SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Widening of an intervertebral foramen in the cervical spine is a striking radiogical finding and generally denotes a patient with a dumbbell spinal tumor. Other, rare causes can also produce widening, such as expansion, tortuosity or elongation of the vertebral arteries, and congenital absence of a pedicle.
PURPOSE: To determine the sensitivity of contrast material-enhanced transcranial color-coded sonography (c-TCCS) compared with that of contrast-enhanced transesophageal echocardiography (c-TEE) for detection of cardiac right-to-left shunt. MATERIALS AND METHODS: Forty consecutive patients with stroke or transient ischemic attack were admitted to the hospital and were examined by using c-TCCS and c-TEE. High-intensity transient signals (HITS) were counted for 25 seconds after the end of the Valsalva maneuver, and the numbers of HITS were classified in one of four categories (zero HITS, one to 10 HITS, >10 HITS without curtain, and curtain). A statistically significant difference was calculated with the Fisher exact test. RESULTS: HITS were counted in 21 (52%) patients by using c-TCCS and c-TEE. With both tests, no HITS were counted in 15 (38%) patients. In two (5%) patients, no HITS were counted with c-TEE but three HITS in one patient and five HITS in the other were counted with c-TCCS. In two (5%) patients, no HITS were counted with c-TCCS, but a small patent foramen ovale (PFO) was seen at c-TEE. With c-TCCS, the sensitivity was 91% (21 of 23) and the specificity was 88% (15 of 17). In 23 patients examined with c-TCCS, 14 (61%) patients had category 1 PFO; seven (30%) patients, category 2 PFO; and two (9%) patients, category 3 PFO. Mean HITS count in patients with category 1 PFO was 4.4 and that for those with category 2 PFO was 27.6. CONCLUSION: c-TCCS is a sensitive noninvasive method for detecting cardiac right-to-left shunt and is as sensitive as c-TEE.
PURPOSE: To investigate if abnormal early contrast enhancement of the aorta and decreased attenuation of pulmonary arteries at deep-inspiration spiral computed tomographic (CT) angiography might be caused by a patent foramen ovale (PFO). MATERIALS AND METHODS: Two hundred forty-four spiral CT angiographic images of the pulmonary arteries obtained during deep inspiration in patients suspected of having pulmonary embolism (PE) were reviewed for evidence of abnormal early enhancement of the aorta. In 45 patients, enhancement of the ascending aorta was equal to or more than that of the pulmonary arteries. Nonenhanced or contrast material-enhanced echocardiography was performed in 39 of these cases. All CT images with abnormal enhancement patterns were graded for contrast quality with respect to sufficient enhancement of pulmonary arteries (four grades) at three anatomic levels: right and left main and lobar and segmental branches. In addition, all spiral CT angiographic images were evaluated concerning the diagnosis of PE and the grouping of central (main pulmonary artery to proximal lobar arteries) and peripheral (beyond proximal lobar branches) locations of emboli. Mean attenuation values of ascending aortas and main pulmonary arteries in group 1 (n = 244) were compared with those in groups 2 and 3 (n = 45) by means of the two-tailed Student t test for unpaired data (P <.05). RESULTS: Attenuation values for ascending aortas in group 1 were significantly lower than those in groups 2 and 3 (P <.001). Attenuation values in main pulmonary arteries were significantly higher in group 1 than in groups 2 and 3 (P <.001). Echocardiographic images showed an intracardiac right-to-left shunt in all 39 cases with abnormal contrast dynamics in the CT study (16% of the whole study population). Three patients had an atrial-septal defect, and 36 had a PFO. Images with a shunt had good (9%), intermediate (37%), fair (33%), and poor (23%) contrast of the pulmonary arteries. Sufficient vessel contrast for the diagnosis of PE could not be achieved in 27 of 45 patients with a shunt, but severe central PE could be ruled out. PE could be diagnosed in 31% of the 244 images, 58% were negative, and 11% were indeterminate. CONCLUSION: A PFO may frequently lead to insufficient attenuation of the pulmonary arteries, which potentially limits the diagnosis of PE if the examination is performed during deep inspiration.
The appearance of the proximal lumbar spinal nerves at magnetic resonance (MR) imaging has not, to the authors' knowledge, been described. MR images and exactly corresponding sections obtained from four cadavers by means of a freezing microtome were correlated to characterize the MR appearance of the proximal spinal nerves. The junction of the dorsal and ventral rami with the dorsal and ventral roots consists of a group of six to 15 fascicles measuring 2-6 mm in length. These fascicles appear in MR images obtained with short repetition times as small foci of lower signal intensity than that of surrounding fat. The proximal spinal nerve and its relationship to the intervertebral disk and osseous margins of the neural foramen can be demonstrated effectively with MR imaging.
Patency of the foramen ovale (PFO) may be a cause of unexplained decompression sickness (DCS) in sports divers. To assess the relationship between PFO and DCS, a case-control study was undertaken in a population of Belgian sports divers. Thirty-seven divers who suffered from neurological DCS were compared with matched control divers who never had DCS. All divers were investigated with transesophageal contrast echocardiography for the presence of PFO. PFO size was semiquantified on the basis of the amount of contrast passage. Divers with DCS with lesions localized in the high cervical spinal cord, cerebellum, inner ear organs, or cerebrum had a significantly higher prevalence of PFO than divers with DCS localizations in the lower spinal cord. For unexplained DCS (DCS without commission of any diving procedural errors), this difference was significant for large PFOs only. We conclude that PFO plays a significant role in the occurrence of unexplained cerebral DCS, but not of spinal DCS. We further stress the importance of standardization and semiquantification of future PFO studies that use transesophageal contrast echocardiography.
Numerous cases of orthodeoxia and platypnea have been reported. Some have been found to be due to intracardiac shunts despite normal intracardiac pressures. In the case presented, a 79-year-old woman was noted to have orthodeoxia and platypnea secondary to a patent foramen ovale (PFO) despite normal intracardiac pressures. She recovered after closure of the PFO. The authors postulate that recent vertebral fractures and subsequent kyphosis, as well as a dilated thoracic aorta, altered intrathoracic relationships and may have led to a stream of venous return being directed across the PFO in the upright position, despite normal intracardiac pressures.
BACKGROUND AND OBJECTIVE: The presence of patent foramen ovale (PFO) and atrioseptal aneurysm (ASA)has been described as a risk factor in cryptogenetic stroke. Patients with unknown origin stroke and PFO have less severe symptoms compared to the rest of cryptogenetic stroke patients. We evaluated the clinical situation in stroke patients with PFO and describe the factors predictive of a better outcome after a year. PATIENTS AND METHOD: 1118 patients between 18 and 70 years old were evaluated, and 223 were classified as having cryptogenetic stroke. Our protocol Included transcranial Doppler, a transesophageal echocardiography (TEE) and a cranial RM. We used the NIH Stroke Scale (NIHSS) to evaluate the clinical situation, and the modified Ranking Scale for the functional outcome. RESULTS: A total of 117 patients had all inclusion criteria. 66 (56.4%) showed a PFO. We observed a younger age, a higher percentage of females (48.4% in PFO vs. 25.5% in no-PFO) and less risk factors in PFO patients, except for migraine (24.6% in PFO vs. 5.9% in no-PFO; p = 0.01). PFO patients had less severe strokes (NIHSS: 3--median--in PFO vs. 5 in no-PFO; p = 0.010) and a lower grade of sequelae (p 0.024). Worse outcome was related to male, initial neurological evaluation (NIHSS) and presence of ASA. After a logistic regression, only the initial clinical situation (NIHSS) and the presence of ASA were associated with sequelae. CONCLUSIONS: PFO patients showed a less severe stroke and better functional outcome. The initial neurological involvement and the presence of ASA are predictive of the clinical situation after a year.
Recent studies reported an increased prevalence of patent foramen ovale (PFO) in patients with migraine with aura (MA+). To investigate the possible relationship between MA+ and paradoxical embolism, we studied the prevalence of both conditions. Investigation of PFO was undertaken in 74 consecutive patients presenting with an acute stroke of undetermined origin. The patients were questioned about MA+ or migraine without aura (MA-) according to the criteria of the International Headache Society. Follow-up was performed to investigate the evolution of MA+ and MA- according to different treatments of stroke. PFO was found in 44 of 74 patients, 16 of whom had MA+ (36%), compared to 4 (13%) MA+ patients without PFO (p = 0.03). Of 25 patients in whom the PFO was considered to play a causal role in the stroke, 13 (52%) had MA+, whereas only 3 (16%) of 19 patients in whom PFO was considered unrelated had MA+ (p = 0.014). Thirty-nine of the patients with MA+ and MA- were studied over a mean follow-up of 13 months. Seven of 15 patients with MA+ and PFO, treated either with surgical closure or anticoagulants, noticed complete disappearance of MA+ attacks. The prevalence of MA+ is high among stroke patients with PFO. In patients with a high presumption of paradoxical embolism, the proportion of MA+ is increased, and this suggests a possible role of this association in the occurrence of the cerebrovascular event. Forty-seven percent of patients with PFO and MA+ reported complete suppression of their aura attacks after surgical closure or anticoagulant treatment. This finding suggests that at least in some patients, MA+ attacks may be due to paradoxical embolism.
A 59-year-old man presented with an intracranial mass that involved the cavernous sinus. It was biopsied percutaneously through the foramen ovale and the diagnosis of meningioma was established. The literature was reviewed for the employment of similar procedures and the potential benefits of this technique explored.
BACKGROUND: Atrial septal aneurysm (ASA) has been considered a potential source of cardiogenic embolism for many years. The ASA Multicenter Italian (ASA-MI) Study evaluated the prevalence and characteristics of ASA in patients with stroke and normal carotid arteries compared with control patients without stroke. The purpose of the present study was to evaluate the frequency of ASA and the association with patent foramen ovale (PFO) in the subgroup of younger patients (aged less than 55 years) included in the ASA-MI Study. METHODS: The ASA-MI Study included 606 patients, enrolled between November 1990 and December 1996: 245 patients with a previous cerebral embolic attack and normal carotid study and a control group of 316 patients. They all underwent transthoracic and transesophageal echocardiography. The subgroup of younger patients aged less than 55 years included 90 patients (61 men and 29 women of mean age 49 +/- 5 years) (group AY). This group was evaluated and compared with an age- and sex-matched control population (61 men; of mean age 48 +/- 6 years) (group BY). RESULTS: The prevalence of ASA was 48.8% (95% confidence interval 40-61) in group AY and 22.2% in the group BY (95% confidence interval 18-33) (chi(2) = 5.968; p = 0.01). Morphological features were similar in the 2 groups of patients. ASA involved the entire septum in 52% of patients of group AY, and in 47.2% of group BY. The prevalence of PFO was 58.8% (95% confidence interval 43-62) in group AY and 28.8% in group BY (95% confidence interval 17-35) (chi(2) = 5.811; p = 0.01). A strong association was found between ASA and PFO. Of the 90 younger patients with stroke, 39 of 44 (88.6%) with ASA also had PFO, compared with 14 of 46 (30.4%) without ASA (chi(2) = 7.370; p = 0.007). CONCLUSION: We found that ASA and PFO were independent predictive factors for stroke in younger patients with stroke and normal carotid arteries and that the association between ASA and PFO bore an increased odds risk.
BACKGROUND: Paradoxical embolism via persistent foramen ovale (PFO) is suspected to be a frequent cause of stroke in younger patients. We investigated whether the prevalence of the risk factors for venous thrombosis factor V Leiden (FVL) and prothrombin G20210A mutation (PT G20210A) is increased in this group of patients. METHODS: We examined FVL and PT G20210A mutation in 220 patients (group 1) with cerebral ischemia associated with a PFO and without other etiology, in 196 patients with cerebral ischemia of an etiology other than PFO (group 2), and in 362 healthy subjects (group 3) from the same region in Germany. RESULTS: Heterozygosity for the PT G20210A mutation was more common in group 1 (5.0%) than in group 3 (1.4%; sex- and age-adjusted odds ratio 3.66; 95% CI 1.25-10.75; p = 0.01). By contrast, the mutation was not more common in group 2 (2.6%; odds ratio 1.50; 95% CI 0.42-5.41; p = 0.5). Prevalences of FVL were not different between groups. CONCLUSIONS: We identified PT G20210A but not FVL - the strongest genetic risk factor for deep venous thrombosis - to be significantly associated with stroke attributed to PFO. These findings rise doubts about the concept of paradoxical brain embolism as the dominating mechanism in stroke associated with PFO.
All studies concerning the detection of patent foramen ovale (PFO) have compared transthoracic or transesophageal echocardiography (c-TEE) to transcranial Doppler ultrasound after contrast injection (c-TCD), but combining both techniques in the search of PFO has received no consideration. Our study aims to substantiate this claim in 37 patients with cryptogenic stroke. It includes two protocols for the detection of PFO to assess the complementarity of c-TCD and c-TEE performed simultaneously or separately. Firstly, we used a standardized protocol, performing c-TCD alone. Secondly, we used a standardized and a simultaneous protocol which associated c-TCD with c-TEE. When c-TCD and/or c-TEE found right-to-left shunts, they were classified as minimal, intermediate and massive. c-TCD revealed all PFO detected by c-TEE in 24 patients out of 37 (65%). Furthermore, c-TCD was positive for a PFO in 5 other patients whereas c-TEE was negative. The degree of right-to-left interatrial shunting varied according to the protocol: c-TCD performed alone found 15 massive, 4 intermediate and 5 minimal shunts whereas 10, 9 and 5, respectively, were detected by c-TCD when it was combined with c-TEE. In contrast, c-TEE revealed 8 massive, 8 intermediate and 8 minimal shunts. c-TCD can identify minimal shunts missed by c-TEE and could be more relevant to detect massive shunts, particularly when not performed simultaneously with c-TEE because no sedation is required for c-TCD alone as opposed to c-TEE: thus patients are more cooperative and produce a better Valsalva strain. c-TEE confirms pulmonary shunts suspected by c-TCD and determines the morphologic characteristics of the interatrial septum. While previous studies opposed c-TEE against c-TCD for the detection of a PFO, we think that both techniques are complementary and that it is interesting to associate them, particularly when they are deferred, to increase the ability of detecting PFO and to specify the degree of right-to-left shunting.
In a study of 525 dry mandibles and dissections in 50 cadavers, the mental foramen (MF) was found: single in 94.67% of the cases and multiple in 5.33%. Its shape was round in 34.48% with an average diameter of 1.68 mm and oval in 65.52% with an average long diameter of 2.37 mm. In 43.66% the MF was located in front of the apex of the root of the second premolar. In children before tooth eruption, the MF is somewhat closer to the alveolar margin; during the eruption period, the MF descends to half way between the margins, and in adults with the teeth preserved, the MF is somewhat closer to the inferior border. With loss of teeth and bone resorption the MF moves upwards closer to the alveolar border. In extreme cases of resorption the MF and the adjacent part of the mandibular canal are open at the alveolar margin. In the dissections the findings were similar. The mental nerve emerged from the MF closer to or at the alveolar border, according to the degree of resorption. In extreme degrees of resorption, the mental nerve and the final part of the inferior alveolar nerve were found directly under the gums. In these cases, the vestibular grooves became very shallow, and the mucosa passed directly from the cheeks over the alveolar ridge. Practical implications of the changes of the MF and mental nerve are discussed.
One hundred dry skulls of adult Chinese of both sexes were studied. They were homogeneous in the form of maxillary arch and having full eruption of the upper third molar, without missing teeth and malposition of teeth. Our findings revealed that the mean distance from the center of the greater palatine foramen (GPF) to the midsagittal plane of the hard palate was 16.00 mm, and to the posterior border of the hard palate, 4.11 mm. The location of the GPF related to the maxillary molars was expressed as percentage in 5 relations. We found that the most common location of the GPF was between the maxillary second and third molars (relation III: 48%), and less common was lingual to the maxillary third molar (relation IV: 33.5%). The usually accepted description of the GPF location was lingual to the second molar (relation II), but in our study this relative position occurred in only 17% of the skulls. The long axis of the greater palatine canal directing to the GPF in the oral cavity was found to be directed anteriorly in 181 openings (90.5%) of the 200 GPF, and only 19 openings (9.5%) directed vertically. The bilateral symmetry of GPF on both sides of each skull was remarkable. The discrepancy of our observations on the Chinese skulls from those on other ethnic groups was discussed. Our findings suggest, therefore, the existence of an ethnic variation and the necessity of a more accurate method of locating the GPF in clinical practice.
The segment V1 of the arteria vertebralis (pathway from its origin from the a. subclavia to the entry into the respective foramen processus transversi) has a special significance in vascular surgery. Contrary to indications in the literature, we found 47.15% of the specimens to have a contorted course in this segment. The tortuosities carried by the respective vessels were found to be horizontal in 42.5%, in a sagittal direction in 30% and in the frontal plane in 27% of the cases. However, no significant difference was found between vessels carrying a tortuosity and those without, regarding the average lengths of the arteries concerned in the segment V1.
It was confirmed that the substances injected into the facial nerve through the stylomastoid foramen, reached every part of the inner ear. In sensitized animals, by repeated provocative injections of antigen, acute reversible episodes, very similar to that of Ménière's disease, were observed. The injection of various solutions and the provocative injection into the sensitized animals, resulted in completely opposite reactions. In sensitized animals, the electrophysiological phenomena of the cochlea also showed fluctuations like Ménière's disease.
BACKGROUND: Percutaneous closure of the patent foramen ovale (PFO) is usually performed under x-ray in combination with ultrasound guidance. We tested the feasibility of applying magnetic resonance (MR) guidance for percutaneous closure of PFO in an animal model, thus avoiding the disadvantage of ionizing radiation. METHODS AND RESULTS: Real-time MRI with radial or spiral k-space filling (15 frames per second) on an interventional 1.5-T high-field whole-body system was exploited to examine the feasibility of MR-guided closure of the PFO in 7 piglets weighing approximately 14 kg. A specially designed prototype nonmagnetic closure device was introduced via the femoral vein. The short bore of the magnet and in-room monitors allowed for visualization and steering of the catheter with the loaded occluder. Catheterization of the left atrium and, finally, correct placement of the device was possible in all animals. Deployment of the device was depicted by real-time MR, and initial misplacement, which occurred in 2 animals, was easily detected and corrected. CONCLUSIONS: Real-time MR guidance of PFO closure, without the use of ionizing radiation, is feasible in an animal model.
BACKGROUND: Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with paradoxical embolism and PFO. METHODS AND RESULTS: We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47+/-14 years) who underwent transcatheter closure of PFO because of paradoxical embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experienced recurrent neurological events (1 fatal stroke and 1 transient ischemic attack), representing an annual risk of recurrence of 0.9%. In addition, 4 (3.6%) of the patients required reintervention for device malalignment or significant shunt. Kaplan-Meier analysis showed a freedom from recurrent embolic events and reintervention of 96% and 90% at 1 and 5 years, respectively. CONCLUSIONS: Transcatheter closure of PFO is a safe and effective therapy for patients with paradoxical embolism and PFO. It is associated with a high success rate, low incidence of hospital complications, and low frequency of recurrent systemic embolic events.