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Biomedical subjects

A H Menezes

Publications and source records attributed to A H Menezes.

At least 73 records · Page 4Linked to original sources
PubMed1989

Arthrodesis of the cervical spine in rheumatoid arthritis.

Forty-one patients who had rheumatoid arthritis were treated with a cervical arthrodesis and were followed for a minimum of twenty-three months. Twenty patients had had an isolated atlanto-axial subluxation; five, isolated cranial settling; and four, subaxial subluxation alone. Twenty patients had an atlanto-axial arthrodesis; sixteen, an occipitocervical arthrodesis; and five, a posterior arthrodesis of the subaxial spine. In addition, two patients had a transoral odontoidectomy and one, an anterior cervical vertebrectomy. At the latest follow-up, thirty-six (88 per cent) of the patients had osseous union, two had fibrous union but were stable, and three had a non-union. All of the problems with union occurred in the patients who had had an isolated atlanto-axial arthrodesis. Clinically, twenty-seven (66 per cent) of the patients had improved, fourteen were unchanged, and none were worse. The preoperative neurological status remained the same postoperatively in thirty patients (73 per cent) and it improved in eleven (27 per cent). Twenty-one of the twenty-three patients who had had marked pain preoperatively had little or no pain at the latest follow-up. Complications included a transient hemiparesis in one patient, a superficial wound infection in two, displacement of an anterior graft in one, a broken wire in three, and erosion of methylmethacrylate into the outer part of the occipital cortex in one. Four patients died, but not as a result of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Aqueductal stenosis and neurofibromatosis: a rare association.

Three cases with rare association of neurofibromatosis, hydrocephalus, and aqueductal stenosis seen at the University of Iowa during the past 20 years are presented. The literature on nontumoral hydrocephalus and aqueductal stenosis in neurofibromatosis is reviewed. Possible explanations for the association of aqueductal stenosis and neurofibromatosis are discussed. It is concluded that aqueductal stenosis, though not common, should nevertheless be considered in the differential diagnosis of hydrocephalus in neurofibromatosis.

Adolescent↗
PubMed1988

Presentation and management of pediatric Chiari malformations without myelodysplasia.

Chiari malformations without myelodysplasia are rarely diagnosed in the pediatric age group. With current neurodiagnostic techniques, however, they are being seen more frequently. Unfortunately, the prognosis is not clear because publications have included a number of different entities, used a variety of surgical approaches, and lacked long term follow-up. Sixteen patients younger than 20 years were treated for Chiari malformations (without myelodysplasia) between 1975 and 1985. The average age was 11 years, and the average duration of symptoms was 20 months. The common symptoms were isolated motor weakness (56%), pain (37.5%), and sensory loss (25%). Frequently seen signs were motor deficit (81%), sensory loss (50%), scoliosis (50%), and cranial nerve palsy (50%). The surgical procedures used were foramen magnum decompression (3 transoral clivus odontoid resections and 15 posterior fossa decompressions with dural grafting), alteration of cerebrospinal fluid (CSF) pathways at the cervicomedullary junction (plugging the foramen cecum and a 4th ventricle to subarachnoid shunt with posterior fossa decompression), and ventriculoperitoneal shunting (2 cases). In follow-up, 37.5% of the patients are asymptomatic, 50% are improved, and 12.5% are stable after an average follow-up period of 43 months. The asymptomatic group was younger (9.3 years) and had a shorter symptom duration (7.2 months) than both the improved (11.9 years, 16.4 months) and the stable groups (15 years, 20 months). Optimal outcome depends on complete evaluation of the abnormal CSF pathways and bony abnormalities at the craniovertebral junction. Operation is then directed toward correction of these abnormalities as delineated radiographically. Of our patients, 87.5% have at least shown improvement, which has been long term in all cases.

Adolescent↗
PubMed1988

Stereotaxic surgery in the treatment of multiple brain abscesses.

Controversy exists regarding the optimal treatment for patients with multiple brain abscesses. These lesions are often small and located deep in the brain and close to vital structures, making surgery difficult. With this in mind the authors review their experience in treating multiple abscesses using computerized tomography (CT)-guided stereotaxic aspiration. From 1983 to 1985, 15 patients were treated for multiple brain abscesses, of whom eight underwent stereotaxic aspiration. There were a total of 28 abscesses in these eight patients: 11 abscesses were aspirated and two excised using CT-guided techniques. Most were cortical in location, although there were 12 in the deep white matter, one in the thalamus, and two in the caudate nucleus. All patients received a total of 6 weeks of antibiotic therapy. Follow-up CT showed resolution of the abscesses in all patients. Currently, four are neurologically normal, one has a mild hemiparesis, one has a well-controlled seizure disorder, and one requires supportive care. A single death occurred 5 weeks postoperatively of unrelated causes. Location, size, and age of an abscess all have bearing upon the response to management and outcome of the patient. Stereotaxic surgery is a procedure with minimal morbidity and mortality. Stereotaxic aspiration should be considered in patients with small, multiple, or deep-seated abscesses, in those who are poor operative candidates, and in those who have failed prior therapy.

Adult↗
PubMed1988

Transoral-transpharyngeal approach to the anterior craniocervical junction. Ten-year experience with 72 patients.

The anterior transoral-transpharyngeal operation to correct ventral irreducible compression of the cervicomedullary junction was utilized in 72 individuals. The patients' ages ranged from 6 to 82 years, and 29 were children. The pathology encountered was primary basilar invagination, rheumatoid irreducible cranial settling, secondary basilar invagination due to migration of odontoid fracture fragments, dystopic os odontoideum, granulation masses, clivus chordoma, osteoblastoma, and chondroma of the atlas. Fifteen patients had associated Chiari malformation with basilar invagination. Fifty-two patients required subsequent atlantoaxial or occipitocervical fusion. Neurological improvement was the rule. There were two deaths within 30 days of surgery: one from myocardial infarction 4 weeks after surgery and one from Gram-negative septicemia of urinary tract origin. There was one pharyngeal wound infection. The ventral transoral approach provides a safe, rapid, and effective means for decompression of the abnormal craniovertebral junction.

Adult↗
PubMed1988

beta-amyloid protein of Alzheimer's disease is found in cerebral and spinal cord vascular malformations.

Congo/Red deposition with birefringence to polarized light was demonstrated focally in cerebrovascular malformations removed surgically from 4 older patients (ages 85, 74, 74, and 63), and in a spinal cord vascular malformation in a 76-year-old patient. Lesser degrees of Congophilic change were observed in cerebrovascular malformations screened from 4 of 10 patients between the ages of 30 and 59. No Congophilic change was seen in 10 cerebrovascular malformations removed from patients under 30 years of age. Congophilic areas in all cases decorated with W-2 and 85/45 polyclonal antibodies raised to peptide sequences of cerebrovascular beta-amyloid and beta-amyloid of senile plaques from patients with Alzheimer's disease. Thus, the amyloid in these vascular malformations is immunologically related to beta-amyloid protein. This finding provides another indication that vascular beta-amyloid deposition is not specific for Alzheimer's disease and suggests that an existing abnormality of vessels may be a predisposing factor.

Adolescent↗
PubMed1987

Intracranial arteriovenous anomalies of infancy: modern concepts.

A variety of cerebrovascular abnormalities may become manifest in the first years of life. We present our recent experience with 7 children, ages 1 week to 7 months of age, who presented with congestive heart failure and progressive head enlargement (3), heart failure alone (1) and head enlargement alone (2). The anomalies include vein of Galen aneurysm (3), complex arteriovenous fistula (2) and posterior fossa dural arteriovenous malformations (2). Computed tomographic scanning was invaluable in delineating the site of the lesion while arterial digital subtraction angiography was utilized to obtain the high-quality images, reduced dye volume and rapid filming. Direct surgical intervention was accomplished in 5 cases, while embolization was utilized in 2. One child underwent direct partial occlusion and embolization. Congestive heart failure resolved in 2 of 3 operated cases and improved in those undergoing embolization. Hydrocephalus improved in 2 cases with the elimination of the fistula. Morbidity included seizures and a hemorrhagic infarction in 1 case. Neurologic outcome was satisfactory and there was no surgical mortality.

Arteriovenous Fistula↗
PubMed1987

Comparative evaluation of intracranial epidermoid tumors with computed tomography and magnetic resonance imaging.

The diagnosis of intracranial epidermoid tumors with computed tomography (CT) is often difficult because of indistinct margins, close proximity to the skull base, and a density similar to that of cerebrospinal fluid (CSF). Recent experience with six histologically confirmed epidermoid tumors served to emphasize the value of magnetic resonance (MR) imaging in studying these lesions. MR images were obtained using varying spin echo and inversion recovery techniques with a 0.5-tesla superconducting magnet. CT with and without enhancement had been performed in each case. In Case 1, CT showed an ill-defined left cerebellopontine angle hypodensity. MR imaging clearly showed the presence of abnormal tissue at that location. Case 2 showed a CSF density mass in the right upper posterior fossa. MR imaging of that area showed a variegated signal of a mass extending supratentorially. CT of Case 3 showed a left medial middle fossa hypodensity with an enhancing rim. MR imaging showed a clearly extraaxial mass in that location. In Case 4, a diffuse cerebellar hemispheric hypodensity was observed on CT and was clearly demarcated by MR studies. A huge lesion, thought initially to be an arachnoid cyst on CT of Case 5, was seen on MR imaging to be a large, extraventricular mass displacing the temporal lobe. Finally, CT in Case 6 was suggestive of a poorly demarcated right cerebellopontine angle lesion, which was seen on MR images to be extraaxial, displacing the brain stem. Various MR images more clearly demonstrate the extent of abnormal tissue than CT of epidermoid tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Lesions in Meckel's cave: variable presentation and pathology.

A series of 12 patients with mass lesions arising from Meckel's cave is presented. Patients' age on presentation ranged from 13 months to 71 years. Nine of the 12 patients had symptoms referable to the fifth cranial nerve, but only three complained of facial pain. The 12 patients presented eight different pathological entities, including meningioma, lipoma, schwannoma, malignant melanotic schwannoma, arachnoid cyst, neurofibroma, epidermoid tumor, and chordoma. Computerized tomography and magnetic resonance imaging were most useful in localizing the lesion to Meckel's cave. All 12 patients underwent a subtemporal approach to the lesion, and gross total removal was achieved in 11. Postoperative results were excellent with no increased neurological deficits seen 3 months postoperatively. Most patients had resolution of the cranial nerve deficits except for fifth nerve function, which was impaired in nine patients postoperatively. This series demonstrates that lesions in Meckel's cave can have a varied and unusual presentation, as well as an assortment of pathology. Total removal of lesions in this area resulted in relief of symptoms in most patients, with minimum morbidity.

Adolescent↗
PubMed1986

MRI versus conventional radiologic examinations in the evaluation of the craniovertebral and cervicomedullary junction.

MRI is superior to conventional radiographic techniques for demonstrating anatomic CMJ distortion and compression in all patients, regardless of the pathology involved. Because of the high incidence of osseous CVJ abnormalities in patients with a Chiari malformation, complete evaluation of these patients requires examination of the osseous CVJ by conventional radiographic methods in addition to the MRI study. Conventional techniques are also helpful for the complete evaluation of inflammatory and osseous lesions involving the CVJ. Occasionally, designation of tumors as intra- or extraaxial may not be possible by MRI alone; additional studies may be necessary. The failure of MRI to demonstrate calcification is a limitation in the evaluation of a variety of pathologic entities, especially neoplasms in which the demonstration of calcification may be a clue to the histologic diagnosis.

Adolescent↗
PubMed1985

Primary intracranial rhabdomyosarcoma.

Primary intracranial rhabdomyosarcoma is rare. Twenty-one cases with dismal outcomes have been reported. We add five children with this disease treated between 1977 and 1982. Their therapy consisted of surgical resection, craniospinal irradiation, and intravenous-intrathecal chemotherapy. Two children have recovered, 21 and 67 months after diagnosis; the last is the longest survival reported in the literature. Two succumbed to tumor recurrence, and one died due to pulmonary embolism. The posterior fossa was invariably a site of tumor at presentation. Diagnosis with light microscopy can be elusive; electron microscopic and immunohistochemical evaluation are necessary to confirm the pathological condition. This is essential so that early, aggressive therapy can be instituted. These diagnostic and therapeutic techniques have led to a reevaluation of this malignancy and its prognosis.

Adolescent↗
PubMed1985

Odontoid upward migration in rheumatoid arthritis. An analysis of 45 patients with "cranial settling".

Lack of correlation between the severity of rheumatoid subluxation of the upper cervical vertebrae and supposed absence of neurological damage has led to the erroneous supposition that this finding is innocuous. Incomplete autopsy studies in rheumatoid arthritis have failed to recognize the cause of death, despite previously proven dramatic occipito-atlanto-axial dislocations. The most feared entity of rheumatoid basilar invagination, namely "cranial settling," is poorly understood. Between 1978 and 1984, the authors treated 45 rheumatoid arthritis patients who were symptomatic with "cranial settling." This consisted of vertical odontoid penetration through the foramen magnum (9 to 33 mm), occipito-atlanto-axial dislocation, lateral atlantal mass erosion, downward telescoping of the anterior arch of C-1 on the axis, and rostral rotation of the posterior arch of C-1 producing ventral and dorsal cervicomedullary junction compromise. Cervicomedullary junction dysfunction has mistakenly been called "entrapment neuropathy," "progression of disease," or "vasculitis." Occipital pain occurred in all 45 patients, myelopathy in 36, blackout spells in 24, brain-stem signs in 17, and lower cranial nerve palsies in 10. Four patients had prior tracheostomies. Four previously asymptomatic patients with "cranial settling" presented acutely quadriplegic. The factors governing treatment were reducibility and direction of encroachment determined by skeletal traction and myelotomography. Transoral odontoidectomy was performed in seven patients with irreducible pathology. All patients underwent occipitocervical bone fusion (with C-1 decompression if needed) and acrylic fixation. Improvement occurred during traction, implying that compression might be the etiology for the neurological signs. There were no complications. Thus, "cranial settling" is a frequent complication of rheumatoid arthritis; although it is poorly recognized, it has serious implications and is treatable.

Aged↗
PubMed1983

Posterior fossa hemorrhage in the term neonate.

Posterior fossa hemorrhage (PFH) in the newborn term infant has been infrequently reported, and before computed tomographic (CT) scanning most were identified at postmortem examination. The origin and causes of PFH in the term neonate differ from those in adults. The main possible causes are: (a) tentorial and falx disruption with avulsion of bridging veins due to mechanical compression and distortion of the head during the birth process, resulting in posterior fossa subdural collections and vermis hematoma, and (b) occipital osteodiastasis associated with cerebellar hemisphere laceration, with intracerebellar hematoma and subdural collections. Three full-term neonates with PFH were operated on with good outcome. Both of the possible causes contributed to the hemorrhage. Review of the literature to date has led to the following conclusions: (a) PFH in the term infant is frequently associated with breech delivery, forceps instrumentation, and prolonged labor with cranial molding. (b) Massive PFH is associated with dural sinus laceration, rupture of the vein of Galen, or rupture of hematoma into the subdural space. Symptoms may be delayed up to 96 hours in cases where there is a small continuing hemorrhage. (c) CT scanning with reconstructions is essential to provide precise localization of the hemorrhage and thus avoid errors in interpretation. (d) Prompt removal of PFH improves survival and decreases sequelae. (e) Shunting procedures are necessary in 36% of the cases.

Adolescent↗