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Biomedical subjects

M Daras

Publications and source records attributed to M Daras.

At least 37 records · Page 2Linked to original sources

Multiple spinal intradural schwannomas in the absence of von Recklinghausen's disease.

A case of multiple spinal schwannomas is reported without any evidence of other manifestations of neurofibromatosis. Although cases of multiple schwannomas have been described in the setting of "Schwannomatosis," this case is unique in that all tumors were within the spinal canal. The presence of a schwannoma should prompt a complete investigation for other tumors of the nervous system preferably with magnetic resonance imaging.

Adult↗

Transient hypodensity on CT scan during hypoglycemia.

A diabetic patient became hypoglycemic with right hemiparesis during a contrast-enhanced CT scan. The scan showed a nonenhancing hypodensity in the left internal capsule, that disappeared the following day after treatment with glucose. This is consistent with experimental models that show selective vulnerability of various brain regions to hypoglycemia.

Aphasia↗

Segmental myoclonus preceding herpes zoster radiculitis.

Segmental myoclonus arising in the spinal cord occurs with several viral infections, including herpes zoster radiculitis. Usually, abnormal movements follow the rash and require drug treatment to suppress. We report a patient with AIDS in whom arm and shoulder myoclonus preceded herpes zoster involving the same segments contralaterally on two occasions. Myoclonus remitted promptly with antiviral treatment. Unlike in other immunosuppressed patients, encephalitis did not occur after the second episode.

Acquired Immunodeficiency Syndrome↗

Use of CT in epilepsy: does it matter how long you wait?

Computer tomography (CT) of the brain is of value for finding potentially correctable lesions in adult patients with new onset seizures. The value of CT is unknown, however, for finding such lesions in adult chronic epileptic patients without prior CT. We compared a group of 177 adult patients who had CT within a year from the onset of seizures to a group of 93 patients who had a history of seizures for more than a year before CT was performed. In the first group, 33 potentially correctable lesions (19%) were found including 17 tumors. The group with chronic epilepsy had 4 (4%) potentially correctable lesions: 3 arteriovenous malformations and 1 meningioma. It seems that CT is of value in discovering potentially removable lesions in chronic epileptic patients, but the likelihood is relatively small. The incidence of stable structural lesions seems to be similar in the two groups.

Adult↗

Central nervous system infarction related to cocaine abuse.

BACKGROUND: Cocaine use in the United States has reached epidemic proportions, and increased availability of "crack" since 1983 has noticeably increased the incidence of neurovascular complications. In this report, we examine the relationship between cocaine use and ischemic infarct. SUMMARY OF COMMENT: This study reports 18 cases of ischemic cerebrovascular events, which occurred among 15 men and three women aged 21-47 years who were evaluated in a 2-year period. Clinical presentations include thirteen cases with hemispheric infarcts, two brain stem strokes, two anterior spinal artery infarcts, and one with both hemispheric and cerebellar infarcts. Nine patients smoked crack, four snorted cocaine, and three injected it intravenously. In two cases, the route of administration could not be determined. Two patients died, but the other survived with various degrees of neurological deficit. CONCLUSIONS: Traditional risk factors for strokes were identified in only six patients, suggesting that these factors are not necessary for the occurrence of a cocaine-related infarct. Multiple overlapping mechanisms may be responsible, including vasospasm, sudden onset of hypertension, myocardial infarction with cardiac arrhythmias, increased platelet aggregation, and vasculitis.

Adult↗

"Rubral" tremor due to midbrain Toxoplasma abscess.

We describe a patient with "rubral" tremor due to a Toxoplasma abscess of the midbrain. Despite treatment that was effective in promoting partial computed tomography resolution of the lesion, the tremor remained unchanged.

Adult↗

Intramedullary spinal cord abscess.

Viral myelitis and bacterial epidural infections are common in intravenous drug abusers, but primary infections of the spinal cord are extremely rare. We report a 50-year-old active intravenous drug user who developed tetraplegia from an intramedullary abscess caused by Pseudomonas cepacia. Despite neurosurgical drainage and appropriate antibiotic therapy, no improvement was seen. Earlier intervention and a high index of suspicion is required in patients with a history of intravenous drug abuse and spinal cord symptoms.

Abscess↗

Muscle contraction headache: dexamethasone suppression test and response to amitriptyline.

Chronic muscle contraction headache (CMCH) and depression have many features in common. Patients with CMCH respond to antidepressants. We attempted to further elucidate this relationship through the use of the dexamethasone suppression test (DST) pattern of patients suffering from CMCH as well as their response to amitriptyline. Twenty drug-free patients suffering from CMCH of at least 6 months' duration were studied with DST and subsequently treated with amitriptyline 75 mg at bedtime. Nineteen patients completed the treatment trial and reported variable headache relief. All cortisol levels were within the expected range. We conclude CMCH patients do not display the DST pattern of endogenous depression.

Adult↗

Epidural spinal infection in intravenous drug abusers.

The incidence of spinal epidural abscess and disk space infection appears to be rising in intravenous drug-using patients. We report 18 cases seen over three years in two municipal hospitals. Staphylococcus aureus was the most common infective agent, but two patients had Mycobacterium tuberculosis infection. Computed tomography of the spine facilitates diagnosis. Early treatment improves outcome but host factors play a role in recovery.

Abscess↗

Cocaine-related intracranial hemorrhage. Report of nine cases and review.

Nine cases of intracranial hemorrhages related to cocaine usage are presented. Another 5 cases from the literature are reviewed. The relationship between severe cocaine-induced hypertension, and the development of subarachnoid or intracerebral hemorrhages is noted, and apparently is related to sudden transient increases of blood pressure related to cocaine use.

Adult↗

Increased prolactin response to thyrotropin releasing hormone during migraine attacks.

Prolactin (PRL) has been associated with the pathogenesis of migraine, and various approaches have been used to investigate its role. In the present study, the PRL response to thyrotropin-releasing hormone (TRH) was evaluated in eight women migraineurs during an attack-free state and during a migraine attack. PRL baseline values were not different in the two states, and the same was true for the TSH responses to TRH. The PRL responses to TRH were, however, significantly higher during the attack, a finding that indicates a latent disturbance of the PRL-regulating systems in migraine, with a higher responsiveness during migraine attacks.

Adult↗