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D Tampieri

Publications and source records attributed to D Tampieri.

At least 37 records · Page 2Linked to original sources
PubMed1995

Curvilinear reconstruction of 3D magnetic resonance imaging in patients with partial epilepsy: a pilot study.

In an attempt to better delineate the abnormalities associated with focal cortical dysgenesis, we performed curvilinear reformatting of the cortex from 3D magnetic resonance (MR) images. Illustrative patients with partial seizures and conventional orthogonal MRI evaluation show that small regions of cortical thickening suggestive of focal dysplastic lesions may not be recognized. In three such patients the curvilinear reformatting demonstrated two additional focal abnormalities of the cortical gyri and better defined the two focal lesions found on conventional orthogonal MR images. This method promises to be a useful tool in the evaluation of epileptic patients with proven or suspected subtle structure cortical abnormalities, particularly focal neuronal migration disorders where cortical thickening, abnormal gyral pattern, and poor delineation of the gray-white matter transition are the main findings.

Brain Damage, Chronic↗
PubMed1995

Periventricular and subcortical nodular heterotopia. A study of 33 patients.

Grey matter heterotopias, demonstrated by MRI, may present with a broad spectrum of clinical severity. We have studied 33 patients with periventricular nodular heterotopias (PNH); 19 (58%) had unilateral and 14 (42%) bilateral lesions. Thirteen of the 19 patients (68%) with unilateral subependymal nodules of grey matter had, in addition, unilateral focal subcortical heterotopias (SNH), comprising 39% of the entire group. Most had normal intellectual and motor function but some presented with mild mental retardation and neurological deficits. Recurrent seizures were described in 82%, mainly partial attacks with temporo-parieto-occipital auras. Nodular heterotopias led to unilateral or bilateral independent temporal epileptic discharges in 47% of epileptic patients with PNH alone and in 61% of those who had SNH in addition. Extratemporal or multilobar, unilateral or bilateral interictal spiking was present in 10 other patients (36%). Two first degree relatives of patients with seizures were affected but had no seizures, three were investigated for other apparently unrelated neurological symptoms: memory impairment, vertigo or transient ischaemic attacks in one person each. Contiguous ovoid nodules of grey matter, symmetrically lining both lateral ventricles, were described in nine patients. Seven of them were female, including four with familial incidence of PNH. Such lesions may explain the familial occurrence of epilepsy in some families. Seven patients underwent anterior temporal resection: two patients with unilateral subependymal and focal subcortical heterotopias were seizure free or significantly improved. Four patients, three with PNH alone and one with additional subcortical nodules, did not improve significantly after surgery. The remaining patient was followed for less than 6 months.

Adolescent↗
PubMed1995

Functional PET scanning in the preoperative assessment of cerebral arteriovenous malformations.

We have evaluated positron emission tomography (PET) scanning during sensory stimulation or during the performance of auditory, visually based or expressive language tasks (activation PET scanning) to determine its reliability in establishing the relationships of cerebral arteriovenous malformations (AVMs) to the ambient cortex in 10 patients. Five patients with a central AVM underwent activation PET scanning combined with three-dimensional MRI during vibrotactile stimulation of the contralateral hand, and 5 patients with AVMs in or around speech areas were similarly scanned during a language task. Vibrotactile stimulation identified the post-central gyrus, establishing the relationship of the AVM to the central region. The results of language activation were specific to the modality (visual, auditory, articulate) on which the task was based. Sensory PET activation scanning is reliable in identifying the pre- and post-central gyri and useful in assessing AVMs in and around the central region. A greater understanding of results in normal controls for specific visual, auditory, and expressive language tasks is necessary before language activation PET scanning can be confidently applied to clinical cases.

Brain↗
PubMed1995

Three-dimensional computed tomographic angiography of cerebral aneurysms.

We describe our technique and results of dynamic, reconstructed, three-dimensional (3-D) computed tomographic (CT) angiography in our first 18 patients with either complex aneurysms, producing subarachnoid hemorrhage or the compression of neighboring structures, or small asymptomatic aneurysms, and assess the role of this technique in treatment planning. A dynamic, infused CT scan producing 1.5-mm cuts of the area of interest was performed, and the two-dimensional images were reconstructed in three dimensions with the ISG Allegro system (ISG Technologies, Toronto, Ontario, Canada). Results were compared with intra-arterial digital subtraction angiography and magnetic resonance angiography. All aneurysms over 3 mm and half of the aneurysms less than or equal to 3 mm were demonstrated by 3-D CT angiography. The neck of the aneurysm, its relationship to the parent artery and associated branches, and its relationship to surrounding bony structures, such as the anterior clinoid, were also demonstrated. This was especially useful for ophthalmic aneurysms. The 3-D image could be rotated on the screen to mimic the operative approach. The active, filling portion and the thrombosed part of partially thrombosed, giant aneurysms could be seen on the same image, and the active, filling portion could be better appreciated with 3-D CT angiography than with magnetic resonance angiography. A partially treated, acrylic-coated aneurysm that could not be completely assessed otherwise has been demonstrated by this technique. 3-D CT angiography is useful in the evaluation of aneurysms, especially when the local anatomy is obscured or distorted by its mass or by the anterior clinoid.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Familial cerebral aneurysms: a study of 13 families.

Despite the recent interest in familial cerebral aneurysms, the epidemiology, natural history, pattern of inheritance, screening of asymptomatic relatives, and the search for a biochemical marker remain problematic. To assess these issues, we report the results of our prospective study of 30 patients with 38 aneurysms (27 ruptured) and of the angiographic screening of asymptomatic relatives, all from 13 families seen consecutively since 1986. Women were over-represented (77%), and patients with multiple aneurysms (17%) were under-represented, compared with sporadic cases. Only 16% of the aneurysms were at the anterior communicating artery. Aneurysms occurred at the same or at the mirror site in 10 of 16 siblings (62%) and in 50% of mother-daughter pairs versus 20% for randomly selected, sporadic aneurysm patients. Rupture occurred in the same decade in 10 of 12 siblings (83%) versus the expected 21% for randomly selected, sporadic aneurysms. The average age at rupture was 47.2 years, and 60% of patients with a ruptured aneurysm were 50 years of age or younger. Seventy percent of patients died or were disabled from aneurysmal rupture. Screening of 41 individuals, including 2 dizygous twins, identified 1 aneurysm and 2 infundibula. A specific pattern of inheritance could not be ascertained from the pedigrees. The presence of an aneurysm was not associated with a specific human leukocyte antigen haplotype or antigen, and collagen Type III was qualitatively and quantitatively normal. Until a biological marker is identified, angiographic screening by intra-arterial digital subtraction or magnetic resonance angiography remains the only way to identify patients at risk of harboring a familial cerebral aneurysm.

Adult↗
PubMed1995

Intramedullary schwannoma.

OBJECTIVE: To present the imaging findings for two cases of intramedullary schwannoma involving the thoracic cord and the conus medullaris. PATIENTS AND METHODS: a 34-year-old man and a 53-year-old woman presented with symptoms of weakness and pain in the lower limbs. Myelography and magnetic resonance imaging as well as other examinations, were performed. RESULTS: The imaging failed to indicate the correct diagnosis in either patient. However, intramedullary schwannoma was confirmed pathologically in both patients. Subtotal excision resulted in local tumour recurrence at 5 and 3 years, respectively. CONCLUSIONS: Intramedullary schwannoma should be considered in the differential diagnosis of spinal cord tumours. The importance of accurate diagnosis from frozen sections at surgical biopsy is emphasized .

Adult↗
PubMed1994

Unusual evolution and computerized tomographic appearance of a gliosarcoma.

A patient with a remote infarct, seizures, mild hemiparesis, and dysphasia became obtunded over four months and died. Computerized tomography (CT) over 5 years showed a consistent, large, wedge-shaped left hemisphere hypodensity with a central calcification, but without signs of mass effect. This was interpreted as an infarct of the left middle cerebral artery territory. Post-mortem examination of the brain revealed the entire area appearing as infarct on CT was a gliosarcoma. We suspect that the unusual CT appearance of the lesion was likely caused by multiple pathologies: a low grade glioma transforming into a gliosarcoma that was able to spread throughout the area of infarct encephalomalacia without revealing a typical CT appearance of mass effect. The patient's brief period of deterioration probably coincided with transformation of the tumor into a gliosarcoma. The variable CT characteristics of gliosarcomas are reviewed.

Brain Neoplasms↗
PubMed1994

Operative strategies for patients with cortical dysplastic lesions and intractable epilepsy.

Cortical dysplastic lesions (CDLs) are usually identified by magnetic resonance imaging (MRI). Clinical, electrographic and histologic findings suggest that focal CDLs (FCDLs) are highly epileptogenic, often involve the rolandic cortex, and can present variable degrees of histopathologic abnormalities. An ictal or "ictal-like" bursting pattern of electrographic activity was recorded over dysplastic cortex in 65% of our patients. Resective surgery can eliminate or significantly reduce seizure frequency in many medically intractable patients, depending on lesion location, degree, and extent of histopathologic abnormalities. Best results are achieved when complete or major excision of both the MRI-visible lesion and the cortical areas displaying ictal electrographic activity can be performed. This is more likely when the degree of histopathologic abnormality is mild to moderate or when the lesion is in a temporal lobe. More severe histopathologic abnormalities and central insular or multilobar lesions usually lead to less favorable results: either major excision of the visualized lesion is impractical or the lesion is microscopically more extensive than shown by MRI. Multilobar resection or hemispherectomy for patients with infantile spasms associated with CDLs and for patients with hemimegalencephaly are often associated with dramatic improvement in seizure control. Callosotomy can be performed in selected patients with diffuse CDLs who have intractable drop attacks.

Adolescent↗
PubMed1994

Angiographic screening and elective surgery of familial cerebral aneurysms: a decision analysis.

Up to 6% of cerebral aneurysms may be familial. Because the pattern of inheritance and the prevalence of aneurysms within families are unknown, the management of family members at risk of harboring a cerebral aneurysm is currently empirical. We established the prevalence of aneurysms in the second generation of individuals with familial cerebral aneurysms and determined the possible benefit of angiographic screening and elective surgery of such individuals by using a simple decision analysis model. Four consecutive families were identified in whom the mother and a child had a ruptured cerebral aneurysm. A total of 19 siblings at risk in the second generation were identified. Fifteen underwent elective cerebral angiography: one had a cerebral aneurysm and two had an infundibulum at the origin of the posterior communicating artery. Including the previously known aneurysms, the prevalence of aneurysms in the second generation was thus established at 29.4%. A decision analysis was performed with 2% as the annual risk of rupture, 72.7% as the risk of death or disability with rupture, 0.1% as the risk of angiography, and 6.5% as the risk of surgery. The benefit in years of survival free of sequelae resulting from angiographic screening and elective surgery (intervention) over natural history was computed for life expectancy corresponding to each quinquennial age group from age 15 to 100 years. Intervention equaled natural history, in terms of years of survival expected with each choice, at a life expectancy of 10.6 years, corresponding to age 76.5 years for men and 80 years for women, and produced a net gain of at least 1 year for patients whose life expectancy was 32 years or more, corresponding to age 53.5 years for women and 49 years for men. Greater benefit was achieved with increasing life expectancy (younger age). The prevalence of aneurysms in the second generation when a mother and child have an aneurysm is 29.4%. Intervention produces a benefit of at least 1 year of survival free of sequelae over natural history in such individuals if their life expectancy is 32 years or more.

Adolescent↗
PubMed1994

Transcranial Doppler ultrasonographic changes after embolization of cerebral arteriovenous malformations.

The authors assessed the potential role of transcranial Doppler ultrasonography (US) in monitoring hemodynamic changes induced by embolization of cerebral arteriovenous malformations. Transcranial Doppler US was performed in eight patients with such lesions before and after embolization with n-butyl cyanoacrylate [corrected]. Changes in mean flow velocity and pulsatility index were analysed in all feeding and nonfeeding arteries. Anatomic and hemodynamic observations were also correlated with the results of digital subtraction angiography. A consistent trend was observed in all treated feeding arteries after embolization: the flow velocity decreased by a mean of 26% or 33 cm/s (p = 0.01, paired t-test), and the pulsatility index increased by a mean of 27% or 0.15 (p = 0.005). Although these changes did not correlate with the degree of angiographic reduction of the nidus (r = -0.31), they were most marked in malformations with a lower Spetzler grade or a higher degree of shunt obliteration. After embolization, recruitment of untreated feeding arteries was documented in two cases and a decrease in the "steal effect" from contralateral nonfeeding arteries in three. Changes in the nonfeeding arteries ipsilateral and contralateral to the malformation were variable. The authors conclude that transcranial Doppler US is a convenient and reliable method to evaluate quantitatively the hemodynamic effects of embolization of cerebral arteriovenous malformations.

Adult↗
PubMed1993

Stages and patterns of centrifugal arrest of diffuse neuronal migration disorders.

Centrifugal migration of newly generated neuroblasts toward the cortical surface can be arrested at different levels, resulting in anatomically different disorders. This is illustrated by three patients with diffuse or generalized neuronal migration disorders (NMDs): pachygyria, subcortical laminar heterotopia ('double-cortex' syndrome), and periventricular laminar heterotopia. All had medically intractable partial and generalized epileptic seizures, but there was no close correlation between the type of dysplasia and intelligence or clinical pattern. The low intelligence found in these patients may relate to the epileptic syndrome, rather than to the NMDs alone. MRI suggested that in this spectrum of disorders the migration process was arrested at different stages, depending on the extent, timing and site of damage to radial glial fibres.

Adult↗
PubMed1993

Preoperative embolization of brain and spinal hemangioblastomas.

Large hemangioblastomas can be difficult to resect because of excessive bleeding. We report our experience with two patients whose large hemangioblastomas were embolized preoperatively and were totally resected with minimal blood loss and satisfactory postoperative outcome. Embolizations were carried out within 3 days of surgery, with the patient under general anesthesia, with 150- to 250-microns Contour emboli. A 65-year-old woman with progressive, severe myelopathy from a 4.5 x 2.1 x 1.4 cm intramedullary hemangioblastoma at T4 underwent embolization of the left T2 and T3 intercostal arteries; a 29-year-old man with Lindau's syndrome and posterior fossa hemorrhage from a 3.8 x 1.8 x 1.8 cm right cerebellar hemangioblastoma underwent embolization of the right posterior inferior cerebellar artery, two right anterior inferior cerebellar arteries, and a dural branch of the right vertebral artery. Embolization led to the complete obliteration of the tumoral blush without neurological sequelae. Both lesions were completely resected with a blood loss of 50 to 100 ml, with bleeding occurring mainly from the pseudocapsule of the lesion. Preoperative embolization of hemangioblastomas is a useful and relatively safe procedure that reduces blood loss at the time of surgery and allows complete resection.

Adult↗
PubMed1993

Spinal angiolipomas. Report of three cases.

Spinal angiolipomas are distinct, benign lesions composed of mature lipocytes admixed with abnormal blood vessels. Three new cases of spinal angiolipoma are presented and 34 previously reported cases are analyzed. The 37 total cases (23 females and 14 males) ranged in age from 17 to 73 years (mean 43 years; median 45 years). The mean age of the female patients was older than that for the males (45.0 vs. 41.6 years; p < 0.001, Student's t-test) and most were peri- or postmenopausal. Prior to diagnosis, 97% of the patients had weakness of the lower extremities, 94% had sensory dysfunction, 84% had hyperreflexia and spasticity, 51% had sphincter dysfunction, and 41% had back pain lasting from 1 to 180 months (mean 28 months). Five (22%) of the 23 female patients were pregnant and two had exhibited significant weight gain coincident with the onset of symptoms. The angiolipomas were extradural in 35 patients and intramedullary in two; seven of the extradural lesions infiltrated the surrounding bone. The tumors extended from C-6 to L-4 and had a predilection for the midthoracic region (53% of cases). Plain radiographs were abnormal in 11 (39%) of 28 patients and in all patients with bone infiltration. Myelograms were abnormal in 97% of 32 patients and showed a complete block in 63% of patients. Computerized tomography (CT) and magnetic resonance (MR) imaging revealed the fat-density lesions in all cases studied. There was vascular enhancement in three of five cases with contrast-infused CT and in the one case with gadolinium-infused MR imaging. All patients improved following resection of the epidural lesions and internal decompression of the intramedullary lesions. It is concluded that spinal angiolipomas predominantly affect women. They involve the thoracic (especially the midthoracic) region, and produce symptoms and signs of spinal compression and, in some cases, bone erosion and pathological fractures. Their symptomatology can be exacerbated by pregnancy and weight gain, suggesting that vascular engorgement and the presence of obesity influence their evolution. Their preponderance in older, peri-, or postmenopausal women, and their clinical exacerbation in pregnant women support a role for hormonal influence. Magnetic resonance imaging is the investigation of choice for the diagnosis of these lesions. Surgery is universally successful in relieving symptoms.

Adult↗
PubMed1993

Imaging of spinal cord hemangioblastomas.

Hemangioblastomas, which are associated with von Hippel-Lindau disease, represent the third most common type of intramedullary spinal cord tumour. The authors reviewed the radiologic findings in five cases of surgically proven spinal cord hemangioblastoma. Magnetic resonance imaging (MRI) could be used to differentiate the various components of these tumors, including the tumour nodule, edema, cysts and syringomyelia. The tumour nodule could be identified as an isointense area surrounded by edema, a cyst or syringomyelia, or as an area adjacent to a signal void (which represented feeding and draining vessels). Tumour nodules demonstrated intense enhancement when gadolinium diethylenetriaminepentaacetic acid was administered. Edema appeared as an ill-defined region of moderately low signal intensity in T1-weighted images and moderately high signal intensity in T2-weighted images. Cysts and syringomyelia appeared as well-defined regions of low signal intensity in T1-weighted images and high signal intensity in T2-weighted images. MRI allows the radiologist to assist the surgeon in determining preoperatively the level of laminectomy appropriate to resect the tumour. Preoperative embolization of the posterior spinal arteries, facilitated by angiography, can be important in reducing perioperative hemorrhage.

Adult↗
PubMed1992

Multiple occult vascular malformations of the brain and spinal cord: MRI diagnosis.

We report a patient with multiple angiographically occult vascular malformations in the brain and spine. Magnetic resonance imaging showed multiple lesions in brain and spine with hypointense areas on both T1 and T2-weighted images. These hypointense areas are usually secondary to hemosiderin deposits consistent with remote bleeding in the lesions. We conclude that when magnetic resonance reveals an intraspinal lesion with signal intensity characteristics consistent with a vascular malformation, an examination of the brain should be performed to rule out associated intracranial lesions. The finding of multiple lesions in the brain with identical signal intensity characteristics reinforces the diagnosis of vascular malformation.

Brain↗