PubMed Health⌕ Search

Biomedical subjects

A J Steers

Publications and source records attributed to A J Steers.

At least 19 recordsLinked to original sources
PubMed2001

Pressure compensation in shunt-dependent hydrocephalus with CSF shunt malfunction.

This study is a retrospective analysis of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) data from 56 children with active hydrocephalus and cerebrospinal fluid (CSF) shunt malfunction. The pressures were measured from a separately sited CSF access device placed in the frontal horn of the lateral ventricle. Of the patients, 79% had an elevated ICP (mean 20+/-12 mmHg). A subgroup of patients demonstrated ten different forms of CSF-filled swelling. This group had significantly lower ICP recordings (P=0.000075) with a mean ICP of 8.5 mmHg compared with the remainder (22.9 mmHg). This pressure 'compensation' was because of additional nonphysiological accommodation of CSF volume. Overall the CPP was normal in 35% of cases despite normal ICP occurring in only 11% of cases. The CPPs were not significantly different in those with and without compensation. Measurement of ICP may not always be a reliable indicator of shunt malfunction in shunt-dependent children who present with compensatory CSF-filled spaces.

Adolescent↗
PubMed1999

A classification of CSF shunt malfunction.

A classification of dysfunctional shunts is proposed and clarification of the terminology discussed. This is based on experience of successive shunt malfunctions over a 3-year period with the aid of ventricular pressure measurements, imaging and clinical semiology. The classification system is both anatomical and functional.

Cerebrospinal Fluid Shunts↗
PubMed1996

Surgical neurology and clinical neurosciences in Edinburgh, Scotland.

Surgical neurology in Edinburgh started > 70 years ago with Norman Dott, after his apprenticeship with Harvey Cushing. It continued under the chairmanship of John Gillingham, until 1980, and then Douglas Miller, who merged the Departments of Surgical Neurology and Medical Neurology to form the Department of Clinical Neurosciences in 1986. Particular strengths of the Edinburgh program have been the management of intracranial aneurysms, stereotactic and functional neurosurgery, the management of head and spinal injury and stroke, and neuro-oncology.

History, 20th Century↗
PubMed1995

Status epilepticus presenting as progressive dysphasia.

Status epilepticus is usually a straightforward diagnosis when a patient has two or more seizures without regaining consciousness. However, when status is non-convulsive and, in particular, has a temporal lobe flavour the clinical presentation may be misleading. Presentation with automatic or psychic behaviour is well recorded. We report a patient with nonconvulsive status who presented with progressive dysphasia with widespread CT and MRI changes. The dysphasia and imaging changes led to a diagnosis of a probable neoplastic brain process but reversed with anticonvulsant treatment.

Adult↗
PubMed1994

Management and long-term outcome following subarachnoid haemorrhage and intracranial aneurysm surgery in elderly patients: an audit of 199 consecutive cases.

To address the question of managing subarachnoid haemorrhage (SAH) in the older patient, the management and outcome of 199 consecutive patients aged > or = 60 years with a confirmed diagnosis of subarachnoid haemorrhage (n = 186) or an unruptured intracranial aneurysm (n = 13) were reviewed. In seven patients, the cause of the SAH was an arterio-venous malformation and these were excluded from further analysis. Angiography was performed in 141 patients with a complication rate of 2.1%. Angiography was not performed in 51 patients and, in this cohort, the in-patient mortality rate was 68.6% and only 27.5% had a favourable outcome at discharge. Operation was not performed in 21 patients with demonstrated aneurysms for a variety of reasons. In this group, the in-patient mortality rate was 47.6% and 38.1% had a favourable outcome at discharge. Eighty-one patients in good neurological grade underwent surgery for a ruptured aneurysm and six patients underwent surgery for a symptomatic unruptured aneurysm. The surgical mortality was 1.1% and a favourable outcome at discharge was achieved in 83.9% of patients. Thirty-three patients were angiographic negative and there was a favourable outcome in 97% of this group. The management mortality in these selected patients admitted to the Department of Clinical Neurosciences was 24.4% and a favourable outcome was recorded in 66.2% of patients. Long-term follow-up (median 40 months, range 3-120 months) was obtained in 97% of discharged patients. The probability of survival at 60 months for patients in good condition at discharge was 0.826 (95% confidence interval 0.722-0.894).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Transcranial Doppler ultrasound findings in cerebral venous sinus thrombosis. Case report.

Transcranial Doppler ultrasound (TCD) findings are described in a patient with acute thrombosis of the sagittal venous sinus. The TCD finding of prominent venous signals adjacent to the middle cerebral artery gave the first indication of the diagnosis, which was subsequently confirmed by computerized tomography. Awareness of the possible TCD findings in patients with a similar history may lead to a more rapid diagnosis of cerebral venous sinus thrombosis.

Female↗
PubMed1993

Heterogeneity of neurological syndromes in survivors of grade 3 and 4 periventricular haemorrhage.

To evaluate the topographical neurological distribution, patterns of abnormal tone and related functional neuromotor impairment after grade 3 and grade 4 intraventricular/periventricular haemorrhage (IPVH), 33 children with previous grade 3 or 4 IPVH of mean gestational age 30.9 weeks (range 25-40 weeks) and mean birth weight 1743 g (range 866-3600 g) were examined neurologically at 4.7 years (range 0.75-10.8 years). Neurological signs were absent in 10/33 cases which were equally distributed between the grade 3 and grade 4 IPVH groups. The largest single topographical neurological distribution was hemiparesis in 8/23, followed jointly by diplegia (cerebral paraplegia) in 6/23 and triplegia in 6/23 cases and finally quadriplegia in 3/23 cases. Grade 4 IPVH tended to result in asymmetrical syndromes, accounting for 7/8 cases of hemiparesis and 5/6 cases of triplegia, whereas all 3/3 cases of quadriplegia followed grade 3 IPVH. The 6/23 cases of diplegia were shared between the grade 3 and grade 4 IPVH groups. Tone was normal in 7/8 of the hemiparetic subjects. Dystonia was the commonest tone abnormality, affecting 8/23 children with neurological disturbance, followed by ataxia/hypotonia in 4/23 and mixed dystonia/hypotonia in 3/23. Only 1/23 cases had signs of spasticity. Spasticity is rare following severe IPVH. Diplegic children had a better functional neuromotor grade than hemiparetic children, who in turn did better than triplegic children. Ataxia hypotonia resulted in better functional outcome than dystronia, which in turn was more favourable than mixed tone patterns. Cranial imaging by ultrasound (US) or computed tomographic (CT) scanning proved an unreliable prognostic indicator except in the case of hemiparesis, for which US scans correctly predicted the affected side in 5/7 cases. The neurological syndromes following severe IPVH differ from the classical encephalopathy of prematurity, and this should lead to a re-appraisal of the trends in the prevalence of cerebral palsy. Caution should be exercised in the interpretation of cranial imaging with regard to pessimistic prognoses in the presence of changes or undue optimism in their absence.

Brain Damage, Chronic↗
PubMed1992

Neurological outcome following neonatal post-haemorrhagic hydrocephalus: the effects of maximum raised intracranial pressure and ventriculo-peritoneal shunting.

UNLABELLED: The neuromotor outcome of 33 survivors of grade 3 or 4 neonatal post-haemorrhagic hydrocephalus born between 1975 and 1988 was assessed at a mean age of 4.7 years (9 months to 13 years). Two outcomes were determined: 12 patients were either normal (10 or had neurological signs without functional impairments (2), while 21/33 were moderately (16), severely (2), or profoundly impaired (3). Intracranial pressure (ICP) was measured in 26/33 patients (4-40 mm Hg): 2 had normal pressures (< 5.6 mm Hg) and were normal. Raised ICP was not significantly different between outcome groups. Twenty-seven children were shunted; 10/27 had five or more operations (up to 14) and all of these had abnormal neurological outcomes, whereas the number of children with 1-4 shunt procedures was equal in both outcome groups. The rise in morbidity after the fourth shunt procedure may be associated with the ventriculitis suffered by 9 of the 10 patients with more than four shunts (P < 0.01): this compares with 4/14 cases of ventriculitis in the children with 2-4 shunts and no cases of infection in the 3/27 who were shunted once. Outcome was independent of antenatal and perinatal factors including the age at or mode of presentation, and was unrelated to grade of intraventricular haemorrhage or parenchymal changes on ultrasound or CT scanning. CONCLUSION: for these small numbers, adverse outcome is statistically related to more than four shunt procedures and ventriculitis but independent of maximum ICP or other perinatal factors.

Birth Weight↗
PubMed1992

Cerebrovascular resistive index assessed by duplex Doppler sonography and its relationship to intracranial pressure in infantile hydrocephalus.

Duplex Doppler sonography and direct intracranial pressure (ICP) measurement were performed on 18 patients with infantile hydrocephalus. ICP was measured through a frontal reservoir or ventricular tap using a nondisplacement pressure transducer. The Pourcelot Resistive Index, RI = (peak systolic-end diastolic)/peak systolic velocity was obtained from pulsed-wave Doppler measurements of blood flow velocity in the anterior (ACA) and/or the middle cerebral (MCA) arteries. There was a statistically significant positive correlation between ICP and RIs in the MCA and ACA. Paired RI measurements in 7 patients with raised ICP decreased significantly from a mean of 0.90 pre-tap to 0.75 post-tap. Our results suggest that the RI provides a reliable measure of cerebrovascular resistance in hydrocephalus. Duplex Doppler ultrasonography thus is a useful noninvasive means of monitoring cerebrohaemodynamic change with simultaneous imaging of ventricular size in infantile hydrocephalus.

Blood Flow Velocity↗
PubMed1992

Cerebral blood-flow velocity and intermittent intracranial pressure elevation during sleep in hydrocephalic children.

The clinical importance of intermittent intracranial pressure (ICP) elevations during sleep in hydrocephalic children is unclear. Eight studies of continuous ICP monitoring with simultaneous cerebral blood-flow velocity (CBFV) measurements were recorded during sleep in seven hydrocephalic children aged between one and 10 years. ICP was measured directly through a frontal reservoir. There were two main patterns of CBFV change in response to raised ICP: a progressive decrease in mean flow velocity and increase in resistance index, suggesting impaired haemodynamic compensation to ICP elevation due to reduced circulatory reserve in patients with limited intracranial compliance; and an increase in mean flow velocity with raised ICP, suggesting that appropriate haemodynamic compensation with increased blood-flow can occur to maintain adequate cerebral perfusion in those with sufficient circulatory reserve. Simultaneous CBFV and ICP measurements may help to identify those with reduced circulatory reserve who are at greater risk of ischaemic insult from episodic increases in ICP.

Blood Flow Velocity↗
PubMed1991

Cerebral blood flow velocity changes after ventricular taps and ventriculoperitoneal shunting.

Transcranial Doppler ultrasonography (TCD) was performed on 14 patients with hydrocephalus (age range 1 day to 12 years old) before and after ventriculoperitoneal shunting. TCD was also performed with simultaneous intracranial pressure (ICP) measurements during ventricular taps through a reservoir in 7 patients. Measurements of the resistance index (RI) = (S-D)/S, peak systolic (S), enddiastolic (D) and time-averaged mean flow velocities were made. After ventricular taps and ventriculoperitoneal shunting there was a significant decrease in RI in all patients. This was due to a greater increase in D compared to S, which suggests a decreased distal cerebrovascular resistance. There was a significant correlation between RI and ICP in the older infants and children and in individual neonates. Successful cerebrospinal fluid diversion reduces ICP and cerebrovascular resistance, thus improving cerebral perfusion. The RI is a reliable index for serial monitoring of cerebrohaemodynamic change in patients with hydrocephalus.

Blood Flow Velocity↗
PubMed1990

Aqueduct stenosis--presentation and prognosis.

In the 14-year period from 1974-1987 during which CT scanning was available in Edinburgh, 36 patients with benign, non-tumour related aqueduct stenosis were identified from a group of 342 patients with hydrocephalus. In terms of age at presentation, the patients separate into two groups, 9 cases diagnosed during the first year of life and 27 patients aged from 7 to 72 years. The presentation in the early cases was fairly acute, the diagnosis was secure and the operative treatment by ventricular peritoneal shunt was relatively free of complications. In the older patients, the first presentation was more chronic, and further investigation required a change of diagnosis in 5 of the 27 patients. More than half of the patients had recurrent symptoms which were much more acute and operative treatment was attended by a significant number of complications including death from intraventricular haemorrhage in one case.

Adolescent↗
PubMed1989

Pleomorphic xanthoastrocytoma. Report of four cases.

Four cases of pleomorphic xanthoastrocytoma (PXA), a low-grade leptomeningeal glioma with a reported favorable prognosis affecting young patients, are reported together with a discussion and review of management and prognosis. A literature review has confirmed a favorable prognosis in at least 50% of patients with this disorder. Seventeen of 35 reported patients are still alive and often seizure-free for a mean period of 7.4 years (range 2 to 18 years) after diagnosis. Five patients have died within 2 years and four between 9 and 25 years after diagnosis of PXA. In some cases in which death followed shortly after diagnosis, there may have been histological confusion between PXA and a malignant glioma with heavily lipidized tumor cells. Nonetheless, transformation of PXA into a malignant astrocytoma or glioblastoma with eventual death may occur many years after initial diagnosis. From the currently reported cases it does not appear possible on clinicopathological grounds to predict which patients will have a favorable prognosis. Optimal management of PXA seems to be primary surgical resection with later surgery for residual or recurrent tumor. The role of radiotherapy in the management of PXA is at this time uncertain.

Adolescent↗
PubMed1988

Gas gangrene occurring soon after compound depressed skull fracture.

Two cases of Clostridium perfringens infection occurring less than 24 hours after compound depressed skull fracture are reported. The infection was principally intracranial in the first and extracranial in the second; both required surgical debridement and antibiotic treatment. Attention is drawn to the rapidity with which a potentially life-threatening infection can develop in civilian head injury and to the implications for acute management of patients with compound depressed fractures.

Adolescent↗
PubMed1988

Multicentric glioma presenting with hemorrhage.

We report a case of multicentric malignant astrocytoma occurring simultaneously in both cerebrum and cerebellum, presenting with hemorrhage into the cerebellar tumor. Hemorrhage into a cerebellar glioma in an adult is very rare. None of the cases of multicentric glioma described in the literature presented with intratumoral hemorrhage. This combination in our patient has prompted us to report this case and to reaffirm the need to consider the diagnosis of malignant glioma in patients with multiple intracranial tumors.

Adult↗
PubMed1988

De novo saccular aneurysms.

The authors report two patients with aneurysmal subarachnoid hemorrhage in whom carotid arteriography revealed aneurysms that had developed at previously normal locations and from infundibula during the years since initial angiography. Neither of these patients had congenital anomalies of the cerebral circulation and, apart from smoking in excess of 30 cigarettes a day, there were no common clinical features. The role of congenital and environmental factors in the formation of aneurysms and the enlargement of infundibula are reviewed.

Adult↗
PubMed1988

Role of a separate subcutaneous cerebro-spinal fluid reservoir in the management of hydrocephalus.

A retrospective survey has been carried out on 56 children with shunted hydrocephalus either with a primary idiopathic cause or as a result of a low spina bifida complex. In all 56 children, a separate reservoir has been inserted at some stage in the management of their hydrocephalus. There was no mortality. Morbidity was not increased from CSF infection or shunt blockage. There was less chance of the initial shunt blocking and there was a lesser incidence of visual and schooling handicap. Double cortical puncture did not result in an increased incidence of hemiplegia or epilepsy. We conclude that a separate reservoir greatly eases the management of these children and does not cause significant increased morbidity.

Adolescent↗