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Biomedical subjects

M G Luken

Publications and source records attributed to M G Luken.

9 recordsLinked to original sources
PubMed1994

Malignant vestibular schwannoma.

A 61-year-old woman underwent a translabyrinthine resection of a right intracanulicular acoustic neuroma, which had been detected in the work-up of sudden hearing loss. At the time of surgery, the tumor was roughly twice as large as indicated by the magnetic resonance scan taken only 2 months previously. The tumor eroded the vertical and transverse crests and extended well into the cerebellopontine angle. It was impossible to distinguish the facial nerve proximal to the geniculate ganglion. All visible tumor was resected, along with the facial nerve. Histological evaluation showed a highly cellular tumor, with many mitoses and areas of necrosis, meeting the criteria for malignant schwannoma. The patient has no stigmata of neurofibromatosis, and has no known relatives with that condition. This case is only the fourth reported of a malignant vestibular schwannoma. The relationships between vestibular schwannoma, neurofibromatosis, and malignancy are discussed.

Case Reports↗
PubMed1983

Posterior fossa epidural hematoma. A report of three cases diagnosed with computed tomography.

CT demonstrated posterior fossa epidural hematoma in three patients with head trauma in whom this diagnosis was not clinically apparent. No patient was in stupor or coma and no patient experienced a lucid interval. Only one patient had signs referable to the posterior fossa. Two patients had occipital skull fracture disclosed by plain radiographs. CT revealed a unilateral biconvex hematoma in two cases, and a bilateral hematoma with supratentorial extension in the third. All patients underwent suboccipital craniectomy and recovered. Therapeutic success in these cases was facilitated by early CT and the rapid disclosure of the unsuspected posterior fossa lesions. CT showing contiguous hematoma below and above the tentorium cerebelli after posterior head trauma is highly suggestive of epidural hematoma arising from the posterior fossa.

Adult↗
PubMed1982

Symptomatic spinal stenosis associated with ankylosing spondylitis.

Patients with ankylosing spondylitis frequently experience back pain and they have a well-known propensity for spinal fractures, but they rarely manifest motor and sensory nerve root impairment. We recently encountered a patient with ankylosing spondylitis who complained of classical spinal claudication with urinary sphincter dysfunction. Computed axial tomography revealed marked lumbosacral lateral recess and foraminal spinal stenosis that was not evident on the myelogram; at operation the stenosis appeared to be the result of extensive posterior soft tissue ossification. This heretofore unrecognized yet potentially treatable complication of ankylosing spondylitis is discussed.

Cauda Equina↗
PubMed1982

Computed tomography of the sacrum: 2. Pathology.

Fifteen cases of primary sacral pathology were analyzed. High-resolution computed tomography was found to be the most accurate means of studying these cases. Certain anatomic changes involving the central canal and sacral foramina were found to be helpful in determining the type of pathology. Although conventional plain films, radionuclide bone scans, and myelography were useful in certain cases, computed tomography was found to be the procedure of choice in the workup of sacral problems.

Adult↗
PubMed1981

The diagnosis of sacral lesions.

Clinical courses are reviewed in 4 recent patients with sacral lesions, each of whom was believed on initial clinical evaluation to have symptomatic herniations of intervertebral discs. In each patient pain in the back tended to overshadow radicular symptoms, and sphincteric disturbances were not prominent. Each patient presented some related objective abnormality on general or neurologic examination. The sacral lesion was invariably visible on technically satisfactory plain roentgenograms of the spine and was obvious on sacral tomography. Conventional myelography was useful in defining communication between the lesion and the subarachnoid space, but otherwise typically it was only subtly and nonspecifically abnormal. Computerized tomography (CT) proved to be the most revealing radiographic technique, demonstrating bony detail as well as internal structure and extent of the lesion; in conjunction with metrizamide myelography, CT provided the most definitive anatomical study. The limited utility of angiography in diagnosing these lesions is discussed, as are the respective hazards of and indications for needle biopsy and open surgical exploration.

Adult↗
PubMed1981

Craniosynostosis: computed tomographic evaluation of skull base and calvarial deformities and associated intracranial changes.

Computed tomography has proven useful in children with craniosynostosis for the evaluation of deformity of the skull base, calvarium, and parenchymal brain structures. A retrospective analysis of 24 children seen during a 4-year period who had adequate preoperative, postoperative, and follow-up scans was carried out. Bone windows were used, and both bone thinning adjacent to fused sutures and thickening of affected sutures were demonstrated. Changes in calvarial contour were easily followed. Current trends in craniofacial reconstructive surgery have placed emphasis on skull base abnormalities; these are readily measured on axial computed tomographic (CT) sections, and postoperative progress may be monitored by serial scanning. In addition, new data revealing distortion of brain structures and cerebrospinal fluid pathways in these children have been obtained with CT scans. These soft tissue abnormalities had not been appreciated before the CT era, and they add a new dimension to the evaluation of these disorders. We think that these abnormalities indicate a local pressure increase on the brain at the fusion site. The restoration of parenchymal changes toward normal during the postoperative period correlated well with cosmetic improvement.

Brain↗
PubMed1980

Recent diagnostic experience with subdural empyema.

The authors review the Neurological Institute experience of six cases of subdural empyema in the 4 years since the introduction there of computerized tomography (CT) scanning. Four patients had no known prior neurological disease, and presented with the classical clinical syndrome of fever, depressed sensorium, and focal seizures; three of these patients had histories or radiographic evidence of sinus disease. The two remaining patients had undergone earlier drainage procedures for chronic subdural hematomas, and presented without neurological symptoms but with low-grade fever and signs of local wound infection. All of the patients of the former (primary) empyema group had technically satisfactory contrasted CT scans at a time when the clinical syndrome was fully developed, and none revealed the subdural collection. Angiograms were performed in three of these cases and were uniformly successful in demonstrating the collections and suggesting their inflammatory natures. Both secondary empyemas were readily visualized by CT, and showed characteristic brightly enhancing membranes. It is concluded that primary and secondary subdural empyemas differ both in clinical presentation and in accuracy of CT diagnosis. In the former group, evidence of sinus disease is suggestive but does not by its absence exclude a purulent subdural collection. In patients with the typical clinical syndrome, reliance on CT is hazardous, and angiography is the diagnostic procedure of choice.

Adolescent↗