge, D.; Avula, S.

    2015-03-01

    Up to 25% of children who undergo brain tumour resection surgery in the posterior fossa develop posterior fossa syndrome (PFS). This syndrome is characterised by mutism and disturbance in speech. Our hypothesis is that there is a correlation between PFS and the occurrence of hypertrophic olivary degeneration (HOD) in lobes within the posterior fossa, known as the inferior olivary nuclei (ION). HOD is exhibited as an increase in size and intensity of the ION on an MR image. Intra-operative MRI (IoMRI) is used during surgical procedures at the Alder Hey Children's Hospital, Liver- pool, England, in the treatment of Posterior Fossa tumours and allows visualisation of the brain during surgery. The final MR scan on the IoMRI allows early assessment of the ION immediately after the surgical procedure. The longitudinal MRI data of 28 patients was analysed in a collaborative study with Alder Hey Children's Hospital, in order to identify the most relevant imaging features that relate to the development of PFS, specifically related to HOD. A semi-automated segmentation process was carried out to delineate the ION on each MRI. Feature selection techniques were used to identify the most relevant features amongst the MRI data, demographics and clinical data provided by the hospital. A support vector machine (SVM) was used to analyse the discriminative ability of the selected features. The results indicate the presence of HOD as the most efficient feature that correlates with the development of PFS, followed by the change in intensity and size of the ION and whether HOD occurred bilaterally or unilaterally.

  4. Therapeutic Impact of Cytoreductive Surgery and Irradiation of Posterior Fossa Ependymoma in the Molecular Era: A Retrospective Multicohort Analysis.

    Science.gov (United States)

    Ramaswamy, Vijay; Hielscher, Thomas; Mack, Stephen C; Lassaletta, Alvaro; Lin, Tong; Pajtler, Kristian W; Jones, David T W; Luu, Betty; Cavalli, Florence M G; Aldape, Kenneth; Remke, Marc; Mynarek, Martin; Rutkowski, Stefan; Gururangan, Sridharan; McLendon, Roger E; Lipp, Eric S; Dunham, Christopher; Hukin, Juliette; Eisenstat, David D; Fulton, Dorcas; van Landeghem, Frank K H; Santi, Mariarita; van Veelen, Marie-Lise C; Van Meir, Erwin G; Osuka, Satoru; Fan, Xing; Muraszko, Karin M; Tirapelli, Daniela P C; Oba-Shinjo, Sueli M; Marie, Suely K N; Carlotti, Carlos G; Lee, Ji Yeoun; Rao, Amulya A Nageswara; Giannini, Caterina; Faria, Claudia C; Nunes, Sofia; Mora, Jaume; Hamilton, Ronald L; Hauser, Peter; Jabado, Nada; Petrecca, Kevin; Jung, Shin; Massimi, Luca; Zollo, Massimo; Cinalli, Giuseppe; Bognár, László; Klekner, Almos; Hortobágyi, Tibor; Leary, Sarah; Ermoian, Ralph P; Olson, James M; Leonard, Jeffrey R; Gardner, Corrine; Grajkowska, Wieslawa A; Chambless, Lola B; Cain, Jason; Eberhart, Charles G; Ahsan, Sama; Massimino, Maura; Giangaspero, Felice; Buttarelli, Francesca R; Packer, Roger J; Emery, Lyndsey; Yong, William H; Soto, Horacio; Liau, Linda M; Everson, Richard; Grossbach, Andrew; Shalaby, Tarek; Grotzer, Michael; Karajannis, Matthias A; Zagzag, David; Wheeler, Helen; von Hoff, Katja; Alonso, Marta M; Tuñon, Teresa; Schüller, Ulrich; Zitterbart, Karel; Sterba, Jaroslav; Chan, Jennifer A; Guzman, Miguel; Elbabaa, Samer K; Colman, Howard; Dhall, Girish; Fisher, Paul G; Fouladi, Maryam; Gajjar, Amar; Goldman, Stewart; Hwang, Eugene; Kool, Marcel; Ladha, Harshad; Vera-Bolanos, Elizabeth; Wani, Khalida; Lieberman, Frank; Mikkelsen, Tom; Omuro, Antonio M; Pollack, Ian F; Prados, Michael; Robins, H Ian; Soffietti, Riccardo; Wu, Jing; Metellus, Phillipe; Tabori, Uri; Bartels, Ute; Bouffet, Eric; Hawkins, Cynthia E; Rutka, James T; Dirks, Peter; Pfister, Stefan M; Merchant, Thomas E; Gilbert, Mark R; Armstrong, Terri S; Korshunov, Andrey; Ellison, David W; Taylor, Michael D

    2016-07-20

    Posterior fossa ependymoma comprises two distinct molecular variants termed EPN_PFA and EPN_PFB that have a distinct biology and natural history. The therapeutic value of cytoreductive surgery and radiation therapy for posterior fossa ependymoma after accounting for molecular subgroup is not known. Four independent nonoverlapping retrospective cohorts of posterior fossa ependymomas (n = 820) were profiled using genome-wide methylation arrays. Risk stratification models were designed based on known clinical and newly described molecular biomarkers identified by multivariable Cox proportional hazards analyses. Molecular subgroup is a powerful independent predictor of outcome even when accounting for age or treatment regimen. Incompletely resected EPN_PFA ependymomas have a dismal prognosis, with a 5-year progression-free survival ranging from 26.1% to 56.8% across all four cohorts. Although first-line (adjuvant) radiation is clearly beneficial for completely resected EPN_PFA, a substantial proportion of patients with EPN_PFB can be cured with surgery alone, and patients with relapsed EPN_PFB can often be treated successfully with delayed external-beam irradiation. The most impactful biomarker for posterior fossa ependymoma is molecular subgroup affiliation, independent of other demographic or treatment variables. However, both EPN_PFA and EPN_PFB still benefit from increased extent of resection, with the survival rates being particularly poor for subtotally resected EPN_PFA, even with adjuvant radiation therapy. Patients with EPN_PFB who undergo gross total resection are at lower risk for relapse and should be considered for inclusion in a randomized clinical trial of observation alone with radiation reserved for those who experience recurrence. © 2016 by American Society of Clinical Oncology.

  5. An unusual and spectacular case of spindle cell lipoma of the posterior neck invading the spinal cervical canal and posterior cranial fossa.

    Science.gov (United States)

    Petit, Damien; Menei, Philippe; Fournier, Henri-Dominique

    2011-11-01

    The authors describe the first case of spindle cell lipoma of the posterior neck invading the upper cervical spinal canal and the posterior cranial fossa. Spindle cell lipoma is an extremely rare variant of benign lipoma. It usually occurs as a solitary subcutaneous well-circumscribed lesion in the posterior neck or shoulders of adult men. Local aggressiveness is unusual. This 61-year-old man presented with an increased left cerebellar syndrome and headaches. He also had a posterior neck tumefaction, which had been known about for a long time. Computed tomography and MR imaging studies revealed a voluminous mass extending to the upper cervical canal and posterior cranial fossa and eroding the neighboring bones. The lesion was well delimited, and contrast enhancement was intense and heterogeneous. The tumor, which had initially developed under the muscles of the posterior neck, was totally resected. Histological assessment revealed numerous fat cells with spindle cells secreting collagen. The large size of the tumor and the submuscular location, bone erosion, and compression of the CNS were unusual in this rare subtype of benign adipose tumor. Its presentation could simulate a sarcoma.

  6. Diffusion tensor imaging in evaluation of posterior fossa tumors in children on a 3T MRI scanner

    International Nuclear Information System (INIS)

    Assis, Zarina Abdul; Saini, Jitender; Ranjan, Manish; Gupta, Arun Kumar; Sabharwal, Paramveer; Naidu, Purushotham R

    2015-01-01

    Primary intracranial tumors in children are commonly located in the posterior fossa. Conventional MRI offers limited information regarding the histopathological type of tumor which is essential for better patient management. The purpose of the study was to evaluate the usefulness of advanced MR imaging techniques like diffusion tensor imaging (DTI) in distinguishing the various histopathological types of posterior fossa tumors in children. DTI was performed on a 3T MRI scanner in 34 untreated children found to have posterior fossa lesions. Using third party software, various DTI parameters [apparent diffusion coefficient (ADC), fractional anisotropy (FA), radial diffusivity, planar index, spherical index, and linear index] were calculated for the lesion. Data were subjected to statistical analysis [analysis of variance (ANOVA)] using SPSS 15.0 software. We observed significant correlation (P < 0.01) between ADC mean and maximum, followed by radial diffusivity (RD) with the histopathological types of the lesions. Rest of the DTI parameters did not show any significant correlation in our study. The results of our study support the hypothesis that most cellular tumors and those with greater nuclear area like medulloblastoma would have the lowest ADC values, as compared to less cellular tumors like pilocytic astrocytoma

  7. Evolution of posterior fossa and brain morphology after in utero repair of open neural tube defects assessed by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Rethmann, Christin; Scheer, Ianina; Kellenberger, Christian Johannes [University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); University of Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich (Switzerland); Children' s Research Center (CRC), Zurich (Switzerland); Meuli, Martin; Mazzone, Luca; Moehrlen, Ueli [University of Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich (Switzerland); Children' s Research Center (CRC), Zurich (Switzerland); University Children' s Hospital Zurich, Department of Pediatric Surgery, Zurich (Switzerland)

    2017-11-15

    To describe characteristics of foetuses undergoing in utero repair of open neural tube defects (ONTD) and assess postoperative evolution of posterior fossa and brain morphology. Analysis of pre- and postoperative foetal as well as neonatal MRI of 27 foetuses who underwent in utero repair of ONTD. Type and level of ONTD, hindbrain configuration, posterior fossa and liquor space dimensions, and detection of associated findings were compared between MRI studies and to age-matched controls. Level of bony spinal defect was defined with exactness of ± one vertebral body. Of surgically confirmed 18 myelomeningoceles (MMC) and 9 myeloschisis (MS), 3 MMC were misdiagnosed as MS due to non-visualisation of a flat membrane on MRI. Hindbrain herniation was more severe in MS than MMC (p < 0.001). After repair, hindbrain herniation resolved in 25/27 cases at 4 weeks and liquor spaces increased. While posterior fossa remained small (p < 0.001), its configuration normalised. Lateral ventricle diameter indexed to cerebral width decreased in 48% and increased in 12% of cases, implying a low rate of progressive obstructive hydrocephalus. Neonatally evident subependymal heterotopias were detected in 33% at preoperative and 50% at postoperative foetal MRI. MRI demonstrates change of Chiari malformation type II (CM-II) features. (orig.)

  8. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    Directory of Open Access Journals (Sweden)

    Chaoliang Tang

    2015-01-01

    patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT or I-gel facilitated endotracheal tube intubation (Group TI. Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P<0.05 versus Group TT. Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.

  9. Evolution of posterior fossa and brain morphology after in utero repair of open neural tube defects assessed by MRI

    International Nuclear Information System (INIS)

    Rethmann, Christin; Scheer, Ianina; Kellenberger, Christian Johannes; Meuli, Martin; Mazzone, Luca; Moehrlen, Ueli

    2017-01-01

    To describe characteristics of foetuses undergoing in utero repair of open neural tube defects (ONTD) and assess postoperative evolution of posterior fossa and brain morphology. Analysis of pre- and postoperative foetal as well as neonatal MRI of 27 foetuses who underwent in utero repair of ONTD. Type and level of ONTD, hindbrain configuration, posterior fossa and liquor space dimensions, and detection of associated findings were compared between MRI studies and to age-matched controls. Level of bony spinal defect was defined with exactness of ± one vertebral body. Of surgically confirmed 18 myelomeningoceles (MMC) and 9 myeloschisis (MS), 3 MMC were misdiagnosed as MS due to non-visualisation of a flat membrane on MRI. Hindbrain herniation was more severe in MS than MMC (p < 0.001). After repair, hindbrain herniation resolved in 25/27 cases at 4 weeks and liquor spaces increased. While posterior fossa remained small (p < 0.001), its configuration normalised. Lateral ventricle diameter indexed to cerebral width decreased in 48% and increased in 12% of cases, implying a low rate of progressive obstructive hydrocephalus. Neonatally evident subependymal heterotopias were detected in 33% at preoperative and 50% at postoperative foetal MRI. MRI demonstrates change of Chiari malformation type II (CM-II) features. (orig.)

  10. Spinal level of myelomeningocele lesion as a contributing factor in posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia.

    LENUS (Irish Health Repository)

    Sweeney, Kieron J

    2013-02-01

    McLone and Knepper\\'s unified theory of Chiari malformation Type II (CM-II) describes how the loss of CSF via the open posterior neuropore fails to create adequate distending pressure for the developing rhomboencephalic vesicle. The authors of the present article describe the relationship between the posterior fossa volume and intracranial cerebellar volume as being related to the distance from the obex of the fourth ventricle to the myelomeningocele lesion using a common mathematical model, the Hagen-Poiseuille law.

  11. Cranial CT with 64-, 16-, 4- and single-slice CT systems-comparison of image quality and posterior fossa artifacts in routine brain imaging with standard protocols

    Energy Technology Data Exchange (ETDEWEB)

    Ertl-Wagner, Birgit; Eftimov, Lara; Becker, Christoph; Reiser, Maximilian [University of Munich, Grosshadern (Germany). Institute of Clinical Radiology; Blume, Jeffrey; Cormack, Jean [Brown University, Center for Statistical Sciences, Providence, RI (United States); Bruening, Roland; Brueckmann, Hartmut [University of Munich, Grosshadern (Germany). Department of Neuroradiology

    2008-08-15

    Posterior fossa artifacts constitute a characteristic limitation of cranial CT. To identify practical benefits and drawbacks of newer CT systems with reduced collimation in routine cranial imaging, we aimed to investigate image quality, posterior fossa artifacts and parenchymal delineation in non-enhanced CT (NECT) with 1-, 4-, 16- and 64-slice scanners using standard scan protocols. We prospectively enrolled 25 consecutive patients undergoing NECT on a 64-slice CT. Three groups with 25 patients having undergone NECT on 1-, 4- and 16-slice CT machines were matched regarding age and sex. Standard routine CT parameters were used on each CT system with helical acquisition in the posterior fossa; the parameters varied regarding collimation and radiation dose. Three blinded readers independently assessed the cases regarding image quality, infra- and supratentorial artifacts and delineation of brain parenchymal structures on a five-point ordinal scale. Reading orders were randomized. A proportional odds model that accounted for the correlated nature of the data was fit using generalized estimating equations. Posterior fossa artifacts were significantly reduced, and the delineation of infratentorial brain structures was significantly improved with the thinner collimation used for the newer CT systems (p<0.001). No significant differences were observed for midbrain structures (p>0.5). The thinner collimation available on modern CT systems leads to reduced posterior fossa artifacts and to a better delineation of brain parenchyma in the posterior fossa. (orig.)

  12. [Ultrasound measurement of fetal posterior fossa at 11 to 13⁺⁶ gestational weeks for screening open spina bifida].

    Science.gov (United States)

    Qin, Feng-Zhen; Li, Sheng-Li; Wen, Hua-Xuan; Ouyang, Yu-Rong; Zheng, Qiong; Bi, Jing-Ru

    2014-06-01

    To establish the normal reference ranges of transabdominal ultrasound measurements of the posterior fossa structure in fetuses at 11 to 13⁺⁶ gestational weeks and explore their clinical value in screening open spina bifida (OSB). Between January, 2013 and September, 541 randomly selected normal fetuses underwent nuchal translucency at the gestational age 11 to 13⁺⁶ weeks. The parameters of the posterior fossa were measured in mid-sagittal view of the fetal face and the axial view of the transverse cerebellum insonated through the anterior fontanel by transabdominal ultrasound to establish the normal reference ranges. The measurements were obtained from 3 fetuses with OSB for comparison with the reference ranges. In normal fetuses, the parameters of the posterior fossa measured in the two views showed no significant differences (P>0.05). Two high echogenic lines were observed in normal fetuses, as compared with one in fetuses with OSB representing the posterior border of the brain stem and the anterior border of the fourth ventricle. The line between the posterior border of the fourth ventricle and the anterior border of the cisterna magna was not displayed in fetuses with OSB. The anteroposterior diameters of the brain stem, the fourth ventricle, and cisterna magna all increased in positive correlation with the crown-lump length in normal fetuses. In the 3 OSB fetuses, the anteroposterior diameter of the brain stem exceeded the 95th percentile and the anteroposterior diameter of fourth ventrical-cisterner magena was below the 5th percentile of the reference range for CRL; the brain stem to fourth ventrical-cisterner magena anteroposterior diameter ratio was increased to above 1. The established normal reference ranges of the parameters of fetal posterior fossa may provide assistance in early OSB detection. The absence of the posterior border of the fourth ventricle and the anterior border of the cisterna magna and a brainstem to fourth ventrical

  13. Quantitative approach to the posterior cranial fossa and craniocervical junction in asymptomatic children with achondroplasia

    International Nuclear Information System (INIS)

    Calandrelli, Rosalinda; Panfili, Marco; D'Apolito, Gabriella; Pedicelli, Alessandro; Colosimo, Cesare; Zampino, Giuseppe; Pilato, Fabio

    2017-01-01

    We propose an magnetic resonance imaging (MRI)-based quantitative morphovolumetric approach to the posterior cranial fossa (PCF) and craniocervical junction (CCJ) changes in achondroplastic patients investigating possible associations with ventriculomegaly and medullary compression. We analyzed MRI of 13 achondroplastic children not treated by surgery. 3D FSPGR T1-weighted images were used to analyze (1) PCF synchondroses; (2) PCF volume (PCFV), PCF brain volume (PCFBV), PCFV/PCFBV ratio, cerebellar volume, cerebrospinal fluid (CSF) spaces volume, and IV ventricle volume; (3) PCF (clivus, supraocciput, exocciput lengths, tentorial angle) and CCJ (AP and LL diameters of foramen magnum (FM)) morphometry; (4) measurements of FM and jugular foramina (JF) areas; and (5) supratentorial ventricular volume. All patients showed synostosis of spheno-occipital synchondroses, eight showed synostosis of intra-occipital synchondroses, nine showed CCJ impingement on the cervical cord but only three had cervical myelopathy. Compared to controls, clivus and exocciput lengths, LL and AP diameters of FM, FM area and JF area were significantly reduced, supraocciput length, tentorial angle, PCFV, PCFBV, cerebellar volume, supratentorial ventricular system volume were significantly increased. A correlation was found between clivus length and supratentorial ventricular volume, premature closure of intra-occipital synchondroses and FM area while a trend was found between FM area and supraocciput length. Our analysis demonstrates a relationship between the shortening of the clivus and the ventriculomegaly. On the other hand the premature closure of PCF synchondroses, the shape, and the growth direction of supraocciput bone contribute to reduce the FM area, causing in some patients medullary compression. (orig.)

  14. Quantitative approach to the posterior cranial fossa and craniocervical junction in asymptomatic children with achondroplasia

    Energy Technology Data Exchange (ETDEWEB)

    Calandrelli, Rosalinda; Panfili, Marco; D' Apolito, Gabriella; Pedicelli, Alessandro; Colosimo, Cesare [Fondazione Policlinico Universitario Agostino Gemelli, Univ. Cattolica del Sacro Cuore, Area Diagnostica per Immagini, Roma (Italy); Zampino, Giuseppe [Fondazione Policlinico Universitario Agostino Gemelli, Univ. Cattolica del Sacro Cuore, Area Salute del Bambino, Roma (Italy); Pilato, Fabio [Fondazione Policlinico Universitario Agostino Gemelli, Univ. Cattolica del Sacro Cuore, Area Neuroscienze, Roma (Italy)

    2017-10-15

    We propose an magnetic resonance imaging (MRI)-based quantitative morphovolumetric approach to the posterior cranial fossa (PCF) and craniocervical junction (CCJ) changes in achondroplastic patients investigating possible associations with ventriculomegaly and medullary compression. We analyzed MRI of 13 achondroplastic children not treated by surgery. 3D FSPGR T1-weighted images were used to analyze (1) PCF synchondroses; (2) PCF volume (PCFV), PCF brain volume (PCFBV), PCFV/PCFBV ratio, cerebellar volume, cerebrospinal fluid (CSF) spaces volume, and IV ventricle volume; (3) PCF (clivus, supraocciput, exocciput lengths, tentorial angle) and CCJ (AP and LL diameters of foramen magnum (FM)) morphometry; (4) measurements of FM and jugular foramina (JF) areas; and (5) supratentorial ventricular volume. All patients showed synostosis of spheno-occipital synchondroses, eight showed synostosis of intra-occipital synchondroses, nine showed CCJ impingement on the cervical cord but only three had cervical myelopathy. Compared to controls, clivus and exocciput lengths, LL and AP diameters of FM, FM area and JF area were significantly reduced, supraocciput length, tentorial angle, PCFV, PCFBV, cerebellar volume, supratentorial ventricular system volume were significantly increased. A correlation was found between clivus length and supratentorial ventricular volume, premature closure of intra-occipital synchondroses and FM area while a trend was found between FM area and supraocciput length. Our analysis demonstrates a relationship between the shortening of the clivus and the ventriculomegaly. On the other hand the premature closure of PCF synchondroses, the shape, and the growth direction of supraocciput bone contribute to reduce the FM area, causing in some patients medullary compression. (orig.)

  15. Retrospective comparison of three-dimensional imaging sequences in the visualization of posterior fossa cranial nerves.

    Science.gov (United States)

    Ors, Suna; Inci, Ercan; Turkay, Rustu; Kokurcan, Atilla; Hocaoglu, Elif

    2017-12-01

    To compare efficancy of three-dimentional SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolutions) and CISS (constructive interference in steady state) sequences in the imaging of the cisternal segments of cranial nerves V-XII. Temporal MRI scans from 50 patients (F:M ratio, 27:23; mean age, 44.5±15.9 years) admitted to our hospital with vertigo, tinnitus, and hearing loss were retrospectively analyzed. All patients had both CISS and SPACE sequences. Quantitative analysis of SPACE and CISS sequences was performed by measuring the ventricle-to-parenchyma contrast-to-noise ratio (CNR). Qualitative analysis of differences in visualization capability, image quality, and severity of artifacts was also conducted. A score ranging 'no artefact' to 'severe artefacts and unreadable' was used for the assessment of artifacts and from 'not visualized' to 'completely visualized' for the assesment of image quality, respectively. The distribution of variables was controlled by the Kolmogorov-Smirnov test. Samples t-test and McNemar's test were used to determine statistical significance. Rates of visualization of posterior fossa cranial nerves in cases of complete visualization were as follows: nerve V (100% for both sequences), nerve VI (94% in SPACE, 86% in CISS sequences), nerves VII-VIII (100% for both sequences), IX-XI nerve complex (96%, 88%); nerve XII (58%, 46%) (p<0.05). SPACE sequences showed fewer artifacts than CISS sequences (p<0.002). Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Appearance of the fetal posterior fossa at 11 + 3 to 13 + 6 gestational weeks on transabdominal ultrasound examination.

    Science.gov (United States)

    Egle, D; Strobl, I; Weiskopf-Schwendinger, V; Grubinger, E; Kraxner, F; Mutz-Dehbalaie, I S; Strasak, A; Scheier, M

    2011-12-01

    To describe the sonographic appearance of the structures of the posterior cranial fossa in fetuses at 11 + 3 to 13 + 6 weeks of pregnancy and to determine whether abnormal findings of the brain and spine can be detected by sonography at this time. This was a prospective study including 692 fetuses whose mothers attended Innsbruck Medical University Hospital for first-trimester sonography. In 3% (n = 21) of cases, measurement was prevented by fetal position. Of the remaining 671 cases, in 604 there was either a normal anomaly scan at 20 weeks or delivery of a healthy child and in these cases the transcerebellar diameter (TCD) and the anteroposterior diameter of the cisterna magna (CM), measured at 11 + 3 to 13 + 6 weeks, were analyzed. In 502 fetuses, the anteroposterior diameter of the fourth ventricle (4V) was also measured. In 25 fetuses, intra- and interobserver repeatability was calculated. We observed a linear correlation between crown-rump length (CRL) and CM (CM = 0.0536 × CRL - 1.4701; R2 = 0.688), TCD (TCD = 0.1482 × CRL - 1.2083; R2 = 0.701) and 4V (4V = 0.0181 × CRL + 0.9186; R2 = 0.118). In three patients with posterior fossa cysts, measurements significantly exceeded the reference values. One fetus with spina bifida had an obliterated CM and the posterior border of the 4V could not be visualized. Transabdominal sonographic assessment of the posterior fossa is feasible in the first trimester. Measurements of the 4V, the CM and the TCD performed at this time are reliable. The established reference values assist in detecting fetal anomalies. However, findings must be interpreted carefully, as some supposed malformations might be merely delayed development of brain structures. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

  17. Avaliação textural por ressonância magnética dos tumores da fossa posterior em crianças Magnetic resonance imaging textural evaluation of posterior cranial fossa tumors in childhood

    Directory of Open Access Journals (Sweden)

    Joelson Alves dos Santos

    2004-08-01

    Full Text Available OBJETIVO: Possibilitar a distinção entre tecidos sãos e patológicos em pacientes da faixa etária pediátrica portadores de tumores da fossa posterior, por meio da análise de parâmetros texturais calculados a partir de imagens de ressonância magnética. MATERIAIS E MÉTODOS: Foram analisados 14 pacientes da faixa etária pediátrica, portadores de tumores da fossa posterior, através da definição dos valores texturais das regiões de interesse representando tecidos sãos e patológicos, com base em imagens de ressonância magnética pesadas em T2 pelo "software" MaZda. RESULTADOS: Houve diferença estatisticamente significativa entre os tecidos normal e tumoral, bem como entre os tecidos presumidamente normais adjacentes e distantes da lesão. Não foi possível a distinção entre edema e tumor. CONCLUSÃO: A avaliação textural por ressonância magnética é uma técnica útil para a determinação de diferenças entre diversos tipos de tecidos, inclusive entre áreas de tecidos presumidamente normais à análise visual.OBJECTIVE: To distinguish healthy from pathological tissues in pediatric patients with posterior cranial fossa tumors using calculated textural parameters from magnetic resonance images. MATERIALS AND METHODS: We evaluated 14 pediatric patients with posterior cranial fossa tumors using the software MaZda to define the texture parameters in selected regions of interest representing healthy and pathological tissues based on T2-weighted magnetic resonance images. RESULTS: There was a statistically significant difference between normal and tumoral tissues as well as between supposedly normal tissues adjacent and distant from the tumoral lesion. CONCLUSION: Magnetic resonance textural evaluation is an useful tool for determining differences among various tissues, including tissues that appear apparently normal on visual analysis.

  18. Long-term quality of life in children treated for posterior fossa brain tumors.

    Science.gov (United States)

    Kulkarni, Abhaya V; Piscione, Janine; Shams, Iffat; Bouffet, Eric

    2013-09-01

    In the face of increasing survival, quality of life (QOL) has become an important indicator of treatment success in children with posterior fossa brain tumors (PFBTs). The authors' objective was to assess the long-term QOL in survivors of PFBT. The authors conducted a cross-sectional study of children who, between birth and age 18 years at diagnosis, had previously been treated at their institution for a PFBT. At the time of assessment for this study, children were between 5 and 19 years old and had received standard treatment for PFBT ending at least 6 months before the assessment. The QOL was measured with the Pediatric Quality of Life Inventory (PedsQL) generic score scales and the Health Utilities Index Mark 3 (HUI3). Multivariate analyses were used to assess several variables (patient related, treatment related, and socioeconomic) for association with QOL. A total of 62 children participated in the study (median age at assessment 11.9 years, interquartile range [IQR] 7.8-14.8, and median age at tumor diagnosis of 4.9 years, IQR 2.5-6.9). Median time since active treatment for their PFBT was 5.2 years (IQR 2.4-10.1). Tumor types included cerebellar pilocytic astrocytoma (45.2%), medulloblastoma (30.6%), ependymoma (11.3%), and brainstem astrocytoma (11.3%). Adjuvant therapy included chemotherapy (40.3%) or radiotherapy (14.5% focal and 21.0% craniospinal radiotherapy). Permanent treatment for hydrocephalus was required in 38.7% of the patients. Tumors recurred in 11.3%, requiring repeat treatment in these patients. The median HUI3 utility score was 0.91 (IQR 0.71-1.00) and the median PedsQL total score was 78.3 (IQR 64.1-92.4). Only the following variables were significantly associated with decreased QOL in multivariable model testing (all p size, decreased family functioning, and lower family income. As a group, long-term survivors of pediatric PFBT appear to have QOL indicators that are similar to those of the general population, although a reasonable

  19. Survival of very young children with medulloblastoma (primitive neuroectodermal tumor of the posterior fossa) treated with craniospinal irradiation

    International Nuclear Information System (INIS)

    Saran, Frank H.; Driever, Pablo Herniz; Thilmann, Christoph; Mose, Stephan; Wilson, Paula; Sharpe, Geoff; Adamietz, Irenaeus A.; Boettcher, Heinz D.

    1998-01-01

    Purpose: Very young children with medulloblastoma are considered to have a worse prognosis than older children. As radiotherapy remains an important part of the treatment, the adverse prognosis could be due to inadequate radiation treatment rather than biological factors. We analyzed the published literature to examine the impact of radiotherapy on survival in this group. Methods and Materials: A Medline search was performed and we reviewed studies of treatment of medulloblastoma where radiotherapy was delivered using megavoltage equipment and the minimum follow-up allowed the calculation of 5-year survival rates. Results: Thirty-nine studies were published between 1979 and 1996 with a treatment including craniospinal irradiation and boost to the posterior fossa. Eleven studies comprising 1366 patients analyzed survival by age at diagnosis. Eight of 11 studies showed a worse 5-year survival for the younger patient group which reached statistical significance in two. There is also a suggestion of a higher proportion of children with metastatic disease at presentation in the very young age group. The usual policy in younger children was to give a lower dose of radiotherapy to the craniospinal axis (CSA) and posterior fossa (PF) with reduction of dose in the range of 15 to 25% compared to standard treatment. As dose reduction to the posterior fossa is associated with worse survival and local recurrence is the predominant site of failure, the major determinant of worse survival in very young children with medulloblastoma may be suboptimal radiotherapy. Protocols including postoperative chemotherapy with delayed, omitted, or only local tumor irradiation do not reach survival rates of protocols with standard radiotherapy, also suggesting a continued importance for irradiation. Conclusion: Very young children with medulloblastoma have a worse prognosis than older children. Inadequate radiation dose and technique to the primary tumor region may be a major contributing

  20. Extradural haematoma of the posterior fossa: a report of eight cases and a review of the literature

    International Nuclear Information System (INIS)

    Brambilla, G.; Rainoldi, F.; Gipponi, D.; Paoletti, P.

    1986-01-01

    The authors review the literature and present 8 cases of extradural haematoma of the posterior fossa operated from 1979 to 1985 at the Neurosurgical Clinic of the University of Pavia. Emphasis is placed on the importance of an early diagnosis of the symptoms which are often ignored due to the absence of specific clinical signs. The authors recognize a substantial improvement in results because of the recent introduction of CT scanning facilities which permit an early and precise diagnosis of this traumatic pathology. (Author)

  1. Patterns of failure following treatment for medulloblastoma: is it necessary to treat the entire posterior fossa?

    International Nuclear Information System (INIS)

    Fukunaga-Johnson, Nina; Lee, Jason H.; Robertson, Patricia; Sandler, Howard M.; McNeil, Elizabeth; Goldwein, Joel W.

    1997-01-01

    Purpose: Craniospinal radiation (CSRT) followed by a boost to the entire posterior fossa (PF) is standard post-operative therapy for patients with medulloblastoma. A large proportion of recurrences after treatment are local with approximately 50-70% of recurrences occurring in the PF. It is unclear, however, whether these failures are occurring in the original tumor bed, or outside the tumor bed but still within the PF. With improved diagnostic imaging, better definition of tumor volumes, and the use of 3D conformal therapy, we may be able to restrict the boost volume to the tumor bed plus a margin without compromising local control. This retrospective study analyzes the patterns of failure within the PF of a series of patients treated with radiation therapy (RT). Methods: From (7(86)) through (2(96)), 27 of 114 (24%) patients > 18 mo and < 18 yr with medulloblastoma, who were treated at the University of Michigan and Children's Hospital of Philadelphia, with RT following surgical resection were found to have a recurrence. RT consisted of CSRT followed by a boost to the entire posterior fossa. Patient's preoperative MRI and/or CT studies were used to compare the original tumor volume with the specific region of local relapse. Failure was defined as MRI or CT evidence of recurrence or positive cerebrospinal fluid cytology. Relapse was scored as local, if it was within the original tumor bed and regional, if it was outside of the tumor bed but still within the PF. Results: The median age of the patients was 8.6 years. Three patients were < 3 years old. (21(27)) had disease localized to the PF. (19(21)) patients received chemotherapy during their treatment regimen; 6 patients did not have information on systemic treatment. The median dose of RT to the craniospinal axis was 32.5 Gy and to the PF was 55.2 Gy. The median time to recurrence was 19.5 months. Local failure within the tumor bed as any component of first failure occurred in 52% ((14(27))) of all failures but

  2. Chronic subdural hematoma of the posterior fossa associated with cerebellar hemorrhage: report of rare disease with MRI findings Hematoma subdural crônico de fossa posterior associado a hemorragia cerebelar espontânea: relato de doença rara com achados de RNM

    Directory of Open Access Journals (Sweden)

    Leodante B. Costa Jr

    2004-03-01

    Full Text Available Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 year-old woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.Hematomas subdurais da fossa posterior são lesões raras, mais comumente relacionadas com traumas graves. A ocorrência de hematomas subdurais crônicos na fossa posterior é muito rara, sendo descritos 15 casos até o momento, boa parte relacionada ao uso de anticoagulantes. Em nossa revisão da literatura, não pudemos encontrar nenhum relato da associação entre hematoma subdural crônico da fossa posterior e hemorragia cerebelar espontânea. Relatamos o caso de paciente de 64 anos com hematoma intraparenquimatoso cerebelar tratado conservadoramente e hematoma subdural crônico, tratado cirurgicamente, cerca de 1 mês após o acidente vascular cerebelar.

  3. A Less Known Stroke Mimic: Posterior Reversible Encephalopathy Syndrome

    Directory of Open Access Journals (Sweden)

    Keneilwe Malomo

    2016-04-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is a clinico-neuro-radiological diagnosis, which can complicate a wide range of conditions. Clinical features include generalised and/or focal neurological deficits. These features are also present in neurovascular disorders, such as stroke. Currently, emphasis in the management of hyperacute stroke is thrombolysis, and it is important to bear in mind stroke mimics as a possible cause of clinical features. The Authors present the case of a 66-year-old man, who presented with acute focal neurological deficit. His brain imaging and history were consistent with PRES.

  4. Sagittal reconstruction computed tomography in metrizamide cisternography. Useful diagnostic procedure for malformations in craniovertebral junction and posterior fossa

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    Mochizuki, H.; Okita, N.; Fujii, T.; Yoshioka, M.; Saito, H. (Tohoku Univ., Sendai (Japan). School of Medicine)

    1982-08-01

    We studied the sagittal reconstruction technique in computed tomography with metrizamide. Ten ml of metrizamide, 170 mg iodine/ml in concentration, were injected by lumbar puncture. After diffusion of the injected metrizamide, axial computed tomograms were taken by thin slice width (5 mm) with overlapped technique. Then electrical sagittal reconstruction was carried out by optioned software. Injection of metrizamide, non-ionic water soluble contrast media, made clear contrasts among bone, brain parenchyma and cerebrospinal fluid with computed tomography. Sagittal reconstruction technique could reveal more precise details and accurate anatomical relations than ordinary axial computed tomography. This technique was applied on 3 cases (Arnold-Chiari malformation, large cisterna magna and partial agenesis cerebellar vermis), which demonstrated a useful diagnostic procedure for abnormalities of craniovertebral junction and posterior fossa. The adverse reactions of metrizamide were negligible in our series.

  5. Internal Occipital Crest Misalignment with Internal Occipital Protuberance: A Case Report of Posterior Cranial Fossa Anatomic Variations

    Science.gov (United States)

    Kim, Jae Ha

    2016-01-01

    During gross anatomy head and neck laboratory session, one dissection group observed an abnormal anatomic variation in the posterior cranial fossa of a 94-year-old male cadaver. The internal occipital crest was not aligned with internal occipital protuberance and groove for superior sagittal sinus. It seemed that the internal occipital protuberance was shifted significantly to the right side. As a result the skull was overly stretched in order to connect with the internal occipital ridge. These internal skull variations of occipital bone landmarks can influence the location of adjacent dural venous sinuses and possibly influence cerebrospinal fluid flow. Similar anatomical anomalies have been attributed to presence of hydrocephalus and abnormalities in cisterna magna. PMID:27648322

  6. Visual Attention in Posterior Stroke and Relations to Alexia

    DEFF Research Database (Denmark)

    Petersen, Anders; Vangkilde, Signe; Fabricius, Charlotte

    2016-01-01

    that reduced visual speed and span may explain pure alexia. Eight patients with unilateral PCA strokes (four left hemisphere, four right hemisphere) were selected on the basis of lesion location, rather than the presence of any visual symptoms. Visual attention was characterized by a whole report paradigm......Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere, while attentional effects of more posterior lesions are less clear. Commonly, such deficits are investigated in relation to specific syndromes like visual...... agnosia or pure alexia. The aim of this study was to characterize visual processing speed and apprehension span following posterior cerebral artery (PCA) stroke. In addition, the relationship between these attentional parameters and single word reading is investigated, as previous studies have suggested...

  7. Comparison of Porcine and Bovine Collagen Dural Substitutes in Posterior Fossa Decompression for Chiari I Malformation in Adults.

    Science.gov (United States)

    Lee, Christine K; Mokhtari, Tara; Connolly, Ian D; Li, Gordon; Shuer, Lawrence M; Chang, Steven D; Steinberg, Gary K; Hayden Gephart, Melanie

    2017-12-01

    Posterior fossa decompression surgeries for Chiari malformations are susceptible to postoperative complications such as pseudomeningocele, external cerebrospinal fluid (CSF) leak, and meningitis. Various dural substitutes have been used to improve surgical outcomes. This study examined whether the collagen matrix dural substitute type correlated with the incidence of postoperative complications after posterior fossa decompression in adult patients with Chiari I malformations. A retrospective cohort study was conducted of 81 adult patients who underwent an elective decompressive surgery for treatment of symptomatic Chiari I malformations, with duraplasty involving a dural substitute derived from either bovine or porcine collagen matrix. Demographics and treatment characteristics were correlated with surgical outcomes. A total of 81 patients were included in the study. Compared with bovine dural substitute, porcine dural substitute was associated with a significantly higher risk of pseudomeningocele occurrence (odds ratio, 5.78; 95% confidence interval, 1.65-27.15; P = 0.01) and a higher overall complication rate (odds ratio, 3.70; 95% confidence interval, 1.23-12.71; P = 0.03) by univariate analysis. There was no significant difference in the rate of meningitis, repeat operations, or overall complication rate between the 2 dural substitutes. In addition, estimated blood loss was a significant risk factor for meningitis (P = 0.03). Multivariate analyses again showed that porcine dural substitute was associated with pseudomeningocele occurrence, although the association with higher overall complication rate did not reach significance. Dural substitutes generated from porcine collagen, compared with those from bovine collagen, were associated with a higher likelihood of pseudomeningocele development in adult patients undergoing Chiari I malformation decompression and duraplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. [A Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Associated with Acute Subdural Hematoma, Extending from the Interhemispheric Space to the Posterior Fossa].

    Science.gov (United States)

    Otsuka, Hiroaki; Fukuda, Yuhtaka; Yoshimura, Shouta; Somagawa, Chika; Hiu, Takeshi; Ono, Tomonori; Ushijima, Ryujirou; Toda, Keisuke; Tsutsumi, Keisuke

    2016-06-01

    A 69-year-old woman was admitted to our hospital because of a sudden severe headache without a history of head trauma. CT and MRI revealed an acute subdural hematoma (ASDH) extending from the right interhemispheric space to the posterior fossa bilaterally, with a small amount of subarachnoid hemorrhage that was predominantly localized to the left side of the basal cistern. CT angiogram demonstrated a long protruding ruptured aneurysm at the junction of the right internal carotid and posterior communicating arteries (IC/PC AN) with a posteroinferior projection, associated with a small bleb located near the tentorial edge close to the ipsilateral posterior clinoid process, for which she received clipping surgery. Though rare, IC/PC AN could cause pure or nearly pure ASDH in the above-mentioned distribution. Therefore, in patients with such ASDH, especially without a history of head injury or precise information regarding the situation at the time of onset, urgent imaging evaluation and early intervention are essential to prevent devastating re-rupture events.

  9. Head CT: Image quality improvement of posterior fossa and radiation dose reduction with ASiR - comparative studies of CT head examinations

    International Nuclear Information System (INIS)

    Guzinski, Maciej; Waszczuk, Lukasz; Sasiadek, Marek J.

    2016-01-01

    To evaluate head CT protocol developed to improve visibility of the brainstem and cerebellum, lower bone-related artefacts in the posterior fossa and maintain patient radioprotection. A paired comparison of head CT performed without Adaptive Statistical Iterative Reconstruction (ASiR) and a clinically indicated follow-up with 40 % ASiR was acquired in one group of 55 patients. Patients were scanned in the axial mode with different scanner settings for the brain and the posterior fossa. Objective image quality analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality analysis was based on brain structure visibility and evaluation of the artefacts. We achieved 19 % reduction of total DLP and significantly better image quality of posterior fossa structures. SNR for white and grey matter in the cerebellum were 34 % to 36 % higher, respectively, CNR was improved by 142 % and subjective analyses were better for images with ASiR. When imaging parameters are set independently for the brain and the posterior fossa imaging, ASiR has a great potential to improve CT performance: image quality of the brainstem and cerebellum is improved, and radiation dose for the brain as well as total radiation dose are reduced. (orig.)

  10. Uncommon evolution of probable central nervous system histoplasmosis: from leptomeningitis to posterior fossa granuloma. A case report with magnetic resonance images

    International Nuclear Information System (INIS)

    Carrilho, Paulo Eduardo Mestrinelli; Alves, Orival

    2006-01-01

    We report a case of a young immunocompetent patient with probable central nervous system histoplasmosis with evolutive peculiar findings seen on magnetic resonance imaging. Leptomeningeal thickening was initially observed which subsequently became a posterior fossa granuloma. The diagnosis of fungal infection was only reached by histopathological study and the treatment was based on long term therapy with fluconazole wth good initial response. (author)

  11. Head CT: Image quality improvement of posterior fossa and radiation dose reduction with ASiR - comparative studies of CT head examinations

    Energy Technology Data Exchange (ETDEWEB)

    Guzinski, Maciej; Waszczuk, Lukasz; Sasiadek, Marek J. [Wroclaw Medical University, Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw (Poland)

    2016-10-15

    To evaluate head CT protocol developed to improve visibility of the brainstem and cerebellum, lower bone-related artefacts in the posterior fossa and maintain patient radioprotection. A paired comparison of head CT performed without Adaptive Statistical Iterative Reconstruction (ASiR) and a clinically indicated follow-up with 40 % ASiR was acquired in one group of 55 patients. Patients were scanned in the axial mode with different scanner settings for the brain and the posterior fossa. Objective image quality analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality analysis was based on brain structure visibility and evaluation of the artefacts. We achieved 19 % reduction of total DLP and significantly better image quality of posterior fossa structures. SNR for white and grey matter in the cerebellum were 34 % to 36 % higher, respectively, CNR was improved by 142 % and subjective analyses were better for images with ASiR. When imaging parameters are set independently for the brain and the posterior fossa imaging, ASiR has a great potential to improve CT performance: image quality of the brainstem and cerebellum is improved, and radiation dose for the brain as well as total radiation dose are reduced. (orig.)

  12. Head CT: Image quality improvement of posterior fossa and radiation dose reduction with ASiR - comparative studies of CT head examinations.

    Science.gov (United States)

    Guziński, Maciej; Waszczuk, Łukasz; Sąsiadek, Marek J

    2016-10-01

    To evaluate head CT protocol developed to improve visibility of the brainstem and cerebellum, lower bone-related artefacts in the posterior fossa and maintain patient radioprotection. A paired comparison of head CT performed without Adaptive Statistical Iterative Reconstruction (ASiR) and a clinically indicated follow-up with 40 % ASiR was acquired in one group of 55 patients. Patients were scanned in the axial mode with different scanner settings for the brain and the posterior fossa. Objective image quality analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality analysis was based on brain structure visibility and evaluation of the artefacts. We achieved 19 % reduction of total DLP and significantly better image quality of posterior fossa structures. SNR for white and grey matter in the cerebellum were 34 % to 36 % higher, respectively, CNR was improved by 142 % and subjective analyses were better for images with ASiR. When imaging parameters are set independently for the brain and the posterior fossa imaging, ASiR has a great potential to improve CT performance: image quality of the brainstem and cerebellum is improved, and radiation dose for the brain as well as total radiation dose are reduced. •With ASiR it is possible to lower radiation dose or improve image quality •Sequentional imaging allows setting scan parameters for brain and posterior-fossa independently •We improved visibility of brainstem structures and decreased radiation dose •Total radiation dose (DLP) was decreased by 19.

  13. Posterior Reversible Encephalopathy Syndrome Presenting as Stroke Mimic

    Directory of Open Access Journals (Sweden)

    Daniel Frick

    2017-05-01

    Full Text Available We present the case of a 33-year-old male with end stage renal disease presenting to the emergency department (ED with headache, dizziness, and unilateral weakness. Initial concern was for ischemic or hemorrhagic stroke. Magnetic resonance imaging confirmed posterior reversible encephalopathy syndrome (PRES. The patient was treated appropriately and made a full neurologic recovery. PRES is an under-recognized diagnosis in the ED. As a stroke mimic, PRES can lead the clinician on an incorrect diagnostic pathway with potential for iatrogenic harm.

  14. Word and face recognition deficits following posterior cerebral artery stroke

    DEFF Research Database (Denmark)

    Kuhn, Christina D.; Asperud Thomsen, Johanne; Delfi, Tzvetelina

    2016-01-01

    Abstract Recent findings have challenged the existence of category specific brain areas for perceptual processing of words and faces, suggesting the existence of a common network supporting the recognition of both. We examined the performance of patients with focal lesions in posterior cortical...... areas to investigate whether deficits in recognition of words and faces systematically co-occur as would be expected if both functions rely on a common cerebral network. Seven right-handed patients with unilateral brain damage following stroke in areas supplied by the posterior cerebral artery were...... included (four with right hemisphere damage, three with left, tested at least 1 year post stroke). We examined word and face recognition using a delayed match-to-sample paradigm using four different categories of stimuli: cropped faces, full faces, words, and cars. Reading speed and word length effects...

  15. Post-operative diffusion weighted imaging as a predictor of posterior fossa syndrome permanence in paediatric medulloblastoma.

    Science.gov (United States)

    Chua, Felicia H Z; Thien, Ady; Ng, Lee Ping; Seow, Wan Tew; Low, David C Y; Chang, Kenneth T E; Lian, Derrick W Q; Loh, Eva; Low, Sharon Y Y

    2017-03-01

    Posterior fossa syndrome (PFS) is a serious complication faced by neurosurgeons and their patients, especially in paediatric medulloblastoma patients. The uncertain aetiology of PFS, myriad of cited risk factors and therapeutic challenges make this phenomenon an elusive entity. The primary objective of this study was to identify associative factors related to the development of PFS in medulloblastoma patient post-tumour resection. This is a retrospective study based at a single institution. Patient data and all related information were collected from the hospital records, in accordance to a list of possible risk factors associated with PFS. These included pre-operative tumour volume, hydrocephalus, age, gender, extent of resection, metastasis, ventriculoperitoneal shunt insertion, post-operative meningitis and radiological changes in MRI. Additional variables included molecular and histological subtypes of each patient's medulloblastoma tumour. Statistical analysis was employed to determine evidence of each variable's significance in PFS permanence. A total of 19 patients with appropriately complete data was identified. Initial univariate analysis did not show any statistical significance. However, multivariate analysis for MRI-specific changes reported bilateral DWI restricted diffusion changes involving both right and left sides of the surgical cavity was of statistical significance for PFS permanence. The authors performed a clinical study that evaluated possible risk factors for permanent PFS in paediatric medulloblastoma patients. Analysis of collated results found that post-operative DWI restriction in bilateral regions within the surgical cavity demonstrated statistical significance as a predictor of PFS permanence-a novel finding in the current literature.

  16. Posterior fossa scintiangiography: documentation of genetic penetrance of von Hippel--Lindau syndrome in a clinically unaffected girl and her father

    International Nuclear Information System (INIS)

    Hattner, R.S.

    1975-01-01

    The syndrome of von Hippel and Lindau is a rare hereditary disorder constituted by retinal angiomata, posterior fossa and spinal cord hemangioblastomata, cystic and adenomatous dysplasia of major organs, and occasionally renal cell carcinomata. Although the syndrome is transmitted by an autosomal dominant gene, the penetrance is variable and affected persons may have any or all of the elements of the disease. The 16-year-old clinically normal daughter of a patient with the von Hippel--Lindau syndrome demonstrated a vascular posterior fossa lesion on /sup 99m/Tc-DTPA scintiangiography that failed detection in delayed images. Contrast arteriography corroborated the presence of a hemangioblastoma. Noninvasive demonstration of the genetic penetrance of this disorder offers its victims an opportunity for low morbidity early surgical cure of the associated brain lesions. (auth)

  17. Revision muduloblastoma and treatment of posterior fossa ependinoma analysis of new therapeutic strategies; Revision de tratamiento de meduloblastoma y ependinoma de fosa posterior analisis de nuevas estrategias terapeuticas

    Energy Technology Data Exchange (ETDEWEB)

    Mara, C.; Rodríguez, R.; Torres, M.; Roldán, G.; Ferreira, V. [Depto. de Oncologia del Hospital de Clínicas, Facultad de Medicina, Universidad de la Republica, Montevideo (Uruguay); Instituto Nacional de Oncología, Ministerio de Salud Pública, Montevideo (Uruguay)

    2010-12-15

    Fulltext: In general the primary tumors of S.n.c. required at some stage in their treatment, use of radiotherapy, usually as postoperative treatment or exclusively in the case that the surgery is not possible, in turn for treatment of some of these tumors association with chemotherapy has shown to be beneficial. In the case of medulloblastomas, ependymomas of the posterior fossa tumors of the choroid plexus and the pineal gland, irradiation technique that used for their particular spread is the total craniospinal irradiation. In this paper a review of the treatment techniques are performed, the overall survival and disease-free survival and complications treatments, in patients with medulloblastoma and ependymomas treated in the Department. Oncology Hospital and Clinics in INDO period of approximately 30 years. Results were compared with the international literature and analysis was performed new perspectives on the therapeutic radiation treatment (radiotherapy 3D shaped for example) and its association with chemotherapy. The results will be analyzed in Congress.

  18. Preservation of the Myofascial Cuff During Posterior Fossa Surgery to Reduce the Rate of Pseudomeningocele Formation and Cerebrospinal Fluid Leak: A Technical Note

    OpenAIRE

    Felbaum, Daniel R; Mueller, Kyle; Anaizi, Amjad; Mason, Robert B; Jean, Walter C; Voyadzis, Jean M

    2016-01-01

    Introduction:?Suboccipital craniotomy is a workhorse neurosurgical operation for approaching the posterior fossa?but carries a high risk of pseudomeningocele and cerebrospinal fluid (CSF) leak. We describe our experience with a simple T-shaped fascial opening that preserves the occipital myofascial cuff as compared to traditional methods to reduce this risk. Methods:?A single institution, retrospective review of prospectively collected database was performed of patients that underwent a suboc...

  19. Trans aqueductal, third ventricle - Cervical subarachnoid stenting: An adjuvant cerebro spinal fluid diversion procedure in midline posterior fossa tumors with hydrocephalus: The technical note and case series.

    Science.gov (United States)

    Teegala, Ramesh

    2016-01-01

    Persistent or progressive hydrocephalus is one of the complex problems of posterior fossa tumors associated with hydrocephalus. The author evaluated the effectiveness of single-stage tumor decompression associated with a stent technique (trans aqueductal third ventricle - Cervical subarachnoid stenting) as an adjuvant cerebro spinal fluid (CSF) diversion procedure in controlling the midline posterior fossa tumors with hydrocephalus. Prospective clinical case series of 15 patients was evaluated from July 2006 to April 2012. Fifteen clinicoradiological diagnosed cases of midline posterior fossa tumors with hydrocephalus were included in this study. All the tumors were approached through the cerebello medullary (telo velo tonsilar) fissure technique. Following the excision of the posterior fossa tumor, a sizable stent was placed across the aqueduct from the third ventricle to the cervical subarachnoid space. There were nine male and six female patients with an average age of 23 years. Complete tumor excision could be achieved in 12 patients and subtotal excision with clearance of aqueduct in remaining three patients. Hydrocephalus was controlled effectively in all the patients. There were no stent-related complications. This study showed the reliability of single-stage tumor excision followed by placement of aqueductal stent. The success rate of this technique is comparable to those of conventional CSF diversion procedures. This is a simple, safe, and effective procedure for the management of persistent and or progressive hydrocephalus. This technique may be very useful in situations where the patient's follow-up is compromised and the patients who are from a poor economic background. Long-term results need further evaluation to assess the overall functioning of this stent technique.

  20. RADIATION THERAPY QUALITY IN CCG/POG INTERGROUP 9961: IMPLICATIONS FOR CRANIOSPINAL IRRADIATION AND THE POSTERIOR FOSSA BOOST IN FUTURE MEDULLOBLASTOMA TRIALS

    Directory of Open Access Journals (Sweden)

    Bernadine eDonahue

    2012-12-01

    Full Text Available Purpose: Associations of RT deviations and outcomes in medulloblastoma have not been defined well, particularly in the era of reduced-dose CSI and chemotherapy. The aim of this study is to evaluate the quality of RT on CCG/POG 9961 and analyze associations of RT deviations with outcome.Methods and Materials: Major volume deviations were assessed based on the distance from specified anatomical region to field edge. We investigated associations of RT deviations with progression-free survival (PFS, overall survival (OS, and explored associations with demographics and clinical variables.Results: Of the 308 patients who were evaluable for volume deviations, 101 patients (33% did not have any. Of the remaining 207 patients, 50% had only minor deviations, 29% had only major deviations, and 21% had both minor and major deviations. Of the patients with major deviations, 73% had a single major deviation. The most common major deviation was in the cribriform plate region, followed by the posterior fossa; posterior fossa deviations resulted from treating less than whole posterior fossa. There were no significant differences in PFS or OS between patients with deviations and those without. There was no evidence of associations of deviations with patient age. Conclusions: Approximately one-third of patients had major volume deviations. There was no evidence of a significant association between these and outcome. This lack of correlation likely reflects the current high quality of radiation therapy delivered in COG institutions, our strict definition of volume deviations, and the relatively few instances of multiple major deviations in individual patients. In is noteworthy that the types of posterior fossa volume deviations observed in this study were not adversely associated with outcome. As we move forward, quality assurance will continue to play an important role to ensure that deviations on study do not influence study outcome.

  1. Uncommon evolution of probable central nervous system histoplasmosis: from leptomeningitis to posterior fossa granuloma. A case report with magnetic resonance images; Evolucao incomum de provavel histoplasmose de sistema nervoso central: de leptomeningite para granuloma da fossa posterior. Relato de caso com imagens por ressonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Carrilho, Paulo Eduardo Mestrinelli; Alves, Orival [Universidade Estadual do Oeste do Parana - UNIOESTE, Cascavel, PR (Brazil). Curso de Medicina. Disciplina de Neurologia e Neurocirurgia]. E-mail: carrilho@certto.com.br; Budant, Manfredo [UNITOM - Unidade de Diagnostico por Imagem, Cascavel, PR (Brazil). Centro de Tomografia; Bozo, Marlon K.; Meirelles, Noel [Universidade Estadual do Oeste do Parana - UNIOESTE, Cascavel, PR (Brazil). Curso de Medicina; Bueno, Alexandre Galvao [ANATOM - Instituto de Anatomia Patologica de Cascavel, PR (Brazil)

    2006-01-15

    We report a case of a young immunocompetent patient with probable central nervous system histoplasmosis with evolutive peculiar findings seen on magnetic resonance imaging. Leptomeningeal thickening was initially observed which subsequently became a posterior fossa granuloma. The diagnosis of fungal infection was only reached by histopathological study and the treatment was based on long term therapy with fluconazole wth good initial response. (author)

  2. The correlation between hematoma volume and outcome in ruptured posterior fossa arteriovenous malformations indicates the importance of surgical evacuation of hematomas.

    Science.gov (United States)

    Yilmaz, Adem; Musluman, Ahmet Murat; Kanat, Ayhan; Cavusoglu, Halit; Terzi, Yuksel; Aydin, Yunus

    2011-01-01

    The correlation between hematoma volume and outcome in ruptured arteriovenous malformations (AVM) with accompanying posterior fossa hematoma was retrospectively evaluated. Microsurgery operations were performed on 127 patients with intracranial AVM between January 1998 and January 2009 at our clinic. Fifteen (11.8%) patients were identified as suffering from posterior fossa AVM, and twelve of these patients presented with a cerebellar hematoma. All patients were clinically evaluated according to the following criteria: modified Rankin Scale (mRS) prior to surgery, Spetzler-Martin grade (SMG) of the AVMs, hematoma volume prior to surgery, and mRS following surgery. Postoperative mRS scores were significantly lower than preoperative scores (p=0.0001). Postoperative outcomes were concordant with the SMG of the AVMs (r=0.67, p=0.033), hematoma volume (r=0.537, p=0.072) and preoperative mRS scores (r=0.764, p=0.004). These analyses show that the postoperative mRS score is strongly correlated with a preoperative mRS score, hematoma volume and SMG. Posterior fossa AVMs present an increased risk for hemorrhage and for increased morbidity and mortality. Cases with hematoma should be operated on an urgent basis. We conclude that hematoma volume is a factor that impacts postoperative results and prognosis. SMG and preoperative mRS scores were also correlated with outcome.

  3. Visual attention in posterior stroke and relations to alexia.

    Science.gov (United States)

    Petersen, A; Vangkilde, S; Fabricius, C; Iversen, H K; Delfi, T S; Starrfelt, R

    2016-11-01

    Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere, while attentional effects of more posterior lesions are less clear. Commonly, such deficits are investigated in relation to specific syndromes like visual agnosia or pure alexia. The aim of this study was to characterize visual processing speed and apprehension span following posterior cerebral artery (PCA) stroke. In addition, the relationship between these attentional parameters and single word reading is investigated, as previous studies have suggested that reduced visual speed and span may explain pure alexia. Eight patients with unilateral PCA strokes (four left hemisphere, four right hemisphere) were selected on the basis of lesion location, rather than the presence of any visual symptoms. Visual attention was characterized by a whole report paradigm allowing for hemifield-specific measurements of processing speed and apprehension span. All patients showed reductions in visual span contralateral to the lesion site, and four patients showed bilateral reductions in visual span despite unilateral lesions (2L; 2R). Six patients showed selective deficits in visual span, though processing speed was unaffected in the same field (ipsi- or contralesionally). Only patients with right hemifield reductions in visual span were impaired in reading, and this could follow either right or left lateralized stroke and was irrespective of visual field impairments. In conclusion, visual span may be affected bilaterally by unilateral PCA-lesions. Reductions in visual span may also be confined to one hemifield, and may be affected in spite of preserved visual processing speed. Furthermore, reduced span in the right visual field seems to be related to reading impairment in this group, regardless of lesion lateralization. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. DTI fiber tractography of cerebro-cerebellar pathways and clinical evaluation of ataxia in childhood posterior fossa tumor survivors.

    Science.gov (United States)

    Oh, Myung Eun; Driever, Pablo Hernáiz; Khajuria, Rajiv K; Rueckriegel, Stefan Mark; Koustenis, Elisabeth; Bruhn, Harald; Thomale, Ulrich-Wilhelm

    2017-01-01

    Pediatric posterior fossa (PF) tumor survivors experience long-term motor deficits. Specific cerebrocerebellar connections may be involved in incidence and severity of motor dysfunction. We examined the relationship between long-term ataxia as well as fine motor function and alteration of differential cerebellar efferent and afferent pathways using diffusion tensor imaging (DTI) and tractography. DTI-based tractography was performed in 19 patients (10 pilocytic astrocytoma (PA) and 9 medulloblastoma patients (MB)) and 20 healthy peers. Efferent Cerebello-Thalamo-Cerebral (CTC) and afferent Cerebro-Ponto-Cerebellar (CPC) tracts were reconstructed and analyzed concerning fractional anisotropy (FA) and volumetric measurements. Clinical outcome was assessed with the International Cooperative Ataxia Rating Scale (ICARS). Kinematic parameters of fine motor function (speed, automation, variability, and pressure) were obtained by employing a digitizing graphic tablet. ICARS scores were significantly higher in MB patients than in PA patients. Poorer ICARS scores and impaired fine motor function correlated significantly with volume loss of CTC pathway in MB patients, but not in PA patients. Patients with pediatric post-operative cerebellar mutism syndrome showed higher loss of CTC pathway volume and were more atactic. CPC pathway volume was significantly reduced in PA patients, but not in MB patients. Neither relationship was observed between the CPC pathway and ICARS or fine motor function. There was no group difference of FA values between the patients and healthy peers. Reduced CTC pathway volumes in our cohorts were associated with severity of long-term ataxia and impaired fine motor function in survivors of MBs. We suggest that the CTC pathway seems to play a role in extent of ataxia and fine motor dysfunction after childhood cerebellar tumor treatment. DTI may be a useful tool to identify relevant structures of the CTC pathway and possibly avoid surgically induced long

  5. Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves.

    Science.gov (United States)

    Noble, David J; Scoffings, Daniel; Ajithkumar, Thankamma; Williams, Michael V; Jefferies, Sarah J

    2016-11-01

    There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42, 45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was -0.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

  6. High-resolution STIR for 3-T MRI of the posterior fossa: visualization of the lower cranial nerves and arteriovenous structures related to neurovascular compression.

    Science.gov (United States)

    Hiwatashi, Akio; Yoshiura, Takashi; Yamashita, Koji; Kamano, Hironori; Honda, Hiroshi

    2012-09-01

    Preoperative evaluation of small vessels without contrast material is sometimes difficult in patients with neurovascular compression disease. The purpose of this retrospective study was to evaluate whether 3D STIR MRI could simultaneously depict the lower cranial nerves--fifth through twelfth--and the blood vessels in the posterior fossa. The posterior fossae of 47 adults (26 women, 21 men) without gross pathologic changes were imaged with 3D STIR and turbo spin-echo heavily T2-weighted MRI sequences and with contrast-enhanced turbo field-echo MR angiography (MRA). Visualization of the cranial nerves on STIR images was graded on a 4-point scale and compared with visualization on T2-weighted images. Visualization of the arteries on STIR images was evaluated according to the segments in each artery and compared with that on MRA images. Visualization of the veins on STIR images was also compared with that on MRA images. Statistical analysis was performed with the Mann-Whitney U test. There were no significant differences between STIR and T2-weighted images with respect to visualization of the cranial nerves (p > 0.05). Identified on STIR and MRA images were 94 superior cerebellar arteries, 81 anteroinferior cerebellar arteries, and 79 posteroinferior cerebellar arteries. All veins evaluated were seen on STIR and MRA images. There were no significant differences between STIR and MRA images with respect to visualization of arteries and veins (p > 0.05). High-resolution STIR is a feasible method for simultaneous evaluation of the lower cranial nerves and the vessels in the posterior fossa without the use of contrast material.

  7. Predicting functional outcomes of posterior circulation acute ischemic stroke in first 36 h of stroke onset.

    Science.gov (United States)

    Lin, Sheng-Feng; Chen, Chin-I; Hu, Han-Hwa; Bai, Chyi-Huey

    2018-04-01

    Posterior circulation acute ischemic stroke constitutes one-fourth of all ischemic strokes and can be efficiently quantified using the posterior circulation Alberta stroke program early computed tomography score (PC-ASPECTS) through diffusion-weighted imaging. We investigated whether the PC-ASPECTS and National Institutes of Health Stroke Scale (NIHSS) facilitate functional outcome prediction among Chinese patients with posterior circulation acute ischemic stroke. Participants were selected from our prospective stroke registry from January 1, 2015, to December 31, 2016. The baseline NIHSS score was assessed on the first day of admission, and brain magnetic resonance imaging was performed within 36 h after stroke onset. Simple and multiple logistic regressions were conducted to determine stroke risk factors and the PC-ASPECTS. Receiver operating characteristics (ROC) curve analysis was performed to compare the NIHSS and PC-ASPECTS. Of 549 patients from our prospective stroke admission registry database, 125 (22.8%) had a diagnosis of posterior circulation acute ischemic stroke. The optimal cutoff for the PC-ASPECTS in predicting outcomes was 7. The odds ratios of the PC-ASPECTS (≤ 7 vs > 7) in predicting outcomes were 6.33 (p = 0.0002) and 8.49 (p = 0.0060) in the univariate and multivariate models, respectively, and 7.52 (p = 0.0041) in the aging group. On ROC curve analysis, the PC-ASPECTS demonstrated more reliability than the baseline NIHSS for predicting functional outcomes of minor posterior circulation stroke. In conclusion, both the PC-ASPECTS and NIHSS help clinicians predict functional outcomes. PC-ASPECTS > 7 is a helpful discriminator for achieving favorable functional outcome prediction in posterior circulation acute ischemic stroke.

  8. Balancing the shortcomings of microscope and endoscope: endoscope-assisted technique in microsurgical removal of recurrent epidermoid cysts in the posterior fossa.

    Science.gov (United States)

    Ebner, F H; Roser, F; Thaher, F; Schittenhelm, J; Tatagiba, M

    2010-10-01

    We report about endoscope-assisted surgery of epidermoid cysts in the posterior fossa focusing on the application of neuro-endoscopy and the clinical outcome in cases of recurrent epidermoid cysts. 25 consecutively operated patients with an epidermoid cyst in the posterior fossa were retrospectively analysed. Surgeries were performed both with an operating microscope (OPMI Pentero or NC 4, Zeiss Company, Oberkochen, Germany) and endoscopic equipment (4 mm rigid endoscopes with 30° and 70° optics; Karl Storz Company, Tuttlingen, Germany) under continuous intraoperative monitoring. Surgical reports and DVD-recordings were evaluated for identification of adhesion areas and surgical details. 7 (28%) of the 25 patients were recurrences of previously operated epidermoid cysts. Mean time to recurrence was 17 years (8-22 years). In 5 cases the endoscope was used as an adjunctive tool for inspection/endoscope-assisted removal of remnants. The effective time of use of the endoscope was limited to the end stage of the procedure, but was very effective. In a modern operative setting and with the necessary surgical experience recurrent epidermoid cysts may be removed with excellent clinical results. The combined use of microscope and endoscope offers relevant advantages in demanding anatomic situations. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Impairment of intellectual functions after surgery and posterior fossa irradiation in children with ependymoma is related to age and neurologic complications

    International Nuclear Information System (INIS)

    Hoff, Katja von; Kieffer, Virginie; Habrand, Jean-Louis; Kalifa, Chantal; Dellatolas, Georges; Grill, Jacques

    2008-01-01

    To investigate the neuropsychological outcome of children treated with surgery and posterior fossa irradiation for localized infratentorial ependymoma. 23 patients (age 0.3 – 14 years at diagnosis) who were treated with local posterior fossa irradiation (54 Gy) underwent one (4 patients) or sequential (19 patients) neuropsychologic evaluation. The last evaluation was performed at a median of 4.5 (1 to 15.5) years after RT. Mean last full scale IQ (FSIQ), verbal IQ (VIQ) and PIQ were 89.1, 94.0, and 86.2 respectively. All patients had difficulties with reading, and individual patients showed deficits in visuospatial, memory and attentional tasks. There was no trend for deterioration of intellectual outcome over time. All 5 children with IQ scores ≤ 75 were under the age of four at diagnosis. There was a significant association between the presence of cerebellar deficits and impaired IQ (72.0 vs 95.2, p < 0,001). The absence of hydrocephalus was an indicator of better neuropsychologic outcome (mean FSIQ of 102.6 vs 83.9, p = 0.025). Within the evaluated cohort, intellectual functions were moderately impaired. Markedly reduced IQ scores were only seen with early disease manifestation and treatment, and postoperative neurological deficits had a strong impact on intellectual outcome

  10. Impairment of intellectual functions after surgery and posterior fossa irradiation in children with ependymoma is related to age and neurologic complications

    Directory of Open Access Journals (Sweden)

    Kalifa Chantal

    2008-01-01

    Full Text Available Abstract Background To investigate the neuropsychological outcome of children treated with surgery and posterior fossa irradiation for localized infratentorial ependymoma. Methods 23 patients (age 0.3 – 14 years at diagnosis who were treated with local posterior fossa irradiation (54 Gy underwent one (4 patients or sequential (19 patients neuropsychologic evaluation. The last evaluation was performed at a median of 4.5 (1 to 15.5 years after RT. Results Mean last full scale IQ (FSIQ, verbal IQ (VIQ and PIQ were 89.1, 94.0, and 86.2 respectively. All patients had difficulties with reading, and individual patients showed deficits in visuospatial, memory and attentional tasks. There was no trend for deterioration of intellectual outcome over time. All 5 children with IQ scores ≤ 75 were under the age of four at diagnosis. There was a significant association between the presence of cerebellar deficits and impaired IQ (72.0 vs 95.2, p Conclusion Within the evaluated cohort, intellectual functions were moderately impaired. Markedly reduced IQ scores were only seen with early disease manifestation and treatment, and postoperative neurological deficits had a strong impact on intellectual outcome.

  11. Preservation of the Myofascial Cuff During Posterior Fossa Surgery to Reduce the Rate of Pseudomeningocele Formation and Cerebrospinal Fluid Leak: A Technical Note.

    Science.gov (United States)

    Felbaum, Daniel R; Mueller, Kyle; Anaizi, Amjad; Mason, Robert B; Jean, Walter C; Voyadzis, Jean M

    2016-12-28

     Suboccipital craniotomy is a workhorse neurosurgical operation for approaching the posterior fossa but carries a high risk of pseudomeningocele and cerebrospinal fluid (CSF) leak. We describe our experience with a simple T-shaped fascial opening that preserves the occipital myofascial cuff as compared to traditional methods to reduce this risk.  A single institution, retrospective review of prospectively collected database was performed of patients that underwent a suboccipital craniectomy or craniotomy. Patient data was reviewed for craniotomy or craniectomy, dural graft, and/or sealant use as well as CSF complications. A pseudomeningocele was defined as a subcutaneous collection of cerebrospinal fluid palpable clinically and confirmed on imaging. A CSF leak was defined as a CSF-cutaneous fistula manifested by CSF leaking through the wound. All patients underwent regular postoperative visits of two weeks, one month, and three months.  Our retrospective review identified 33 patients matching the inclusion criteria. Overall, our cohort had a 21% (7/33) rate of clinical and radiographic pseudomeningocele formation with 9% (3/33) requiring surgical revision or a separate procedure. The rate of clinical and radiographic pseudomeningocele formation in the myofascial cuff preservation technique was less than standard techniques (12% and 31%, respectively). Revision or further surgical procedures were also reduced in the myofascial cuff preservation technique vs. the standard technique (6% vs 13%).  Preservation of the myofascial cuff during posterior fossa surgery is a simple and adoptable technique that reduces the rate of pseudomeningocele formation and CSF leak as compared with standard techniques.

  12. Immunohistochemical analysis of H3K27me3 demonstrates global reduction in group-A childhood posterior fossa ependymoma and is a powerful predictor of outcome.

    Science.gov (United States)

    Panwalkar, Pooja; Clark, Jonathan; Ramaswamy, Vijay; Hawes, Debra; Yang, Fusheng; Dunham, Christopher; Yip, Stephen; Hukin, Juliette; Sun, Yilun; Schipper, Matthew J; Chavez, Lukas; Margol, Ashley; Pekmezci, Melike; Chung, Chan; Banda, Adam; Bayliss, Jill M; Curry, Sarah J; Santi, Mariarita; Rodriguez, Fausto J; Snuderl, Matija; Karajannis, Matthias A; Saratsis, Amanda M; Horbinski, Craig M; Carret, Anne-Sophie; Wilson, Beverly; Johnston, Donna; Lafay-Cousin, Lucie; Zelcer, Shayna; Eisenstat, David; Silva, Marianna; Scheinemann, Katrin; Jabado, Nada; McNeely, P Daniel; Kool, Marcel; Pfister, Stefan M; Taylor, Michael D; Hawkins, Cynthia; Korshunov, Andrey; Judkins, Alexander R; Venneti, Sriram

    2017-11-01

    Posterior fossa ependymomas (EPN_PF) in children comprise two morphologically identical, but biologically distinct tumor entities. Group-A (EPN_PFA) tumors have a poor prognosis and require intensive therapy. In contrast, group-B tumors (EPN_PFB) exhibit excellent prognosis and the current consensus opinion recommends future clinical trials to test the possibility of treatment de-escalation in these patients. Therefore, distinguishing these two tumor subtypes is critical. EPN_PFA and EPN_PFB can be distinguished based on DNA methylation signatures, but these assays are not routinely available. We have previously shown that a subset of poorly prognostic childhood EPN_PF exhibits global reduction in H3K27me3. Therefore, we set out to determine whether a simple immunohistochemical assay for H3K27me3 could be used to segregate EPN_PFA from EPN_PFB tumors. We assembled a cohort of 230 childhood ependymomas and H3K27me3 immunohistochemistry was assessed as positive or negative in a blinded manner. H3K27me3 staining results were compared with DNA methylation-based subgroup information available in 112 samples [EPN_PFA (n = 72) and EPN_PFB tumors (n = 40)]. H3K27me3 staining was globally reduced in EPN_PFA tumors and immunohistochemistry showed 99% sensitivity and 100% specificity in segregating EPN_PFA from EPN_PFB tumors. Moreover, H3K27me3 immunostaining was sufficient to delineate patients with worse prognosis in two independent, non-overlapping cohorts (n = 133 and n = 97). In conclusion, immunohistochemical evaluation of H3K27me3 global reduction is an economic, easily available and readily adaptable method for defining high-risk EPN_PFA from low-risk posterior fossa EPN_PFB tumors to inform prognosis and to enable the design of future clinical trials.

  13. Human Foramen Magnum Area and Posterior Cranial Fossa Volume Growth in Relation to Cranial Base Synchondrosis Closure in the Course of Child Development.

    Science.gov (United States)

    Coll, Guillaume; Lemaire, Jean-Jacques; Di Rocco, Federico; Barthélémy, Isabelle; Garcier, Jean-Marc; De Schlichting, Emmanuel; Sakka, Laurent

    2016-11-01

    To date, no study has compared the evolution of the foramen magnum area (FMA) and the posterior cranial fossa volume (PCFV) with the degree of cranial base synchondrosis ossification. To illustrate these features in healthy children. The FMA, the PCFV, and the ossification of 12 synchondroses according to the Madeline and Elster scale were retrospectively analyzed in 235 healthy children using millimeter slices on a computed tomography scan. The mean FMA of 6.49 cm in girls was significantly inferior to the FMA of 7.67 cm in boys (P < .001). In both sexes, the growth evolved in a 2-phase process, with a phase of rapid growth from birth to 3.75 years old (yo) followed by a phase of stabilization. In girls, the first phase was shorter (ending at 2.6 yo) than in boys (ending at 4.33 yo) and proceeded at a higher rate. PCFV was smaller in girls (P < .001) and displayed a biphasic pattern in the whole population, with a phase of rapid growth from birth to 3.58 yo followed by a phase of slow growth until 16 yo. In girls, the first phase was more active and shorter (ending at 2.67 yo) than in boys (ending at 4.5 yo). The posterior interoccipital synchondroses close first, followed by the anterior interoccipital and occipitomastoidal synchondroses, the lambdoid sutures simultaneously, then the petro-occipital and spheno-occipital synchondroses simultaneously. The data provide a chronology of synchondrosis closure. We showed that FMA and PCFV are constitutionally smaller in girls at birth (P ≤ .02) and suggest that a sex-related difference in the FMA is related to earlier closure of anterior interoccipital synchondroses in girls (P = .01). AIOS, anterior interoccipital synchondrosesFMA, foramen magnum areaLS, lambdoid suturesOMS, occipitomastoidal synchondrosesPCFV, posterior cranial fossa volumePIOS, posterior interoccipital synchondrosesPOS, petro-occipital synchondrosesSOS, spheno-occipital synchondrosisyo, years old.

  14. Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome

    Directory of Open Access Journals (Sweden)

    Lukman Femi Owolabi

    2016-01-01

    Full Text Available Background: Posterior circulation stroke (PCS, though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. Objective: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. Materials and Methods: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. Results: Posterior circulation ischemic stroke accounted for 57 (9.6% of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7 and 13 females (mean age 46.3 ± 13.7. Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7. However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9% patients. Hypertension was the most common risk factor (86%. Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7% patients had an ischemic stroke. Twenty-one (36.8% of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. Conclusions: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke.

  15. Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke.

    Science.gov (United States)

    Sporns, Peter; Schmidt, Rene; Minnerup, Jens; Dziewas, Rainer; Kemmling, André; Dittrich, Ralf; Zoubi, Tarek; Heermann, Philipp; Cnyrim, Christian; Schwindt, Wolfram; Heindel, Walter; Niederstadt, Thomas; Hanning, Uta

    2016-01-01

    Computed tomography perfusion (CTP) has a high diagnostic value in the detection of acute ischemic stroke in the anterior circulation. However, the diagnostic value in suspected posterior circulation (PC) stroke is uncertain, and whole brain volume perfusion is not yet in widespread use. We therefore studied the additional value of whole brain volume perfusion to non-contrast CT (NCCT) and CT angiography source images (CTA-SI) for infarct detection in patients with suspected acute ischemic PC stroke. This is a retrospective review of patients with suspected stroke in the PC in a database of our stroke center (n = 3,011) who underwent NCCT, CTA and CTP within 9 h after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and pc-ASPECTS locations of ischemia. Three imaging models - A (NCCT), B (NCCT + CTA-SI) and C (NCCT + CTA-SI + CTP) - were compared with regard to the misclassification rate relative to gold standard (infarction in follow-up imaging) using the McNemar's test. Of 3,011 stroke patients, 267 patients had a suspected stroke in the PC and 188 patients (70.4%) evidenced a PC infarct on follow-up imaging. The sensitivity of Model C (76.6%) was higher compared with that of Model A (21.3%) and Model B (43.6%). CTP detected significantly more ischemic lesions, especially in the cerebellum, posterior cerebral artery territory and thalami. Our findings in a large cohort of consecutive patients show that CTP detects significantly more ischemic strokes in the PC than CTA and NCCT alone. © 2016 S. Karger AG, Basel.

  16. Posterior superior temporal sulcus responses predict perceived pleasantness of skin stroking

    Directory of Open Access Journals (Sweden)

    Monika Davidovic

    2016-09-01

    Full Text Available Love and affection is expressed through a range of physically intimate gestures, including caresses. Recent studies suggest that posterior temporal lobe areas typically associated with visual processing of social cues also respond to interpersonal touch. Here, we asked whether these areas are selective to caress-like skin stroking. We collected functional magnetic resonance imaging (fMRI data from 23 healthy participants and compared brain responses to skin stroking and vibration. We did not find any significant differences between stroking and vibration in the posterior temporal lobe; however, right posterior superior temporal sulcus (pSTS responses predicted healthy participant's perceived pleasantness of skin stroking, but not vibration. These findings link right pSTS responses to individual variability in perceived pleasantness of caress-like tactile stimuli. We speculate that the right pSTS may play a role in the translation of tactile stimuli into positively valenced, socially relevant interpersonal touch and that this system may be affected in disorders associated with impaired attachment.

  17. Primary extraparenchymal hemorrhage of the posterior cranal fossa as a premonitory symptom of atlanto-axial instability; Traumatische extraparenchymale Blutung der hinteren Schaedelgrube als Warnsymptom einer atlantoaxialen Instabilitaet

    Energy Technology Data Exchange (ETDEWEB)

    Holl, K.; Rolli, K.; Olschowski, A.; Wurm, G. [Neurochirurgische Abt., Landesnervenklinik Linz (Austria); Nussbaumer, K. [Neuroradiologische Abt., Landesnervenklinik Linz (Austria)

    2001-07-01

    The contribution discusses the cases of five patients with cranio-cerebral trauma, (four children and one adult patient), where CT examination revealed extraparenchymal hemorrhage of the posterior cranal fossa, which did not fit into their pattern of intracranial trauma and therefore gave reason to suspect a lesion of the upper cervical spine. The various types of hemorrhage found are explained, as well as the underlying cervical spine lesions, and the choice of respective therapies which proved to be successful. (orig./CB) [German] Wir berichten ueber fuenf Patienten nach Schaedel-Hirn-Trauma, deren gemeinsamer Befund in der kraniellen Computertomographie eine extraparenchymale Blutung der hinteren Schaedelgrube (HSG) ohne Zusammenhang mit dem uebrigen intrakraniellen Verletzungsmuster bzw. ohne sonstige intrakranielle Verletzung war. Es handelte sich um vier Kinder und einen Erwachsenen mit einem Durchschnittsalter von 8,8 (4-22) Jahren. Drei dieser Patienten wiesen eine epidurale Blutung am Clivus bzw. am Foramen magnum auf, bei einem Patienten handelte es sich um eine Subarachnoidalblutung um das Cerebellum, bei einem weiteren Patienten lag eine Blutung im IV. Ventrikel vor. Diese infratentoriellen Blutungen waren der erste Hinweis, dass eine Verletzung in der oberen Halswirbelsaeule (HWS) vorliegen koennte. Es wurde bei den vier Kindern als zugrundeliegende Ursache der Blutung eine ligamentaere Verletzung C1/C2 diagnostiziert, nur bei dem erwachsenen Patienten lag eine knoecherne Verletzung C1/C2 vor. Die Therapie erfolgte in den vier Faellen mit Instabilitaet chirurgisch, bei dem Patienten ohne Instabilitaet konservativ. Nach einem mittleren Nachbeobachtungszeitraum von 5,2 Jahren waren alle operierten Patienten klinisch gebessert bzw. weiterhin neurologisch unauffaellig. Es konnte bei allen Patienten eine stabile Situation C1/C2 bei guter Funktionalitaet der HWS nachgewiesen werden. (orig.)

  18. A prospective study on fetal posterior cranial fossa assessment for early detection of open spina bifida at 11-13 weeks.

    Science.gov (United States)

    Kose, Semir; Altunyurt, Sabahattin; Keskinoglu, Pembe

    2018-01-01

    The objective of this study was to test three measurements: brain stem (BS), intracranial translucency (IT) and brain stem to occipital bone distance (BSOB), as well as one landmark: cisterna magna (CM) visibility, for early diagnosis of open spina bifida (OSB) in a low risk population. A prospective observational study was undertaken in a university hospital. A sample of 1479 women consented to participate between 20 September 2013 and 30 June 2015. Measurements were performed from the mid-sagittal view, as is routinely used for nuchal thickness assessment. CM visibility was assessed qualitatively as the third anechoic band in the posterior cranial fossa (PCF). All pregnancies were screened with a combination of maternal serum alpha-fetoprotein and second trimester anomaly scan and followed until delivery. Predictive values were calculated for each marker. We were able to diagnose two OSB cases and highly suspect one Dandy-Walker malformation case at the first trimester scan by the observation of PCF. PCF characteristics of OSB cases were increased BS diameter, increased BS-BSOB ratio and non-visualization of the CM. All the markers demonstrated high sensitivity and specificity but CM visibility reached the highest positive predictive value. Due to relatively high false positive rates, PCF measurements could not reach a satisfactory performance to validate their clinical use as a single marker. CM visibility has the advantage of being a qualitative marker and reduces the need for sophisticated and time-consuming measurements. Intracranial translucency and BS-BSOB ratio measurements should be used when the CM visibility is absent or in doubt. © 2017 Japanese Teratology Society.

  19. Posterior circulation ischemic stroke-clinical characteristics, risk factors, and subtypes in a north Indian population: a prospective study.

    Science.gov (United States)

    Mehndiratta, Manmohan; Pandey, Sanjay; Nayak, Rajeev; Alam, Anwar

    2012-04-01

    Posterior circulation stroke accounts for approximately 20% of all strokes with varied clinical presentation, which differ from strokes in anterior circulation, with reference to etiology, clinical features, and prognosis. Short penetrating and circumferential branches in the posterior circulation supply the brain stem, thalamus, cerebellum, occipital, and medial temporal lobes. We prospectively analyzed 80 participants of posterior circulation ischemic stroke from a registry of 944 participants attending a tertiary care referral university hospital. Patients were analyzed for demographics, stroke risk factors, clinical characteristics, neuroimaging, and stroke subtypes. Posterior circulation ischemic stroke accounted for 80 (8.5%) of 944 of all strokes and 80 (10.45%) of 765 of ischemic stroke. Sixty-three were males with mean age 51.7 ± 14.4 years. Twenty-one participants were young (defined as age less than 45 years). Hypertension was found to be the most common risk factor (63.75%). Vertigo was the most common clinical symptom reported in 45 (56.25%) cases. Sixty-eight (85%) patients had large artery disease, 8 (10%) had documented cardioembolic source, 3 (3.75%) small artery disease, and 2 (2.5%) vasculitis. Posterior cerebral artery was most commonly involved. Topographically distal intracranial involvement was most frequent (66.25%) followed by proximal (30%) and middle intracranial territory (3.75%). Our study demonatrated the occurrence of posterior circulation stroke in relatively younger age group compared to the Western world. We also found higher percentage of large artery disease, while cardioembolism as a less frequent cause of posterior circulation ischemic stroke in North Indian population. Distal territory involvement was most common in our study.

  20. SU-F-T-208: An Efficient Planning Approach to Posterior Fossa Tumor Bed Boosts Using Proton Pencil Beam Scanning in Fixed-Beam Room

    International Nuclear Information System (INIS)

    Ju, N; Chen, C; Gans, S; Hug, E; Cahlon, O; Chon, B; Tsai, H; Sine, K; Mah, D; Wolden, S; Yeh, B

    2016-01-01

    Purpose: A fixed-beam room could be underutilized in a multi-room proton center. We investigated the use of proton pencil beam scanning (PBS) on a fixed-beam as an alternative for posterior fossa tumor bed (PF-TB) boost treatments which were usually treating on a gantry with uniform scanning. Methods: Five patients were treated with craniospinal irradiation (CSI, 23.4 or 36.0 Gy(RBE)) followed by a PF-TB boost to 54 Gy(RBE) with proton beams. Three PF-TB boost plans were generated for each patient: (1) a uniform scanning (US) gantry plan with 4–7 posterior fields shaped with apertures and compensators (2) a PBS plan using bi-lateral and vertex fields with a 3-mm planning organ-at-risk volume (PRV) expansion around the brainstem and (3) PBS fields using same beam arrangement but replacing the PRV with robust optimization considering a 3-mm setup uncertainty. Results: A concave 54-Gy(RBE) isodose line surrounding the brainstem could be achieved using all three techniques. The mean V95% of the PTV was 99.7% (range: 97.6% to 100%) while the V100% of the PTV ranged from 56.3% to 93.1% depending on the involvement of the brainstem with the PTV. The mean doses received by 0.05 cm"3 of the brainstem were effectively identical: 54.0 Gy(RBE), 53.4 Gy(RBE) and 53.3 Gy(RBE) for US, PBS optimized with PRV, and PBS optimized with robustness plans respectively. The cochlea mean dose increased by 23% of the prescribed boost dose in average from the bi-lateral fields used in the PBS plan. Planning time for the PBS plan with PRV was 5–10 times less than the US plan and the robustly optimized PBS plan. Conclusion: We have demonstrated that a fixed-beam with PBS can deliver a dose distribution comparable to a gantry plan using uniform scanning. Planning time can be reduced substantially using a PRV around the brainstem instead of robust optimization.

  1. SU-F-T-208: An Efficient Planning Approach to Posterior Fossa Tumor Bed Boosts Using Proton Pencil Beam Scanning in Fixed-Beam Room

    Energy Technology Data Exchange (ETDEWEB)

    Ju, N; Chen, C; Gans, S; Hug, E; Cahlon, O; Chon, B; Tsai, H; Sine, K; Mah, D [Procure Treatment Center, Somerset, New Jersey (United States); Wolden, S [Memorial Sloan Kettering Cancer Center, New York, NY (United States); Yeh, B [Mount Sinai Hospital, New York, NY (United States)

    2016-06-15

    Purpose: A fixed-beam room could be underutilized in a multi-room proton center. We investigated the use of proton pencil beam scanning (PBS) on a fixed-beam as an alternative for posterior fossa tumor bed (PF-TB) boost treatments which were usually treating on a gantry with uniform scanning. Methods: Five patients were treated with craniospinal irradiation (CSI, 23.4 or 36.0 Gy(RBE)) followed by a PF-TB boost to 54 Gy(RBE) with proton beams. Three PF-TB boost plans were generated for each patient: (1) a uniform scanning (US) gantry plan with 4–7 posterior fields shaped with apertures and compensators (2) a PBS plan using bi-lateral and vertex fields with a 3-mm planning organ-at-risk volume (PRV) expansion around the brainstem and (3) PBS fields using same beam arrangement but replacing the PRV with robust optimization considering a 3-mm setup uncertainty. Results: A concave 54-Gy(RBE) isodose line surrounding the brainstem could be achieved using all three techniques. The mean V95% of the PTV was 99.7% (range: 97.6% to 100%) while the V100% of the PTV ranged from 56.3% to 93.1% depending on the involvement of the brainstem with the PTV. The mean doses received by 0.05 cm{sup 3} of the brainstem were effectively identical: 54.0 Gy(RBE), 53.4 Gy(RBE) and 53.3 Gy(RBE) for US, PBS optimized with PRV, and PBS optimized with robustness plans respectively. The cochlea mean dose increased by 23% of the prescribed boost dose in average from the bi-lateral fields used in the PBS plan. Planning time for the PBS plan with PRV was 5–10 times less than the US plan and the robustly optimized PBS plan. Conclusion: We have demonstrated that a fixed-beam with PBS can deliver a dose distribution comparable to a gantry plan using uniform scanning. Planning time can be reduced substantially using a PRV around the brainstem instead of robust optimization.

  2. Validation of the DRAGON score in 12 stroke centers in anterior and posterior circulation.

    Science.gov (United States)

    Strbian, Daniel; Seiffge, David J; Breuer, Lorenz; Numminen, Heikki; Michel, Patrik; Meretoja, Atte; Coote, Skye; Bordet, Régis; Obach, Victor; Weder, Bruno; Jung, Simon; Caso, Valeria; Curtze, Sami; Ollikainen, Jyrki; Lyrer, Philippe A; Eskandari, Ashraf; Mattle, Heinrich P; Chamorro, Angel; Leys, Didier; Bladin, Christopher; Davis, Stephen M; Köhrmann, Martin; Engelter, Stefan T; Tatlisumak, Turgut

    2013-10-01

    The DRAGON score predicts functional outcome in the hyperacute phase of intravenous thrombolysis treatment of ischemic stroke patients. We aimed to validate the score in a large multicenter cohort in anterior and posterior circulation. Prospectively collected data of consecutive ischemic stroke patients who received intravenous thrombolysis in 12 stroke centers were merged (n=5471). We excluded patients lacking data necessary to calculate the score and patients with missing 3-month modified Rankin scale scores. The final cohort comprised 4519 eligible patients. We assessed the performance of the DRAGON score with area under the receiver operating characteristic curve in the whole cohort for both good (modified Rankin scale score, 0-2) and miserable (modified Rankin scale score, 5-6) outcomes. Area under the receiver operating characteristic curve was 0.84 (0.82-0.85) for miserable outcome and 0.82 (0.80-0.83) for good outcome. Proportions of patients with good outcome were 96%, 93%, 78%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 2%, 4%, 89%, and 97% for 0 to 1, 2, 3, 8, and 9 to 10 points, respectively. When tested separately for anterior and posterior circulation, there was no difference in performance (P=0.55); areas under the receiver operating characteristic curve were 0.84 (0.83-0.86) and 0.82 (0.78-0.87), respectively. No sex-related difference in performance was observed (P=0.25). The DRAGON score showed very good performance in the large merged cohort in both anterior and posterior circulation strokes. The DRAGON score provides rapid estimation of patient prognosis and supports clinical decision-making in the hyperacute phase of stroke care (eg, when invasive add-on strategies are considered).

  3. Hyperdense basilar artery sign diagnoses acute posterior circulation stroke and predicts short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Xiaoping [Affiliated Hospital of China Medical University at Shenyang, Department of Neurology, Shengjing Hospital, Shenyang (China); Guo, Yang [Shengjing Hospital, Department of Neurology, Shenyang (China)

    2010-12-15

    It is well established that the hyperdense middle cerebral artery sign is a specific marker for early ischemia in anterior circulation. However, little is known about the hyperdense basilar artery sign (HDBA) in posterior circulation. Our aim was to determine whether the HDBA sign has utility in early diagnosis of acute posterior circulation stroke and prediction of short-term outcome. Three-blinded readers examined unenhanced computed tomography scans for the HDBA sign, and materials were classified into two groups according to this sign. Vascular risk factors, admission and discharge National Institute of Health Stroke Scale (NIHSS) scores, short-term outcome, and radiological findings between the two groups were compared. One hundred and twenty-six cases of acute posterior circulation stroke (PCS) were included in the study. No statistically significant differences were found in risk factors of ischemic stroke, except atrial fibrillation (P = 0.025). Admission and discharge NIHSS scores for the positive HDBA group were significantly higher than scores for the negative HDBA group (P = 0.001, 0.002, respectively). The infarction territory for the positive HDBA group was mainly multi-region in nature (51.6%, P < 0.001), while the negative HDBA group showed mainly middle territory infarction. Significant independent predictors of short-term outcome included the HDBA sign (P < 0.001) and admission NIHSS scores (P < 0.001). Approximately half of the HDBA patients showed multi-region infarction and a serious neurological symptom. Based on our results, this sign might not only be helpful in early diagnosis of acute PCS but also be able to correlate with a poor short-term outcome. (orig.)

  4. Vertebral Artery Hypoplasia and Posterior Circulation Infarction in Patients with Isolated Vertigo with Stroke Risk Factors.

    Science.gov (United States)

    Zhang, Dao Pei; Lu, Gui Feng; Zhang, Jie Wen; Zhang, Shu Ling; Ma, Qian Kun; Yin, Suo

    2017-02-01

    We aimed in this study to investigate the prevalence of vertebral artery hypoplasia (VAH) in a population with isolated vertigo in association with stroke risk factors, to determine whether VAH is an independent risk factor for posterior circulation infarction (PCI). We sequentially enrolled 245 patients with isolated vertigo with at least 1 vascular risk factor, who were divided into PCI and non-PCI groups, according to present signs of acute infarction on diffusion-weighted magnetic resonance imaging. All patients underwent magnetic resonance angiography and cervical contrast-enhanced magnetic resonance angiography to screen for VAH. Univariate and multivariate logistic regression analyses were performed to identify the significant risk factors for PCI. VAH was found in 64 of 245 patients (26%). VAH (odds ratio [OR] = 2.70, 95%confidence interval [CI] 1.17-6.23, P = .020), median stenosis of the posterior circulation (OR = 7.09, 95%CI = 2.54-19.79, P vertigo with PCI complicated by VAH was mainly small-artery occlusion. Our findings suggest that VAH is an independent risk factor for PCI in patients with isolated vertigo with confirmed risk from stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Posterior reversible encephalopathy syndrome mimicking a left middle cerebral artery stroke.

    Science.gov (United States)

    Terranova, Santo; Kumar, Jai Dev; Libman, Richard B

    2012-01-01

    Certain Acute Clinical presentations are highly suggestive of stroke caused by specific mechanisms. One example of this would be the sudden onset of aphasia without hemiparesis often reflecting cerebral embolism, frequently from a cardiac source. Posterior reversible encephalopathy syndrome (PRES) describes a usually reversible neurologic syndrome with a variety of presenting symptoms from headache, altered mental status, seizures, vomiting, diminished spontaneity and speech, abnormalities of visual perception and visual loss. We report a patient presenting with elevated blood pressure, CT characteristics of PRES but a highly circumscribed neurologic syndrome (Wernicke's Aphasia without hemiparesis) suggestive of a cardioembolic stroke affecting the left MCA territory. That is, PRES mimicked a focal stroke syndrome. The importance of recognizing this possibility is that his deficits resolved with blood pressure control, while other treatments, such as intensifying his anticoagulation would have been inappropriate. In addition, allowing his blood pressure to remain elevated as is often done in the setting of an acute stroke might have perpetuated the underlying pathophysiology of PRES leading to a worse clinical outcome. For this reason PRES needs to be recognized quickly and treated appropriately.

  6. [Acute surgical treatment of malignant stroke].

    Science.gov (United States)

    Lilja-Cyron, Alexander; Eskesen, Vagn; Hansen, Klaus; Kondziella, Daniel; Kelsen, Jesper

    2016-10-24

    Malignant stroke is an intracranial herniation syndrome caused by cerebral oedema after a large hemispheric or cerebellar stroke. Malignant middle cerebral artery infarction is a devastating disease with a mortality around 80% despite intensive medical treatment. Decompressive craniectomy reduces mortality and improves functional outcome - especially in younger patients (age ≤ 60 years). Decompression of the posterior fossa is a life-saving procedure in patients with malignant cerebellar infarctions and often leads to good neurological outcome.

  7. Magnetic resonance imaging of the cranial nerves in the posterior fossa: a comparative study of t2-weighted spin-echo sequences at 1.5 and 3.0 tesla.

    Science.gov (United States)

    Fischbach, F; Müller, M; Bruhn, H

    2008-04-01

    High-field magnetic resonance imaging (MRI) at 3.0 Tesla (T) is rapidly gaining clinical acceptance. Whether doubling of the field strength of 1.5T and the subsequent increase in signal-to-noise ratio (SNR) leads to a significant improvement of image quality is not automatically given. To evaluate the depiction of fine anatomic detail in the posterior fossa, focusing on brain nerves, on T2-weighted imaging, and to define the potential advantage of imaging at 3.0T versus 1.5T. In total, 10 brainstem nerve pairs of 12 volunteers were identified on T2-weighted MR images of 2- and 5-mm section thickness acquired at 1.5T and 3.0T. The MR images were compared for each subject at both field strengths by three independent readers who rated image quality according to depiction of anatomic detail and contrast by using a rating scale. In general, MR images at 3.0T were considered more conspicuous and less noisy than images at 1.5T. The SNR value measured was almost doubled. With respect to structural identification and contrast according to the rating scale, observer scores were significantly improved both for standard imaging with 5-mm sections and high-resolution imaging with 2-mm sections at 3.0T. Direct comparison revealed a significant increase for evaluated image quality criteria and the number of nerves detected. The comparison revealed a clear advantage in favor of T2-weighted MRI at 3.0T vs. 1.5T in depicting the roots and course of brain nerves in the posterior fossa.

  8. Are Homo sapiens nonsupranuchal fossa and Neanderthal suprainiac fossa convergent traits?

    Science.gov (United States)

    Nowaczewska, Wioletta

    2011-04-01

    The autapomorphic status of the Neanderthal suprainiac fossa was recently confirmed. This was a result of a detailed analysis of the internal bone composition in the area of the suprainiac depression on Neanderthal and Homo sapiens specimens. However, while anatomical differences between Neanderthal suprainiac fossa and the depression in the inion region of the occipital bone of fossil and recent Homo sapiens have been discussed in detail, the etiology of these structures has not been resolved. In this article, the hypothesis that the Homo sapiens non-supranuchal fossa and the Neanderthal suprainiac fossa both formed to maintain the optimal shape of the occipital plane (to minimize strain on the posterior cranial vault) is tested. First, the variation in the expression of the fossa above inion in the crania of recent Homo sapiens from European, African, and Australian samples was examined, and the degree of structural similarity between these depressions and the Neanderthal suprainiac fossa was assessed. Next, the relationship between the shape of the occipital squama in the midsagittal plane and two particular features (the degree of the occipital torus development and the occurrence of a depression in the inion region that is not the supranuchal fossa) were analyzed. Based on the results, it is suggested that the Homo sapiens non-supranuchal fossa and Neanderthal suprainiac fossa are convergent traits. Copyright © 2010 Wiley-Liss, Inc.

  9. Pituitary fossa: a correlative anatomic and MR study

    International Nuclear Information System (INIS)

    Mark, L.; Pech, P.; Daniels, D.; Charles, C.; Williams, A.; Haughton, V.

    1984-01-01

    This study characterizes the normal appearance of the pituitary fossa in partial saturation magnetic resonance (MR) images. In sagittal images, the pituitary fossa appears inhomogeneous. Correlation of sagittal MR images in normal subjects with sagittal cryomicrotomic images in cadavers suggests that the highest intensity signal from the posterior-inferior pituitary fossa is due to a fat pad. This conclusion was supported by MR images and postmortem cryotome sections obtained in normal subhuman primates

  10. Quantitative study of the opticocarotid and carotid-oculomotor windows for the interpeduncular fossa, before and after internal carotid artery mobilization and posterior communicating division.

    Science.gov (United States)

    Kim, Young-Don; Elhadi, Ali M; Mendes, George A C; Maramreddy, Naveen; Agrawal, Abhishek; Kalb, Samuel; Nakaji, Peter; Spetzler, Robert F; Preul, Mark C

    2015-03-01

    The management of basilar apex (BX) aneurysms remains problematic. We quantified the surgical exposure of the BX through the opticocarotid window (OCW) and the carotid-oculomotor window (COW), before and after mobilization of the internal carotid artery and division of the posterior communicating artery (PCoA). Eleven silicone-injected cadaveric heads were dissected bilaterally. The surgical dissection was divided into 4 major steps: (1) supraorbital modified orbitozygomatic craniotomy, (2) mobilization of the internal carotid artery after drilling out the anterior clinoid process intradurally and cutting the distal dural ring, (3) drilling out the posterior clinoid process and dorsum sellae, and (4) dividing the PCoA from the posterior third portion of the vessel. A frameless navigation system was used to quantify the surgical exposure area of the BX through the OCW and COW. The total surgical area increased significantly from steps 1 to 4 (P PCoA significantly increased the overall surgical area for permanent clip application (P PCoA and height of the BX.

  11. Posterior communicating artery hypoplasia as a risk factor for acute ischemic stroke in the absence of carotid artery occlusion.

    Science.gov (United States)

    Chuang, Yu-Ming; Liu, Chih-Yang; Pan, Po-Jung; Lin, Ching-Po

    2008-12-01

    Posterior communicating artery (PCoA) hypoplasia is a fetal variant of the Circle of Willis. According to angiograms and autopsy reports, this congenital variation is found in 6-21% of the general population. PCoA hypoplasia only becomes a risk factor for ischemic stroke in the presence of ipsilateral internal carotid artery (ICA) occlusion. The aim of our study was to determine the role of PCoA hypoplasia in acute ischemic stroke in the absence of ICA occlusion. We examined 310 acute ischemic stroke patients (mean age+/-standard deviation; 68.9+/-15.6 years). Cerebral magnetic resonance angiography was performed within 72 hours of ischemic stroke onset. For comparison, a risk factor-matched control group was recruited. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to estimate the independent effect of potential risk factors. The overall incidence of PCoA hypoplasia in our experimental group was 19.35% (n=60), which was significantly higher than in the control group (8.20%, n=22, p=0.036, OR, 3.21; 95% CI, 1.43-9.62). The most common ischemic event was ipsilateral thalamic lacunar infarctions with or without occipital lobe involvement. Based on our results, PCoA hypoplasia appears to be a contributor to the risk of ischemic stroke, even in the absence of ICA occlusion. This risk is especially pronounced for strokes involving arteries that penetrate the thalamus.

  12. Multi-Institution Prospective Trial of Reduced-Dose Craniospinal Irradiation (23.4 Gy) Followed by Conformal Posterior Fossa (36 Gy) and Primary Site Irradiation (55.8 Gy) and Dose-Intensive Chemotherapy for Average-Risk Medulloblastoma

    International Nuclear Information System (INIS)

    Merchant, Thomas E.; Kun, Larry E.; Krasin, Matthew J.; Wallace, Dana; Chintagumpala, Murali M.; Woo, Shiao Y.; Ashley, David M.; Sexton, Maree; Kellie, Stewart J.; Ahern, Verity M.B.B.S.; Gajjar, Amar

    2008-01-01

    Purpose: Limiting the neurocognitive sequelae of radiotherapy (RT) has been an objective in the treatment of medulloblastoma. Conformal RT to less than the entire posterior fossa (PF) after craniospinal irradiation might reduce neurocognitive sequelae and requires evaluation. Methods and Materials: Between October 1996 and August 2003, 86 patients, 3-21 years of age, with newly diagnosed, average-risk medulloblastoma were treated in a prospective, institutional review board-approved, multi-institution trial of risk-adapted RT and dose-intensive chemotherapy. RT began within 28 days of definitive surgery and consisted of craniospinal irradiation (23.4 Gy), conformal PF RT (36.0 Gy), and primary site RT (55.8 Gy). The planning target volume for the primary site included the postoperative tumor bed surrounded by an anatomically confined margin of 2 cm that was then expanded with a geometric margin of 0.3-0.5 cm. Chemotherapy was initiated 6 weeks after RT and included four cycles of high-dose cyclophosphamide, cisplatin, and vincristine. Results: At a median follow-up of 61.2 months (range, 5.2-115.0 months), the estimated 5-year event-free survival and cumulative incidence of PF failure rate was 83.0% ± 5.3% and 4.9% ± 2.4% (± standard error), respectively. The targeting guidelines used in this study resulted in a mean reduction of 13% in the volume of the PF receiving doses >55 Gy compared with conventionally planned RT. The reductions in the dose to the temporal lobes, cochleae, and hypothalamus were statistically significant. Conclusion: This prospective trial has demonstrated that irradiation of less than the entire PF after 23.4 Gy craniospinal irradiation for average-risk medulloblastoma results in disease control comparable to that after treatment of the entire PF

  13. The ABCD2 score is better for stroke risk prediction after anterior circulation TIA compared to posterior circulation TIA.

    Science.gov (United States)

    Wang, Junjun; Wu, Jimin; Liu, Rongyi; Gao, Feng; Hu, Haitao; Yin, Xinzhen

    2015-01-01

    Transient ischemic attacks (TIAs) are divided into anterior and posterior circulation types (AC-TIA, PC-TIA, respectively). In the present study, we sought to evaluate the ABCD2 score for predicting stroke in either AC-TIA or PC-TIA. We prospectively studied 369 consecutive patients who presented with TIA between June 2009 and December 2012. The 7 d occurrence of stroke after TIA was recorded and correlated with the ABCD2 score with regards to AC-TIA or PC-TIA. Overall, 273 AC-TIA and 96 PC-TIA patients were recruited. Twenty-one patients with AC-TIA and seven with PC-TIA developed a stroke within the subsequent 7 d (7.7% vs. 7.3%, p = 0.899). The ABCD2 score had a higher predictive value of stroke occurrence in AC-TIA (the AUC was 0.790; 95% CI, 0.677-0.903) than in PC-TIA (the AUC was 0.535; 95% CI, 0.350-0.727) and the z-value of two receiver operating characteristic (ROC) curves was 2.24 (p = 0.025). AC-TIA resulted in a higher incidence of both unilateral weakness and speech disturbance and longer durations of the symptoms. Inversely, PC-TIA was associated with a higher incidence of diabetes mellitus (19.8% vs. 10.6%, p = 0.022). Evaluating each component of scores, age ≥ 60 yr (OR = 7.010, 95% CI 1.599-30.743), unilateral weakness (OR = 3.455, 95% CI 1.131-10.559), and blood pressure (OR = 9.652, 95% CI 2.202-42.308) were associated with stroke in AC-TIA, while in PC-TIA, diabetes mellitus (OR = 9.990, 95% CI 1.895-52.650) was associated with stroke. In our study, the ABCD2 score could predict the short-term risk of stroke after AC-TIA, but might have limitation for PC-TIA.

  14. Posterior fossa meningioma (surgical experiences) | Moussa ...

    African Journals Online (AJOL)

    Symptoms included headache (75%), cerebellar manifestations (60%), cranial nerve affection (40%) and hearing disturbances (15%). Most of the cases (50%) were cerebellopontine angle meningioma while the least (5%) were foramen magnum meningioma. Surgical approaches used included retrosigmoid approach ...

  15. Isolated posterior fossa involvement of progressive multifocal ...

    African Journals Online (AJOL)

    2017-11-14

    Nov 14, 2017 ... and the HIV pandemic has resulted in an increased prevalence of PML, affecting 3% – 7% of HIV- infected ... majority of HIV-infected patients with PML have CD4 lymphocyte counts < 200 cells/mm3. JC ... infrequent contrast enhancement.3 There is no involvement of the optic nerves or spinal cord. Isolated ...

  16. Posterior Circulation Stroke After Bronchial Artery Embolization. A Rare but Serious Complication

    International Nuclear Information System (INIS)

    Laborda, Alicia; Tejero, Carlos; Fredes, Arturo; Cebrian, Luis; Guelbenzu, Santiago; Gregorio, Miguel Ángel de

    2013-01-01

    Bronchial artery embolization (BAE) is the treatment of choice for massive hemoptysis with rare complications that generally are mild and transient. There are few references in the medical literature with acute cerebral embolization as a complication of BAE. We report a case of intracranial posterior territory infarctions as a complication BAE in a patient with hemoptysis due to bronchiectasis.

  17. Posterior Circulation Stroke After Bronchial Artery Embolization. A Rare but Serious Complication

    Energy Technology Data Exchange (ETDEWEB)

    Laborda, Alicia [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Tejero, Carlos [Hospital Clinico Universitario Lozano Blesa, Servicio de Neurologia (Spain); Fredes, Arturo, E-mail: fredesarturo@gmail.com [Universidad de Zaragoza, Hospital Quiron, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Cebrian, Luis; Guelbenzu, Santiago; Gregorio, Miguel Angel de, E-mail: mgregori@unizar.es [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain)

    2013-06-15

    Bronchial artery embolization (BAE) is the treatment of choice for massive hemoptysis with rare complications that generally are mild and transient. There are few references in the medical literature with acute cerebral embolization as a complication of BAE. We report a case of intracranial posterior territory infarctions as a complication BAE in a patient with hemoptysis due to bronchiectasis.

  18. Benign neurilemmoma in the infratemporal fossa involving maxillary sinus and pterygopalatine fossa

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Heo, Min Suk; Lee, Jin Koo; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul [Seoul National University College of Medicine, Seoul (Korea, Republic of); An, Chang Hyeon [Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

    2004-12-15

    Neurilemmoma is a benign tumor of the nerve sheath that arises on cranial and spinal nerve roots as well as along the course of peripheral nerves. A case of a neurilemmoma that arose in the left infratemporal fossa of a 29- year-old male was presented. Plain radiographs, enhanced computed tomography scan, and magnetic resonance imaging demonstrated a large, well-circumscribed, heterogeneously enhanced mass with extension into the pterygopalatine fossa. Displaced by the large mass, bowing-in of the posterior maxillary antral wall was noted and a provisional diagnosis of a benign soft tissue tumor was made. The mass was completely excised and a diagnosis of neurilemmoma was confirmed.

  19. Kinematic features of rear-foot motion using anterior and posterior ankle-foot orthoses in stroke patients with hemiplegic gait.

    Science.gov (United States)

    Chen, Chih-Chi; Hong, Wei-Hsien; Wang, Chin-Man; Chen, Chih-Kuang; Wu, Katie Pei-Hsuan; Kang, Chao-Fu; Tang, Simon F

    2010-12-01

    To evaluate the kinematic features of rear-foot motion during gait in hemiplegic stroke patients, using anterior ankle-foot orthoses (AFOs), posterior AFOs, and no orthotic assistance. Crossover design with randomization for the interventions. A rehabilitation center for adults with neurologic disorders. Patients with hemiplegia due to stroke (n=14) and able-bodied subjects (n=11). Subjects with hemiplegia were measured walking under 3 conditions with randomized sequences: (1) with an anterior AFO, (2) with a posterior AFO, and (3) without an AFO. Control subjects were measured walking without an AFO to provide a normative reference. Rear-foot kinematic change in the sagittal, coronal, and transverse planes. In the sagittal plane, compared with walking with an anterior AFO or without an AFO, the posterior AFO significantly decreased plantar flexion to neutral at initial heel contact (P=.001) and the swing phase (PRehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Supratentorial arterial ischemic stroke following cerebellar tumor resection in two children.

    Science.gov (United States)

    Catsman-Berrevoets, Coriene E; van Breemen, Melanie; van Veelen, Marie Lise; Appel, Inge M; Lequin, Maarten H

    2005-01-01

    We describe two children who developed ischemic strokes in the territory of the middle cerebral artery, one 7 days and one 11 days after resection of a cerebellar tumor. In the first child, another infarction occurred in the territory of the contralateral middle cerebral artery 5 days after the first stroke. No specific cause or underlying risk factor other than the surgical procedure was found. The subacute clinical course at stroke onset resembled that of the 'posterior fossa syndrome', suggesting a common underlying mechanism.

  1. Hemicraniectomy for Ischemic and Hemorrhagic Stroke: Facts and Controversies.

    Science.gov (United States)

    Gupta, Aman; Sattur, Mithun G; Aoun, Rami James N; Krishna, Chandan; Bolton, Patrick B; Chong, Brian W; Demaerschalk, Bart M; Lyons, Mark K; McClendon, Jamal; Patel, Naresh; Sen, Ayan; Swanson, Kristin; Zimmerman, Richard S; Bendok, Bernard R

    2017-07-01

    Malignant large artery stroke is associated with high mortality of 70% to 80% with best medical management. Decompressive craniectomy (DC) is a highly effective tool in reducing mortality. Convincing evidence has accumulated from several randomized trials, in addition to multiple retrospective studies, that demonstrate not only survival benefit but also improved functional outcome with DC in appropriately selected patients. This article explores in detail the evidence for DC, nuances regarding patient selection, and applicability of DC for supratentorial intracerebral hemorrhage and posterior fossa ischemic and hemorrhagic stroke. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. 3D CBCT anatomy of the pterygopalatine fossa.

    Science.gov (United States)

    Rusu, Mugurel Constantin; Didilescu, Andreea Cristiana; Jianu, Adelina Maria; Păduraru, Dumitru

    2013-03-01

    The anatomy of the pterygopalatine fossa keeps a traditional level and is viewed as constant, even though a series of structures neighboring the fossa are known to present individual variations. We aimed to evaluate on 3D volume renderizations the anatomical variables of the pterygopalatine fossa, as related to the variable pneumatization patterns of the bones surrounding the fossa. The study was performed retrospectively on cone beam computed tomography (CBCT) scans of 100 patients. The pterygopalatine fossa was divided into an upper (orbital) and a lower (pterygomaxillary) floor; the medial compartment of the orbital floor lodges the pterygopalatine ganglion. The pneumatization patterns of the pterygopalatine fossa orbital floor walls were variable: (a) the posterior wall pneumatization pattern was determined in 89.5 % by recesses of the sphenoidal sinus related to the maxillary nerve and pterygoid canals; (b) the upper continuation of the pterygopalatine fossa with the orbital apex was narrowed in 79.5 % by ethmoid air cells and/or a maxillary recess of the sphenoidal sinus; (c) according to its pneumatization pattern, the anterior wall of the pterygopalatine fossa was a maxillary (40.5 %), maxillo-ethmoidal (46.5 %), or maxillo-sphenoidal (13 %) wall. The logistic regression models showed that the maxillo-ethmoidal type of pterygopalatine fossa anterior wall was significantly associated with a sphenoidal sinus only expanded above the pterygoid canal and a spheno-ethmoidal upper wall. The pterygopalatine fossa viewed as an intersinus space is related to variable pneumatization patterns which can be accurately identified by CBCT and 3DVR studies, for anatomic and preoperatory purposes.

  3. Volume-artifact reduction modality by helical CT of the anterior, middle and posterior carnial fossae. Comparison with conventional CT; Volumen-Artefakt-Reduktionstechnik mittels Spiral-CT in der vorderen, mittleren und hinteren Schaedelgrube. Vergleich mit der konventionellen kranialen CT

    Energy Technology Data Exchange (ETDEWEB)

    Dorenbeck, U.; Finkenzeller, T.; Hill, K.; Feuerbach, S.; Link, J. [Regensburg Univ. (Germany). Inst. fuer Roentgendiagnostik

    2000-04-01

    Purpose: The object of this study was to determine the extent to which a new volume-artifact reduction (VAR) modality using helical CT was able to reduce artifacts in the anterior, middle and posterior fossae in comparison with conventional CT (sequential mode). Methods: In a prospective, randomized trial, 50 patients underwent helical CT (VAR) and 50 underwent sequential CT. The results were evaluated by three radiologists; influences on image quality where scaled between 1 (no artifact) and 4 (not assessable). Eight regions of the anterior, middle and posterior fossae were evaluated. Results: On average, artifacts were scaled at 2.5 in helical CT (VAR) and 3.1 in conventional CT. Significant differences were seen at the eyeball, anterior to the petrosol bone, at the internal occipital crest, and at the level of the transverse sinus (p<0.005). Conclusions: Helical CT with the VAR modality is superior to conventional, sequential CT in the area of the anterior, middle and posterior fossae. (orig.) [German] Ziel: Das Ziel dieser Studie war herauszufinden, inwieweit ein neuer Volumen-Artefakt-Reduktionsmodus (VAR) im Spiral-CT in der vorderen, mittleren und hinteren Schaedelgrube gegenueber der Einzelschicht-CT zu einer Artefaktverringerung beitragen kann. Methoden: In einer prospektiven randomisierten Studie wurden 50 Untersuchungen mit Spiral-CT und 50 mit Einzelschicht-CT bezueglich Artefakten verglichen. Die Auswertung erfolgte durch drei Radiologen, die Bildqualitaet wurde in einer Skala zwischen 1 (kein Artefakt) und 4 (Beurteilung der Region wegen Artefakten nicht moeglich) angegeben. Acht anatomische Regionen in der vorderen, mittleren und hinteren Schaedelgrube wurden auf Beeintraechtigung durch Artefakte untersucht. Ergebnisse: Im Durchschnitt betrug die Bewertung fuer die Artefaktbeeintraechtigung beim Spiral-CT (VAR) 2,5 gegenueber 3,1 bei der Einzelschicht-CT. Der VAR-Modus ermoeglichte in der mittleren und hinteren Schaedelgrube sowie im Balbus oculi

  4. The effects of posterior talar glide with dorsiflexion of the ankle on mobility, muscle strength and balance in stroke patients: a randomised controlled trial

    OpenAIRE

    Lee, Jin; Kim, Ju-O; Lee, Byoung-Hee

    2017-01-01

    [Purpose] The purpose of this study was to examine the effectiveness of posterior talar glide (PTG) with dorsiflexion of the ankle on stroke patients ankle mobility, muscle strength, and balance ability. [Subjects and Methods] Thirty-four subjects were randomly assigned to either a PTG with dorsiflexion group (PTG; n=17), or a weight-bearing with placebo PTG group (control; n=17). Subjects in the PTG group performed PTG with dorsiflexion, designed to improve ankle mobility, muscle strength an...

  5. Lower uric acid is associated with poor short-term outcome and a higher frequency of posterior arterial involvement in ischemic stroke.

    Science.gov (United States)

    Liu, Hanxiang; Reynolds, Gavin P; Wang, Wenmin; Wei, Xianwen

    2018-03-06

    Uric acid has neuroprotective properties in experimental and clinical studies of neurodegenerative disease. It is, however, associated with increased risk of stroke, yet, despite some inconsistent findings, increasing evidence suggests it may also be related to improved stroke outcomes. We have determined whether there is an effect of plasma uric acid on the short-term outcome of stroke patients in a general hospital setting using the modified Rankin Scale (mRS). We also investigated the relationship of uric acid with other clinical correlates. Plasma uric acid was determined in 108 acute ischemic stroke patients and their mRS scores measured. Patients with a poor outcome (mRS > 2) had significantly lower uric acid than those with a better outcome; this remained after correcting for the effect of sex on uric acid concentrations. There was no significant association with other epidemiological factors or with cognitive function determined by Mini-Mental State Examination. An association between uric acid and the cerebral circulation was also found in which lower uric acid occurs with posterior artery involvement. These findings demonstrate in a naturalistic cohort of patients the association of uric acid with short-term disability following ischemic stroke. They also raise the question of whether uric acid may influence the regional brain involvement in stroke.

  6. Stroke

    Science.gov (United States)

    ... doctor Preventing falls Stroke - discharge Swallowing problems Images Brain Carotid stenosis, x-ray of the left artery Carotid stenosis, x-ray of the right artery Stroke Brainstem function Cerebellum - function Circle of Willis Left cerebral hemisphere - ...

  7. Medusae Fossae Formation

    Science.gov (United States)

    2002-01-01

    (Released 10 April 2002) The Science This THEMIS visible image was acquired near 7o S, 172o W (188o E) and shows a remarkable martian geologic deposit known as the Medusae Fossae Formation. This Formation, seen here as the raised plateau in the upper two-thirds of the image, is a soft, easily eroded deposit that extends for nearly 1,000 km along the equator of Mars. In this region the deposit has been heavily eroded by the wind to produce a series of linear ridges called yardangs. These parallel ridges point in direction of the prevailing winds that carved them, and demonstrate the power of martian winds to sculpt the dry landscape of Mars. The Medusae Fossae Formation has been completely stripped from the surface in the lower third of the image, revealing a harder layer below that is more resistant to wind erosion. The easily eroded nature of the Medusae Fossae Formation suggests that it is composed of weakly cemented particles, and was most likely formed by the deposition of wind-blown dust or volcanic ash. Several ancient craters that were once completely buried by this deposit are being exposed, or exhumed, as the overlying Medusae Formation is removed. Very few impact craters are visible on this Formation, indicating that the surface seen today is relatively young, and that the processes of erosion are likely to be actively occurring. The Story Medusa of Greek mythology fame, the name-giver to this region, had snaky locks of hair that could turn a person to stone. Wild and unruly, this monster of the underworld could certainly wreak havoc on the world of the human imagination. As scary as she was, Medusa would have no advantage over the fierce, masterful winds blowing across Mars, which once carved the streaky, terrain at the top of this image. Wild and whipping, these winds have slowly eroded away the 'topsoil,' revealing ancient craters and other surface features they once covered. The loosely cemented particles of this 'topsoil' are likely made up of dust

  8. Hemodynamic stroke: A rare pitfall in cranio cervical junction surgery

    Directory of Open Access Journals (Sweden)

    Jan Frederick Cornelius

    2014-01-01

    Full Text Available Surgical C1C2-stabilization may be complicated by arterial-arterial embolism or arterial injury. Another potential complication is hemodynamic stroke. The latter might be induced in patients with poor posterior fossa collateralization (risk factor 1 when the vertebral artery (VA is compressed during reduction (risk factor 2. We report a clinical case where this rare situation occurred: A 72-year old patient was undergoing C1C2-stabilization for subluxation due to rheumatoid arthritis. Preoperative computed tomography angiography (CTA had shown poor collaterals in the posterior fossa. Furthermore, intraoperative Doppler ultrasound (US detected unilateral VA occlusion during reduction. It appeared to be a high-risk situation for hemodynamic stroke. Surgical inspection of the VA found osteofibrous compressing elements. Arterial decompression was performed resulting in the normal flow as detected by US. Subsequently, C1C2-stabilization could be realized. The clinical and radiological outcome was very favorable. In C1C2-stabilization precise analysis of preoperative CTA and intraoperative US are important to detect risk factors of hemodynamic stroke. Using these data may prevent this rare, but potentially life-threatening complication.

  9. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    Energy Technology Data Exchange (ETDEWEB)

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin [Hannover Medical School, Department of Neurology and Clinical Neurophysiology, Hannover (Germany); Becker, Hartmut; Goetz, Friedrich [Hannover Medical School, Department of Neuroradiology, Hannover (Germany)

    2008-01-15

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  10. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    International Nuclear Information System (INIS)

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin; Becker, Hartmut; Goetz, Friedrich

    2008-01-01

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  11. The topographic relations of the high jugular fossa to the inner ear

    International Nuclear Information System (INIS)

    Wadin, K.; Wilbrand, H.

    1986-01-01

    The radioanatomy of high jugular fossae and their topographic relations to the inner ear structures were investigated in 245 unselected temporal bones. One hundred and fifty specimens were submitted to multidirectional and 10 to computed tomography. After careful chemical and fermentative maceration plastic casts were made, using polyester resin and silicone rubber. With the use of vacuum, even minute structures became filled with the casting material. The specimens offered a three-dimensional view of the jugular fossae and surrounding structures. Fifty-eight (24%) of the total 245 specimens had high jugular fossae at a level above the lower border of the round window. Five casts showed a dehiscence of the peripheral portion of the vestibular aqueduct caused by the high jugular fossa. In 2 casts the proximal portion of the cochlear aqueduct was affected. In some casts the posterior semicircular canal, the facial canal, the stapedial muscle and the round window lay so close to the fossa that a dehiscence could not be excluded. In a clinical material of 102 high fossae the radiographic findings were in accordance with the experimental results. High jugular fossae were predominantly found in pyramids with low-grade mastoid bone pneumatization and sparse or no perilabyrinthine air cells. (orig.)

  12. Effects of a high jugular fossa and jugular bulb diverticulum on the inner ear

    International Nuclear Information System (INIS)

    Wadin, K.; Thomander, L.; Wilbrand, H.; Uppsala Univ.

    1986-01-01

    From a series of patients undergoing routine radiographic examination, 112 temporal bones with a high jugular fossa were selected. Among these, 43 jugular bulb diverticula were found. The structures affected by a high fossa or diverticulum were recorded and correlated to the clinical symptoms of the patient. The vestibule was suspected to be affected in five patients. Two of these patients had tinnitus and vertigo, and three had hearing loss. In one of the latter the hearing loss was most marked in the supine position. The cochlea was close to the fossa in three patients, all of whom had tinnitus. Four patients had a defect of the posterior semicircular canal. One of them lost his hearing after a severe fit of coughing, became unsteady and showed signs of a fistula. The internal acoustic meatus and the mastoid portion of the facial canal were affected in two and four patients, respectively, who had no recorded symptoms. Twelve of 34 patients with Meniere's disease and a high jugular fossa on the side of the diseased ear had a dehiscence of the vestibular aqueduct caused by the fossa or diverticulum, compared with nine of 58 patients in the unselected material. For comparison and demonstration of topographic relationships, 58 casts of unselected radiograhed temporal bone specimens with high jugular fossae or diverticula were investigated. In patients with a high jugular fossa or jugular bulb diverticulum, tomographic assessment may be of value. (orig.)

  13. Endoscopic approach to the infratemporal fossa

    Directory of Open Access Journals (Sweden)

    Ahmed Youssef

    2014-06-01

    Conclusions: Endoscopic endonasal transpterygoid approach is considered one of the most useful surgical solutions to manage selected tumors that involve the infratemporal fossa. A good understanding of the endoscopic anatomy of infratemporal fossa allows safe and complete resection of lesions arising or extending to infratemporal fossa.

  14. Uncommon posterior cranial fossa anomalies: MRI with clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, P. [Dept. of Radiology, University Hospitals, Leuven (Belgium); Kendall, B.E. [Lysholm Radiological Dept., National Hospital for Neurology and Neurosurgery, London (United Kingdom); Wilms, G. [Dept. of Radiology, University Hospitals, Leuven (Belgium); Halpin, S.F.S. [Lysholm Radiological Dept., National Hospital for Neurology and Neurosurgery, London (United Kingdom); Casaer, P. [Dept. of Paediatrics, University Hospitals, Leuven (Belgium); Baert, A.L. [Dept. of Radiology, University Hospitals, Leuven (Belgium)

    1995-01-01

    The clinical and MRI findings in two cases of rhombencephalosynapsis (RS) and two of tectocerebellar dysraphia (TCD) with an associated occipital encephalocele were studied to elucidate the clinical picture and embryogenesis of these rare anomalies. To our knowledge, only one case of TCD [1] and four of RS [2, 3] examined by MRI during life have been reported. The clinical picture in the cases of RS was rather constant and there were similarities with TCD. Consideration of the embryogenesis of the neural tube suggests a temporal proximity of the abnormalities, with TCD arising at a slightly earlier time. (orig.)

  15. Posterior cranial fossa tumours in children at Kenyatta National ...

    African Journals Online (AJOL)

    Difficulties in diagnosis especially in children less than three years is well documented. Limited diagnostic modalities and lack of awareness of the symptoms and signs as well as societal perception of children's complaints contributes to late presentation. Kenyatta National Hospital Neurosurgical unit is the only specialized ...

  16. Management of Posterior Fossa Medulloblastoma in Adults | Fouad ...

    African Journals Online (AJOL)

    Background: Medulloblastoma is a malignant tumor of the cerebellum that occurs predominantly in children. It is rare in adults and accounts for less than 1 % of all adult primary brain tumors. Objective: This study was done ... treatment died: one from distant metastasis and one from recurrent disease. Ten patients remained ...

  17. Posterior fossa gangliocytoma with facial nerve invasion: case report

    Directory of Open Access Journals (Sweden)

    Koerbel Andrei

    2003-01-01

    Full Text Available A 5 year-old boy with a cerebellar gangliocytoma with a peripheral right facial paresis and ataxia is presented. His MRI showed a heterogenous, diffuse lesion, isointense on T1 and hyperintense on T2-weigthed sequences, involving the right cerebellar hemisphere with direct extension into the right facial nerve. The present case is the first description of a gangliocytoma with direct facial nerve invasion, as demonstrated for the facial nerve paresis and supported by MRI and surgical inspection.

  18. Diseases of the optic fossa

    International Nuclear Information System (INIS)

    Sakuma, S.; Banno, T.

    1983-01-01

    By using a whole body CT unit for coronal tomography, it is possible to observe the extraocular muscles at the same time. Diseases of the optic fossa that can be investigated by CT include muscular hypertrophy due to toxic goiter, calcification of the sclera in hyperparathyroidismus, foreign bodies, inflammatory pseudotumor, retrobulbar tumor, tumor of the retina, tumor of the choroidea, and tumor of the sclera

  19. Assessment of growth dynamics of human cranium middle fossa in foetal period.

    Science.gov (United States)

    Skomra, Andrzej; Kędzia, Alicja; Dudek, Krzysztof; Bogacz, Wiesław

    2014-01-01

    Available literature analysis demonstrated smallness of studies of cranial base. The goal of the study was to analyse the medial fossa of the human cranium in the foetal period against other fossae. Survey material consisted of 110 human foetuses at a morphological age of 16-28 weeks of foetal life, CRL 98-220 mm. Anthropological, preparation method, reverse method and statistical analysis were utilized. The survey incorporated the following computer programmes: Renishaw, TraceSurf, AutoCAD, CATIA. The reverse method seems especially interesting (impression with polysiloxane (silicone elastomer of high adhesive power used in dentistry) with 18 D 4823 activator. Elicited impression accurately reflected complex shape of cranium base. On assessing the relative rate of cranium medial fossa, the rate was found to be stable (linear model) for the whole of the analysed period and is 0.19%/week, which stands for the gradual and steady growth of the middle fossa in relation to the whole of the cranium base. At the same time, from the 16th till 28th week of foetal life, relative volume of the cranium middle fossa increases more intensively than cranium anterior fossa, whereas the cranium middle fossa volume as compared with the cranium posterior fossa is definitely slower. In the analysed period, the growth rate of the cranium base middle fossa was bigger in the 4th and 5th weeks than in the 6th and 7th weeks of foetal life. The investigations revealed cranium base asymmetry of the left side. Furthermore, the anterior fossae volume on the left side is significantly bigger than the one of the fossae on the right side. Volume growth rate is more intensive in the 4th and 5th than in the 6th and 7th weeks of foetal life. In the examined period, the relative growth rate of cranium base middle fossa is 0.19%/week and it is stable - linear model. The study revealed correlations in the form of mathematical models, which enabled foetuses age assessment.

  20. Glenoid fossa position in Class II malocclusion associated with mandibular retrusion.

    Science.gov (United States)

    Giuntini, Veronica; De Toffol, Laura; Franchi, Lorenzo; Baccetti, Tiziano

    2008-09-01

    To assess the position of the glenoid fossa in subjects with Class II malocclusion associated with mandibular retrusion and normal mandibular size in the mixed dentition. A sample of 30 subjects (16 male, 14 female), age 9 years +/- 6 months, with skeletal and dental Class II malocclusion associated with mandibular retrusion, normal skeletal vertical relationships, and normal mandibular dimensions, was compared with a matched group of 37 subjects (18 male, 19 female) with skeletal and dental Class I relationships. The comparisons between the Class II group and the control group on the cephalometric measures for the assessment of glenoid fossa position were performed by means of a nonparametric test for independent samples (Mann-Whitney U-test, P < .05). Subjects with Class II malocclusion presented with a significantly more distal position of the glenoid fossa, when compared with the control group as measured by means of three parameters (GF-S on FH, GF-Ptm on FH, and GF-FMN). A posteriorly displaced glenoid fossa is a possible diagnostic feature of Class II malocclusion associated with mandibular retrusion. An effective cephalometric measurement to evaluate glenoid fossa position is the distance from the glenoid fossa to the frontomaxillonasal suture (GF-FMN).

  1. Effects of a high jugular fossa and jugular bulb diverticulum on the inner ear. A clinical and radiologic investigation

    Energy Technology Data Exchange (ETDEWEB)

    Wadin, K.; Thomander, L.; Wilbrand, H.

    From a series of patients undergoing routine radiographic examination, 112 temporal bones with a high jugular fossa were selected. Among these, 43 jugular bulb diverticula were found. The structures affected by a high fossa or diverticulum were recorded and correlated to the clinical symptoms of the patient. The vestibule was suspected to be affected in five patients. Two of these patients had tinnitus and vertigo, and three had hearing loss. In one of the latter the hearing loss was most marked in the supine position. The cochlea was close to the fossa in three patients, all of whom had tinnitus. Four patients had a defect of the posterior semicircular canal. One of them lost his hearing after a severe fit of coughing, became unsteady and showed signs of a fistula. The internal acoustic meatus and the mastoid portion of the facial canal were affected in two and four patients, respectively, who had no recorded symptoms. Twelve of 34 patients with Meniere's disease and a high jugular fossa on the side of the diseased ear had a dehiscence of the vestibular aqueduct caused by the fossa or diverticulum, compared with nine of 58 patients in the unselected material. For comparison and demonstration of topographic relationships, 58 casts of unselected radiograhed temporal bone specimens with high jugular fossae or diverticula were investigated. In patients with a high jugular fossa or jugular bulb diverticulum, tomographic assessment may be of value.

  2. Communication in conversation in stroke patients.

    Science.gov (United States)

    Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile

    2010-07-01

    In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe

  3. Irreducible Traumatic Posterior Shoulder Dislocation

    Directory of Open Access Journals (Sweden)

    Blake Collier

    2017-01-01

    coracoid, marked limitation of abduction, and complete absence of external rotation with a fixed internal rotation deformity.2 Lesions commonly associated with traumatic posterior subluxation/dislocation are the reverse Hill-Sachs,3 a posterior labral detachment, glenohumeral ligament lesions,4 rotator cuff tears or posterior bony fractures.1 In order to make an accurate diagnosis it is important to obtain adequate x-ray imaging, including a “Y” view.2 Anteroposterior x-rays may show widening of the glenohumeral joint resembling a “light bulb” shape of the humeral head. However, definitive diagnosis is made by the “Y” view which shows the humeral head displaced posteriorly and no longer covering the glenoid fossa6. Irreducible acute posterior dislocation of the shoulder is extremely rare5 and only one other case has been reported in the literature.7

  4. Posterior Reversible Encephalopathy (PRES)

    International Nuclear Information System (INIS)

    Moron E, Fanny E; Diaz Marchan, Pedro

    2005-01-01

    The Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical Syndrome composed of cephalea, alteration in vision and convulsions, usually observed in patients with sudden elevation of arterial pressure. The imagenologic evidence shows reversible vasogenic brain edema without stroke. Its location is predominantly posterior; it affects the cortex and the subcortical white matter of the occipital, parietal and temporal lobes. The treatment with antihypertensive drugs and the removing of immunosupressor medication are generally associated with complete neurological recovery; this is reflected also in the images which return to their basal condition. The untreated hypertension, on the other side, can result in a progressive defect of the autoregulation system of the central nervous system with cerebral hemorrhage, irreversible brain stroke, coma and death

  5. Radiographic imaging of the canine intercondylar fossa

    International Nuclear Information System (INIS)

    Montgomery, R.D.; Fitch, R.B.; Hathcock, J.T.; LaPrade, R.F.; Wilson, M.E.; Garrett, P.D.

    1996-01-01

    The intercondylar fossa is believed to play an important role in the pathology of cranial cruciate ligament rupture and therefore has received considerable attention in the last decade. Accurate radiographic imaging of the intercondylar fossa requires that the central x-ray beam pass through the center of the intercondylar “tunnel”. The anatomy of the canine intercondylar fossa is similar to humans, however, the orientations of the intercondylar fossa's differ. Consequently, the positioning techniques described for humans are not appropriate for the dog. To pass through the center of the dog, intercondylar fossa, the central x-ray beam should be 12° (S.D. 1.7°) caudal from the femoral diaphysis in the sagittal plane and obliqued caudolateral to craniomedial 7° (S.D. 0.60°) (caudo78°proximo7° lateralcraniodistomedial oblique). Cross table positioning was used with the hip flexed and the radiograph cassette placed on the cranial surface of the stifle. However, superimposition of the tuber ischii and soft tissues caudal to the femur made 15° to 20° the best angle obtainable. There was not a significant difference (p = 0.17) in the notch width index between a 12° versus 20° angle of the central x-ray beam caudal to the femoral diaphysis, both with 7° of external rotation of the stifle. The notch width index of 0.252 obtained from radiographic measurements was not significantly different from measurements obtained grossly of 0.254 (n = 26; p = 0.69). Failure to oblique the central x-ray beam caused a significant (p = 0.0008) decrease in the apparent fossa width radiographically

  6. 21 CFR 872.3950 - Glenoid fossa prosthesis.

    Science.gov (United States)

    2010-04-01

    ...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3950 Glenoid fossa prosthesis. (a) Identification. A glenoid fossa prosthesis is a device that is intended to be implanted in the temporomandibular...

  7. Herniographic appearance of the lateral inguinal fossa

    International Nuclear Information System (INIS)

    Ekberg, O.; Kesek, P.

    1987-01-01

    Herniography frequently reveals clinically undetected groin hernia. Thereby herniography contributes to the clinical work-up in patients with obscure groin pain. However, the distinction between clinically important and unimportant abnormalities within the lateral inguinal fossa can be difficult. This study was therefore designed in order to elucidate the herniographic appearance of the lateral inguinal fossa in patients with obscure groin pain. Herniographic findings were compared with laterality of the patients' symptoms. The lateral umbilical fold was visible in only 47% of the groins. A triangular shaped outpouching from the lateral inguinal fossa and a patent processus vaginalis were found with equal frequency on the left and right side. They were five times as frequent in men as in women. Their presence did not correlate with laterality of the patients' symptoms. Indirect hernias were almost twice as common on the symptomatic side as compared with the asymptomatic side. On the left side they were found twice as often in men as in women while there was no significant sex difference on the right side. Our results show that neither a patent processus vaginalis nor a triangular outpouching from the lateral inguinal fossa correlate with the laterality of the patients' symptoms while true indirect hernias do. (orig.)

  8. Endoscopic Diagnosis of Pyriform Fossa Lymphoma

    Directory of Open Access Journals (Sweden)

    A Thomson

    1996-01-01

    Full Text Available Many endoscopists do not inspect the gastrointestinal tract superior to the cricopharyngeus, despite the fact that gastrointestinal symptoms (dysphagia, odynophagia and chest pain can be produced by glottic and supraglottic lesions. A case of incoordinate swallowing secondary to a right-sided pyriform fossa lymphoma diagnosed at gastroscopy is presented.

  9. Temporal fossa hemangiopericytoma: a case series.

    Science.gov (United States)

    Heiser, Marc A; Waldron, James S; Tihan, Tarik; Parsa, Andrew T; Cheung, Steven W

    2009-10-01

    Review clinical experience with temporal fossa hemangiopericytomas (HPCs). Retrospective case series review. Tertiary referral center. Intracranial HPCs within the temporal fossa. Craniotomy for either subtotal or gross total tumor excision. Determination of clinical outcome (alive with no evidence of disease, alive with disease, and died of disease). Five cases of HPC involving the temporal fossa were treated at our tertiary referral center for the period from 1995 to 2008. All but 1 patient were men. The age of presentation ranged from 31 to 62 years, and duration of follow-up ranged from 8 to 153 months. Clinical presentation was protean; headache was the most common symptom. Gross total tumor excision was achieved in 2 patients, whereas subtotal tumor excision was achieved in 3 patients. Reasons for subtotal resection included excessive intraoperative blood loss and inextricable tumor. Histologically, all tumors were composed of tightly packed, randomly oriented (jumbled-up) tumor cells with little intervening collagen. CD34 staining mostly highlighted the vascular background. One patient died of disease, 2 patients were alive with disease, and 2 patients had no evidence of disease. Management of temporal fossa HPC is challenging because clinical presentation is often late, and extent of tumor excision is constrained by vital structures in the cranial base and intracranial contents. A multidisciplinary approach with neurosurgery and neurotology undertaken to achieve the most complete tumor resection possible, whereas minimizing morbidity are likely to confer a longer period of symptom-free survival and improves curability of these difficult lesions.

  10. Bony landmark between the attachment of the medial meniscus posterior root and the posterior cruciate ligament: CT and MR imaging assessment

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, Masataka; Furumatsu, Takayuki; Miyazawa, Shinichi; Kodama, Yuya; Hino, Tomohito; Kamatsuki, Yusuke; Ozaki, Toshifumi [Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama (Japan)

    2017-08-15

    (1) To reveal the prevalence of the bony recess (posterior dimple) and (2) to determine the position of the posterior dimple on the tibial plateau using three-dimensional computed tomography (3DCT). In this study, a retrospective review of 112 patients was performed to identify the posterior dimple and to evaluate its position on 3DCT. Magnetic resonance images (MRIs) were also used to determine the positional relationship among the posterior cruciate ligament (PCL), medial meniscus posterior insertion (MMPI), and posterior dimple. The posterior dimple was observed in 100 of 112 knees (89.3%) on 3DCT. The center of the posterior dimple was 13.6 ± 0.8 mm from the medial tibial eminence apex. MRI showed that the posterior dimple separated the tibial attachment of the PCL and MMPI. This is the first study to discuss the prevalence and position of the bony recess in the posterior intercondylar fossa. (orig.)

  11. Bony landmark between the attachment of the medial meniscus posterior root and the posterior cruciate ligament: CT and MR imaging assessment

    International Nuclear Information System (INIS)

    Fujii, Masataka; Furumatsu, Takayuki; Miyazawa, Shinichi; Kodama, Yuya; Hino, Tomohito; Kamatsuki, Yusuke; Ozaki, Toshifumi

    2017-01-01

    (1) To reveal the prevalence of the bony recess (posterior dimple) and (2) to determine the position of the posterior dimple on the tibial plateau using three-dimensional computed tomography (3DCT). In this study, a retrospective review of 112 patients was performed to identify the posterior dimple and to evaluate its position on 3DCT. Magnetic resonance images (MRIs) were also used to determine the positional relationship among the posterior cruciate ligament (PCL), medial meniscus posterior insertion (MMPI), and posterior dimple. The posterior dimple was observed in 100 of 112 knees (89.3%) on 3DCT. The center of the posterior dimple was 13.6 ± 0.8 mm from the medial tibial eminence apex. MRI showed that the posterior dimple separated the tibial attachment of the PCL and MMPI. This is the first study to discuss the prevalence and position of the bony recess in the posterior intercondylar fossa. (orig.)

  12. Posterior Circulation Ischemic Stroke—Clinical Characteristics, Risk Factors, and Subtypes in a North Indian Population: A Prospective Study

    OpenAIRE

    Mehndiratta, Manmohan; Pandey, Sanjay; Nayak, Rajeev; Alam, Anwar

    2012-01-01

    Background and Purpose: Posterior circulation stroke accounts for approximately 20% of all strokes with varied clinical presentation, which differ from strokes in anterior circulation, with reference to etiology, clinical features, and prognosis. Short penetrating and circumferential branches in the posterior circulation supply the brain stem, thalamus, cerebellum, occipital, and medial temporal lobes. Materials and Methods: We prospectively analyzed 80 participants of posterior circulation i...

  13. Muscular Variation In The Neck Region With Narrowing Of The Minor And Major Supraclavicular Fossa

    Directory of Open Access Journals (Sweden)

    Humberto Ferreira Arquez

    2017-06-01

    Full Text Available Background: The sternocleidomastoideus muscle is the most prominent landmarks of the surface anatomy of the neck, separates the anterior part of the neck (anterior triangle from the posterior part of the neck (posterior triangle. An accessory head of sternocleidomastoideus muscle may cause complications while trying to access vital neurovascular structures that are located in the minor and major supraclavicular fossa. The purpose of this study is to describe an anatomical variation of the sternocleidomastoideus muscle and clinical impact. Methods and Findings: The anatomical variations described were found during routine dissection conducted in the laboratory of Morphology of the University of Pamplona in two male cadavers of 47 and 75 years respectively. Measurements were taken using a Vernier caliper. Topographic details of the variations were examined, recorded and photographed. The morphological variations in the number of heads (three and four of origin of sternocleidomastoideus muscle was found in two male subjects in right and left neck, bilaterally.  The posterior cervical triangle was diminished. The bilateral narrowing of the minor and major supraclavicular fossa minimizing space needed for potential surgical access. The branching patterns of the spinal accessory nerve and arterial patterns were normal. Conclusions: The Knowledge of the presence of additional heads of sternocleidomastoideus muscle it might cause difficulties in subclavian or external jugular vein catheterization, and in surgical interventions involving structures lying under the sternocleidomastoideus muscle. These variations must be kept in mind while approaching the region to avoid complications as the classical anatomical landmarks might be misinterpreted and confuse.

  14. Mammary-type myofibroblastoma of popliteal fossa

    International Nuclear Information System (INIS)

    Scotti, C.; Camnasio, F.; Fontana, F.; Fraschini, G.; Rizzo, N.; De Cobelli, F.; Peretti, G.M.

    2008-01-01

    Mammary-type myofibroblastoma is a very rare, benign, spindle cell lesion, arising mainly in the inguinal region. This clinical entity strictly duplicates the features of its breast counterpart. To our knowledge, this is the first report of this particular lesion occurring in the popliteal fossa. We discuss the clinical, radiological and histopathological features of this case, emphasizing the role of incisional biopsy in such an unusual neoplasia. (orig.)

  15. [Cochlear implantation through the middle fossa approach].

    Science.gov (United States)

    Szyfter, W; Colletti, V; Pruszewicz, A; Kopeć, T; Szymiec, E; Kawczyński, M; Karlik, M

    2001-01-01

    The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding.

  16. Computed tomography of lacrimal fossa tumors

    International Nuclear Information System (INIS)

    Park, Chan Sup; Kim, Young Goo; Chang, Kee Hyun

    1985-01-01

    The lacrimal fossa can be involved by a wide spectrum of orbital pathology. The correct diagnosis is important to avoid unnecessary procedure and to do appropriate management. 14 patients with mass lesions in the lacrimal fossa were evaluated with computed tomography (CT) and clinical findings. The results were as follows: 1. Final diagnosis of 14 cases with lacrimal fossa tumors was pleomorphic adenoma in 3 cases, adenoid cystic carcinoma in 1 case, pseudotumor in 5 cases, lymphoma in 2 cases, neurofibroma in 1 case, chloroma in 1 case and metastatic adenocarcinoma in 1 case. 2. The duration of symptoms of pleomorphic adenoma was more than 1 year and characteristic CT findings were globular masses with pressure erosion of the adjacent bone. Patient with adenoid cystic carcinoma had a short history of symptoms. CT showed a fusiform mass but intracranial extension with frank destruction of sphenoid bone. 3. Patients with pseudotumor and lymphoma had symptoms for less than 1 year. The CT findings were ill-defined infiltrative patterns with scleral thickening and the differential diagnosis of them was difficult. 4. The margins of neurofibroma and chloroma were well defined while that of the metastic adenocarcinoma was ill-defined. 5. The degree and the extent of the contrast enhancement gave no benefit in the differential diagnosis of each disease entities and even of the benign and malignant lesions

  17. The bihemispheric posterior inferior cerebellar artery

    International Nuclear Information System (INIS)

    Cullen, Sean P.; Ozanne, Augustin; Alvarez, Hortensia; Lasjaunias, Pierre

    2005-01-01

    Rarely, a solitary posterior inferior cerebellar artery (PICA) will supply both cerebellar hemispheres. We report four cases of this variant. We present a retrospective review of clinical information and imaging of patients undergoing angiography at our institution to identify patients with a bihemispheric PICA. There were four patients: three males and one female. One patient presented with a ruptured arteriovenous malformation, and one with a ruptured aneurysm. Two patients had normal angiograms. The bihemispheric PICA was an incidental finding in all cases. The bihemispheric vessel arose from the dominant left vertebral artery, and the contralateral posterior inferior cerebellar artery was absent or hypoplastic. In all cases, contralateral cerebellar supply arose from a continuation of the ipsilateral PICA distal to the choroidal point and which crossed the midline dorsal to the vermis. We conclude that the PICA may supply both cerebellar hemispheres. This rare anatomic variant should be considered when evaluating patients with posterior fossa neurovascular disease. (orig.)

  18. Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae.

    Science.gov (United States)

    Upadhyay, Smita; Dolci, Ricardo L L; Buohliqah, Lamia; Fiore, Mariano E; Ditzel Filho, Leo F S; Prevedello, Daniel M; Otto, Bradley A; Carrau, Ricardo L

    2016-02-01

    Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm(2)) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.

  19. Imaging techniques in evaluation of juvenile angiofibroma with lateral extension in the pterygopalatine and infratemporal fossa

    International Nuclear Information System (INIS)

    Szymanska, A.; Pietura, R.; Drelich-Zbroja, A.; Trojanowski, P.

    2004-01-01

    Juvenile angiofibroma is a benign tumour arising in the nasopharynx and penetrating laterally into the pterygopalatine fossa, infratemporal fossa and orbit. Precise preoperative evaluation of the presence and extension of its lateral spread is crucial for choosing the best surgical approach and performing radical operation. The aim of the study was to assess usefulness of imaging methods in diagnosis and evaluation of lateral extension of juvenile angiofibroma. In a group of 39 patients operated on from 1973 to 2002 due to juvenile angiofibroma in 21 (54%) cases a lateral extension of the tumor was diagnosed. All patients underwent carotid angiography (CA) and lateral plain skull X-ray. Computed tomography (CT) was performed in 18,and magnetic resonance imaging (MRI) in 4 patients. In all cases the extension of the tumor and its lateral spread was verified during surgery. A widening of the pterygopalatine fossa on lateral plain X-ray was present in 13 (62%) patients. CT and MRI demonstrated the presence of lateral extension in all patients diagnosed with these methods. In 9 cases, lateral CA revealed dislodgement of the internal maxillary artery by the tumor in the pterygopalatine fossa. The presence of big lateral extension of the juvenile angiofibroma is demonstrated on lateral plain X-ray as anterior bowing of the posterior wall of the maxillary sinus (Holman-Miller sign). MRI shows better than CT the extent and margins of the tumor in soft tissues. Lateral CA shows dislodgement of the internal maxillary artery and its course in relation to the lateral extension of the tumor, which is important for surgical planning. (author)

  20. Pediatric Stroke

    Science.gov (United States)

    ... and Patient Resources Home » Patients & Families » About Stroke » Pediatric Stroke » Introduction Introduction What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Introduction Types of Stroke Diagnosis and Treatment ...

  1. Recovery of Dysphagia in Lateral Medullary Stroke

    OpenAIRE

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia...

  2. Stroke subtypes and factors associated with ischemic stroke in ...

    African Journals Online (AJOL)

    Stroke subtypes assessed four OCSP (Oxfordshire Communi-. African Health Sciences Vol 15 Issue 1, March 2015. 68. 69 ty Stroke Project Classification) subtypes classification. 13 was used with lacunar circulation infarct (LACI) and total anterior (TACI), partial anterior (PACI), posterior. (POCI) circulation infarcts as non ...

  3. Surgical approach to posterior inferior cerebellar artery aneurysms.

    Science.gov (United States)

    La Pira, Biagia; Sturiale, Carmelo Lucio; Della Pepa, Giuseppe Maria; Albanese, Alessio

    2018-02-01

    The far-lateral is a standardised approach to clip aneurysms of the posterior inferior cerebellar artery (PICA). Different variants can be adopted to manage aneurysms that differ in morphology, topography, ruptured status, cerebellar swelling and surgeon preference. We distinguished five paradigmatic approaches aimed to manage aneurysms that are: proximal unruptured; proximal ruptured requiring posterior fossa decompression (PFD); proximal ruptured not requiring PFD; distal unruptured; distal ruptured. Preoperative planning in the setting of PICA aneurysm surgery is of paramount importance to perform an effective and safe procedure, to ensure an adequate PFD and optimal proximal control before aneurysm manipulation.

  4. Infratemporal and temporal fossa abscess complicating dental extraction.

    OpenAIRE

    Diacono, M S; Wass, A R

    1998-01-01

    Abscess formation in the infratemporal and temporal fossae is rare. Their presentation to accident and emergency departments is unusual and consequently may cause problems with diagnosis. Once diagnosed, treatment should be aggressive with intravenous antibiotics and surgical drainage.

  5. Extra-skeletal Ewing's sarcoma of the nasal fossa.

    Science.gov (United States)

    Lane, S; Ironside, J W

    1990-07-01

    Extraskeletal Ewing's sarcoma is rarely found arising in the head and neck region. An unusual case arising in the nasal fossa in a young child is reported and the differential diagnosis, pathology and treatment discussed.

  6. EVALUATION OF RIGHT ILIAC FOSSA MASS-A RETROSPECTIVE STUDY

    OpenAIRE

    Raja Billy Graham; Vijayabhasker

    2016-01-01

    Mass in right iliac fossa is one of the common clinical surgical entity with varied etiologies, involving intra peritoneal organs like vermiform appendix, caucus, ileum, retroperitoneal structures like kidneys, blood vessels etc., and abdominal wall masses like desmoids tumor. To know the etiology and the various pattern of presentation of right iliac fossa mass in our institution a retrospective study was designed including all adult patients diagnosed to have a mass in right ili...

  7. Anatomic measurements of the posterior tympanum related to the round window vibroplasty in congenital aural atresia and stenosis patients.

    Science.gov (United States)

    Chen, Keguang; Yin, Dongming; Lyu, Huiying; Yang, Lin; Zhang, Tianyu; Dai, Peidong

    2016-01-01

    With the aggravation of the external auditory canal malformation, the size of extra-niche fossa became smaller, providing concrete data and valuable information for the better design, selecting and safer implantation of the transducer in the area of round window niche. Three-dimensional measurements and assessments before surgery might be helpful for a safer surgical approach and implantation of a vibrant soundbridge. The aim of this study was to investigate whether differences exist in the morphology of the posterior tympanum related to the round window vibroplasty among congenital aural atresia (CAA), congenital aural stenosis (CAS), and a normal control group, and to analyze its effect on the round window implantation of vibrant soundbridge. CT images of 10 normal subjects (20 ears), 27 CAS patients (30 ears), and 25 CAA patients (30 ears) were analyzed. The depth and the size of outside fossa of round window niche related to the round window vibroplasty (extra-niche fossa)and the distances between the center of round window niche and extra-niche fossa were calculated based on three-dimensional reconstruction using mimics software. Finally, the data were analyzed statistically. The size of extra-niche fossa in the atresia group was smaller than in the stenosis group (p < 0.05); furthermore, the size of extra-niche fossa in the stenosis group was smaller than that of the control group (p < 0.05). There was no statistically significant difference of the depth of extra-niche fossa among different groups.

  8. Stroke Treatments

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... works by dissolving the clot and improving blood flow to the part of the brain being deprived ...

  9. 3DCRT for posterior fossa: Sparing of surrounding organs at risk

    African Journals Online (AJOL)

    Azza Helal

    2013-06-25

    Jun 25, 2013 ... spinal cord, thyroid gland, pharynx, parotid glands and mandible using three different 3DCRT ... Methods: Ten patients underwent CT simulation for treatment .... structures such as the developing brain, bone, thyroid gland,.

  10. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients

    Directory of Open Access Journals (Sweden)

    Han-Song Sheng

    2017-08-01

    Conclusion: Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.

  11. Cerebellar mutism syndrome in children with brain tumours of the posterior fossa

    DEFF Research Database (Denmark)

    Wibroe, Morten; Cappelen, Johan; Castor, Charlotte

    2017-01-01

    and four Dutch centres will join with a total annual accrual of 130 patients. Three other major European centres are invited to join from 2016/17. Follow-up will run for 12 months after inclusion of the last patient. All patients are treated according to local practice. Clinical data are collected through...

  12. Fossa navicularis magna detection on cone-beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Syed, Ali Z. [Dept. of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland(United States); Mupparapu, Mel [Div. of Radiology, University of Pennsylvania School of Dental Medicine, Philadelphia (United States)

    2016-03-15

    Herein, we report and discuss the detection of fossa navicularis magna, a close radiographic anatomic variant of canalis basilaris medianus of the basiocciput, as an incidental finding in cone-beam computed tomography (CBCT) imaging. The CBCT data of the patients in question were referred for the evaluation of implant sites and to rule out pathology in the maxilla and mandible. CBCT analysis showed osseous, notch-like defects on the inferior aspect of the clivus in all four cases. The appearance of fossa navicularis magna varied among the cases. In some, it was completely within the basiocciput and mimicked a small rounded, corticated, lytic defect, whereas it appeared as a notch in others. Fossa navicularis magna is an anatomical variant that occurs on the inferior aspect of the clivus. The pertinent literature on the anatomical variations occurring in this region was reviewed.

  13. Estenose da fossa intercondilar após estabilização articular com retalho de fáscia lata em cães Intercondylar fossa stenosis after joint stabilization using a fascial strip in dogs

    Directory of Open Access Journals (Sweden)

    André Luis Selmi

    2012-01-01

    Full Text Available Determinaram-se os índices de largura da fossa intercondilar (FI, após transecção do ligamento cruzado cranial em nove cães adultos submetidos à estabilização articular com retalho de fáscia lata. Os joelhos foram alocados em dois grupos, sendo o joelho direito (GI submetido à incisuroplastia troclear (ITR e posterior estabilização articular, e o joelho esquerdo submetido somente à substituição ligamentar (GC. Cada grupo foi dividido em três subgrupos correspondentes aos momentos de eutanásia aos 30, 90 e 180 dias de pós-operatório. Os índices de largura da FI foram determinados, macroscópica e radiograficamente, pela mensuração da abertura cranial da FI nos terços cranial, médio e caudal, e indexados em relação à largura epicondilar. Observou-se aumento significativo dos índices macroscópicos e radiográficos nas articulações do GI, sendo estes estatisticamente diferentes daqueles das articulações de GC. Não foi observada estenose intercondilar nos joelhos de GC após a estabilização articular. Conclui-se que a estabilização articular com retalho de fáscia lata preveniu a estenose da fossa intercondilar, e que a ITR promoveu o alargamento permanente dessa estrutura.Intercondylar fossa width indexes (IFWI were determined in nine adult dogs submitted to intercondylar notchplasty (IN after transection of the cranial cruciate ligament (CCL followed by a fascial strip stabilization. The right stifle was submitted to IN followed by fascial strip reconstruction of the CCL (GI while in the left stifle IN was not performed (GC. Each group was then divided into three subgroups which corresponded to time of euthanasia at 30, 90 and 180 days after surgery. IFWI were determined, both macroscopically and radiographically, by measuring the cranial outlet of the intercondylar fossa in relation to the epicondylar width. A significant increase was observed in indexes of GI following IN, and these differed from indexes of

  14. Stroke in tuberculous meningitis.

    Science.gov (United States)

    Misra, Usha Kant; Kalita, Jayantee; Maurya, Pradeep Kumar

    2011-04-15

    Stroke in tuberculous meningitis (TBM) occurs in 15-57% of patients especially in advance stage and severe illness. The majority of strokes may be asymptomatic because of being in a silent area, deep coma or associated pathology such as spinal arachnoiditis or tuberculoma. Methods of evaluation also influence the frequency of stroke. MRI is more sensitive in detecting acute (DWI) and chronic (T2, FLAIR) stroke. Most of the strokes in TBM are multiple, bilateral and located in the basal ganglia especially the 'tubercular zone' which comprises of the caudate, anterior thalamus, anterior limb and genu of the internal capsule. These are attributed to the involvement of medial striate, thalamotuberal and thalamostriate arteries which are embedded in exudates and likely to be stretched by a coexistent hydrocephalus. Cortical stroke can also occur due to the involvement of proximal portion of the middle, anterior and posterior cerebral arteries as well as the supraclinoid portion of the internal carotid and basilar arteries which are documented in MRI, angiography and autopsy studies. Arteritis is more common than infarction in autopsy study. The role of cytokines especially tumor necrosis factor (TNFα), vascular endothelial growth factor (VEGF) and matrix metaloproteineases (MMPs) in damaging the blood brain barrier, attracting leucocytes and release of vasoactive autocoids have been suggested. The prothrombotic state may also contribute to stroke in TBM. Corticosteroids with antitubercular therapy were thought to reduce mortality and morbidity but their role in reducing strokes has not been proven. Aspirin also reduces mortality and its role in reducing stroke in TBM needs further studies. Copyright © 2010 Elsevier B.V. All rights reserved.

  15. Endoscopic Endonasal Transturbinate Approach to the Pterygopalatine Fossa in the Management of Juvenile Nasopharyngeal Angiofibromas

    Directory of Open Access Journals (Sweden)

    Satoru Kodama

    2012-01-01

    Full Text Available Pterygopalatine fossa (PPF is a difficult-to-access anatomic area located behind the posterior wall of the maxillary sinus. Juvenile nasopharyngeal angiofibroma (JNA often affects this area, and the management of feeding artery to the tumor is important in the surgery. Endoscopic endonasal approach to the PPF without endangering all other nasal structures is useful in the management of JNA. We describe a new approach to the PPF, endoscopic transturbinate approach, which is effective in the management of JNA. Submucous inferior turbinoplasty was performed, and sphenopalatine artery, the feeder to the tumor, was identified at the sphenopalatine foramen. The posterior wall of maxillary sinus was removed. Internal maxillary artery was identified in the PPF and was ligated with a hemoclip. The tumor in the PPF was pushed into the nasal cavity. These procedures were all performed via submucous turbinate tunnel. Then, the tumor was successfully removed in en bloc from the nasal cavity by transnasal approach without ethmoidectomy. This approach improves accessibility and visualization in the PPF and potential to reduce intraoperative bleeding due to ligation of the feeder safely without touching the tumor. Endoscopic transturbinate approach is effective in the management of early stage of JNA.

  16. Packing of Renal Fossa: Useful Technique for Intractable Bleeding ...

    African Journals Online (AJOL)

    There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone ...

  17. Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

    Directory of Open Access Journals (Sweden)

    Jan Plzák

    Full Text Available OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.

  18. Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

    Science.gov (United States)

    Plzák, Jan; Kratochvil, Vít; Kešner, Adam; Šurda, Pavol; Vlasák, Aleš; Zvěřina, Eduard

    2017-01-01

    OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa. PMID:29069259

  19. Transpterygoid Approach to a Dermoid Cyst in Pterygopalatine Fossa

    Directory of Open Access Journals (Sweden)

    Ordones, Alexandre Beraldo

    2014-01-01

    Full Text Available Objective To describe a case of dermoid cyst arising from the pterygopalatine fossa and review the literature. Methods We report a case of a 23-year-old man who suffered a car accident 2 years before otolaryngologic attendance. He had one episode of generalized tonic-clonic seizure and developed a reduction of visual acuity of the left side after the accident. Neurologic investigation was performed and magnetic resonance imaging revealed an incidental finding of a heterogeneous ovoid lesion in the pterygopalatine fossa, hyperintense on T2-weighted imaging. Results Endoscopic sinus surgery with transpterygoid approach was performed. The ovoid lesion was noted in the pterygopalatine fossa. Puncture for intraoperative evaluation showed a transparent thick fluid. Surprisingly, hair and sebaceous glands were found inside the cyst capsule. The cyst was excised completely. Histologic examination revealed a dermoid cyst. The patient currently has no evidence of recurrence at 1 year postoperatively. Conclusion This unique case is a rare report of a dermoid cyst incidentally diagnosed. An endoscopic transnasal transpterygoid approach may be performed to treat successfully this kind of lesion. Although rare, it should be considered in the differential diagnosis of expansive lesions in the pterygopalatine fossa, including schwannoma, angiofibroma, esthesioneuroblastoma, osteochondroma, cholesterol granuloma, hemangioma, lymphoma, and osteoma.

  20. Piezosurgery for the repair of middle cranial fossa meningoencephaloceles.

    Science.gov (United States)

    Acharya, Aanand N; Rajan, Gunesh P

    2015-03-01

    To describe the use of a piezosurgery medical device to perform a craniotomy and produce a split calvarial graft for the repair of middle cranial fossa meningoencephaloceles. Retrospective case review. Tertiary referral hospital. Ten consecutive patients undergoing middle cranial fossa approach for the repair of meningoencephaloceles. Therapeutic. Intraoperative and postoperative complications, success rate as defined by the ability to fashion a split calvarial graft that achieves complete closure of the tegmen defect. As a secondary outcome measure, evidence of integration of the split calvarial bone graft with the adjacent skull base was assessed. There were no intraoperative or postoperative complications. An appropriately sized calvarial bone graft was produced, and complete closure of the tegmen defect was achieved in all 10 cases. Computed tomography demonstrated evidence of integration of the bone graft in eight cases between 4 and 9 months after surgery. The piezosurgery medical device provides a safe and effective means by which the middle fossa craniotomy and split calvarial bone graft can be produced to repair defects of the middle fossa tegmen, with integration of the bone graft in the majority of cases.

  1. Recovery of Dysphagia in Lateral Medullary Stroke

    Directory of Open Access Journals (Sweden)

    Hitesh Gupta

    2014-01-01

    Full Text Available Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  2. Recovery of Dysphagia in lateral medullary stroke.

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.

  3. Recovery of Dysphagia in Lateral Medullary Stroke

    Science.gov (United States)

    Gupta, Hitesh; Banerjee, Alakananda

    2014-01-01

    Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function. PMID:25045555

  4. Experiences in Performing Posterior Calvarial Distraction.

    Science.gov (United States)

    McMillan, Kevin; Lloyd, Mark; Evans, Martin; White, Nicholas; Nishikawa, Hiroshi; Rodrigues, Desiderio; Sharp, Melanie; Noons, Pete; Solanki, Guirish; Dover, Stephen

    2017-05-01

    The use of posterior calvarial distraction (PCD) for the management of craniosynostosis is well recognized. The advantages of using this technique include increased cranial volume, decreased intracranial pressure, relief of posterior fossa crowding, improved cerebrospinal fluid (CSF) circulation at the cranio-cervical junction with cessation, and possible resolution of syrinx.The authors retrospectively review their first 50 patients who have undergone PCD under the senior author's care in our unit.The demographics, diagnoses, intraoperative approach with techniques in distractor placement and outcomes of each patient were obtained through an electronic craniofacial database and written patient records. Analysis of complication rates (bleeding, distraction problems, CSF leaks, and infection) was included.A total of 31 boys and 19 girls underwent the procedure between October 2006 and September 2015 with a median age was 17.7 months (range 4 months to 19 years). Of those 50 children, 34 of the cohort were proven to be syndromic by genetic testing.The median length of inpatient stay was 9.4 days (range 3-43 days). Average distraction distance was 24 mm.Complications including CSF leaks, bleeding, distractor problems, and severe complications (recorded in 3 patients) are discussed. Our overall complication rate was 50%.Favorable outcomes included resolution of Chiari, syrinx, and raised intracranial pressure in the majority of patients where distraction was successful.The authors recommend that PCD should be considered the primary treatment for increasing calvarial volume. The authors discuss our experiences and technical innovations over the past decade.

  5. Posterior Cerebral Infarction following Loss of Guide Wire

    Directory of Open Access Journals (Sweden)

    Jean-Marc Bugnicourt

    2013-01-01

    Full Text Available Stroke after internal jugular venous cannulation typically leads to acute carotid or vertebral arteries injury and cerebral ischemia. We report the first case of delayed posterior cerebral infarction following loss of guide wire after left internal jugular venous cannulation in a 46-year-old woman with a history of inflammatory bowel disease. Our observation highlights that loss of an intravascular guide wire can be a cause of ischemic stroke in patients undergoing central venous catheterization.

  6. Posterior Cerebral Infarction following Loss of Guide Wire

    OpenAIRE

    Bugnicourt, Jean-Marc; Belhomme, Denis; Bonnaire, Bruno; Constans, Jean-Marc; Manaouil, Cécile

    2013-01-01

    Stroke after internal jugular venous cannulation typically leads to acute carotid or vertebral arteries injury and cerebral ischemia. We report the first case of delayed posterior cerebral infarction following loss of guide wire after left internal jugular venous cannulation in a 46-year-old woman with a history of inflammatory bowel disease. Our observation highlights that loss of an intravascular guide wire can be a cause of ischemic stroke in patients undergoing central venous catheterizat...

  7. Malignant Transformation of Endometriosis in the Ischioanal Fossa

    Directory of Open Access Journals (Sweden)

    Jordan S. Klebanoff

    2018-01-01

    Full Text Available We present the case of a 28-year-old nulliparous female with malignant transformation of an ectopic focus of endometriosis in the right ischioanal fossa. A 28-year-old nulliparous patient with a past medical history of polycystic ovarian syndrome (PCOS was diagnosed with endometrioid adenocarcinoma in her right ischioanal fossa. Initially, patient presented to an emergency department and underwent a CT scan of the appendix to rule out appendicitis. A multiloculated cystic lesion adjacent to the right obturator internus muscle was found. She underwent surgical resection of the mass, which confirmed FIGO grade 2 endometrioid adenocarcinoma, followed by localized radiation therapy. Malignancy arising in endometriosis is rare, and the influence of PCOS on the rate of malignant transformation is not well established.

  8. Antecubital Fossa Solitary Osteochondroma with Associated Bicipitoradial Bursitis

    Directory of Open Access Journals (Sweden)

    Colin Ng

    2015-01-01

    Full Text Available Antecubital fossa lesions are uncommon conditions that present to the orthopaedic clinic. Furthermore, the radius bone is an uncommonly reported location for an osteochondroma, especially when presenting with a concurrent reactive bicipitoradial bursitis. Osteochondromas are a type of developmental lesion rather than a true neoplasm. They constitute up to 15% of all bone tumours and up to 50% of benign bone tumours. They may occur as solitary or multiple lesions. Multiple lesions are usually associated with a syndrome known as hereditary multiple exostoses (HME. Malignant transformation is known to occur but is rare. Bicipitoradial bursitis is a condition which can occur as primary or secondary (reactive pathology. In our case, the radius bone osteochondroma caused reactive bicipitoradial bursitis. The differential diagnosis of such antecubital fossa masses is vast but may be narrowed down through a targeted history, stepwise radiological investigations, and histological confirmation. Our aim is to ensure that orthopaedic clinicians keep a wide differential in mind when dealing with antecubital fossa mass lesions.

  9. Anterolateral corridor approach to the infratemporal fossa and central skull base in maxillectomy: rationale and technical aspects.

    Science.gov (United States)

    McMahon, Jeremy D; Crowther, John; Taylor, William M; Wong, Ling Siew; Paterson, Tom; Devine, John; Wales, Craig; MacIver, Colin

    2015-11-01

    We describe the technical aspects and report our clinical experience of a surgical approach to the infratemporal fossa that aims to reduce local recurrence after operations for cancer of the posterior maxilla. We tested the technique by operating on 3 cadavers and then used the approach in 16 patients who had posterolateral maxillectomy for disease that arose on the maxillary alveolus or junction of the hard and soft palate (maxillary group), and in 19 who had resection of the masticatory compartment and central skull base for advanced sinonasal cancer (sinonasal group). Early proximal ligation of the maxillary artery was achieved in all but one of the 35 patients. Access to the infratemporal fossa enabled division of the pterygoid muscles and pterygoid processes under direct vision in all cases. No patient in the maxillary group had local recurrence at median follow up of 36 months. Four patients (21%) in the sinonasal group had local recurrence at median follow up of 27 months. Secondary haemorrhage from the cavernous segment of the internal carotid artery resulted in the only perioperative death. The anterolateral corridor approach enables controlled resection of tumours that extend into the masticatory compartment. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Ischemic Stroke

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge ... Your Technology Guide High Blood Pressure and Stroke Importance of Physical Activity See More Multimedia Las minorías ...

  11. Paediatric stroke

    African Journals Online (AJOL)

    2011-04-02

    Apr 2, 2011 ... Organization definition of stroke is 'a clinical syndrome of rapidly developing focal or global ..... In the case of sickle cell disease primary and secondary prevention is by ... stroke and must involve caregivers. Prognosis7,10,17.

  12. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness.

    Science.gov (United States)

    Newman-Toker, David E; Kerber, Kevin A; Hsieh, Yu-Hsiang; Pula, John H; Omron, Rodney; Saber Tehrani, Ali S; Mantokoudis, Georgios; Hanley, Daniel F; Zee, David S; Kattah, Jorge C

    2013-10-01

    Dizziness and vertigo account for about 4 million emergency department (ED) visits annually in the United States, and some 160,000 to 240,000 (4% to 6%) have cerebrovascular causes. Stroke diagnosis in ED patients with vertigo/dizziness is challenging because the majority have no obvious focal neurologic signs at initial presentation. The authors sought to compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [HINTS]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [ABCD2]). This was a cross-sectional study of high-risk patients (more than one stroke risk factor) with acute vestibular syndrome (AVS; acute, persistent vertigo or dizziness with nystagmus, plus nausea or vomiting, head motion intolerance, and new gait unsteadiness) at a single academic center. All underwent neurootologic examination, neuroimaging (97.4% by magnetic resonance imaging [MRI]), and follow-up. ABCD2 risk scores (0-7 points), using the recommended cutoff of ≥4 for stroke, were compared to a three-component eye movement battery (HINTS). Sensitivity, specificity, and positive and negative likelihood ratios (LR+, LR-) were assessed for stroke and other central causes, and the results were stratified by age. False-negative initial neuroimaging was also assessed. A total of 190 adult AVS patients were assessed (1999-2012). Median age was 60.5 years (range = 18 to 92 years; interquartile range [IQR] = 52.0 to 70.0 years); 60.5% were men. Final diagnoses were vestibular neuritis (34.7%), posterior fossa stroke (59.5% [105 infarctions, eight hemorrhages]), and other central causes (5.8%). Median ABCD2 was 4.0 (range = 2 to 7; IQR = 3.0 to 4.0). ABCD2 ≥ 4 for stroke had sensitivity of 61.1%, specificity of 62.3%, LR+ of 1.62, and LR- of 0.62; sensitivity was lower for those

  13. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  14. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?

    Directory of Open Access Journals (Sweden)

    Babl Franz E

    2011-10-01

    Full Text Available Abstract Background Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke. Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS Methods Children aged 1 month to Results 47 children with AIS were identified. 34 had anterior, 12 had posterior and 1 child had anterior and posterior circulation infarcts. Median age was 9 years and 51% were male. Median time from symptom onset to ED presentation was 21 hours but one third of children presented within 6 hours. The most common presenting stroke symptoms were arm (63%, face (62%, leg weakness (57%, speech disturbance (46% and headache (46%. The most common signs were arm (61%, face (70% or leg weakness (57% and dysarthria (34%. 36 (78% of children had at least one positive variable on FAST and 38 (81% had a positive score of ≥1 on the ROSIER scale. Positive scores were less likely in children with posterior circulation stroke. Conclusion The presenting features of pediatric stroke appear similar to adult strokes. Two adult stroke recognition tools have fair to good sensitivity in radiologically confirmed childhood AIS but require further development and modification. Specificity of the tools also needs to be determined in a prospective cohort of children with stroke and non-stroke brain attacks.

  15. Incidence of Clavicular Rhomboid Fossa in Northeastern Thais: An Anthropological Study

    Directory of Open Access Journals (Sweden)

    Ailadda Kaewma

    2016-01-01

    Full Text Available The rhomboid fossa of clavicle is used to determine the age and sex in anthropology and forensic sciences. The variant types of rhomboid fossa on inferior surface have been reported in many races except in Thais. This study therefore was aimed at classifying the types of the rhomboid fossa in Northeastern Thais. The identified 476 Northeastern Thais dried clavicles (270 males and 206 females were observed and recorded for the types of rhomboid fossa. The results showed that Thai-rhomboid fossa could be classified into 4 types: Type 1: smooth; Type 2: flat; Type 3: elevated; and Type 4: depressed, respectively. The incidences of rhomboid fossa were as follows: Type 1: 0.21%; Type 2: 19.75%; Type 3: 76.26%; and Type 4: 3.78%, respectively. Additionally, it was found that the percentage of Type 4 (11.84% was much greater than that of female (1.94% compared to other types. This incidence of rhomboid fossa types especially Type 4 may be a basic knowledge to be used in sex identification. The high incidence of rhomboid fossa in both sexes of Northeastern Thai clavicles was Type 3 (elevated type.

  16. Schwannoma of the facial nerve involving the middle cranial fossa:case report

    Institute of Scientific and Technical Information of China (English)

    SAI Ke; CHEN Zhong-ping

    2007-01-01

    @@ Facial nerve schwannoma involving the middle cranial fossa is quite rare,and its accurate diagnosis is very difficult before SUrgery.Here we present a case of schwannoma of the facial nerve at the middle cranial fossa that was misdiagnosed previously at a local hospital and then cured in our hospital.

  17. Preauricular infratemporal fossa approach for advanced malignant parotid tumors.

    Science.gov (United States)

    Leonetti, John P; Benscoter, Brent J; Marzo, Sam J; Borrowdale, Richard W; Pontikis, George C

    2012-09-01

    The aims of this study were to demonstrate the surgical technique involved in the preauricular infratemporal fossa (ITF) approach, outline the clinical indications for use of this technique, and present the results in using this approach in 159 patients with malignant parotid tumors. At the conclusion of this article, the reader should be able to understand the utility of the preauricular infratemporal fossa approach in the management of patients with advanced malignant parotid tumors. This was a retrospective chart review of 159 patients treated at a tertiary care academic medical center following institutional review board approval. A comprehensive medical records review was performed for all patients with malignant parotid tumors who underwent a preauricular ITF approach between July 1988 and July 2010. The most common presenting symptoms were pain and trismus, whereas the presence of a parotid mass and facial paralysis were the most common clinical signs. Mucoepidermoid and adenoid cystic carcinoma accounted for 63% of the tumors, and perineural invasion was found in nearly 71% of the patients. Despite negative surgical margins in 92% of the patients, local or regional tumor recurrence was found in 17% of the cases. The mean follow-up time was 12.8 years. The preauricular ITF approach should be used in the surgical extirpation of advanced malignant parotid neoplasms. This technique provides proximal facial nerve identification, internal carotid artery protection, and negative tumor margins at the skull base. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  18. [A pediatric case of hydatid cyst in the infratemporal fossa].

    Science.gov (United States)

    Hiroual, A; Elbouihi, M; Fawzi, S; Lahmiti, S; Aimmadeddine, S; Mansouri-Hattab, N

    2014-06-01

    Hydatid cyst or disease is an anthropozoonosis due to the development of the larval form of the taenia Echinococcus granulosus in humans. It is endemic in Morocco. The location of a hydatid cyst in the infratemporal fossa (ITF) is extremely rare. The authors report a pediatric case. An 11 year old child was admitted to hospital with a history of left latero-facial swelling gradually increasing in volume for 2 months, CT scan of the face revealed a cystic formation of 7 cm diameter sitting at the left ITF, hydatid serology was negative. A transzygomatic approach allowed the excision of the cyst. The histopathological examination of the resected specimen confirmed the diagnosis of hydatid cyst. The location at the infratemporal fossa of an expansive process such as hydatid cyst in children may have a particular impact on adjacent structures and a more meaningful clinical expression. The rate of growth of hydatid cysts is highly variable and ranges from 1 to 5 cm a year. Hydatid serology is often negative. CT examination is the gold-standard radiological examination. Surgical removal of the hydatid cyst is the most effective treatment. The transzygomatic approach allowed a sufficient access to the cyst and a good quality of excision. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Posterior capsule opacification.

    Science.gov (United States)

    Wormstone, I Michael; Wang, Lixin; Liu, Christopher S C

    2009-02-01

    Posterior Capsule Opacification (PCO) is the most common complication of cataract surgery. At present the only means of treating cataract is by surgical intervention, and this initially restores high visual quality. Unfortunately, PCO develops in a significant proportion of patients to such an extent that a secondary loss of vision occurs. A modern cataract operation generates a capsular bag, which comprises a proportion of the anterior and the entire posterior capsule. The bag remains in situ, partitions the aqueous and vitreous humours, and in the majority of cases, houses an intraocular lens. The production of a capsular bag following surgery permits a free passage of light along the visual axis through the transparent intraocular lens and thin acellular posterior capsule. However, on the remaining anterior capsule, lens epithelial cells stubbornly reside despite enduring the rigours of surgical trauma. This resilient group of cells then begin to re-colonise the denuded regions of the anterior capsule, encroach onto the intraocular lens surface, occupy regions of the outer anterior capsule and most importantly of all begin to colonise the previously cell-free posterior capsule. Cells continue to divide, begin to cover the posterior capsule and can ultimately encroach on the visual axis resulting in changes to the matrix and cell organization that can give rise to light scatter. This review will describe the biological mechanisms driving PCO progression and discuss the influence of IOL design, surgical techniques and putative drug therapies in regulating the rate and severity of PCO.

  20. Spondylolisthesis and Posterior Instability

    International Nuclear Information System (INIS)

    Niggemann, P.; Beyer, H.K.; Frey, H.; Grosskurth, D.; Simons, P.; Kuchta, J.

    2009-01-01

    We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI

  1. Spondylolisthesis and Posterior Instability

    Energy Technology Data Exchange (ETDEWEB)

    Niggemann, P.; Beyer, H.K.; Frey, H.; Grosskurth, D. (Privatpraxis fuer Upright MRT, Koeln (Germany)); Simons, P.; Kuchta, J. (Media Park Klinik, Koeln (Germany))

    2009-04-15

    We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI.

  2. Stroke Rehabilitation.

    Science.gov (United States)

    Belagaje, Samir R

    2017-02-01

    Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

  3. Posterior Urethral Valves

    Directory of Open Access Journals (Sweden)

    Steve J. Hodges

    2009-01-01

    Full Text Available The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality for this disorder has improved due to early diagnosis and intensive neonatal care, thanks in part to the widespread use of prenatal ultrasound evaluations. In fact, the most common reason for the diagnosis of posterior urethral valves presently is the evaluation of infants for prenatal hydronephrosis. Since these children are often diagnosed early, the urethral obstruction can be alleviated rapidly through catheter insertion and eventual surgery, and their metabolic derangements can be normalized without delay, avoiding preventable infant mortality. Of the children that survive, however, early diagnosis has not had much effect on their long-term prognosis, as 30% still develop renal insufficiency before adolescence. A better understanding of the exact cause of the congenital obstruction of the male posterior urethra, prevention of postnatal bladder and renal injury, and the development of safe methods to treat urethral obstruction prenatally (and thereby avoiding the bladder and renal damage due to obstructive uropathy are the goals for the care of children with posterior urethral valves[1].

  4. The role of ovarian fossa evaluation in patients with ovarian endometriosis.

    Science.gov (United States)

    De Cicco Nardone, Carlo; Terranova, Corrado; Plotti, Francesco; Ricciardi, Roberto; Capriglione, Stella; Luvero, Daniela; Caserta, Donatella; Moscarini, Massimo; Benedetti Panici, Pierluigi; Angioli, Roberto

    2015-10-01

    The aim of this study is to evaluate prospectively the presence of endometriosis in the peritoneum of the ovarian fossa of patients affected by endometriomas and its correlation with the adhesion between this peritoneum and endometrioma. Patients presenting ovarian endometriomas and candidate to laparoscopy were considered for inclusion in the study. Patients underwent laparoscopic excision of endometriomas. The presence of adherence of the ovarian fossa to endometrioma was investigated. In all patients, the removal of a peritoneum fragment from the ovarian fossa of the affected ovary was carried out. 68 patients were enrolled in the study. 48 patients presented adhesions to the ovarian fossa. Histopathologic examination of the peritoneum of the ovarian fossa revealed the presence of endometriosis in 87 % of patients presenting adhesions of the endometriomas with ovarian fossa; surprisingly it was present only in 15 % of patients not presenting this condition (p endometriosis on the peritoneal surface of the fossa. This condition significantly correlates with pain symptoms and may predict endometrioma recurrence. The removal of this peritoneum in case of adherent endometrioma may potentially reduce the incidence of recurrence.

  5. Posterior microphthalmos pigmentary retinopathy syndrome.

    Science.gov (United States)

    Pehere, Niranjan; Jalali, Subhadra; Deshmukh, Himanshu; Kannabiran, Chitra

    2011-04-01

    Posterior Microphthalmos Pigmentary Retinopathy Syndrome (PMPRS). Posterior microphthalmos (PM) is a relatively infrequent type of microphthalmos where posterior segment is predominantly affected with normal anterior segment measurements. Herein, we report two siblings with posterior microphthalmos retinopathy syndrome with postulated autosomal recessive mode of inheritance. A 13-year-old child had PM and retinitis pigmentosa (RP) and his 7-year-old sister had PM, RP, and foveoschisis. The genetics of this syndrome and variable phenotype is discussed. Importance of being aware of posterior microphthalmos and its posterior segment associations is highlighted.

  6. Stroke Care 2: Stroke rehabilitation

    NARCIS (Netherlands)

    Langhorne, P.; Bernhardt, J.; Kwakkel, G.

    2011-01-01

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

  7. Ischiorectal abscess and ischiorectal-vaginal fistula as delayed complications of posterior intravaginal slingplasty: a case report.

    Science.gov (United States)

    Chen, Heidi Wen-Chu; Guess, Marsha K; Connell, Kathleen A; Bercik, Richard S

    2009-10-01

    Synthetic meshes have been used extensively to augment surgical management of pelvic organ prolapses. Posterior intravaginal sling (IVS) is a technique used for correcting vaginal vault/apical prolapse, posterior vaginal prolapse or rectocele. There are limited data on long-term safety of this procedure. In a subanalysis of the IVS tapes from the SUSPEND trial performed secondary to the large number of patients with complications of suburethral sling erosions after IVS, it was noted that the sling erosion tended to have a delayed presentation secondary to poor incorporation of the mesh. A 48-year-old woman with cystocele, uterine prolapse and rectocele had undergone total vaginal hysterectomy, mesh-augmented anterior repair, posterior colporrhaphy and posterior intravaginal slingplasty (IVS) in July 2005. Thirty months after the surgery, she presented with gradual symptoms of copious vaginal discharge for several weeks followed by constant right buttock pain and swelling. Examination was notable for intact mesh with no signs of erosion and a 3-cm induration deep within the right buttock. Computed tomography suggested a pelvic abscess. Magnetic resonance imaging confirmed a right ischiorectal fossa abscess and a vaginal fistula. The patient underwent sling excision, right ischiorectal fossa exploration and vaginal fistula repair. A fistulous tract was found to extend along the intact sling from the vaginal epithelium toward the right ischiorectal fossa. At 2 months' followup, there were no recurrences or other complications. This is the first report of a delayed complication of an ischiorectal abscess associated with an ischiorectal-vaginal fistula that presented 30 months after the placement of a posterior IVS.

  8. Robotic posterior retroperitoneal adrenalectomy.

    Science.gov (United States)

    Okoh, Alexis Kofi; Yigitbas, Hakan; Berber, Eren

    2015-09-01

    Since its initial description by Mercan et al. laparoscopic posterior retroperitoneal (PR) adrenalectomy has served as an alternaltive to the transabdominal (TL) approach for the treatment of adrenal pathologies. Robotic adrenal surgery has been reported to improve surgeon ergonomics and facilitate dissection. In patients with bilateral adrenal masses, PR adrenalectomy may be the approach of choice. We herein describe the technique, discuss its limitations and present a critical review of the current literature. © 2015 Wiley Periodicals, Inc.

  9. Endovascular treatment of a true posterior communicating artery aneurysm

    OpenAIRE

    Munarriz, Pablo M.; Castaño-Leon, Ana M.; Cepeda, Santiago; Campollo, Jorge; Alén, Jose F.; Lagares, Alfonso

    2014-01-01

    Background: Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. Case Description: A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. F...

  10. Preventing stroke

    Science.gov (United States)

    ... with which you were born Changes to your lifestyle You can change some risk factors for stroke, ... sodium (salt). Read labels and stay away from unhealthy fats. Avoid foods with: Saturated fat Partially-hydrogenated ...

  11. Stroke Rehabilitation

    Science.gov (United States)

    ... of the effects of a stroke Trouble swallowing (dysphagia) Problems with bowel or bladder control Fatigue Difficulty ... NINDS Focus on Disorders Alzheimer's & Related Dementias Epilepsy Parkinson's Disease Spinal Cord Injury Traumatic Brain Injury Focus ...

  12. Decreased Sudomotor Function is Involved in the Formation of Atopic Eczema in the Cubital Fossa

    Directory of Open Access Journals (Sweden)

    Aya Takahashi

    2013-01-01

    Conclusions: These results suggest that decreased sweating is a major source of water in the stratum corneum, and decreased sudomotor function may be involved in both the cause and aggravation of representative atopic eczema in the cubital fossa.

  13. Remote multiple intracranial hemorrhage in multiple metastatic lung adenocarcinoma following decompression of posterior fossa lesion: Unknown cause

    Directory of Open Access Journals (Sweden)

    Subhas Konar

    2015-01-01

    Full Text Available Cerebral metastasis can present with hemorrhage. However, multiple hemorrhages in metastatic lesions following surgical decompression of a single lesion are never reported. We report a case of cerebral metastasis from lung cancer that developed multiple hemorrhages in supratentorial metastatic lesions following surgical resection of an infratentorial lesion.

  14. Nonprojectile penetrating iron rod from the oral cavity to the posterior cranial fossa: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Lan ZG

    2018-03-01

    Full Text Available Zhi Gang Lan,1 Seidu A Richard,1–3 Jin Li,1 Chaohua Yang1 1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Department of Immunology, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China; 3Department of Surgery, Volta Regional Hospital, Ho, Ghana, West Africa Introduction: Nonprojectile penetrating skull base injuries as a result of falls have rarely been confronted in normal neurosurgery although a few nonmissile injuries have been reported. These kinds of injuries represent a life-threatening emergency. Case presentation: We present an unusual case of a 25-year-old male construction worker who suffered an accidental penetrating skull base injury when he fell on a metal rod while he was walking on a 2-meter-high platform. He was clinically stable at presentation. Skull radiograph showed a solid metallic bar, 30 cm long, that penetrated through the right anguli oris eminence and was lodged low in the right occipital bone. Conclusion: Penetrating injury to the head is considered a form of severe traumatic brain injury. Although case of penetrating head injuries as a result of fall from heights are very rare, we anticipate the construction works on high-rise buildings are at maximum risk. We advise that removal of this kind of foreign bodies be done in the theater and not outside because of risk of involvement of larger vessels leading to fatal hemorrhage. We further suggest that patients with nonprojectile injuries should undergo a preoperative computed tomography-angiography to rule out any vascular injury. Keywords: nonprojectile, fall, hemorrhage, skull, penetrating injury, construction

  15. Unusual Ventilatory Response to Exercise in Patient with Arnold-Chiari Type 1 Malformation after Posterior Fossa Decompression

    Directory of Open Access Journals (Sweden)

    Keely Smith

    2016-01-01

    Full Text Available We present a case of a 17-year-old Hispanic male with Arnold-Chiari Type 1 [AC-Type 1] with syringomyelia, status post decompression, who complains of exercise intolerance, headaches, and fatigue with exertion. The patient was found to have diurnal hypercapnia and nocturnal alveolar hypoventilation. Cardiopulmonary testing revealed blunting of the ventilatory response to the rise in carbon dioxide (CO2 resulting in failure of the parallel correlation between increased CO2 levels and ventilation; the expected vertical relationship between PETCO2 and minute ventilation during exercise was replaced with an almost horizontal relationship. No new pathology of the brainstem was discovered by MRI or neurological evaluation to explain this phenomenon. The patient was placed on continuous noninvasive open ventilation (NIOV during the day and CPAP at night for a period of 6 months. His pCO2 level decreased to normal limits and his symptoms improved; specifically, he experienced less headaches and fatigue during exercise. In this report, we describe the abnormal response to exercise that patients with AC-Type 1 could potentially experience, even after decompression, characterized by the impairment of ventilator response to hypercapnia during exertion, reflecting a complete loss of chemical influence on breathing with no evidence of abnormality in the corticospinal pathway.

  16. [Positional damage of the sciatic nerve during neurosurgical intervention into the posterior cranial fossa in the sitting position].

    Science.gov (United States)

    Konovalov, A N; Lubnin, A Iu; Shimanskiĭ, V N; Kolycheva, M V; Ogurtsova, A A; Grigorian, A A

    2009-01-01

    The paper describes a rare case of severe, but reversible bilateral damage to the sciatic nerve (compression neuropathy) in a patient with Blumenbach's clivus meningioma developing during 12-hour operation removing the tumor in the patient's sitting position on the operating table. The etiology and prevention of this complication are discussed.

  17. Giant posterior fossa mature teratoma with adjacent subacute haematoma, compressive on the brainstem, with acute hydrocephalus. Case report

    Directory of Open Access Journals (Sweden)

    Balasa D.

    2016-09-01

    Full Text Available Mature teratoma of the vermis is a rare entity in neurosurgical adulthood pathology. We present the case of a 65 years old patient, admited as an emergency for intense headache (VAS 8/10, nausea, vomiting, gait ataxia, orizontal nistagmus, dismetria, disdiadocokinezia, predominant on the left side, long tracts signs, predominant on the left side. Native and contrast CT and MRI scan of the head revealed a tumoral lesion, in the vermian, paravermian and in the fourth ventricle, with the aspect of a teratoma with intratumoral subacute haemorrhage including a giant lesion 5,5/5/4,5 cm, compressive on mesencephalon, and with suprajacent acute internal hidrocephalus. Emergency neurosurgery was performed (occipital infratentorial craniectomy, microneurosurgical total tumoral resection and haematoma evacuation. Postoperative, the patient recovered progressivelly , subtotal neo and arhicerebellar symptoms. The motor long tract signs recovered slower and persisted incomplete.

  18. The Posterior Fossa and Foreign Accent Syndrome : Report of Two New Cases and Review of the Literature

    NARCIS (Netherlands)

    Keulen, Stefanie; Mariën, Peter; van Dun, Kim; Bastiaanse, Roelien; Manto, Mario; Verhoeven, Jo

    Foreign accent syndrome is a rare motor speech disorder that causes patients to speak their language with a non-native accent. In the neurogenic condition, the disorder develops after lesions in the language dominant hemisphere, often affecting Broca's area, the insula, the supplementary motor area

  19. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  20. Effect of Rapid Maxillary Expansion on Glenoid Fossa and Condyle-Fossa Relationship in Growing Patients (MEGP): Study Protocol for a Controlled Clinical Trial

    Science.gov (United States)

    Ghoussoub, Mona Sayegh; Rifai, Khaldoun; Garcia, Robert; Sleilaty, Ghassan

    2018-01-01

    Aims and Objectives: Rapid maxillary expansion (RME) is an orthodontic nonsurgical procedure aiming at increasing the width of the maxilla by opening mainly the intermaxillary suture in patients presenting a transverse maxillary skeletal deficiency. The objectives of the current prospective controlled clinical and radiographic study are to evaluate the hypothesis that RME in growing patients will result in radiographic changes at the level of interglenoid fossa distance, condyle-fossa relationship, and nasal cavity widths compared to the group who received no treatment initially and served as untreated control. Materials and Methods: In this prospective controlled clinical and radiographic study, forty healthy growing patients selected from a school-based population following a large screening campaign, ranging in age between 8 and 13 years, presenting a maxillary constriction with bilateral crossbite, and candidates for RME are being recruited. The first group will include participants willing to undergo treatment (n = 25) and the other group will include those inclined to postpone (n = 15). Results: The primary outcome is to compare radiologically the interglenoid fossa distance and the condyle-fossa relationship; nasal cavity width will be a secondary outcome. A multivariable analysis of Covariance model will be used, with the assessment of the time by group interaction, using age as covariate. The project protocol was reviewed and approved by the Ethics Committee of the Lebanese University, National Institute in Lebanon (CUEMB process number 31/04/2015). The study is funded by the Lebanese University and Centre National de Recherche Scientifique, Lebanon (Number: 652 on 14/04/2016). Conclusion: This prospective controlled clinical trial will give information about the effect of RME on the glenoid fossa and condyle-fossa relationship and its impact on the nasal cavity width. Trial Registration: Retrospectively registered in BioMed Central (DOI10.1186/ISRCTN

  1. Dislocation of a mandibular condyle in the middle cranial fossa, diagnosed 54 years after trauma

    OpenAIRE

    De Mol, Antoni; Nicolielo, Laura; Ghekiere, Olivier; Jacobs, Reinhilde; Politis, Constantinus

    2017-01-01

    Abstract Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma. We report the remarkable case of a 63-year-old patient in whom trauma 54 years prior to consultation resulted in intrusion of the right mandibular condyle into the middle cranial fossa. The diagnosis was missed because of insufficient data provided by conventional radiographies. Failure of timely diagnosis and lack of appropriate treatment resulted in temporomandibular joi...

  2. Endoscopic transnasal resection of anterior cranial fossa meningiomas.

    Science.gov (United States)

    de Divitiis, Enrico; Esposito, Felice; Cappabianca, Paolo; Cavallo, Luigi M; de Divitiis, Oreste; Esposito, Isabella

    2008-01-01

    The extended transnasal approach, a recent surgical advancements for the ventral skull base, allows excellent midline access to and visibility of the anterior cranial fossa, which was previously thought to be approachable only via a transcranial route. The extended transnasal approach allows early decompression of the optic canals, obviates the need for brain retraction, and reduces neurovascular manipulation. Between 2004 and 2007, 11 consecutive patients underwent transnasal resection of anterior cranial fossa meningiomas--4 olfactory groove (OGM) and 7 tuberculum sellae (TSM) meningiomas. Age at surgery, sex, symptoms, and imaging studies were reviewed. Tumor size and tumor extension were estimated, and the anteroposterior, vertical, and horizontal diameters were measred on MR images. Medical records, surgical complications, and outcomes of the patients were collected. A gross-total removal of the lesion was achieved in 10 patients (91%), and in 1 patient with a TSM only a near-total (> 90%) resection was possible. Four patients with preoperative visual function defect had a complete recovery, whereas 3 patients experienced a transient worsening of vision, fully recovered within few days. In 3 patients (2 with TSMs and 1 with an OGM), a postoperative CSF leak occurred, requiring a endoscopic surgery for skull base defect repair. Another patient (a case involving a TSM) developed transient diabetes insipidus. The operative time ranged from 6 to 10 hours in the OGM group and from 4.5 to 9 hours in the TSM group. The mean duration of the hospital stay was 13.5 and 10 days in the OGM and TSM groups, respectively. Six patients (3 with OGMs and 3 with TSMs) required a blood transfusion. Surgery-related death occurred in 1 patient with TSM, in whom the tumor was successfully removed. The technique offers a minimally invasive route to the midline anterior skull base, allowing the surgeon to avoid using brain retraction and reducing manipulation of the large vessels and

  3. Glenoid fossa position in Class III malocclusion associated with mandibular protrusion.

    Science.gov (United States)

    Innocenti, Cristina; Giuntini, Veronica; Defraia, Efisio; Baccetti, Tiziano

    2009-04-01

    Our aim in this study was to investigate the position of the glenoid fossa in subjects with Class III malocclusion associated with mandibular protrusion to better clarify the role of this craniofacial component in Class III skeletal disharmony. A sample of 30 subjects, aged 8 years +/- 6 months, with skeletal and dental Class III malocclusion associated with mandibular protrusion, normal skeletal vertical relationships, and normal mandibular dimensions, was compared with a control group of 33 subjects with skeletal and dental Class I relationships. The comparisons between the Class III group and the control group on the cephalometric measures for the assessment of glenoid fossa position were performed with the Mann-Whitney U test at P <0.05. Subjects with Class III malocclusion had a significantly more mesial position of the glenoid fossa, when compared with the control group as measured with 3 parameters. An anterior position of the glenoid fossa is a possible diagnostic anatomic feature of Class III malocclusion associated with mandibular protrusion. An effective measurement to evaluate glenoid fossa position in craniofacial relationships is the cephalometric distance from the glenoid fossa to the frontomaxillary-nasal suture.

  4. Reversible posterior leukoencephalopathy syndrome

    International Nuclear Information System (INIS)

    Lee, Eun Ja; Yu, Won Jong; Ahn, Kook Jin; Jung, So Lyung; Lee, Yeon Soo; Kim, Ji Chang; Kang, Si Won; Song, Chang Joon; Song, Soon-Young; Koo, Ja Hong; Kim, Man Deuk

    2001-01-01

    To review reversible posterior leukoencephalopathy syndrome. We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine ; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes ; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement ; in one, enhancement was mild, and in tow, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions ; in two, small infarctions remained but the extent of the lesions had decreased. Reversible posterior

  5. Reversible posterior leukoencephalopathy syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Ja; Yu, Won Jong; Ahn, Kook Jin; Jung, So Lyung; Lee, Yeon Soo; Kim, Ji Chang; Kang, Si Won [The Catholic Univ. of Korea, Taejon (Korea, Republic of); Song, Chang Joon [Chungnam National Univ. School of Medicine, Cheonju (Korea, Republic of); Song, Soon-Young; Koo, Ja Hong [Kwandong Univ. College of Medicine, Myungji Hospital, Seoul (Korea, Republic of); Kim, Man Deuk [College of Medicine Pochon CHA Univ., Seoul (Korea, Republic of)

    2001-10-01

    To review reversible posterior leukoencephalopathy syndrome. We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine ; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes ; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement ; in one, enhancement was mild, and in tow, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions ; in two, small infarctions remained but the extent of the lesions had decreased. Reversible posterior

  6. Posterior Urethral Strictures

    Directory of Open Access Journals (Sweden)

    Joel Gelman

    2015-01-01

    Full Text Available Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty.

  7. Posterior Urethral Strictures

    Science.gov (United States)

    Gelman, Joel; Wisenbaugh, Eric S.

    2015-01-01

    Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty. PMID:26691883

  8. Atherosclerosis and Stroke

    Science.gov (United States)

    ... Stroke Association.org Professionals for Stroke Association.org Shop for Stroke Association.org Support for Stroke Association. ... endothelium significantly. The artery’s diameter shrinks and blood flow decreases, reducing oxygen supply. How atherosclerotic plaque causes ...

  9. The management of right iliac fossa pain - is timing everything?

    LENUS (Irish Health Repository)

    McCartan, D P

    2012-01-31

    BACKGROUND: Right iliac fossa (RIF) pain remains the commonest clinical dilemma encountered by general surgeons. We prospectively audited the management of acute RIF pain, examining the relationship between symptom duration, use of pre-operative radiological imaging and patient outcome. METHODS: Over a six-month period, 302 patients, median age 18 years, 59% female, were admitted with RIF pain. Symptoms, clinical findings and laboratory results were documented. Patient management, timing of radiological investigations and operations, and outcome were recorded prospectively. RESULTS: Non-specific abdominal pain (26%), gynaecological (22%) and miscellaneous causes (14%) accounted for most admissions. Ultimately, 119 patients (39%) had appendicitis. Anorexia, tachycardia or rebound tenderness in the RIF significantly predicted a final diagnosis of appendicitis. Patients with perforated appendicitis (n = 29) had a longer duration of pre-hospital symptoms (median 50h) compared to those with simple appendicitis (median 17 h) (p<0.001). The use of pre-operative imaging resulted in an increased time to surgery but was not associated with increased post-operative morbidity or perforated appendicitis. CONCLUSION: The majority of patients presenting to hospital with RIF pain did not have appendicitis. Increased duration of pre-hospital symptoms was the main factor associated with perforated appendicitis. However, increased in-hospital time to theatre was not associated with perforated appendicitis or post-operative morbidity.

  10. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability

    International Nuclear Information System (INIS)

    Weishaupt, D.; Zanetti, M.; Hodler, J.; Nyffeler, R.W.; Gerber, C.

    2000-01-01

    Objective. To assess the shape of the posterior glenoid rim in patients with recurrent (atraumatic) posterior instability.Design and patients. CT examinations of 15 shoulders with recurrent (atraumatic) posterior instability were reviewed in masked fashion with regard to abnormalities of the glenoid shape, specifically of its posterior rim. The glenoid version was also assessed. The findings were compared with the findings in 15 shoulders with recurrent anterior shoulder instability and 15 shoulders without instability. For all patients, surgical correlation was available.Results. Fourteen of the 15 (93%) shoulders with recurrent (atraumatic) posterior shoulder instability had a deficiency of the posteroinferior glenoid rim. In patients with recurrent anterior instability or stable shoulders such deficiencies were less common (60% and 73%, respectively). The craniocaudal length of the deficiencies was largest in patients with posterior instability. When a posteroinferior deficiency with a craniocaudal length of 12 mm or more was defined as abnormal, sensitivity and specificity for diagnosing recurrent (atraumatic) posterior instability were 86.7% and 83.3%, respectively. There was a statistically significant difference in glenoid version between shoulders with posterior instability and stable shoulders (P=0.01).Conclusion. Recurrent (atraumatic) posterior shoulder instability should be considered in patients with a bony deficiency of the posteroinferior glenoid rim with a craniocaudal length of more than 12 mm. (orig.)

  11. Heat Stroke

    DEFF Research Database (Denmark)

    Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg

    2017-01-01

    not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat......Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity...... and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...

  12. Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension.

    Science.gov (United States)

    Tripathi, Manjul; Deo, Rama Chandra; Suri, Ashish; Srivastav, Vinkle; Baby, Britty; Kumar, Subodh; Kalra, Prem; Banerjee, Subhashis; Prasad, Sanjiva; Paul, Kolin; Roy, Tara Sankar; Lalwani, Sanjeev

    2015-07-01

    The surgical corridor to the upper third of the clivus and ventral brainstem is hindered by critical neurovascular structures, such as the cavernous sinus, petrous apex, and tentorium. The traditional Kawase approach provides a 10 × 5-mm fenestration at the petrous apex of the temporal bone between the 5th cranial nerve and internal auditory canal. Due to interindividual variability, sometimes this area proves to be insufficient as a corridor to the posterior cranial fossa. The authors describe a modification to the technique of the extradural anterior petrosectomy consisting of additional transcavernous exploration and medial mobilization of the cisternal component of the trigeminal nerve. This approach is termed the modified Dolenc-Kawase (MDK) approach. The authors describe a volumetric analysis of temporal bones with 3D laser scanning of dry and drilled bones for respective triangles and rhomboid areas, and they compare the difference of exposure with traditional versus modified approaches on cadaver dissection. Twelve dry temporal bones were laser scanned, and mesh-based volumetric analysis was done followed by drilling of the Kawase triangle and MDK rhomboid. Five cadaveric heads were drilled on alternate sides with both approaches for evaluation of the area exposed, surgical freedom, and angle of approach. The MDK approach provides an approximately 1.5 times larger area and 2.0 times greater volume of bone at the anterior petrous apex compared with the Kawase's approach. Cadaver dissection objectified the technical feasibility of the MDK approach, providing nearly 1.5-2 times larger fenestration with improved view and angulation to the posterior cranial fossa. Practical application in 6 patients with different lesions proves clinical applicability of the MDK approach. The larger fenestration at the petrous apex achieved with the MDK approach provides greater surgical freedom at the Dorello canal, gasserian ganglion, and prepontine area and better

  13. Progressive posterior cortical dysfunction

    Directory of Open Access Journals (Sweden)

    Fábio Henrique de Gobbi Porto

    Full Text Available Abstract Progressive posterior cortical dysfunction (PPCD is an insidious syndrome characterized by prominent disorders of higher visual processing. It affects both dorsal (occipito-parietal and ventral (occipito-temporal pathways, disturbing visuospatial processing and visual recognition, respectively. We report a case of a 67-year-old woman presenting with progressive impairment of visual functions. Neurologic examination showed agraphia, alexia, hemispatial neglect (left side visual extinction, complete Balint's syndrome and visual agnosia. Magnetic resonance imaging showed circumscribed atrophy involving the bilateral parieto-occipital regions, slightly more predominant to the right . Our aim was to describe a case of this syndrome, to present a video showing the main abnormalities, and to discuss this unusual presentation of dementia. We believe this article can contribute by improving the recognition of PPCD.

  14. Progressive posterior cortical dysfunction

    Science.gov (United States)

    Porto, Fábio Henrique de Gobbi; Machado, Gislaine Cristina Lopes; Morillo, Lilian Schafirovits; Brucki, Sonia Maria Dozzi

    2010-01-01

    Progressive posterior cortical dysfunction (PPCD) is an insidious syndrome characterized by prominent disorders of higher visual processing. It affects both dorsal (occipito-parietal) and ventral (occipito-temporal) pathways, disturbing visuospatial processing and visual recognition, respectively. We report a case of a 67-year-old woman presenting with progressive impairment of visual functions. Neurologic examination showed agraphia, alexia, hemispatial neglect (left side visual extinction), complete Balint’s syndrome and visual agnosia. Magnetic resonance imaging showed circumscribed atrophy involving the bilateral parieto-occipital regions, slightly more predominant to the right. Our aim was to describe a case of this syndrome, to present a video showing the main abnormalities, and to discuss this unusual presentation of dementia. We believe this article can contribute by improving the recognition of PPCD. PMID:29213665

  15. Implante coclear via fossa craniana média: uma nova técnica para acesso ao giro basal da cóclea Cochlear implantation through the middle cranial fossa: a novel approach to access the basal turn of the cochlea

    Directory of Open Access Journals (Sweden)

    Aline Gomes Bittencourt

    2013-04-01

    Full Text Available A técnica clássica para o implante coclear é realizada através de mastoidectomia e timpanotomia posterior. A abordagem pela fossa craniana média provou ser uma alternativa valiosa, embora venha sendo usada para o implante coclear apenas esporadicamente e sem normatização. OBJETIVO: Descrever uma nova abordagem para expor o giro basal da cóclea para o implante coclear através da fossa craniana média. MÉTODO: Cinquenta ossos temporais foram dissecados. A cocleostomia foi realizada através de uma abordagem via fossa craniana média, na parte mais superficial do giro basal da cóclea, usando o plano meatal e seio petroso superior como pontos de reparo. A parede lateral do meato acústico interno foi dissecada após o broqueamento e esqueletização do ápice petroso. A parede dissecada do meato acústico interno foi acompanhada longitudinalmente até a cocleostomia. Design: Estudo anatômico de osso temporal. RESULTADOS: Em todos os ossos temporais, apenas a parte superficial do giro basal da cóclea foi aberta. A exposição do giro basal da cóclea permitiu que as escalas timpânica e vestibular fossem visualizadas. Assim, não houve dificuldade na inserção do feixe de eletrodos através da escala timpânica. CONCLUSÃO: A técnica proposta é simples e permite exposição suficiente do giro basal da cóclea.The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation. OBJECTIVE: To describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa. METHOD: Fifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and

  16. Posterior brain in fetuses with open spina bifida at 11 to 13 weeks.

    Science.gov (United States)

    Lachmann, Robert; Chaoui, Rabih; Moratalla, Jose; Picciarelli, Gemma; Nicolaides, Kypros H

    2011-01-01

    To measure the changes in the posterior fossa in first-trimester fetuses with open spina bifida (OSB). The brain stem diameter and brain stem to occipital bone (BSOB) diameter were measured in stored images of the mid-sagittal view of the fetal face at 11(+0) to 13(+6) weeks from 30 fetuses with OSB and 1000 normal controls. In the control group, the brain stem and BSOB diameter increased significantly with crown-rump length (CRL) and the brain stem to BSOB ratio decreased. In the spina bifida group, the brain stem diameter was above the 95th percentile of the control group in 29 (96.7%) cases, the BSOB diameter was below the 5th percentile in 26 (86.7%) and the brain stem to BSOB ratio was above the 95th percentile in all cases. At 11 to 13 weeks the majority of fetuses with OSB have measurable abnormalities in the posterior brain.

  17. The enlargement of geniculate fossa of facial nerve canal: a new CT finding of facial nerve canal fracture

    International Nuclear Information System (INIS)

    Gong Ruozhen; Li Yuhua; Gong Wuxian; Wu Lebin

    2006-01-01

    Objective: To discuss the value of enlargement of geniculate fossa of facial nerve canal in the diagnosis of facial nerve canal fracture. Methods: Thirty patients with facial nerve canal fracture underwent axial and coronal CT scan. The correlation between the fracture and the enlargement of geniculate fossa of facial nerve canal was analyzed. The ability of showing the fracture and enlargement of geniculate fossa of facial nerve canal in axial and coronal imaging were compared. Results: Fracture of geniculate fossa of facial nerve canal was found in the operation in 30 patients, while the fracture was detected in CT in 18 patients. Enlargement of geniculate ganglion of facial nerve was detected in 30 patients in the operation, while the enlargement of fossa was found in CT in 28 cases. Enlargement and fracture of geniculate fossa of facial nerve canal were both detected in CT images in 18 patients. Only the enlargement of geniculate fossa of facial nerve canal was shown in 12 patients in CT. Conclusion: Enlargement of geniculate fossa of facial nerve canal was a useful finding in the diagnosis of fracture of geniculate fossa in patients with facial paralysis, even no fracture line was shown on CT images. (authors)

  18. Isolated transient vertigo: posterior circulation ischemia or benign origin?

    Science.gov (United States)

    Blasberg, Tobias F; Wolf, Lea; Henke, Christian; Lorenz, Matthias W

    2017-06-14

    Isolated transient vertigo can be the only symptom of posterior circulation ischemia. Thus, it is important to differentiate isolated vertigo of a cerebrovascular origin from that of more benign origins, as patients with cerebral ischemia have a much higher risk for future stroke than do those with 'peripheral' vertigo. The current study aims to identify risk factors for cerebrovascular origin of isolated transient vertigo, and for future cerebrovascular events. From the files of 339 outpatients with isolated transient vertigo we extracted history, clinical and technical findings, diagnosis, and follow-up information on subsequent stroke or transient ischemic attack (TIA). Risk factors were analyzed using multivariate regression models (logistic or Cox) and reconfirmed in univariate analyses. On first presentation, 48 (14.2%) patients received the diagnosis 'probable or definite cerebrovascular vertigo'. During follow-up, 41 patients suffered stroke or TIA (event rate 7.9 per 100 person years, 95% confidence interval (CI) 5.5-10.4), 26 in the posterior circulation (event rate 4.8 per 100 person years, 95% CI 3.0-6.7). The diagnosis was not associated with follow-up cerebrovascular events. In multivariate models testing multiple potential determinants, only the presentation mode was consistently associated with the diagnosis and stroke risk: patients who presented because of vertigo (rather than reporting vertigo when they presented for other reasons) had a significantly higher risk for future stroke or TIA (p = 0.028, event rate 13.4 vs. 5.4 per 100 person years) and for future posterior circulation stroke or TIA (p = 0.044, event rate 7.8 vs. 3.5 per 100 person years). We here report for the first time follow-up stroke rates in patients with transient isolated vertigo. In such patients, the identification of those with cerebrovascular origin remains difficult, and presentation mode was found to be the only consistent risk factor. Confirmation in an independent

  19. Endoscopic Management of Posterior Epistaxis

    OpenAIRE

    Paul, J.; Kanotra, Sohit Paul; Kanotra, Sonika

    2011-01-01

    The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26–50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of ...

  20. A Percutaneous Transtubular Middle Fossa Approach for Intracanalicular Tumors.

    Science.gov (United States)

    Bernardo, Antonio; Evins, Alexander I; Tsiouris, Apostolos J; Stieg, Philip E

    2015-07-01

    In cases of small intracanalicular tumors (≤ 1.5 cm), the middle fossa approach (MFA) provides the ability for adequate tumor removal with preservation of existing auditory function. Application of a minimally invasive tubular retractor in this approach may help mitigate the risk of postoperative seizures, aphasia, and venous complications by minimizing intraoperative retraction of the temporal lobe. We propose a minimally invasive microscopic and/or endoscopic percutaneous transtubular MFA for the management of intracanalicular tumors. Subtemporal keyhole craniectomies were performed on 5 preserved cadaveric heads (10 sides), with 6 sides previously injected with a synthetic tumor model. A ViewSite Brain Access System tubular retractor (Vycor Medical, Inc., Boca Raton, Florida, USA) was used to provide minimal temporal retraction and protection of the surrounding anatomy. An extradural dissection of the internal auditory canal was performed under microscopic and endoscopic visualization with a minimally invasive surgical drill and tube shaft instruments, the intracanalicular tumors were removed, and degree of resection was assessed. All 10 approaches were completed successfully through the tubular retractor with minimal retraction of the temporal lobe. Excellent visualization of the structures within the internal auditory canal was achieved with both the microscope and 3-dimensional endoscope. On the 6 synthetic intracanalicular tumors resected, 5 gross total (Grade I) and 1 near total (Grade II) resections were achieved. A percutaneous transtubular MFA is a feasible minimally invasive option for resection of small intracanalicular tumors with potential preservation of auditory function, reduced temporal retraction, and enhanced protection of surrounding structures. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. 3D printing the pterygopalatine fossa: a negative space model of a complex structure.

    Science.gov (United States)

    Bannon, Ross; Parihar, Shivani; Skarparis, Yiannis; Varsou, Ourania; Cezayirli, Enis

    2018-02-01

    The pterygopalatine fossa is one of the most complex anatomical regions to understand. It is poorly visualized in cadaveric dissection and most textbooks rely on schematic depictions. We describe our approach to creating a low-cost, 3D model of the pterygopalatine fossa, including its associated canals and foramina, using an affordable "desktop" 3D printer. We used open source software to create a volume render of the pterygopalatine fossa from axial slices of a head computerised tomography scan. These data were then exported to a 3D printer to produce an anatomically accurate model. The resulting 'negative space' model of the pterygopalatine fossa provides a useful and innovative aid for understanding the complex anatomical relationships of the pterygopalatine fossa. This model was designed primarily for medical students; however, it will also be of interest to postgraduates in ENT, ophthalmology, neurosurgery, and radiology. The technical process described may be replicated by other departments wishing to develop their own anatomical models whilst incurring minimal costs.

  2. Congenital cholesteatoma of the infratemporal fossa with congenital aural atresia and mastoiditis: a case report

    Directory of Open Access Journals (Sweden)

    Abdel-Aziz Mosaad

    2012-06-01

    Full Text Available Abstract Background Congenital cholesteatoma may be expected in abnormally developed ear, it may cause bony erosion of the middle ear cleft and extend to the infratemporal fossa. We present the first case of congenital cholesteatoma of the infratemporal fossa in a patient with congenital aural atresia that has been complicated with acute mastoiditis. Case presentation A sixteen year old Egyptian male patient presented with congenital cholesteatoma of the infratemporal fossa with congenital aural atresia complicated with acute mastoiditis. Two weeks earlier, the patient suffered pain necessitating hospital admission, magnetic resonance imaging revealed a soft tissue mass in the right infratemporal fossa. On presentation to our institute, Computerized tomography was done as a routine, it proved the diagnosis of mastoiditis, pure tone audiometry showed an air-bone gap of 60 dB. Cortical mastoidectomy was done for treatment of mastoiditis, removal of congenital cholesteatoma was carried out with reconstruction of external auditory canal. Follow-up of the patient for 2 years and 3 months showed a patent, infection free external auditory canal with an air-bone gap has been reduced to 35db. One year after the operation; MRI was done and it showed no residual or recurrent cholesteatoma. Conclusions Congenital cholesteatoma of the infratemporal fossa in cases of congenital aural atresia can be managed safely even if it was associated with mastoiditis. It is an original case report of interest to the speciality of otolaryngology.

  3. Xylometazoline abuse induced ischemic stroke in a young adult.

    Science.gov (United States)

    Leupold, Daniela; Wartenberg, Katja E

    2011-01-01

    substance abuse is an important cause of ischemic stroke in the young. This includes over-the-counter dietary supplements and cough and cold remedies, which were reported to be an independent risk factor for hemorrhagic stroke. this article describes a young male patient with acute ischemic infarctions in the posterior inferior cerebellar and posterior cerebral artery territories bilaterally, the right cerebral peduncle, the left pontine tegmentum, and lateral pons following abuse of xylometazoline-containing nasal decongestant for 10 years. this is the first report in the literature of posterior circulation strokes because of chronic xylometazoline abuse. We hope to contribute to increase knowledge and awareness of the public about these serious complications of cough-and-cold remedies as well as dietary supplements containing sympathomimetics.

  4. Radiographic and computed tomographic evaluation of the canine intercondylar fossa in normal stifles and after notchplasty in stable and unstable stifles

    International Nuclear Information System (INIS)

    Fitch, R.B.; Hathcock, J.T.; Montgomery, R.D.

    1996-01-01

    The role of the intercondylar fossa in cranial cruciate ligament injury has gained notable attention in humans and it's role is now being questioned in animals. Controversy exists regarding the accuracy of radiographs and computed tomography (CT) in evaluating the intercondylar fossa. This study compared radiographic and CT evaluation with gross evaluation of the intercondylar fossa. Six greyhounds were evaluated before notchplasty, immediately after notchplasty and 6 months after notchplasty in stable and unstable stifles. A fossa width index was used for comparison because it negates the effects of patient size and radiographic magnification. The fossa width index is calculated by dividing the width of the intercondylar fossa by the total condylar width. The fossa width indices of dogs determined from radiographs and CT were not significantly different before notchplasty except for the cranial fossa width indices which were more inconsistent and tended to underestimate the size when compared to gross measurements. At six months, both stable and unstable stifles had refilling of the notchplasty, but the unstable stifles had significantly greater refilling resulting in no significant enlargement in intercondylar fossa size as compared to the prenotchplasty size. Osteophytes that occurred within the intercondylar fossa were less radiopaque and more easily visualized by computed tomography. Computed tomography provided several advantages, including clearer visualization of the intercondylar fossa, avoiding superimposition of the intercondylar fossa by caudal thigh muscles or tuber ischii and the ability to analyze the cranial and caudal components of the intercondylar fossa separately

  5. Recurrent Wernicke's aphasia: migraine and not stroke!

    Science.gov (United States)

    Mishra, Nishant Kumar; Rossetti, Andrea O; Ménétrey, André; Carota, Antonio

    2009-05-01

    We report the clinical findings of a 40-year-old woman with recurrent migraine presenting with Wernicke's aphasia in accordance with the results of a standardized battery for language assessment (Boston Aphasia Diagnostic Examination). The patient had no evidence of parenchymal or vascular lesions on MRI and showed delta and theta slowing over the left posterior temporal leads on the EEG. Although the acute onset of a fluent aphasia suggested stroke as a likely etiology, the recurrence of aphasia as the initial symptom of migraine was related to cortical spreading depression and not to stroke.

  6. Clival osteomyelitis resulting from spread of infection through the fossa navicularis magna in a child

    International Nuclear Information System (INIS)

    Prabhu, Sanjay P.; Zinkus, Timothy; Cheng, Alan G.; Rahbar, Reza

    2009-01-01

    The fossa navicularis is a notch-like bone defect in the basiocciput that has been hitherto considered as an anatomical variant of the clivus and not previously described as a potential source of clival or skull base pathology. We report the imaging findings in a 5-year-old child who presented acutely with a retropharyngeal abscess and osteomyelitis of the clivus. Imaging after treatment revealed a ''notch-like'' defect in the anterior clivus consistent with a fossa navicularis. Based on these appearances, we postulate that the lymphoid tissue of the pharyngeal tonsil residing in the fossa navicularis served as a route through which infection spread and subsequently developed into clival osteomyelitis, which is a rare diagnosis. This case is unique, and we believe that the presence of this variant in young children may be important and is not merely an anatomical curiosity. (orig.)

  7. Ependymoma of the pituitary fossa. Case report and review of the literature.

    Science.gov (United States)

    Mukhida, Karim; Asa, Sylvia; Gentili, Fred; Shannon, Patrick

    2006-10-01

    The authors describe a case of pituitary fossa ependymoma and discuss its immunohistochemical and ultrastructural characteristics. A 43-year-old man presented with decreased libido and panhypopituitarism. Magnetic resonance imaging demonstrated a well-demarcated enhancing lesion of the pituitary fossa that was completely resected via a transsphenoidal approach. Ependymomas rarely occur in the pituitary fossa, and have been reported in this location only three times in humans and once in a horse. This is the first study in which investigators examined the appearance of a pituitary ependymoma by using electron microscopy. Theories of the origin and treatment of these rare tumors are discussed as they relate to other articles on intracranial ependymomas.

  8. Concomitant boost radiotherapy for squamous carcinoma of the tonsillar fossa

    International Nuclear Information System (INIS)

    Gwozdz, John T.; Morrison, William H.; Garden, Adam S.; Weber, Randal S.; Peters, Lester J.; Ang, K. Kian

    1997-01-01

    Purpose: To assess the efficacy of a concomitant boost fractionation schedule of radiotherapy for treating patients with squamous carcinoma of the tonsillar fossa. Patients and Methods: Between December 1983 and November 1992, 83 patients with squamous carcinoma of the tonsil were treated with concomitant boost fractionation. The distribution of American Joint Committee on Cancer T stages was TX-4, T1-5, T2-29, T3-41, T4-4; N stages were NX-1, N0-26, N1-13, N2-31, N3-12. Patients were treated with standard large fields to 54 Gy in 6 weeks. The boost treatment consisted of a second daily 1.5 Gy fraction for 10-12 fractions, usually delivered during the final phase of treatment. The tumor dose was 69-72 Gy, given over 6 weeks. Twenty-one patients, who all had N2 or N3 regional disease, underwent neck dissections, either before (13 patients) or 6 weeks after radiotherapy (8 patients); the other patients were treated with radiotherapy alone. Results: The 5-year actuarial disease-specific survival and overall survival rates were 71 and 60%, respectively. Patients with T2 and T3 primary tumors had 5-year actuarial local control rates of 96 and 78%, respectively. Patients with T3 disease who received the final-phase boost had a 5-year actuarial local control rate of 82%. Actuarial 5-year regional disease control rates were N0, 92%; N1, 76%; N2, 89%; and N3, 89%. The 21 patients who had neck dissections all had their disease regionally controlled. Patients presenting with nodal disease or after a node excision who were treated with radiation alone had a 5-year actuarial regional disease control rate of 79%. All but five patients had confluent Grade 4 mucositis during treatment. Severe late complications attributable to radiation included mandibular necrosis, in-field osteosarcoma, and chronic dysphagia for solid foods. Conclusions: High rates of local and regional disease control were achieved with the concomitant boost fractionation schedule, with few cases of severe late

  9. The Radiological Spectrum of Orbital Pathologies that Involve the Lacrimal Gland and the Lacrimal Fossa

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Won Sang; Ahn, Kook Jin; Park, Mi Ra; Kim, Ji Young; Choi, Jae Jeong; Kim, Bum Soo; Hahn, Seong Tai [Catholic University College of Medicine, Seoul (Korea, Republic of)

    2007-08-15

    CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a nonenhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. Clinically, the lesions of the lacrimal gland and fossa are found as palpable masses in the superior lateral aspect of the orbit, and these lesions constitute about 5-13% of all of the orbital masses confirmed by biopsy. Many different pathological entities arise from the lacrimal gland and fossa, and as each of them requires a different therapeutic approach, the radiological characterization of each lesion is important. Approximately, half of the lacrimal gland masses are tumors of epithelial origin and the rest are lesions that arise from lymphoid or inflammatory diseases. Pseudotumors, metastatic masses and developmental cysts may also occur in the lacrimal fossa. This paper aims to discuss the radiologic findings of the lesions that are found in

  10. The Radiological Spectrum of Orbital Pathologies that Involve the Lacrimal Gland and the Lacrimal Fossa

    International Nuclear Information System (INIS)

    Jung, Won Sang; Ahn, Kook Jin; Park, Mi Ra; Kim, Ji Young; Choi, Jae Jeong; Kim, Bum Soo; Hahn, Seong Tai

    2007-01-01

    CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a nonenhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. Clinically, the lesions of the lacrimal gland and fossa are found as palpable masses in the superior lateral aspect of the orbit, and these lesions constitute about 5-13% of all of the orbital masses confirmed by biopsy. Many different pathological entities arise from the lacrimal gland and fossa, and as each of them requires a different therapeutic approach, the radiological characterization of each lesion is important. Approximately, half of the lacrimal gland masses are tumors of epithelial origin and the rest are lesions that arise from lymphoid or inflammatory diseases. Pseudotumors, metastatic masses and developmental cysts may also occur in the lacrimal fossa. This paper aims to discuss the radiologic findings of the lesions that are found in

  11. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. [Morphometric evaluation of the lateral fossa during the pre-gyrus period].

    Science.gov (United States)

    Varlam, H; Macovei, G N; Antohe, D St

    2002-09-01

    During edification of neocortex, the lateral fossa is involved in the process of development of cerebral hemispheres. It changes its shape and, from a shallow depression at the end of the 3rd month, it becomes a triangular surface with marked borders. Finally, in the same time with the appearance of circumvolutions the opercles that limit it come closer and give rise to the lateral sulcus. The evolution of the lateral fossa can be analysed by linear and surface parameters. Morphometric and statistic analyse of these parameters, compared with those of the cerebral hemisphere, allowed us to establish some original criteria for appreciating the growth of the foetal brain.

  13. Chololesterol granuloma in the middle cranial fossa: report of two cases

    International Nuclear Information System (INIS)

    Morioka, T.; Fujii, K.; Nishio, S.; Hasuo, K.; Hisashi, K.; Miyagi, Y.; Nagata, S.; Fukui, M.

    1995-01-01

    We report two cases of cholesterol granuloma in the middle cranial fossa. On CT the lesions appeared as a nonspecific, nonenhancing soft-tissue mass with bone erosion. On MRI they were seen as areas of high signal intensity surrounded by a low-intensity peripheral zone on both T1- and T2-weighted images. Cholesterol granuloma is thought to occur when pneumatised cells in the temporal bone become obstructed. Although this lesion usually occurs in the petrous bone, it can extend to the middle cranial fossa. The diagnosis and surgical management are discussed. (orig.)

  14. Relationship between external and histologic features of progressive stages of caries in the occlusal fossa

    DEFF Research Database (Denmark)

    Ekstrand, K R; Kuzmina, I; Bjørndal, L

    1995-01-01

    highly correlated (rs = 0.90). Dentinal changes were also highly correlated with enamel changes (rs = 0.85). The histologic classifications in conjunction with the macroscopical observations made it possible to demonstrate a clear relationship between the external degree of caries progression......) and 8 (M) classification criteria, ranging from 'sound' to 'cavitation with dentine involvement'. Six radiographic scores were used in the classification. Sections 250 microns in thickness were cut in buccolingual direction through the central fossa, and the fossa section with the most extensive...

  15. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  16. Overlapping sphincteroplasty and posterior repair.

    Science.gov (United States)

    Crane, Andrea K; Myers, Erinn M; Lippmann, Quinn K; Matthews, Catherine A

    2014-12-01

    Knowledge of how to anatomically reconstruct extensive posterior-compartment defects is variable among gynecologists. The objective of this video is to demonstrate an effective technique of overlapping sphincteroplasty and posterior repair. In this video, a scripted storyboard was constructed that outlines the key surgical steps of a comprehensive posterior compartment repair: (1) surgical incision that permits access to posterior compartment and perineal body, (2) dissection of the rectovaginal space up to the level of the cervix, (3) plication of the rectovaginal muscularis, (4) repair of internal and external anal sphincters, and (5) reconstruction of the perineal body. Using a combination of graphic illustrations and live video footage, tips on repair are highlighted. The goals at the end of repair are to: (1) have improved vaginal caliber, (2) increase rectal tone along the entire posterior vaginal wall, (3) have the posterior vaginal wall at a perpendicular plane to the perineal body, (4) reform the hymenal ring, and (5) not have an overly elongated perineal body. This video provides a step-by-step guide on how to perform an overlapping sphincteroplasty and posterior repair.

  17. Classification of posterior vitreous detachment

    Science.gov (United States)

    Kakehashi, Akihiro; Takezawa, Mikiko; Akiba, Jun

    2014-01-01

    Diagnosing a posterior vitreous detachment (PVD) is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT). By biomicroscopy, the vitreous condition is determined based on the presence or absence of a PVD. The PVD then is classified as either a complete posterior vitreous detachment (C-PVD) or a partial posterior vitreous detachment (P-PVD). A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage) and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage). A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]). By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. A shallow PVD without shrinkage of the posterior vitreous cortex has two subtypes: an age-related shallow PVD and a perifoveal PVD associated with a macular hole. PMID:24376338

  18. Primary Posterior Mediastinum Hydatid Cyst

    International Nuclear Information System (INIS)

    Ahmed, M.; Eid, A. F.; Sheikh, M. Y.; Yiannakou, N.

    2014-01-01

    Primary posterior mediastinal hydatid cyst is a serious health problem for the Mediterranean countries. We diagnosed a case of a 46-year-old female with a primary posterior mediastinum hydatid cyst on CT and MRI. It was provisionally identified as either a hydatid cyst or bronchogenic cyst or neuroenteric cyst. CT guided aspiration with 18 gauge needle confirmed as hydatid sand. This is very rare in this population but it should be kept in mind when one is looking at any cyst in the posterior mediastinum. (author)

  19. Default Mode Network Connectivity in Stroke Patients.

    Science.gov (United States)

    Tuladhar, Anil Man; Snaphaan, Liselore; Shumskaya, Elena; Rijpkema, Mark; Fernandez, Guillén; Norris, David G; de Leeuw, Frank-Erik

    2013-01-01

    The pathophysiology of episodic memory dysfunction after infarction is not completely understood. It has been suggested that infarctions located anywhere in the brain can induce widespread effects causing disruption of functional networks of the cortical regions. The default mode network, which includes the medial temporal lobe, is a functional network that is associated with episodic memory processing. We investigated whether the default mode network activity is reduced in stroke patients compared to healthy control subjects in the resting state condition. We assessed the whole brain network properties during resting state functional MRI in 21 control subjects and 20 'first-ever' stroke patients. Patients were scanned 9-12 weeks after stroke onset. Stroke lesions were located in various parts of the brain. Independent component analyses were conducted to identify the default mode network and to compare the group differences of the default mode network. Furthermore, region-of-interest based analysis was performed to explore the functional connectivity between the regions of the default mode network. Stroke patients performed significantly worse than control subjects on the delayed recall score on California verbal learning test. We found decreased functional connectivity in the left medial temporal lobe, posterior cingulate and medial prefrontal cortical areas within the default mode network and reduced functional connectivity between these regions in stroke patients compared with controls. There were no significant volumetric differences between the groups. These results demonstrate that connectivity within the default mode network is reduced in 'first-ever' stroke patients compared to control subjects. This phenomenon might explain the occurrence of post-stroke cognitive dysfunction in stroke patients.

  20. Sex differences in cryptogenic stroke with patent foramen ovale.

    Science.gov (United States)

    Nedeltchev, Krassen; Wiedmer, Sebastian; Schwerzmann, Markus; Windecker, Stephan; Haefeli, Tobias; Meier, Bernhard; Mattle, Heinrich P; Arnold, Marcel

    2008-09-01

    Sex differences in patients with patent foramen ovale (PFO) and cryptogenic stroke have not been systematically analyzed. We aimed to determine sex influences on demographics, vascular risk factors, clinical manifestations, stroke location, and clinical outcome. One thousand two hundred eighty-eight consecutive patients with ischemic stroke or transient ischemic attack (TIA) were admitted to a single stroke center. All patients underwent a complete stroke workup including clinical examination, standard blood tests, cerebral and vascular imaging, transesophageal echocardiography, and 24-hour electrocardiography. In 500 patients, no definite etiology could be established (cryptogenic stroke/TIA). Of them, 167 patients (107 men and 60 women, mean age 52 +/- 13 years) had an PFO. The prevalence of PFO in patients with cryptogenic stroke or TIA was higher in men than in women (38% vs 28%, P = .014). Stroke severity and the prevalence of risk factors did not differ between the 2 sexes. There was an independent association between male sex and stroke location in the posterior cerebral circulation (OR 3.0, 95% CI 1.4-6.5, P = .006). Men and women did not differ in respect to PFO grade, prevalence of right-to-left shunt at rest, or coexistence of atrial septal aneurysm. Clinical outcome at 3 months was similar in both sexes. Patent foramen ovale was more prevalent in men than in women with cryptogenic stroke. There were no sex influences on age, risk factors, echocardiographic characteristics of PFO, or clinical outcome. Male sex was independently associated with stroke in the posterior cerebral circulation.

  1. Variations of posterior vitreous detachment

    OpenAIRE

    Kakehashi, A.; Kado, M.; Akiba, J.; Hirokawa, H.

    1997-01-01

    AIMS—To identify variations in posterior vitreous detachment (PVD) and establish a clinical classification system for PVD.
METHODS—400 consecutive eyes were examined using biomicroscopy and vitreous photography and classified the PVD variations—complete PVD with collapse, complete PVD without collapse, partial PVD with thickened posterior vitreous cortex (TPVC), or partial PVD without TPVC.
RESULTS—In each PVD type, the most frequently seen ocular pathologies were as follows: in complete PVD ...

  2. Endovascular treatment of a true posterior communicating artery aneurysm.

    Science.gov (United States)

    Munarriz, Pablo M; Castaño-Leon, Ana M; Cepeda, Santiago; Campollo, Jorge; Alén, Jose F; Lagares, Alfonso

    2014-01-01

    Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. Further studies revealed a 3 mm left PCoA aneurysm arising from the PCoA itself, attached to neither the internal carotid artery nor the posterior cerebral artery. Endovascular treatment was performed and the aneurysm was coiled completely. Technical advances in endovascular interventional technology have permitted an additional approach to these lesions. The possible endovascular significance of the treatment of true PCoA aneurysms is discussed.

  3. Cysts of the fossa of Rosenmüller: report of two cases.

    Science.gov (United States)

    Lloyd, Simon K W; Di Cuffa, Riccardo A; Seymour, Felicity K; Savy, Lloyd E; Grant, Henry R

    2010-08-01

    Cystic lesions of the nasopharynx are rare. Two cases of mucous retention cysts originating from the fossa of Rosenmüller are described, together with their characteristic radiologic appearance, which allows differentiation from other types of lesions in this region. The differential diagnosis and treatment options are discussed.

  4. Is bacterial colonisation of the tonsillar fossa a factor in post-tonsillectomy haemorrhage?

    NARCIS (Netherlands)

    Stephens, J. C.; Georgalas, C.; Kyi, M.; Ghufoor, K.

    2008-01-01

    OBJECTIVES: To identify if there is a link between bacterial colonisation of the tonsillar fossa and post-tonsillectomy haemorrhage. STUDY DESIGN AND SETTING: Prospective non-interventional study of 105 patients who underwent tonsillectomy during a seven-month period. The study took place in a

  5. Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma.

    Science.gov (United States)

    Struewer, Johannes; Kiriazidis, Ilias; Figiel, Jens; Dukatz, Thomas; Frangen, Thomas; Ziring, Ewgeni

    2012-07-01

    Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma due to anatomical and biomechanical factors. Owing to the proximity of the temporal glenoid fossa to the middle meningeal artery, there is the risk of serious sequelae in case of trauma. The authors report the case of a 36-year-old male patient, who was beaten up in a family dispute and presented with complex mandibular and maxillofacial fractures, including mandibular condyle intrusion into the middle cranial fossa causing extensive meningeal bleeding. The patient underwent immediate surgery, with evacuation of the epidural haematoma via a temporal approach. In addition open reduction and reconstruction of the temporal glenoid fossa via anatomic reduction of the fragments was performed. A functional occlusion was re-established via miniplate reconstruction of the complex mandibular body and ramus fractures. Prompt diagnosis and a multidisciplinary approach are essential to minimize the complications. Advanced imaging modalities of computed tomography are indicated. Treatment options should be individualized in particular in case of suspected neurological injury. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  6. Temporalis myofascial repair of traumatic defects of the anterior fossa. Technical note.

    Science.gov (United States)

    Gillespie, R P; Shagets, F W; de los Reyes, R A

    1986-06-01

    Bilateral temporalis myofascial flaps in continuity with frontal periosteum can be used in repairing extensive dural and bone defects of the anterior cranial fossa floor. The technique of preserving and using this flap is described and offers an alternative to the use of frontal pericranial tissue for repair of anterior dural defects.

  7. The intercondylar fossa of the normal canine stifle: an anatomic and radiographic study

    International Nuclear Information System (INIS)

    Fitch, Randall B.; Montgomery, Ronald D.; Milton, James L.; Garrett, Phillip D.; Kincaid, Steven A.; Wright, James C.; Terry, Glenn C.

    1995-01-01

    The intercondylar fossa (ICF) in dogs consists of a cranial outlet, intercondylar shelf, caudal arch, caudal outlet, a medial wall, and a lateral wall. The normal cranial outlet is bell-shape and, in mixed-breed dogs (mean body weight 19.2 kg, N = 21), measured 5.8 mm cranially, 8.1 mm centrally, and 10.3 mm caudally. The ICF is oriented 12 degree from the dorsal plane of the femoral diaphysis and obliqued 7 degree , proximolateral to distomedial, in the sagittal plane. To adjust for dog size, a fossa width index (FWI) was calculated by dividing the cranial outlet width by the distance between epicondyles. The normal FWI as determined in this study was 0.18 cranially, 0.25 centrally, and 0.32 caudally. The fossa height index was 0.31. Contact between the ICF and the cranial cruciate ligament began at about 115 degree of extension. The contact area moved cranially in the intercondylar fossa as the stifle was extended. Evaluation of the ICF can be performed radiographically but positioning is critical

  8. Infraorbital Foramen and Pterygopalatine Fossa Location in Dry Skulls: Anatomical Guidelines for Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Omar Masabni

    2017-01-01

    Full Text Available Purpose. The aim of the study was to locate the infraorbital foramen (IOF in relation to the infraorbital margin (IOM for proper injections of local anesthetics in skull specimens. Another aim was to determine the depth of needle penetration into pterygopalatine fossa through the greater palatine canal (GPC. Materials and Methods. 102 skull halves were used to measure the distances between (1 IOF and IOM and (2 IOF and alveolar ridge of maxilla at second premolar. Needles were inserted and bent at a 45° angle, passing through the GPC at the level of hard palate. The depth of the tip of needle emerging out of GPC into pterygopalatine fossa was measured. Results. The mean distance between IOF and IOM was 6.46±1.57 mm on the right side and 6.74±1.72 mm on the left. The mean distance between IOF and alveolar bone process of the maxilla at second premolar was 29.07±3.58 mm on the right side and 29.39±3.78 mm on the left. The mean depth of penetration of the needle into the pterygopalatine fossa was similar on both sides. Conclusions. Proper identification of IOF and pterygopalatine fossa is of great significance during local anesthesia injections, due to their close proximity to vital anatomic structures.

  9. Infratemporal fossa extension of primary parotid squamous cell carcinoma: a rare entity with diagnosis dilemma

    International Nuclear Information System (INIS)

    Karaf, J.H.; Gendeh, B.S.; Yunus, M.R.M.

    2015-01-01

    Primary squamous cell carcinoma of parotid gland is rare but it is an aggressive neoplasm that can have extension into the infratemporal fossa. We report a 60-year-old female presenting with toothache over left lower molar causing a diagnostic dilemma. (author)

  10. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  11. Temporal lobe sulcal pattern and the bony impressions in the middle cranial fossa: the case of the el Sidrón (Spain) neandertal sample.

    Science.gov (United States)

    Rosas, Antonio; Peña-Melián, Angel; García-Tabernero, Antonio; Bastir, Markus; De La Rasilla, Marco

    2014-12-01

    Correspondence between temporal lobe sulcal pattern and bony impressions on the middle cranial fossae (MCF) was analyzed. MCF bone remains (SD-359, SD-315, and SD-1219) from the El Sidrón (Spain) neandertal site are analyzed in this context. Direct comparison of the soft and hard tissues from the same individual was studied by means of: 1) dissection of two human heads; 2) optic (white light) surface scans; 3) computed tomography and magnetic resonance of the same head. The inferior temporal sulcus and gyrus are the features most strongly influencing MCF bone surface. The Superior temporal sulcus and middle temporal and fusiform gyri also leave imprints. Temporal lobe form differs between Homo sapiens and neandertals. A wider and larger post-arcuate fossa (posterior limit of Brodmann area 20 and the anterior portion of area 37) is present in modern humans as compared to neandertals. However other traits of the MCF surface are similar in these two large-brained human groups. A conspicuous variation is appreciated in the more vertical location of the inferior temporal gyrus in H. sapiens. In parallel, structures of the lower surface of the temporal lobe are more sagittally orientated. Grooves accommodating the fusiform and the lower temporal sulci become grossly parallel to the temporal squama. These differences can be understood within the context of a supero-lateral deployment of the lobe in H. sapiens, a pattern previously identified (Bastir et al., Nat Commun 2 (2011) 588-595). Regarding dural sinus pattern, a higher incidence of petrosquamous sinus is detected in neandertal samples. © 2014 Wiley Periodicals, Inc.

  12. Driving After a Stroke

    Science.gov (United States)

    ... 23,2015 Can I drive after a stroke? Driving is often a major concern after someone has a stroke. It’s not unusual for stroke survivors to want to drive. Being able to get around after a stroke is important. Safety behind the wheel is even more important after ...

  13. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  14. Endoscopic management of posterior epistaxis.

    Science.gov (United States)

    Paul, J; Kanotra, Sohit Paul; Kanotra, Sonika

    2011-04-01

    The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26-50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of the bleeding vessel. Of these, in four cases unsuspected diagnosis was made. Of the remaining 19, in three patients, the bleeding point could not be localized accurately and these patients were managed by anteroposterior packing. The rest of the 16 patients were managed by endoscopic cauterization. In four patients, there was recurrence of bleeding within 24 h. In one of these, cauterization controlled the bleeding while in the rest nasal packing had to be resorted to. Thus, of the 23 patients of posterior epistaxis subjected to nasal endoscopy, we could avoid nasal packing in 17 (74%). To conclude, endoscopic nasal cauterization is recommended as the first line to treatment in all cases of posterior epistaxis. This will not only prevent the uncomfortable and potentially dangerous nasal packing but also help in finding the underlying pathology.

  15. Posterior Reversible Leukoencephalopathy Syndrome Associated with Pazopanib

    Directory of Open Access Journals (Sweden)

    Robert Foerster

    2013-04-01

    Full Text Available A 62-year-old female patient with metastatic renal cell carcinoma under third-line treatment with pazopanib for 8 weeks suddenly developed severe headaches, grand mal seizures and paresis of the left arm in combination with gait instability as well as nausea and vomiting during her vacation abroad. The emergency physician measured systolic blood pressure values over 300 mm Hg and suspected a stroke. The CT imaging without contrast agent in a local hospital did not show any pathologic findings despite bone metastases. The colleagues suspected cerebral metastases or meningeosis carcinomatosa and referred the patient to our department for further diagnostics and treatment planning. An MRI scan ruled out the suspected cerebral metastases or meningeosis carcinomatosa, but showed signs of reversible posterior leukoencephalopathy syndrome (RPLS in the form of band-like hyperintensities as a sign of cytotoxic edema in the gray and white matter of the left parietal lobe. The patient then reported that similar blood pressure values had been measured shortly after the start of a first-line therapy with sunitinib, so that we discontinued the current treatment with pazopanib. Within 6 days the neurologic symptoms vanished and the patient was discharged. An intermittent hypertension persisted. A follow-up MRI 3 weeks later showed an RPLS-typical cortical infarction in the affected area. RPLS should be considered as the actual reason for neurologic findings in hypertensive patients with known metastatic cancers under tyrosine kinase inhibitor therapy.

  16. Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid-middle cranial fossa approach.

    Science.gov (United States)

    Carlson, Matthew L; Copeland, William R; Driscoll, Colin L; Link, Michael J; Haynes, David S; Thompson, Reid C; Weaver, Kyle D; Wanna, George B

    2013-11-01

    The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome. A retrospective case series including all patients who underwent a middle fossa craniotomy or combined mastoid-middle cranial fossa repair of encephalocele and/or CSFF between 2000 and 2012 was accrued from 2 tertiary academic referral centers. Eighty-nine consecutive surgeries (86 patients, 59.3% women) were included. The mean age at time of surgery was 52.3 years, and the left side was affected in 53.9% of cases. The mean delay between symptom onset and diagnosis was 35.4 months, and the most common presenting symptoms were hearing loss (92.1%) and persistent ipsilateral otorrhea (73.0%). Few reported a history of intracranial infection (6.7%) or seizures (2.2%). Thirteen (14.6%) of 89 cases had a history of major head trauma, 23 (25.8%) were associated with chronic ear disease without prior operation, 17 (19.1%) occurred following tympanomastoidectomy, and 1 (1.1%) developed in a patient with a cerebral aqueduct cyst resulting in obstructive hydrocephalus. The remaining 35 cases (39.3%) were considered spontaneous. Among all patients, the mean body mass index (BMI) was 35.3 kg/m(2), and 46.4% exhibited empty sella syndrome. Patients with spontaneous lesions were statistically significantly older (p = 0.007) and were more commonly female (p = 0.048) compared with those with nonspontaneous pathology. Additionally, those with spontaneous lesions had a greater BMI than those with nonspontaneous disease (p = 0.102), although this difference did not achieve statistical significance. Thirty-two surgeries (36.0%) involved a middle fossa craniotomy alone, whereas 57 (64.0%) involved a combined mastoid-middle fossa repair. There were 7 recurrences (7.9%); 2 patients with recurrence developed

  17. Transesophageal Echocardiographically-Confirmed Pulmonary Vein Thrombosis in Association with Posterior Circulation Infarction.

    LENUS (Irish Health Repository)

    Kinsella, Justin A

    2010-01-01

    Pulmonary venous thromboembolism has only been identified as a cause of stroke with pulmonary arteriovenous malformations\\/fistulae, pulmonary neoplasia, transplantation or lobectomy, and following percutaneous radiofrequency ablation of pulmonary vein ostia in patients with atrial fibrillation. A 59-year-old man presented with a posterior circulation ischemic stroke. \\'Unheralded\\' pulmonary vein thrombosis was identified on transesophageal echocardiography as the likely etiology. He had no further cerebrovascular events after intensifying antithrombotic therapy. Twenty-eight months after initial presentation, he was diagnosed with metastatic pancreatic adenocarcinoma and died 3 months later. This report illustrates the importance of doing transesophageal echocardiography in presumed \\'cardioembolic\\' stroke, and that potential \\'pulmonary venous thromboembolic\\' stroke may occur in patients without traditional risk factors for venous thromboembolism. Consideration should be given to screening such patients for occult malignancy.

  18. Influence of Connector Width on the Stress Distribution of Posterior Bridges under Loading

    Directory of Open Access Journals (Sweden)

    A. Azary

    2011-06-01

    Full Text Available Objective: In all ceramic fixed partial dentures the connector area is a common fracture location. The survival time of three-unit fixed partial dentures may be improved by altering the connector design in regions of maximum tension. The purpose of this study was to determine the effect of buccolingual increase of the connector width on the stress distribution in posterior fixed partial dentures made of IPS Empress 2. To simulate the anatomical condition, we used three-dimensional finite element analysis to generate.Materials and Methods: Three models of three-unit bridges replacing the first molar were prepared. The buccolingual connector width varied from 3.0 to 5.0 mm. Bridges were vertically loaded with 600 N at one point on the central fossa of the pontic, at 12 points along the cusp-fossa contact (50 N each, or at eight points along the cusp-marginal ridge contact (75 N each. Alternatively, a load of 225 N was applied at a 45º angle from the lingual side.Results: Stress concentrations were observed within or near the connectors. The von Mises stress decreased by increasing connector width, regardless of whether the loading was applied vertically or at an angle.Conclusion: Within the limitations of this study, we conclude that increasing the connector width decreases the failure probability when a vertical or angled load is applied.

  19. Unsuccessful outcomes after posterior urethroplasty.

    Science.gov (United States)

    Engel, Oliver; Fisch, Margit

    2015-03-01

    Posterior urethroplasty is the most common strategy for the treatment of post-traumatic urethral injuries. Especially in younger patients, post-traumatic injuries are a common reason for urethral strictures caused by road traffic accidents, with pelvic fracture or direct trauma to the perineum. In many cases early endoscopic realignment is the first attempt to restore the junction between proximal and distal urethra, but in some cases primary realignment is not possible or not enough to treat the urethral injury. In these cases suprapubic cystostomy alone and delayed repair by stricture excision and posterior urethroplasty is an alternative procedure to minimise the risk of stricture recurrence.

  20. Diagnostic Error in Stroke-Reasons and Proposed Solutions.

    Science.gov (United States)

    Bakradze, Ekaterina; Liberman, Ava L

    2018-02-13

    We discuss the frequency of stroke misdiagnosis and identify subgroups of stroke at high risk for specific diagnostic errors. In addition, we review common reasons for misdiagnosis and propose solutions to decrease error. According to a recent report by the National Academy of Medicine, most people in the USA are likely to experience a diagnostic error during their lifetimes. Nearly half of such errors result in serious disability and death. Stroke misdiagnosis is a major health care concern, with initial misdiagnosis estimated to occur in 9% of all stroke patients in the emergency setting. Under- or missed diagnosis (false negative) of stroke can result in adverse patient outcomes due to the preclusion of acute treatments and failure to initiate secondary prevention strategies. On the other hand, the overdiagnosis of stroke can result in inappropriate treatment, delayed identification of actual underlying disease, and increased health care costs. Young patients, women, minorities, and patients presenting with non-specific, transient, or posterior circulation stroke symptoms are at increased risk of misdiagnosis. Strategies to decrease diagnostic error in stroke have largely focused on early stroke detection via bedside examination strategies and a clinical decision rules. Targeted interventions to improve the diagnostic accuracy of stroke diagnosis among high-risk groups as well as symptom-specific clinical decision supports are needed. There are a number of open questions in the study of stroke misdiagnosis. To improve patient outcomes, existing strategies to improve stroke diagnostic accuracy should be more broadly adopted and novel interventions devised and tested to reduce diagnostic errors.

  1. Is there a dural wall between the cavernous sinus and the pituitary fossa? Anatomical and MRI findings

    International Nuclear Information System (INIS)

    Dietemann, J.L.; Diniz, R.; Reis, M. Jr.; Neugroschl, C.; Vinclair, L.; Maillot, C.

    1998-01-01

    We compared MRI studies of the sellar area and embryological and adult histological studies of the cavernous sinuses and pituitary fossa. MRI studies were performed in 50 normal subjects with coronal sections using a fast inversion-recovery sequence to demonstrate the dural walls of the cavernous sinus and pituitary fossa. With this sequence, dura mater appears as a high-signal linear structure. The lateral and superior walls of the cavernous sinus was easily identified on all studies, but demonstration of a dural wall separating the cavernous sinus from the pituitary fossa was not possible. These results correlated well with embryological and adult histological studies obtained from 14 specimens. The absence of a strong separation between the pituitary fossa and the cavernous sinus explains the high incidence of extension of pituitary tumours to the cavernous sinuses and vice versa. (orig.) (orig.)

  2. Sonographic templates of newborn perforator stroke.

    Science.gov (United States)

    Abels, Lyanne; Lequin, Maarten; Govaert, Paul

    2006-07-01

    Many paediatric strokes occur in the perinatal period. Improvement in neuroimaging has increased detection in newborns with neurological symptoms. To define sonographic templates of neonatal stroke in the territory of perforators of the anterior choroidal artery (AChA) and the anterior (ACA), middle (MCA) and posterior (PCA) cerebral arteries. In 24 neonates with perforator stroke, we retrospectively studied antenatal and perinatal events. Brain sonography was performed with an 8.5-MHz probe. Only hyperechoic lesions in the thalamus and/or striatum and/or centrum semiovale were included. MRI was obtained using a 1.5-T machine. We detected 28 perforator strokes in 24 infants (6 preterm): 5 MCA medial striate, 8 MCA lateral striate, 3 MCA centrum semiovale, 4 ACA Heubner's, 5 PCA thalamic arteries, 1 AChA, and 2 hypothalamic perforators. We attributed clinical seizures to stroke in two infants only. Catheter-related embolism (certain in three, possible in six others) and birth trauma (two) were probable causes. Specific conditions were found in six others. Only one infant (in nine evaluated) had an increased prothrombotic risk (fII mutation). In describing the lesions, we focused on the templates of infarction as seen in a parasagittal US sweep. Infarcts were confirmed by MRI in 21 patients. Our study showed that infarct topography can be evaluated reliably with brain sonography. This is important given the asymptomatic character of most lesions.

  3. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Facial Nerve Schwannoma Involving Middle Cranial Fossa: When the Unilateral Sensorineural Hearing Loss Guide to the Correct Diagnosis

    OpenAIRE

    De Stefano, Alessandro; Dispenza, Francesco; Kulamarva, Gautham

    2011-01-01

    The Facial Nerve Schwannoma is a rare tumor and it seldom involved the middle cranial fossa. Facial nerve schwannoma has various manifestations, including facial palsy but unfortunately facial nerve is very resistant to compression and often facial nerve paralysis or a facial weakness are not present. We present a case of giant facial nerve schwannoma involved the middle cranial fossa without facial nerve paralysis. In these cases the unilateral hearing loss (if present) guide to a correct di...

  5. Prevention of posterior capsular opacification

    NARCIS (Netherlands)

    Nibourg, Lisanne M; Gelens, Edith; Kuijer, Roelof; Hooymans, Johanna Mm; van Kooten, Theo G; Koopmans, Steven A

    Posterior capsular opacification (PCO) is a common complication of cataract surgery. The development of PCO is due to a combination of the processes of proliferation, migration, and transdifferentiation of residual lens epithelial cells (LECs) on the lens capsule. In the past decades, various forms

  6. The ectopic posterior pituitary gland

    African Journals Online (AJOL)

    2013-11-04

    Nov 4, 2013 ... crinology with short stature, delayed bone age and biochemical features suggestive of hypo pituitarism. Magnetic resonance imaging of the brain demonstrated a flattened anterior pituitary gland within the sella, associated with absence of the infundibular stalk and an ectopic posterior pituitary gland (Fig.

  7. [Posterior ceramic bonded partial restorations].

    Science.gov (United States)

    Mainjot, Amélie; Vanheusden, Alain

    2006-01-01

    Posterior ceramic bonded partial restorations are conservative and esthetic approaches for compromised teeth. Overlays constitute a less invasive alternative for tooth tissues than crown preparations. With inlays and onlays they are also indicated in case of full arch or quadrant rehabilitations including several teeth. This article screens indications and realization of this type of restorations.

  8. Influence of occlusal splints on TMJ condyle-fossa relationship and disc shape

    OpenAIRE

    Braun, Barbara Victoria

    2012-01-01

    Background. Occlusal splints are nowadays commonly used in dentistry to treat symptoms of myoarthropathies of the masticatory system, but also to treat simple occlusal parafunctions. Still, the exact mechanism by which the treatment works is unknown. The aim of this study was to find out the answers to following questions: 1. is there an immediate change of the minimum condyle-fossa distance and accompanying disc thickness by inserting a Michigan splint and 2. is it possible to displace the m...

  9. A nomenclature for vertebral fossae in sauropods and other saurischian dinosaurs.

    Directory of Open Access Journals (Sweden)

    Jeffrey A Wilson

    Full Text Available BACKGROUND: The axial skeleton of extinct saurischian dinosaurs (i.e., theropods, sauropodomorphs, like living birds, was pneumatized by epithelial outpocketings of the respiratory system. Pneumatic signatures in the vertebral column of fossil saurischians include complex branching chambers within the bone (internal pneumaticity and large chambers visible externally that are bounded by neural arch laminae (external pneumaticity. Although general aspects of internal pneumaticity are synapomorphic for saurischian subgroups, the individual internal pneumatic spaces cannot be homologized across species or even along the vertebral column, due to their variability and absence of topographical landmarks. External pneumatic structures, in contrast, are defined by ready topological landmarks (vertebral laminae, but no consistent nomenclatural system exists. This deficiency has fostered confusion and limited their use as character data in phylogenetic analysis. METHODOLOGY/PRINCIPAL FINDINGS: We present a simple system for naming external neural arch fossae that parallels the one developed for the vertebral laminae that bound them. The nomenclatural system identifies fossae by pointing to reference landmarks (e.g., neural spine, centrum, costal articulations, zygapophyses. We standardize the naming process by creating tripartite names from "primary landmarks," which form the zygodiapophyseal table, "secondary landmarks," which orient with respect to that table, and "tertiary landmarks," which further delineate a given fossa. CONCLUSIONS/SIGNIFICANCE: The proposed nomenclatural system for lamina-bounded fossae adds clarity to descriptions of complex vertebrae and allows these structures to be sourced as character data for phylogenetic analyses. These anatomical terms denote potentially homologous pneumatic structures within Saurischia, but they could be applied to any vertebrate with vertebral laminae that enclose spaces, regardless of their developmental

  10. Branchial fistula arising from pyriform fossa: CT diagnosis of a case and discussion of radiological features.

    Science.gov (United States)

    Chauhan, Narvir Singh; Sharma, Yash Paul; Bhagra, Tilak; Sud, Bindu

    2012-01-01

    Anomalies of third or fourth branchial apparatus origin are very uncommon and present as recurrent neck infections or thyroiditis with a predominant left-sided involvement. Radiological diagnosis requires a high index of suspicion and is critical for initiation of proper treatment. We describe a case of branchial sinus of pyriform fossa with external fistulization that presented in adulthood and was diagnosed on computed tomographic scan. The radiological features of this rare anomaly are revisited. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Primary hydatid disease of the infratemporal fossa and the parotid gland

    International Nuclear Information System (INIS)

    Kalovidouris, A.; Gouliamos, A.; Andreou, I.; Levett, J.; Vlahos, I.; Papavasiliou, C.; Ioannovits, I.

    1985-01-01

    Hydatid disease should be considered in the differential diagnosis of lesions causing swelling of the parotid area or exophthalmos in patients originating from countries where the incidence of the disease is high. An unusual case of hydatid disease located in the infratemporal fossa and the anterior parotid region is presented. Computed Tomography is a valuable tool for establishment of the diagnosis, before any surgical approach to the lesion is initiated and for postoperative follow-up and evaluation. (orig.) [de

  12. Primary hydatid disease of the infratemporal fossa and the parotid gland

    Energy Technology Data Exchange (ETDEWEB)

    Kalovidouris, A.; Gouliamos, A.; Andreou, I.; Levett, J.; Vlahos, I.; Papavasiliou, C.; Ioannovits, I.

    1985-05-01

    Hydatid disease should be considered in the differential diagnosis of lesions causing swelling of the parotid area or exophthalmos in patients originating from countries where the incidence of the disease is high. An unusual case of hydatid disease located in the infratemporal fossa and the anterior parotid region is presented. Computed Tomography is a valuable tool for establishment of the diagnosis, before any surgical approach to the lesion is initiated and for postoperative follow-up and evaluation.

  13. The Lost City Hydrothermal Field: A Spectroscopic and Astrobiological Analogue for Nili Fossae, Mars.

    Science.gov (United States)

    Amador, Elena S; Bandfield, Joshua L; Brazelton, William J; Kelley, Deborah

    2017-11-01

    Low-temperature serpentinization is a critical process with respect to Earth's habitability and the Solar System. Exothermic serpentinization reactions commonly produce hydrogen as a direct by-product and typically produce short-chained organic compounds indirectly. Here, we present the spectral and mineralogical variability in rocks from the serpentine-driven Lost City Hydrothermal Field on Earth and the olivine-rich region of Nili Fossae on Mars. Near- and thermal-infrared spectral measurements were made from a suite of Lost City rocks at wavelengths similar to those for instruments collecting measurements of the martian surface. Results from Lost City show a spectrally distinguishable suite of Mg-rich serpentine, Ca carbonates, talc, and amphibole minerals. Aggregated detections of low-grade metamorphic minerals in rocks from Nili Fossae were mapped and yielded a previously undetected serpentine exposure in the region. Direct comparison of the two spectral suites indicates similar mineralogy at both Lost City and in the Noachian (4-3.7 Ga) bedrock of Nili Fossae, Mars. Based on mapping of these spectral phases, the implied mineralogical suite appears to be extensive across the region. These results suggest that serpentinization was once an active process, indicating that water and energy sources were available, as well as a means for prebiotic chemistry during a time period when life was first emerging on Earth. Although the mineralogical assemblages identified on Mars are unlikely to be directly analogous to rocks that underlie the Lost City Hydrothermal Field, related geochemical processes (and associated sources of biologically accessible energy) were once present in the subsurface, making Nili Fossae a compelling candidate for a once-habitable environment on Mars. Key Words: Mars-Habitability-Serpentinization-Analogue. Astrobiology 17, 1138-1160.

  14. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Stroke Heroes Among Us Difficulty Swallowing After Stroke (Dysphagia) Updated:Nov 15,2016 Excerpted and adapted from "Swallowing Disorders After a Stroke," Stroke Connection Magazine July/August ...

  15. Interactive web-based programs to teach functional anatomy: the pterygopalatine fossa.

    Science.gov (United States)

    Sinav, Ahmet; Ambron, Richard

    2004-07-01

    Certain areas of the body contain structures that are difficult to envision in their proper spatial orientations and whose functions are complex and difficult to grasp. This is especially true in the head, where many structures are relatively small and inaccessible. To address this problem, we are designing Web-based programs that consist of high-resolution interactive bitmap illustrations, prepared using Adobe Photoshop, and vector-based animations, prepared via Macromedia Flash. Flash action script language is used for the animations. We have used this approach to prepare a program on the pterygopalatine fossa, an important neurovascular junction in the deep face that is especially difficult to approach by dissection and to depict in static images in an atlas. The program can be viewed online at http://cds.osr.columbia.edu/anatomy/ppfossa/. A table of contents simplifies navigation through the program and a menu enables the user to identify each of the vascular and neuronal components and either to insert or to remove each from its position in the fossa. The functional anatomy of the nerves in the fossa is animated. For example, users can activate and subsequently follow action potentials as they course along axons to their targets. This high degree of interactivity helps promote learning.

  16. Pressure Sore at an Unusual Site- the Bilateral Popliteal Fossa: A Case report

    Directory of Open Access Journals (Sweden)

    Kamal Kataria

    2012-05-01

    Full Text Available Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature.

  17. Temporal fossa defects: techniques for injecting hyaluronic acid filler and complications after hyaluronic acid filler injection.

    Science.gov (United States)

    Juhász, Margit Lai Wun; Marmur, Ellen S

    2015-09-01

    Facial changes with aging include thinning of the epidermis, loss of skin elasticity, atrophy of muscle, and subcutaneous fat and bony changes, all which result in a loss of volume. As temporal bones become more concave, and the temporalis atrophies and the temporal fat pad decreases, volume loss leads to an undesirable, gaunt appearance. By altering the temporal fossa and upper face with hyaluronic acid filler, those whose specialty is injecting filler can achieve a balanced and more youthful facial structure. Many techniques have been described to inject filler into the fossa including a "fanned" pattern of injections, highly diluted filler injection, and the method we describe using a three-injection approach. Complications of filler in the temporal fossa include bruising, tenderness, swelling, Tyndall effect, overcorrection, and chewing discomfort. Although rare, more serious complications include infection, foreign body granuloma, intravascular necrosis, and blindness due to embolization into the ophthalmic artery. Using reversible hyaluronic acid fillers, hyaluronidase can be used to relieve any discomfort felt by the patient. Injectors must be aware of the complications that may occur and provide treatment readily to avoid morbidities associated with filler injection into this sensitive area. © 2015 Wiley Periodicals, Inc.

  18. Management of the stricture of fossa navicularis and pendulous urethral strictures

    Directory of Open Access Journals (Sweden)

    Shrawan K Singh

    2011-01-01

    Full Text Available Objective : Management of distal anterior urethral stricture is a common problem faced by practicing urologists. Literature on urethral stricture mainly pertains to bulbar urethral stricture and pelvic fracture urethral distraction defect. The present article aims to review the management of the strictures of fossa navicularis and pendulous urethra. Materials and Methods : The literature in English language was searched from the National Library of Medicine database, using the appropriate key words for the period 1985-2010. Out of 475 articles, 115 were selected for the review based on their relevance to the topic. Results : Etiology of stricture is shifting from infective to inflammatory and iatrogenic causes. Stricture of fossa navicularis is most often caused by lichen sclerosus et atrophicus and instrumentation. Direct visual internal urethrotomy is limited to selected cases in the management of pendulous urethral stricture. With experience and identification of various prognostic factors, conservative management by dilatation and internal urethrotomy is being replaced by various reconstructive procedures, using skin flaps and grafts with high success rates. Single-stage urethroplasty is preferred over the 2-stage procedure as the latter disfigures the penis and poses sexual problems temporarily. Conclusions : Flaps or grafts are useful for single-stage reconstruction of fossa navicularis and pendulous urethral strictures. The buccal and lingual mucosa serves as a preferred resource material for providing the inner lining of the urethra. Off-the-shelf materials, such as acellular collagen matrix, are promising.

  19. Management of the stricture of fossa navicularis and pendulous urethral strictures

    Science.gov (United States)

    Singh, Shrawan K.; Agrawal, Santosh K.; Mavuduru, Ravimohan S.

    2011-01-01

    Objective: Management of distal anterior urethral stricture is a common problem faced by practicing urologists. Literature on urethral stricture mainly pertains to bulbar urethral stricture and pelvic fracture urethral distraction defect. The present article aims to review the management of the strictures of fossa navicularis and pendulous urethra. Materials and Methods: The literature in English language was searched from the National Library of Medicine database, using the appropriate key words for the period 1985-2010. Out of 475 articles, 115 were selected for the review based on their relevance to the topic. Results: Etiology of stricture is shifting from infective to inflammatory and iatrogenic causes. Stricture of fossa navicularis is most often caused by lichen sclerosus et atrophicus and instrumentation. Direct visual internal urethrotomy is limited to selected cases in the management of pendulous urethral stricture. With experience and identification of various prognostic factors, conservative management by dilatation and internal urethrotomy is being replaced by various reconstructive procedures, using skin flaps and grafts with high success rates. Single-stage urethroplasty is preferred over the 2-stage procedure as the latter disfigures the penis and poses sexual problems temporarily. Conclusions: Flaps or grafts are useful for single-stage reconstruction of fossa navicularis and pendulous urethral strictures. The buccal and lingual mucosa serves as a preferred resource material for providing the inner lining of the urethra. Off-the-shelf materials, such as acellular collagen matrix, are promising. PMID:22022062

  20. Pressure Sore at an Unusual Site- the Bilateral Popliteal Fossa: A Case report

    Science.gov (United States)

    Kataria, Kamal; Sagar, Sushma; Singhal, Manish; Yadav, Rajni

    2012-01-01

    Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature. PMID:29181131

  1. Packing of renal fossa: Useful technique for intractable bleeding after open pyelolithotomy surgery

    Directory of Open Access Journals (Sweden)

    Mohinder Kumar Malhotra

    2012-01-01

    Full Text Available There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone surgery in peripheral hospitals. Several studies have shown the usefulness of temporary packing to control bleeding in liver injuries and following open heart operations. Packing of the renal fossa with laparotomy pads in unstable patients, and transferring the patient to the surgical intensive care unit (ICU is also described in trauma but not in controlling bleeding after open pyelolithotomy .This study comprises of three such patients whose kidneys were salvaged by a simple procedure of temporary packing of renal fossa for period of 24-48 hours who had developed life threatening haemorrhage after open pyelolithotomy. This technique is simple and worth trying especially for surgeons who are contemplating nephrectomy as prolonged packing has not lead to any compromise in renal functions. The aim of this manuscript is very limited and clear. Packing is not a licence to carry out open pyelolithotomy without proper expertise and local backup or resources. Principles of safe and ethical surgical practice should never be violated as it can lead to medico legal complications.

  2. Delayed effect of radiation therapy on extracerebral cavernous angioma in the middle fossa

    International Nuclear Information System (INIS)

    Shibata, Shobu; Mori, Kazuo

    1988-01-01

    This is a report of a case with extracerebral cavernous angioma in the middle fossa which had received radiation therapy. Follow-up study with serial computed tomography during and after irradiation were presented. A 62-year-old housewife complained of vertigo. CT scan revealed a slightly high density area in the left middle cranial fossa which was markedly enhanced with contrast media. Left carotid angiography demonstrated a large avascular mass in the left middle fossa and no feeding artery or draining vein was visualized except a faint irregular stain in the venous phase. Irradiation with a total dose of 50 Gy was delivered. At the end of radiation, CT scan revealed a slight decrease in size and CT number of the tumor. Follow-up CT scans 5 months later showed 50 % regression of the tumor and 19 months later were negative for tumor. It is concluded that in case of an extracerebral cavernous angioma with massive hemorrhage, radiation of up to 30 - 50 Gy was a method of choice. The treatment results in the possibility of eliminating surgery and the benefit of irradiation may not become evident until the first year. (author)

  3. Bare spot of the glenoid fossa in children: incidence and MRI features

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hee Kyung; Emery, Kathleen H. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Salisbury, Shelia R. [Cincinnati Children' s Hospital Medical Center, Centers for Epidemiology and Biostatistics, Cincinnati, OH (United States)

    2010-07-15

    The bare spot of the glenoid fossa is a normal cartilage defect seen frequently in adults. It has been used on arthroscopy as a landmark for the center of the glenoid fossa. There are no reports of this variant in children, but we have noted it on some pediatric clinical shoulder MRI studies. Our main purpose is to evaluate the incidence of the bare spot in children and define location and MRI features. Shoulder MRI studies (total 570) from 2004 to 2008 were reviewed. Children were divided into two age groups: group 1, 0-10 years (n=200), group 2, 11-20 years (n=370). A total of 12 bare spots (2.1%) were identified; all were seen in group 2. Eight (67%) were central and four were eccentric in the glenoid fossa. All showed a well-marginated focal cartilage defect containing hyperintense joint fluid or contrast agent. Three also had air. The bare spot is seen in children. The absence in children younger than 10 years and the low incidence in the second decade support the proposed acquired nature. Familiarity with this finding is important so as not to misinterpret it as a pathologic condition. (orig.)

  4. Chronic Expanding Hematoma in the Popliteal Fossa after Pseudoaneurysm Surgery because of Nail Puncture

    Directory of Open Access Journals (Sweden)

    Serdar Yilmaz

    2014-01-01

    Full Text Available Hematomas caused by surgery or trauma that persist and expand slowly for more than a month are defined as chronic expanding hematomas (CEH. Magnetic resonance imaging (MRI is useful for the diagnosis. Total excision with the pseudocapsule is the treatment method. Pseudoaneurysms result from arterial wall disruptions and can be mistaken for CEH. We present a rare case report of a 45-year-old man with a large, painful swelling in his left popliteal fossa. He had a puncture wound by a nail 11 years ago and a gradually expanding mass occurred in his popliteal fossa. A pseudoaneurysm was detected and operated a year later. After surgery, a gradually expanding mass recurred in his popliteal fossa. On the arteriography, the popliteal artery was occluded and the blood flow was maintained with collateral vessels. On MRI, an enormous swelling of 115 × 107 × 196 cm in diameter was seen. It was diagnosed as CEH and was excised completely protecting the collateral vessels and there was no recurrence after a year from the surgery.

  5. Neurinomas of the facial nerve extending to the middle cranial fossa

    International Nuclear Information System (INIS)

    Ichikawa, Akimichi; Tanaka, Ryuichi; Matsumura, Kenichiro; Takeda, Norio; Ishii, Ryoji; Ito, Jusuke.

    1986-01-01

    Three cases with neurinomas of the facial nerve are reported, especially with regard to the computerized tomographic (CT) findings. All of them had a long history of facial-nerve dysfunction, associated with hearing loss over periods from several to twenty-five years. Intraoperative findings demonstrated that these tumors arose from the intrapetrous portion, the horizontal portion, or the geniculate portion of the facial nerve and that they were located in the middle cranial fossa. The histological diagnoses were neurinomas. CT scans of three cases demonstrated round and low-density masses with marginal high-density areas in the middle cranial fossa, in one associated with diffuse low-density areas in the left temporal and parietal lobes. The low-density areas on CT were thought to be cysts; this was confirmed by surgery. Enhanced CT scans showed irregular enhancement in one case and ring-like enhancement in two cases. High-resolution CT scans of the temporal bone in two cases revealed a soft tissue mass in the middle ear, a well-circumscribed irregular destruction of the anterior aspect of the petrous bone, and calcifications. These findings seemed to be significant features of the neurinomas of the facial nerve extending to the middle cranial fossa. We emphasize that bone-window CT of the temporal bone is most useful in detecting a neurinoma of the facial nerve in its early stage in order to preserve the facial- and acoustic-nerve functions. (author)

  6. Posterior insular cortex - a site of vestibular-somatosensory interaction?

    Science.gov (United States)

    Baier, Bernhard; Zu Eulenburg, Peter; Best, Christoph; Geber, Christian; Müller-Forell, Wibke; Birklein, Frank; Dieterich, Marianne

    2013-09-01

    Background In previous imaging studies the insular cortex (IC) has been identified as an essential part of the processing of a wide spectrum of perception and sensorimotor integration. Yet, there are no systematic lesion studies in a sufficient number of patients examining whether processing of vestibular and the interaction of somatosensory and vestibular signals take place in the IC. Methods We investigated acute stroke patients with lesions affecting the IC in order to fill this gap. In detail, we explored signs of a vestibular tone imbalance such as the deviation of the subjective visual vertical (SVV). We applied voxel-lesion behaviour mapping analysis in 27 patients with acute unilateral stroke. Results Our data demonstrate that patients with lesions of the posterior IC have an abnormal tilt of SVV. Furthermore, re-analysing data of 20 patients from a previous study, we found a positive correlation between thermal perception contralateral to the stroke and the severity of the SVV tilt. Conclusions We conclude that the IC is a sensory brain region where different modalities might interact.

  7. Infarcts presenting with a combination of medial medullary and posterior inferior cerebellar artery syndromes.

    Science.gov (United States)

    Lee, Hyung; Baik, Seung Kug

    2004-09-15

    Cerebellar and medial medullary infarctions are well-known vertebrobasilar stroke syndromes. However, their development in a patient with distal vertebral artery occlusion has not been previously reported. A 49-year-old man with longstanding hypertension suddenly developed vertigo, right-sided Horner syndrome, and left-sided weakness. An MRI of the brain showed acute infarcts in the right inferior cerebellum (posterior inferior cerebellar artery territory) and the right upper medial medulla (direct penetrating branches of vertebral artery). Magnetic resonance angiogram showed occlusion of the distal vertebral artery on the right side. Atherothrombotic occlusion of the distal vertebral artery may cause this unusual combination of vertebrobasilar stroke.

  8. Ischemic Stroke Following Multiple Traumas in a Child: A Case Report

    Directory of Open Access Journals (Sweden)

    Pei-Jung Lin

    2006-04-01

    Full Text Available Stroke is an uncommon disorder in children but an increasingly recognized cause of disability. Acute stroke may be attributable to trauma, but this topic is seldom discussed. In limited reports, most ischemic strokes following trauma were detected after a considerable delay. Early recognition of stroke following trauma might reduce secondary neurologic complications. We report a case of posterior cerebral artery area infarct following multiple traumas in a child. A comprehensive etiologic survey was undertaken and discussed. Although the definite pathogenesis is still unclear, adequate, individualized, and uncomplicated management can significantly affect the outcome.

  9. Pediatric ischemic stroke due to dengue vasculitis.

    Science.gov (United States)

    Nanda, Subrat Kumar; Jayalakshmi, Sita; Mohandas, Surath

    2014-10-01

    Dengue infection is an important arboviral infection in southeast Asia, especially in India. Neurological manifestations of dengue are increasingly recognized. We report an ischemic stroke due to dengue vasculitis in an 8-year-old child. We present a girl with a short febrile illness followed by episodic severe headache, with gradually progressive hemiparesis and visual impairment. Her brain magnetic resonance imaging revealed multiple infarctions in the anterior and posterior circulation. The magnetic resonance angiogram revealed irregular narrowing of bilateral middle cerebral arteries, right anterior cerebral artery, left posterior cerebral, and bilateral vertebral arteries suggestive of vasculitis. Her dengue serology was strongly positive for immunoglobulin M with 68.9 panbio units. The rest of the evaluation for pediatric stroke was unremarkable. She was treated with intravenous followed by oral corticosteroids and recovered totally with resolution of vasculitis on magnetic resonance angiogram over the next 3 months. This child illustrates possible immune-mediated vasculitis caused by dengue infection which is rather a rare presentation in a child who subsequently recovered well. One should consider dengue in childhood strokes in endemic regions. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Brain Basics: Preventing Stroke

    Science.gov (United States)

    ... NINDS) are committed to reducing that burden through biomedical research. What is a Stroke? A stroke, or "brain ... Testimony Legislative Updates Impact NINDS Contributions to Approved Therapies ... Director, Division of Intramural Research

  11. Stroke Warning Signs

    Science.gov (United States)

    ... person to repeat a simple sentence, like "The sky is blue." Is the person able to correctly ... to Your Doctor to Create a Plan The Life After Stroke Journey Every stroke recovery is different. ...

  12. [Genetics of ischemic stroke].

    Science.gov (United States)

    Gschwendtner, A; Dichgans, M

    2013-02-01

    Stroke is one of the most widespread causes of mortality und disability worldwide. Around 80 % of strokes are ischemic and different forms of intracranial bleeding account for the remaining cases. Monogenic stroke disorders are rare but the diagnosis may lead to specific therapeutic consequences for the affected patients who are predominantly young. In common sporadic stroke, genetic factors play a role in the form of susceptibility genes. Their discovery may give rise to new therapeutic options in the future.

  13. Classification of posterior vitreous detachment

    OpenAIRE

    Kakehashi, Akihiro; Takezawa, Mikiko; Akiba, Jun

    2013-01-01

    Akihiro Kakehashi,1 Mikiko Takezawa,1 Jun Akiba21Department of Ophthalmology, Jichi Medical University, Saitama Medical Center, Saitama, 2Kanjodori Eye Clinic, Asahikawa, JapanAbstract: Diagnosing a posterior vitreous detachment (PVD) is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography...

  14. Mandibular fossa morphology during therapy with a fixed functional orthodontic appliance : A magnetic resonance imaging study.

    Science.gov (United States)

    Kinzinger, Gero Stefan Michael; Hourfar, Jan; Kober, Cornelia; Lisson, Jörg Alexander

    2018-03-01

    During therapy of distoclusion entailing a rigid, fixed orthodontic appliance, the mandibular fossa and condyle are ideally remodeled, while dentoalveolar effects occur through adaptive mechanisms. Adaptive processes, especially in the fossa region, have not been adequately investigated. Our magnetic resonance imaging (MRI) investigation aimed to assess the effects of therapy with a functional mandibular advancer (FMA) on mandibular fossa morphology. We monitored via MRI the therapeutic course of 25 patients at three time points. Visual findings and metric assessments were carried out in the sagittal plane. Three-dimensional (3D) reconstructions of the joint structure of two exemplary patients were also made. Visual examinations of the MRI slices at the three time points revealed no changes in fossa shape in any of the 50 temporomandibular joints. Lateral comparisons showed that the morphology of the fossae of all 25 patients was identical. Metric analysis demonstrated no significant alterations in width, depth, or in their ratio, not even laterally. Nine measurements of the distances between the porion, mandibular fossa, and articular eminence revealed no significant changes in total or on the left and right sides, or intralaterally. The visual findings and metric analyses of parasagittal MRI slices did not indicate any morphological changes in the mandibular fossa or articular eminence in patients with distoclusion treated via a rigid, fixed orthodontic appliance. However, special reworking of the MRI data facilitated reconstruction of the surfaces of joint structures in 3D. This new method makes it possible to depict more accurately and noninvasively the adaptive mechanisms not ascertainable via metric methods and to assess them as 3D structures.

  15. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women...

  16. Seizure development after stroke.

    Science.gov (United States)

    Misirli, H; Ozge, A; Somay, G; Erdoğan, N; Erkal, H; Erenoğlu, N Y

    2006-12-01

    Although there have been many studies on seizures following stroke, there is still much we do not know about them. In this study, we evaluated the characteristics of seizures in stroke patients. There were 2267 patients with a first-ever stroke, and after excluding 387 patients, 1880 were available for analysis. Of these 1880 patients, we evaluated 200 patients with seizures and 400 patients without seizures. We investigated the seizures according to age, gender, stroke type, the aetiology of ischaemic stroke and the localisation of the lesion. The seizures were classified as early onset and late onset and the seizure type as partial, generalised or secondarily generalised. Seizures occurred in 200 (10.6%) of 1880 strokes. The number of patients with seizures were 138 (10.6%) in ischaemic stroke group and 62 (10.7%) in haemorrhagic stroke group. Patients with ischaemic strokes had 41 embolic (29.7%) and 97 thrombotic (70.3%) origin, and these were not statistically significant in comparison with controls. Cortical involvement for the development of seizures was the most important risk factor (odds ratios = 4.25, p < 0.01). It was concluded that embolic strokes, being younger than 65 years old, and cortical localisation of stroke were important risks for developing seizures.

  17. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  18. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2014-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  19. Morphological risk factors of stroke during thoracic endovascular aortic repair.

    Science.gov (United States)

    Kotelis, Drosos; Bischoff, Moritz S; Jobst, Bertram; von Tengg-Kobligk, Hendrik; Hinz, Ulf; Geisbüsch, Philipp; Böckler, Dittmar

    2012-12-01

    This study aims to identify independent factors correlating to an increased risk of perioperative stroke during thoracic endovascular aortic repair (TEVAR). A prospective maintained TEVAR database, medical records, and imaging studies of 300 patients (205 men; median age of all, 66 years, range 21-89), who underwent TEVAR between March 1997 and February 2011, were reviewed. Preoperative CT data sets were reviewed by two experienced radiologists with focus on the atheroma burden in the aortic arch (grade I, normal, to grade V, ulcerated or pedunculated atheroma). Aortic arch geometry (arch types I-III) was documented. Further parameters included in the univariate analysis were age, gender, urgency of repair, duration of procedure, adenosine-induced cardiac arrest or rapid pacing, proximal landing zone, left subclavian artery (LSA) coverage, and number of stent grafts. Multivariate logistic regression analysis was performed to assess the independent correlations of potential risk factors. Atherosclerotic aneurysm was the most common pathology (44%). One hundred and fifty-four of our patients (51%) were treated under urgent or emergent conditions. Seventeen percent of all patients had significant arch atheroma (grade IV or V), and 43% had a steep type III aortic arch. The perioperative stroke was 4% (12 patients; median age, 73 years, range 31-78). Two strokes were lethal (0.7%). All strokes were classified as embolic based on imaging characteristics. In eight patients, strokes were located in the left cerebral hemisphere (seven of them in the anterior and one in the posterior circulation). Four stroke patients (one in the left posterior circulation) underwent LSA coverage without revascularization. Three stroke patients had severe arch atheroma grade V. Five patients suffering stroke were recognized to have a type III aortic arch. Strokes were equally distributed between zones 0-2 vs. 3-4 (n = 6 each, 5 vs. 3.3%). The highest incidence was found in zone 1 (11

  20. Condyle-fossa modifications and muscle interactions during herbst treatment, part 1. New technological methods.

    Science.gov (United States)

    Voudouris, John C; Woodside, Donald G; Altuna, Gurkan; Kuftinec, Mladen M; Angelopoulos, Gerassimos; Bourque, Paul J

    2003-06-01

    Changes in the condyle, the glenoid fossa, and the muscles of mastication were investigated in subjects undergoing continuous orthopedic advancement of the mandible with a Herbst-block appliance. The total sample consisted of 56 subjects and included 15 nonhuman primates (in the middle mixed, early permanent, and permanent dentitions), 17 human Herbst patients in the early permanent dentition, and 24 human controls from the Burlington Growth Center. The 8 nonhuman primates in the middle mixed dentition were the focus of this study. Mandibular advancement was obtained progressively in 5 animals by adding stops to the telescopic arms of fixed functional Herbst appliances with occlusal coverage; activations of 5.0 mm, 7.0 mm, and 8.0 mm were achieved. Two primates served as controls, and the third was a sham control. Two experimental animals and the 2 controls also wore surgically implanted electromyographic electrodes in the superior and inferior heads of the lateral pterygoid muscles and in the superficial masseter and anterior digastric muscles. Changes in condylar growth direction and amount were assessed with the Björk method from measurements made on serial cephalometric tracings superimposed on metallic implants. Undecalcified sections, treated with intravenous tetracycline vital staining, were viewed with fluorescence microscopy to examine histologic changes in the condyle and the glenoid fossa. New bone formation in the fossa associated with continuous mandibular protrusion was quantified by using computerized histomorphometric analysis of decalcified histological sections and polarized light. The unique combination of permanently implanted electromyographic electrodes, tetracycline vital staining, and histomorphometry represents a significant technological advancement in methods and materials. Together, they demonstrated different muscle-bone interaction results for functional appliances than those reported in previous studies. In Part 1 of this study, we

  1. Preoperative irradiation of an extracerebral cavernous hemangioma in the middle fossa

    International Nuclear Information System (INIS)

    Shibata, Shobu; Kurihara, Masaki; Mori, Kazuo; Amamoto, Yuhei.

    1981-01-01

    This is a report of case with the extracerebral cavernous hemangioma in the middle fossa in which total removal was carried out after radiotherapy. Follow-up study with computed tomography during and after irradiation are presented. A 44-year-old house-wife complained of a decreased vision of the both eyes and paresis of the left upper and lower limbs. CT scan revealed a slightly high density area in the right middle cranial fossa which was markedly enhanced with contrast media. Right carotid angio-graphy demonstrated a large avascular mass in the right middle fossa and no feeding artery or draining vein was visualized except a faint irregular stain in the venous phase. An attempt to total removal of the tumor had failed to success because of extensive hemorrhage from the tumor. Histological examination revealed a cavernous hemangioma. Irradiation with a total dose of 5000 rads was delivered. After irradiation. CT scan revealed a marked decrease of size and EMI number of the tumor. At this stage, hypervascular mass lesion with feeding arteries was noted in conventional angiography. Tumor stain in prolonged injection angiography was also visualized. In the second operation, removal of the tumor was performed without any difficulty and hemorrhage was controlled easily by electrocoagulation. Histology revealed a marked narrowing of vessels with an increase in the connective tissues. In the central part of specimen, there noted findings of coagulation necrosis, intraluminal thrombus formations and so on, which were attributed to the influence of radiation. It is concluded that in case of a extracerebral cavernous hemangioma with massive hemorrhage, radiation of up to 3000 - 5000 rads was a method of choice. The treatment results in an increase of probability of total removal of the tumor. (author)

  2. ModFossa: A library for modeling ion channels using Python.

    Science.gov (United States)

    Ferneyhough, Gareth B; Thibealut, Corey M; Dascalu, Sergiu M; Harris, Frederick C

    2016-06-01

    The creation and simulation of ion channel models using continuous-time Markov processes is a powerful and well-used tool in the field of electrophysiology and ion channel research. While several software packages exist for the purpose of ion channel modeling, most are GUI based, and none are available as a Python library. In an attempt to provide an easy-to-use, yet powerful Markov model-based ion channel simulator, we have developed ModFossa, a Python library supporting easy model creation and stimulus definition, complete with a fast numerical solver, and attractive vector graphics plotting.

  3. Congenital piriform fossa sinus tract presenting as an asymptomatic neck mass in an infant

    International Nuclear Information System (INIS)

    Bloom, David A.; Adler, Brent H.; Forsythe, Robert C.; Mutabagani, Khaled; Teich, Steven

    2003-01-01

    A 5-month-old girl with an asymptomatic left-sided neck mass was demonstrated by ultrasound and upper gastrointestinal series (UGI), and confirmed at surgery, to have a congenital piriform fossa sinus tract (CPFST) that communicated with an intrathyroidal cyst. To demonstrate a case of CPFST presenting as an asymptomatic neck mass. Nearly all cases of CPFST present with infection or pain, making this case unique. Case report and review of the literature. CPFST with an associated cyst should be added to the differential diagnosis of asymptomatic cystic neck masses in infants, especially if the cyst is intrathyroidal by ultrasound. (orig.)

  4. Visible and Near-Infrared Spectroscopy of Hephaestus Fossae Cratered Cones, Mars

    Science.gov (United States)

    Dapremont, A.; Wray, J. J.

    2017-12-01

    Hephaestus Fossae are a system of sub-parallel fractures on Mars (> 500 km long) interpreted as near-surface tensional cracks [1]. Images of the Martian surface from the High Resolution Imaging Science Experiment have revealed cratered cones within the Hephaestus Fossae region. A volcanic origin (cinder/tuff cones) has been proposed for these features based on morphometric measurements and fine-scale surface characteristics [2]. In an effort to further constrain the origin of these cones as the products of igneous or sedimentary volcanism, we use data from the Compact Reconnaissance Imaging Spectrometer for Mars (CRISM). We take advantage of CRISM's S (0.4 - 1.0 microns) and L (1.0 - 3.9 microns) detector wavelength ranges to investigate the presence or absence of spectral signatures consistent with previous identifications of igneous and mud volcanism products on Mars [3,4]. Hephaestus Fossae cratered cone rims exhibit a consistent nanophase ferric oxide signature. We also identify ferrous phases and 3-micron absorptions (attributed to fundamental vibrational stretch frequencies in H2O) on the crater rims of several cones. Mafic signatures on cratered cone rims support an igneous provenance for these features. The 3-micron absorptions are consistent with the presence of structurally bound or adsorbed water. Our CRISM observations are similar to those of small edifice features in Chryse Planitia, which were interpreted as mud volcanism products based on their enrichment of nanophase ferric minerals and 3-micron absorptions on summit crater rims [3]. Hydrothermal activity was invoked for a Coprates Chasma pitted cone (scoria/tuff cone) based on CRISM identification of partially dehydrated opaline silica, which we do not observe in Hephaestus Fossae [4]. Our spectral observations are more consistent with mud volcanism, but we do not definitively rule out an igneous volcanic origin for the cones in our study region. We demonstrate that VNIR spectroscopy is a valuable

  5. Superolateral dislocation of an intact mandibular condyle into the temporal fossa: case report and literature review.

    Science.gov (United States)

    Sharma, Divashree; Khasgiwala, Ankit; Maheshwari, Bharat; Singh, Charanpreet; Shakya, Neelam

    2017-02-01

    Temporomandibular joint dislocation refers to the dislodgement of mandibular condyle from the glenoid fossa. Anterior and anteromedial dislocations of the mandibular condyle are frequently reported in the literature, but superolateral dislocation is a rare presentation. This report outlines a case of superolateral dislocation of an intact mandibular condyle that occurred in conjunction with an ipsilateral mandibular parasymphysis fracture. A review of the clinical features of superolateral dislocation of the mandibular condyle and the possible techniques of its reduction ranging from the most conservative means to extensive surgical interventions is presented. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Surgery for juvenile nasopharyngeal angiofibroma with lateral extension to the infratemporal fossa.

    Science.gov (United States)

    Yamada, Masato; Tsunoda, Atsunobu; Tokumaru, Takao; Aoyagi, Masaru; Kawano, Yoshihisa; Yano, Tomoyuki; Kishimoto, Seiji

    2014-08-01

    The study aimed to assess the usefulness of skull base surgery for large juvenile nasopharyngeal angiofibroma (JNA) with lateral extension to the infratemporal fossa. Eleven cases were enrolled for this study, and the mean age was 17.7 years old (range: 8-32). Six out of 11 cases underwent surgery as an initial treatment, and the other five underwent secondary surgery after initial surgery or radiotherapy in other institutions. The range of extension of tumor, feeding arteries, surgical approach, and treatment outcome were estimated. All tumors originated from the sphenopalatine foramen. Based on the imaging study, there was extension to the cavernous sinus observed in eight cases, as well as to the middle cranial fossa (8), orbit (4), and anterior cranial fossa (1). These tumors were diagnosed as Andrews' Stage IVa (3) and IVb (8). However, infiltration into the cavernous sinus was observed in one case only during surgery. Ten tumors were separated carefully from the cavernous sinus or dura and were accurately diagnosed as Stage IIIb. In all cases, the main arterial feeders of the JNAs were branches of the external carotid artery, which were embolized prior to surgery. However, 10 cases were also fed by branches of the internal carotid artery (branches of the ophthalmic artery), in which these arteries could not be embolized. Coronal skin incision (1) and a facial dismasking flap (9) were used, and in one case, wide lateral skin incision with temporary incision of the facial nerve was applied. The orbito-zygomatic approach and its modification was applied to all the cases. Fronto-lateral craniotomy was applied in four cases and lateral craniotomy in seven cases. Total resection was achieved in 10 cases and subtotal resection in one case. No mortality was noted in this series. Temporal trismus was observed in all cases which subsided gradually. Cheek numbness and facial palsy were observed in three and two cases, respectively. Coupled with craniotomy, tumor removal

  7. Huge interparietal posterior fontanel meningohydroencephalocele

    Directory of Open Access Journals (Sweden)

    Jorge Félix Companioni Rosildo

    2015-03-01

    Full Text Available Congenital encephalocele is a neural tube defect characterized by a sac-like protrusion of the brain, meninges, and other intracranial structures through the skull, which is caused by an embryonic development abnormality. The most common location is at the occipital bone, and its incidence varies according to different world regions. We report a case of an 1-month and 7-day-old male child with a huge interparietal-posterior fontanel meningohydroencephalocele, a rare occurrence. Physical examination and volumetric computed tomography were diagnostic. The encephalocele was surgically resected. Intradural and extradural approaches were performed; the bone defect was not primarily closed. Two days after surgery, the patient developed hydrocephaly requiring ventriculoperitoneal shunting. The surgical treatment of the meningohydroencephalocele of the interparietal-posterior fontanel may be accompanied by technical challenges and followed by complications due to the presence of large blood vessels under the overlying skin. In these cases, huge sacs herniate through large bone defects including meninges, brain, and blood vessels. The latter present communication with the superior sagittal sinus and ventricular system. A favorable surgical outcome generally follows an accurate strategy taking into account individual features of the lesion.

  8. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz

    2017-02-01

    Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

  9. Stroke in Commercial Flights.

    Science.gov (United States)

    Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli

    2016-04-01

    Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.

  10. Orthodontic treatment for posterior crossbites.

    Science.gov (United States)

    Agostino, Paola; Ugolini, Alessandro; Signori, Alessio; Silvestrini-Biavati, Armando; Harrison, Jayne E; Riley, Philip

    2014-08-08

    A posterior crossbite occurs when the top back teeth bite inside the bottom back teeth. When it affects one side of the mouth, the lower jaw may have to move to one side to allow the back teeth to meet together. Several treatments have been recommended to correct this problem. Some treatments widen the upper teeth while others are directed at treating the cause of the posterior crossbite (e.g. breathing problems or sucking habits). Most treatments have been used at each stage of dental development. This is an update of a Cochrane review first published in 2001. To assess the effects of orthodontic treatment for posterior crossbites. We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 21 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE via OVID (1946 to 21 January 2014), and EMBASE via OVID (1980 to 21 January 2014). We searched the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults. Two review authors, independently and in duplicate, screened the results of the electronic searches, and extracted data and assessed the risk of bias of the included studies. We attempted to contact the first named authors of the included studies for missing data and for clarification. We used risk ratios (RR) and 95% confidence intervals (CIs) to summarise dichotomous (event) data, and mean differences (MD) with 95% CIs to summarise continuous data. We performed meta-analyses using fixed-effect models (we would have used random-effects models if we had included four or more studies in a meta-analysis) when comparisons and outcomes were sufficiently similar. We

  11. Significance of periventricular hyperintensity in T2 weighted MRI on memory dysfunction and depression after stroke

    International Nuclear Information System (INIS)

    Bokura, Hirokazu; Kobayashi, Shotai; Yamaguchi, Shuhei; Yamashita, Kazuya; Koide, Hiromi

    1994-01-01

    We studied the effect of periventricular hyperintensity (PVH) in T2 weighted MRI on memory function and post-stroke depression in 159 patients with cerebrovacular disease. Memory function was assessed with Hasegawa's scale, and depressive state was estimated with Zung's self-rating depression scale. Patients showing diffusely distributed PVH had significantly low scores in memory function tests. Localized PVH around the anterior horns of the laterals ventricle was also associated with impaired memory function when the area of PVH was large. The incidence of post-stroke depression was high in patients with large PVH around the anterior horn in comparison with patients with PVH around the posterior horn. The severity of PVH around the posterior horn did not affect memory function and post-stroke depression. These findings suggest that memory dysfunction and post-stroke depression were accelerated by the diffusely or anteriorly distributed PVH. (author)

  12. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

  13. Intramedullary femoral nailing through the trochanteric fossa versus greater trochanter tip : a randomized controlled study with in-depth functional outcome results

    NARCIS (Netherlands)

    Moein, C. M. Ansari; ten Duis, H. J.; Oey, P. L.; de Kort, G. A. P.; van der Meulen, W.; van der Werken, Chr

    2011-01-01

    In a level 1 university trauma center, an explorative randomized controlled study was performed to compare soft tissue damage and functional outcome after antegrade femoral nailing through a trochanteric fossa (also known as piriform fossa) entry point to a greater trochanter entry point in patients

  14. Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

    OpenAIRE

    Grace Vincent-Onabajo; Taritei Moses

    2016-01-01

    Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke?whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk fac...

  15. Branchial sinus of the piriform fossa: reappraisal of third and fourth branchial anomalies.

    Science.gov (United States)

    James, Adrian; Stewart, Craig; Warrick, Paul; Tzifa, Constance; Forte, Vito

    2007-11-01

    The objective of this study was to review clinical and embryologic aspects of third and fourth branchial anomalies. Retrospective study. We reviewed the institutional and departmental databases at our institution to identify all cases of third and fourth branchial anomalies encountered from 1992 to 2006. All patient records were examined with respect to demographics, clinical history, and radiologic and pathologic reports. We identified 17 cases of third and fourth branchial anomalies, the largest series of its kind reported to date. The lesions were predominantly left sided, all presenting with neck infection. Fistula formation was iatrogenic, secondary to incision and drainage. Preoperative direct laryngoscopy always revealed a pit within the apex of the piriform fossa. Surgical excision involved ipsilateral thyroidectomy as the lesion passed through the thyroid gland. No lesions following the classical course of a either a third or fourth branchial anomaly were identified. The clinical presentation of branchial sinuses arising from the piriform fossa is more in keeping with derivation from the thymopharyngeal duct (of the third pouch) than the hypothetical course of third and fourth branchial fistulae.

  16. Ultrasound and magnetic resonance imaging findings in Schistosomiasis mansoni: expanded gallbladder fossa and fatty hilum signs

    Directory of Open Access Journals (Sweden)

    Luciana Cristina dos Santos Silva

    2012-08-01

    Full Text Available INTRODUCTION: There is no study relating magnetic resonance imaging (MRI to ultrasound (US findings in patients with Schistosomiasis mansoni. Our aim was to describe MRI findings inpatients with schistosomal liver disease identified by US. METHODS: Fifty-four patients (mean age 41.6±13.5years from an area endemic for Schistosomiasis mansoni were selected for this study.All had US indicating liver schistosomal fibrosis and were evaluated with MRI performed witha 1.5-T superconducting magnet unit (Sigma. RESULTS: Forty-seven (87% of the 54 patientsshowing signs of periportal fibrosis identified through US investigation had confirmed diagnosesby MRI. In the seven discordant cases (13%, MRI revealed fat tissue filling in the hilar periportalspace where US indicated isolated thickening around the main portal vein at its point of entryto the liver. We named this the fatty hilum sign. One of the 47 patients with MRI evidence ofperiportal fibrosis had had his gallbladder removed previously. Thirty-five (76.1% of the other46 patients had an expanded gallbladder fossa filled with fat tissue, whereas MRI of the remainingeleven showed pericholecystic signs of fibrosis. CONCLUSIONS: Echogenic thickening of thegallbladder wall and of the main portal vein wall heretofore attributed to fibrosis were frequentlyidentified as fat tissue in MRI. However, the gallbladder wall thickening shown in US (expandedgallbladder fossa in MRI is probably secondary to combined hepatic morphologic changes inschistosomiasis, representing severe liver involvement.

  17. Transzygomatic approach with intraoperative neuromonitoring for resection of middle cranial fossa tumors.

    Science.gov (United States)

    Son, Byung Chul; Lee, Sang Won; Kim, Sup; Hong, Jae Taek; Sung, Jae Hoon; Yang, Seung-Ho

    2012-02-01

    The authors reviewed the surgical experience and operative technique in a series of 11 patients with middle fossa tumors who underwent surgery using the transzygomatic approach and intraoperative neuromonitoring (IOM) at a single institution. This approach was applied to trigeminal schwannomas (n = 3), cavernous angiomas (n = 3), sphenoid wing meningiomas (n = 3), a petroclival meningioma (n = 1), and a hemangiopericytoma (n = 1). An osteotomy of the zygoma, a low-positioned frontotemporal craniotomy, removal of the remaining squamous temporal bone, and extradural drilling of the sphenoid wing made a flat trajectory to the skull base. Total resection was achieved in 9 of 11 patients. Significant motor pathway damage can be avoided using a change in motor-evoked potentials as an early warning sign. Four patients experienced cranial nerve palsies postoperatively, even though free-running electromyography of cranial nerves showed normal responses during the surgical procedure. A simple transzygomatic approach provides a wide surgical corridor for accessing the cavernous sinus, petrous apex, and subtemporal regions. Knowledge of the middle fossa structures is essential for anatomic orientation and avoiding injuries to neurovascular structures, although a neuronavigation system and IOM helps orient neurosurgeons.

  18. High precision locations of long-period events at La Fossa Crater (Vulcano Island, Italy

    Directory of Open Access Journals (Sweden)

    Salvatore Rapisarda

    2009-06-01

    Full Text Available Since the last eruption in 1888-90, the volcanic activity on Vulcano Island (Aeolian Archipelago, Italy has been limited to fumarolic degassing. Fumaroles are mainly concentred at the active cone of La Fossa in the northern sector of the island and are periodically characterized by increases in temperature as well as in the amount of both CO2 and He. Seismic background activity at Vulcano is dominated by micro-seismicity originating at shallow depth (<1-1.5 km under La Fossa cone. This seismicity is related to geothermal system processes and comprises long period (LP events. LPs are generally considered as the resonance of a fluid-filled volume in response to a trigger. We analyzed LP events recorded during an anomalous degassing period (August-October 2006 applying a high precision technique to define the shape of the trigger source. Absolute and high precision locations suggest that LP events recorded at Vulcano during 2006 were produced by a shallow focal zone ca. 200 m long, 40 m wide and N30-40E oriented. Their occurrence is linked to magmatic fluid inputs that by modifying the hydrothermal system cause excitation of a fluid-filled cavity.

  19. Stroke And Substance Abuse

    OpenAIRE

    A Chitsaz

    2017-01-01

    Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injec...

  20. Stroke Prevention & Treatment: Diet & Nutrition

    Science.gov (United States)

    ... Prevention & Treatment: Diet & Nutrition Stroke Prevention & Treatment: Diet & Nutrition A healthy diet can reduce your risk for ... Treatment How does a stroke affect eating and nutrition? Stroke can devastate a person's nutritional health because ...

  1. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke

  2. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... Prevent Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and ... can’t change some of your risks for heart disease and stroke, but you can manage many of ...

  3. Epileptic seizures in patients with a posterior circulation infarct

    Directory of Open Access Journals (Sweden)

    Yüksel Kaplan

    2014-08-01

    Full Text Available OBJECTIVE: The aim of this study was to investigate the frequency of seizures and the clinical features of patients with seizures related to a posterior circulation infarct (POCI. METHODS: We reviewed all ischemic stroke patients admitted to our clinic between January 2011 and January 2012. The patients’ database information was retrospectively analyzed. Fifty-five patients with a POCI were included in the study. We reviewed all patients with epileptic seizures related to a POCI. Age, gender, recurrent stroke, risk factors, etiology, radiographic localization, the seizure type and onset time, and the electroencephalographic findings of patients were evaluated. We excluded all patients who had precipitating conditions during seizures such as taking drugs, acid-base disturbances, electrolyte imbalance, and history of epilepsy. RESULTS: Seizures were observed in four patients (3 male, 1 female with a POCI related epileptic seizures (7.2%. The etiology of strokes was cardiac-embolic in 3 patients and vertebral artery dissection in 1 patient. Seizures occurred in 2 patients as presenting finding, in 1 patient within 7 days, and 1 patient within 28 days. Primary generalized tonic-clonic seizures occurred in 3 patients and simple partial seizures with secondary generalization in 1 patient. Three patients had cerebellum infarction at the left hemisphere. One patient had lateral medullary infarction at the right side. The electroencephalographic findings of patients were normal. CONCLUSION: Studies involving patients with seizures related to a POCI are novel and few in number. Three patients with seizure had cerebellum infarction. The cerebellum in these patients may contribute via different mechanisms over seizure activity.

  4. Demographic Characteristics of Stroke Types in Adıyaman

    Directory of Open Access Journals (Sweden)

    Yaşar Altun

    2018-03-01

    Full Text Available Objective: We aimed to investigate the etiologic, demographic, clinical features, and risk factors of patients who were hospitalized, followed up, and treated due to stroke in our hospital. Materials and Methods: In this study, the hospital records of patients diagnosed as having stroke or cerebrovascular disease (CVD between January 2013 and January 2015 in Adıyaman University Training and Research Hospital, where patients with stroke are frequently admitted or transferred, were retrospectively investigated. Results: In the past two years, 683 patients were followed-up or treated for stroke and CVD in our hospital. Stroke patients constituted 0.06% of all emergency admissions. Of these patients, 87.8% were diagnosed as having ischemic stroke and 8.6% were diagnosed as having hemorrhagic stroke. The sex distribution was almost equal (50.8% were males and 49.2% were females. Based on the results of brain scans performed during admission, radiologically, 498 (81.1% patients showed evidence of anterior system involvement and 116 (18.9% patients showed evidence of posterior system involvement. No focal areas were observed in computed tomography scans in 508 patients. However, diffusion magnetic resonance findings of these 508 patients were pathologic. Most of the patients with stroke were aged above 65 years (74.9%. The most common symptom during admission was unilateral muscle weakness (63.3%, and 58.6% of the patients were brought to the hospital by ambulance. Conclusion: As well as the results of our study being parallel to previous studies, our study also reflects the majority of stroke data in Adıyaman, Turkey, and provides significant results regarding our geographic region

  5. Topography of acute stroke in a sample of 439 right brain damaged patients.

    Science.gov (United States)

    Sperber, Christoph; Karnath, Hans-Otto

    2016-01-01

    Knowledge of the typical lesion topography and volumetry is important for clinical stroke diagnosis as well as for anatomo-behavioral lesion mapping analyses. Here we used modern lesion analysis techniques to examine the naturally occurring lesion patterns caused by ischemic and by hemorrhagic infarcts in a large, representative acute stroke patient sample. Acute MR and CT imaging of 439 consecutively admitted right-hemispheric stroke patients from a well-defined catchment area suffering from ischemia (n = 367) or hemorrhage (n = 72) were normalized and mapped in reference to stereotaxic anatomical atlases. For ischemic infarcts, highest frequencies of stroke were observed in the insula, putamen, operculum and superior temporal cortex, as well as the inferior and superior occipito-frontal fascicles, superior longitudinal fascicle, uncinate fascicle, and the acoustic radiation. The maximum overlay of hemorrhages was located more posteriorly and more medially, involving posterior areas of the insula, Heschl's gyrus, and putamen. Lesion size was largest in frontal and anterior areas and lowest in subcortical and posterior areas. The large and unbiased sample of stroke patients used in the present study accumulated the different sub-patterns to identify the global topographic and volumetric pattern of right hemisphere stroke in humans.

  6. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  7. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2013-01-01

    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  8. Ischemic Stroke: MedlinePlus Health Topic

    Science.gov (United States)

    ... Spanish Thrombolytic therapy (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Ischemic Stroke updates ... cardiogenic embolism Stroke - slideshow Thrombolytic therapy Related Health Topics Hemorrhagic Stroke Stroke Stroke Rehabilitation National Institutes of ...

  9. Usefulness of high-resolution 3D multifusion medical imaging for preoperative planning in patients with posterior fossa hemangioblastoma: technical note.

    Science.gov (United States)

    Yoshino, Masanori; Nakatomi, Hirofumi; Kin, Taichi; Saito, Toki; Shono, Naoyuki; Nomura, Seiji; Nakagawa, Daichi; Takayanagi, Shunsaku; Imai, Hideaki; Oyama, Hiroshi; Saito, Nobuhito

    2017-07-01

    Successful resection of hemangioblastoma depends on preoperative assessment of the precise locations of feeding arteries and draining veins. Simultaneous 3D visualization of feeding arteries, draining veins, and surrounding structures is needed. The present study evaluated the usefulness of high-resolution 3D multifusion medical imaging (hr-3DMMI) for preoperative planning of hemangioblastoma. The hr-3DMMI combined MRI, MR angiography, thin-slice CT, and 3D rotated angiography. Surface rendering was mainly used for the creation of hr-3DMMI using multiple thresholds to create 3D models, and processing took approximately 3-5 hours. This hr-3DMMI technique was used in 5 patients for preoperative planning and the imaging findings were compared with the operative findings. Hr-3DMMI could simulate the whole 3D tumor as a unique sphere and show the precise penetration points of both feeding arteries and draining veins with the same spatial relationships as the original tumor. All feeding arteries and draining veins were found intraoperatively at the same position as estimated preoperatively, and were occluded as planned preoperatively. This hr-3DMMI technique could demonstrate the precise locations of feeding arteries and draining veins preoperatively and estimate the appropriate route for resection of the tumor. Hr-3DMMI is expected to be a very useful support tool for surgery of hemangioblastoma.

  10. Diagnostic neuroimaging in stroke

    International Nuclear Information System (INIS)

    Jarenwattananon, A.; Khandji, A.; Brust, J.C.M.

    1988-01-01

    Since the development of cerebral angiography 60 years ago, there has been a proliferation of increasingly sophisticated, expensive, and, fortunately, safe imaging techniques for patients with cerebrovascular disease. In addition, occlusive and hemorrhagic stroke are now recognized as having a wide variety of possible causes. This chapter addresses the different imaging options available for particular kinds of stroke

  11. Relational Processing Following Stroke

    Science.gov (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian

    2013-01-01

    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  12. Stroke (For Kids)

    Science.gov (United States)

    ... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... for Educators Search English Español Stroke KidsHealth / For Kids / Stroke What's in this article? What Happens During ...

  13. Burden of stroke in Bangladesh.

    Science.gov (United States)

    Islam, Md Nazmul; Moniruzzaman, Mohammed; Khalil, Md Ibrahim; Basri, Rehana; Alam, Mohammad Khursheed; Loo, Keat Wei; Gan, Siew Hua

    2013-04-01

    Stroke is the third leading cause of death in Bangladesh. The World Health Organization ranks Bangladesh's mortality rate due to stroke as number 84 in the world. The reported prevalence of stroke in Bangladesh is 0.3%, although no data on stroke incidence have been recorded. Hospital-based studies conducted in past decades have indicated that hypertension is the main cause of ischaemic and haemorrhagic stroke in Bangladesh. The high number of disability-adjusted life-years lost due to stroke (485 per 10,000 people) show that stroke severely impacts Bangladesh's economy. Although two non-governmental organizations, BRAC and the Centre for the Rehabilitation of the Paralysed, are actively involved in primary stroke prevention strategies, the Bangladeshi government needs to emphasize healthcare development to cope with the increasing population density and to reduce stroke occurrence. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  14. MR-Guided Laser-Induced Thermotherapy of the Infratemporal Fossa and Orbit in Malignant Chondrosarcoma via a Modified Technique

    International Nuclear Information System (INIS)

    Vogl, Thomas J.; Mack, Martin G.; Straub, Ralf; Eichler, Katrin; Zangos, Stephan

    2001-01-01

    A 76-year-old patient presented with a recurrent mass of a malignant chondrosarcoma in the right infratemporal fossa and in the left maxillary sinus with orbital invasion. The patient was treated with a palliative intention with MR-guided laser-induced thermotherapy using a modified applicator technique. Following treatment clinical symptoms improved and MRI revealed complete laser-induced tumor necrosis

  15. Bone changes in the condylar head and mandibular fossa in patients with temporomandibular disorders. Helical CT observation

    International Nuclear Information System (INIS)

    Shimahara, Satoru; Ariyoshi, Yasunori; Kimura, Yoshihiro; Shimahara, Masashi

    2011-01-01

    In the present study, we investigated whether bone changes are present in sites impossible to observe by panoramic X-ray and Schuller's X-ray examination, namely the medial of the condylar head and mandibular fossa, in patients with type IV temporomandibular joint disorders. We observed the articular fossa using computed tomography, which is able to obtain detailed 3-dimensional information, in patients with type IV temporomandibular disorders. We examined 120 joints of 60 patiens who visited the Department of Oral Surgery, Osaka Medical College Hospital. Each condylar head was clearly visualized in panoramic X-ray and Schuller's X-ray examination findings, and shown to have possible changes unilaterally. Each joint was diagnosed as type IV, according to the diagnostic guidelines set by Japanese Society for Temporomandibular Joint, and further examined using helical CT. Changes in condylar head; We concluded that bone changes were present with considerable probability in the medial of condylar head in a manner similar to those found in the lateral and center of joints with type IV temporomandibular disorders. Changes in mandibular fossa; The bone changes occurred in various locations of the mandibular fossa, while they appeared significantly more frequently in the condylar head. We think that our finding will contribute to development of treatment strategies for temporomandibular disorders, as they clarify bone changes in sites previously unreported. (author)

  16. Sporadic Carney complex without PRKAR1A mutation in a young patient with ischemic stroke.

    Science.gov (United States)

    Aguiar de Sousa, Diana; Gouveia, Ana Isabel; Wessling, Ana; Geraldes, Ruth; Canhão, Patrícia

    2015-03-01

    We describe a 29-year-old male, with a previous history of testicular tumor, who presented with a posterior circulation ischemic stroke associated to an atrial myxoma. Dermatologic observation disclosed spotty skin and mucosal pigmentation (lentigines), and a cutaneous myxoma was histopathologically confirmed. Although there was no family history of any of the Carney complex (CNC) features and no mutations in the PRKAR1A gene were found, these findings lead to the diagnosis of CNC. We emphasize the importance of recognizing this entity in young patients with stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Ischemic Volume and Neurological Deficit: Correlation of Computed Tomography Perfusion with the National Institutes of Health Stroke Scale Score in Acute Ischemic Stroke.

    Science.gov (United States)

    Furlanis, Giovanni; Ajčević, Miloš; Stragapede, Lara; Lugnan, Carlo; Ridolfi, Mariana; Caruso, Paola; Naccarato, Marcello; Ukmar, Maja; Manganotti, Paolo

    2018-04-30

    The National Institutes of Health Stroke Scale (NIHSS) is the most adopted stroke patients' evaluation tool in emergency settings to assess the severity of stroke and to determine the patients' eligibility for specific treatments. Computed tomography perfusion (CTP) is crucial to identify salvageable tissue that can benefit from the reperfusion treatment. The aim of this study is to identify the relation between the NIHSS scores and the hypoperfused volumes evaluated by CTP in patients with hyperacute ischemic stroke. This retrospective study was conducted on 105 patients with ischemic stroke who underwent NIHSS assessment and CTP in the hyperacute phase. Hypoperfused volume was evaluated by CTP maps processed with semi-automatic algorithm. An analysis was conducted to determine the degree of correlation between the NIHSS scores and the ischemic lesion volumes and to investigate the relation between the anterior and the posterior circulation strokes, as well as between the right and the left hemispheric strokes. A significant correlation was found between ischemic volume and NIHSS score at baseline (r = .82; P correlation was identified in the anterior circulation stroke (r = .76; P correlated for the left and the right hemispheric strokes (r = .83 and .81; P correlation between the baseline NIHSS score and the ischemic volume estimated by CTP. We confirmed that NIHSS is a reliable predictor of perfusion deficits in acute ischemic stroke. CTP allows fast imaging assessment in the hyperacute phase. The results highlight the importance of these diagnostic tools in the assessment of stroke severity and in acute decision-making. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Selective posterior lumbosacral rhizotomy for the management ...

    African Journals Online (AJOL)

    tion in 95% of cases. The majority showed ... selective posterior rhizotomy technique whereby the cauda equina ... assessed pre- and postoperatively by means of clinical examination ... were attending cerebral palsy schools and receiving spe- cialised ... root sections on cats demonstrated clearly that posterior root section ...

  19. Evaluation of the outcomes after posterior urethroplasty.

    Science.gov (United States)

    Liberman, Daniel; Pagliara, Travis J; Pisansky, Andrew; Elliott, Sean P

    2015-03-01

    Posterior urethral injury is a clinically significant complication of pelvic fractures. The management is complicated by the associated organ injuries, distortion of the pelvic anatomy and the ensuing fibrosis that occurs with urethral injury. We report a review of the outcomes after posterior urethroplasty in the context of pelvic fracture urethral injury.

  20. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

  1. Stroke mimic diagnoses presenting to a hyperacute stroke unit.

    Science.gov (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

    2016-10-01

    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  2. Silent internal sinus of the pyriform fossa: a rare adult manifestation of a branchial anomaly.

    Science.gov (United States)

    Lin, Chao-Jung; Lin, Yaoh-Shiang; Kang, Bor-Hwang; Lee, Jin-Chin

    2003-03-01

    Branchial anomalies present with a wide range of pathologic characteristics, including cysts, fistulas, and sinuses of the head and neck region. Branchial cysts are most commonly diagnosed during the second through fourth decades of life, while branchial sinuses and fistulas are diagnosed almost exclusively in children with infection episodes. Only rarely has an internal sinus of a third or fourth branchial anomaly manifested in adults as a noninfectious swelling in the neck during swallowing. In this report, we describe our experience treating a 21-year-old man with a left-sided swallowing-induced neck protrusion of 10 years' duration. Findings of physical examination, videolaryngoscopy, and a pharyngoesophagogram confirmed the diagnosis of internal sinus of the pyriform fossa, with uncertain origin of a third or fourth branchial anomaly. The patient underwent regular follow-up as an outpatient and experienced no further infectious episodes.

  3. A branchial cyst of the pyriform fossa transoral laser resection: a case report.

    Science.gov (United States)

    Abdelfattah, Hesham Mostafa; Ahmed, Mohammed Elrabie; Ahmed, Mona El-Rabie; Ahmed, Mohamed Abd El-Kader; Moussa, Abd-Elmateen

    2016-02-01

    Pyriform sinus malformations represent rare third and fourth branchial anomalies. Fistulae at the latter site were initially described and make up less than 1 % of all brachial anomalies. They may be discovered incidentally, or may present as a neck mass with recurrent infection, dysphagia, or airway compromise, and can be an unusual cause of dysphonia in infant and children. Here, we present a case of third branchial cyst located in pharyngeal wall of the left pyriform sinus which presented with dysphonia since birth in a 6-year-old girl. Transoral CO2 laser excision was carried out successfully with no communicating tract. The patient's dysphonia showed progressive regression at 1-year follow-up. Third branchial cyst in the left pyriform sinus (Bailey's type IV) is an unusual cause of dysphonia in pediatric. Our present case report is the first brachial cyst to be reported in the pyriform fossa and the second branchial anomalies to be excised transorally with CO2 laser.

  4. Infraorbital nerve block within the Pterygopalatine fossa of the horse: anatomical landmarks defined by computed tomography

    International Nuclear Information System (INIS)

    Carsten, S.; Hagen, G.

    2008-01-01

    In order to provide anaesthesia of the equine maxillary cheek teeth, a local nerve block of the infraorbital nerve in the pterygopalatine fossa had been proposed, which is referred to as the 'Palatine Bone Insertion' (PBI). As several complications with this method were reported, our study was designed to recommend a modified injection technique which avoids the risk of puncturing of relevant anatomical structures. Five cadaver heads and two living horses were examined by contrast medium injections and subsequent computed tomography (CT). Spinal needles were inserted using two different insertion techniques: The above mentioned (PBI), and a modification called 'Extraperiorbital Fat Body Insertion' (EFBI). Both techniques (PBI and EFBI) provide a consistent distribution of contrast medium around the infraorbital nerve. However, only the EFBI technique is appropriate to minimize the risk of complications. This study is an example for the permanent challenge of anatomists to supply a basis for clinical and surgical procedures

  5. Cholecystokinin-Assisted Hydrodissection of the Gallbladder Fossa during FDG PET/CT-guided Liver Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Tewari, Sanjit O., E-mail: tewaris@mskcc.org [Memorial Sloan-Kettering Cancer Center, Molecular Imaging and Therapy Service, Department of Radiology (United States); Petre, Elena N., E-mail: petree@mskcc.org [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States); Osborne, Joseph, E-mail: osbornej@mskcc.org [Memorial Sloan-Kettering Cancer Center, Molecular Imaging and Therapy Service, Department of Radiology (United States); Sofocleous, Constantinos T., E-mail: sofoclec@mskcc.org [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States)

    2013-12-15

    A 68-year-old female with colorectal cancer developed a metachronous isolated fluorodeoxyglucose-avid (FDG-avid) segment 5/6 gallbladder fossa hepatic lesion and was referred for percutaneous ablation. Pre-procedure computed tomography (CT) images demonstrated a distended gallbladder abutting the segment 5/6 hepatic metastasis. In order to perform ablation with clear margins and avoid direct puncture and aspiration of the gallbladder, cholecystokinin was administered intravenously to stimulate gallbladder contraction before hydrodissection. Subsequently, the lesion was ablated successfully with sufficient margins, of greater than 1.0 cm, using microwave with ultrasound and FDG PET/CT guidance. The patient tolerated the procedure very well and was discharged home the next day.

  6. Cine-magnetic resonance imaging evaluation of communication between middle cranial fossa arachnoid cysts and cisterns

    International Nuclear Information System (INIS)

    Eguchi, Takahiko; Nikaido, Yuji; Shiomi, Kazuaki; Fujimoto, Takatoshi; Otsuka, Hiroyuki; Takeuchi, Hiroshi; Taoka, Toshiaki.

    1996-01-01

    Cine-magnetic resonance (MR) imaging examinations were performed in 10 patients with middle cranial fossa arachnoid cysts to evaluate communication between the cysts and the normal cerebrospinal fluid (CSF) space. Eight of 10 patients were evaluated by time of flight cine-MR imaging, and two by phase contrast cine-MR imaging. Two patients underwent membranectomy of the cysts, and were evaluated both pre-and postoperatively. Computed tomography cisternography was used to confirm communication between the cysts and the surrounding cisterns. Pulsatile fluid motion within the cysts was present in all patients. However, marked fluid motion and jet flow between the cysts and the surrounding cisterns were only observed in communicating cysts. In the two patients who underwent membranectomy, postoperative examination found greater fluid motion and jet flow not previously present. Cine-MR imaging demonstration of marked pulsatile fluid motion accompanied by jet flow suggests that a cyst communicates with the normal CSF space. (author)

  7. Development of stroke-induced quadriplegia after endovascular repair of blunt aortic injury pseudoaneurysm.

    Science.gov (United States)

    Amoudi, Abdullah S; Merdad, Anas A; Makhdoom, Ahmed Q; Jamjoom, Reda A

    2015-01-01

    Endovascular repair of blunt aortic injury is now a first-line approach in management. This can warrant coverage of the left subclavian artery (LSA), which could lead to posterior strokes. In this case report, we present a severe complication of endovascular repair of a traumatic aortic aneurysm. A 53-year-old man presented with blunt aortic injury, endovascular repair was carried out where the left subclavian artery was covered. The intervention had a 100% technical success. Twelve hours later, he was discovered to have quadriplegia, a CT scan showed a large left cerebellar infarction extending to the medulla oblongata and proximal spinal cord. Strokes complicate 3% of thoracic endovascular aortic repairs, 80% of those strokes occur in patients who had their LSA`s covered. Most patients however, tolerate the coverage. Although our patient had a dominant right vertebral artery, and lacked risks for these strokes, he developed an extensive stroke that left him quadriplegic.

  8. Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, L; Nygård, A; Ovesen, C

    2014-01-01

    INTRODUCTION: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments....... The aim of this study was to assess the prevalence of CT angiography (CTA)-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke....... METHOD: The analysis was based on 657 consecutive patients with symptoms of acute stroke and a final diagnosis of ischemic stroke or transient ischemic attack. On admission, a noncontrast CT cerebrum and CTA were performed. A senior consultant neuroradiologist, blinded to clinical data, reviewed all CTA...

  9. Treatment and diagnosis of middle fossa arachnoid cyst. Ventriculofiberscopy and cine-MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kamikawa, Shuji; Kuwamura, Keiichi [Hyogo Prefectural Awaji Hospital, Sumoto (Japan); Tamaki, Norihiko

    1998-07-01

    The treatment of intracranial arachnoid cysts is controversial regarding its surgical indication and operative procedures. Conventional surgical approaches such as fenestration, membranectomy, and shunting operation are invasive. Also CT cisternography and/or RI cisternography are invasive, when it has been performed to evaluate the possible CSF communications between the arachnoid cyst and subarachnoid space. Between July 1994 and February 1997, 10 patients with intracranial middle fossa arachnoid cysts were treated with a newly developed ventriculofiberscope which is characterized by splendid mechanical flexibility and high resolution. The cine-MRI, which is a non-invasive diagnostic tool, is used to evaluate the CSF circulation around the cyst fenestration. The patients` ages ranged from 4 months to 10 years, with a mean of 4.46 years. The cyst locations were left middle fossa (9), and right (1). Eight patients presented with macrocrania, 4 with developmental delay, three with seizure, two with headache, and one with subdural hematoma. The patients were preoperatively evaluated by means of MRI and cine-MR images. In all patients ventriculofiberscopic procedures including cyst fenestration, membranous dissection, cyst puncture and shriveling were successfully performed. Postoperative MR and cine-MR studies have shown reduction of the cyst size and appropriate CSF circulation. Neuroendoscopic procedures seem to be the first choice for children with arachnoid cysts and the ventriculofiberscope proved to be very useful not only for cyst fenestration but also for cyst dissection. In addition, the non-invasive cine-MR studies are useful for long follow-up at OPD. (author)

  10. Topographical anatomy of superficial veins, cutaneous nerves, and arteries at venipuncture sites in the cubital fossa.

    Science.gov (United States)

    Mikuni, Yuko; Chiba, Shoji; Tonosaki, Yoshikazu

    2013-01-01

    We investigated correlations among the superficial veins, cutaneous nerves, arteries, and venous valves in 128 cadaveric arms in order to choose safe venipuncture sites in the cubital fossa. The running patterns of the superficial veins were classified into four types (I-IV) and two subtypes (a and b). In types I and II, the median cubital vein (MCV) was connected obliquely between the cephalic and basilic veins in an N-shape, while the median antebrachial vein (MAV) opened into the MCV in type I and into the basilic vein in type II. In type III, the MCV did not exist. In type IV, additional superficial veins above the cephalic and basilic veins were developed around the cubital fossa. In types Ib-IVb, the accessory cephalic vein was developed under the same conditions as seen in types Ia-IVa, respectively. The lateral cutaneous nerve of the forearm descended deeply along the cephalic vein in 124 cases (97 %), while the medial cutaneous nerve of the forearm descended superficially along the basilic vein in 94 (73 %). A superficial brachial artery was found in 27 cases (21 %) and passed deeply under the ulnar side of the MCV. A median superficial antebrachial artery was found in 1 case (1 %), which passed deeply under the ulnar side of the MCV and ran along the MAV. Venous valves were found at 239 points in 28 cases with superficial veins, with a single valve seen at 79 points (33 %) and double valves at 160 points (67 %). At the time of intravenous injection, caution is needed regarding the locations of cutaneous nerves, brachial and superficial brachial arteries, and venous valves. The area ranging from the middle segment of the MCV to the confluence between the MCV and cephalic vein appears to be a relatively safe venipuncture site.

  11. Stroke Risk Factors and Symptoms

    Science.gov (United States)

    ... » [ pdf, 433 kb ] Order Materials » Stroke Risk Factors and Symptoms Risk Factors for a Stroke Stroke prevention is still ... it. Treatment can delay complications that increase the risk of stroke. Transient ischemic attacks (TIAs). Seek help. ...

  12. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad

    2015-01-01

    Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.

  13. Functional changes of neural circuits in stroke patients with dysphagia: A meta-analysis.

    Science.gov (United States)

    Liu, Lu; Xiao, Yuan; Zhang, Wenjing; Yao, Li; Gao, Xin; Chandan, Shah; Lui, Su

    2017-08-01

    Dysphagia is a common problem in stroke patients with unclear pathogenesis. Several recent functional magnetic resonance imaging (fMRI) studies had been carried out to explore the cerebral functional changes in dysphagic stroke patients. The aim of this study was to analysis these imaging findings using a meta-analysis. We used seed-based d mapping (SDM) to conduct a meta-analysis for dysphagic stroke patients prior to any kind of special treatment for dysphagia. A systematic search was conducted for the relevant studies. SDM meta-analysis method was used to examine regions of increased and decreased functional activation between dysphagic stroke patients and healthy controls. Finally, six studies including 81 stroke patients with dysphagia and 78 healthy controls met the inclusion standards. When compared with healthy controls, stroke patients with dysphagia showed hyperactivation in left cingulate gyrus, left precentral gyrus and right posterior cingulate gyrus, and hypoactivation in right cuneus and left middle frontal gyrus. The hyperactivity of precentral gyrus is crucial in stroke patients with dysphagia and may be associated with the severity of stroke. Besides the motor areas, the default-mode network regions (DMN) and affective network regions (AN) circuits are also involved in dysphagia after stroke. © 2017 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

  14. Brain magnetic resonance imaging findings in cryptogenic stroke patients under 60 years with patent foramen ovale

    Energy Technology Data Exchange (ETDEWEB)

    Boutet, Claire, E-mail: claire.boutet@chu-st-etienne.fr [Department of Radiology, University Hospital of Saint-Etienne (France); Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Rouffiange-Leclair, Laure, E-mail: laurerouffiange@hotmail.com [Department of Radiology, University Hospital of Saint-Etienne (France); Garnier, Pierre, E-mail: pierre.garnier@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Quenet, Sara, E-mail: sara.quenet@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Delsart, Daphné, E-mail: daphne.delsart@hotmail.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, Saint-Etienne (France); Inserm, CIE3, F-42055 Saint-Etienne (France); Varvat, Jérôme, E-mail: jvarvat@9online.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Epinat, Magali, E-mail: magali.epinat@chu-st-etienne.fr [Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Department of Neurology, University Hospital of Saint-Etienne (France); Schneider, Fabien, E-mail: fabien.schneider@univ-st-etienne.fr [Department of Radiology, University Hospital of Saint-Etienne (France); Thrombosis Research Group EA 3065, Jean Monnet University, Saint-Etienne (France); Antoine, Jean-Christophe, E-mail: j.christophe.antoine@chu-st-etienne.fr [Department of Neurology, University Hospital of Saint-Etienne (France); Lyon Neuroscience Research Center, INSERM U1028 – CNRS UMR5292 (France); EA 4338, Jean Monnet University, Saint-Etienne (France); and others

    2014-05-15

    Purpose: To compare magnetic resonance imaging (MRI) brain feature in cryptogenic stroke patients with patent foramen ovale (PFO), cryptogenic stroke patients without PFO and patients with cardioembolic stroke. Materials and methods: The ethics committee required neither institutional review board approval nor informed patient consent for retrospective analyses of the patients’ medical records and imaging data. The patients’ medical files were retrospectively reviewed in accordance with human subject research protocols. Ninety-two patients under 60 years of age were included: 15 with cardioembolic stroke, 32 with cryptogenic stroke with PFO and 45 with cryptogenic stroke without PFO. Diffusion-weighted imaging of brain MRI was performed by a radiologist blinded to clinical data. Univariate, Fischer's exact test for qualitative data and non-parametric Wilcoxon test for quantitative data were used. Results: There was no statistically significant difference found between MRI features of patients with PFO and those with cardioembolic stroke (p < .05). Patients without PFO present more corticosubcortical single lesions (p < .05) than patients with PFO. Patients with PFO have more often subcortical single lesions larger than 15 mm, involvement of posterior cerebral arterial territory and intracranial occlusion (p < .05) than patients with cryptogenic stroke without PFO. Conclusion: Our study suggests a cardioembolic mechanism in ischemic stroke with PFO.

  15. Hyponatremia in stroke

    Directory of Open Access Journals (Sweden)

    Sheikh Saleem

    2014-01-01

    Full Text Available Introduction: Hyponatremia is a common electrolyte disorder encountered in patients of neurological disorders which is usually either due to inappropriate secretion of Antidiuretic hormone (SIADH or cerebral salt wasting syndrome (CSWS. We conducted this study in a tertiary care hospital to determine the incidence and etiology of hyponatremia in patients of stroke admitted in the hospital. Materials and Methods: It was a prospective study done over a period of two years that included established cases of stroke diagnosed on the basis of clinical history, examination and neuroimaging. 1000 stoke patients were evaluated for hyponatremia (serum sodium <130 meq/l. The data was analysed using Chi-square test using SPSS (Statistical package for social science software. Results: Out of 1000 patients, 353 patients had hyponatremia. Out of this 353 patients, 238 (67% had SIADH and 115 (33% had CSWS. SIADH was seen in 83 patients who had ischemic stroke and 155 patients of hemorrhagic stroke. CSWS was found in 38 patients with ischemic stroke and 77 patients with hemorrhagic stroke. Statistical analysis revealed that hyponatremia significantly affects the outcome of stroke especially when it is due to CSWS rather than SIADH. Conclusion: Incidence of hyponatremia in our study population was 35%. In patients of hyponatremia 67% were having SIADH and 33% were having CSWS. Overall hyponatremia affected the outcome of stroke especially when caused by CSWS. Therefore close monitoring of serum sodium must be done in all patients who are admitted with stroke and efforts must be made to determine the cause of hyponatremia, in order to properly manage such patients thereby decreasing the mortality rate.

  16. Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke.

    Science.gov (United States)

    Bouslama, Mehdi; Haussen, Diogo C; Aghaebrahim, Amin; Grossberg, Jonathan A; Walker, Gregory; Rangaraju, Srikant; Horev, Anat; Frankel, Michael R; Nogueira, Raul G; Jovin, Tudor G; Jadhav, Ashutosh P

    2017-12-01

    Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23-5.56; P =0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04-1.13; P <0.0001), and successful reperfusion status (odds ratio=10.80; 95% confidence interval, 1.36-85.96; P =0.025) were associated with good outcome. In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular

  17. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke

    2015-01-01

    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  18. Clinical neurogenetics: stroke.

    Science.gov (United States)

    Rost, Natalia S

    2013-11-01

    Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Determinan Penyakit Stroke

    Directory of Open Access Journals (Sweden)

    Woro Riyadina

    2013-02-01

    Full Text Available Penyakit stroke merupakan penyebab kematian dan kecacatan kronik yang paling tinggi pada kelompok umur diatas usia 45 tahun terbanyak di Indonesia. Tujuan penelitian ini untuk mengidentifikasi determinan utama yang berhubungan dengan penyakit stroke pada masyarakat di kelurahan Kebon Kalapa Bogor. Analisis lanjut terhadap 1.912 responden subset baseline data penelitian “Studi Kohort Faktor Risiko Penyakit Tidak Menular” Data dikumpulkan dengan metode wawancara pada penduduk tetap di kelurahan Kebon Kalapa, Kecamatan Bogor Tengah, Bogor tahun 2012. Diagnosis stroke berdasarkan anamnesis dan pemeriksaan dokter spesialis syaraf. Variabel independen meliputi karakteristik sosiodemografi, status kesehatan dan perilaku berisiko. Data dianalisis dengan uji regresi logistik ganda. Penyakit stroke ditemukan pada 49 (2,6% orang. Determinan utama stroke meliputi hipertensi (OR = 4,20; IK 95% = 2,20 – 8,03, penyakit jantung koroner (OR = 2,74; IK 95% = 1,51 – 4,99, diabetes melitus (OR = 2,89; IK 95% = 1,47 – 5,64, dan status ekonomi miskin (OR = 1,83 ; IK 95% = 1,03 – 3,33. Pencegahan penyakit stroke dilakukan dengan peningkatan edukasi (kampanye/penyuluhan melalui pengendalian faktor risiko utama yaitu hipertensi dan pencegahan terjadinya penyakit degeneratif lain yaitu penyakit jantung koroner dan diabetes melitus. Stroke disease is the leading cause of death and chronic disabi lity in most over the age of 45 years in Indonesia. The aim of study was to identify the major determinants of stroke disease in Kebon Kalapa community in Bogor. A deep analyze was conducted in 1.912 respondents based on the subset of baseline data “Risk Factors Cohort Study of Non Communicable Diseases.” Data was collected by interviews on Kebon Kalapa community, Bogor in 2012. Stroke diagnosis was determined by anamnesis and neu-rological examination with specialist. Independent variables were sociodemographic characteristics, health status and risk behavior

  20. Posterior labral injury in contact athletes.

    Science.gov (United States)

    Mair, S D; Zarzour, R H; Speer, K P

    1998-01-01

    Nine athletes (seven football offensive linemen, one defensive lineman, and one lacrosse player) were found at arthroscopy to have posterior labral detachment from the glenoid. In our series, this lesion is specific to contact athletes who engage their opponents with arms in front of the body. All patients had pain with bench pressing and while participating in their sport, diminishing their ability to play effectively. Conservative measures were ineffective in relieving their symptoms. Examination under anesthesia revealed symmetric glenohumeral translation bilaterally, without evidence of posterior instability. Treatment consisted of glenoid rim abradement and posterior labral repair with a bioabsorbable tack. All patients returned to complete at least one full season of contact sports and weightlifting without pain (minimum follow-up, > or = 2 years). Although many injuries leading to subluxation of the glenohumeral joint occur when an unanticipated force is applied, contact athletes ready their shoulder muscles in anticipation of impact with opponents. This leads to a compressive force at the glenohumeral joint. We hypothesize that, in combination with a posteriorly directed force at impact, the resultant vector is a shearing force to the posterior labrum and articular surface. Repeated exposure leads to posterior labral detachment without capsular injury. Posterior labral reattachment provides consistently good results, allowing the athlete to return to competition.

  1. Posterior encephalopathy with vasospasm: MRI and angiography

    International Nuclear Information System (INIS)

    Weidauer, S.; Gaa, J.; Lanfermann, H.; Zanella, F.E.; Sitzer, M.; Hefner, R.

    2003-01-01

    Posterior encephalopathy is characterised by headache, impairment of consciousness, seizures and progressive visual loss. MRI shows bilateral, predominantly posterior, cortical and subcortical lesions with a distribution. Our aim was to analyse the MRI lesion pattern and angiographic findings because the pathophysiology of posterior encephalopathy is incompletely understood. We report three patients with clinical and imaging findings consistent with posterior encephalopathy who underwent serial MRI including diffusion-weighted imaging (DWI) and construction of apparent diffusion coefficient (ADC) maps, and four-vessel digital subtraction angiography (DSA). DWI revealed symmetrical subcortical and cortical parieto-occipital high signal. High and also low ADCs indicated probable vasogenic and cytotoxic oedema. On follow-up there was focal cortical laminar necrosis, while the white-matter lesions resolved almost completely, except in the arterial border zones. DSA revealed diffuse arterial narrowing, slightly more marked in the posterior circulation. These findings suggest that posterior encephalopathy may in some cases be due to diffuse, severe vasospasm affecting especially in the parieto-occipital grey matter, with its higher vulnerability to ischemia. Cerebral vasospasm due to digitoxin intoxication, resulting in posterior encephalopathy, has not yet been described previously. (orig.)

  2. Hypertension and experimental stroke therapies

    OpenAIRE

    O'Collins, Victoria E; Donnan, Geoffrey A; Macleod, Malcolm R; Howells, David W

    2013-01-01

    Hypertension is an established target for long-term stroke prevention but procedures for management of hypertension in acute stroke are less certain. Here, we analyze basic science data to examine the impact of hypertension on candidate stroke therapies and of anti-hypertensive treatments on stroke outcome. Methods: Data were pooled from 3,288 acute ischemic stroke experiments (47,899 animals) testing the effect of therapies on infarct size (published 1978–2010). Data were combined using meta...

  3. Stroke: Hope through Research

    Science.gov (United States)

    ... in a compromised state for several hours. With timely treatment these cells can be saved. The ischemic ... this research is the use of transcranial magnetic stimulation (TMS) in stroke rehabilitation. Some evidence suggests that ...

  4. Healthy Living after Stroke

    Science.gov (United States)

    ... Nutrition Cooking for Health Food for Thought: Heart-healthy Diet is Also Good For Your Brain Physical Activity Get Moving and Boost Your Brain Power Understanding Risky Conditions Converging Risk Factors for Stroke ...

  5. The "Know Stroke" Campaign

    Science.gov (United States)

    ... Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents For ... Javascript on. NINDS is conducting a public awareness campaign across the United States to educate people about ...

  6. Recovering after stroke

    Science.gov (United States)

    ... urine from their body. To prevent skin or pressure sores: Clean up after incontinence Change position often and ... artery surgery - discharge Daily bowel care program Preventing pressure ulcers Stroke - discharge References Dobkin BH. Neurological rehabilitation In: ...

  7. National Stroke Association

    Science.gov (United States)

    ... partnership will offer free access to the RapidSOS Haven app for one year, providing individuals with enhanced ... of care to thrive after stroke. Make your tax-deductible donation today to support the growing needs ...

  8. Strokes (For Parents)

    Science.gov (United States)

    ... paralysis or weakness on one side of the body language or speech delays or changes, such as slurring ... uses many different types of therapy to help children recover from stroke. Outlook At this time, no ...

  9. Stroke - risk factors

    Science.gov (United States)

    ... oxygen. Brain cells can die, causing lasting damage. Risk factors are things that increase your chance of ... a disease or condition. This article discusses the risk factors for stroke and things you can do ...

  10. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  11. Posterior alien hand syndrome: case report

    International Nuclear Information System (INIS)

    Rohde, S.; Weidauer, S.; Lanfermann, H.; Zanella, F.

    2002-01-01

    The alien hand syndrome (AHS) is involuntary uncontrolled movement of an arm with a sense of estrangement from the limb itself. AHS was initially used to describe interhemispheric disconnection phenomena in patients with lesions in the anterior corpus callosum, but it has been found in patients with posterior cerebral lesions without involvement of the corpus callosum, for example parietal infarcts or corticobasal degeneration. The posterior alien hand syndrome is less frequent and presents with nonpurposive behaviour like lifting the arm or writhing fingers. We report an 80-year-old woman with a posterior AHS of the dominant right hand. MRI showed atrophy of the pre- and postcentral gyri without involvement of the corpus callosum. We discuss the aetiology of the posterior AHS and the differences from the anterior varieties. (orig.)

  12. Posterior reversible encephalopathy syndrome: Some novel ...

    African Journals Online (AJOL)

    The third, a thalassaemic child receiving regular blood transfusions, had PRES ... anterior brain instead of the classically described posterior parts of .... 7 months. 3 years. 5 years. 4 years. Gender. Female. Male. Female. Female ... Developed.

  13. POSTERIOR APPROACH FOR HIP ARTHROPLASTY: A SINGLE ...

    African Journals Online (AJOL)

    postulated advantages and disadvantages. Objective: Presentation of a case series of primary and revision arthroplasty utilizing the posterior approach. ... Centre over a period of one year were queried and data extracted and recorded.

  14. Autopsy approach to stroke.

    Science.gov (United States)

    Love, Seth

    2011-02-01

    Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology. © 2010 Blackwell Publishing Limited.

  15. Post-stroke psychosis: how long should we treat?

    Directory of Open Access Journals (Sweden)

    Maria do Céu Ferreira

    2017-06-01

    Full Text Available Abstract Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone. At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

  16. Distribution territories and causative mechanisms of ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Rovira, A.; Grive, E.; Alvarez-Sabin, J. [Unidad de Resonancia Magnetica, Hospital Vall d' Hebron, Barcelona (Spain)

    2005-03-01

    Ischemic stroke prognosis, risk of recurrence, clinical assessment, and treatment decisions are influenced by stroke subtype (anatomic distribution and causative mechanism of infarction). Stroke subtype diagnosis is better achieved in the early phase of acute ischemia with the use of multimodal MR imaging. The pattern of brain lesions as shown by brain MR imaging can be classified according to a modified Oxfordshire method, based on the anatomic distribution of the infarcts into six groups: (1) total anterior circulation infarcts, (2) partial anterior circulation infarcts, (3) posterior circulation infarcts, (4) watershed infarcts, (5) centrum ovale infarcts, and (6) lacunar infarcts. The subtype of stroke according to its causative mechanism is based on the TOAST method, which classifies stroke into five major etiologic groups: (1) large-vessel atherosclerotic disease, (2) small-vessel atherosclerotic disease, (3) cardioembolic source, (4) other determined etiologies, and (5) undetermined or multiple possible etiologies. The different MR imaging patterns of acute ischemic brain lesions visualized using diffusion-weighted imaging and the pattern of vessel involvement demonstrated with MR angiography are essential factors that can suggest the most likely causative mechanism of infarction. This information may have an impact on decisions regarding therapy and the performance of additional diagnostic tests. (orig.)

  17. Posterior atlantoaxial dislocation without odontoid fracture

    International Nuclear Information System (INIS)

    Chaudhary, Reema; Raut, Abhijit; Chaudhary, Kshitij; Metkar, Umesh; Rathod, Ashok; Sanghvi, Darshana

    2008-01-01

    We report a case of posterior atlantoaxial dislocation without a fracture of the odontoid in a 35-year-old woman. There have been nine reported cases of similar injury in the English literature. The integrity of the transverse ligament following posterior atlantoaxial dislocations has not been well documented in these reports. In the present case, MRI revealed an intact transverse ligament, which probably contributed to the stability of the C1-C2 complex following closed reduction. (orig.)

  18. Posterior amorphous corneal dystrophy: case report

    OpenAIRE

    Oliveira, Lauro Augusto de [UNIFESP; Vieira, Luiz Antônio [UNIFESP; Freitas, Denise de [UNIFESP; Sousa, Luciene Barbosa de [UNIFESP

    2006-01-01

    O objetivo deste trabalho é alertar o oftalmologista da possibilidade de se deparar com casos raros de distrofias corneanas. Neste caso correlacionamos os achados clínicos da distrofia amorfa posterior com refração, topografia e biomicroscopia ultra-sônica.The purpose of this paper is to warn the ophthalmologist about the possibility of facing rare cases of corneal dystrophies. Clinical findings of a case of posterior amorphous dystrophy were correlated with refraction, topography, and ultras...

  19. Mature teratoma of the posterior mediastinum

    Energy Technology Data Exchange (ETDEWEB)

    Kurosaki, Y.; Tanaka, Y.O.; Itai, Y. [Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-shi, Ibaraki-ken 305 (Japan)

    1998-02-01

    The vast majority of germ cell tumors in the thorax arise at or near the thymus. We report a case of a 41-year-old man with mature teratoma of the posterior mediastinum. He was asymptomatic and was incidentally found to have a posterior mediastinal mass. Computed tomography was helpful in suggesting a diagnosis of mature teratoma by demonstrating the presence of fat and calcification. The differential diagnosis included neurogenic tumors, liposarcoma, and extramedullary hematopoiesis. (orig.) With 2 figs., 18 refs.

  20. Mature teratoma of the posterior mediastinum

    International Nuclear Information System (INIS)

    Kurosaki, Y.; Tanaka, Y.O.; Itai, Y.

    1998-01-01

    The vast majority of germ cell tumors in the thorax arise at or near the thymus. We report a case of a 41-year-old man with mature teratoma of the posterior mediastinum. He was asymptomatic and was incidentally found to have a posterior mediastinal mass. Computed tomography was helpful in suggesting a diagnosis of mature teratoma by demonstrating the presence of fat and calcification. The differential diagnosis included neurogenic tumors, liposarcoma, and extramedullary hematopoiesis. (orig.)

  1. An unusual cause of posterior mediastinal cyst

    Directory of Open Access Journals (Sweden)

    Sahajal Dhooria

    2015-01-01

    Full Text Available Cystic lesions of the mediastinum may be congenital or acquired. The differential diagnosis depends on their location in the mediastinum. Cysts in the posterior mediastinum are generally developmental cysts and are neurogenic or of foregut origin. We report the case of a 14-year-old boy, who presented with dry cough and progressively increasing breathlessness, and was found to have a cystic lesion in the posterior mediastinum. Fine needle aspiration from the cyst helped make a diagnosis of tuberculosis.

  2. Analytic posteriors for Pearson's correlation coefficient.

    Science.gov (United States)

    Ly, Alexander; Marsman, Maarten; Wagenmakers, Eric-Jan

    2018-02-01

    Pearson's correlation is one of the most common measures of linear dependence. Recently, Bernardo (11th International Workshop on Objective Bayes Methodology, 2015) introduced a flexible class of priors to study this measure in a Bayesian setting. For this large class of priors, we show that the (marginal) posterior for Pearson's correlation coefficient and all of the posterior moments are analytic. Our results are available in the open-source software package JASP.

  3. Analytic posteriors for Pearson's correlation coefficient

    OpenAIRE

    Ly, A.; Marsman, M.; Wagenmakers, E.-J.

    2018-01-01

    Pearson's correlation is one of the most common measures of linear dependence. Recently, Bernardo (11th International Workshop on Objective Bayes Methodology, 2015) introduced a flexible class of priors to study this measure in a Bayesian setting. For this large class of priors, we show that the (marginal) posterior for Pearson's correlation coefficient and all of the posterior moments are analytic. Our results are available in the open‐source software package JASP.

  4. Post-partum posterior reversible encephalopathy syndrome

    OpenAIRE

    B. V. Triveni; Salman Mohammed Sheikh; Deepak Shedde

    2014-01-01

    Posterior Reversible Encephalopathy Syndrome (PRES) is a clinicopathological syndrome associated with various clinical conditions presenting with headache, encephalopathy, seizure and cortical visual disturbances. Radiological findings in PRES are thought to be due to vasogenic edema predominantly in posterior cerebral hemispheres and are reversible with appropriate management. We present a case of post partum PRES,A 29 year old primigravida of 33 weeks 3 days period of gestation who prese...

  5. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2018-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  6. Delayed Single Stage Perineal Posterior Urethroplasty

    International Nuclear Information System (INIS)

    Ali, S.; Shahnawaz; Shahzad, I.; Baloch, M. U.

    2015-01-01

    Objective: To determine the delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture/distraction defect. Study Design: Descriptive case series. Place and Duration of Study: Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2009 to December 2011. Methodology: Patients were selected for delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture / distraction defect. All were initially suprapubically catheterized followed by definitive surgery after at least 3 months. Results: Thirty male patients were analyzed with a mean follow-up of 10 months, 2 patients were excluded as they developed failure in first 3 months postoperatively. Mean patients age was 26.25 ± 7.9 years. On follow-up, 7 patients (23.3 percentage) experienced recurrent stricture during first 10 months. Five (16.6 percentage) patients were treated successfully with single direct visual internal urethrotomy. Two patients (6.6 percentage) had more than one direct visual internal urethrotomy and considered failed. Re-do perineal urethroplasty was eventually performed. The overall success rate was 93.3 percentage with permissive criteria allowing single direct visual internal urethrotomy and 76.6% with strict criteria allowing no more procedures postoperatively. Conclusion: Posterior anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and distraction defect even after multiple prior procedures. (author)

  7. Delayed Single Stage Perineal Posterior Urethroplasty.

    Science.gov (United States)

    Ali, Shahzad; Shahnawaz; Shahzad, Iqbal; Baloch, Muhammad Umar

    2015-06-01

    To determine the delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture/distraction defect. Descriptive case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from January 2009 to December 2011. Patients were selected for delayed single stage perineal posterior urethroplasty for treatment of posterior urethral stricture / distraction defect. All were initially suprapubically catheterized followed by definitive surgery after at least 3 months. Thirty male patients were analyzed with a mean follow-up of 10 months, 2 patients were excluded as they developed failure in first 3 months postoperatively. Mean patient's age was 26.25 ± 7.9 years. On follow-up, 7 patients (23.3%) experienced recurrent stricture during first 10 months. Five (16.6%) patients were treated successfully with single direct visual internal urethrotomy. Two patients (6.6%) had more than one direct visual internal urethrotomy and considered failed. Re-do perineal urethroplasty was eventually performed. The overall success rate was 93.3% with permissive criteria allowing single direct visual internal urethrotomy and 76.6% with strict criteria allowing no more procedures postoperatively. Posterior anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and distraction defect even after multiple prior procedures.

  8. Early endoscopic realignment in posterior urethral injuries.

    Science.gov (United States)

    Shrestha, B; Baidya, J L

    2013-01-01

    Posterior urethral injury requires meticulous tertiary care and optimum expertise to manage successfully. The aim of our study is to describe our experiences with pelvic injuries involving posterior urethra and their outcome after early endoscopic realignment. A prospective study was carried out in 20 patients with complete posterior urethral rupture, from November 2007 till October 2010. They presented with blunt traumatic pelvic fracture and underwent primary realignment of posterior urethra in our institute. The definitive diagnosis of urethral rupture was made after retrograde urethrography and antegrade urethrography where applicable. The initial management was suprapubic catheter insertion after primary trauma management in casualty. After a week of conservative management with intravenous antibiotics and pain management, patients were subjected to the endoscopic realignment. The follow up period was at least six months. The results were analyzed with SPSS software. After endoscopic realignment, all patients were advised CISC for the initial 3 months. All patients voided well after three months of CISC. However, 12 patients were lost to follow up by the end of 6 postoperative months. Out of eight remaining patients, two had features of restricture and were managed with DVU followed by CISC again. One patient with restricture had some degree of erectile dysfunction who improved significantly after phospodiesterase inhibitors. None of the patients had features of incontinence. Early endoscopic realignment of posterior urethra is a minimally invasive modality in the management of complete posterior urethral injury with low rates of incontinence and impotency.

  9. Traumatic lesions of the posterior urethra.

    Science.gov (United States)

    Velarde-Ramos, L; Gómez-Illanes, R; Campos-Juanatey, F; Portillo-Martín, J A

    2016-11-01

    The posterior urethral lesions are associated with pelvis fractures in 5-10% of cases. The posterior urethra is attached to the pelvis bone by puboprostatic ligaments and the perineal membrane, which explains why disruption of the pelvic ring can injure the urethra at this level. To identify suspected cases of posterior urethral trauma and to perform the diagnosis and its immediate or deferred management. Search in PubMed of articles related to traumatic posterior urethral lesions, written in English or Spanish. We reviewed the relevant publications including literature reviews and chapters from books related to the topic. With patients with pelvis fractures, we must always rule out posterior urethral lesions. The diagnostic examination of choice is retrograde urethrography, which, along with the severity of the condition, will determine the management in the acute phase and whether the treatment will be performed immediately or deferred. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. Despite the classical association between posterior urethral lesions and pelvic fractures, the management of those lesions (whether immediate or deferred) remains controversial. Thanks to the growing interest in urethral disease, there are an increasing number of studies that help us achieve better management of these lesions. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Impact of posterior communicating artery on basilar artery steno-occlusive disease.

    Science.gov (United States)

    Hong, J M; Choi, J Y; Lee, J H; Yong, S W; Bang, O Y; Joo, I S; Huh, K

    2009-12-01

    Acute brainstem infarction with basilar artery (BA) occlusive disease is the most fatal type of all ischaemic strokes. This report investigates the prognostic impact of the posterior communicating artery (PcoA) and whether its anatomy is a safeguard or not. Consecutive patients who had acute brainstem infarction with at least 50% stenosis of BA upon CT angiography (CTA) were studied. The configuration of PcoA was divided into two groups upon CTA: "textbook" group (invisible PcoA with good P1 and P2 segment) and "fetal-variant of PcoA" group (only visible PcoA with absent P1 segment). Baseline demographics, radiological findings and stroke mechanisms were analysed. A multiple regression analysis was performed to predict clinical outcome at 30 days (modified Rankin disability Scale (mRSPcoA (26 bilateral, 18 unilateral). By multiple logistic regression analysis, the atherosclerotic mechanism (OR 18.0; 95% CI 3.0 to 107.0) and presence of fetal-variant PcoA (OR 5.1; 95% CI 1.4 to 18.8) were independent predictors for good prognosis and initial NIH stroke scale score (OR 1.24 per one-point increase; 95% CI 1.1 to 1.4) for poor prognosis. Fetal-variant PcoA appears to act as a safeguard against ischaemic insult in acute stroke victims involving the brainstem with BA occlusive disease. This result can be explained by the fact that patients with fetal-variant PcoA have a smaller area of posterior circulation and a possibility of retrograde filling into the upper brainstem through the fetal-variant PcoA.

  11. Stroke risk perception among participants of a stroke awareness campaign

    Science.gov (United States)

    Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus

    2007-01-01

    Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. Stroke risk factor knowledge, perception of lifetime stroke risk and risk factor status were included in the questionnaire, and the determinants of good risk factor knowledge and high stroke risk perception were identified using logistic regression models. Results Overall stroke risk factor knowledge was good with 67–96% of the participants recognizing established risk factors. The two exceptions were diabetes (recognized by 49%) and myocardial infarction (57%). Knowledge of a specific factor was superior among those affected by it. 13% of all participants considered themselves of having a high stroke risk, 55% indicated a moderate risk. All major risk factors contributed significantly to the perception of being at high stroke risk, but the effects of age, sex and education were non-significant. Poor self-rated health was additionally associated with high individual stroke risk perception. Conclusion Stroke risk factor knowledge was high in this study. The self perception of an increased stroke risk was associated with established risk factors as well as low perception of general health. PMID:17371603

  12. Echocardiographic Wall Motion Abnormality in Posterior Myocardial Infarction: The Diagnostic Value of Posterior Leads

    Directory of Open Access Journals (Sweden)

    A Darehzereshki

    2008-06-01

    Full Text Available Background: For the purpose of ascertaining myocardial infarction (MI and ischemia, the sensitivity of the initial 12-lead ECG is inadequate. It is risky to diagnose posterior MI using only precordial reciprocal changes, since the other leads may be more optimally positioned for the identification of electrocardiographic changes. In this study, we evaluated the relationship between electrocardiography changes and wall motion abnormalities in patients with posterior MI for earlier and better diagnosis of posterior MI.Methods: In this prospective cross-sectional study, we enrolled patients with posterior MI who had come to the Emergency Department of Shariati Hospital with their first episode of chest pain. A 12-lead surface electrocardiogram using posterior leads (V7-V9 was performed for all participants. Patients with ST elevation >0.05 mV or pathologic Q wave in the posterior leads, as well as those with specific changes indicating posterior MI in V1-V2, were evaluated by echocardiography in terms of wall motion abnormalities. All data were analyzed using SPSS and p<0.05 were considered statistically significant.Results: Of a total 79 patients enrolled, 48 (60.8% were men, and the mean age was 57.35±8.22 years. Smoking (54.4% and diabetes (48% were the most prevalent risk factors. In the echocardiographic evaluation, all patients had wall motion abnormalities in the left ventricle and 19 patients (24.1% had wall motion abnormalities in the right ventricle. The most frequent segment with motion abnormality among the all patients was the mid-posterior. The posterior leads showed better positive predictive value than the anterior leads for posterior wall motion abnormality.Conclusion: Electrocardiography of the posterior leads in patients with acute chest pain can help in earlier diagnosis and in time treatment of posterior MI.

  13. Guidelines for the treatment of acute ischaemic stroke.

    Science.gov (United States)

    Alonso de Leciñana, M; Egido, J A; Casado, I; Ribó, M; Dávalos, A; Masjuan, J; Caniego, J L; Martínez Vila, E; Díez Tejedor, E; Fuentes, B; Álvarez-Sabin, J; Arenillas, J; Calleja, S; Castellanos, M; Castillo, J; Díaz-Otero, F; López-Fernández, J C; Freijo, M; Gállego, J; García-Pastor, A; Gil-Núñez, A; Gilo, F; Irimia, P; Lago, A; Maestre, J; Martí-Fábregas, J; Martínez-Sánchez, P; Molina, C; Morales, A; Nombela, F; Purroy, F; Rodríguez-Yañez, M; Roquer, J; Rubio, F; Segura, T; Serena, J; Simal, P; Tejada, J; Vivancos, J

    2014-03-01

    Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 °C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  14. Do brain lesions in stroke affect basic emotions and attachment?

    Science.gov (United States)

    Farinelli, Marina; Panksepp, Jaak; Gestieri, Laura; Maffei, Monica; Agati, Raffaele; Cevolani, Daniela; Pedone, Vincenzo; Northoff, Georg

    2015-01-01

    The aim of the current study was to investigate basic emotions and attachment in a sample of 86 stroke patients. We included a control group of 115 orthopedic patients (matched for age and cognitive status) without brain lesions to control for unspecific general illness effects of a traumatic recent event on basic emotions and attachment. In order to measure basic emotions and attachment style we applied the Affective Neuroscience Personality Scale (ANPS) and the Attachment Style Questionnaire (ASQ). The stroke patients showed significantly different scores in the SEEKING, SADNESS, and ANGER subscales of the ANPS as well as in the Relationship as Secondary Attachment dimension of the ASQ when compared to the control group. These differences show a pattern influenced by lesion location mainly as concerns basic emotions. Anterior, medial, left, and subcortical patients provide scores significantly lower in ANPS-SEEKING than the control group; ANPS-SADNESS scores in anterior, right, medial, and subcortical patients were significantly higher than those of the control group. ANPS-ANGER scores in posterior, right, and lateral patients were significantly higher than those in the control group; finally, the ANPS-FEAR showed slightly lower scores in posterior patients than in the control group. Minor effects on brain lesions were also individuated in the attachment style. Anterior lesion patients showed a significantly higher average score in the ASQ-Need for Approval subscale than the control group. ASQ-Confidence subscale scores differed significantly in stroke patients with lesions in medial brain regions when compared to control subjects. Scores at ANPS and ASQ subscales appear significantly more correlated in stroke patients than in the control group. Such finding of abnormalities, especially concerning basic emotions in stroke brain-lesioned patients, indicates that the effect of brain lesions may enhance the interrelation between basic emotions and attachment with

  15. Relearning the Basics: Rehabilitation after a Stroke

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Stroke Rehabilitation Relearning the Basics: Rehabilitation After a Stroke Past ... to help them recover successfully. What is post-stroke rehabilitation? Rehab helps stroke survivors relearn skills lost to ...

  16. Code stroke in Asturias.

    Science.gov (United States)

    Benavente, L; Villanueva, M J; Vega, P; Casado, I; Vidal, J A; Castaño, B; Amorín, M; de la Vega, V; Santos, H; Trigo, A; Gómez, M B; Larrosa, D; Temprano, T; González, M; Murias, E; Calleja, S

    2016-04-01

    Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  17. [CLINICAL STUDIES ON EFFECT OF ARTHROSCOPIC INTERCONDYLAR FOSSA ANGIOPLASTY ON ABILITY OF NEUROMUSCULAR CONTROL IN ELDERLY PATIENTS WITH KNEE OSTEOARTHRITIS].

    Science.gov (United States)

    Huang, Jingmin; Wang, Haijiao; Wu, Jiang; Li, Dongchao; Li, Yuhong

    2015-08-01

    To study the effect of arthroscopic intercondylar fossa angioplasty on the ability of neuromuscular control of the knee joint in elderly patients with knee osteoarthritis (KOA). Between June 2012 and March 2013, 20 elderly patients with KOA and in accordance with inclusion and exclusion criteria underwent arthroscopic intercondylar fossa angioplasty (operation group), and 20 healthy elderly people served as control group. There was no significant difference in age, height, weight, and body mass index between 2 groups (P > 0.05). The proprioception capability (using passive regeneration test at measurement angles of 15, 30, and 60°) and quadriceps mobilization [including maximum voluntary contraction (MVC), central activation ratio (CAR), and activation deficit (AD)] were measured to avaluate the neuromuscular control of the knee; the Lysholm score was used to evaluate knee function. The above indexes were measured to assess the knee neuromuscular control and recovery of joint function in patients of operation group at 3, 6, and 9 months after operation. Compared with the control group, MVC, CAR, and Lysholm scores were significantly decreased, and the AD and passive knee angle difference were significantly increased in operation group (P 0.05). Arthroscopic intercondylar fossa angioplasty can relieve ACL pressure, abrasion, and impact, which will recover the ability of neuromuscular control, increase proprioception and quadriceps mobilization capacity, and improve the joint function.

  18. Late night activity regarding stroke codes: LuNAR strokes.

    Science.gov (United States)

    Tafreshi, Gilda; Raman, Rema; Ernstrom, Karin; Rapp, Karen; Meyer, Brett C

    2012-08-01

    There is diurnal variation for cardiac arrest and sudden cardiac death. Stroke may show a similar pattern. We assessed whether strokes presenting during a particular time of day or night are more likely of vascular etiology. To compare emergency department stroke codes arriving between 22:00 and 8:00 hours (LuNAR strokes) vs. others (n-LuNAR strokes). The purpose was to determine if late night strokes are more likely to be true strokes or warrant acute tissue plasminogen activator evaluations. We reviewed prospectively collected cases in the University of California, San Diego Stroke Team database gathered over a four-year period. Stroke codes at six emergency departments were classified based on arrival time. Those arriving between 22:00 and 8:00 hours were classified as LuNAR stroke codes, the remainder were classified as 'n-LuNAR'. Patients were further classified as intracerebral hemorrhage, acute ischemic stroke not receiving tissue plasminogen activator, acute ischemic stroke receiving tissue plasminogen activator, transient ischemic attack, and nonstroke. Categorical outcomes were compared using Fisher's Exact test. Continuous outcomes were compared using Wilcoxon's Rank-sum test. A total of 1607 patients were included in our study, of which, 299 (19%) were LuNAR code strokes. The overall median NIHSS was five, higher in the LuNAR group (n-LuNAR 5, LuNAR 7; P=0·022). There was no overall differences in patient diagnoses between LuNAR and n-LuNAR strokes (P=0·169) or diagnosis of acute ischemic stroke receiving tissue plasminogen activator (n-LuNAR 191 (14·6%), LuNAR 42 (14·0%); P=0·86). Mean arrival to computed tomography scan time was longer during LuNAR hours (n-LuNAR 54·9±76·3 min, LuNAR 62·5±87·7 min; P=0·027). There was no significant difference in 90-day mortality (n-LuNAR 15·0%, LuNAR 13·2%; P=0·45). Our stroke center experience showed no difference in diagnosis of acute ischemic stroke between day and night stroke codes. This

  19. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang

    2017-07-01

    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

  20. Child-Mediated Stroke Communication: findings from Hip Hop Stroke.

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2012-01-01

    Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.