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Watanabe G, Conching A, Ogasawara C, Chavda V, Bin-Alamer O, Haider AS, Priola SM, Sharma M, Hoz SS, Chaurasia B, Umana GE, Palmisciano P. Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes. Neurosurg Rev 2023; 46:135. [PMID: 37273079 PMCID: PMC10240133 DOI: 10.1007/s10143-023-02044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/06/2023] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Abstract
Bilateral basal ganglia hemorrhages (BBGHs) represent rare accidents, with no clear standard of care currently defined. We reviewed the literature on BBGHs and analyzed the available conservative and surgical strategies. PubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies reporting patients with BBGHs. Clinical characteristics, management, and outcomes were analyzed. We included 64 studies comprising 75 patients, 25 (33%) traumatic and 50 (67%) non-traumatic. Traumatic cases affected younger patients (mean age 35 vs. 46 years, p=0.014) and males (84% vs. 71%, p=0.27) and were characterized by higher proportion of normal blood pressures at admission (66% vs. 13%, p=0.0016) compared to non-traumatic cases. Most patients were comatose at admission (56%), with a mean Glasgow Coma Scale (GCS) score of 7 and a higher proportion of comatose patients in the traumatic than in the non-traumatic group (64% vs. 52%, p=0.28). Among the traumatic group, motor vehicle accidents and falls accounted for 79% of cases. In the non-traumatic group, hemorrhage was most associated with hypertensive or ischemic (54%) and chemical (28%) etiologies. Management was predominantly conservative (83%). Outcomes were poor in 56% of patients with mean follow-up of 8 months. Good recovery was significantly higher in the traumatic than in the non-traumatic group (48% vs. 17%, p=0.019). BBGHs are rare occurrences with dismal prognoses. Standard management follows that of current intracerebral hemorrhage guidelines with supportive care and early blood pressure management. Minimally invasive surgery is promising, though substantial evidence is required to outweigh the potentially increased risks of bilateral hematoma evacuation.
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Affiliation(s)
- Gina Watanabe
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Andie Conching
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Christian Ogasawara
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Vishal Chavda
- Department of Pathology, Stanford of School of Medicine, Stanford University Medical Centre, Stanford, Palo Alto, CA, USA
| | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Stefano M Priola
- Department of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA.
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Appachu MS, Purohit S, Lakshmaiah KC, Kumari BSA, Appaji L. Posterior reversible encephalopathy syndrome in pediatric acute leukemia: Case series and literature review. Indian J Med Paediatr Oncol 2014; 35:79-82. [PMID: 25006290 PMCID: PMC4080669 DOI: 10.4103/0971-5851.133727] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state coupled with a unique radio imaging appearance. We describe this rare, mostly reversible condition in five cases undergoing similar treatment under preset protocol (MCP-841) for acute lymphoblastic leukemia (ALL) at our centre. Hypertension is a well-known adverse effect of high-dose corticosteroid therapy primarily mediated by its effects on the mineralocorticoid receptor especially in pediatric population and we hypothesize that this may be the etiology of PRES in two of these patients.
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Affiliation(s)
- M Sandhya Appachu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Samit Purohit
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - K C Lakshmaiah
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - B S Aruna Kumari
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - L Appaji
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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Marrone LCP, Gadonski G, Diogo LP, Brunelli JPF, Martins WA, Laguna GDO, Bahlis LF, Filho JRH, da Costa BEP, Poli-de-Figueiredo CE, Marrone ACH, da Costa JC. Posterior reversible encephalopathy syndrome: differences between pregnant and non-pregnant patients. Neurol Int 2014; 6:5376. [PMID: 24744848 PMCID: PMC3980148 DOI: 10.4081/ni.2014.5376] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/23/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiologic entity not yet understood, that presents with transient neurologic symptoms and particular radiological findings. Few papers show the differences between pregnant and non-pregnant patients. We review the cases of 38 women diagnosed with PRES, in order to find significant differences between pregnant (18) and non-pregnant (20) patients. We found differences among the age of patients (25.83 years old in pregnant and 29.31 years old in non pregnant; P=0.001); in the mean of highest systolic blood pressure, that was higher in non-pregnant group (185:162 mmHg; P=0.121); and in creatinine levels that was higher in non-pregnant group (3.47:1.04 mg/dL; P=0.001). To our knowledge, just a few papers analyzed whether PRES syndrome presented in the same way in pregnant and non-pregnant patients. The differences and the possible pathophisiology of this syndrome still remain enigmatic.
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Affiliation(s)
- Luiz Carlos Porcello Marrone
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Giovani Gadonski
- Service of Nephrology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Luciano Passamani Diogo
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - João Pedro Farina Brunelli
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - William Alves Martins
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Gabriela de Oliveira Laguna
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Laura Fuchs Bahlis
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - João Rubião Hoefel Filho
- Service of Radiology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Bartira Ercilia Pinheiro da Costa
- Service of Nephrology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Carlos Eduardo Poli-de-Figueiredo
- Service of Nephrology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Antônio Carlos Huf Marrone
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
| | - Jaderson Costa da Costa
- Service of Neurology, Instituto do Cérebro, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre, Brazil
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Marrone LCP, Marrone BF, de la Puerta Raya J, Gadonski G, da Costa JC. Gemcitabine monotherapy associated with posterior reversible encephalopathy syndrome. Case Rep Oncol 2011; 4:82-7. [PMID: 21475595 PMCID: PMC3072184 DOI: 10.1159/000324581] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Posterior reversible encephalopathy syndrome is a clinicoradiologic entity that may present with headaches, altered mental status, seizures and visual loss as well as specific neuroimaging findings. We report a case of a 74-year-old woman receiving adjuvant gemcitabine chemotherapy as monotherapy for a stage IIa pancreatic adenocarcinoma, who developed posterior reversible encephalopathy syndrome.
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Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual disturbances, and seizures. Radiological features typically include edema of the posterior cerebral regions, especially of the parietooccipital lobes. Atypical imaging features, such as involvement of anterior cerebral regions, deep white matter, and the brain stem are also frequently seen. Vasoconstriction is common in vascular imaging. Different conditions have been associated with PRES, but toxemia of pregnancy, solid organ or bone marrow transplantation, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension are most commonly described. The pathophysiology of PRES is unclear and different hypotheses are being discussed. Posterior reversible encephalopathy syndrome is best managed by monitoring and treatment in the setting of a neurointensive care unit. The prognosis is usually benign with complete reversal of clinical symptoms within several days, when adequate treatment is immediately initiated. Treatment of severe hypertension, seizures, and withdrawal of causative agents represent the hallmarks of specific therapy in PRES. Delay in diagnosis and treatment may lead to permanent neurological sequelae. Therefore, awareness of PRES is of crucial importance for the intensivist.
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Affiliation(s)
- Dimitre Staykov
- Neurology Department, University of Erlangen-Nuremberg, Germany.
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Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 2009; 30:1371-9. [PMID: 19386731 DOI: 10.3174/ajnr.a1588] [Citation(s) in RCA: 226] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Hemorrhage is known to occur in posterior reversible encephalopathy syndrome (PRES), but the characteristics have not been analyzed in detail. The purpose of this study was to evaluate the imaging and clinical features of hemorrhage in PRES. MATERIALS AND METHODS Retrospective assessment of 151 patients with PRES was performed, and 23 patients were identified who had intracranial hemorrhage at toxicity. Hemorrhage types were identified and tabulated, including minute focal hemorrhages (<5 mm), sulcal subarachnoid hemorrhage, and focal hematoma. Clinical features of hemorrhage and nonhemorrhage PRES groups were evaluated, including toxicity blood pressure, coagulation profile/platelet counts, coagulation-altering medication, and clinical conditions associated with PRES. Toxicity mean arterial pressure (MAP) groups were defined as normal (<106 mm Hg), mildly hypertensive (106-116 mm Hg), or severely hypertensive (>116 mm Hg). RESULTS The overall incidence of hemorrhage was 15.2%, with borderline statistical significance noted between the observed clinical associations (P = .07). Hemorrhage was significantly more common (P = .02) after allogeneic bone marrow transplantation (allo-BMT) than after solid-organ transplantation. The 3 hemorrhage types were noted with equal frequency. A single hemorrhage type was found in 16 patients, with multiple types noted in 7. Patients undergoing therapeutic anticoagulation were statistically more likely to develop hemorrhage (P = .04). No difference in hemorrhage incidence was found among the 3 blood pressure subgroups (range, 14.9%-15.9%). CONCLUSIONS Three distinct types of hemorrhage (minute hemorrhage, sulcal subarachnoid hemorrhage, hematoma) were identified in PRES with equal frequency. The greatest hemorrhage frequency was seen after allo-BMT and in patients undergoing therapeutic anticoagulation. Hemorrhage rate was independent of the toxicity blood pressure.
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Affiliation(s)
- H M Hefzy
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol 2008; 29:1036-42. [PMID: 18356474 DOI: 10.3174/ajnr.a0928] [Citation(s) in RCA: 686] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state coupled with a unique CT or MR imaging appearance. Recognized in the setting of a number of complex conditions (preeclampsia/eclampsia, allogeneic bone marrow transplantation, organ transplantation, autoimmune disease and high dose chemotherapy) the imaging, clinical and laboratory features of this toxic state are becoming better elucidated. This review summarizes the basic and advanced imaging features of PRES, along with pertinent features of the clinical and laboratory presentation and available histopathology. Many common imaging/clinical/laboratory observations are present among these patients, despite the perception of widely different associated clinical conditions.
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Affiliation(s)
- W S Bartynski
- Department of Radiology, Division of Neuroradiology, University of Pittsburgh, Presbyterian University Hospital, Pittsburgh, PA 15213, USA.
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9
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Thomas SV, Somanathan N, Radhakumari R. Interictal EEG changes in eclampsia. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1995; 94:271-5. [PMID: 7537199 DOI: 10.1016/0013-4694(95)98478-q] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The pathogenesis of seizures and encephalopathy in eclampsia remains obscure even today. There are only a few reports on EEG findings in eclampsia. This is a report of the interictal EEG changes in 8 patients with eclampsia who were evaluated prospectively. The major EEG changes observed were (1) slowing of the background activity (generalized slowing in 4 patients and focal slowing in 3 patients) and (2) intermittent spike and sharp wave transients (5 patients). These abnormalities had disappeared in all except 2 patients when the EEG was repeated on the seventh day. A comparison is drawn between eclampsia and hypertensive encephalopathy for the clinical, EEG and CT/MRI findings. The pathogenesis of seizures and encephalopathy could be similar in these two conditions. It is worth while considering these EEG changes while planning the treatment of eclampsia.
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Affiliation(s)
- S V Thomas
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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11
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Kim D, Mayberg MR, Eskridge JM, Newell DW, Winn HR. Reversal of acute ischemic hypodense lesions on computed tomography. J Stroke Cerebrovasc Dis 1993; 3:240-3. [DOI: 10.1016/s1052-3057(10)80068-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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12
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Kökçü A, Ustün C, Bolat O, Akan H, Küçük M, Cokşenim S, Tunali G. Basal ganglia and white matter in pregnancy-induced hypertension. Neuroradiology 1993; 35:284-5. [PMID: 8492896 DOI: 10.1007/bf00602616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A Kökçü
- Department of Obstetrics and Gynecology, Ondokuzmais University Faculty of Medicine, Samsun, Turkey
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13
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Swartjes JM, Schutte MF, Bleker OP. Management of eclampsia: cardiopulmonary arrest resulting from magnesium sulfate overdose. Eur J Obstet Gynecol Reprod Biol 1992; 47:73-5. [PMID: 1426514 DOI: 10.1016/0028-2243(92)90217-m] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
An eclamptic seizure occurring at 32+2 weeks of gestation was treated with magnesium sulfate. Accidentally an overdose was given. As a consequence, the patient had a cardiopulmonary arrest. Immediate resuscitation and calcium gluconate administration did restore vital functions. Pregnancy continued for 4 weeks after the accident. Both mother and child left the hospital in good condition.
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Affiliation(s)
- J M Swartjes
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
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14
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Ram Z, Sadeh M, Shacked I, Sahar A, Hadani M. Magnesium sulfate reverses experimental delayed cerebral vasospasm after subarachnoid hemorrhage in rats. Stroke 1991; 22:922-7. [PMID: 1853412 DOI: 10.1161/01.str.22.7.922] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We induced experimental delayed cerebral vasospasm by the intracisternal injection of greater than 0.5 ml blood in 30 rats. Seventy-two hours later the basilar artery was exposed via the transclival approach and photographed at high-power magnification through an operating microscope. We then evaluated the effect of topical (n = 30) and intravenous (n = 20) magnesium sulfate on the spastic artery by computerized image analysis. A greater than 50% reduction in baseline diameter of the basilar artery was observed in the rats subjected to subarachnoid hemorrhage compared with the 10 controls (p less than 0.0001). Intravenous magnesium sulfate dilated the spastic artery to approximately 75% of the baseline diameter in control rats (p less than 0.0001). Topical magnesium sulfate caused dramatic dilation of the basilar artery in both the control and the subarachnoid hemorrhage groups to near 150% of the baseline diameter in the controls (p less than 0.001). All rats receiving intravenous magnesium sulfate reached therapeutic plasma levels of the ion. Hemodynamic effects were mild and immediately reversible upon cessation of magnesium sulfate administration. We suggest that magnesium has a role in the treatment of subarachnoid hemorrhage-induced vasospasm in humans.
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Affiliation(s)
- Z Ram
- Department of Neurosurgery, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Hashomer, Israel
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15
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Abstract
Blindness is a rare but dramatic complication of pregnancy and delivery. We present the case of a patient who developed toxemia at the time of delivery that with ineffective treatment resulted in cortical blindness without seizure activity. The pathogenesis as well as the diagnostic workup and treatment of this unusual complication are discussed.
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Affiliation(s)
- V P Verdile
- Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pennsylvania
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16
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el Gammal T, Brooks B, Harbour R, Kline L, Jacob P. MR of uncommon congenital and vascular lesions of the intracranial visual pathways. Neuroradiology 1990; 32:488-91. [PMID: 2287377 DOI: 10.1007/bf02426461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The MR findings of two patients with rare congenital abnormalities of the optic pathways are reported and illustrated, including one case of unilateral aplasia of the optic chiasm, tract, and visual radiations and another patient with anophthalmos. In three other patients with unusual vascular causes of visual disturbance, MR was important in early establishment of an accurate diagnosis and had consequent implications for decisions regarding further patient management.
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Kolawole TM, Patel PJ, Yaqub B, al-Tahan AR, Malabarey T, al-Meshari AA. Computed tomographic changes of the brain in toxaemia of pregnancy. Eur J Radiol 1990; 11:46-53. [PMID: 2204532 DOI: 10.1016/0720-048x(90)90102-h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Four cases of toxaemia of pregnancy examined with computed tomography scans of the brain are reported. A review of the literature reveals 19 other cases with previously reported CT brain scans. The review shows intracerebral oedema as the main finding. Haemorrhage, massive or punctate was noted in four cases. The pathogenesis of the CT changes and the clinico-radiological correlation of the visual disturbances are discussed.
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Affiliation(s)
- T M Kolawole
- Department of Radiology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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18
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Abstract
Recent evidence supports the concept that cerebral vasospasm is involved in the pathogenesis of eclampsia. Magnesium, which has a beneficial effect in eclampsia, may act by opposing calcium-dependent arterial constriction, thereby relieving vasospasm. Magnesium may also antagonize the increase in intracellular calcium concentration caused by ischemia and thus prevent cell damage and death. Magnesium might have a role in the treatment of cerebral vasospasm and ischemia, such as occurs in subarachnoid hemorrhage, ischemic stroke, and brain trauma.
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Affiliation(s)
- M Sadeh
- Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Fredriksson K, Lindvall O, Ingemarsson I, Astedt B, Cronqvist S, Holtås S. Repeated cranial computed tomographic and magnetic resonance imaging scans in two cases of eclampsia. Stroke 1989; 20:547-53. [PMID: 2929032 DOI: 10.1161/01.str.20.4.547] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In two cases of eclampsia with consumptive thrombocytopenia, the maximum increase in blood pressure and the lowest platelet count coincided with the maximum degree of neurologic and neuroradiologic abnormality. Computed tomograms showed decreased attenuation, and T2-weighted magnetic resonance images showed increased signal intensity focally in the cerebral cortex and the deep gray and white matter. Blood pressure, platelet count, clinical status, and roentgenograms normalized completely in both cases. Severe arterial hypertension and disseminated transitory microvascular occlusions presumably caused multiple small foci of brain edema that resolved without remaining detectable ischemic brain damage.
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Affiliation(s)
- K Fredriksson
- Department of Neurology, University Hospital, Lund, Sweden
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20
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Abstract
From 1980 to 1986, head computed tomographic scans were performed in 49 women with eclampsia managed according to the standardized regimen used at Parkland Memorial Hospital. Abnormal radiographic findings were seen in 14 (29%). Although this incidence may have been affected by the temporal relationship of the scan to the seizure, it was greatly impacted by technical resolution obtained with succeeding improved equipment. In the last 3 years of the study more than a third of these scans showed some abnormality, and in 1986, using "fourth-generation" equipment, half were abnormal. These areas of radiographic hypodensity correspond to those with petechial hemorrhages and local edema that have been described at autopsy in women who died after eclamptic episodes. All women recovered fully despite ominous findings in some. We conclude that the clinical utility of tomography in women with otherwise "uncomplicated eclampsia" is limited because these findings seldom alter management.
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Affiliation(s)
- C E Brown
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School, Dallas 75235
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Richards A, Graham D, Bullock R. Clinicopathological study of neurological complications due to hypertensive disorders of pregnancy. J Neurol Neurosurg Psychiatry 1988; 51:416-21. [PMID: 3361333 PMCID: PMC1032870 DOI: 10.1136/jnnp.51.3.416] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Forty-three women with neurological complications secondary to eclampsia or severe pre-eclampsia were studied by CT scanning and in six intracranial pressure (ICP) monitoring was carried out. In seven women who died, neuropathological findings were correlated with clinical features. Cerebral oedema was present in 27 of the patients studied and the severity of oedema correlated to the duration of intermittent seizures. In five of the six women who had ICP measured, this was found to be transiently high. Intracranial haemorrhage was demonstrated in four of the 43 women, all of whom died. Hypoxic-ischaemic cerebral damage and fibrinoid necrosis were the most important neuropathological lesions identified. The management of neurological complications of eclampsia may be placed upon a more rational basis by an understanding of the mechanisms responsible for these lesions.
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Affiliation(s)
- A Richards
- Department of Obstetrics, University of Natal
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Abstract
We describe a patient who experienced focal cerebral and brainstem ischemia in the setting of postpartum eclampsia. Cerebral angiography showed spasm of large- and medium-caliber arteries. This case provides rare documentation that vasospasm may account for cerebral ischemia in eclamptic women with focal signs. This observation suggests that in such patients cerebral angiography may be informative and useful.
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Affiliation(s)
- B L Trommer
- Department of Neurology, Northwestern University Medical School, Evanston Hospital, Illinois 60201
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Lewis LK, Hinshaw DB, Will AD, Hasso AN, Thompson JR. CT and angiographic correlation of severe neurological disease in toxemia of pregnancy. Neuroradiology 1988; 30:59-64. [PMID: 3357569 DOI: 10.1007/bf00341945] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two patients with severe cerebral symptoms of toxemia of pregnancy were examined using computed tomography (CT) and angiography. CT disclosed extensive areas of low attenuation within the cerebral hemispheres. Angiography revealed constriction and narrowing of proximal and peripheral vessels suggesting vasculitis with extensive areas of impaired regional cerebral blood flow. A review of the known pathology and the theories regarding the pathophysiology of the cerebral effects of toxemia is presented.
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Affiliation(s)
- L K Lewis
- Department of Radiation Sciences, Loma Linda University Medical Center, California
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