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Biomedical subjects

M Estes

Publications and source records attributed to M Estes.

34 records · Page 2Linked to original sources
PubMed1986

Magnetic resonance imaging (1.5 tesla) in patients with intractable focal seizures.

Magnetic resonance (MR) (1.5 tesla) studies were performed in ten patients with temporal lobe epilepsy and two with temporofrontal epilepsy. Two patients with temporal lobe epilepsy and one with temporofrontal epilepsy exhibited areas of increased signal intensity on T2-weighted images in the mesiobasal portion of the temporal lobe shown by electroencephalography to be the epileptogenic focus; no analogous abnormalities had been found in these patients on computed tomographic scans. Pathologic studies have not revealed a specific ultrastructural correlate for the MR findings in this group of patients. We found MR to be a useful, noninvasive diagnostic adjunct in the presurgical assessment of some patients with temporal lobe epilepsy. Where abnormalities were found, they corresponded with the epileptogenic focus as defined by electroencephalography.

Adult↗
PubMed1986

Proton magnetic resonance imaging in ischemic cerebrovascular disease.

Proton magnetic resonance imaging (MRI) using a 0.6- or 1.5-Tesla superconductive magnet was compared with high-resolution computed tomography (CT) in 60 patients with transient ischemic attacks (TIAs) or brain infarction. MRI showed focal parenchymal changes in 84% of patients with TIAs, whereas CT showed similar changes in 42%. The sensitivity of MRI was also greater in patients with infarcts, but the difference between CT and MRI was not as great. Infarcts were usually better delineated by MRI regardless of location. However, MRI failed to reveal cortical infarcts that were clearly seen on contrast-enhanced CT scans and was unable to clearly distinguish subacute from chronic hemorrhagic infarcts. MRI changes were best detected with T2-weighted images and usually appeared as multiple areas of increased signal intensity in the subcortical and periventricular white matter. MRI changes often could not be correlated with the clinical history and neurological findings; identical changes have been seen in patients with no history of cerebrovascular disease.

Acute Disease↗
PubMed1985

Flecainide: electrophysiologic and antiarrhythmic properties in refractory ventricular tachycardia.

Twenty-two patients with coronary artery disease and spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) underwent intracardiac electrophysiologic evaluation and, when possible, ambulatory monitoring before and after therapy with flecainide (mean dose 418 +/- 87 mg [mean +/- standard deviation]). An average of 4 antiarrhythmic agents were used and were unsuccessful before therapy with flecainide was begun. During 64 +/- 16 hours of control Holter monitoring in 16 patients, all had 1 or more salvos of VT, as well as ventricular premature complexes (VPCs). Programmed stimulation during the control period induced VT in 17 of 22 patients. After flecainide therapy, Holter monitoring showed elimination of all forms of VT in all but 1 patient, as well as significant reduction of paired VPCs by 95% (p less than 0.03) and single VPCs by 70% (p less than 0.005). Electrophysiologic study during flecainide therapy showed significant increases in AH, HV, PR, QRS and QTc intervals, and the ventricular effective refractory period. Programmed stimulation in 17 patients taking flecainide, with a mean plasma level of 1,075 +/- 521 ng/ml, showed ablation of inducible VT in only 2 patients, a worsening in 5 and continued VT inducibility in 10. Adverse effects that required drug withdrawal were infrequent and encountered in patients who received higher drug levels: 1 patient with congestive heart failure and 1 with severe sinus bradycardia. Thus, although flecainide suppresses complex ventricular arrhythmias on Holter recordings, it rarely alters the response to programmed stimulation. Caution is recommended in its use for recurrent sustained VT or VF and in the interpretation of electrophysiologic studies until the predictive value of programmed stimulation with flecainide therapy is established.

Adult↗
PubMed1982

Anterior spinal artery syndrome with chronic traumatic aortic aneurysm.

Shortly after severe blunt chest trauma, a young man experienced neurological symptoms suggestive of a spinal cord lesion at the lower thoracic level. The symptoms resolved at first, but then recurred 3 years later and progressed slowly. Neurological workup failed to define the cause until a thoracic aortogram showed an aneurysm in the middle portion of the descending aorta in close proximity to a vessel supplying the anterior spinal artery. After the operative repair with precautions taken to avoid further neurological injury, the neurologic deficit resolved partially. Because of the potential for symptomatic spinal cord ischemia resulting from lesions of the aorta, angiographic delineation of the spinal cord blood supply is valuable in planning operative repair.

Adult↗
PubMed1980

Intracranial hemorrhage with amphetamine abuse.

Intracranial hemorrhage (ICH) occurred in a drug abuser soon after self-administration of amphetamine. Other reported cases indicate a consistent clinical picture, sometimes fatal or causing permanent neurologic disability.

Adult↗
PubMedDate not supplied

Magnetic resonance of intracranial epidermoids.

The magnetic resonance images of seven patients with biopsy-proven epidermoids were evaluated. The epidermoids were hypointense on T1-weighted images. Intermediate density images revealed the tumors to be heterogeneous in signal intensity consisting of areas of hypo- and isointensity. Signal intensity on T2-weighted images was hyperintense and inhomogeneous in all but one case. CT performed in five patients demonstrated the tumors to be well-defined hypodense lesions without contrast enhancement.

Adolescent↗
PubMedDate not supplied

Temporal lobe epilepsy in early childhood.

To explore the electroclinical features of temporal lobe epilepsy (TLE) in early childhood, we studied results of video-EEG and other tests of 14 children aged 16 months to 12 years selected by seizure-free outcome after temporal lobectomy. Four children had mesiotemporal sclerosis, 1 had cortical dysplasia, and 9 had low-grade temporal neoplasms. The children had complex partial seizures (CPS) with symptomatology similar to that of adults with TLE, including decreased responsiveness and automatisms. Automatisms tended to be simpler in the younger children, typically limited to lip smacking and fumbling hand gestures. Scalp/sphenoidal EEG showed anterior/inferior temporal interictal sharp waves and unilateral temporal seizure onset in the 4 children with mesiotemporal sclerosis and in the child with cortical dysplasia, but EEG findings in 9 children with low-grade temporal tumors were complex, including multifocal interictal sharp waves or poorly localized or falsely lateralized EEG seizure onset. In children without tumors, video-EEG was critical to localization of the epileptogenic zone for resection, but in patients with tumors video-EEG was less localizing and its main value was to confirm that the reported behaviors were epileptic seizures with semiology typical of temporal lobe onset.

Age Factors↗
PubMedDate not supplied

Mirror focus: function of seizure frequency and influence on outcome after surgery.

The concept of the mirror focus (MF) implies that an actively discharging epileptiform region may induce similar paroxysmal behavior in a homologous site. In a group of patients with complex partial seizures (CPS) we investigated whether occurrence of a MF was influenced by certain clinical factors and whether surgical outcome was influenced by the presence of an MF. Factors studied included age at onset, duration, and total number of seizures. Patients had had CPS for > 3 years and had pathologically proven temporal lobe neoplasms. Seizure frequency was estimated by the history-taking physician. We estimated total seizure number by multiplying frequency by duration. Seven patients had MF, and 15 did not. Mean age at onset of seizures, duration of seizure disorder, and total seizure number did not vary statistically between the two groups of patients. All patients with an MF except 1 were seizure-free at follow-up. Ten of the 15 patients without MF were seizure-free. Three patients who were not seizure-free had had subtotal resection owing to tumor overlap with eloquent cortex. We conclude that an MF is not a contraindication to operation even when the preponderance of interictal spike activity is contralateral to the tumor or when seizures appear to arise from the MF on scalp EEG.

Adolescent↗
PubMedDate not supplied

Response of CSF IgG to steroids in an 18-month-old with chronic inflammatory polyradiculoneuropathy.

During recovery from a upper respiratory infection, an acquired chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) developed in a previously healthy 18-month-old girl. The CIDP followed a monophasic course and left her severely quadriparetic. One year after her neurologic deficit had stabilized, the cerebrospinal fluid (CSF) IgG synthesis rate was markedly elevated, and oligoclonal bands were identified in her CSF, suggesting ongoing inflammation. Her electromyogram (EMG) and nerve biopsy were consistent with a severe acquired segmental demyelinating polyradiculoneuropathy. A course of corticosteroid therapy resulted in dramatic, sustained, clinical and electromyographic improvement, normalization of CSF IgG synthesis rate, and disappearance of the oligoclonal bands. We are not aware of any previous reports that correlate serial measurements of CSF IgG synthesis rate and oligoclonal bands with clinical and electromyographic responses to corticosteroids in a child with acquired CIDP. We suggest that these CSF parameters are potentially useful in demonstrating active inflammation in cases of acquired CIDP even after clinical stabilization of neurologic deficits, predicting response to therapy, and monitoring resolution of the pathologic process.

Chronic Disease↗
PubMedDate not supplied

MR imaging of metastatic GI adenocarcinoma in brain.

PURPOSE: To investigate an observed preferential T2-shortening effect seen in patients with intracerebral metastases from adenocarcinoma of the GI tract. METHODS: Ten patients with intracerebral metastases from adenocarcinoma of the GI tract were evaluated with MR imaging with CT and histopathologic correlation. RESULTS: Nine of 10 patients demonstrated intracranial masses with decreased signal intensity on T2-weighted images. T1-weighted images showed decreased or isointense signal in all cases. Special histologic staining was performed in four of 10 cases, all of which were positive for increased protein (mucin) with no evidence of blood products or calcium. CONCLUSION: We propose that the observed preferential T2-shortening effect is secondary to slowing of rotational and translational proton motion caused by increased protein concentration in the form of mucin.

Adenocarcinoma↗