1/10. Cerebral arterial fenestrations associated with intracranial saccular aneurysms.Fenestrations of cerebral arteries other than the anterior communicating artery are rare congenital anomalies, which may be associated with saccular aneurysms. In such cases, the aneurysms may be located at the fenestration itself or may involve other intracranial vessels. This kind of association is not infrequently the cause of angiographic diagnostic problems, as well as surgical difficulties, and consequently needs to be well known to physicians. Four recent cases of rare fenestrations of cerebral arteries associated with intracranial aneurysms are reported in this study and discussed together with a review of the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. oculomotor nerve palsy from posterior communicating artery aneurysm.The mortality rate for posterior communicating artery (PCA) aneurysm with oculomotor nerve palsy is 33 per 100. The incidence of oculomotor palsy with PCA aneurysm varies from 34% to 56%. The classic presentation of a PCA aneurysm involving the oculomotor nerve is sudden onset of severe unilateral frontal headache, ptosis, a dilated and fixed pupil, and limitations of adduction, depression, and elevation of the eye. Carotid arteriography is diagnostic. This case is presented because of the high probability of being seen first by a primary care physician. Delay in clinical recognition and treatment can have dire consequences for the patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Delayed visual loss due to trauma of the internal carotid artery.The group of six patients in this study experienced delayed visual loss following head trauma. Visual loss occurred from 1 day to 13 years after the initial injury. All patients suffered indirect trauma to the internal carotid artery resulting in formation of either an aneurysm or pseudoaneurysm or a carotid-cavernous fistula. review of the radiologic and clinical findings was performed in six patients. The diagnosis was established by computed tomography, magnetic resonance imaging, and angiography. All patients had follow-up clinical evaluation and imaging studies. Treatment by neurosurgical or interventional neuroradiologic procedures resulted in significant visual improvement in five patients. Different pathophysiologic mechanisms could be correlated with the delayed visual loss produced by the two types of lesions. The pathologic changes associated with the aneurysms/pseudoaneurysms included direct compression of optic nerves and/or chiasm and intracranial hematoma. A carotid-cavernous fistula caused delayed visual loss by either hematoma at the orbital apex or compression of the chiasm and/or optic nerves by saccular dilatation of the cavernous sinus. The delayed onset of decreased vision following head trauma should alert the physician to the possibility of a traumatic aneurysm/pseudoaneurysm or a carotid-cavernous fistula. Different neuro-ophthalmologic symptoms can usually be correlated with the pathologic changes demonstrated by neuroimaging procedures.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Electronic stethoscope for detection of cerebral aneurysm, vasospasm and arterial disease.A specially designed acoustic stethoscope electronic-computer-analysis system has repeatedly detected and identified angiographically demonstrated anteriorly located intracranial aneurysms by their characteristic signals. The system has detected and measured clinically significant disease in the carotid siphon and bifurcation, even in cases with normal angiograms, and has recorded the onset and disappearance of cerebral vasospasm. Our data suggests that an aneurysm may act as a flexible Helmholtz resonator, possibly being driven by vortex shed or turbulence. Our goal is the development of a safe, non-invasive method by which the physician could investigate warning symptoms of aneurysms, cerebral vasospasm, and arterial disease in order to recommend preventive surgery or medical treatment early before the patient's condition might deteriorate. Individual cases, falsely positive and negative results are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. cerebrovascular disorders associated with pregnancy.stroke is a leading cause of maternal death. Intracerebral hemorrhage may be associated with eclampsia, metastatic choriocarcinoma or ruptured arteriovenous malformations. Intracranial venous thrombosis may result from a hypercoagulable state or local intracranial vascular damage. subarachnoid hemorrhage is usually caused by the rupture of an intracranial aneurysm or arteriovenous malformation. signs and symptoms of stroke in pregnancy can be confusing. The physician must be aware of these signs to avoid mismanagement of the pregnant stroke patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Autosomal dominant polycystic kidney disease.Autosomal dominant polycystic kidney disease (ADPKD) is an important cause of medical morbidity in the united states that affects one-half million persons and accounts for ESRD in about 10% of the chronic dialysis population. In addition to its effects on the kidney, the disease has important manifestations in the cardiovascular system (aneurysms, hypertension) and the gastrointestinal tract (hepatic cysts). Clinically important renal complications can develop as the disease progresses that require specialized attention, such as urinary tract infection, pain, and nephrolithiasis. The underlying cellular defect that causes ADPKD has eluded investigators thus far, but abnormalities in cellular proliferation, the tubular basement membrane, and cell fluid secretion appear important in pathogenesis. Factors that mediate progressive interstitial fibrosis and failure of renal function are undefined, although rigorous control of blood pressure appears to be an important therapeutic measure. Recent advances in molecular biology have localized the abnormal gene to chromosome 16 in 90% of families, making early genetic screening of asymptomatic family members possible in many cases. A positive diagnosis may have important effects on employment status, as well as health insurance, so that family members sometimes refuse to be assessed for the presence of the disease. Because of such complex social factors, counseling of an asymptomatic individual by his or her physician is required when considering the use of screening tests for ADPKD. Inadequate patient education may still represent an impediment to early detection, genetic counseling, and timely treatment of disease complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Findings of negligence followed communication lapses in BC aneurysm case.Negligence is sometimes established on the basis of lapses in communication and patient care management that, in hindsight, could have been avoided. A recent BC court case concerned a patient who died because of a ruptured aneurysm. A Supreme Court judge found that some of the physicians involved had failed in their duty to diagnose the patient's condition properly, or failed to communicate to one another significant signs of the patient's illness, and failed to refer him in time to the medical specialists who could have diagnosed and treated his condition promptly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. The complexity of caring for patients with ruptured cerebral aneurysm: case studies.Ruptured intracerebral aneurysm causes instantaneous neurologic chaos and is associated with high morbidity ad mortality. The event initiates a cascade of physiologic and structural changes that manifest themselves in a variety of clinical symptoms. The critical care team of nurses, physicians, and therapists must rapidly identify the cause; understand the pathology; and use advanced assessment techniques, medications, and interventions to stabilize the patient and to counter the horrendous effects of the injury. Interventions that include endovascular aneurysm coiling and cerebral angioplasty are providing new options for isolating the aneurysm and countering the effects of vasospasm. Through an integrated team approach, recovery from ruptured aneurysm will be maximized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Creutzfeldt-Jakob disease associated with cadaveric dura mater grafts -- japan, January 1979-May 1996.In 1997, a nongovernmental surveillance group for Creutzfeldt-Jakob disease (CJD) in japan reported to the Ministry of health and Welfare its analysis of a 1996 mail questionnaire survey of neurologic, psychiatric, and neuropathologic institutions throughout japan. This analysis identified 829 patients with CJD diagnosed by physicians during January 1979-May 1996, including a large number (43 patients) who had received a cadaveric dura mater graft during a neurosurgical (42) or orthopedic (one) procedure during 1979-1991. This report presents a summary of features of these 43 cases, which indicated that at least 41 of these patients had received dura mater grafts from the same processor, and describes CJD in the most recent recipient of a dura mater graft. The findings indicate that an international outbreak of CJD associated with a single brand of dura mater grafts is larger than previously recognized and that recipients of contaminated grafts may remain at risk for CJD at least 16 years following receipt of grafts.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. The ophthalmology of intracranial vascular abnormalities.PURPOSE: To provide a practical review of the ophthalmologic manifestations of intracranial vascular abnormalities. methods: We reviewed ocular manifestations of the most common intracranial vascular abnormalities: intracranial aneurysms, carotid-cavernous fistulas, arteriovenous malformations, and cavernous malformations. RESULTS: Unruptured aneurysms can compress the third cranial nerve and the anterior visual pathways. Ruptured aneurysms and subarachnoid hemorrhage can result in Terson syndrome and papilledema. Direct and indirect carotid-cavernous fistulas most commonly cause the classic triad of proptosis, conjunctival chemosis, and cranial bruit but can masquerade as chronic conjunctivitis. arteriovenous malformations, with or without hemorrhage, may compress portions of the retrochiasmal pathways, causing visual field loss. Cavernous malformations, when in the brainstem, commonly cause abnormalities of supranuclear, nuclear, and fascicular ocular motility. CONCLUSIONS: The ophthalmologist may be the first physician to encounter clinical manifestations of intracranial vascular abnormalities that may herald devastating neurologic complications. Prompt diagnosis facilitates appropriate management and therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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