Biomedical subjects

Avinoam Shuper

Publications and source records attributed to Avinoam Shuper.

10 recordsLinked to original sources

PubMed2006

Puberty as a risk factor for less favorable visual outcome in idiopathic intracranial hypertension.

PURPOSE: To test the hypothesis that puberty is a risk factor for poorer visual outcome in idiopathic intracranial hypertension (IIH). DESIGN: Retrospective chart review case series. METHODS SETTING: Tertiary referral center, neuro-ophthalmology unit. PATIENT POPULATION: Ninety-six patients with IIH followed for a minimum of one year. OBSERVATION: Age (grouped into prepubertal, pubertal, teenage, or adult), obesity, initial intracranial pressure (ICP), measurements and presence of hypertension, anemia, or renal failure were correlated with final visual outcome using chi(2), stepwise logistic regression, and model-selection log linear analyses. MAIN OUTCOME MEASURES: Visual outcome was graded into "excellent" -- no evidence of an optic neuropathy or any permanent visual field defect in either eye, "moderate"-- evidence of an optic neuropathy and/or a mild (nasal constriction) visual field defect, or "poor outcome" (peripheral constriction) -- permanent visual field defect. RESULTS: Outcome data were complete for 96 patients. Moderate to poor visual outcome, as opposed to excellent, was significantly associated with puberty (P = .007 using the gender-specific definition of puberty, .0002 using the broad definition). Moderate-poor visual outcome occurred in none of seven IIH patients of prepubertal age (<9 years), in 15 of 26 patients presenting between nine to 16 years, in two of six patients aged 17 to 22 years, and in seven of 57 adult patients over the age of 23 years. CONCLUSIONS: In this series of 96 patients with IIH, visual outcome was less favorable in pubertal patients than in prepubertal, teenage, and adult patients. We recommend that clinicians maintain a high index of awareness when caring for pubescent children with IIH.

Acetazolamide↗

PubMed2006

Idiopathic granulomatous encephalitis mimicking malignant brain tumor.

Idiopathic granulomatous encephalitis is a rare disorder of unknown etiology, undetermined treatment, and often grave prognosis. This article describes a 4-year-old female who presented with a single focal febrile convulsion followed a few weeks later by right-sided hemiparesis. A huge infiltrative cerebral mass tumor was found which proved to be a granuloma on histologic study. Despite a thorough evaluation, including tissue studies and search for an infectious agent, no etiology could be identified, and the final diagnosis was idiopathic granulomatous encephalitis. Recurrent resections and high-dose steroid treatment failed to control the process, and the patient died of disease 6 months after presentation. Evaluation and treatment of idiopathic granulomatous encephalitis should be aggressive, and the possibility of chemotherapy and perhaps even radiotherapy should be considered if there is no response to steroids.

Anti-Bacterial Agents↗

PubMed2005

Role of MRI in the management of children with diffuse pontine tumors: a study of 15 patients and review of the literature.

BACKGROUND: Pontine tumors carry the worst prognosis of all brain tumors. In most cases, the diagnosis is based solely on MR imaging, without biopsy. OBJECTIVE: To describe the MR findings of pontine tumors at diagnosis and during follow-up and correlate those with prognosis and to assess the value of MR imaging in patient management compared to clinical evaluation. MATERIALS AND METHODS: Ninety-one MR scans of 15 children with diffuse pontine tumors were reviewed at diagnosis and during follow-up. The parameters analyzed were as follows: tumor extent, area, and volume; encasement of the basilar artery; presence of exophytic component; necrosis; cysts; hydrocephalus; and intensity and enhancement. Findings were correlated to length of progression-free and overall survival. Trends of amelioration or worsening on imaging were compared with the clinical findings. RESULTS: Median length of progression-free survival was 10 months, and median survival was 20 months. Only hydrocephalus at presentation was associated with shorter progression-free survival (P=0.02). On the last examination of each patient, the craniocaudal diameter was significantly greater than at diagnosis (P=0.03). The concordance between the imaging and the clinical findings was good. CONCLUSION: MR is the mainstay for the diagnosis and management of pontine tumors. Cranial growth seems to be an ominous sign. However, the prognostic value of MR is limited. MR findings correlate well with the clinical examination.

Adolescent↗

PubMed2005

Task switching after cerebellar damage.

The authors of this study investigated task switching following cerebellar damage. The study group consisted of 7 children and adolescents (M age=13.8 years) who underwent surgical removal of a benign posterior fossa tumor. They were tested at a sufficient interval after surgery (M lag=6.13 years) for restoration of normal cognitive skills and intelligence. Although all showed normal learning of the task compared with control participants, when rapid behavioral changes were required (short preparation time), they exhibited behavioral rigidity manifested by enhanced switching cost. These results are in line with another study on serial reaction time with the same patients (A. Berger et al., in press). They have important implications for our understanding of the cognitive sequelae of early cerebellar damage as well as the involvement of the cerebellum in task switching.

Adolescent↗

PubMed2005

CSF pressure measurement during anesthesia: an unreliable technique.

BACKGROUND: The measurement of cerebrospinal fluid (CSF) pressure is necessary for many clinical indications. Its accuracy may be compromised in frightened or uncooperative children who find it difficult to relax sufficiently. The aim of the present study was to evaluate possible effects of general anesthesia on CSF pressure values. METHODS: Lumbar puncture was performed under general anesthesia in 15 patients aged 4.5-20 years for the evaluation of headaches associated with a swollen optic nerve. Cerebrospinal fluid pressure was measured with a manometer when the patient was fully anesthetized (opening pressure) and then continuously recorded until the patient regained consciousness. The opening pressure was compared with the lowest pressure measured at the termination of the procedure (end-measurement pressure). RESULTS: Seventeen pressure measurements were performed in 15 patients. In all but two measurements, differences were noted between the opening and end pressure, ranging from 5 to 13 cmH(2)O. The opening pressure was abnormally high in 16 measurements, and the end pressure was abnormally high in seven. The difference between the two measurements was highly significant (P < 0.001). CONCLUSIONS: Lumbar puncture performed under general anesthesia may yield two pressure measurements. Many factors, such as hypercarbia and the anesthetic agent used, may influence the results. Owing to the dynamic changes in CSF pressure, measurements made under anesthesia may be unreliable.

Adolescent↗

PubMed2004

Swedish interactive thresholding algorithm fast for following visual fields in prepubertal idiopathic intracranial hypertension.

OBJECTIVE: To examine the reliability of Swedish Interactive Thresholding Algorithm Fast (SITA Fast) visual fields (VFs) in prepubertal idiopathic intracranial hypertension (IIH) and to compare whether age, gender, or severity of visual outcome influenced the reliability of VF tests. DESIGN: Prospective, longitudinal cohort study. PARTICIPANTS: Twenty-six prepubertal children (<11 years of age; mean age, 7.2 years) with IIH. TESTING: Children were prospectively followed up using a child-oriented program, which included SITA Fast VF tests. Age, gender, and severity of visual outcome were correlated with reliability of performance on SITA Fast VFs using a 1-way analysis of variance, point-biserial correlation, and the chi-square test for independence of observation. MAIN OUTCOME MEASURES: Statistical analyses results that correlated the reliability of SITA Fast VFs with age, gender, and visual outcome. RESULTS: Three children were treated at the age of 2 years and were unable to perform automated VF tests. Four children were treated at the age of 4 years, 3 of whom were able to perform repeatable reliable SITA Fast VF tests. Forty-two eyes of 21 children had an average SITA Fast test time of 4.5 minutes for each eye, compared with 8 minutes using the Fastpac strategy. Age was not associated with reliability scores of SITA Fast tests (F = 0.971, not significant [ns]). Gender did not influence the reliability of SITA Fast VF tests (chi-square((1)) = 0.669, ns), nor did severity of visual outcome (chi-square((2)) = 3.348, ns). Visual deficits were observed in 55% of patients at presentation and in 27% of patients after resolution of papilledema. CONCLUSIONS: The SITA Fast VF tests can be performed from age 4 years and offer a reliable method for shortening test time. A child-oriented follow-up program, which entails a shortened testing time, may improve outcome in prepubertal IIH.

Algorithms↗

PubMed2004

Ictus emeticus (ictal vomiting).

Vomiting is rarely the main ictal manifestation of epilepsy, and it is likely associated with more than one type of epilepsy. Its possible mechanism involves the spread of abnormal electrical activity through descending insular or limbic circuits. This report describes a child with difficult-to-control ictal vomiting arising from a left temporal epileptic focus. Ictus emeticus is a specific epileptic presentation which can have a chronic, intractable nature requiring repetitive therapeutic trials with antiepileptic medications. In the patient described here, the disease posed a diagnostic dilemma in its early stages. The ictal electroencephalogram is crucial for the diagnosis.

Child↗

PubMed2003

Short-term subarachnoid space drainage: a potential treatment for extraventricular hydrocephalus.

INTRODUCTION: Extraventricular hydrocephalus (EVOH), defined as the enlargement of all CSF compartments in the absence of an obstructing lesion, is usually associated with an increased head circumference and a relatively benign clinical course. Occasionally, because of concern about increased intracranial pressure (ICP), treatment with diuretics is initiated. In most cases, surgical drainage or diversion is not indicated. EVOH may follow a more alarming clinical course and be associated with developmental delay and/or other symptoms of increased ICP. CASE REPORT: We describe a 6-month-old girl with EVOH and developmental delay who was treated with temporary drainage of the subarachnoid space. Clinical response was immediate, with stabilization of the head circumference and improvement in motor performance. We propose that such a surgical procedure might be considered for more frequent use in selected cases.

Algorithms↗

PubMed2003

Epilepsy associated with pediatric brain tumors: the neuro-oncologic perspective.

The aim of the study was to correlate the onset of epilepsy with the disease stage in children with brain tumors through treatment and follow-up in the oncologic department. The study sample consisted of a heterogenous group of 219 children who were aged 6 months to 11 years, manifested brain tumors, and had been treated and monitored in the Department of Pediatric Oncology of the Schneider Children's Medical Center of Israel since 1991. The overall rate of epilepsy was 14.6%, which rose to 38% in those with cortical tumors. Two major causes of epilepsy were evident: tumor-related and treatment-related. The first group could be further divided into epilepsy starting at or before diagnosis of brain tumor, epilepsy associated with tumor progression, and epilepsy starting at end-stage disease. The second group could be divided into epilepsy caused by radiation damage to the brain and epilepsy related to another postoperative state. The data emphasize the significance of striving for complete tumor resection and the potential damage from the use of radiotherapy to the brain. The authors suggest that a change in local neurotransmitter balance may be the mechanism underlying tumor-related epilepsy.

Adolescent↗

PubMed2002

Methotrexate-related neurotoxicity in the treatment of childhood acute lymphoblastic leukemia.

The addition of methotrexate to treatment protocols in children with acute lymphoblastic leukemia has been found beneficial in preventing central nervous system relapse. However, MTX itself may be associated with neurologic morbidities, the most significant of which is leukoencephalopathy. The present study describes the clinical spectrum of leukoencephalopathy, which ranges from a subclinical disease manifested only radiologically to a progressive, devastating encephalopathy. The interaction of MTX with other components of the treatment protocol is discussed, as is the effect of leucovorin. A summary is presented of the metabolic pathways that may be involved in the development of MTX toxicity. Researchers are still seeking a biochemical marker to aid in the determination of the amount of MTX that may be safely administered.

Antimetabolites, Antineoplastic↗