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Biomedical subjects

J Lester

Publications and source records attributed to J Lester.

At least 19 recordsLinked to original sources
PubMed1987

Resistance to cerebrospinal fluid outflow and intracranial pressure in patients with hydrocephalus after subarachnoid haemorrhage.

Resistance to CSF-outflow (Rout) and intracranial pressure (ICP) were measured in 33 patients with hydrocephalus after subarachnoid haemorrhage (SAH). Eleven patients examined between 10 to 30 days after SAH had high pressure hydrocephalus (HPH). Twenty-two patients had normal pressure hydrocephalus (NPH). All HPH-patients had ICP above 15 mmHg, plateau waves and B-waves, a median Rout of 59 mmHg x ml-1 x min-1 (range 29-100). All NPH-patients had a normal ICP level, no plateau waves, but long periods of B-waves and a median Rout of 22 mmHg x ml-1 x min-1 (range 6-47). Of the 11 patients with HPH six were shunted and five had temporary ventricular drainage. Five patients improved and six died. Of the five survivors only one went back to work. Of the 22 NPH-patients 18 were treated with a shunt, one refused shunt operation and three had normal Rout. Seventeen improved after shunting. At follow-up 12 had a normal social life, 5 lived in a nursing home and 1 was dead. Thus, early development of hydrocephalus after subarachnoid haemorrhage is associated with a high Rout and a high ICP, whereas late (more than one month) hydrocephalus may be associated with normal ICP and high Rout. Patients with NPH and a high Rout have frequent B-waves and should be shunted. Patients with a long interval from subarachnoid haemorrhage to the diagnosis of hydrocephalus often have a normal ICP, low frequency of B-waves, normal CSF-dynamics and need no shunting.

Adult↗
PubMed1987

High-resolution nuclear magnetic resonance imaging and single photon emission computerized tomography--cerebral blood flow in a case of pure sensory stroke and mild dementia owing to subcortical arteriosclerotic encephalopathy (Binswanger's disease).

Pure sensory stroke (PSS) is typically caused by a lacunar infarct located in the ventral-posterior (VP) thalamic nucleus contralateral to the paresthetic symptoms. The lesion is usually so small that it cannot be seen on computerized tomography (CT), as illustrated by our case. In our moderately hypertensive, 72-year-old patient with PSS, CT scanning and conventional nuclear magnetic resonance imaging (NMRI) scanning using a 7-mm-thick slice on a 1.5 Tesla instrument all failed to visualize the thalamic infarct. Using the high-resolution mode with 2-mm slice thickness it was, however, clearly seen. In addition, NMRI unexpectedly showed diffuse periventricular demyelinization as well as three other lacunar infarcts, i.e., findings characteristic of subcortical arteriosclerotic encephalopathy (SAE). This prompted psychometric testing, which revealed signs of mild (subclinical) dementia, in particular involving visiospatial apraxia; this pointed to decreased function of the right parietal cortex, which was structurally intact on CT and NMRI. Single photon emission computerized tomography by Xenon-133 injection and by hexamethyl-propyleneamine-oxim labeled with Technetium-99m showed asymmetric distribution of cerebral blood flow (CBF), with an 18% lower value in the right parietal cortex compared to the left side; this indicated asymmetric disconnection of the cortex by the SAE. Thus, the tomograms of the functional parameter, CBF, correlated better with the deficits revealed by neuropsychological testing than by CT or NMRI.

Aged↗
PubMed1986

Carotid surgery, cognitive function, and cerebral blood flow in patients with transient ischemic attacks.

Psychological testing, cerebral blood flow (CBF) measurement, and computed tomographic scan were performed before and 3 months after operation in 31 patients subjected to endarterectomy of the internal carotid artery (ICA) because of transient ischemic attacks and in 11 control patients operated on for atherosclerosis of the lower extremities. In preoperative psychological testing both carotid surgery patients and controls performed somewhat below the normal level for their age group. Postoperatively, cognitive functions improved in the carotid surgery group but not in the control group. The improvement was related to the laterality of the operation, being more marked in verbal tests in patients with left ICA operation and in visuospatial tests in patients with right ICA operation. Postoperatively regional CBF improved in 2 patients only. Hence the intellectual improvement could not be related to changes in CBF. Intellectual deterioration in patients with internal carotid atherosclerosis may be delayed or terminated by surgical abolition of the source of multiple cerebral embolizations.

Adult↗
PubMed1986

Spontaneous intracerebral haematomas. Clinical and computertomographic findings and long-term outcome after surgical treatment.

Fifty-four patients, aged 15 to 81 years had a spontaneous intracerebral haematoma surgically removed (51 patients) or had ventricular drainage. One-third had arterial hypertension. Two thirds were alert or drowsy preoperatively and two thirds presented with hemiparesis or decerebrate rigidity. Lobar haematomas constituted 72%, deep supratentorial constituted 21% and cerebellar haematomas 7%. Volume of the haematomas ranged from 10 to 205 ml. 10 patients died in the early postoperative phase and 8 patients died later. Among 36 survivors, 35 were evaluated 15-115 months postoperatively. 10 had resumed part of their earlier occupation. Another 12 were incapacitated and the remaining 13 patients needed nursing care. No patient was neurologically or neuropsychologically intact, but 19 had only slight disabilities. CT-changes at follow-up ranged from no abnormalities at all to low-density lesions, possibly associated with dilatation of a lateral ventricle or porencephaly depending on the size of the haematoma and possible ventricular penetration. Surgical evacuation of ICH is recommended in lobar or deep supratentorial haematomas exceeding 20 ml except in patients older than 60 already unconscious. Smaller haematomas with intraventricular extension may benefit from ventricular drainage or, in the fossa posterior, even from evacuation in case of increasing brain stem compression.

Adolescent↗
PubMed1977

Computed tomography of orbital lesions. A radiological study of 144 cases.

During the first two years with the 160 x 160 matrix EMI scanner 144 consecutive patients referred with suspicion of orbital disease were subjected to 190 computed tomography (CT) examinations. The X-ray attenuation and enhancement patterns of the various lesions were analyzed. In general it was difficult to correlate these parameters with the histopathological features. Hemangiomas, however, showed little enhancement and meningiomas a large degree of enhancement, while malignancies, lymphomas and pseudotumors were mainly intermediate. With orbital Graves' disease a low preinjection attenuation and a large enhancement (with normal striated neck muscle as a reference) was found in the external eye muscles. The diagnostic accuracy of CT (n=143) was compared to that of A/scan ultrasonography (US, n=80) and carotid angiography (n=40). CT showed the highest accuracy of the three methods, but CT differed only statistically from carotid angiography.

Adolescent↗
PubMed1977

Computer tomography of cerebellopontine angle lesions.

Computer tomography (CT) was used in 53 consecutive patients with a working diagnosis of cerebellopontine angle tumor. The CT was performed with the 160 X 160 matrix scanner, height of sections was 13 mm. Metrizoate sodium (1.5 ml/kg of body weight) was used for tumor enhancement. Seventeen CT scans revealed tumors; one patient proved at operation to be false-positive. Thirty-six CT scans revealed no tumors; two examinations may prove to be false-negative, but surgical verification has so far not been obtained. The smallest tumor demonstrated by CT extended 7 mm into the angle, while one of the possible false-negative CT scans after iophendylate injection cisternography showed a tumor extending 5 mm into the angle. It is concluded that CT is a harmless, noninvasive neuroradiological procedure, and should precede invasive procedures. It can be used safely in patients with increased intracranial pressure.

Adult↗
PubMed1976

Cerebellopontine pantopaque cisternography and tomography of the internal acoustic meatus in the diagnosis of angle tumors.

The results of 106 consecutive Pantopaque cisternographies performed at the neuro-radiological department, Rigshospitalet, are presented. 41 positive and 65 negative examinations were found. Good accordance between radiological tumor size estimation and size of actual, surgically verified tumor was noted. A comparison between tomography of the internal auditory canal and pantopaque cisternography of the posterior fossa has been made, and we found 6 cases with normal tomography and positive cisternography. Furthermore 17 cases (26%) with pathological tomographic examination of internal auditory canal as well as a negative finding at Pantopaque cisternography, were encountered. Therefore we conclude that asymmetry of the radiological appearance of the internal auditory canal at tomography is not of decisive importance in the indication for cisternography, but the examination should be included in the test battery in search for cerebellopontine angle pathology. We agree with other authors that Pantopaque cisternography is without any doubt the final and most conclusive examination available for the diagnosis of cerebellopontine angle tumors. A system of grading the different objective findings giving indication for Pantopaque cisternography has been made.

Auditory Pathways↗
PubMed1976

Computer tomography in the diagnosis of cerebellopontine angle tumours.

53 patients clinically suspected of having a cerebellopontine angle (CPA) lesion were examined by computer tomography (CT) with 160 X 160 matrix EMI scanner. 17 cases (32%) had tumour positive CT, of which 12 were neurinomas and 1 meningioma. 1 CT suggestive of a CPA lesion was false positive and 1 unoperated case is probably a false negative CT. Three of the eleven verified neurinomas (27%) were of the medial type originating in the angle cistern. One neurinoma protruding 1 cm into the cistern showed no contrast enhancement. 2 CT scans (3.8%) were unsatisfactory due to movements and the large size of the head. CT is valuable for the investigation of CPA pathology and the diagnostic efficiency compares favourably to other neuroradiological procedures.

Adolescent↗