PubMed Health⌕ Search

Biomedical subjects

B J Stern

Publications and source records attributed to B J Stern.

At least 37 records · Page 2Linked to original sources
PubMed1993

Intramedullary spinal sarcoidosis: clinical and magnetic resonance imaging characteristics.

We present a retrospective series of the clinical and MRI findings in 16 patients with intramedullary spinal sarcoidosis (ISS), including 12 patients studied with gadolinium-DTPA. The spectrum of MRI findings includes leptomeningeal enhancement, fusiform spinal cord enlargement, focal or diffuse intramedullary disease, and spinal cord atrophy. We present a classification of ISS correlating the clinical progression and the temporal sequence of MRI abnormalities. Improvement occurred in five of 12 patients (42%) treated with immunosuppressive therapy.

Adult↗
PubMed1993

Black-white differences in stroke risk among young adults.

BACKGROUND AND PURPOSE: Little information is available regarding black-white differences in stroke incidence in young adults. METHODS: Cerebral infarction and intracerebral hemorrhage rates among adults 15 to 44 years of age were studied in Baltimore City and Baltimore County for 1988. Diagnoses were based on neurologist review of data obtained from medical records at 41 hospitals by neurological nurses. RESULTS: The cerebral infarction rates per 100,000 were 22.8 for black males, 10.3 for white males, 20.7 for black females, and 10.8 for white females. The intracerebral hemorrhage rates per 100,000 were 14.2 for black males, 4.6 for white males, 4.8 for black females, and 1.5 for white females. CONCLUSIONS: Blacks had significantly (P < .05) higher rates than whites for both cerebral infarction and intracerebral hemorrhage. Cerebral infarction rates are high in Baltimore compared with Florence, Italy, or Stockholm, Sweden.

Adolescent↗
PubMed1992

The treatment of neurosarcoidosis with cyclosporine.

Six patients with refractory neurosarcoidosis were enrolled in a 12-month open-label trial to investigate the safety and efficacy of cyclosporine therapy. Patients were stabilized on a corticosteroid dose, randomized to a low-dose or high-dose cyclosporine group (with appropriate target whole blood cyclosporine levels) for 6 months, and assessed by prospectively defined studies. The corticosteroid dose was adjusted as clinically tolerated. We found that the corticosteroid dose could be lowered to 30% to 58% of the initial stabilization dose in conjunction with cyclosporine therapy, at the time of maximal clinical and laboratory improvement. However, four patients deteriorated while using corticosteroids and cyclosporine; one of these patients died. At the time of clinical deterioration, the prednisone dose ranged from 6 to 22.5 mg daily (or the equivalent). No serious toxic effects developed from cyclosporine therapy. Cyclosporine treatment is a reasonably safe and effective adjunct to corticosteroid therapy for patients with refractory neurosarcoidosis, although clinical deterioration can occur despite combination therapy.

Adult↗
PubMed1991

Germ cell tumors masquerading as central nervous system sarcoidosis.

The diagnosis of central nervous system sarcoidosis is uncertain without typical multisystem involvement. We describe two patients with isolated central nervous system mass lesions whose biopsy results were consistent with sarcoidosis. After a progressive clinical course, they were found to have diencephalic germinomas. Germ cell tumors, in particular, should be considered in the differential diagnosis of central nervous system sarcoidosis as they are potentially treatable, occur in intracranial locations favored by sarcoidosis mass lesions, and may be surrounded by granulomatous inflammation that can be mistaken for the noncaseating granulomas of sarcoidosis.

Adolescent↗
PubMed1991

Clinical implications of seizures in neurosarcoidosis.

Seizures are a recognized manifestation of neurosarcoidosis, but their clinical relevance is not well established. We reviewed the characteristics, clinical correlations, and prognosis of seizures in 79 patients with neurosarcoidosis. Thirteen (15%) of the 79 patients had seizures, and in eight patients (10%) a seizure was the first manifestation of neurosarcoidosis. These seizures were generalized tonic-clonic seizures in 12 patients (92%) and partial seizures in four patients (31%). The patients with neurosarcoidosis with seizures were more likely to have a progressive or relapsing clinical course and intracranial mass lesions (four patients [31%]), encephalopathy or vasculopathy (eight patients [62%]), or hydrocephalus (five patients [38%]). These central nervous system disorders, rather than the seizures per se, were responsible for most of the serious morbidity and the two deaths (15%) among our patients with seizures. Indeed seizure control was good in 11 (85%) of 13 patients treated with combinations of steroids and antiepileptic medications. Seizures are an important sign in neurosarcoidosis because they are associated with more severe and progressive or relapsing forms of central nervous system sarcoidosis and may be an early manifestation of such disorders.

Adolescent↗
PubMed1991

Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma.

Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries ("post-traumatic migraine"-PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a "whiplash" neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range 1 to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. Physicians must be aware of PTM, as it is both common and treatable.

Adolescent↗
PubMed1991

Stroke in the young. (Part I).

We have discussed some of the more common etiologic categories found in young patients with stroke. Though many of the causes are rare, in the aggregate they account for many of the conditions leading to stroke. In Part II of this series (July 1991), we will explore some of the less common causes of stroke in the young and outline an approach to the patient.

Adolescent↗
PubMed1991

Stroke in the young. Part II.

Evaluation of the young stroke patient often requires an interdisciplinary approach because of the complexity of the problems encountered. We discuss some of the less common causes of stroke and present an approach to the patient.

Adolescent↗
PubMed1990

Sarcoidosis of the CNS: comparison of unenhanced and enhanced MR images.

Sarcoidosis involving the CNS has a predilection for the leptomeninges, although parenchymal involvement occurs. We retrospectively evaluated the appearance of CNS sarcoidosis on unenhanced and enhanced MR images. MR studies were abnormal in 17 of 20 patients with CNS sarcoidosis. In all 17 patients, meningeal disease was detected on the gadopentetate-dimeglumine-enhanced T1-weighted images; the disease was detected on unenhanced images in three patients. Well-defined leptomeningeal patterns of enhancement were present in 15 patients. Other areas of involvement were the dura; brain parenchyma including hypothalamus, periventricular white matter, and ventricular ependyma; optic chiasm; and pituitary gland. Gadopentetate dimeglumine optimally evaluates meningeal disease and highlights the importance of the leptomeninges and Virchow-Robin spaces in the pathogenesis of CNS sarcoidosis. Enhanced MR is the preferred imaging technique for the evaluation of CNS sarcoidosis.

Adult↗
PubMed1988

Plasma atrial natriuretic factor and subarachnoid hemorrhage.

Hyponatremia is common following aneurysmal subarachnoid hemorrhage and has been linked to the syndrome of inappropriate secretion of antidiuretic hormone. However, the demonstration of volume depletion and natriuresis in some patients has suggested that salt wasting is a more likely etiology. Atrial natriuretic factor appears to play a role in both central and peripheral regulation of sodium homeostasis. To investigate the behavior of circulating atrial natriuretic factor following subarachnoid hemorrhage, we studied 25 patients with intracranial aneurysms: 21 after acute subarachnoid hemorrhage and four without evidence of recent rupture. Atrial natriuretic factor was measured by radioimmunoassay of extracted plasma (normal value, 20.8 +/- 24.6, mean +/- 3 SD). Mean +/- SEM plasma atrial natriuretic factor concentration was elevated to 84 +/- 25 pg/ml on Day 1, rose to 134 +/- 29 pg/ml on Day 3, and fell to 86 +/- 17 pg/ml by Day 7 after subarachnoid hemorrhage (p less than 0.01). In two patients (9.5%) who developed hyponatremia after aneurysm rupture, plasma concentrations were no different from that in the group as a whole; concentrations in patients with no evidence of recent subarachnoid hemorrhage were not elevated. Neither fluid administration nor timing of surgery could account for the elevated concentrations. We conclude that concentrations of circulating atrial natriuretic factor are elevated after subarachnoid hemorrhage but do not solely account for the accompanying hyponatremia.

Atrial Natriuretic Factor↗
PubMed1988

Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus.

We studied the effect of seizures and myoclonus following cardiopulmonary resuscitation (CPR) on the outcome of all comatose adult survivors of CPR over an 8-year period. Either seizures or myoclonus occurred in 50 of 114 patients (44%): seizures in 41 patients (36%) and myoclonus in 40 (35%). Status epilepticus or status myoclonus occurred in 36 patients (32%), and 19 (17%) had myoclonic status epilepticus (MSE). Seizures and myoclonus per se were not significantly related to outcome, but status epilepticus, status myoclonus, and, particularly, MSE were predictive of poor outcome as judged by survival and recovery of consciousness.

Adult↗
PubMed1987

Outpatient care of the stroke patient.

With fewer patients being admitted to the hospital and more therapeutic options becoming available for stroke care, an increasing number of management decisions will need to be made on outpatients. The challenge of outpatient stroke care is caring for the total patient. The neurologist should view stroke as a dynamic process, often the result of several risk factors and the cause of other problems. The hectic pace of office practice can make full assessment of the patient difficult and state-of-the-art management a formidable goal.

Ambulatory Care↗
PubMed1987

Neurosarcoidosis: the long-term clinical course.

We reviewed 25 patients with neurosarcoidosis followed for at least 5 years or until death. Seventeen patients (68%) had a monophasic illness. Eight (32%) had a relapsing course, with recurrences similar to the original manifestations months later. Patients with cerebral manifestations or hydrocephalus were most likely to relapse. Seven of eight patients with relapsing disease had exacerbations while taking 10 mg prednisone or less.

Cranial Nerve Diseases↗
PubMed1987

Neurosarcoidosis: cerebrospinal fluid lymphocyte subpopulations.

CSF lymphocyte subpopulations of eight patients with neurosarcoidosis were examined. CSF or CT was abnormal in all. The CSF T4/T8 (helper/suppressor) ratio was elevated at 6.8 and 7.6 in two patients; in one, there were only CSF T4 cells. The ratio was normal in five patients.

Adult↗
PubMed1987

MR and CT evaluation of intracranial sarcoidosis.

Fourteen patients with CNS manifestations of neurosarcoidosis were evaluated by MR imaging and CT. Evaluations were done on a 0.5-T superconductive magnet with T1- and T2-weighted sequences. CT with contrast was obtained in all patients. The granulomatous lesions were classified by location into basilar, convexity, intrahemispheric, and periventricular white-matter involvement. Hydrocephalus with or without an associated lesion was also noted. MR determined the presence of disease in all patients (100%), but was less accurate than CT in depicting disease in two patients (14%). CT determined the presence of disease in 12 patients (85%) and was less accurate than MR in delineating hypothalamic involvement in two patients and periventricular white-matter disease in three patients. There was great variability in the appearance of intracranial sarcoidosis on MR. Three patients had lesions that were isointense or hypointense (relative to cerebral cortex) on both T1- and T2-weighted images while nine patients had lesions that were hyperintense on T2-weighted images. Convexity involvement and hydrocephalus were well documented by both CT and MR. These results indicate that both MR and CT are helpful in fully evaluating a patient with suspected intracranial sarcoidosis.

Adult↗