PubMed Health⌕ Search

Biomedical subjects

R W Hurst

Publications and source records attributed to R W Hurst.

At least 55 records · Page 3Linked to original sources
PubMed1994

Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings.

PURPOSE: To assess the prevalence of MR evidence for diffuse axonal injury at 1.5 T in patients with normal head CT findings after mild head injury. METHODS: Twenty consecutive patients with mild head injury (Glasgow Coma Scale, 13 to 15; no subsequent deterioration, loss of consciousness < 20 minutes) and normal head CT findings were examined with MR at 1.5 T. Pulse sequences included a conventional T2-weighted spin-echo sequence (2500-3000/30,80/1[repetition time/echo time/excitations]) and a T2*-weighted gradient-echo sequence (750/40/2, 10 degrees flip angle). Each sequence was read independently by two blinded readers. RESULTS: The readers agreed that abnormalities compatible with diffuse axonal injury were present in the white matter of 6 (30%) of 20 patients (95% confidence interval, 12% to 54%). Both readers agreed that foci of high signal intensity were present on the T2-weighted spin-echo sequence in 3 (15%) of the 20 cases (95% confidence interval, 3% to 38%) and that foci of hypointensity compatible with hemorrhagic shear injury were present on the T2*-weighted sequence in 4 (20%) of the 20 patients (95% confidence interval, 6% to 44%). Both types of abnormality were noted by the readers in one patient. CONCLUSIONS: MR shows evidence of diffuse axonal injury in some patients with normal head CT findings after mild head injury. These lesions may represent the pathologic substrate underlying the postconcussion syndrome that occurs in many patients with moderate to severe head injury.

Adolescent↗
PubMed1994

Transient monocular blindness in carotid occlusion testing.

A patient developed monocular blindness 23 minutes into a temporary balloon occlusion test of the carotid artery, on the side being tested. His vision returned to normal 1 minute after the balloon was deflated. The authors emphasize the importance of complete frequent neurologic examination during this kind of test.

Blindness↗
PubMed1993

Angiographic assessment of the transverse sinus and vein of labbé to avoid complications in skull base surgery.

Advances in the field of skull base surgery have dramatically reduced the mortality and morbidity of operations on the skull base. Nevertheless, cerebral ischemic events from compromised blood supply to areas of the brain still occur. Although arterial compromise is responsible for a majority of these events, the venous side of the circulation can also play a role in producing cerebral infarctions. A key area of cerebral venous drainage is at the junction of the transverse sinus, sigmoid sinus, and vein of Labbé. Absence of the transverse sinus with the outflow of the vein of Labbé limited to the sigmoid sinus puts these patients at an increased risk for venous infarcts when this area is manipulated during skull base surgery. We have studied 100 consecutive carotid angiograms performed on 50 individuals for carotid artery disease or to rule out aneurysms. We have found that 16.7% of individuals have one atretic transverse sinus. We discuss our results and the implications that they have in skull base surgery. It is our hope that a better understanding of the cerebral venous drainage patterns will help skull base surgeons avoid complications in the future.

Journal Article↗
PubMed1993

Role of transcranial Doppler in neuroradiological treatment of intracranial vasospasm.

BACKGROUND AND PURPOSE: The expanded role of interventional neuroradiological treatment for post-subarachnoid hemorrhage vasospasm has highlighted the diagnostic utility of transcranial Doppler studies in this condition. The role of transcranial Doppler in follow-up and determining the need for repeat intervention has not been previously emphasized. SUMMARY OF REPORT: Intracranial angioplasty for clinically evident vasospasm after subarachnoid hemorrhage was performed in four patients. In two patients, transcranial Doppler flow velocities remained elevated despite initial anatomic correction of the vasospasm. Reangiography revealed new areas of involvement by vasospasm. Reangioplasty or papaverine infusion treatment of the new lesions resulted in decreased flow velocities and clinical improvement in all patients. CONCLUSIONS: Transcranial Doppler has a more significant role than has been previously emphasized in the management of patients undergoing interventional neuroradiological treatment for intracranial vasospasm. Specifically, the persistence of elevated transcranial Doppler flow velocities after intracranial angioplasty suggests the need for repeat angiographic evaluation and possibly further therapy.

Aged↗
PubMed1992

Mycotic aneurysms of the intracavernous carotid artery: a case report and review of the literature.

A case of mycotic aneurysm of the intracavernous carotid artery is reported and the literature is reviewed on this uncommon entity. Nineteen cases have been reported, most often occurring in the clinical setting of meningitis. Management recommendations include angiographic confirmation of aneurysm and follow-up with magnetic resonance imaging during antibiotic therapy. Evidence of aneurysm enlargement is an indication for endovascular trapping of the aneurysm or carotid occlusion.

Aneurysm, Infected↗
PubMed1992

Reversible arteriovenous malformation-induced venous hypertension as a cause of neurological deficits.

A case of a dural arteriovenous malformation with prominent localizing neurological deficits is reported. The venous drainage of the lesion and the lack of a significant pial supply implicate venous hypertension as the mechanism of neurological dysfunction. This mechanism is supported further by the angiographic changes and the prompt resolution of the deficits after endovascular treatment. This case illustrates the potential for this frequently postulated but rarely confirmed pathophysiological mechanism to cause reversible neurological dysfunction.

Cerebral Veins↗
PubMed1990

The role of ultrasound in the management of vein of Galen aneurysms in infancy.

Ultrasonography can be the key imaging modality for neonatal patients with vein of Galen aneurysms. Ultrasound can be used to diagnose the condition, monitor transtorcular embolization procedures, and follow-up these patients after embolization to assess the effectiveness of embolization and to check for complications.

Cerebral Angiography↗
PubMed1989

Computed tomographic features of esthesioneuroblastoma.

Esthesioneuroblastomas are uncommon neoplasms of the superior nasal cavity originating from olfactory epithelium. High resolution CT features of this neoplasm have not been well studied. Nine cases of esthesioneuroblastoma were reviewed to evaluate findings on high resolution CT. Homogeneous soft tissue masses with relatively uniform enhancement centered in the superior nasal cavity are characteristic. Bony erosion is frequent and usually accompanied by molding of bone. Staging, determined by extension and critical for treatment decisions, is well evaluated by CT.

Adult↗
PubMed1988

Choledochal cyst: diagnosis in neonates.

We have described the radionuclide scintigraphic and sonographic findings in two cases of neonatal choledochal cyst. These studies can be used in complementary fashion in evaluating this uncommon cause of neonatal jaundice.

Common Bile Duct Diseases↗
PubMed1988

"Idiopathic" cerebellar calcifications: association with hypothyroidism?

During a 3-year period, unexplained intracerebellar calcifications were seen at computed tomographic (CT) examination in six patients. A surprisingly high association with hypothyroidism was seen, with two-thirds of these patients showing the abnormality. Although an uncommon finding at CT, the presence of cerebellar calcification may indicate hypothyroidism.

Aged↗
PubMedDate not supplied

Neonatal dural venous sinus thrombosis associated with central venous catheterization: CT and MR studies.

We report a case of extensive thrombosis of dural venous sinuses associated with placement of a central venous catheter in the jugular vein. Cases such as this one, though uncommon, underscore a potentially devastating complication associated with central venous catheterization and emphasize caution in catheter placement particularly in neonates.

Catheterization, Central Venous↗
PubMedDate not supplied

Ictal tinnitus.

Unilateral high pitched tinnitus was the sole epileptic ictal manifestation of a 45-year-old woman. Electrographic seizures originated from the contralateral midtemporal area and consistently correlated with tinnitus. Computed tomography (CT) demonstrated a lesion involving the superior temporal gyrus and inferior portion of the supramarginal gyrus. The case illustrates a cortical origin of tinnitus.

Cerebral Cortex↗
PubMedDate not supplied

Extracranial aneurysms of the posterior inferior cerebellar artery.

OBJECTIVE: Extracranial aneurysms of the distal posterior inferior cerebellar artery (PICA) are extremely rare and sometimes difficult to diagnose without an adequate angiogram. We present the first series of 3 patients who were evaluated by the senior author and treated surgically. METHODS AND RESULTS: All 3 patients presented with subarachnoid hemorrhage (SAH). Clincial symptoms, included occipital headache, nuchal rigidity, abducens nerve palsy and rapid neurologic deterioration. A unilateral injection of the vertebral artery failed to show the distal contralateral PICA and the aneurysm in 1 patient. All patients underwent aneurysm clipping through a posterior fossa craniectomy and C-1 laminectomy. The aneurysms were located on the tonsillomedullary segment of the PICA, 10-12 mm below the level of the foramen magnum. CONCLUSIONS: It is important to adequately visualize the distal extent of both PICAs or these aneurysms may not be seen. Patients who present with SAH must have the entirety of both vertebral arteries evaluated to avoid missing these aneurysms. The aneurysms were located adjacent to the atlas necessitating an upper cervical laminectomy for adequate surgical exposure. In general, the patients did well postoperatively and none of the patients developed cerebral vasospasm.

Adolescent↗
PubMedDate not supplied

Angiographic findings in two cases of aneurysmal malformation of vein of Galen prior to spontaneous thrombosis: therapeutic implications.

Two cases of aneurysmal malformations of the vein of Galen with later spontaneous thrombosis are reported. Angiograms before thrombosis in both cases showed mural type aneurysmal malformations of the vein of Galen with slow arteriovenous shunts and associated stagnation of contrast in the venous sac secondary to severe outflow restriction. Based on these angiographic findings, the patients were managed conservatively and the arteriovenous malformations of the vein of Galen thrombosed with good clinical outcomes. Twenty cases of spontaneous thrombosis previously reported in the literature are reviewed.

Cerebral Angiography↗
PubMedDate not supplied

Neonatal craniopharyngioma: CT and ultrasonographic features.

A case of craniopharyngioma in a neonate is reported and the literature on neonatal craniopharyngioma reviewed. First reported in 1952 and previously considered rare, the diagnosis of these neonatal tumors has increased with the use of noninvasive imaging including CT and ultrasound. The CT and ultrasound features of this uncommon but potentially treatable entity are described.

Angiography↗