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Biomedical subjects

B E Kendall

Publications and source records attributed to B E Kendall.

At least 91 records · Page 5Linked to original sources
PubMed1992

Neurological and neuropsychological performance in HIV seropositive men without symptoms.

Ninety five HIV seropositive and 32 seronegative homosexual men were recruited to a prospective study of the early features and natural history of the neurological manifestations of HIV infection. There was no evidence from the initial neurological examination, a neuropsychological test battery, nerve conduction studies, somatosensory evoked potentials from the legs, P300 event related auditory evoked potentials, magnetic stimulation of the motor cortex, or MRI scans that HIV infected men without symptoms in CDC groups II/III differed significantly from a well matched seronegative comparison group. Only the subgroup in CDC IV showed evidence of impairment, and this was restricted to their performance on some of the cognitive tests. The results imply that, despite early invasion of the CNS by HIV, major disturbances of function manifest themselves only when the patient becomes immunosuppressed. The importance of an appropriate comparison group and awareness of the potentially confounding influences such as age, education, exposure to alcohol and drugs, and mood and anxiety in such studies is stressed. The essentially negative findings are important in the understanding of the pathogenesis of neurological effect in HIV infection and in the design and interpretation of therapeutic trials.

AIDS Dementia Complex↗
PubMed1992

High dose steroids in acute relapses of multiple sclerosis: MRI evidence for a possible mechanism of therapeutic effect.

The integrity of the blood-brain barrier (BBB) in multiple sclerosis (MS) was monitored by serial gadolinium-(Gd)-DTPA enhanced MRI during and after the treatment of acute relapses with a three day course of high dose intravenous methylprednisolone (IVMP). During treatment there was a rapid reduction of BBB abnormalities in 96% of enhancing lesions. In spite of sustained clinical improvement, many lesions re-enhanced within a few days of stopping IVMP, and new lesions frequently appeared within one month. It is possible that the rapid, albeit transient, reversal of BBB abnormalities contributes to the accelerated recovery from relapses associated with IVMP treatment.

Adult↗
PubMed1992

Does myodil introduced for ventriculography lead to symptomatic lumbar arachnoiditis?

Although there is a substantial body of evidence implicating Myodil or Pantopaque as a cause of lumbar arachnoiditis, assessment of the clinically based evidence is complicated by the additional potentially causative factors present in a high proportion of cases. These include pre-existing spinal pathology, traumatic lumbar puncture and surgery. The aim of this retrospective study was to attempt to ascertain whether Myodil introduced via ventricular catheter was associated with subsequent development of symptomatic lumbar arachnoiditis. In 222 patients in whom clinical records were reviewed there was no excess of back pain following ventriculography compared to the general population. Myodil ventriculography does not appear to be a major cause of symptomatic lumbar arachnoiditis. Several unavoidable problems with the methodology of this study are discussed.

Adolescent↗
PubMed1992

Imaging of pediatric and congenital brain disease.

The etiology of hemiplegic cerebral palsy has been elucidated by surveys of affected children using CT. MR imaging has contributed to the more exact diagnosis of the nature and extent of hypoxic ischemic damage and allows the accurate estimation of the time of the insult. Serial MR imaging and MR spectroscopy may be useful for predicting the prognosis for cerebral palsy and neurodevelopmental delay. The damage caused by intrauterine infection is best appreciated on MR imaging, though CT is important in showing calcification. Similar considerations apply to tuberous sclerosis, and new observations may facilitate MR imaging diagnosis. Gadolinium-enhanced MR imaging is the most accurate modality for detection of tumor recurrence and metastatic spread. Enhancement due to reactions to and complications of surgery can usually be distinguished. The reliability of MR imaging in showing many congenital anomalies provides evidence of the incidence of these lesions and contributes to understanding the disordered embryology. Most of the changes described in inherited metabolic disorders are nonspecific, but they may suggest a particular diagnosis, and MR imaging is the most sensitive modality for monitoring progress. Lifesaving intervention for arteriovenous malformations involving the vein of Galen requires detailed noninvasive imaging for selecting the most effective approach. Technical developments in diffusion and in flow imaging promise to further increase our diagnostic capabilities and to limit the application of invasive techniques.

Brain↗
PubMed1991

Major differences in the dynamics of primary and secondary progressive multiple sclerosis.

In patients with primary and secondary progressive multiple sclerosis (MS), major differences in the pattern and extent of abnormality on cerebral magnetic resonance imaging (MRI) between the two groups have recently been demonstrated. In the present study, 24 patients, matched for age, sex, duration of disease, and disability, had serial gadolinium diethylenetriaminepentaacetic acid-enhanced MRI over a 6-month period. The 12 patients in the secondary progressive group had a total of 109 new lesions over this time (18.2 lesions per patient per year) and 87% of these enhanced. Enhancement also occurred within and at the edge of preexisting lesions. In contrast, only 20 new lesions were seen in the primary progressive group (3.3 lesions per patient per year) and only one of these enhanced. There was no difference in the degree of clinical deterioration between the two groups over the 6-month period. These findings may indicate a difference in the dynamics of disease activity between the two forms of progressive MS, particularly in relation to the inflammatory component of the lesions, and have important implications for the selection of patients and the monitoring of disease activity in therapeutic trials.

Adult↗
PubMed1991

The pathophysiology of acute optic neuritis. An association of gadolinium leakage with clinical and electrophysiological deficits.

Eighteen patients with acute optic neuritis underwent optic nerve magnetic resonance imaging (MRI) before and after injection of gadolinium-diethylene triamine pentacetic acid (Gd-DTPA). Ten were re-examined 4 weeks later. Leakage of Gd-DTPA across the blood-optic nerve barrier was a consistent finding in the acute lesion, and its presence was associated with abnormal visual acuity and colour vision, retro-ocular pain on eye movement, and afferent pupillary defect, and a reduced amplitude of the P100 component of the visual evoked potential. Gd-DTPA leakage had ceased in 9/11 nerves when restudied 4 wks later, and this evolution was associated with improved visual acuity and an increased P100 amplitude. Leakage is likely to reflect inflammation, and we conclude that the latter plays an important part in the production of conduction block and clinical deficit, and that its resolution is an important step in clinical remission from acute episodes of demyelination.

Adolescent↗
PubMed1991

Destructive lesions in demyelinating disease.

Three cases are presented in which clinical and radiological features suggested the diagnosis of glioma but surgical biopsy revealed a demyelinating process, with tissue destruction and cyst formation in two. One patient had clinically definite multiple sclerosis. Two had probable acute disseminated encephalomyelitis. Treatment with high dose steroids is appropriate when there is clinical or investigative evidence to suggest the presence of demyelinating disease, before deciding on biopsy.

Adolescent↗
PubMed1991

Partial, non-thrombotic, superior sagittal sinus occlusion due to occipital skull tumours.

Two cases are described in which raised intracranial pressure occurred as a result of superior sagittal sinus (SSS) occlusion by an occipital skull tumour. One was a plasmacytoma, the other a metastatic deposit from a Ewing's sarcoma. The difficulties in diagnosis of this syndrome are illustrated together with the importance and success of appropriate treatment. From the literature it appears possible that these two tumours may be particularly likely to occlude the SSS and the reasons for this are discussed.

Adult↗
PubMed1991

Damaged ligaments at the craniocervical junction presenting as an extradural tumour: a differential diagnosis in the elderly.

An extradural mass at the craniocervical junction causing progressive neurological disability in five elderly patients is described. The lesion, which might be confused with a meningioma or other tumour, is composed of amorphous degenerate fibrocartilaginous material and could be due to degeneration of the ligaments responsible for atlanto-axial stability. Recognition of the condition early is important as the patient's clinical condition will deteriorate without decompression. Anterior transoral removal is relatively simple, unlike surgery for tumours in the area, and will not destabilise the craniovertebral junction. It is likely that a proportion of these lesions are undetected, misdiagnosed or untreated to the detriment of the patient.

Aged↗
PubMed1991

The odontoid process in Morquio-Brailsford's disease. The effects of occipitocervical fusion.

High definition computed cervical myelograms have been made in flexion and extension in 13 patients with Morquio-Brailsford's disease. We observed that: 1) odontoid dysplasia was present in every case, with a hypoplastic dens and a detached distal portion which was not always ossified; 2) atlanto-axial instability was mild, and anterior atlanto-axial subluxation was absent in most cases; 3) severe spinal cord compression, when present, was due to anterior extradural soft-tissue thickening; 4) this compression was not relieved by flexing or extending the neck and was manifested early in life; 5) posterior occipitocervical fusion resulted in disappearance of the soft-tissue thickening and normalisation of subsequent development of the dens. We conclude that the severity of neurological involvement at the craniovertebral junction was determined by soft-tissue changes, not by the type of odontoid dysplasia nor by subluxation. Posterior occipitocervical fusion proved to be an effective treatment.

Adult↗
PubMed1991

Type III collagen mutations cause fragile cerebral arteries.

Premature vascular aneurysms and fragility of cerebral arteries are commonly associated with type III collagen mutations and physical signs suggesting a generalized abnormality of connective tissue. Sometimes these traits are clearly genetically transmitted. Here we present seven examples of early cerebrovascular aneurysms or fragility including five examples of carotid cavernous sinus aneurysms. With one exception in which we suspect the mutation is too small to be detected, all of them had easily visible abnormalities of their type III collagen proteins. Further work in progress will eventually allow the characterization of their mutations at gene sequence level and will be followed by the ability to prevent transmission of the mutant genes in these families.

Adult↗