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M I Chimowitz

Publications and source records attributed to M I Chimowitz.

30 records · Page 2Linked to original sources
PubMed1991

Treatment of intractable arterial hemorrhage during stereotactic brain biopsy with thrombin. Report of three patients.

Of 165 consecutive patients undergoing computerized tomography- or magnetic resonance imaging-guided stereotactic brain biopsies at the Cleveland Clinic between June, 1987, and November, 1989, four patients (2.4%) developed arterial hemorrhage refractory to conventional efforts to secure hemostasis. Craniotomy was performed in one of these patients to control the hemorrhage; in the other three, 0.5 to 2 cc of thrombin (5000 U/cc) was slowly injected via the biopsy cannula, resulting in immediate control of bleeding in all three cases. Postoperatively, the first two patients treated with 1 to 2 cc of thrombin were slow to awaken; one had evidence of vasospasm by transcranial Doppler ultrasound studies and multiple infarcts on cranial computerized tomography, while the other had a moderate-sized frontal hematoma with intracranial hypertension. After prolonged recovery periods, only mild neurological deficits persisted in both patients. The third patient, treated with 0.5 cc of thrombin, had an uneventful postoperative course. Thrombin is highly effective for stopping intractable arterial hemorrhage during stereotactic brain biopsy; however, it is a vasospastic agent and may have been responsible for the cerebral infarctions in one patient. Therefore, thrombin should be used only as a last resort, short of craniotomy, to control intractable arterial hemorrhage during stereotactic brain biopsy.

Adolescent↗
PubMed1990

Intracranial hypertension associated with unruptured cerebral arteriovenous malformations.

Only 6 patients with intracranial hypertension associated with unruptured cerebral arteriovenous malformations have been reported. We report 6 additional patients seen at the Cleveland Clinic during the past 10 years. The average age was 28 years (range, 19-44 years); 4 were women. Symptoms and signs included papilledema (6 patients), headache (6), transient nonepileptic focal symptoms (4), visual obscurations (3), ipsilateral carotid or ocular bruits (3), abnormal visual fields (3), focal seizures (2), and progressive visual loss (1). Enhanced computed tomography (CT) or magnetic resonance imaging (MRI) demonstrated the malformations in all 6 patients. The malformations were large, supplied by the branches of the middle and anterior cerebral arteries, with the posterior cerebral artery contributing in 3 patients, and all drained into the superior sagittal sinus. Associated venous obstruction was seen in 2 patients. Four patients underwent excision of the arteriovenous malformation, with resolution of papilledema in all 4. Measurements of cortical arterial and venous pressures during surgery in 3 patients showed decreased feeding artery pressures and elevated draining vein pressures, which normalized after removal of the malformation. Treatment in the 2 remaining patients consisted of medical therapy (acetazolamide, furosemide, steroids) alone in 1 patient, and in conjunction with proton beam radiation in the other. Papilledema resolved in the former patient, but the patient receiving proton beam radiation still had papilledema 2 years later. Intracranial hypertension associated with unruptured cerebral arteriovenous malformations occurs in young patients with high flow malformations that drain into the superior sagittal sinus, and is likely the result of increased cortical venous and superior sagittal sinus pressure. Excision of the malformation effectively reduces the intracranial pressure.

Adult↗
PubMed1990

The accuracy of bedside neurological diagnoses.

The accuracy of bedside diagnoses was prospectively studied in 100 consecutive patients admitted to the neurology service at New England Medical Center, Boston. Each patient was evaluated independently by a junior resident, a senior resident, and a staff neurologist, who were required to make an anatomical and etiological diagnosis based solely on the history and physical examination. Fourteen patients were excluded because their diagnoses were known before admission. Of the remaining 86 patients, it was possible to confirm anatomical and etiological diagnoses in 40 by matching the clinical syndromes with highly specific laboratory findings. In the other 46 patients, the diagnoses could not be confirmed because the laboratory studies (including magnetic resonance imaging) were negative or nondiagnostic. In the 40 patients with laboratory confirmed final diagnoses, the clinical diagnoses of the junior residents, senior residents, and staff neurologists were correct in 26 (65%), 30 (75%), and 31 (77%), respectively. There was a trend for error rates to be higher among junior residents than staff (p = 0.06). The errors by the junior residents, [senior residents], (staff) were attributed to incomplete history and examination in 4 [1] (0), inadequate fund of knowledge in 4 [3] (3), and poor diagnostic reasoning in 6 [6] (6). These results indicate that technology is not a panacea for our diagnostic difficulties and that there is room for improvement in our clinical skills, especially diagnostic reasoning.

Adult↗
PubMed1990

Ipsilateral leg weakness associated with carotid stenosis.

Ipsilateral motor or sensory symptoms associated with carotid occlusive diseases are rare. We report a 52-year-old man who presented with aphasia, right hemiparesis, mild left leg weakness, and bilateral Babinski's signs. During the previous 10 days, he had experienced three episodes of left leg numbness and incoordination that occurred either alone or in association with right arm and leg weakness. Computed tomography showed infarcts in the right frontoparietal (parasagittal), left frontal, and left parietal lobes. Cerebral angiography revealed 60% stenosis of the right internal carotid artery, 80% stenosis of the left internal carotid artery, absence of the A1 segment of the right anterior cerebral artery, filling of the right anterior cerebral artery from the left carotid circulation only, and a normal vertebrobasilar system. This report illustrates that leg weakness may occur ipsilateral to carotid disease if the contralateral anterior cerebral artery is supplied by the ipsilateral carotid artery.

Carotid Arteries↗
PubMed1990

Mechanism of stroke in patients taking aspirin.

During a 1-year period, we prospectively studied the mechanism and severity of stroke in 47 patients sustaining a cerebral infarction while taking aspirin. The mechanism of stroke was undetermined in 12 patients (26%). In the remaining 35 patients, we identified 39 potential mechanisms: large-artery atherosclerosis (19 patients, 40%), cardioembolism (15 patients, 32%), and small-vessel occlusive disease (5 patients, 11%). Of 11 patients with carotid atherosclerosis and stroke, 9 (82%) had greater than 90% carotid stenosis or occlusion; of 12 patients with stroke of undetermined mechanism, 10 (83%) had previous stroke, of which 8 were also of undetermined mechanisms. Disability after stroke was moderate or severe in 27 patients (57%). These data suggest that (1) stroke in patients taking aspirin has a variety of etiologies and frequently causes moderate or severe disability; (2) patients with carotid disease failing aspirin often have high-grade carotid stenosis or occlusion; (3) stroke of undetermined mechanism may recur more frequently than other stroke subtypes in patients taking aspirin.

Adult↗
PubMed1989

HIV-associated CIDP.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Stroke in patients with fusiform vertebrobasilar aneurysms.

We studied seven patients with brainstem infarction and large fusiform vertebrobasilar (VB) aneurysms to clarify the clinical, radiologic, and pathologic features. All presented with pontine infarcts; one also had a cerebellar infarct. VB TIAs preceded brainstem infarction in four patients. Angiography and CT documented VB fusiform aneurysmal dilatation. Four had intraluminal thrombi and one had severe basilar artery stenosis. Two distinct clinical pictures emerged: unilateral pontine infarcts with favorable outcome, presumably related to obstruction of a pontine penetrating artery at its origin from the posterior wall of the aneurysmal basilar artery, and major fatal bilateral pontine infarcts from basilar artery occlusion. Two patients came to autopsy. One had thrombus in the dilated basilar artery and a posterior cerebral artery branch embolus with hemorrhagic occipital infarction; the other had basilar artery thrombus with aneurysmal rupture and subarachnoid hemorrhage. Fusiform VB aneurysms caused brainstem stroke by intraluminal thrombus, local embolism, atherostenosis, and obstruction of paramedian penetrating arteries. Subarachnoid hemorrhage is an uncommon complication.

Adult↗
PubMed1984

A computerized genetic record system.

The quantity of data stored in manual medical records--which is a function of the level of sophistication of medical practice--has become unmanageable. The need for efficient access to this information can be met by computerization. A number of automated medical record systems have been developed for this purpose, invariably by physicians with computer expertise. The recent development of 'application generators' (a specific group of versatile packaged software systems) now enables a wide range of applications to be effectively computerized by end-users (the people who ultimately use the systems) who have no knowledge of computers. The utilization of an application generator to computerize the medical records of patients seen at the Department of Human Genetics of the University of Cape Town Medical School is described and discussed.

Computers↗
PubMedDate not supplied

Detection and evaluation of intrapulmonary vascular shunt with "contrast Doppler" transesophageal echocardiography.

Contrast echocardiography is useful for detecting intrapulmonary right-to-left shunt lesions. In a patient with suspected pulmonary arteriovenous fistula, contrast transesophageal echocardiography was used to demonstrate the presence of a right-to-left shunt. By use of a combination of two-dimensional echocardiography, contrast injection, and pulsed Doppler echocardiography, each pulmonary vein was successfully interrogated for evidence of contrast shunting. This case demonstrates that contrast transesophageal echocardiography is useful for the detection of intrapulmonary fistulas and that it has the potential for localization of the shunt lesion.

Arteriovenous Malformations↗
PubMedDate not supplied

Is there a role for heparin in the management of complications of subarachnoid hemorrhage?

Proven effective therapy to prevent ischemic deficits and other complications after subarachnoid hemorrhage is lacking despite extensive research efforts. A literature review documented both clinical and experimental evidence suggesting that heparin may be effective in preventing ischemic deficits after subarachnoid hemorrhage by reversing vasospasm, improving blood flow through narrowed vessels, and preventing the development of a proliferative angiopathy. Additional evidence suggests that heparinization of the cerebrospinal fluid following subarachnoid hemorrhage may prevent the development of hydrocephalus. In the only clinical trial using heparin after subarachnoid hemorrhage, the incidence of rebleeding in the heparinized patients was no higher than in the control group. We conclude that the existing preliminary data concerning a role for heparin in the management of the complications of subarachnoid hemorrhage is promising, but further controlled studies are needed prior to clinical application.

Brain Ischemia↗