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D Sobel

Publications and source records attributed to D Sobel.

28 records · Page 2Linked to original sources

Cerebrospinal fluid rhinorrhea: evaluation with metrizamide cisternography.

Metrizamide computed tomographic cisternography was used to examine 27 patients (19 males and eight females, 14-59 years old) clinically suspected of having cerebrospinal fluid fistulae with rhinorrhea. Twenty-one fistulae were traumatic and six were spontaneous. Five to 6 ml of metrizamide (or lopamidol, two cases) were injected by lumbar puncture at a concentration of 185-200 mg I/ml for direct coronal and axial computed tomographic sections of the skull base. Cerebrospinal fluid rhinorrhea was present at the time of examination in 12 of 27 cases. Results were evaluated according to three criteria: (1) metrizamide passage through the bony and dural defect; (2) demonstrable site of the fracture and/or bony defect; and (3) metrizamide visualized within a paranasal sinus, nasal cavity, or cotton pledget. The examination was considered positive when criterion 1 alone was present and when 2 and 3 were associated. In 15 of 27 cases, cisternography was positive, with the exact site of cerebrospinal fluid leakage demonstrated in 10 patients. In six cases, the results were not definitive; only one of the criteria (2 or 3) was fulfilled. In six cases, cisternography was normal. Seventeen patients underwent surgery. The site of cerebrospinal fistulae was ethmoidal in nine cases, frontoethmoidal in seven, sphenoidal in two, and sphenoethmoidal in one. The relative value of metrizamide computed tomographic cisternography compared with other diagnostic studies, polytomography, positive or negative contrast studies, and radionuclides, is discussed. Diagnostic pitfalls include artifacts and partial volume effect.

Adolescent↗

Relative value of computed tomography and hypocycloidal tomography in the diagnosis of pituitary microadenoma. A radio-surgical correlative study.

The relative value of a second generation CT scanner and complex motion polytomography are compared in 36 patients undergoing transsphenoidal surgery due to clinical and biological evidence of pituitary hypersecretion. CT findings of focal glandular hypodensity in 17 patients and upward convexity of the sellar contents in 15 patients suggested the presence of a pituitary microadenoma. Complex motion tomographic findings suggesting a microadenoma were found in 21 of 32 cases and included bulging of the sellar floor or localized thinning of the lamina dura. Selective transsphenoidal adenomectomy was performed on 34 of the 36 patients and the preoperative location based on CT scanning data was positively correlated with surgical results in 75% of the cases. When there is a strong clinical suspicion of pituitary hypersecretion both CT and polytomography may suggest the existence and location of a microadenoma. CT should be the radiographic technique of choice since it produces accurate information as to the size and density of the pituitary gland.

Adenoma↗

Radiography of trigeminal neuralgia and hemifacial spasm.

Radiographic findings in 68 patients with trigeminal neuralgia and 24 patients with hemifacial spasm are reviewed. The relative value of various radiographic diagnostic procedures is discussed. Trigeminal neuralgia and hemifacial spasm are usually caused by vascular compression of the trigeminal root entry zone and facial nerve exit zone respectively. Computed tomography (CT) of the posterior fossa is the only radiographic screening procedure required. Angiography should be reserved for patients in whom CT findings suggest an aneurysm or tumor.

Adult↗

Love and pain.

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Humans↗

Tolerability and efficacy of Hexabrix in cerebral angiography.

In a double-blind study of 62 patients, Hexabrix was compared with Conray 60% in cerebral angiography. Both agents were injected into the same patient, the patient serving as his own control, and volumes injected into a single vessel were identical. Considerably less pain was experienced with Hexabrix. Changes in pulse, respiration and blood pressure were not significantly different. The two contrast media provided images of comparable quality.

Adult↗

CT identification of cortical speech areas in the human brain.

In four human left cerebral hemispheres the cortical speech areas were identified, having been marked by differential color code before transverse sectioning. The results from the anatomic dissection specimens were compared with thin CT sections in normal individuals, the CT plane being aligned to the orbitomeatal plane as an external reference, and thus closely parallel to the bicommissural plane, as an internal reference. The same cortical structures were identified in the CT sections. A strategic approach to CT examination of the cortical speech areas is formulated, based on the external-internal system of reference.

Cerebral Cortex↗

CNS manifestations of hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) is a familial angiodysplastic disorder. Dermal, mucosal, and visceral vascular lesions of this disorder are well known. However, central nervous system (CNS) manifestations, occurring in as many as one-third of patients, have not been well appreciated until recently. The etiology of neurologic symptomatology includes hypoxemia or ischemia secondary to pulmonary arteriovenous shunting, vascular lesions of the brain and spinal cord ranging from aneurysms to arteriovenous malformations, brain abscesses secondary to pulmonary arteriovenous fistulas, and portal systemic encephalopathy. Angiographic and computed tomographic findings in four patients with CNS involvement in HHT are reported.

Adult↗

Cisternal enhancement after subarachnoid hemorrhage.

Abnormal computed tomographic enhancement in the basal cisterns and cortical sulci was observed in 21 of 42 patients after subarachnoid hemorrhage. The appearance is similar to that described in granulomatous infection and metastatic disease. The enhancement was associated with an increased incidence of hydrocephalus, but it did not correlate with clinical grade, arterial spasm, location of bleed, or temporal relation to bleed. Presumably, abnormal cisternal enhancement is due initially to increased vascular permeability and later to increased vascularity associated with arachnoiditis.

Adolescent↗