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Biomedical subjects

E E Awwad

Publications and source records attributed to E E Awwad.

At least 19 recordsLinked to original sources
PubMed1999

The solitary intraspinal vertebral osteochondroma. An unusual cause of compressive myelopathy: features and literature review.

STUDY DESIGN: Reports of four patients with compressive myelopathy from solitary intraspinal vertebral osteochondromas. OBJECTIVES: To evaluate the clinical presentation and radiographic findings of patients with intraspinal osteochondroma with compressive myelopathy and to review the relevant English-language medical literature. SUMMARY OF BACKGROUND DATA: Involvement of the spine by solitary osteochondromas is rare. The addition of the current four cases to those already reported makes a total of 41 published cases of solitary vertebral osteochondromas with spinal cord compression. METHODS: Clinical histories, computed tomographic studies, magnetic resonance imaging studies, routine radiographs, and/or myelographic studies of the lesions were reviewed. A review of the English-language medical literature also was done. RESULTS: Patients gradually improved or symptoms stopped progressing after surgical removal of the lesions. Although magnetic resonance imaging is the preferred method for localizing the lesion, computed tomography can be more specific, because of its sensitivity, when the diagnosis is in doubt. CONCLUSIONS: Osteochondromas represent a hyperplastic-dysplastic disturbance of bone from progressive endochondral ossification. The tumors slowly enlarge, creating insidious but progressive symptoms. Magnetic resonance imaging, computed tomography, and postmyelogram computed tomography are useful in evaluating the size and extent of spinal osteochondromas as a cause of spinal cord compression.

Adolescent↗
PubMed1997

MRI in Lhermitte-Duclos disease.

Lhermitte-Duclos disease (LDD) is a disorder sometimes referred to as a dysplastic gangliocytoma of the cerebellum. This is a focally indolent growth of the cerebellar cortex in which the folia enlarge due to a profusion of dysplastic cortical neurons and a thickening of the molecular layer. Loss of Purkinje cells and thinning of medullary white matter results. The enlarged folia lose their secondary foldings and asymmetrically expand the cerebellar hemisphere. These morphologic features produce a characteristic pattern on some CTs and all MRIs, affording an opportunity for a preoperative diagnosis. MRI of a pathologic specimen suggested that the abnormal T1 and T2 signals corresponded to the atrophic folial white matter, thickened granule cell layer, and outer molecular layer. Because of inherent Hounsfield artifact in posterior fossa with CT, MRI is the imaging modality of choice, with better visualized striated pattern. The uniqueness of these imaging features obviates the need for an obligatory biopsy for asymptomatic patients and either permits more definitive planning for surgical decompression or, in restricted lesions, guides more assuredly complete excision of the cerebellar mass.

Adult↗
PubMed1996

Warfarin-induced spondyloarthropathy with pseudotumor-like appearance. A case report.

STUDY DESIGN: This case report illustrates an unusual complication of chronic warfarin administration. OBJECTIVES: The presurgical determination that the destructive process at L1-L2 was not infection or neoplasm involved the recognition that there was instability at this level resulting from chronic stress fractures. SUMMARY OF BACKGROUND DATA: Periosteal or osseous hemorrhagic masses (pseudotumors) have been well described in patients with hemophilia. To the authors' knowledge, this is the first reported case of this well-known phenomenon occurring in the axial skeleton as a consequence of warfarin administration. METHODS: Serial radiographic studies of the lumbar spine were available showing a progressive destructive lesion at L1-L2 and coinciding with the initiation of warfarin anticoagulation after aortic valve replacement. RESULTS: The destructive mass was demonstrated surgically to represent a large partially solidified chronic hematoma. CONCLUSIONS: Patients with stress fractures of the posterior arch and subsequent instability may be subject to development of such a spondyloarthropathy. Recognition of this unusual potential complication of warfarin therapy would prevent an incorrect diagnosis of tumor or infection. Early recognition of its occurrence could lead to early spinal stabilization.

Aged↗
PubMed1995

Predictive value of postmyelographic computed tomography for patients with severe postmyelographic headache.

Our goal was to determine if evidence of cerebrospinal fluid (CSF) leakage on routine postmyelogram computed tomography (CT) of the lumbar spine was useful in predicting subsequent development of moderate or severe headaches in patients having outpatient myelography. We reviewed postmyelogram CT studies of the lower lumbar region of 89 patients for radiographic indication of CSF leakage. These patients had outpatient lumbar myelography. We conducted telephone interviews to determine whether a postmyelographic headache occurred. Correlation of CT-verifiable contrast leakage with subsequent development of postmyelogram headache was statistically significant. The early radiographic identification of such patients affords the opportunity for additional measures, such as extended bed confinement, to decrease the morbidity of myelography. Additionally, statistical correlation of such findings should provide an objective method of evaluating the effectiveness of alterations in myelographic technique.

Blood Patch, Epidural↗
PubMed1995

MR in neurofibromatosis of the larynx.

We report the MR results of four patients with plexiform neurofibromas of the larynx. Three had irregular margins and were circumferential around the airway. The distinction between regularly and irregularly shaped neurofibromas may have implications for symptom onset.

Biopsy↗
PubMed1992

Current imaging concepts of thoracic intervertebral disks.

This article reviews the current concepts of thoracic herniated disks using the radiologic literature as well as our own experience with more than 100 thoracic HNPs. The relative frequency of asymptomatic thoracic HNPs is documented. Points of interest include the optimal technique, criteria for interpretation, strengths and weaknesses of various imaging modalities, including water-soluble myelography, CT myelography, and magnetic resonance imaging. Additionally, the protean clinical manifestations of thoracic HNPs and current operative management are briefly addressed.

Artifacts↗
PubMed1991

Open depressed skull fracture missed on computed tomography: a case report.

A case of an open depressed skull fracture that was missed on standard computed tomographic (CT) scan is presented. The fracture was seen on a CT generated lateral scout film, and after repositioning the gantry, further CT images clearly showed the fracture and underlying brain injury. The authors recommend that all patients with head trauma undergoing head CT have either a CT generated lateral scout film or a lateral skull radiograph to assess the vertex of the skull, an area poorly visualized on standard axial images.

Adult↗
PubMed1991

Asymptomatic versus symptomatic herniated thoracic discs: their frequency and characteristics as detected by computed tomography after myelography.

We retrospectively reviewed the myelograms of 433 patients and identified those who had no symptoms or signs referable to the thoracic cord, roots, or nerves. By post-myelography computed tomographic scan criteria, our frequency of asymptomatic thoracic herniated discs (ATHDs) was calculated. Post-myelography computed tomographic scans of 68 ATHDs were analyzed. Their imaging characteristics were compared with our own series of 5 symptomatic thoracic herniated discs and symptomatic thoracic herniated discs in the literature. We were unable to identify any imaging features that could reliably classify a disc as an ATHD or a symptomatic thoracic herniated disc. Our results call into question the propriety of prophylactic surgery for ATHDs, even when the lesions are radiographically impressive.

Adult↗
PubMed1990

Occult thoracic intradural extramedullary spinal canal lesions discovered by extending cervical and lumbar myelography.

We retrospectively reviewed the extended myelograms of 388 patients and identified two clinically occult intradural extramedullary lesions of the thoracic region of the spinal canal. Quality evaluation of the adjacent thoracic region can be quickly and simply performed at the time of lumbar or cervical myelography with the high volumes of relatively nontoxic water soluble intrathecal contrast agents allowed today. We recommend this screen to detect otherwise occult thoracic lesions.

Female↗
PubMed1989

Magnetic resonance imaging of cerebral venous thrombosis secondary to "low-dose" birth control pills.

The clinical and radiographic features of cerebral deep venous thrombosis in a 21-year-old white woman are presented. This nulliparous patient presented with relatively mild clinical symptoms and progressing mental status changes. The only known risk factor was "low-dose" oral contraceptive pills. The magnetic resonance image (MRI) showed increased signal intensity from the internal cerebral veins, vein of Galen, and straight sinus. The diagnosis was confirmed by arterial angiography.

Adult↗
PubMed1987

Preoperative computerized tomographic imaging in hyperparathyroidism.

The surgery of hyperparathyroidism can be technically very difficult, even for an experienced surgeon. Until the present decade, preoperative localization procedures were of little help because of poor resolution of imaging modalities, significant morbidity, and the cost of invasive procedures. The efficacy of preoperative high-resolution CT scanning was evaluated in ten patients with primary hyperparathyroidism who had not previously been operated on. Contrast and noncontrast scans were performed on each patient, under the supervision of an experienced radiologist. Surgical findings were the standard against which all CT scans were judged. Each patient was diagnosed as having a single adenoma. Preoperative scans localized eight of ten adenomas for an overall sensitivity of 80 percent. In one patient, the adenoma was incorrectly localized for a specificity of 89 percent. The smallest adenoma correctly localized measured 4 x 4 mm in its axial dimensions. In addition to shortening operative time, accurate preoperative localization permitted use of unilateral dissection technique. Recent literature has repeatedly proved unilateral dissection superior to bilateral dissection by production of identical cure rates and a 2- to 12-fold decrease in postoperative hypocalcemia. We suggest that CT scanning be considered in the routine preoperative workup of patients who have primary hyperparathyroid disease.

Adenoma↗