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Biomedical subjects

L D Cromwell

Publications and source records attributed to L D Cromwell.

50 records · Page 3Linked to original sources
PubMed1977

Asymptomatic angiographic occlusion of the internal carotid artery: an indication for emergency endarterectomy.

A 56-year-old man had retinal artery embolization from a carotid artery atheroma. Complete occlusion of the internal carotid artery occurred during cerebral angiography, but the patient developed no acute symptoms of cerebral ischemia. The patient immediately underwent emergency carotid endarterectomy which he tolerated well, and follow-up angiography nine days later demonstrated continued patency. The patient has remained neurologically unchanged.

Arterial Occlusive Diseases↗
PubMed1976

Pediatric pneumoencephalography with nitrous oxide.

The recent advances in neurodiagnostic procedures have changed pneumoencephalography. Now we must find the smallest lesions and demonstrate accurately their relationships to the ventricular system cisterns and surrounding structures. Complex blurring motion tomography gives this detail, but the pediatric patients are difficult to examine and immobilization during the long exposure needed for tomography frequently compromises the airway. Hypoventilation from sedation and from the radiographic positioning may lead to increased intracranial pressure. By performing pediatric pneumoencephalography under general anesthesia, with nitrous oxide as both an anesthetic agent and as the contrast material, we are able to control patient motion, preserve the child's airway, and prevent hypoventilation. The nitrous oxide, rapidly diffusible, is a good contrast agent, as large volumes can be used and the gas leaves the ventricular system quickly after the discontinuation of the anesthetic. This rapid reabsorption and elimination of the subarachnoid gas may decrease pneumoencephalographic morbidity.

Adolescent↗
PubMed1975

Selective cerebral angiography through the axillary artery.

The femoral artery approach to cerebral angiography has become well accepted. Some patients, however, are not candidates for femoral catheterization because of severe arteriosclerosis. One hundred cerebral angiograms were performed in 88 severely arteriosclerotic patients, using No. 5 French polyethylene catheters and the axillary approach. The technique, degree of success, patient population, and their complications are described. This approach allows selective vertebral and internal carotid artery injections. Only one serious complication occurred, thrombosis of the axillary artery. Because of the time saved, this technique is often preferable to the femoral approach in severely arteriosclerotic patients.

Axillary Artery↗
PubMed1975

Selective carotid angiography in the diagnosis of fibrous histiocytoma. A case report.

Selective carotid angiography is of value in the diagnosis of an orbital fibrous histiocytoma, an uncommon tumor with a high local recurrence rate and frequent distant metastases. The angiogram shows the physical extent of the tumor and also suggests its general microscopic anatomy. Comparison is made with similar angiographic presentations seen in cerebellar hemangioblastomas, glomus tumors, meningiomas, and hemangiopericytomas.

Adult↗
PubMedDate not supplied

Auditory dysfunction caused by multiple sclerosis: detection with MR imaging.

We reviewed the MR examinations of 167 patients who presented over a 3-year period with a chief symptom of hearing loss and/or tinnitus. In 14 of these patients the only MR abnormality was the presence of multiple parenchymal high-signal foci on T2-weighted images. Nine of the 14 had clinical evidence of multiple sclerosis; the remaining five had no clinical evidence of multiple sclerosis. Lesions in the auditory pathways, potentially responsible for the patients' symptoms, were identified in only five cases. We recommend T2-weighted images of the whole brain in addition to T1-weighted images of the internal auditory canals and cerebellopontine angles in patients with hearing loss. In some patients, lesions found at higher levels in the periventricular white matter may provide the only clue to the origin of auditory abnormalities.

Adult↗
PubMedDate not supplied

MR imaging of corpus callosotomy.

MR findings in 13 patients who underwent corpus callosotomy for medically intractable seizures were reviewed. Preoperative MR studies were available in nine patients: five showed at least one morphological and/or MR signal abnormality including corpus callosal thinning (four cases), cerebellar atrophy (two cases), cortical atrophy (two cases), and periventricular hyperintensity on T2-weighted images (one case). Four patients had normal MR studies. Postoperative MR studies were obtained in 11 patients with subtotal callosotomy and two with total callosotomy. Of all pulse sequences, sagittal T1-weighted images best showed the surgical division, although two cases displayed a coaptation artifact, which was misleading. A surgical clip placed at the posterior extent of the callosotomy was best visualized with sagittal T1-weighted imaging. Two patients (15%) had MR findings consistent with subacute blood in the callosum, and three patients (23%) demonstrated parafalcial hyperintensity on T2-weighted images 1 week after callosotomy. Motion artifact was a significant problem with coronal imaging and T2-weighted pulse sequences in postoperative patients. Patients selected for corpus callosotomy may have a normal baseline MR or show nonspecific abnormalities. MR imaging is an effective method for evaluating callosal division, and in some cases, may demonstrate signal changes consistent with surgically related edema and/or blood.

Adolescent↗
PubMedDate not supplied

Treatment of cerebral arteriovenous malformations: combined neurosurgical and neuroradiologic approach.

Experience with 31 intraoperative embolizations performed on 23 patients is reported. The procedure involves the direct injection of embolic material into the main arterial feeders during craniotomy. The combined effort involves the exposure of the lesion at craniotomy, standard arteriotomy, and fluoroscopically monitored intravascular infusion of contrast material followed by the injection of bucrylate (IBCA, Ethicon, Somerville, NJ) mixed with tantalum or Pantopaque into the feeding vessels and into the interstices of the malformation. It was concluded that the procedure significantly diminishes operating time and blood loss for the lesions that were subsequently resected. Fluoroscopy coupled with high-quality stop-frame videotape recording allows a detailed study of the flow characteristics of the malformation so that polymerization time can be regulated appropriately. Follow-up varied from 3 months to 4 1/2 years. There were two deaths related to the procedure and one additional complication of cortical blindness that partially resolved. None of the survivors rebled. Most of the survivors improved.

Adolescent↗