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At least 1,153 records · Page 64Linked to original sources

PubMed1997

[Is transcatheter occlusion of a persistent foramen ovale a possibility for the avoidance of a paradoxical embolism?].

BACKGROUND AND OBJECTIVE: Cerebral embolism may have different causes with sometimes serious consequences. If no specific reason can be found, paradoxical embolization through a persistent foramen ovale (PFO) is increasingly as a cause of the cerebral ischaemia. This study was undertaken to ascertain whether in patients with cerebral embolism occlusion of a PFO with a transcatheter technique can prevent further cerebral emboli. PATIENTS AND METHODS: Indications for transcatheter occlusion were based on neurological signs (ischaemic stroke), cardiovascular diagnosis, and coagulation tests. Between August 1991 and July 1996, transcatheter occlusion of a PFO was performed in 28 fully anticoagulated patients (median age 37.8 [15.4-65.4] years). The mean PFO diameter was 9.5 mm (3-17), mean duration of fluoroscopy 18.3 (8.7-43.1) min. The Rashkind device was implanted in three patients, the Sideris buttoned device in 25. During the follow-up period (2-64 months; mean 13 months) renewed neurological symptoms occurred in only one patient. Transoesophageal echocardiography excluded thrombi on the implanted device or in the left atrium, and a residual PFO. The cause of the one neurological episode is therefore not clear. All other patients have remained free of symptoms and recurrence without anticoagulation after placement of the device. CONCLUSIONS: Transcatheter occlusion of a PFO is a relatively simple and safe procedure. Our results suggest that it can at least lower the incidence of further cerebral embolizations. The clinical value of the method in comparison with anticoagulation requires further study.

Adolescent↗

PubMed1991

Transsigmoid approach for tumors of the jugular foramen.

A transsigmoid approach is detailed for removal of tumors involving the jugular foramen. This approach was used in seven patients, eliminates the need for facial nerve transposition, and helps to preserve cochleovestibular function. The sigmoid sinus is packed and both the facial nerve and the labyrinth are identified. This approach provides excellent vision of the intradural and extradural course of the lower cranial nerves, rendering preservation of isolated nerves within the neural compartment feasible.

Journal Article↗

PubMed1996

Tubercle at the foramen magnum.

The presence of a tubercle in the anterior margin of the foramen magnum has been studied in a total of 382 skulls of white adult humans. Its incidence was 1.3%. A radiographic study of this tubercle has been carried out to clarify its cause and internal morphology. The position of this tubercle may be related to traumatic medullar lesions of the occipitovertebral region.

Journal Article↗

PubMed1995

Anterolateral and posterolateral approaches to the foramen magnum: technical description and experience from 97 cases.

Over a 12-year period (1981-1993), 97 lesions located in the foramen magnum area were treated using either the posterolateral or the anterolateral approach. The former is a lateral extent of the midline posterior approach; the latter is the technique of exposure of the cervical vertebral artery applied at the C-1 to C-2 level. The choice between the two types of lateral approaches was made following three modes of localization: anteroposterior attachment, relation to the dura, and relation to the vertebral artery. Both techniques are described in detail, with special attention paid to the bone and dural openings, which vary according to the localization.The treated lesions include 91 tumors, 4 craniocervical junction malformations, 1 synovial cyst, and 1 abcess. A complete resection was realized in 95% of the tumoral cases, with a very limited morbidity and mortality (3%).

Journal Article↗

PubMed1994

Papillary (malignant) meningioma of the foramen magnum presenting as a posterior neck mass.

Meningiomas and neurofibromas are the most common extramedullary tumors in the region of the foramen magnum. The clinical symptoms are variable, including headache, occipitocervical pain, and hoarseness. Neurological symptoms are present only in 40% of cases. The age group ranges from 4 to 56 years. A number of patients are misdiagnosed as multiple sclerosis, syringomyelia, and cervical disc disease. The overall incidence of these tumors vary from 1.6 to 2.4%. The majority of meningiomas are histologically benign. Papillary (malignant) meningiomas are even rarer in this location. The present report is that of a 46-year-old man who developed a painless mass in the nape of his neck, without any neurological symptoms. Following initial biopsy at another hospital, a definitive resection was undertaken at Loyola University Medical Center. The diagnosis of a malignant meningioma was made after extensive immunohistochemical and electron microscopic studies. The patient developed a positive cervical lymph node 1 year later, which was excised and showed identical histopathologic features.

Case Reports↗

PubMed1994

Transfacial transpterygomaxillary access to foramen rotundum, sphenopalatine ganglion, and the maxillary nerve in the management of atypical facial pain.

Post-traumatic atypical facial pain syndromes are refractory to medical therapy and thus challenging to treat. Some of these patients have a facial causalgia syndrome that may include autonomic as well as trigeminal fibers as the anatomic mediators. A procedure that may be of both diagnostic and therapeutic benefit is a nerve block in the region of the foramen rotundum. This allows access to both the maxillary nerve and the sphenopalatine ganglion. A simple technique developed to perform this procedure is described, and the results in a series of six patients are presented.

Journal Article↗

PubMed1993

[Transient thrombus in patent foramen ovale with pulmonary and paradoxical embolization].

Ten days after surgical treatment of a gastric perforation a 70-year-old woman developed progressive dyspnoea and hypertension without any signs of deep vein thrombosis. Emergency echocardiography revealed acute cor pulmonale with a dilated right atrium and ventricle, as well as paradoxical ventricular septal motion. In addition it demonstrated an elongated, extremely mobile thrombus stuck in a patent foramen ovale with most of it floating in the right atrium, the remainder in the left atrium. Within 2 hours of the ultrasound examination she went into fulminant pulmonary embolism with circulatory arrest and paradoxical embolization from the atria to the brain, after which the intraatrial thrombus was no longer detectable. She was successfully resuscitated and thrombolysis was immediately started with tissue-plasminogen activator (100 mg over 90 min), with ensuing stabilization of the circulation. The patient was gradually weaned off the ventilator over the following few days, but she died 10 days after the resuscitation from the severe cerebral damage.

Aged↗

PubMed2000

Structural and compliant anatomy of the patent foramen ovale in patients undergoing transcatheter closure.

BACKGROUND: Most current intracardiac closure devices target the atrial septal defect. However, defects such as the patent foramen ovale (PFO) have unique structural features that may influence rational device design. With mounting interest in transcatheter techniques for closure of PFO in patients with cryptogenic stroke, a clearer understanding of these features is warranted. METHODS: Retrospectively, we reviewed angiograms obtained at the time of transcatheter closure of PFOs with a non-self-centering device in a group of 21 patients with a history of stroke. RESULTS: The PFO appeared as a tunnel of varying length (2.4 to 19.5 mm, mean 9.1 +/- 4.7 mm) bounded by septum secundum and septum primum. The potential area of the defect was as small as 12.2 mm(2) and as large as 121.1 mm(2). With device placement, the tunnel length shortened or disappeared (0.5 +/- 1.6 mm) by inferior displacement of the more compliant septum primum. CONCLUSIONS: In patients with PFO referred for transcatheter closure, the defect most commonly appeared as a tunnel-like defect between a thicker, less compliant septum secundum and a thinner, more compliant septum primum. Although the length of the undisturbed tunnel varied widely, the tunnel was shortened or eliminated by placement of a non-self-centering device. The observation that PFO anatomy can be predictably altered by some devices may have an impact on device design or implantation technique.

Adult↗

PubMed2003

Interatrial septal mobility predicts larger shunts across patent foramen ovales: an analysis with transmitral Doppler scanning.

BACKGROUND: The association of patent foramen ovale (PFO) with cryptogenic stroke is strongest in patients with larger shunts and patients with atrial septal aneurysms (ASAs). We postulated that the potency of ASA as a risk factor for stroke relates to the size of shunt across PFOs associated with mobile atrial septae. The purpose of this study was to investigate the relationship between atrial septal mobility and the degree of right-to-left shunting with a transthoracic transmitral Doppler scanning (TMD) contrast technique. METHODS: In 165 consecutive patients, transthoracic TMD recordings were made during a saline contrast study with the patient at rest and after a maneuver to increase right atrial pressure. Bubble transit corresponded to high intensity signals in the velocity envelope of the mitral inflow profile and was quantified by a bubble score. RESULTS: A PFO was diagnosed in 59 patients (36%). In 50 patients with PFO and adequate echocardiography images, the incidence of ASA was 52%. In this group, both total septal mobility and leftward deviation predicted the TMD bubble score at rest (Spearman rho 0.64, 0.64, respectively, P <.001) and after the maneuver (Spearman rho 0.74, 0.73, P <.001). In 28 patients with cerebral ischemic events, the maneuver bubble score was predictive for cryptogenic stroke (P =.02, odds ratio 7.58). There was a trend toward significance between total septal motion and cryptogenic stroke (P =.06). CONCLUSION: Atrial septal mobility predicts the degree of right-to-left shunts across PFOs. The role of excessive septal mobility in the etiology of stroke may therefore be caused by the greater opportunity for paradoxical embolism because of the size of the associated trans-PFO shunt.

Adult↗

PubMed2001

Intra-atrial thrombus after surgical closure of patent foramen ovale.

Patent foramen ovale (PFO) represents a potential path for paradoxical embolism and is associated with cryptogenic stroke. It has been suggested that because a PFO represents a repairable lesion (by surgical or transcatheter methods), repair may be the optimal treatment to prevent recurrent stroke. This report describes a patient with recurrent neurologic and peripheral embolic events, which occurred approximately 6 months after the surgical closure of a PFO. The diagnosis of an intra-atrial thrombus with a small residual PFO was made by subsequent transesophageal echocardiography. Thrombus formation at the closure site needs to be considered in a patient with recurrent embolic events after closure of a PFO.

Echocardiography, Transesophageal↗

PubMed2002

Transcatheter closure of atrial septal defect and patent foramen ovale in adult patients using the Amplatzer occlusion device: no evidence for thrombus deposition with antiplatelet agents.

Transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) using the Amplatzer septal occluder (AGA Medical, Minneapolis, Minn) is an alternative to surgical closure. There are only limited data on the thrombogenic potential of the device. Thirty-seven patients (14 men, 23 women) underwent device closure of their ASD (n = 21) or PFO (n = 16) at a mean age of 47 +/- 14 years (range, 18-72). The device was successfully deployed in all patients. Thirty-three of 37 patients received antiplatelet therapy with clopidogrel bisulfate and aspirin for a total of 6 months. Four patients in atrial fibrillation were also anticoagulated (international normalized ratio 2.0 to 3.0). No thrombus was detected in any patient on either side of the device by transthoracic and transesophageal echocardiography and there were no cases of symptomatic thromboembolism. Right-to-left interatrial shunting was diagnosed by contrast transesophageal echocardiography with the Valsalva's maneuver. At 1-month follow-up, minimal right-to-left shunting was detected in 6 patients (2 PFO, 4 ASD). Two patients (PFO) had minimal shunting at 1 month but not at 6 months. In 3 patients (ASD), inducible right-to-left shunting persisted at 6 months. In conclusion, our results obtained from a modest number of patients indicate that antiplatelet therapy is safe and effective in preventing thrombus formation on the septal occluder surface.

Adolescent↗

PubMed2003

Patent foramen ovale: anatomy versus pathophysiology--which determines stroke risk?

This study investigated anatomic and pathophysiologic variables that may determine which patent foramen ovale (PFO) are associated with cerebrovascular accidents (CVAs). Anatomic features of a PFO have been identified as risk factors that predispose certain people to cryptogenic strokes (strokes of unknown cause). However, potential pathophysiologic variables that can determine the pressure gradient between left and right atria, which could influence the right-to-left shunt through a PFO, have not been examined. A retrospective study included 78 consecutive patients in whom PFOs were detected during routine transesophageal echocardiography examination. Group I included 36 patients with CVAs of unknown cause (cryptogenic stroke). Group II included 42 patients without CVAs whose PFOs were incidental findings. Anatomic features measured included separation and overlap between septum primum and septum secundum, interatrial septal motion, and the relative size of the right-to-left shunt with peripheral saline solution contrast injections. Pathophysiologic variables considered were those that could cause elevated left atrial pressure, thereby minimizing the right-to-left shunt.Patients with a clinical neurologic event (group I) had a larger right-to-left shunt volume of contrast bubbles than did patients with asymptomatic PFO (group II; P =.004). The size of the overlap between septum primum and septum secundum was less in patients from group I as compared with patients from group II (7.5 +/- 3.4 mm versus 9.9 +/- 6.0 mm; P =.026). However, other anatomic features of PFO that are determinants of the "opening" were not significantly different between the 2 groups. No statistically significant difference was found in the distance of the separation between septum primum and septum secundum (2.5 +/- 2.0 mm versus 1.9 +/- 1.6 mm; P = not significant). The prevalence of interatrial septal aneurysm was also similar between the 2 groups (28% versus 21%; P = not significant). However, the prevalence of variables that could potentially raise left atrial pressure was greater in patients without CVA as compared with those with a CVA (48% versus 14%; P =.01). In our study, anatomic features alone did not determine interatrial shunt size and pathophysiologic variables that could raise left atrial pressures did differentiate between patients with a PFO with a CVA/transient ischemic attack and those without it. Thus, both anatomic and pathophysiologic mechanisms should be considered in determination of the potential clinical significance of a PFO.

Adult↗

PubMed2000

Quantitative sensory nerve conduction threshold (sNCT) evaluation of the trigeminal nerve at the mental foramen area.

STATEMENT OF PROBLEM: There is a need for a quick, objective, quantitative sensory test of the mandibular inferior alveolar nerve to assess sensory dysfunction due to trauma, infection, or disease. PURPOSE: This study evaluated the reliability and reproducibility of a commercially available electrodiagnostic quantitative sensory nerve conduction threshold (sNCT) evaluation testing method and established normative values for future evaluation of nerve dysfunction. MATERIAL AND METHODS: Rapid current perception threshold (R-CPT) values were obtained with Neurometer CPT/C, an electrodiagnostic sNCT device that administers an alternating constant-current sinusoid waveform stimulus at either 2000 Hz (H) (Hertz [cycles/second]), 250 Hz (M), or 5 Hz (L) at intensity levels ranging from 0.001 to 10 mA. Thirty-four healthy subjects were tested then retested by the same operator from 7 days to 153 days. R-CPT evaluation was performed over the mental foramen bilaterally with dual disposable gold-plated electrodes and a hypoallergenic electrode gel held in place using nonconductive adhesive tape. Two consecutive identical R-CPT measures were obtained for each stimulation frequency for determination of the final R-CPT value. RESULTS: On the left side, there was no difference between the first and second test (P > .05). On the right side, there was a statistical difference between the first and second test for L, M, and H, but the confidence interval is very narrow and the differences are not clinically significant. CONCLUSION: From the values obtained, R-CPT testing was reliable for the quantification of sensory function in healthy individuals.

Adult↗

PubMed2005

Closure of a patent foramen ovale: effective therapy of migraine and occipital stroke.

Whether stroke in a patient with migraine and patent foramen ovale (PFO) is due to PFO or migraine is difficult to decide. In a 33-year-old woman with migraine with aura, a visual field defect developed acutely. Neurological investigation revealed double vision when looking to the left and exaggerated patella tendon reflexes. Since then the patient complained about permanent visual impairment. CT- and MRI-scans of the brain showed a right occipital ischemic stroke. Intensive search for risk factors revealed cigarette smoking and chronic hypovolemia On transesophageal echocardiography an inter-atrial hypermobile septum and a PFO were detected. The patient underwent closure of the PFO by means of an Amplatzer PFO occluder nine weeks after the stroke. Since then she did not experience a further cerebrovascular event or migraine attack. This case shows that in a patient with PFO and migraine with aura, stroke may be attributable to migraine rather than to PFO. Occlusion of the PFO may reduce the frequency and intensity of migraine attacks.

Adult↗

PubMed1998

The interest of surgical closure of patent foramen ovale after stroke: a preliminary open study of 8 cases.

The risk of stroke and the risk of recurrent strokes in patients with patent foramen ovale (PFO) need a prevention that still remains a therapeutic problem. There are 4 preventive treatments: anti-agregants, anti-coagulants, transcatheter closure, and surgical closure of PFO. The aim of this study was to demonstrate that surgical closure of PFO is safe and useful for prevention of strokes. Eight patients with stroke and PFO diagnosed by transesophageal echography (TEE) were prospectively selected for surgical closure. It was necessary to be younger than 70 years, not to have another cause of stroke, and to have either recurrent strokes or several ischemic lesions on MRI, isolated for PFO associated with an atrial septal aneurysm, and to have a Valsalva maneuver or cough inducing the stroke. For these reasons, these patients were considered to be an homogenous group with a strong relationship between the PFO and the stroke, and with a high risk of recurrence of stroke. The 8 patients had a direct suture of the PFO with a cardiopulmonary bypass. All patients were followed-up with clinical, MRI and TEE examinations during 12 months after surgery. No surgical complications were observed. After one year, without any anticoagulant treatment, no recurrent stroke or transient ischemic attack, no new ischemic lesions on MRI, nor neuropsychological disturbance were noted. No post-surgical inter-atrial right-to-left shunting was observed. In the absence of controlled studies to guide therapeutic options, our data suggest that surgical closure of PFO in patients with stroke, is safe and efficacious to prevent recurrent stroke without any anticoagulants in the first year of follow-up. Further studies are needed to evaluate the long-term role of surgical closure of PFO as an alternative to prolonged anti-thrombotic treatment.

Adult↗

PubMed1998

Low frequency of clinically silent circulating emboli in patients with mitral valve prolapse or patent foramen ovale detected by bigated transcranial Doppler ultrasound.

Patent foramen ovale (PFO), but not uncomplicated mitral valve prolapse (MVP), is a possible source of cardiac embolism to the brain. There are only a few reports on the frequency of clinically silent circulating microemboli in these two conditions. We performed 1-hour recordings of one middle cerebral artery in 4 patients with MVP and 14 patients with PFO to detect circulating microemboli. For the identification of microembolic signals we used blinded off-line evaluation and bigated transcranial Doppler sonography (sampling from two different depths in the vessel). Microembolic signals were detected conventionally in 3 out of 14 patients with PFO (3, 8, and 14 microemboli/h), and in none out of the 4 patients with MVP. The absence of microembolic signals in patients with MVP and the low frequency of microemboli in patients with PFO reflect the different embolic potential of these two cardiac abnormalities.

Adult↗

PubMed2004

Organic and psychogenic factors leading to executive dysfunctions in a patient suffering from surgery of a colloid cyst of the Foramen of Monro.

The authors report a 41-year-old female patient who had suffered from colloid cyst of the Foramen of Monro. After surgical intervention in which the cyst was completely removed, her hydrocephalus decreased to normal ventricle size measured by MRI. However, the patient became depressive and reported vast difficulties in everyday life decision-making. An examination twenty months after surgery indicated psychiatric symptoms and abnormalities in personality. Neuropsychological investigation revealed average to above average performance in anterograde memory, attention, information processing, and intelligence. In contrast, the patient was severely impaired in decision-making, complex executive functions, and social cognition. In 18F-2-fluoro-2-deoxy-D-glucose (18FDG-PET) hypometabolism in bilateral dorsolateral prefrontal cortex, cingulate cortex and left fusiform gyrus was observed. The authors conclude that in this case decision-making deficits and executive dysfunctions are influenced by both organic and psychogenic factors.

Adult↗

PubMed2004

Surgical closure of patent foramen ovale in patients with suspected paradoxical embolism: long-term results.

OBJECTIVE: It is thought that a patent foramen ovale (PFO) is the crucial mechanism in patients with suspected paradoxical embolism and cryptogenic stroke. It has been hypothesized that closure of the PFO would prevent further cerebrovascular incidents. We describe our early and late experience with surgical closure of the PFO in patients with paradoxical embolism. PATIENTS AND METHODS: Between May 1994 and December 2001, 33 patients (26 men, 7 women; mean age, 55.2 +/- 8.7 years; range, 37-74) underwent surgical closure of a PFO at our institution. All patients had preoperatively suffered from a stroke and/or a transient ischemic attack, after which echocardiography showed a PFO. Mean follow-up at 99 +/- 30 months (range, 10-111 months) was 100% complete. RESULTS: All patients survived the operative procedure. Early complications occurred in four patients (12%). Actuarial survival at 1, 5 and 8 years was 97 +/- 3%, 97 +/- 5% and 94 +/- 8%, respectively. At long-term follow-up all but two patients were alive. The deaths of these two patients were related to malignancy and ischemic heart disease, respectively. Two patients (6%) had suffered a residual cerebrovascular event after successful surgery. CONCLUSION: Surgical closure of PFO in patients with paradoxical embolism can safely be performed with a low risk of early mortality. Residual thromboembolic events were rare and in those few it occurred it did so with the interatrial septum being closed, indicating that in those patients the PFO was not the mechanism of the thromboembolic event in the first place.

Adult↗