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Biomedical subjects

J L Atkinson

Publications and source records attributed to J L Atkinson.

At least 37 records · Page 2Linked to original sources
PubMed1999

Absent pachymeningeal gadolinium enhancement on cranial MRI despite symptomatic CSF leak.

CSF leak is recognized to cause orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPMGE) on MRI. We report six patients with typical symptoms and documented CSF leaks without DPMGE. Two had normal meninges from the onset; one initially had normal meninges, but subsequently DPMGE developed. In three, the initially noted DPMGE resolved while they were still symptomatic with documented continued CSF leaks. Absent DPMGE does not rule out CSF leak. When clinical manifestations suggest this disorder, additional diagnostic studies should be pursued.

Adolescent↗
PubMed1999

Familial trigeminal neuralgia and contralateral hemifacial spasm.

A patient was evaluated with familial trigeminal neuralgia (TN) and contralateral hemifacial spasm. The mother of the patient, 5 of 10 siblings, and 1 nephew also had TN confirmed by neurologists. The transmission of TN was suggestive of an autosomal dominant inheritance. This family provides additional evidence of a genetic basis for TN in selected cases and also provokes further speculation on a common unifying hypothesis of pathophysiology in cranial rhizopathies.

Aged↗
PubMed1999

Prolactinoma manifesting with symptomatic hydrocephalus.

Prolactinomas are the most common secretory adenomas of pituitary origin. They typically manifest with symptoms referable to their endocrinologic effects or, if of sufficient size, to visual changes due to compression of the optic chiasm. Pituitary adenomas manifesting with hydrocephalus are rare. To our knowledge, only three such cases have previously been reported. We describe an 81-year-old woman with a pituitary adenoma that manifested with hydrocephalus. In addition, we review the literature and discuss therapeutic options.

Aged↗
PubMed1999

Preliminary comparison of the endoscopic transnasal vs the sublabial transseptal approach for clinically nonfunctioning pituitary macroadenomas.

OBJECTIVE: To assess the advantages and disadvantages of an endoscopic transnasal approach to pituitary surgery for a select group of clinically nonfunctioning macroadenomas and to compare results of this approach with the sublabial transseptal approach at a single institution. PATIENTS AND METHODS: We retrospectively reviewed the records of 26 patients with clinically nonfunctioning pituitary macroadenomas approached endoscopically and 44 matched control patients with the same tumors approached sublabially between January 1, 1995, and October 31, 1997. RESULTS: At baseline, the groups were not significantly different for age, sex distribution, number of comorbid conditions, visual field defects, degree of anterior pituitary insufficiency, or preoperative assessment of tumor volume or invasiveness. Mean (SD) operative times were significantly reduced in the endoscopic group vs the sublabial group: 2.7 (0.7) hours vs 3.4 (0.9) hours (P < .001). Postoperative assessment of surgical resection and postoperative alterations of anterior pituitary function or visual fields were not significantly different between groups, and complication rates were similar in both groups. CONCLUSION: This endoscopic transnasal approach to pituitary resection results in significantly shorter operative time without compromising the extent of tumor resection. The distinct disadvantage of this approach is an off-center view of the sella and a diminished working channel to the sella turcica. For these reasons, the endoscopic approach or its variation is an alternative to the sublabial approach but should be considered only by experienced pituitary neurosurgeons.

Adenoma↗
PubMed1998

Traumatic internal carotid artery dissections caused by blunt softball injuries.

This report describes recently treated patients with carotid artery dissection caused by blunt softball injuries, as well as the results of a study of carotid artery trauma in a community. Data obtained through the medical records linkage system used for epidemiologic studies in Olmsted County, MN were used to identify all cases of traumatic internal carotid artery dissection diagnosed from 1987 through 1994. Four patients with traumatic internal carotid artery dissections were identified during the 8-year period under study. In two patients (50%) the carotid dissection was a result of the direct impact of a softball. A 39-year-old-man, who developed transient cerebral ischemic symptoms, and a 35-year-old woman, who developed a painful Horner's syndrome, were struck by a softball on the anterolateral aspect of the neck. Both patients had a low carotid bifurcation. These data suggest that internal carotid artery dissections may be underrecognized sequelae of direct softball injuries to the anterolateral neck. A low carotid bifurcation may be a risk factor for such injuries.

Adult↗
PubMed1998

Size and components of poult yolk sacs.

An experiment was designed to examine the effects of strain of turkey, size of egg, and stage of embryonic development on yolk and yolk sac utilization. Sixty eggs from Nicholas and British United Turkeys of America (BUTA) breeders were selected within each of the weight categories 70 to 76, 80 to 86, and 90 to 96 g. These eggs were incubated under commercial conditions, and eggs selected at 0 or 25 d incubation, at hatch, and 24 h posthatch and yolk and embryos were weighed and assayed for fat, protein, or fatty acids. Yolk weight declined from 23.7 g at setting to 4.66 g at hatch and subsequently to 2.87 g, 24 h posthatch. Yolk weight was affected by strain and egg weight and a number of significant (P < 0.05) interactions were observed. Nicholas strain birds yielded the largest yolks, with the strain difference being most pronounced for the largest egg weight category. Larger turkey eggs contained more water, such that at 24 h posthatch there was double the amount of residual water in the yolk sac. At 24 h posthatch, the Nicholas poults had more water available in the residual yolk. Egg weight had little effect on lipid reserve in the yolk or yolk sac after 25 d incubation. Fatty acid profile of yolk lipids changed little throughout incubation. A number of strain differences are seen in fatty acid profile in the yolk during utilization, although these are quite small and may not be of sufficient magnitude to account for any strain differences seen in early poult viability or growth. Data suggests that the poult and chick may be different in metabolism of various lipid fractions, although in general nutrient utilization by the poult follows a fairly well established sequence of events.

Animals↗
PubMed1998

The early critical phase of severe head injury: importance of apnea and dysfunctional respiration.

BACKGROUND: Apnea is a known response of concussive head injury. Hypoxic or ischemic brain injury has been documented in a high percentage of severe head injury deaths. The respiratory response after head injury remains poorly defined, however, and its contribution to hypoxic or ischemic mechanisms after severe head injury is unknown. METHODS: Eighteen anesthetized but spontaneously breathing rats were subjected to fluid percussion head injury of varying severities. Respiratory rate and volume of air were recorded before and after injury with a Hans Rudolph/Varadyne pneumotach differential pressure transducer and graphically measured. Postmortem inspection of the brains was performed. RESULTS: Apnea and subsequent respiratory dysfunction are directly proportional to the magnitude of energy delivered to the brain. Higher energy results in a dysfunctional or absent respiratory response, probably attributable to failure or disorganized function of the medullary respiratory center. CONCLUSION: This study for the first time graphically depicts the respiratory response after head injury. Higher energy delivered to the brain directly correlates with a markedly abnormal respiratory response that probably contributes significantly to subsequent hypoxic or ischemic brain injury. The absence of the space-occupying hematoma or gross parenchymal disruption suggests that in the clinical setting many of these patients may otherwise have survivable head injury if rescued by early ventilatory assistance.

Animals↗
PubMed1998

Evidence of posterior fossa hypoplasia in the familial variant of adult Chiari I malformation: case report.

OBJECTIVE AND IMPORTANCE: A case of familial Chiari I malformation and a review of the literature are presented. Recent posterior fossa morphological studies suggest that the sporadic variant of adult Chiari I malformation may be caused by occipital dysplasia and overcrowding of posterior fossa contents. This analysis was applied retrospectively for two of the three members of this familial variant. CLINICAL PRESENTATION: A family is described in which symptomatic Chiari I malformation occurred in two generations: monozygotic twin sisters and the daughter of one sister. The monozygotic twins developed symptoms within 1 year of each other, and both had associated syringomyelia. The daughter of one of the twins presented with symptomatic tonsillar herniation alone at a young age. INTERVENTION: All three family members underwent surgical decompression of the craniovertebral junction, with or without syringosubarachnoid shunting, with good results. CONCLUSION: Cases of familial Chiari I malformation are rare, although they are probably under-reported. An evaluation of posterior fossa morphology in these patients suggests that occipital dysplasia and overcrowding of posterior fossa contents may be the substrate for both familial and sporadic cases of Chiari I malformation and suggests a unifying concept of origin.

Adolescent↗
PubMed1998

Juxtafacet cysts of the cervical spine.

OBJECTIVE: We report a retrospective series of 13 patients who presented with symptoms and signs caused by cervical juxtafacet cysts. Clinical findings, radiographic features, surgical management strategies, and possible causes are reported and discussed. METHODS: We reviewed clinical histories, radiographic studies, surgical notes, and pathological records of all 13 patients who underwent surgery for subaxial cervical juxtafacet cysts from 1984 to 1997 at the Mayo Clinic in Rochester, MN. During the summer of 1997, surgical outcomes were assessed by direct or telephone interview. RESULTS: Nine patients were men and four were women. The average age at the time of presentation was 66 years. One patient had undergone a previous anterior cervical fusion below the level of the cyst. Ten patients presented with radiculopathies. Two patients presented with myeloradiculopathies. One patient presented with a cervical myelopathy. Computed tomographic myelography and magnetic resonance imaging were essential in establishing a preoperative diagnosis. The cysts were located at C7-T1 in nine patients, at C4-C5 in two patients, at C6-C7 in one patient, and at C3-C4 in one patient. All patients underwent posterior laminectomy or hemilaminectomy, excision of the cyst, and decompression of the thecal sac and/or nerve root. Two patients underwent concurrent posterior fusion procedures for instability. All patients experienced good to excellent relief of their radicular pain. All three myelopathies stabilized after surgery. There were no major complications or recurrences. CONCLUSION: Juxtafacet cysts seem to be a degenerative change of the cervical spine rather than a traumatic event. Similar to their counterparts in the lumbar spine, they tend to arise in segments with increased mobility. Surgical treatment is effective.

Aged↗
PubMed1998

Orthostatic headaches caused by CSF leak but with normal CSF pressures.

OBJECTIVE: To report that the syndrome of orthostatic headaches caused by CSF leak can be seen with persistently normal CSF pressures. BACKGROUND: CSF leak or shunt overdrainage is known to cause orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPGE), typically associated with unmeasurable or very low CSF pressures. METHODS: Of 40 consecutive patients with orthostatic headaches and DPGE, all had low or unmeasurable CSF pressures, except seven patients who had consistently normal CSF pressures and are thus reported. All had undergone multiple CSF examinations. RESULTS: Two patients had overdraining shunts, and five had documented CSF leaks. One refused treatment, but the other six patients responded to surgical treatment or epidural blood patch with complete resolution of symptoms and related MRI abnormalities. CONCLUSIONS: Some patients with symptomatic CSF leaks may have CSF opening pressures that are consistently within normal limits. In the presence of convincing clinical features and imaging abnormalities, a normal CSF pressure should not discourage the clinician from searching for a source of CSF leak.

Adult↗
PubMed1998

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases.

OBJECT: Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail. METHODS: The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation. CONCLUSIONS: This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

Adult↗
PubMed1998

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks.

OBJECT: Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. METHODS: Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22-61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. CONCLUSIONS: All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3-58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Adult↗
PubMed1998

Tardy sciatic nerve palsy following apophyseal avulsion fracture of the ischial tuberosity. Case report.

This 4 1-year-old man presented with a 2-year history of symptoms and signs of sciatic nerve compression. Imaging studies revealed a large ossified fragment within the biceps muscle of the thigh abutting the sciatic nerve at the level of the lesser trochanter. The bony fragment resulted from an unrecognized apophyseal avulsion fracture of the ischial tuberosity, which the patient had sustained while sprinting 27 years earlier. External neurolysis of the sciatic nerve and excision of the mass led to a successful outcome.

Adult↗
PubMed1997

Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils.

The authors report their experience using electrolytically detachable coils for the treatment of ruptured posterior circulation aneurysms. Twenty-six patients with 28 posterior circulation aneurysms were treated. All patients were referred for endovascular treatment by experienced vascular neurosurgeons. Patients underwent follow-up angiography immediately after treatment, 1 to 6 weeks posttreatment, and 6 months posttreatment. Six-month follow-up angiograms obtained in 19 patients with 20 aneurysms demonstrated that 18 (90%) of the 20 aneurysms were 99 to 100% occluded, one aneurysm (5%) was approximately 90% occluded, and one aneurysm (5%) was approximately 75% occluded. The patient with the aneurysm that was approximately 75% occluded needed additional treatment, consisting of parent artery balloon occlusion, and was considered a treatment failure (3.8% of patients). There was one treatment-associated mortality (3.8%) but no treatment-associated serious neurological or nonneurological morbidity in the patient group. There was no recurrent aneurysm rupture during treatment or during the mean 27-month follow-up period. Endovascular treatment of ruptured posterior circulation aneurysms with electrolytically detachable coils can be accomplished with low morbidity and mortality rates. The primary goal of treatment--preventing recurrent aneurysm--can be achieved over the short term. Endovascular coil occlusion will play an important role in the treatment of ruptured posterior circulation aneurysms, particularly if long-term efficacy in preventing recurrent aneurysm hemorrhage can be documented.

Adult↗
PubMed1996

Progressive intracranial aneurysmal disease in a child with progressive hemifacial atrophy (Parry-Romberg disease): case report.

Intracranial aneurysms are uncommon in children, and their presence often leads to suspicion of a systemic connective tissue disorder. We describe the case of a young male patient with progressive hemifacial atrophy (Parry-Romberg disease) and multiple intracranial aneurysms, a previously undescribed association, and propose that a neural crest defect may be the underlying abnormality in this patient. At age 5 years, the patient was treated for a giant aneurysm of the left cavernous carotid artery with carotid ligation in the neck and a superficial temporal artery-middle cerebral artery bypass. At age 12 years, the patient was similarly treated for a giant aneurysm of the right cavernous carotid artery, which had progressed from a previously noted minute dilatation at age 5 years, with carotid ligation and a superficial temporal artery-middle cerebral artery bypass. At age 21 years, the patient was endovascularly treated for a de novo saccular aneurysm of the left posterior cerebral artery at the P1-P2 junction and a fusiform aneurysm of the distal left posterior cerebral artery. Various studies have suggested that the facial dermis, the subcutaneous tissues, and the skeleton, as well as the tunica media of the cervicocephalic arteries, all arise from neural crest cells, and a disorder of neural crest migration might explain the constellation of findings in this patient.

Adolescent↗
PubMed1996

Effects of growth hormone administration and dietary protein intake on insulin-like growth factor I and growth hormone receptor mRNA Expression in porcine liver, skeletal muscle, and adipose tissue.

The effects of growth hormone (GH) and dietary protein on expression of IGF-I and GH receptor (GHR) genes in liver, muscle, and fat of pigs were investigated. Forty-eight intact male Large White x Landrace pigs were allotted to eight treatment groups (four diets with or without GH). The pigs were restriction-fed one of four diets, which differed only in their protein content (9.9, 13.1, 16.2, and 19.4%, as-fed basis), for a total of 3 wk. The pigs were then injected intramuscularly with either porcine GH (50 micrograms.kg-1.d-1 of rpST) or vehicle for the last 7 d. Pigs were slaughtered 4 h after the final injection. Total RNA was extracted from all tissues and then RNase protection assays were performed to measure expression of IGF-I and GHR genes. Expression of IGF-I mRNA was found to be GH responsive in the liver, semitendinosus (ST), and adipose tissue (P < .01) but not in longissimus muscle (LD). Dietary protein increased IGF-I expression only in the adipose tissue (P < .01). Expression of class 2 transcripts of IGF-I were observed only in the livers of GH-treated pigs, with no effect of dietary protein. Expression of GHR mRNA was found to increase with GH administration in liver and skeletal muscle (LD and ST, P < .05) but not in adipose tissue. There were diet x GH interactions on GHR expression in liver, ST, and adipose tissue, resulting in the highest GHR expression being in the high protein-fed, GH-treated group for liver, but in the low protein-fed, GH-treated group for muscle and adipose tissue. This study demonstrates tissue-specific control of expression of the two genes and also tissue-specific promoter usage (IGF-I exon 2 in liver) in response to GH administration.

Adipose Tissue↗