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PubMedDate not supplied

Neoplasms of spinal origin involving the foramen magnum. Neurodiagnostic considerations on 36 cases.

The radiological problems concerning the diagnosis of neoplasms of spinal origin involving the foramen magnum are discussed on the basis of 36 cases studied. The high number of apparently normal neurodiagnostic examinations are investigated and accordingly explained. Some anatomical features of the area involved are examined in relation to the misleading results. As a result of the studies conducted, opaque myelography is recommended as the best neurodiagnostic procedure particularly in cases of poor clinical conditions. Of the 22% of apparently normal myelographies, 8% appears to be related either to technical features or 14% to incorrect clinical information with regard to the tumor level. Our data stress the importance of following the clinical course of the development of these neoplasms, hardly distinguishable from other degenerative processes. Our findings indicate that a normal myelogram alone does not justify the diagnosis of a non-surgical entity. Therefore repeated neuroradiological investigations are advisable.

Foramen Magnum↗

PubMed1995

[Acute bacterial meningitis and foramen magnum syndrome as a presentation of odontoid osteomyelitis. A case report].

A 77-year-old male was hospitalized with a 6-day history of severe posterior cervical pain and headache. An initial lumbar puncture revealed polymorphonuclear pleocytosis indicating pyogenic meningitis. The blood and throat cultures on admission were positive for Staphylococcus aureus. A combination of ceftriaxone and ABPC, both of which were sensitive to the pathogen, were intravenously administered for one month, by which he responded well as to the meningitis. However, he was found to have persistent neck pain, and wasting and weakness of the shoulder girdles, which were associated with polyneuropathy-like sensory loss. Neuroimaging studies disclosed a partial destruction of the odontoid process, subluxation of the atlantoaxial joint, MRI evidence of an inflammatory pseudomass formation dorsal to the odontoid process and an increased uptake of radionuclide on bone scanning, all of which were indicative of osteomyelitic processes at the region of the axis; i.e., the meningitis was thought to be secondary to osteomyelitis of the odontoid process and hence the foramen magnum syndrome characteristic to this particular case was explained by the compression of the cervicomedullary junction due to the pseudomass. To our knowledge, this is the first case of primary odontoid osteomyelitis to be reported in Japan.

Acute Disease↗

PubMed1994

[Intradural hematoma of the foramen magnum associated with factor XIII deficiency].

A 50-year-old woman, with a history of IgG monoclonal gammapathy, presented with meningitis and intradural hematoma of the foramen magnum associated with factor XIII deficiency. The patient died postoperatively of diffuse haemorrhage. Inhibitors to factor XIII are extremely rare and are congenital or acquired. Patients with factor XIII inhibitor can experience severe bleeding, and many died of cerebral haemorrhage. The role of this defect is discussed. We recommend an extensive investigation of haemostasis for patients with both episode of haemorrhagic disorder and monoclonal gammapathy.

Factor XIII Deficiency↗

PubMed1993

[French language Society of Neurosurgery. 44th Annual Congress. Brussels, 8-12 June 1993. Tumors of the foramen magnum].

Since what seems to be the first reported case of foramen magnum (F.M.) tumor by Hallopeau in 1874, literature on tumoral pathology of this region is rather scarce; beside reports of single cases or short series, there are very few large series and most of them are not recent (Meyer et coll., Yasuoka et coll., Guidetti and Spallone). The present report includes 230 cases of extramedullary tumors collected from 21 french departments over the last ten years (series of the French Speaking Society of Neurosurgery = S.N.C.L.F. series). Delimitation of what is called the F.M. region is rarely given in the literature. In this report, the inferior limit is put at the C2 level and the superior one at the ponto-medullary junction and the lower third of the clivus. To belong to the F.M. region, tumor must have its main part or its insertion within these limits even if it extends beyond them. On the contrary, if the gross development is out of these limits but with some extension into the F.M. region, the case is rejected. A chapter of this report deals with the anatomy of the F.M. with emphasis on the points useful for the management of the tumors. Some details are given on the dimensions of the different parts of the F.M. as given by anatomical studies and also by measurements on C.T. scanner and M.R.I. including during flexion and extension of the head. The S.N.C.L.F. series is then analyzed as a whole. It includes 106 meningiomas (M), 49 neurinomas (N), 28 chordomas (Ch), 32 osseous tumors (T.Os) (19 primary and 13 metastasis) and 15 cases considered as uncommon tumors. (T. Part.) (4 melanomas, 3 hemangioblastomas, 3 dermoid or epidermoid cysts, 2 ependymomas, 1 cavernoma, 1 angiomyolipoma and 1 cholesterin cyst). Mean age is 47 years, with a sex ratio F/M of 1.5/1. Duration of symptoms before diagnosis is of 27 months. Topography is classified into 3 groups anterior (70 cases), lateral (142 cases) and posterior (24 cases). A particular definition is given to these localizations, essentially referring to surgical difficulties and specially for meningiomas. The localization of a tumor is defined by the point of attachment to any structure (dura, spinal root, spinal cord); anterior tumors are attached to the F.M. on both sides of the midline; lateral tumors between the midline and the dentate ligament and posterior ones behind the dentate ligament. According to this way of classification, N are always lateral even if they present anterior or posterior extensions.(ABSTRACT TRUNCATED AT 400 WORDS)

Brain Neoplasms↗

PubMed1994

Meningiomas of the cerebellopontine angle and foramen magnum.

The most commonly occurring meningiomas in the posterior cranial fossa are located along the posterior surface of the temporal bone in the region of the cerebellopontine angle. Topics discussed in this article include clinical features, radiologic findings, surgical techniques, postoperative care, alternative treatments, and meningiomas of the foramen magnum. The author underscores the need for early diagnosis of these lesions so that surgical intervention can result in optimal chances for recovery.

Cerebellar Neoplasms↗

PubMed1994

Evaluation of the foramen magnum dimensions.

The metric values of the foramen magnum (FM) were studied both by dry skull measurements and tomographic measurements. Anteroposterior (AP) and transverse diameters of 88 skulls in three different groups were taken into consideration. The mean AP value for the 38 skulls of the first group (Late Byzantine Era, A.D. 13th century) was 35.6 +/- 2.3 mm, while the mean transverse value was 29.9 +/- 2.1 mm. Twenty-seven skulls of the 20th century had the mean values of 35.1 +/- 2.8 and 28.7 +/- 2.2 mm for AP and transverse measurements, respectively. The third group consisted of computed tomography (CT) measurements of 23 outpatients in the radiology department. Their mean AP value was 36.4 +/- 2.8 and the mean transverse value was 30.0 +/- 1.4 mm. When the measurements of 88 skulls of the three groups were considered together, the mean AP value was 35.6 +/- 2.7 and the transverse value was 29.5 +/- 2.1 mm. There is no significant difference between the total mean value of the present study and that of other authors. However, if the three groups are considered separately, the mean transverse value shows significant differences, especially that of the second group. Also the radiographic and tomographic measurements of other authors have higher results than the present results, perhaps due to methodologic differences.

Anthropology, Physical↗

PubMed1996

An increased frequency of patent foramen ovale in patients with transient global amnesia. Analysis of 53 consecutive patients.

OBJECTIVE: Alerted by the number of patients with transient global amnesia (TGA) in whom Valsalvalike activities immediately preceded the onset of TGA, we have investigated the frequency of patent foramen ovale (PFO) as the prerequisite for paradoxical embolism. DESIGN: Case series with comparison to a control group. SETTING: Hospitalized and ambulatory patients at the neurological departments of the Alfried Krupp Hospital, Essen, Germany, and the Rheinisch-Westfälische-Technische Hochschule, Aachen, Germany. PATIENTS: Fifty-three consecutive patients with TGA were evaluated by the 2 centers between 1988 and 1995. RESULTS: Using contrast transcranial Doppler sonography we have observed a PFO in 55% of the patients with TGA, compared with 27% of a control group of 100 patients. This difference was statistically significant (P < .01). Twenty-five patients with TGA (47%), 15 of them with a proven PFO, reported a precipitating activity, such as the lifting of heavy weights, immediately before the TGA occurred. CONCLUSIONS: In addition to other pathological mechanisms, paradoxical embolism with temporobasal ischemia could possibly play a role in the clinical syndrome of TGA. This hypothesis could explain the frequent observation of preceding Valsalvalike activities in patients with TGA.

Adult↗

PubMed2002

Endovascular closure of a patent foramen ovale in the fat embolism syndrome: changes in the embolic patterns as detected by transcranial Doppler.

BACKGROUND: The posttraumatic fat embolism syndrome (FES) is characterized by petechiae and pulmonary and cerebral dysfunction. A patent foramen ovale (PFO) could worsen the prognosis of FES by allowing larger emboli to reach the systemic circulation. Transcranial Doppler ultrasonography can be used to diagnose and monitor cerebral microembolism in FES. OBJECTIVE: To describe a case of successful percutaneous closure of PFO in a patient with posttraumatic FES with excellent clinical outcome. PATIENT AND METHODS: A 17-year-old girl presented with a posttraumatic long-bone fracture complicated by typical severe FES. Transcranial Doppler disclosed multiple microembolic signals over both middle cerebral and basilar arteries. A large PFO was diagnosed by transesophageal echocardiogram. A brain magnetic resonance image with diffusion-weighted sequences showed multiple bilateral areas of abnormal diffusion in watershed territories. Percutaneous PFO closure with a buttoned device was successfully performed. RESULTS: Closure of PFO was associated with marked reduction in the number and intensity of microembolic signals. Subsequent surgical repair of the fracture with the patient under transcranial Doppler monitoring was uneventful. There was excellent correlation between clinical course and microembolic signal load by transcranial Doppler. CONCLUSIONS: Cerebral fat embolism after long-bone fractures can be detected in vivo and monitored over time with the use of transcranial Doppler techniques. If a PFO is present, its closure before surgical manipulation of the fracture is feasible and could have important protective effects against massive systemic embolization.

Adolescent↗

PubMed2004

Ischemic stroke during sexual intercourse: a report of 4 cases in persons with patent foramen ovale.

BACKGROUND: The association between patent foramen ovale (PFO) and stroke risk in young adults is controversial and poorly understood. Paradoxical embolization through a PFO represents a possible mechanism by which PFO might predispose to stroke. OBJECTIVE: To describe 4 patients with PFO who experienced the onset of ischemic stroke during sexual intercourse. DESIGN: Case series. SETTING: Tertiary referral stroke clinic. PATIENTS: Consecutive patients experiencing stroke during intercourse. RESULTS: All 4 patients were found to have PFO. Despite a thorough evaluation, no other etiology for stroke was identified. CONCLUSION: We suggest that paradoxical embolization through a PFO due to elevated intrathoracic pressure during sexual activity could be a potential mechanism for stroke in these patients.

Adult↗

PubMed1997

Bilateral sensorineural deafness and hydrocephalus due to foramen of Monro obstruction in sibs: a newly described autosomal recessive disorder.

We identified a Canadian-Mennonite family in which a brother and sister have hydrocephalus due to obstruction at the foramen of Monro and profound bilateral sensorineural deafness. This appears to be a unique combination of anomalies and, to our knowledge, has not been reported previously. Both parents and a brother are phenotypically normal. The parents are second cousins. Thus, on the basis of consanguinity, affected sibs of both sexes, and in the absence of evidence for intrauterine infections or other adverse perinatal events, this syndrome is likely inherited in an autosomal recessive fashion.

Abnormalities, Multiple↗

PubMed1996

In utero congestive heart failure due to maternal indomethacin treatment for polyhydramnios and premature labour in a fetus with antenatal closure of the foramen ovale.

A case of severe fetal congestive heart failure due to occlusion of the ductus arteriosus in a mother treated with indomethacin for polyhydramnios and premature contractions is described. Closure of the fetal foramen ovale that escaped detection by prenatal echocardiography was later demonstrated at neonatal autopsy. This case suggests that indomethacin treatment in a ductus-dependent fetus may be hazardous. Therefore, careful surveillance of the fetus exposed to indomethacin in utero is warranted.

Adult↗

PubMed1999

New self-expanding patent foramen ovale occlusion device.

Our purpose was to evaluate a new self-expanding device for closure of the patent foramen ovale (PFO). A transeptal catheter passage through the flap of the fossa ovalis was performed with a transeptal needle inside a catheter, creating a PFO in two minipigs. In an additional five animals, a naturally occurring PFO was found. The device is made from 0.005 inch nitinol wire mesh with polyester fabric inside, similar in construction to the Amplatzer atrial septal occluder. However, the left atrial disc is smaller (18 mm) than the right atrial disc (26 mm). Both discs are connected by a very short flexible waist (3 mm) that allows free movement of both retention discs. Pulmonary and right atrial angiography were performed after placement, at 1 month, and at 3 months follow-up. Placement of the device was technically successful in six animals. One animal died from ventricular fibrillation during placement. Pulmonary angiography and echocardiography showed complete occlusion of the PFO in six animals. Two animals were sacrificed after 1 month and four animals after 3 months. In the animals sacrificed at 1 month, histopathological examination showed partial (n = 2) endothelialization, and in the 3 months follow-up group (n = 4) endothelialization was complete. The device appears to be highly effective for occlusion of PFOs. This procedure may be performed as an outpatient procedure due to the small 7 Fr delivery system sheath. Cathet. Cardiovasc. Intervent. 47:370-376, 1999.

Alloys↗

PubMed2000

Closure of patent foramen ovale in patients with orthodeoxia-platypnea using the amplatzer devices.

We present a series of four patients with orthodeoxia-platypnea who underwent successful transcatheter closure of their patent foramen ovale using the Amplatzer devices (Amplatzer septal occluder/Amplatzer PFO occluder). The average saturation increased from 81% to 96% with complete resolution of symptoms. The Amplatzer devices are safe and effective treatment options for patients with orthodeoxia-platypnea.

Aged↗

PubMed2000

Nonsurgical closure of a patent foramen ovale in a patient with carcinoid heart disease and severe hypoxia from interatrial shunting.

We report the percutaneous transcatheter closure of a patent foramen ovale using an Amplatzer septal occluder in a rare patient with carcinoid heart disease involving both the right and left heart who presented with severe hypoxemia secondary to intra-atrial shunting. We believe this is the first report of this technique being utilized in a patient with carcinoid heart disease and it may represent an alternative to surgical closure in these patients at high risk for surgical complications.

Carcinoid Heart Disease↗

PubMed2001

Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography.

Transesophageal echocardiography (TEE) has been employed successfully for guiding transcatheter device closure of secundum atrial septal defect (ASD) and patent foramen ovale (PFO). However, the use of TEE for device closure requires general anesthesia. Intracardiac echocardiography (ICE) can provide similar anatomical views that might replace the use of TEE for device closure. Eleven patients (eight female/three male) with secundum ASD and PFO associated with strokes underwent attempts at transcatheter closure of their defects under sequential TEE and ICE guidance (six patients) and under ICE alone (five patients). The ages of the patients ranged from 6.6 to 74.7 yr, and their weights ranged from 23 to 124.5 kg. The sizes of the defects, as measured by TEE (six patients), ranged from 3 to 27 mm and, as measured by ICE (11 patients), from 3 to 27 mm. The balloon-stretched diameter of the ASD, as measured by TEE (six patients), ranged from 16 to 38 mm and, as measured by ICE (11 patients), from 16 to 35 mm. Both techniques correlated well for the measured two-dimensional diameter and for the balloon-stretched diameter (r = 0.97 and 0.98, respectively). Both TEE and ICE provided similar views of the defects and the various stages of device deployment. Owing to the proximity of the left atrium to the esophagus, however, the images obtained by ICE were more helpful and informative than those obtained by TEE. All patients experienced successful device placement (six patients under both TEE and ICE; five patients under ICE guidance alone); complete closure of the defects was effected in nine patients, whereas two patients had small residual shunts. There were no complications. We conclude that ICE provides unique images of the atrial communications and measurements similar to those obtained by TEE. ICE potentially could replace TEE as a guiding imaging tool for ASD and PFO device closure, thus eliminating the need for general anesthesia.

Adolescent↗

PubMed1986

A population study of the jugular foramen bridging of the human cranium.

The author previously proposed a simple standard for diagnosing the jugular foramen bridging in man. The incidence of this bridging trait was investigated according to that standard in nine cranial series of East Indians, Micronesians, Japanese, Ainu, Mongols, Aleuts, Alaskan Eskimos, Canadian Eskimos, and Ontario Iroquois. No sex difference in incidence of the trait was recognized. Side difference in trait incidence was also slight but was statistically significant in the combined series of all the population samples examined. The bridging trait occurred more frequently on the right side than on the left side. Occurrences of the bridging trait were definitely associated between sides. Incidence of the trait was less in East Indians, Ontario Iroquois, and Micronesians, but greater in Alaskan Eskimos and Canadian Eskimos, the incidences in Japanese, Ainu, Aleuts, and Mongols being intermediate. The differences in trait incidence among the nine population samples were considered to reflect the differences in genetic compositions of these specific populations.

Alaska↗

PubMed1977

Herniation through the foramen of Morgagni in children.

Eight cases of herniation through the foramen of Morgagni are described. They fell into two distinct groups presenting either as neonatal respiratory distress or as an incidental findings in older children. Diagnosis is essentially radiological, stressing the importance of a lateral film. Surgical repair is advocated. the abdominal approach being perferred. Pneumopericardium is a rare but severe complication.

Child↗

PubMed2002

Transcatheter closure of patent foramen ovale in patients with paradoxical embolism: intermediate-term risk of recurrent neurological events.

Closure of patent foramen ovale (PFO) has been proposed as an alternative to anticoagulation in patients with presumed paradoxical emboli. We report our preliminary intermediate results of patients who underwent transcatheter PFO closure for paradoxical embolism using DAS-Angel Wings occluder or Amplatzer devices. Eighteen patients (8 male/10 female) underwent catheter closure of their PFOs at a median age of 42 years. The complete closure rate was 67% immediately after the procedure and 100% at a mean follow-up interval of 2.2 +/- 1.8 years. The mean fluoroscopy time and procedure time in the Amplatzer group were 8.5 +/- 3.2 min and 65 +/- 21 min, respectively, which were significantly shorter than those of DAS-Angel Wings group (18.9 +/- 4.7 min and 137 +/- 28 min, respectively). There were no recurrent embolic neurological events following device placement in this subset of patients. No complications were encountered either during or after the closure procedure. In conclusion, transcatheter closure of PFO seems to be an effective alternative therapy in the prevention of presumed paradoxical emboli. Further study is needed to identify patients most likely to benefit from this intervention.

Adolescent↗