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Biomedical subjects

M E Mawad

Publications and source records attributed to M E Mawad.

At least 19 recordsLinked to original sources
PubMed2006

Neonate with vein of Galen malformation and heart failure: serial changes in plasma B-type natriuretic peptide following endovascular embolization.

We report a neonate with vein of Galen malformation (VGM) who developed congestive heart failure (CHF) early after birth. Serial changes in plasma B-type natriuretic peptide (BNP) following an endovascular embolization procedure for VGM were mirrored in his clinical CHF status. The plasma BNP level markedly increased to 1800 pg/ml (normal, <100 pg/ml) in accordance with the severity of CHF. It rapidly decreased to 356 pg/ml during the first week after endovascular embolization for VGM. In the following 3 weeks there was an unexpected upward trend in plasma BNP despite echocardiography revealing normal biventricular function. After additional evaluation and treatment for CHF, BNP decreased again and the patient's clinical status concurrently improved. The patient was discharged with a normal BNP level. Monitoring serial plasma BNP provides valuable information regarding the need for additional evaluation or treatment of newborns with CHF and may be used to document improvement.

Central Nervous System Vascular Malformations↗
PubMed2001

Aneurysms of the posterior cerebral artery: classification and endovascular treatment.

BACKGROUND AND PURPOSE: We present a retrospective review of our experience in the endovascular treatment of posterior cerebral artery (PCA) aneurysms. We detail the anatomic location of these aneurysms, the technique of endovascular treatment, morphologic results, and clinical outcome. We also discuss the segmental anatomy of the PCA as it relates to the various neurologic deficits that may result from occlusion of the parent artery. METHODS: From 1993 to 1998, 20 patients (12 female, eight male; mean age, 44 yrs) harboring a PCA aneurysm were treated via an endovascular approach. One patient had two aneurysms, comprising a total of 21 lesions. Fourteen (66%) of 21 aneurysms were saccular in nature, five (24%) were giant serpentine aneurysms, and two (10%) were posttraumatic. All aneurysms were treated using Guglielmi detachable coils (GDC) either by selective obliteration of the aneurysm sac or by parent artery occlusion. RESULTS: Fourteen (66%) of the 21 aneurysms were successfully treated with preservation of the parent artery. In the remaining seven (33%), the parent artery was permanently occluded. The overall complication rate in this series was 15%, with a permanent morbidity rate of 10% and a 0% mortality rate. CONCLUSION: Aneurysms of the PCA are rare compared with other locations in the intracranial circulation. Saccular PCA aneurysms can be treated effectively, by use of GDC, to obliterate the aneurysm yet preserve the parent artery. Fusiform and giant serpentine aneurysms of the PCA can effectively be treated by permanent occlusion of the parent artery; in these cases, thorough knowledge of the PCA segmental anatomy is crucial in order to select the site of occlusion and to avoid major neurologic deficits.

Adult↗
PubMed1997

Treatment of dissecting pseudoaneurysm of the cervical internal carotid artery using a wall stent and detachable coils: case report.

OBJECTIVE AND IMPORTANCE: This case illustrates the use of an endovascular stent and coiling combination to treat a giant wide-necked pseudoaneurysm of the cervical internal carotid artery. CLINICAL PRESENTATION: A 20-year-old male patient presented with a bilateral dissection of the cervical internal carotid artery and a right giant wide-necked pseudoaneurysm of the cervical segment of the internal carotid artery after a high-speed motor vehicle collision. INTERVENTION: After failing conservative therapy, the patient was treated by endovascular placement of a Palmaz wall stent at the level of the pseudoaneurysm and filling of the pseudoaneurysm with multiple Guglielmi detachable coils. Obliteration of the pseudoaneurysm was achieved, and patency of the right internal carotid artery was maintained. CONCLUSION: The patient's neurological symptoms resolved completely after treatment, and he sustained no neurological complications during the 20-month follow-up period. This case illustrates the successful treatment of a wide-based giant pseudoaneurysm by using a combination of an endovascular stent and coil embolization.

Adult↗
PubMed1997

Incidence of cerebral vasospasm after endovascular treatment of acutely ruptured aneurysms: report on 69 cases.

Cerebral vasospasm is the most common cause of morbidity and mortality in patients admitted to the hospital after suffering aneurysmal subarachnoid hemorrhage (SAH). The early surgical removal of subarachnoid clots and irrigation of the basal cisterns have been reported to reduce the incidence of vasospasm. In contrast to surgery, the endovascular treatment of aneurysms does not allow removal of subarachnoid clots. In this study the authors measured the incidence of symptomatic vasospasm after early endovascular treatment of acutely ruptured aneurysms with Guglielmi detachable coils (GDCs). Sixty-nine patients classified as Hunt and Hess Grades I to III underwent occlusion of intracranial aneurysms via GDCs within 72 hours of rupture. The amount of blood on the initial computerized tomography (CT) scan was classified by means of Fisher's scale. Symptomatic vasospasm was defined as the onset of neurological deterioration verified with angiographic or transcranial Doppler studies. Hypertensive, hypervolemic, hemodilution therapy, with or without intracranial angioplasty, was used to treat vasospasm after GDC placement. Symptomatic vasospasm occurred in 16 (23%) of 69 patients. The clinical grade at admission and the amount of blood on the initial CT were both associated with the incidence of subsequent vasospasm. At 6-month clinical follow-up examination, 12 of these 16 patients experienced a good recovery, two were moderately disabled, and two patients had died of vasospasm. In conclusion, the 23% incidence of symptomatic vasospasm in this series compares favorably with that found in conventional surgical series of patients with acute aneurysmal SAH. These results indicate that endovascular therapy does not have an unfavorable impact on cerebral vasospasm.

Acute Disease↗
PubMed1996

Fatal subarachnoid hemorrhage from the rupture of a totally intracavernous carotid artery aneurysm: case report.

Intracavernous carotid artery aneurysms usually cause symptoms because of gradual expansion without rupture. Most such aneurysms that do rupture lead to a carotid-cavernous fistula. Very few cases of rupture leading to subarachnoid hemorrhage have been reported. We report a case in which rupture of an entirely intracavernous carotid artery aneurysm led to death from a massive subarachnoid hemorrhage.

Aged↗
PubMed1995

Giant serpentine aneurysms: radiographic features and endovascular treatment.

PURPOSE: To describe the characteristic CT, MR, and angiographic features of giant serpentine aneurysms and discuss their endovascular treatment. METHODS: Thirteen patients with giant serpentine aneurysms were studied at our institution in the last 3 years. They all underwent CT and MR studies as well as cerebral angiography. More recently, some of the patients were studied with MR angiography. Seven patients had endovascular occlusion of the giant serpentine aneurysms, 3 with N-butyl cyanoacrylate, 2 with Guglielmi detachable coils, and 2 with detachable balloons. RESULTS: Giant serpentine aneurysms mimic cerebral neoplasms on CT and MR studies; they are often associated with mass effect and adjacent edema, and they enhance with contrast medium. The cerebral angiogram shows a residual irregular lumen of the partially clotted aneurysm, which continues into normal branches supplying the distal arterial territory. Six patients were treated successfully with an endovascular approach consisting of complete and permanent occlusion of the parent artery. CONCLUSION: Giant serpentine aneurysms from a subgroup of large intracranial aneurysms that have specific CT, MR, and angiographic features, which should be recognized before their treatment. The endovascular treatment of the aneurysm consists of permanent occlusion of the parent artery.

Adolescent↗
PubMed1995

Long-term histopathologic changes in canine aneurysms embolized with Guglielmi detachable coils.

PURPOSE: To evaluate the long-term histologic changes, including those in the ultrastructure of the neoendothelium, occurring in experimental canine aneurysms obliterated with Guglielmi detachable coils. METHODS: Ten experimental aneurysms were surgically created in mongrel dogs using side-to-side jugular carotid fistulas that were subsequently ligated to form blind pouch venous aneurysms dependent on the carotid circulation. The aneurysms were obliterated with Guglielmi detachable coils, and the animals were kept in observation. Six months after the endovascular obliteration of the aneurysms, repeat carotid arteriography was performed to assess for potential recanalization of the aneurysms. The animals were then killed and submitted for autopsy. The carotid artery and the embolized aneurysm were resected and studied with light and electron microscopy. RESULTS: Both completely obliterated and recanalized aneurysms were excluded from the parent circulation by an endothelialized layer of connective tissue. The fundus of the aneurysm was completely obliterated by heavy reactive fibrous tissue surrounding the coils with very minimal, if any, inflammatory reaction. The neointima is composed of three well-identifiable layers, the most superficial of which is formed of new endothelial cells positioned next to each other in a cobblestone fashion over a basal membrane. CONCLUSION: In the absence of histologic data in human aneurysms obliterated with Guglielmi detachable coils, several observations made in our experimental study help in the understanding of the long-term results expected from this endovascular technique.

Aneurysm↗
PubMed1994

Metastatic adenocarcinoma to the brain: MR with pathologic correlation.

PURPOSE: To describe the appearance on T2-weighted scans of metastatic adenocarcinoma to the brain and to show that the hypointensity frequently associated with these lesions is not related to the presence of mucin, blood products, iron, or calcium. METHODS: The MR scans of 14 patients with metastatic adenocarcinoma to the brain were reviewed retrospectively. The signal intensity on T2-weighted scans of the solid enhancing portion of the tumors was compared with white matter. Histologic examination of the surgical specimens included special stains to search for calcium, mucin, and iron. RESULTS: Eight of nine surgical and all six nonsurgical lesions were either iso- or hypointense to white matter on T2-weighted scans. There was no correlation with tumor histology or the presence of mucin, blood products, iron, or calcium. CONCLUSIONS: The presence of a hypointense intraaxial mass on T2-weighted scans strongly suggests the possibility of metastatic adenocarcinoma. The MR appearance is not explained by the presence of mucin, blood products, iron, or calcium. This phenomenon most likely reflects the relaxation parameters of the tissue from which the metastasis arose.

Adenocarcinoma↗
PubMed1991

The limitations of magnetic resonance imaging in the diagnosis of pathologic vertebral fractures.

Magnetic resonance imaging has been increasingly used in recent years to screen patients with suspected spinal metastases. The authors present four cases, all of whom were elderly patients with vertebral compression fractures, who were diagnosed with magnetic resonance imaging to have probable neoplastic involvement. In each case, vertebral body biopsies indicated a benign pathology. The authors discuss the diagnostic criteria of magnetic resonance imaging of spinal metastases and the limitations of magnetic resonance imaging in the diagnosis of pathologic vertebral fractures.

Aged↗
PubMed1991

Spinal intramedullary ependymal cyst. Report of three cases.

Three cases of spinal intramedullary ependymal cyst, two at the thoracolumbar junction and one in the cervical spinal cord, are reported in women in their fifth to seventh decades. Neurological signs and symptoms were extremity dysesthesias, paresthesias, and weakness. Plain cervical and lumbothoracic x-ray films were normal for the patients' age. Magnetic resonance (MR) imaging demonstrated a rounded cystic intramedullary mass at the thoracolumbar junction in two cases and at C3-7 in one case. The signal intensity of the cyst contents approximated that of cerebrospinal fluid on T1- and T2-weighted images. Upon administration of gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA), MR imaging showed no enhancement in the cyst wall or cavity. Myelotomy and cyst drainage were performed in each case, and the neurological status of each patient improved. The lining of the cyst was biopsied in one of the three patients undergoing surgery and was composed of a single layer of cuboidal cells supported by glial tissue. Periodic acid-Schiff staining of the tissue did not reveal a basement membrane. The findings in these cases suggest that the Gd-DTPA-enhanced MR imaging appearance of intramedullary spinal ependymal cyst is consistent and allows for accurate preoperative diagnosis with or without biopsy.

Cysts↗
PubMed1990

Spinal cord ischemia after resection of thoracoabdominal aortic aneurysms: MR findings in 24 patients.

MR images of the thoracic spinal cord were made in 24 patients who developed signs and symptoms of spinal cord ischemia or infarction following surgery for a thoracoabdominal aortic aneurysm. Findings consisted primarily of four different patterns of signal abnormalities in the distribution of the anterior spinal artery. These abnormalities were identified as types A-D, depending on the degree of involvement of the gray matter and surrounding white matter. We found good correlation between the distribution of the signal abnormalities in the cord, the severity of the neurologic deficits, and the clinical outcome. MR is the imaging method of choice for diagnosing spinal cord ischemia or infarction. A thorough knowledge of the spinal cord arterial territories is crucial for characterizing ischemic MR signal abnormalities and for differentiating them from other causes of myelopathy.

Adolescent↗
PubMed1988

Coexistence of multiple arteriovenous malformations and an anomalous aortic arch.

An unusual case of multiple congenital arteriovenous malformations (AVM) coexistent with an anomalous aortic arch is described. Our patient had been asymptomatic, with physical findings limited to a low grade systolic murmur, until the onset of acute subarachnoid hemorrhage. Arteriography was technically difficult and failed to demonstrate the origin of his hemorrhage or the configuration of his aortic arch. However, an AVM within the neck muscles was visualized. Magnetic resonance imaging of his chest revealed a right-sided, retroesophageal aortic arch with an anomalous pattern of branching. The intracranial AVM and the course of the great vessels was clearly revealed at autopsy. A possible embryologic mechanism underlying the origin and distribution of the arch vasculature is discussed.

Adult↗
PubMed1985

CT and angiography of primary extradural juxtasellar tumors.

The computed tomographic and angiographic features of 15 histologically proven primary extradural juxtasellar tumors were retrospectively reviewed. Five chordomas were characterized by prominent bone erosion and a significant posterior fossa component. Four trigeminal nerve neuromas each demonstrated bone erosion centered about Meckel's cave and moderate to marked contrast enhancement. Two cavernous sinus meningiomas revealed moderate contrast enhancement, expansion of the cavernous sinus, and moderate angiographic stain. Two cavernous hemangiomas of the cavernous sinus were intensely enhancing and demonstrated angiographic stain. Opacification of the sphenoid sinus with prominent bone destruction and lack of contrast enhancement was characteristic of a sphenoid sinus mucocele. The dural reflection could be directly visualized or indirectly inferred in each case.

Adolescent↗
PubMed1984

Computed tomography of the carotid space and related cervical spaces. Part I: Anatomy.

The carotid space, parapharyngeal space, and paraspinal space are described. The carotid space is shown on computed tomography (CT) to be posterior to the parapharyngeal space and separated from it by the styloid apparatus. The paraspinal space is posterior to the carotid space and separated from it by the longus and anterior scalene muscles.

Humans↗
PubMed1984

Computed tomography of the carotid space and related cervical spaces. Part II: Neurogenic tumors.

Fourteen neurogenic tumors of the neck were examined with computed tomography (CT) and, in ten cases, angiography. Schwannomas and paragangliomas occurred in the carotid space. These tumors could be distinguished on CT from those occurring more anteriorly, in relation to the parapharyngeal space, and more posteriorly, in relation to the paraspinal space. Schwannomas alone occurred in the paraspinal space. Schwannomas were heterogeneously hypodense before contrast enhancement and at least partially hyperdense after contrast enhancement, with displacement of adjacent vessels on CT, and, if they were of vagal origin, anteromedial displacement of the internal carotid artery on angiography. Paragangliomas usually were homogeneously hyperdense after contrast enhancement, with incorporation of adjacent vessels on CT, and, if they were of carotid body origin, lateral displacement of the internal carotid artery on angiography.

Adolescent↗
PubMed1984

Occlusive vascular disease associated with cerebral arteriovenous malformations.

Selective carotid angiography and computed tomography were used in a study of the association of occlusive vascular disease with cerebral arteriovenous malformations in 13 patients. The arterial occlusions ranged from focal stenosis in the major artery supplying the malformation to complete occlusion of the supraclinoid internal carotid artery with subsequent development of "moyamoya" collaterals. The majority of the arterial occlusions were proximal to the vascular malformation. Some, however, extended distal to the major branch supplying the arteriovenous malformation (AVM). Selective angiography with subtraction techniques defines the distinct angioarchitecture of these AVMs and the associated stenoses and collateral telangiectases.

Adult↗
PubMed1983

Computed tomography of the nasopharynx and related spaces. Part II: Pathology.

Malignant tumors of the nasopharynx were analyzed by region of origin and route of spread. Nasopharyngeal carcinomas produced early submucosal infiltration of the deglutitional muscle layer with enlargement of the levator palati muscle and lateral displacement of the parapharyngeal space. Serous otitis media was frequently associated, and the trigeminal nerve was occasionally involved. Intracranial extension via the foramen lacerum was frequent. Metastases to the infratemporal fossa produced early involvement of the masticatory muscle layer with medial displacement of the parapharyngeal space. Adenoid cystic carcinomas showed late but disproportionate involvement of the sphenoid sinus. Chordomas extended into the retropharyngeal soft tissues via the petro-occipital fissure. Maxillary sinus carcinomas, which were very large at the time of presentation and impinged on the nasopharynx, showed extensive destruction of the pterygoid plates.

Carcinoma, Adenoid Cystic↗