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2.
J Neurol ; 270(2): 917-924, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36315254

ABSTRACT

BACKGROUND: Video-oculography (VOG) is used to quantify functional deficits in internuclear ophthalmoplegia (INO), whereas MRI can detect the corresponding structural lesions in the medial longitudinal fasciculus (MLF). This study investigates the diagnostic agreement of MRI compared to VOG measurements. METHODS: We prospectively compared structural MRI findings and functional VOG measures of 63 MS patients to assess their diagnostic agreement for INO. RESULTS: MRI detected 12 true-positive and 92 true-negative MLF lesions for INO compared to VOG (12 true-positive and 38 true-negative patients) but identified one-third of the MLF lesions on the wrong side. MRI ratings were specific (92.0%) to detect MLF lesions but not sensitive (46.2%) for diagnosing INO (86.4% and 63.2% by patient). Accordingly, MRI has a high positive likelihood ratio of 5.77 but a modest negative likelihood ratio of 0.59 for the probability of INO (4.63 and 0.43) with an accuracy of 82.5% (79.4%). CONCLUSION: MRI assessments are highly specific but not sensitive for detecting INO compared to VOG. While MRI identifies MLF lesions in INO, VOG quantifies the deficit. As a simple, quick, and non-invasive test for diagnosing and tracking functional INO deficits, it will hopefully find its place in the diagnostic and therapeutic pathways of MS.


Subject(s)
Multiple Sclerosis , Ocular Motility Disorders , Ophthalmoplegia , Humans , Multiple Sclerosis/complications , Multiple Sclerosis/diagnostic imaging , Ocular Motility Disorders/diagnostic imaging , Ocular Motility Disorders/etiology , Magnetic Resonance Imaging
4.
Ann Otol Rhinol Laryngol ; 127(12): 919-925, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30244591

ABSTRACT

INTRODUCTION:: The aim of this study was to analyze the sensitivity and specificity of non-echoplanar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of cholesteatoma, with a focus on its value as an adjunct to clinical examination. METHODS:: In a prospective cohort study, 92 cases were divided into 2 groups: "clinically cholesteatoma" ( n = 79) and "clinically no cholesteatoma" ( n = 13). Non-EPI DW MRI was performed preoperatively in all cases. The presence of a cholesteatoma was assessed by clinicians otoscopically, by neuroradiologists on non-EPI DW MRI, by the surgeon intraoperatively, and finally by the pathologist postoperatively. Data analysis was performed for specificity, sensitivity, positive predictive value, negative predictive value, and interrater variability. RESULTS:: The sensitivity and specificity were 89.3% and 75%, respectively, in the "clinically cholesteatoma" group and 0% and 100% in the "clinically no cholesteatoma" group. Non-EPI DW MRI had a positive predictive value of 98.5% when cholesteatoma was suspected clinically and a negative predictive value of 84.6% when cholesteatoma was not suspected clinically. CONCLUSION:: If cholesteatoma is suspected clinically, non-EPI DW MRI is not necessary. If there is no clinical suspicion of cholesteatoma in second-look situations, sensitivity is low and serial follow-up MRI with long intervals is advised.


Subject(s)
Cholesteatoma, Middle Ear , Diffusion Magnetic Resonance Imaging/methods , Ear, Middle/diagnostic imaging , Otologic Surgical Procedures , Adult , Cholesteatoma, Middle Ear/diagnosis , Cholesteatoma, Middle Ear/physiopathology , Cholesteatoma, Middle Ear/surgery , Cohort Studies , Female , Humans , Male , Middle Aged , Otologic Surgical Procedures/adverse effects , Otologic Surgical Procedures/methods , Otoscopy/methods , Prospective Studies , Reproducibility of Results , Secondary Prevention/methods , Sensitivity and Specificity , Switzerland , Symptom Assessment/methods , Treatment Outcome
5.
Case Rep Neurol Med ; 2015: 827168, 2015.
Article in English | MEDLINE | ID: mdl-25694837

ABSTRACT

Background. Funicular myelosis is a known consequence of exposure to nitrous oxide. Nevertheless, there are only a few clinical trials assessing its long-term effects and there is no literature about the role of nutritional vitamin B12 supplementation in the context of nitrous oxide abuse. Case Descriptions. We diagnosed funicular myelosis in a young butcher, who consumed high amounts of meat regularly. Since the diagnostic process did not reveal any metabolic causes, reinterrogation of the patient uncovered recreational abuse of nitrous oxide out of whipped cream can gas cartridges. After stopping abuse and supplementation of vitamin B12, the patient recovered almost completely. Conclusions. In our case, even high nutritional vitamin B12 uptake could not compensate the noxious effects of nitrous oxide. Since there are emerging reports of increasing misuse, this should be considered in the diagnostic and therapeutic care of patients with nitrous oxide abuse. Furthermore, our case emphasizes that patients with vitamin B12 deficiency should be assessed for nitrous oxide abuse.

6.
Case Rep Otolaryngol ; 2013: 941530, 2013.
Article in English | MEDLINE | ID: mdl-24455375

ABSTRACT

The diagnosis, work-up, and treatment of sudden sensorineural hearing loss and sudden vestibular loss vary widely between units. With the increasing access to both magnetic resonance imaging and objective vestibular testing, our understanding of the various aetiologies at hand is increasing. Despite this, the therapeutic options are limited and without a particularly strong evidence base. We present a rare, yet increasingly diagnosed, case of intralabyrinthine haemorrhage (ILH) together with radiological, audiological, and vestibular test results. Of note, this occurred spontaneously and has shown partial recovery in all the mentioned modalities.

7.
Oncology ; 83(1): 1-9, 2012.
Article in English | MEDLINE | ID: mdl-22688083

ABSTRACT

BACKGROUND: Patients with glioblastoma (GBM) inevitably develop recurrent or progressive disease after initial multimodal treatment and have a median survival of 6-9 months from time of progression. To date, there is no accepted standard treatment for GBM relapse or progression. Patupilone (EPO906) is a novel natural microtubule-stabilizing cytotoxic agent that crosses the blood-brain barrier and has been found to have preclinical activity in glioma models. METHODS: This is a single-institution, early-phase I/II trial of GBM patients with tumor progression who qualified for second surgery with the goal of evaluating efficacy and safety of the single-agent patupilone (10 mg/m(2), every 3 weeks). Patients received patupilone 1 week prior to second surgery and every 3 weeks thereafter until tumor progression or toxicity. Primary end points were progression-free survival (PFS) and overall survival (OS) at 6 months as well as patupilone concentration in tumor tissue. Secondary end points were toxicity, patupilone concentration in plasma and translational analyses for predictive biomarkers. RESULTS: Nine patients with a mean age of 54.6 ± 8.6 years were recruited between June 2008 and April 2010. Median survival and 1-year OS after second surgery were 11 months (95% CI, 5-17 months) and 45% (95% CI, 14-76), respectively. Median PFS was 1.5 months (95% CI, 1.3-1.7 months) and PFS6 was 22% (95% CI, 0-46), with 2 patients remaining recurrence-free at 9.75 and 22 months. At the time of surgery, the concentration of patupilone in tumor tissue was 30 times higher than in the plasma. Tumor response was not predictable by the tested biomarkers. Treatment was generally well tolerated with no hematological, but cumulative, though reversible sensory neuropathy grade ≤3 was seen in 2 patients (22%) at 8 months and grade 4 diarrhea in the 2nd patient (11%). Non-patupilone-related peri-operative complications occurred in 2 patients resulting in discontinuation of patupilone therapy. There were no neurocognitive changes 3 months after surgery compared to baseline. CONCLUSIONS: In recurrent GBM, patupilone can be given safely pre- and postoperatively. The drug accumulates in the tumor tissue. The treatment results in long-term PFS in some patients. Patupilone represents a valuable novel compound which deserves further evaluation in combination with radiation therapy in patients with GBM.


Subject(s)
Antineoplastic Agents/therapeutic use , Central Nervous System Neoplasms/drug therapy , Epothilones/therapeutic use , Glioblastoma/drug therapy , Aged , Antineoplastic Agents/adverse effects , Antineoplastic Agents/blood , Apoptosis/drug effects , Brain Neoplasms/drug therapy , Brain Neoplasms/mortality , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Central Nervous System Neoplasms/mortality , Central Nervous System Neoplasms/pathology , Central Nervous System Neoplasms/surgery , Combined Modality Therapy , Epothilones/adverse effects , Epothilones/blood , Glioblastoma/mortality , Glioblastoma/pathology , Glioblastoma/surgery , Humans , Ki-67 Antigen/analysis , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/mortality , Treatment Outcome , Tubulin/analysis
8.
Neuroradiology ; 50(12): 1035-9, 2008 Dec.
Article in English | MEDLINE | ID: mdl-18791708

ABSTRACT

INTRODUCTION: Various endovascular techniques can be used to treat cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH) including intra-arterial administration of vasodilator drugs such as papaverine or nicardipine and balloon dilatation of the affected vessel segment. Papaverine is known to have side effects, and we report a possible new one. MATERIALS AND METHODS: After the treatment of cerebral vasospasm in a SAH patient by intra-arterial administration of papaverine into the left posterior cerebral artery, severe mesencephalic extravasation of blood and contrast media was detected. RESULTS: After reviewing the literature, the authors conclude that interruption of the blood-brain barrier by papaverine most likely combined with a secondary hyperperfusion phenomena, and perhaps a direct toxic effect on brain tissue was the mechanism of this major complication. CONCLUSION: In treating vasospasm in areas with a high density of perforating arteries, especially in the posterior circulation, papaverine should be used cautiously because a safe regimen has yet to be established. In this situation, alternative agents such as calcium channel blockers could be considered, but evidence-based data are still missing.


Subject(s)
Blood-Brain Barrier/drug effects , Papaverine/adverse effects , Papaverine/pharmacokinetics , Vasodilator Agents/adverse effects , Vasodilator Agents/pharmacokinetics , Vasospasm, Intracranial/drug therapy , Aged , Extravasation of Diagnostic and Therapeutic Materials/etiology , Female , Humans , Infusions, Intra-Arterial , Posterior Cerebral Artery , Subarachnoid Hemorrhage/complications , Vasospasm, Intracranial/etiology
9.
Neurol Res ; 30(3): 251-5, 2008 Apr.
Article in English | MEDLINE | ID: mdl-17803843

ABSTRACT

BACKGROUND AND PURPOSE: The assessment of blood flow speed by imaging modalities is of increasing importance for endovascular treatment, such as stent implantation, of cerebral aneurysms. The subtracted vortex centers path line method (SVC method) utilizes image post-processing for determining flow quantitatively. In current practice, intra-aneurysmal flow in an in vitro model is visualized by laser sheet translumination and digitally recorded. In this study, we applied this method to cinematic angiography (CA), which is the preferred imaging method for endovascular interventions, to analyse hemodynamic changes. The SVC method was applied to the images and compared with results of the slipstream line method with colored fluid. METHODS: A transparent tubular model was constructed of silicone which included an aneurysm 10 mm in diameter and having a 5 mm neck on a straight parent artery with a diameter of 3.5 mm. The model was integrated into a pulsatile circulation system. By CA, successive images at 25 frames/s with injection of contrast were obtained. RESULTS AND CONCLUSION: Rotating vortexes of contrast, which advanced along the wall of the aneurysm, were observed in successive images of the aneurysm cavity. This phenomenon was also observed in the successive images with the slipstream line method. The speed of the vortex center was calculated and the results show that the vortex speed of CA was the same as that under the slipstream line method. This indicates the possibility of applying the SVC method to medical imaging equipment for analysis of the flow in aneurysms containing stent.


Subject(s)
Cerebral Angiography/methods , Hemodynamics , Intracranial Aneurysm/physiopathology , Blood Flow Velocity/physiology , Humans , Image Processing, Computer-Assisted/methods , Middle Cerebral Artery/physiopathology , Models, Cardiovascular , Phantoms, Imaging , Regional Blood Flow/physiology
10.
Neurol Res ; 27 Suppl 1: S120-8, 2005.
Article in English | MEDLINE | ID: mdl-16197837

ABSTRACT

OBJECTIVES: Stent implantation across the neck of cerebral aneurysms may induce intra-aneurysmal flow reduction, and consequently saccular thrombosis and vessel wall repair. To analyse the influence of different stent parameters on such flow reduction, we studied the flow changes in vascular models, induced by a series of stents. METHODS: Two different neck-sized elastic sidewall aneurysm models were connected to a circulatory loop. Twenty different stents were introduced in both models to analyse the effect of their parameters, such as porosity, filament diameter and permeability. Flow patterns were visualized by using glass particles and laser sheet translumination. The digitally recorded data were transferred for computer analysis. The changes of the vortex velocity for each stent model combination were investigated and statistically evaluated. RESULTS: Intra-aneurysmal flow analysis showed dispersion of the vortices of a variable degree, and velocity reduction of 30% mean in model 1 and 49% mean in model 2. By statistical analysis three groups of stents ('best', 'medium', 'worst') were identified, according to their haemodynamic efficacy. No correlations were observed between the haemodynamic performance of the stents and the porosity, filament diameter and permeability values separately. The stent effects were on average more important in the large-necked than in the small-necked aneurysm model. DISCUSSION: Stent implantation induces intra-aneurysmal loss of vortex coherence and flow reduction. The analysed stent parameters show complex interrelationship, including also stent 'design'. The difference in the haemodynamic efficacy of the individual stents between the two models raises the question of 'stent positioning effects'.


Subject(s)
Hemodynamics/physiology , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/surgery , Stents , Blood Flow Velocity , Elasticity , Humans , Models, Cardiovascular , Regional Blood Flow
11.
AJNR Am J Neuroradiol ; 25(10): 1750-9, 2004.
Article in English | MEDLINE | ID: mdl-15569741

ABSTRACT

BACKGROUND AND PURPOSE: Stent implantation alone might not be sufficient to produce definitive treatment of cerebral aneurysms. Therefore, extended experimental work is needed to improve results. We show the feasibility of using an in vitro anatomically shaped elastic model for flow evaluation before and after stent implantation. METHODS: Based on human vascular casting, an anatomic elastic internal carotid artery model, including an aneurysm on the supraclinoid portion, was manufactured. The model was connected to a circulatory loop to simulate physiological flow. After visualization of the flow by using glass particles and laser sheet translumination, the digitally recorded data were transferred for computer analysis. Intra-saccular flow pattern changes and the vortex velocity reduction induced by the stent were investigated qualitatively and quantitatively. RESULTS: The distal neck of the aneurysm behaved as a flow divider. Therefore, it was directly exposed to the hemodynamic stress. Inside the sac, a well-defined vortex formed and progressed along the wall toward the proximal neck. After stent implantation this pattern changed significantly; the vortex appeared more dispersed and its residence time increased. The velocity reduction was 32%. Velocity peak was observed close to the distal neck in both cases. CONCLUSION: In vitro anatomic elastic models are feasible for flow evaluation with laser sheet translumination. In our model, stent implantation resulted in hemodynamic changes that might favor the exclusion of the aneurysm from the circulation and can prevent regrowth of the aneurysmal sac.


Subject(s)
Carotid Artery Diseases/physiopathology , Carotid Artery Diseases/therapy , Carotid Artery, Internal , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/therapy , Models, Cardiovascular , Elasticity , Equipment Design , Humans , Regional Blood Flow , Stents
12.
J Neurosurg ; 99(4): 775-8, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14567616

ABSTRACT

Transarterial particulate embolization is indicated for benign intracranial dural arteriovenous fistulas (DAVFs) that have no dangerous venous reflux. This treatment, however, does not cure these lesions. In this case report the authors describe a spontaneously occurring DAVF that was treated by implanting coils through a transarterial microcatheter into the affected venous channel. The channel was separate from the normal dural sinuses. The pathological architecture of the fistula and the usefulness of this approach are discussed.


Subject(s)
Central Nervous System Vascular Malformations/therapy , Adult , Carotid Artery, External/diagnostic imaging , Carotid Artery, External/surgery , Catheters, Indwelling , Central Nervous System Vascular Malformations/complications , Central Nervous System Vascular Malformations/diagnosis , Cerebral Angiography , Cerebral Veins/diagnostic imaging , Cerebral Veins/surgery , Diagnosis, Differential , Embolization, Therapeutic/instrumentation , Humans , Male , Tinnitus/diagnosis , Tinnitus/etiology
13.
Orv Hetil ; 143(44): 2469-77, 2002 Nov 03.
Article in Hungarian | MEDLINE | ID: mdl-12674801

ABSTRACT

Percutaneous vertebroplasty (PVP) is a radiologically guided therapeutic procedure, which consists of percutaneous injection of a liquid polymer (bone cement) into a destroyed vertebral body. PVP was invented in 1984, in France, first for treating vertebral body haemangioma. Since its introduction the indications have been expanded progressively and today PVP is indicated mainly for treatment of vertebral haemangioma, malignant vertebral tumor and osteoporotic vertebral compression fracture. The unique advantage of this technique is that besides the stabilization of the vertebral body--and partly in connection with this--it affords prompt and lasting pain relief. Based on published data the success rate of the procedure is 80-100% with a complication rate of 1-10%. Thus, PVP is a valuable minimally invasive tool, providing immediate pain relief and early mobility in carefully selected patients. However, further work is needed to define the benefits of PVP compared to the standard treatment. The purpose of this paper is to demonstrate the technique by analyzing scientific reports published to date and summarizing the first author's own experience gained at the University Hospital of Geneva, Department of Neuroradiology, Switzerland.


Subject(s)
Bone Cements , Bone Cements/pharmacology , Hemangioma/therapy , Spinal Fractures/therapy , Spinal Neoplasms/therapy , Spine , Biopsy , Bone Cements/adverse effects , Contraindications , Humans , Osteoporosis/complications , Phlebography , Polymethyl Methacrylate/pharmacology , Spinal Fractures/etiology , Treatment Outcome
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