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Biomedical subjects

D M Kaufman

Publications and source records attributed to D M Kaufman.

15 recordsLinked to original sources
PubMed1992

Migraine visual auras. A medical update for the psychiatrist.

Auras of visual aberrations as well as other neurological disturbances including somatosensory and perceptual symptoms that precede a headache distinguish migraine with aura (classic migraine) from migraine without an aura (common migraine) and other varieties of headache. Visual auras that characterize migraine with aura can be classified and distinguished from other neurologic and psychiatric causes of visual aberrations. Examples of migraine visual auras, which are often described but rarely shown in the medical literature, are presented and their mechanism is discussed.

Hallucinations↗
PubMed1992

The persistent vegetative state: an analysis of clinical correlates and costs.

A review was compiled of 23 patients in the persistent vegetative state; a condition that developed while the patients were in an acute care hospital. Before the onset of the persistent vegetative state, eight patients had had dementia, 11 were functionally dependent, and seven had neurologic disorders that gradually led to the persistent vegetative state. For patients in the persistent vegetative state, three types of mechanical support--respirators, nasogastric or gastrotomy tubes, and intravenous lines--were utilized. All three were necessary in 43% of patients, two types in 52%, and one type in 4%. All patients in the persistent vegetative state required at least one type of mechanical assistance. Their course was complicated in all cases by incontinence, and in the majority, by decubiti, pneumonia, and urinary tract infection. Only one patient improved enough to be able to say a few words. These patients required active medical care and invasive procedures that were costly but futile. The hospital bills obtained for 13 patients averaged $170,000, and the length of stay for all patients averaged 197 days, the equivalent to a total number of bed-days of 12.5 bed-years. The poor outcomes, requirements for mechanical support, and frequency of complications--especially when neurologic impairments were present before the onset of the persistent vegetative state--should be considered when evaluating the cost in hospital bills and bed occupancy.

Adult↗
PubMed1979

Detection of cognitive deficits by a brief mental status examination: the Cognitive Capacity Screening Examination, a reappraisal and a review.

Results of a brief mental status questionnaire, the Cognitive Capacity Screening Examination (CCSE), were compared with the clinical evaluations of 59 patients on a neurology service. In 71% of the cases, the CCSE scores correctly indicated a cognitive deficit (true-positive) or the absence of one (true-negative); false-negative results were observed in 15% and questionable negative results were found in 10%. Abnormal neurologic physical signs were present in 90% of all patients with cognitive deficits. In this population, although positive CCSE scores were reliable, negative scores were often misleading. Mild diffuse intellectual dysfunction (dementia) and some discrete intellectual deficits (aphasia and anosognosia) went undetected. Cognitive deficits associated with major cerebral disease were unappreciated in nine patients. Caution is recommended in interpreting negative CCSE scores. Abbreviated screening devices are only a preliminary approach to mental status evaluation; this test requires further refinement.

Aged↗
PubMed1979

Computed tomography in Herpes simplex encephalitis.

Eight patients with Herpes simplex encephalitis had computed cranial tomography (CT). In every case, areas of decreased attenuation were found in the temporal lobe(s); these areas extended to the insular cortex and often to the frontal or parietal lobes. This change developed between the third and the eleventh day of illness. It was present, sometimes only in retrospect, in patients who were alert as well as patients who were comatose. Compared to the isotopic brain scan, electroencephalogram, and cerebral angiogram, CT demonstrates changes that are indicative of H simplex early enough in the course of the illness to be therapeutically useful.

Adult↗
PubMed1978

Recent cases of intracranial tuberculomas.

While intracranial tuberculomas have become uncommon in industrial nations, 12 patients with signs and symptoms of an intracranial mass lesion were recently found to have tuberculomas. Clinical findings suggestive of tuberculosis were frequently subtle or absent. Five patients did not have extracranial tuberculosis. Two patients had intracranial tuberculomas that became superinfected with bacteria and appeared initially as pyogenic brain abscesses. Intracranial tuberculomas in this country almost always occur in adults and represent reactivation of dormant infection. Medical therapy alone is indicated as the initial therapy except in the presence of intolerably increased intracranial pressure. A chemotherapeutic regimen is suggested.

Adult↗
PubMed1977

Computed tomography (CT) in the diagnosis of intracranial abscesses. Brain abscess, subdural empyema, and epidural empyema.

Nine cases of brain abscess, five of subdural empyema, and one of epidural empyema with associated subdural empyema were identified using computed tomography (CT). Smal and multiple abscesses as well as unilateral, bilateral, and parafalcine empyemas were detected. These lesions were demonstrated rapidly and accurately, even in areas that are demonstrated poorly by other diagnostic techniques. No false-negative studies were found in cases of brain abscess or subdural empyema. However, since the appearance of brain abscesses of CT scans is similar to that of neoplastic and vascular lesions, false-positive reports of brain abscess were encountered.

Brain Abscess↗
PubMed1976

Intracranial surgery for cerebral artery aneurysms. Five years' experience.

During the previous five years, there were 133 cases of intracranial surgery for cerebral artery aneurysms. For patients with aneurysms in the anterior circulation and in good preoperative condition, the surgical morbidity was 28% and the mortality was 19%. A depressed sensorium preoperatively, an age of 50 years or above, and an interval of less than 15 days from rupture to surgery were associated with markedly increased mortality. The results of this series, which do not compare favorably with those from foreign referral centers, are partially the result of disproportionate numbers of patients in those poor-risk groups. The possible advantages of regionalization are, nevertheless, apparent. Further comparative studies should be conducted on an interinstitutional basis.

Age Factors↗
PubMed1976

Focal angiographic abnormalities with subdural empyema.

Thirteen patients with subdural empyema underwent arteriography preoperatively and three were restudied postoperatively. Arterial vascular changes were found in nine cases and consisted of localized or diffuse arterial irregularities. In two cases the arterial changes resolved with effective therapy. These arterial changes are similar in appearance and response to therapy to those noted with meningitis; however, in this series they were shown to have occured in seven cases with subdural empyema but without associated meningitis. Therefore, empyema alone may cause localized or diffuse arterial irregularities.

Adolescent↗
PubMed1976

Central nervous system aspergillosis in two young adults.

Unusual and unique features were present in the cases of two patients with central nervous system aspergillosis: One had a previously unreported complication of aspergillosis, extracranial internal carotid artery thrombosis documented by angiography, and in the other patient, cerebral granulomas developed from Aspergillus fumigatus in association with intravenous narcotic abuse. The latter etiologic mechanism was suggested once before. Neither of these patients showed other underlying disease. A detailed neuropathologic examination correlated the salient clinical findings with formation of aspergillosis cerebral granulomata, basilar meningitis, and arterial occlusion. Diagnostic and therapeutic methods in this disease are limited.

Adult↗
PubMed1975

Subdural empyema: analysis of 17 recent cases and review of the literature.

Subdural empyema is an intracranial infection that has remained difficult to diagnose and to treat. Seventeen patients with this infection, treated between 1967 and 1974, are analyzed and compared to published series with particular regard to diagnosis using newer procedures and treatment, considering the primary focus of infection. The infection is usually located in the supratentorial spaces, is often bilateral, and results most often from para-nasal sinusitis (single most common cause), otitis, neurosurgical operative infections, and meningitis in infants. Patients suffering from subdural empyema generally present with rapid onset of depressed sensorium, seizures, focal neurological deficits, and signs of increased intracranial pressure, following a period of days to weeks characterized by headache and fever. All 17 of our patients demonstrated localizing neurological signs and 16 manifested either fever or leukocytosis. Diagnostic studies, except for cerebral arteriography, do not reliably corroborate or exclude the diagnosis. Cerebral arteriography established the diagnosis and defined the location and extent of the empyema in all of our cases. The EEG and brain scan produced frequent false-negative and/or non-localizing results in 10 and 8 patients, respectively. The cerebrospinal fluid was abnormal from all 15 patients examined by lumbar puncture, but the findings were similar to those in other infectious and non-infectious central nervous system diseases. Signs of transtentorial herniation developed within eight hours following lumbar puncture in three of seven patients who had exhibited signs of increased intracranial pressure before the procedure was performed. Bacterial cultures were positive in 13 of our cases. A review of our data and that of other studies indicates that the organisms associated with subdural empyema are consistent with those expected from infections of the primary site; e.g. sinusitis, otitis, meningitis, site of prior neurosurgery. A therapeutic approach is suggested which emphasizes specific antibiotic regimens appropriate to the primary site of infection and prompt neurosurgical intervention with evacuation of the subdural spaces bilaterally. In general, combination antimicrobial therapy employing high parenteral doses of penicillin G, a semi-synthetic penicillinase-resistant penicillin and chloramphenicol is recommended.

Adolescent↗
PubMedDate not supplied

Cranial nerve palsies in Streptococcus pneumoniae meningitis.

Cranial nerve palsies are uncommon in nontuberculous bacterial meningitis. We report a patient with Streptococcus pneumoniae meningitis, multiple cranial nerve involvement, and cerebellar signs suggestive of basilar meningitis. Nontuberculous bacterial meningitis should be considered in the differential diagnosis of basilar meningitis.

Adolescent↗
PubMedDate not supplied

Cerebellar hemorrhage: reliability of clinical evaluation.

Surgery without confirmatory radiological contrast studies has been advocated in patients suspected of having a cerebellar hemorrhage. To determine the reliabiligy of the clinical evaluation, records were reviewed of 33 patients in whom the diagnosis of cerebellar hemorrhage was initially suspected or subsequently confirmed. In 13 patients the correct diagnosis had been made initially by clinical evaluation, but in ten patients the correct diagnosis was not suspected at the initial evaluation. The remaining ten patients had typical backgrounds, symptoms, and signs of a spontaneous cerebellar hemorrhage, but radiological contrast studies and clinical observation indicated that other neurological lesions were responsible. Thus, utilizing solely the clinical evaluation, the diagnosis of cerebellar hemorrhage may be made only with difficulty and not with the certainty required for emergency surgery.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging in ischemic injury after heart transplantation in rats.

Magnetic resonance imaging with and without gadolinium (Gd)-DTPA has been shown to enable detection of coronary occlusive ischemic injury and heart transplant rejection. This study was performed to examine findings on magnetic resonance images associated with ischemic injury after heart transplantation in rats. Magnetic resonance imaging was performed immediately before death in 22 rats, between 1 and 90 days after isogeneic (Lewis grafts, Lewis host; or Fischer graft, Fischer host) heterotopic heart transplantation. Ischemic injury, characterized histologically by cellular infiltration or myocyte necrosis, correlated inversely with graft duration. It was graded as moderate to severe in 5 of 5 rats killed at 1 to 2 days, and in 0 of 9 animals killed at greater than or equal to 30 days. T2-weighted myocardial signal intensity (TR = 2.3 seconds; TE = 90 milliseconds) correlated inversely with graft duration and was significantly greater in grafts with moderate or severe histologic abnormalities than in grafts with absent or minimal changes. GD-DTPA-induced myocardial enhancement was judged on T1-weighted images (TR = 0.5 seconds, TE = 25 milliseconds). Areas of intense enhancement were present in all seven grafts with severe histologic abnormalities, but in only 3 of 15 grafts with absent to moderate histologic abnormalities. In conclusion, after heart transplantation in rats, ischemic injury causes increased T2-weighted signal intensity and Gd-DTPA-induced T1-weighted signal enhancement--findings similar to those described in transient coronary occlusive ischemia and in graft rejection. Abnormalities seen on magnetic resonance images during the first few posttransplant weeks may represent ischemic injury rather than rejection.

Animals↗