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N Okais

Publications and source records attributed to N Okais.

At least 19 recordsLinked to original sources
PubMed2006

[Etiologic spectrum of intracerebral hemorrhage in young patients].

INTRODUCTION: Hemorrhagic stroke is uncommon in young patients. The etiologic spectrum is very wide in the literature. The purpose of this study was to determine the range of etiology in a group of patients completely investigated and to study the relation with a history of high blood pressure. PATIENTS AND METHODS: We reviewed study database, clinical and diagnostic records of 130 patients identified in a population based study, aged 18 to 55 years presenting with hemorrhagic stroke. There were divided into two groups: 67 patients treated at Hotel-Dieu Hospital in Beirut, Lebanon, and 63 patients reviewed at Yale New Haven Hospital, Connecticut, USA. Patients presenting with selective subarachnoidal or intraventricular hemorrhage were excluded. Diagnostic evaluation was assessed for completeness (based on prospectively articulated evidence based criteria) and for identifiable etiology of hemorrhagic stroke and its relation to high blood pressure. RESULTS: There were 84 cases (64%) with complete diagnostic workup. The most common cause of incomplete investigations in remaining cases was death, poor neurological condition and incomplete follow up. Hematoma was superficially located (lobar) in 59.2%, deep seated (thalamo-capsulo-lenticular) in 26%, within the brain stem in 8.7% and cerebellar in 6.1%. An etiology was established in 70.4% of cases (pial AVM 16.7%, aneurysms 15.5%, hematological disorders 13%, cavernous malformations 10.7%, tumors 4.8%, bleeding within ischemic area 3.8%, vasculitis 2.3%, venous thrombosis 1.2% and venous angioma 1.2%. 29.6% of patients remained with undetermined etiology despite complete investigations. In a subgroup of 45 patients, a history of high blood pressure was found in 46.7%. In this cohort, an underlying etiology was established in 71% of cases. CONCLUSION: Complete investigation can establish an etiology in 70% of young patients who survived hemorrhagic stroke, independently from the presence of a history of high blood pressure.

Adolescent↗
PubMed2004

[Central neurocytoma. Four patients].

We report four cases of central neurocytoma we operated on at our institution, between 1994 and 2002. This uncommon lesion occurred in young patients, was located in the lateral ventricules and was revealed by signs of intracranial hypertension. The tumor was totally removed in three cases and subtotally in one. Immunohistochemistry provided useful information to distinguish neurocytoma from other nervous system tumors. Prognosis was excellent in two patients. One patient developed tumor recurrence seven years after surgery, without any progression on further follow up evaluation. In the last patient, the tumor showed a more aggressive progression requiring the adjunction of radiosurgery.

Adolescent↗
PubMed2003

[Anterior cervical discectomy with or without bone graft placement in the treatment of cervical radiculopathy. Long-term results].

BACKGROUND AND PURPOSE: Anterior approach for cervical radiculopathy is a frequently performed operation in neurosurgery. The goal of this study is to evaluate the short and long-term results of anterior cervical discectomy with and without fusion. METHODS: Between 1984 and 1999, we operated on 101 patients presenting with cervical radiculopathy by an anterior approach. The operation consisted of one-level discectomy in 74 cases, two-level discectomy in 25 cases and three-level discectomy in 2 cases. Eighty-four out of 130 levels operated on were fused. Evaluation was done following a consultation with dynamic cervical X-rays and by telephone using a detailed questionnaire. Follow-up was obtained in 91 cases with a mean of 54 months in fused patients, and a mean of 45 months in the non-fused patients. RESULTS: Post-operative results were good in 95% in the 2 groups of patients. We encountered 8 complications, all in patients operated with bone graft placement. Five patients were reoperated on at an adjacent level, 4 being fused previously. CONCLUSIONS: The 2 techniques are comparable in term of goods results at short and long-term follow-up. Anterior discectomy without fusion is associated with less complications, less post-operative pain, and less operative time cost.

Adult↗
PubMed2002

Linear and whorled nevoid hypermelanosis with bilateral giant cerebral aneurysms.

A 24-year-old woman presented with bilateral giant intracavernous carotid artery aneurysms manifesting as a cavernous sinus syndrome on the left side, and anisocoria, ophthalmic pain, and oculomotor paresis on the left side. Physical examination showed mild hyperextensibility of the metacarpophalangeal joints, amelogenesis imperfecta, and hyperpigmentation following Blaschko lines. Analysis of the NEMO gene for incontinentia pigmenti syndrome and of collagen III for Ehlers-Danlos type IV was normal. Skewed X-inactivation patterns in blood lymphocytes were detected. To the best of our knowledge, this association of linear hyperpigmentation and cerebral aneurysms has never been previously reported.

Adult↗
PubMed2002

[Subcranial subfrontal approach for the treatment of extensive cerebrospinal fluid leaks].

BACKGROUND AND PURPOSE: Over the time, the management of cerebrospinal fluid (CSF) rhinorrhea has been a major surgical challenge. In this paper, we will describe our experience using the extended anterior subcranial approach for the repair of extensive or previously treated CSF leaks. This approach consists of a nasoorbitofrontal bony flap, then an ethmoidectomy and sphenoidectomy are performed and the empty space is filled with subcutaneous fat, a pediculated periostal flap is dissected and layed extradurally at the base of the anterior cranial fossa. METHODS: Between January 1994 and December 1999, we reviewed the charts of 7 men and 3 women with a mean age of 36.5 years. The etiology was traumatic in 8 cases. One patient had a spontaneous CSF leak, the other had a macroprolactinoma. RESULTS: The average duration of surgery was 5 hours. Patients were kept in the Intensive Care unit for an average period of 36 hours. The mean follow-up period was 30 months. The success rate was 100%. Postoperatively, all of our patients were anosmic, four of them had anosmia as a preoperative finding. Cosmetically, the skin incisions are limited to the bicoronal incision. CONCLUSION: Knowing that the classical subfrontal and endoscopic approaches have their definite indications, our experience with the extended anterior subfrontal approach in the treatment of extensive or multiple anterior fossa defects suggests that it is a reliable procedure, giving an excellent access with low morbidity, provided that the patients are selected properly.

Adipose Tissue↗
PubMed2002

[Infections after missile head injury. Experience during the Lebanese civilian war].

OBJECTIVE: Establish the risk factors for infection following missile head injuries (MHI). METHODS: Between 1975 and 1990, 500 cases of MHI were admitted, with only 272 responding to inclusion criteria. After initial evaluation including CT scan for 177 patients, all underwent craniectomy with debridement and duroplasty. A retrospective study was undertaken in order to identify the risk factors that increase the infection rate. RESULTS: The global infection rate was 11.39%. Among the studied factors, those increasing the infection rate were: coma on admission (17.6% vs 7.6%), penetrating wounds (12.93% vs 7% for tangential wounds), intracerebral trajectory length over 6 cm (18.42% vs 6.32%), air sinuses effraction (25.8% vs 9.54%), a surgical delay over 72 hours (41.6% vs 10.6%), inadequate duroplasty (28% vs 7.33%), cerebrospinal fluid (CSF) fistulae (58.62% vs 5.76%). The presence of postoperative bone fragments did not increase the infection rate (11.4% vs 11.2%). DISCUSSION AND CONCLUSION: Adequate duroplasty and aggressive treatment of CSF fistulae decrease the infection rate. There is no need to reoperate on residual bone fragments after adequate debridment. A delay of 24 to 48 hours should be considered, to facilitate the procedure without increasing the infection risk.

Adolescent↗
PubMed2001

Acute paraplegia revealing an intraspinal neurenteric cyst in a child.

The authors report a case of intraspinal neurenteric cyst in a 22-month-old child, who presented with acute paraplegia following a vesicourethrogram. Despite 8 days' delay in surgical decompression, he made a complete neurological recovery. Neurenteric cysts are rare congenital lesions of the spinal canal lined with an epithelium of endodermal origin. They are usually located at the cervicothoracic junction and present with progressive mild to moderate signs of myelopathy. This is a unique case in regard both to its clinical presentation and to the excellent outcome after 8 days of complete paraplegia.

Acute Disease↗
PubMed1999

[Temporary occlusion in surgical management of intracranial aneurysm. Report of 54 cases].

Temporary arterial occlusion (TAO) is commonly used in the surgery of intracranial giant aneurysms. Its usefulness and safety in the surgical management of all cases of aneurysms remains to be proved. We report a series of 54 patients operated on for an intracranial aneurysm with the use of TAO. Among the 27 patients, admitted before the 4th day following post subarachnoid hemorrhage with I or II on WFNS score clinically, 24 had early aneurysm surgery. The size of the aneurysm was small in 16 cases, medium in 22, large in 13 and giant in 3 cases. The protocol proposed by Batjer in 1988 for large and giant aneurysms (etomidate, normotention and hypervolemia) was used without any electrophysiological monitoring. All patients underwent a post-operative cerebral CT scan to evaluate the incidence of a cerebral ischemia. Serial transcranial doppler was used to evaluate the severity of vasospasm. Clinical results were assessed using the GOS. TAO was elective in 51 patients and done after peroperative aneurysm rupture in 3 patients. The duration of TAO was less than 5 mn in 25 patients, between 5 and 10 min in 12, between 10 and 15 in 11, between 15 and 20 in 5 and more than 20 min in one patient. The last one developed a reversible neurological deficit secondary to ischemia attribuated to TAO. Intracranial aneurysm peroperative rupture was noted in 3 patients, clinical vasospam in 13 patients. These results allow us to recommend the routine use of TAO in the surgery of intracranial aneurysm. When application time is limited and cerebral protection used, TAO is safe. It decreases the risk of intraoperative rupture from a 18% rate in literature to 4.2% in our present experience and the risk of symptomatic vasospasm is not increased.

Adult↗
PubMed1999

[Cervical myelopathy from ossification of the posterior longitudinal vertebral ligament. Report of 2 cases].

BACKGROUND AND PURPOSE: Cervical myelopathy due to an ossification of the posterior longitudinal ligament (OPLL) is a rare entity in western countries but frequent in Japan. We report on two Lebaneese patients aged 67 and 72 years respectively, who were twins and presented with OPLL. METHODS: Diagnosis was made on myelography in the first case (1989) and on MRI of the cervical spine in the second case (1994). RESULTS: A wide laminectomy was performed in the first case followed by a marked improvement. In the second case, corporectomy of the third, fourth and fifth vertebra with removal of the ligament followed by bone graft didn't improve the clinical symptoms. CONCLUSION: The cause of OPLL remains unknown: genetic factors and metabolic abnormalities are outlined. Treatment options are discussed.

Aged↗
PubMed1999

[Growing fracture of the orbital roof. A case report].

We report a case of growing fracture of the orbital roof in a 5-year-old child. The presenting sign was a pulsatile orbital mass. This child had a history of a minor head injury with orbital impact 2 years ago. Cerebral CT scan revealed a diastatic fracture of the right orbital roof. On MRI a leptomeningeal cyst extending in the orbital cavity was shown. Frontal craniotomy with direct repair of the dural and bone defects was performed. The outcome was excellent. In the literature the exact pathophysiology of the growing fractures is still debated but a dural laceration along the fracture line is noted in all the cases. They are mostly located in the cranial convexity, and rarely affect the skull base. Only 5 similar cases were found in the relevant literature. Growing fracture of the orbital roof should be suspected if ocular symptoms appears in childs who have sustained a head injury several months or years ago.

Accidental Falls↗
PubMed1997

[Thyroid-stimulating hormone hypophyseal adenoma. A case report].

TSH pituitary adenomas represent less than 1% of operated pituitary adenomas. More then 200 cases have been described till now and more patients are now identified since the widespread of ultrasensitive TSH assay which can detect paradoxical situations of elevated serum thyroxine levels with detectable TSH levels. Differential diagnosis must be done with pituitary resistance to thyroid hormones, disorder in which there is a state of "TSH mediated hyperthyroidism". Transsphenoidal surgery remains the treatment of choice of TSH secreting adenoma. A medical treatment with octreotide can improve biological findings and induce tumor shrinking. We report in this paper a TSH pituitary adenoma in a young girl of 15 years old.

Adenoma↗
PubMed1997

[Value of increased MRI signal intensity in cervical arthrosis in myelopathies].

The case of 52 patients with cervical myelopathy were reviewed to determine whether a high signal intensity lesion present on T2 weighted spin echo imaging appears to be an important indicator for predicting prognosis. Preoperatively, there were areas of increased signal intensity in 23 patients. The lesion was clearly demonstrated on T1 weighted images in only one case. Postoperatively, MRI was performed in 9 cases, one showed decreased signal intensity compared to the preoperative levels, and 8 had no change. The pre and postoperative clinical conditions of the patients whose preoperative MR images showed areas of increase signal intensity were not worse than those patients who did not have these areas of increased signal intensity. The postoperative recovery of the eight patients who exhibited no change of the signal intensity was very satisfactory. The pathophysiology of such an abnormality is presumed to be related to edema, myelomalacia or gliosis. However, the presence of these areas of high signal intensity does not appear to be an indicator of a bad clinical prognosis.

Adult↗
PubMed1997

[Cerebral metastasis disclosing osteosarcoma. Apropos of a case].

Brain metastasis from osteosarcoma is a rare entity. Almost 20 cases have been reported in the literature. We report an illustrative case of a 15 years old boy presenting with isolated brain metastase revealing a fibular osteosarcoma. Diagnostic methods and treatment modalities are discussed.

Adolescent↗
PubMed1996

[Thermocoagulation in the treatment of facial neuralgia. Preliminary results in 22 cases].

Twenty-two patients suffering from trigeminal neuralgia were treated by thermocoagulation from June 92 to June 94 at Hôtel-Dieu de France Hospital. Epidemiological, clinical, para-clinical elements and the therapeutic approach were studied. The results after a median follow-up of one year were satisfactory in twenty patients (90.9%) who became asymptomatic. No major complication was noticed. Two recurrences occurred however, one responded to another thermolesion. We propose and discuss this technic for the treatment of the trigeminal neuralgia.

Adult↗
PubMed1990

[Critical study of 200 surgically treated lumbar disk hernias].

The authors reviewed 200 cases of operated lumbar disk hernias. Hernias of the L4-L5 disk were twice as frequent as those of the L5-S1 disk. When clinical examination revealed simultaneous involvement of the L5 and S1 nerve roots, the L4-L5 disk was more frequently responsible (75%). Clinical examination alone was not sufficient to localize the level of the disk hernia and CT scan used for this purpose had a sensitivity of 93.2%. In 20% of cases, the CT scan demonstrated a second asymptomatic lesion. The results of surgical treatment were assessed as 83% good and very good results and 50% complete cures. The authors propose the following recommendations: Look for involvement of the L5 and S1 nerve roots which is suggestive of an L4-L5 hernia; only operate after radiological demonstration of the level of the herniated disk; do not operate on asymptomatic lesions detected by CT scan.

Adolescent↗
PubMedDate not supplied

[Stereotaxic approach in deep cerebral lesions].

The authors report a retrospective study (April 92-April 95) of 60 CT guided stereotactic biopsies. The procedure offered accurate histological diagnosis in 56 cases. There were 38 glial tumors, the majority being of high grade (III-IV). Five abscesses were evacuated and medically treated. Complications occurred in 5% of cases. These results are compatible with those reported in the literature. The simplicity and accuracy of stereotactic procedure are confirmed, making it an imperative step in the management of intraxial space occupying lesion when surgical resection is negotiable. The other applications of the stereotactic procedure are exposed.

Adolescent↗