Biomedical subjects

M H Brisman

Publications and source records attributed to M H Brisman.

9 recordsLinked to original sources

PubMed1999

Thyrocervical to vertebral artery transposition and ipsilateral carotid endarterectomy.

BACKGROUND: We report a new method for treating patients with symptomatic high-grade stenosis of the proximal vertebral artery associated with high-grade stenosis of the ipsilateral carotid artery. METHODS: Our patient had high-grade stenosis of the proximal right vertebral artery as well as high-grade stenosis of the ipsilateral carotid artery and suffered continued posterior circulation ischemic neurological deficits despite anticoagulation. RESULTS: The patient was successfully treated with a carotid endarterectomy and thyrocervical-to-vertebral artery transposition in a single operation. CONCLUSION: This procedure has the advantage in this setting of avoiding additional cross clamping on the diseased carotid artery that would normally be required for the vertebral-to-carotid artery transposition with carotid endarterectomy. Also, thrombosis at one anastamosis site would not endanger the other site as well.

Aged↗

PubMed1997

Results of surgery for head and neck tumors that involve the carotid artery at the skull base.

To evaluate the results of surgery in patients with head and neck cancers that involved the internal carotid artery at the skull base the authors retrospectively reviewed a consecutive series of 17 patients who underwent surgery at Mount Sinai Hospital over a 4-year period. In general, patients who underwent tumor resection with carotid preservation had less advanced disease (two of seven tumors were recurrences) than patients who underwent tumor resection with carotid sacrifice (seven of 10 tumors were recurrences). Of seven patients who underwent resection with carotid preservation, six had good outcomes (five patients alive in good condition, one dead at 2.2 years) and none had strokes. Of seven patients who underwent resection with carotid sacrifice and bypass, five had good outcomes (four alive in good condition, one dead at 2.5 years with no local recurrence) and two suffered graft occlusions that led to strokes, one of which was major and permanently disabling. Of three patients who underwent resection with carotid sacrifice and ligation without revascularization, there were no good outcomes: all three patients died within 6 months of surgery, two having suffered major permanently disabling strokes. The overall results (11 [65%] of 17 with good outcomes at an average follow-up period of 2.1 years) compared very favorably with historical nonsurgical controls. The authors conclude that tumor resection with carotid preservation carries the lowest risk of stroke and should usually be the treatment of choice. For patients with more advanced and recurrent disease, in whom it is believed that carotid preservation would prevent a safe and oncologically meaningful resection, carotid sacrifice with carotid bypass may be a useful treatment option. Carotid sacrifice without revascularization seems to be the treatment option with the least favorable results.

Aged↗

PubMed1997

Radiologic evaluation in patients with head injury.

Head injury is common. With many excellent imaging techniques readily available, radiologic evaluation has become critical in the management of patients with head injuries. We review the indications for various imaging studies in patients with head injury. In general, a noncontrast computed tomography of the head is the study of choice for patients with head injury and should be performed whenever there is reasonable suspicion of a serious injury to the brain.

Cost-Benefit Analysis↗

PubMed1997

Surgical management of subarachnoid hemorrhage.

Spontaneous subarachnoid hemorrhage is usually caused by a ruptured cerebral aneurysm. Aneurysmal rupture classically presents with sudden severe headache, often accompanied by an altered mental status. Diagnosis is made with computed tomography or lumbar puncture. Patients with ruptured cerebral aneurysms are at risk for rebleeding, cerebral artery vasospasm (and subsequent ischemia or stroke), and hydrocephalus. Early surgical clipping of the aneurysm under the microscope is usually the initial treatment of choice. This surgery prevents rebleeding and allows for safe use of pressors in the event that clinical vasospasm develops. Factors that would favor delayed surgery, "coiling" procedures, or conservative management include poor patient condition, basilar artery aneurysms, and unusually large or irregular aneurysms. Patients with ruptured aneurysms are treated with nimodipine, a calcium-channel blocker, to help prevent vasospasm-related ischemia. The degree of vasospasm that develops in the first 2 wks after aneurysmal rupture is assessed by transcranial Doppler sonography and cerebral angiography, in addition to the clinical examination. Patients with symptomatic vasospasm are kept well hydrated and treated with pressors (provided the aneurysm has been successfully clipped).

Aneurysm, Ruptured↗

PubMed1996

Idiopathic granulomatous hypophysitis.

A case is described of an elderly woman who presented with headaches, hypopituitarism, and visual disturbances and was found to have idiopathic granulomatous hypophysitis, a rare lesion of the pituitary gland. Preoperative magnetic resonance imaging demonstrated a well-circumscribed lesion, which was isointense on both T1- and T2-weighted imaging and enhanced uniformly with administration of gadolinium contrast enhancement, not unlike a macroadenoma. The present case and 12 other cases from the literature are reviewed.

Journal Article↗

PubMed1996

Intracerebral hemorrhage occurring remote from the craniotomy site.

OBJECTIVE: The purpose of this study was to analyze the available clinical data on postoperative intracerebral hemorrhages that occur in locations remote from the sites of craniotomy. METHODS: The findings of 37 cases of postoperative intracerebral hemorrhages occurring remote from the craniotomy sites were reviewed (5 from our records and 32 from the literature). RESULTS: Remote postoperative intracerebral hemorrhages presented within the first few hours postoperatively in 78% of the patients and were not related to the types of lesions for which the craniotomies were performed. Supratentorial procedures that produced infratentorial hemorrhages involved operations in the deep sylvian fissure and paraclinoid region in 81% of the patients and hemorrhages in the cerebellar vermis in 67% of the patients. Infratentorial procedures that produced supratentorial hemorrhages were performed with the patient in the sitting position for 87% of the patients. The remote supratentorial hemorrhages that occurred were superficial and lobar in 84% of the patients, as opposed to deep and basal ganglionic, which are classic locations for hypertensive hemorrhages. Remote intracerebral hemorrhages occurring after craniotomies were not associated with hypertension, coagulopathy, cerebrospinal fluid drainage, or underlying occult lesions. These hemorrhages commonly led to significant complications; 5 of 37 patients (14%) were left severely disabled, and 12 of 37 patients (32%) died. CONCLUSIONS: Remote intracerebral hemorrhage is a rare complication of craniotomy with significant morbidity and mortality. Such hemorrhages likely develop at or soon after surgery, tend to occur preferentially in certain locations, and can be related to the craniotomy site, operative positioning, and nonspecific mechanical factors. They do not seem to be related to hypertension, coagulopathy, cerebrospinal fluid drainage, or underlying pathological abnormalities.

Adult↗

PubMed1996

Symptoms of pituitary apoplexy rapidly reversed with bromocriptine. Case report.

Macroprolactinomas rarely present with apoplexy. The authors describe a patient with a macroprolactinoma who presented with apoplexy and rapid progression of a third nerve palsy. The patient was managed expectantly with bromocriptine, and within 48 hours, the patient's third nerve palsy had completely resolved. The authors suggest that all patients who present with pituitary apoplexy in the presence of a pituitary tumor receive an immediate course of bromocriptine and steroid therapy until the prolactin level can be determined. Emergency surgery is indicated if visual function is abnormal and the tumor is not a prolactinoma.

Adult↗

PubMed1993

Reversible dementia due to macroprolactinoma. Case report.

Subfrontal tumors are an infrequent cause of dementia. Most of those that do cause dementia are meningiomas, and the symptoms may recede when the tumor is resected. A patient with a huge prolactinoma who came to medical attention because of dementia is described. The tumor shrank dramatically after bromocriptine therapy and the patient's mental status returned to normal.

Behavior↗

PubMed1992

The effect of mild hypothermia on permanent focal ischemia in the rat.

The effect of mild hypothermia on cerebral injury was evaluated in a rat model of permanent middle cerebral artery (MCA) and ipsilateral carotid artery occlusion. The MCA occlusion was performed in rats at temporalis muscle temperatures of 30 degrees C, 33 degrees C, 34.5 degrees C and 36.5 degrees C (n = 10, 8, 10, and 13, respectively). The animals were kept at the desired temperature for 1 hour and rewarmed to 36.5 degrees C. In a separate group of animals (n = 11), the temperature was decreased to 33 degrees C 1 hour after performing the arterial occlusion at normothermia. These animals were rewarmed to 36.5 degrees C after another hour with side by side controls (n = 9) kept at 36.5 degrees C throughout the experiment. Twenty-four hours after the MCA occlusion, rats were killed and the percentage of infarcted right hemisphere was determined in coronal brain sections with 2,3,5-triphenyltetrazolium chloride. The percentage of infarcted volume at 30 degrees C, 33 degrees C, and 34.5 degrees C (9.3 +/- 2.1%, 8.2 +/- 2.2%, and 8.4 +/- 2.2%) (SEM) was significantly smaller than at 36.5 degrees C (19.6 +/- 1.6%, P < 0.01). There were no significant differences between the hypothermic groups. When rats were cooled to 33 degrees C 1 hour after the arterial occlusion, the percentage of infarcted volume was also significantly smaller than the control group (8.0 +/- 1.8% vs. 17.4 +/- 2.1%) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗