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Biomedical subjects

M D Hourihan

Publications and source records attributed to M D Hourihan.

At least 19 recordsLinked to original sources
PubMed2004

Venous angioma of the facial nerve: a case report.

BACKGROUND: Lower motor neurone type facial nerve palsy is a common condition that is very rarely caused by a neoplastic lesion. CASE DESCRIPTION: This case report describes a progressive facial palsy in a 62-year-old man because of a vascular tumor of the facial nerve. Histologic examination confirmed it to be a venous angioma. CONCLUSION: Meticulous imaging of the facial nerve is required to diagnose cases of progressive facial nerve palsy caused by a neoplastic lesion.

Facial Nerve↗
PubMed2004

Spinal subdural haematoma: how relevant is the INR?

STUDY DESIGN: Case report. OBJECTIVE: To report a rare cause of spinal cord compression. SETTING: University Hospital, Wales, UK. CASE REPORT: A 67-year-old gentleman on oral anticoagulation for atrial fibrillation presented with a 4-h history of progressive loss of sensation and weakness in both legs; there was no history of trauma. On examination, he had a flaccid paraplegia with altered sensation in the L1,2,3 dermatomes and complete anaesthesia in the L4,5 distribution. Knee and ankle jerk reflexes were absent, plantars were equivocal and anal sphincter tone was reduced. The patient's international normalized ratio (INR) was 4.1. An MR scan showed an extensive intradural haematoma compressing the cauda equina. The anticoagulation was reversed and an urgent T12-L2 laminectomy was performed; findings were a circumferential haematoma at L1 extending in the anterior canal between T10 and L3. The patient had an uneventful postoperative course generally, but at 1 week there was no neurological recovery. CONCLUSION: This case highlights that anticoagulation even when well controlled is not without risk. This is particularly of concern as the number of patients receiving long-term anticoagulation therapy has doubled between 1993 and 1998.

Aged↗
PubMed2004

Are T1 weighted images helpful in MRI of cervical radiculopathy?

MRI in patients with cervical myelopathy or radiculopathy usually includes T(1) weighted (T(1)W) and T(2) weighted (T(2)W) images. We prospectively examined a hypothesis that T(2)W alone is sufficient to diagnose the cause of cervical myelopathy and radiculopathy and that the T(1)W sagittal images do not provide additional useful information. 30 patients presenting with a history of cervical radiculopathy with or without myelopathy were prospectively assessed by MRI. Those with a history suggestive of intrinsic primary cord disease or who had previously had surgery were excluded. Two neuroradiologists, blinded to the clinical information, separately viewed the sagittal and axial T(2)W images alone, and at a later time, the full set of T(1)W and T(2)W images. Image quality, location and severity of disease and confidence of diagnosis at each level were scored on 4- or 5-point scales. The T(1) sequences did not demonstrate any significant lesions not already seen on the T(2)W images alone. The T(1)W sequence may safely be omitted in patients with radiculopathy.

Adult↗
PubMed2000

Diagnosing CADASIL using MRI: evidence from families with known mutations of Notch 3 gene.

Clinical data and MRI findings are presented on 18 subjects from two families with neuropathologically confirmed CADASIL. DNA analysis revealed mutations in exon 4 of Notch 3 gene in both families. All family members with mutations in Notch 3 gene had extensive abnormalities on MRI, principally lesions in the white matter of the frontal lobes and in the external capsules. Of several family members in whom a diagnosis of CADASIL was suspected on the basis of minor symptoms, one had MRI changes consistent with CADASIL; none of these cases carried a mutation in the Notch 3 gene. MRI and clinical features that may alert the radiologist to the diagnosis of CADASIL are reviewed. However, a wide differential diagnosis exists for the MRI appearances of CADASIL, including multiple sclerosis and small-vessel disease secondary to hypertension. The definitive diagnosis cannot be made on MRI alone and requires additional evidence, where available, from a positive family history and by screening DNA for mutations of Notch 3 gene.

Adult↗
PubMed1999

A prospective comparison of brain contrast characteristics and lesion detection using single-shot fast spin-echo and fast spin-echo.

MRI is limited by movement artefact, even with current imagers, when examining a restless or claustrophobic patient. We prospectively analysed the images of 92 patients produced by a single-shot fast spin-echo (SSFSE) pulse sequence and compared them with conventional (FSE) and reduced-time fast spin-echo (RT-FSE) techniques, with regard to lesion detection and movement artefact in brain imaging. Images obtained in each case were independently reviewed and scored for overall diagnosis, number of lesions detected, and movement artefact. FSE showed 1217 lesions, RT-FSE 1137, and SSFSE 1044. This discrepancy arose mainly in patients with multiple sclerosis or small-vessel disease, since with SSFSE we were less able to separate small, adjacent low-contrast lesions than with FSE. Arbitrary movement scores were 36, 25 and zero respectively. There were, however, no clinically significant differences in overall diagnosis between the three techniques. SSFSE thus proved a reliable, fast, accurate method for obtaining T2-weighted images, and may be of particular use in the restless, claustrophobic or obtunded patient.

Algorithms↗
PubMed1999

Computed tomography evaluation of the inner ear as a diagnostic, counselling and management strategy in patients with congenital sensorineural hearing impairment.

The value of computed tomography (CT) of the petrous bone in the investigation of congenital sensorineural hearing impairment has been questioned. We have conducted a study to establish the usefulness of CT of the temporal bone in the evaluation and management of a consecutive series of unselected adolescent patients with congenital sensorineural hearing impairment of greater than 50 dB HL. Seventy-one patients (142 ears) were identified and images reviewed to establish the incidence of inner ear malformations. Fifteen ears were found to be abnormal in eight patients (seven bilateral and one unilateral abnormality). Three patients had Mondini abnormalities and one of these also had dilatation of the lateral semicircular canals. There were five patients with dilatation of the vestibular aqueduct. One patient had a unilateral dysplasia of the middle and external ear. A variety of incidental intracranial abnormalities were also discovered. We conclude that CT does have a valuable role in the management of SNHI.

Adolescent↗
PubMed1999

Multi-disciplinary research can be more than parallel-disciplinary research: the case of GPs' use of magnetic resonance imaging.

OBJECTIVES: We aimed to show how in multi-disciplinary research data collected to meet the needs of one discipline can provide information of value to another. METHODS: Using the critical incident technique, 25 GPs were interviewed about recent scans requested for patients with knee and lumbar spine complaints. Transcripts of the interviews were scrutinized from both a medical and an economic perspective. RESULTS: Five key economic issues where further research is needed were identified. CONCLUSIONS: The total value of the information provided by multi-disciplinary research may exceed the sum of the information collected to meet the requirements of the individual disciplines.

Cooperative Behavior↗
PubMed1999

Posterior fossa epithelial cyst: case report and review of the literature.

A 49-year old woman with progressive cranial nerve signs and hemiparesis was found at MR imaging and at surgery to have a cyst at the foramen magnum. Immunohistochemistry and electron microscopy showed an epithelial cyst of endodermal origin. MR findings were of an extraaxial mass, with short T1 and T2 times. Unless immunohistochemistry and electron microscopy are used in the final diagnosis of such cysts, all posterior fossa cysts lined by a single layer of epithelium should be described simply as epithelial cysts.

Brain Diseases↗
PubMed1997

MRI of the anterior optic pathways following enucleation.

We examined five patients who had enucleation of one eye for inflammatory or neoplastic disease, using MRI at 1.5 Tesla. None had symptoms referable to the enucleated orbit. In addition, age- and-sex matched individuals were imaged as control subjects, and a further 15 subjects, referred for other than orbital disease, were reviewed. Measurements were made retrospectively of the dimensions of the optic chiasm to establish normal values. All five patients showed abnormalities on MRI following enucleation: abnormal signal within the optic nerve remnant on short tau inversion recovery (STIR) images, and atrophy of the nerve remnant and the chiasm. These findings were not apparent in the control or normal subjects. Such findings are to be expected following enucleation and should not be interpreted as indicating active pathology.

Aged↗
PubMed1995

MRI of idiopathic orbital inflammatory syndrome using fat saturation and Gd-DTPA.

Idiopathic orbital inflammatory syndrome encompasses a group of inflammatory conditions for which no systemic or local cause can be found, and is commonly referred to as orbital pseudotumour. On conventional MRI sequences subtle areas of inflammation or enhancing tissue can easily be masked by the high signal intensity of orbital fat and involvement of the fat itself may not be appreciated. We describe the MRI features of three patients with idiopathic orbital inflammation using frequency-selective fat saturation and Gd-DTPA.

Adipose Tissue↗
PubMed1993

Isolated atraumatic third nerve palsy: clinical features and imaging techniques.

We have reviewed 34 consecutive patients imaged for an isolated third nerve palsy over a 2-year period. With pupil sparing the third nerve palsy was most often due to ischaemic microvascular disease. The commonest cause of a third nerve palsy with pupillary involvement was a posterior communicating artery aneurysm. Clinical features such as speed of onset, pain and completeness of palsy were not reliable in the diagnosis of either the nature or the location of the cause. Pupillary involvement was however often associated with a compressive lesion. Imaging along the whole course of the nerve is recommended for adequate evaluation.

Adult↗
PubMed1992

Case report: acute subdural haematoma--an unusual presentation of a meningioma.

Acute subdural haemorrhage is usually the result of a head injury, but when it occurs without a history of trauma, an underlying cause must be suspected. An unusual case is described of an acute subdural haematoma in association with a parasagittal meningioma. This is a rare but serious complication of a meningioma and outcome depends upon prompt removal of the tumour.

Acute Disease↗