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Biomedical subjects

J E Dalman

Publications and source records attributed to J E Dalman.

7 recordsLinked to original sources
PubMed1999

Transcranial Doppler monitoring during carotid endarterectomy helps to identify patients at risk of postoperative hyperperfusion.

OBJECTIVES: to investigate whether transcranial Doppler (TCD) monitoring can identify patients at risk of hyperperfusion, and whether active postoperative treatment of selected patients decreases the risk of intracerebral haemorrhage (ICH). DESIGN: a case cohort study of 688 patients undergoing carotid endarterectomy (CEA) with intraoperative TCD monitoring. METHODS: sixty-two patients (9%) fulfilled the TCD criteria for hyperperfusion, i.e. >100% increase of peak blood flow velocity or pulsatility index of the middle cerebral artery, compared to preclamp baseline values. In these patients, blood pressure was closely monitored and controlled postoperatively. RESULTS: postoperatively, seven of these patients (11%) exhibited clinical signs or symptoms of hyperperfusion but no cerebral haemorrhage (ICH). This is a significantly better outcome (p <0.005) compared to a 2% incidence of ICH after CEA in previous years in our hospital. CONCLUSIONS: patients at risk of hyperperfusion syndrome after CEA can be identified intraoperatively by TCD monitoring. In these selected patients, immediate and adequate postoperative treatment of hypertension results in a decreased risk of intracerebral haemorrhage.

Aged↗
PubMed1997

Cortical blindness.

A 79-year-old woman with persistent cortical blindness caused by bilateral temporo-occipital infarctions was followed for 8 months. She had no light or visual motion perception. Our patient's visual imagery was intact, which was demonstrated when drawing elementary shapes; however, her drawing of objects was poor. Optokinetic nystagmus could not be elicited, but the vestibulo-ocular reflex (VOR) seemed intact. Although she was able to suppress her VOR by 'fixating' her outstretched hand which moved in phase with her head and body, she showed saccadic tracking eye movements in an attempt to visually 'follow' the self-generated movements of her outstretched hand, while her body and head were stationary. Such saccadic tracking seemed to be different from the previously described smooth tracking of self-moved targets by patients with acquired blindness caused by anterior visual pathway dysfunction.

Aged↗
PubMed1996

Whipple's disease and the central nervous system. A case report and a review of the literature.

A 65-year-old man was suffering from recurrent manic psychosis accompanied by weight loss. He also had a history of pleural effusion, aspecific migratory non-deforming seronegative polyarthritis, sensorineural hearing loss and semicircular canal paresis. Whipple's disease (WD) had been diagnosed at the age of 63 years. On admission to hospital) he had weight loss, diarrhoea in combination with an organic brain syndrome, hemiparesis and ophthalmoplegia, including internuclear ophthalmoplegia (INO). A clinical diagnosis of central nervous system (CNS) WD was made. MRI revealed a thalamus lesion that halved in size during sulfamethoxazole-trimethoprim treatment. The organic brain syndrome and ophthalmoplegia diminished also, as did the cerebrospinal fluid (CSF) IgG level. A review of CNS WD is presented and implications for treatment are discussed.

Aged↗
PubMed1995

Interhemispheric subdural hematoma in adults: case reports and a review of the literature.

The interhemispheric subdural hematoma is a relatively uncommon type of subdural hematoma, especially seen in patients with blood clotting disturbances. When its mass becomes sufficiently large, specific neurological abnormalities such as hemiparesis and signs of the falx syndrome are seen. Treatment can consist of conservative observation or craniotomy and is dictated by the clinical course. Conservative management is the treatment of choice for patients without disturbances of consciousness and for patients with stable clinical conditions. Surgical treatment is necessary in patients with progressive deterioration. Three case reports are presented, as well as a review of 64 cases described in the literature. The salient aspects of this clinical entity are discussed.

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PubMed1994

Cardiac arrest in Guillain-Barré syndrome and the use of suxamethonium.

A patient is described with severe Guillain-Barré syndrome resulting in tetraplegia. Artificial ventilation was necessary. There were signs of autonomic dysfunction such as systolic hypertension and excessive sweating. He developed fatal cardiac electromechanic dissociation after intravenous suxamethonium administration for a second endotracheal intubation because of respiratory failure.

Adult↗