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Biomedical subjects

E R Heinz

Publications and source records attributed to E R Heinz.

At least 19 recordsLinked to original sources
PubMed1991

CT patterns of intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction.

Computed tomographic (CT) patterns of intracranial hemorrhage (ICH) were determined in 1,696 patients undergoing thrombolytic therapy for acute myocardial infarction. ICH occurred at 33 sites in 0.77% of patients (n = 13). Thirty-six percent of hemorrhages (n = 12) were intraparenchymal, 33% (n = 11) were subdural, 24% (n = 8) were subarachnoid, and 6% (n = 2) were intraventricular. Eight-four percent (n = 26) of all nonventricular hemorrhages were supratentorial in location. The most common site of ICH was supratentorial and intraparenchymal (10 of 33). In 11 of the 13 patients with ICH, clinical symptoms occurred within 24 hours of the initiation of thrombolytic therapy. A fatal outcome resulted in three of the four patients who had clinical symptoms within 3.5 hours after beginning thrombolytic therapy. The CT findings of multiple intracranial bleeding sites, substantial mass effect with midline shift, and large-volume intraparenchymal hematomas were associated with increased mortality. ICH associated with thrombolytic therapy for acute myocardial infarction has a grave prognosis, with 62% of patients dying during hospitalization.

Aged↗
PubMed1990

MR imaging in patients with temporal lobe seizures: correlation of results with pathologic findings.

Thirty-nine consecutive patients with medically intractable complex partial seizures were studied with electroencephalography and MR imaging to localize an epileptogenic focus for temporal lobectomy. The patients were divided into three groups on the basis of pathologic findings after lobectomy: Group 1 comprised 13 patients with neoplasms, hamartomas, or cysts; group 2 comprised 13 patients with moderate and severe mesial temporal sclerosis (one patient was included in both groups 1 and 2); and group 3 comprised 14 patients who underwent aspiration lobectomy, which yielded limited tissue for pathologic study so no pathologic diagnosis was made. The majority of the patients in group 3 were assumed to have mesial temporal sclerosis. Abnormal MR signal in the temporal lobe on T2-weighted images was graded as minimal increase (1+), intermediate or moderate increase (2+), and very significant increase (3+). An abnormal signal was demonstrated in 26 (67%) of the 39 patients. In group 1, the tumor/cyst subgroup, an abnormal signal was seen in all 13 patients. Most had 3+ signal. There was increased signal in eight (62%) of 13 patients in group 2 and in six (43%) of 14 patients in group 3. This study suggests that MR can detect almost all tumors and a significant number of mesial temporal sclerosis lesions in individuals with complex partial seizures. On the basis of this small series, individuals who exhibit significant signal (3+) can be expected to have neoplasms, hamartomas, or cysts, and patients who exhibit minimal signal (1+) will usually have mesial temporal sclerosis.

Adult↗
PubMed1989

Radiation therapy treatment planning in supratentorial glioblastoma multiforme: an analysis based on post mortem topographic anatomy with CT correlations.

In a previous study of the brains of 15 adults with glioblastoma multiforme who received minimal or no radiotherapy we determined the topographic distribution of tumor cells. All 15 brains had been fixed and then cut in the coronal or horizontal plane. The distribution of neoplastic cells was determined and entered onto tracings of the whole mount histologic sections. The last CT scans obtained prior to death of 11 of the patients were reviewed independently by a neuroradiologist who traced, on the CT scans, the outer edge of both the contrast-enhancing area and the peritumoral low density "edema". Presented with the neuroradiologist's assessment of the contrast enhancing rim of tumor and of the "edema", a radiotherapist and a radiation dosimetrist, in the present study, prepared treatment plans for a 6 MeV linear accelerator. In 9 of the 11 cases in which immediately antemortum CT scans were available, radiation treatment of the contrast enhancing area alone with a 1 cm margin would have missed portions of the histologically identified tumor. Treatment of the contrast enhancing area along with the peritumoral "edema", with a 1 cm margin, would have covered histologically identified tumor in six of the 11 cases. Treatment of the contrast enhancing area, all "edema", and a 3 cm margin around the "edema" would have covered histologically identified tumor in all cases. Tumors tended to track along nerve pathways. In those lesions near the midline it was common for tumor to cross the corpus callosum. We conclude that radiotherapy with fields designed to treat the contrast enhancing region alone or this region plus "edema" with a tight margin will frequently miss tumor which can be histologically identified by our technique.

Adult↗
PubMed1989

Significant extracranial carotid stenosis: detection on routine cerebral MR images.

Severe stenosis of the cervical internal carotid artery was detected on magnetic resonance images in three patients from a series of eight with abnormality of flow. In contrast to complete loss of "flow void" in the horizontal carotid within the petrous bone seen in patients with complete occlusion, these three patients had partial flow void in which there was a central area of signal void in the artery, surrounded by circumferential increase in signal in the outer third of the artery. This was seen on axial views at right angles to the long axis of the artery below the petrous bone and on "in-plane" sections through the horizontal carotid canal. An animal model with 70% and 90% carotid stenosis and carotid occlusion was created. The model with 70% stenosis showed no significant change. The 90% stenosis model showed partial flow void in the center of the lumen with peripheral signal exactly as seen in the human patients.

Adult↗
PubMed1989

Brain iron in progressive supranuclear palsy: clinical, magnetic resonance imaging, and neuropathological findings.

A patient with progressive supranuclear palsy demonstrated a region-specific decrease in T2 signal during high-field-strength brain magnetic resonance imaging. At autopsy the T2-signal hypointensity was found to correspond topographically to increased deposition of ferric iron. The potential clinical, radiologic, and pathophysiologic implications of these findings are discussed.

Brain↗
PubMed1989

Efficacy of MR vs CT in epilepsy.

We studied 59 seizure patients with CT, MR, and EEG to determine the efficacy of each in the detection of an epileptogenic focus. EEG was most sensitive (67%), MR was next (53%), and CT was least sensitive (42%). MR detected an abnormality in five patients (8%) in whom CT was negative. EEG was positive in each of these patients. CT failed to demonstrate any focal lesion not detected by MR. MR and CT detected focal abnormalities in seven patients (12%) who had negative EEGs. Five of the seven patients had brain tumors. Eighteen of the 26 patients who underwent surgery had positive CT and MR; 14 of these patients had tumors. The remaining eight patients who had surgery all had temporal lobectomies for intractable seizures; none had tumors. In the complex partial seizure subgroup of 34 patients, MR was positive in 44%, CT was positive in 29%, and EEG was positive in 80%. We consider MR to be the imaging procedure of choice for the detection of an epileptogenic focus in seizure patients. When indicated, CT may be performed as a second procedure to try to distinguish neoplasm from thrombosed vascular malformations and other lesions.

Brain Neoplasms↗
PubMed1988

Intracranial atherosclerosis following radiotherapy.

We describe a case of severe intracranial atherosclerosis in a young man who had received therapeutic radiation for a presumed brain neoplasm. Since there was no evidence of vascular disease outside the radiation ports, we speculate that accelerated atherosclerosis was induced by radiation and that hyperlipidemia may have predisposed him to this effect.

Arteriosclerosis↗
PubMed1988

Neuroimaging of scuba diving injuries to the CNS.

Diving accidents related to barotrauma constitute a unique subset of ischemic insults to the CNS. Victims may demonstrate components of arterial gas embolism, which has a propensity for cerebral involvement, and/or decompression sickness, with primarily spinal cord involvement. Fourteen patients with diving-related barotrauma were studied with MR imaging of the brain and spinal cord and with CT of the brain. In four patients with presumed cerebral gas embolism, cranial MR was abnormal in three patients while CT was abnormal in only one. Twelve patients had decompression sickness and spinal cord symptoms. MR documented spinal cord abnormalities in three patients. However, scans obtained early in our study were frequently limited by technical constraints. MR of the brain is more sensitive than conventional CT scanning techniques in detecting and characterizing foci of cerebral ischemia caused by embolic barotrauma to the CNS. Although spinal MR may be less successful in the localization of spinal cord lesions related to decompression sickness, these lesions were previously undetectable by other neuroimaging methods.

Adolescent↗
PubMed1988

Topographic anatomy and CT correlations in the untreated glioblastoma multiforme.

To provide baseline information for the "local" therapy of the glioblastoma multiforme (GBM), whole-brain histological sections of 15 untreated GBM's were studied to determine the distribution of neoplastic cells. These findings were then compared with the computerized tomography (CT) scans in 11 cases in order to determine the extent to which the peripheral portion of the neoplasm can be estimated by the presence of a low-density area without contrast enhancement. The results of the histological study confirmed the marked heterogeneity of GBM's and disclosed a great variability in the geometry, extent, and character of the peripheral "infiltrating" margin. In spite of the widely held concept that glioblastomas are localized within 2 cm of the contrast-enhanced rim, there were three cases in this two-dimensional study in which this distance was exceeded, and it seems likely that three-dimensional reconstructions would have detected additional cases in which neoplastic cells extended beyond this arbitrary limit. Only three of the 15 GBM's were restricted to the distribution of one internal carotid or one vertebral artery. To the extent that the neoplasms in the present series are representative, this suggests that glioblastomas will be difficult to treat successfully by intra-arterial therapy using existing therapeutic agents. Correlations of histological sections with the CT scans revealed that the vast majority of the neoplastic tissue was contained within the contrast-enhancing and "peritumoral" areas of low density, but that in five cases fingers of neoplasm extended for short distances beyond the outer margin of the latter region. This indicates that the distribution of cells of a GBM cannot be inferred from CT images since the "peritumoral" area of low density can over- or underestimate the extent of the lesion.

Aged↗
PubMed1988

Adipose tissue in the filum terminale: a computed tomographic finding that may indicate tethering of the spinal cord.

Adipose tissue in the filum terminale is frequently associated with tethering of the spinal cord in patients with spina bifida occulta. We recently saw a patient with low back pain and no spina bifida occulta, in whom adipose tissue was noted in the area of the filum on an unenhanced computed tomographic (CT) scan. The patient had a tethered cord. This case suggested that, when CT scanning is done as the first imaging study in the evaluation of low back pain, fatty tissue in the area of the filum may be an indicator for tethering of the spinal cord. The present study was undertaken to determine the validity of using CT scan-detectable filal fat in the identification of possible tethered spinal cords among a group of patients experiencing low back pain. The presence of fat in the fila of 12 patients with the radiologically and histologically tethered cord syndrome was evaluated and the fila of 47 autopsied patients whose clinical history showed no back pain were examined histologically. There were accumulations of adipose tissue in the fila of 11 of the 12 (91%) patients with the tethered cord syndrome and in the fila of 9 of the 47 patients (17%) in the autopsy series. Of the 9 autopsy patients with fat in their fila, however only 3 patients (6%) exhibited collections of adipose tissue in the CT detection range (2 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1987

Intracerebral malignant melanoma: high-field-strength MR imaging.

Thirteen patients with intracerebral malignant melanoma underwent high-field-strength (1.5-T) magnetic resonance (MR) imaging. The images were correlated with computed tomography (CT) scans (n = 7) and surgical specimens (n = 7). Most commonly, these lesions were hyperintense to normal white matter on T1-weighted images and hypointense to normal white matter on T2-weighted images. Hemorrhage in the lesion may have a greater influence on this unique appearance than does melanin. The increased tissue sensitivity of MR imaging allowed for 22% greater lesion detection than did CT.

Adult↗
PubMed1987

Subcortical arteriosclerotic encephalopathy: brain stem findings with MR imaging.

Magnetic resonance images of 44 patients who had varying degrees of supratentorial signal abnormalities compatible with subcortical arteriosclerotic encephalopathy (SAE) were reviewed for posterior fossa findings. Brain stem lesions frequently accompanied supratentorial SAE and were seen as multiple, fairly symmetric areas of poorly defined, increased signal intensity on axial T2-weighted images. Involvement was generally confined to the central portions of the mid and upper pons. The typical appearance of brain stem involvement by SAE and its probable pathogenesis are reviewed.

Aged↗
PubMed1987

Pathological and radiological correlation of subarachnoid hemorrhage in phencyclidine abuse. Case report.

Although hypertension can be associated with phencyclidine (PCP) use, subarachnoid hemorrhage (SAH) is a rare result. The radiological and pathological findings are reported of a patient with acute SAH who had chromatographic evidence of PCP in his blood. The occurrence of SAH in a patient who uses PCP may be caused by a disrupted arterial vessel wall and/or vasospasm due to the pharmacological action of the drug on the cerebral vasculature.

Adolescent↗
PubMed1985

Intra-arterial digital subtraction angiography of the spinal cord.

Digital subtraction angiography (DSA) of the spinal cord was performed in 6 patients using selective intra-arterial injections of contrast material. Two arteriovenous malformations of the spinal cord, 1 dural fistula, and 1 case of multiple hemangioblastomas were studied. Contrast and spatial resolution were satisfactory for defining normal and abnormal vascularity while reducing examination time, contrast dosage, patient discomfort, and film cost. The only significant limitation was misregistration artifacts seen on lateral views encompassing the diaphragm.

Adult↗
PubMed1984

Role of computed tomography in the radiological evaluation of painful radiculopathy after negative myelography: foraminal neural entrapment.

Thirty-five patients with an unremarkable or a negative water-soluble contrast myelogram and a diagnosis of foraminal neural entrapment made or more firmly established by computed tomography (CT) were detected in evaluating 950 patients presenting for myelography. The CT criterion of foraminal neural entrapment was the presence of a mass displacing epidural fat and encroaching on the neural intervertebral foramen or lateral recess so as to compromise an emerging nerve root. The entrapment (confirmed operatively) was due to a laterally prolapsed disc (16 cases), superior articular hypertrophy (4 cases), lateral recess stenosis (3 cases), posterolateral vertebral bone lipping (2 cases), tumors (6 cases), postoperative scarring (2 cases), spondylolisthesis (1 case), and synovial cysts that encroached on the neural foramina (1 case). CT is an important additional investigation in patients with a painful radiculopathy and a negative or equivocal water-soluble contrast myelogram.

Adult↗
PubMed1982

Radiographic quantitation of reversible blood-brain barrier disruption in vivo.

Cranial computed tomography (CT) was used to quantitate disruption of the blood-brain barrier (BBB) in dogs in vivo following intracarotid infusion of hypertonic mannitol. The degree of opening varied with the same dose and infusion rate. The ratio of contrast enhancement in brain vs. venous blood was elevated in 4 of 5 mannitol-treated animals, with the greatest enhancement occurring in the ipsilateral basal ganglia and cortical gray matter. The statistical significance and reproducibility of the derived CT numbers used for brain and venous blood calculations, as well as the linear relationship between iodine concentration and CT enhancement, was affirmed by obtaining multiple consecutive scans.

Animals↗
PubMed1982

Late sequelae of spinal cord trauma. Myelographic and surgical correlation.

Eighteen patients with posttraumatic paraplegia were examined myelographically at 2 months to 30 years after the injury, and the findings correlated with surgical exploration. The following six myelographic patterns were seen: 1) tethered cord and subarachnoid adhesions; 2) proximal cord cysts; 3) loculated subarachnoid cysts; 4) proximal cord atrophy; 5) extradural fibrosis; and 6) complete obliteration of the subarachnoid space at the level of trauma due to extradural fibrosis and/or bone encroachment on the vertebral canal. Myelography with or without computerized tomography (CT) accurately reflected the gross pathological process. The examination is indicated prior to surgical intervention: the structural lesion in four patients extended two or more vertebral levels above the site of the original bone injury and was not easily predictable preoperatively. When combined with CT, myelography allowed evaluation of the transverse anatomy of the vertebral canal and its contents; it was especially useful when the canal was narrowed or distorted by bone and soft tissue. Water-soluble contrast media provided a more detailed evaluation of the spinal cord and subarachnoid space, and were the preferred agents. If a posttraumatic syrinx is suspected, these are the agents of choice.

Adult↗