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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors analysed the correlation between different clinical, radiological, and pathological variables and the presence and intensity of brain oedema associated to intracranial meningioma in 400 consecutive patients studied by computerized tomography (CT). The following factors did not show significant correlation with brain oedema development: the age and sex of the patient, the occurrence of focal deficits, the presence of skull changes (endostosis, exostosis, osteolysis), the occurrence of tumour calcification, the density of the tumour on plain CT scan, the presence of a cystic component, the pathological subtype of meningioma (both conventional and non-conventional), and the presence of histological features of tumour aggressiveness, such as an increased vascularization, high cellularity, high mitotic index, pleomorphism, necrosis, and brain infiltration. Factors showing a statistically significant correlation with the presence and intensity of brain oedema at the bivariate analysis were: the presence of symptoms (p < 0.001), the duration of the clinical history (p < 0.05), the location and size of the tumour (p < 0.001), the type (heterogeneous vs homogeneous), and intensity of tumour contrast enhancement (p < 0.001), the presence of irregular tumour margins (p < 0.001), and the existence of focal low density intratumoural areas (p < 0.001). The multivariate analysis using only clinical parameters showed that the group of variables with the highest power for predicting the presence of brain oedema (concordance level of 76.8%) included: the presence of symptoms, the occurrence of seizures (focal or generalized), the presence of an intracranial hypertension syndrome, and the age of the patient. The multivariate analysis using only anatomico-radiological parameters showed that the model which included the size of the tumour, the intensity of contrast enhancement, the tumour margins, and meningioma location, predicted the presence of brain oedema in 80.8% of the cases. Though the results of the present study do not definitively support any of the major physiopathological theories proposed to explain brain oedema formation in patients with intracranial meningioma, some findings could favour the so-called hydrodynamic theory.
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PMID:Brain oedema in patients with intracranial meningioma. Correlation between clinical, radiological, and histological factors and the presence and intensity of oedema. 880 Mar 22

We report one case of radio-induced meningiomas revealed by an intracranial hypertension in an 46 year-old woman. A history of cephalic irradiation during infancy for a vascular nevus, not spontaneously reported by the patient, had been discovered because of the association with a radio-induced cataract. Meningiomas are a rare, severe and late complication of cephalic radiotherapy. The history of irradiation is not always spontaneously reported by the patient.
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PMID:[Post-radiotherapy multifocal meningioma]. 929 70

An extremely unusual calvarial meningioma in a 77-year-old woman is reported. The meningioma spread widely and symmetrically within the calvaria and grew extracranially within the scalp as well as intracranially. Reactive dural hyperplasia induced narrowing of the intracranial space and occlusion of the superior sagittal sinus, resulting in intracranial hypertension. After external decompression, the patient's symptoms markedly resolved. The authors review the literature on calvarial meningioma, discuss its pathogenesis, and propose mechanisms responsible for the patient's intracranial hypertension.
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PMID:Diffuse calvarial meningioma. Case report and review of the literature. 1022 68

We report our experience with 79 intracranial meningiomas operated on between 1960 and 1995 in Dakar Senegal. In our geographical region issues concerning diagnosis, therapy and clinical course are still a topic of debate due mainly to the lack of high-performance technical units. All patients were admitted with evident symptoms. The classically described prevalence was not found in this series. Thirty-one cases presented intracranial hypertension with or without a focal syndrome which evidenced a motor deficit in 32 cases and irritative lesions in 24. External bulging of the meningioma was observed in a large number of cases (11.4%). Until 1994, angiography was the only available means of diagnosis. Mortality was high (30 cases) and results depended on delay to surgery, tumor localization and operative conditions. Our results have been improving over the years but cannot be sustained unless the technical unit is upgraded.
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PMID:[Intracranial meningiomas. The Dakar experience apropos of 79 cases]. 1044 54

Several evidences indicate that GH and/or insulin-like growth factor I (IGF-I) are involved in the regulation of cardiovascular function. In patients with childhood and adulthood-onset GH deficiency (GHD), the impairment of cardiac performance is manifest primarily as a reduction in the left ventricular (LV) mass (LVM), inadequacy of LV ejection fraction both at rest and at peak exercise, and abnormalities of LV diastolic filling. No study has been reported to date in elderly GHD patients that investigated cardiac function. In particular, it is unknown whether cardiac function is modified in accordance with patients' age as a physiological response to aging, as in normal subjects the rate and extent of LV filling are reduced with age. This study was designed to evaluate heart morphology and function, by echocardiography and equilibrium radionuclide angiography, respectively, in rigorously selected elderly patients with GHD but without evidence of other complications able to affect cardiac performance. Eleven patients with hypopituitarism (6 men and 5 women, aged 60-72 yr) and 11 sex- age- and body mass index-matched healthy subjects entered this study. None of the patients and controls presented with or had previously suffered from other concomitant diseases, such as diabetes mellitus, coronary artery diseases, long-standing hypertension, and hyperthyroidism, which could affect cardiac function. All patients had been previously operated on via the transsphenoidal and/or transcranic route for nonfunctioning pituitary adenoma, meningioma, or craniopharyngioma, and 6 of them had been irradiated. Eight patients had FSH/LH insufficiency, 5 had TSH insufficiency, and 6 had ACTH insufficiency, appropriately replaced. All subjects were tested with the combined arginine plus GHRH test showing a GH response below 9 microg/L. No significant difference was found in plasma IGF-I levels (49.2 +/- 8.5 vs. 71.8 +/- 7.5 microg/L) between patients and controls. However, IGF-I levels were lower than the normal range in 8 patients and 3 controls. Interventricular septum thickness (9.1 +/- 0.2 vs. 9.1 +/- 0.2 mm), LV posterior wall thickness (9.1 +/- 0.2 vs. 9.0 +/- 0.2 mm), and LVM after correction for body surface area (97.6 +/- 1.8 vs. 99.9 +/- 1.5 g/m2) were similar in patients and controls. Similarly, the LV ejection fraction at rest was similar in patients and controls (57.1 +/- 2% vs. 63.2 +/- 2.5%; P = NS), and it was normal (> or = 50%) in all controls and in 10 of 11 patients. By contrast, the LV ejection fraction at peak exercise was markedly depressed in elderly GHD patients compared to age-matched controls (51 +/- 2.5% vs. 73.3 +/- 3%; P < 0.001). A normal response (> or = 5% increase compared to basal value) of LV ejection fraction at peak exercise was found in 8 controls (72.7%) and in 2 of 11 patients (18.2%). No difference was found in the peak rate of LV filling, whether peak filling rate was normalized to end-diastolic volume (2.5 +/- 0.2 vs. 2.6 +/- 0.2 end-diastolic volume/s) or stroke volume (4.3 +/- 0.3 vs. 4.0 +/- 0.3 stroke volume/s), between patients and controls. Finally, exercise duration was significantly shorter in elderly GHD patients than in age-matched controls (7.2 +/- 2.1 vs. 9.1 +/- 0.2 min; P < 0.01). In the patient group, the GH peak after arginine plus GHRH test was significantly correlated with the LV ejection fraction at rest (r = 0.822; P < 0.01), whereas IGF-I was significantly correlated with the peak rate of LV filling whether the peak filling rate was normalized to end-diastolic volume (r = -0.863; P < 0.001) or stroke volume (r = -0.616; P < 0.05) or expressed as the ratio of peak filling rate to peak ejection fraction rate (r = -0.736; P < 0.01). Disease duration was significantly correlated with heart rate at peak exercise (r = 0.614; P < 0.05) and with systolic and diastolic blood pressures both at rest (r = 0.745; P < 0.01 and r = 0.650; P < 0.05) and at peak exercise (r = 0.684; P < 0.05 and r =
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PMID:Impaired cardiac performance in elderly patients with growth hormone deficiency. 1056 33

Postoperative cerebellar hemorrhage after a supratentorial craniotomy represents a rare event. We report a case of a patient with a meningioma of the jugum who developed suddenly after surgery a neurological deterioration due to a cerebellar hemorrhage detected on the CT scan. An occipital craniectomy and an external ventricular drainage were performed in emergency. A complete neurological recovery was observed after surgery. Nineteen similar other cases are found in the literature. Pre- and postoperative high blood pressure, lowered intracranial pressure and mispositioning of the head during surgery could be at the origin of the hemorrhage. Size of the hemorrhage, time between diagnosis and treatment represent two prognostic factors. All patients, who present a neurological deterioration in postoperative course, must have CT scan including posterior fossa.
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PMID:[Cerebellar hemorrhage complicating a supratentorial craniotomy. A case report and review of the literature]. 1101 79

The CSF-pressure-lowering effects of indomethacin in seven patients with idiopathic intracranial hypertension and one patient with symptomatic intracranial hypertension due to a non-space-occupying meningioma are reported. CSF opening pressure between 350 and 500 mm H2O (mean 400 mm H2O) was promptly reduced by 80 to 200 mm H2O (mean reduction, 139 mm H2O) for at least 10 minutes in all patients after IV administration of 50 mg indomethacin. Four patients had mild and transient side effects (dizziness). Indomethacin might be an alternative drug for treatment of intracranial hypertension.
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PMID:Indomethacin reduces CSF pressure in intracranial hypertension. 1106 Dec 68

Presentation of a case of a "central type" neurofibromatosis in a 56-year old woman, clinically diagnosed erroneously as multiple sclerosis with a 20 years long course. Disturbances of hearing, walking, sight, sensitivity, incontinentia, intracranial hypertension and headache represented the main symptoms. More than 120 intracranial and tens of intraspinal meningiomas represented the leading postmortem finding. In a lesser frequency spinal plexiform neurofibromas and schwannomas were also found. The death was attributed to aspiration purulent bronchopneumonia. Various types of meningioma were seen microscopically, including secretory type and a type with amyloid. Immunostaining was positive with S-100 protein and EMA. Negative expression was found with vimentin, CEA, smooth muscle actin, estrogen and progesterone receptors, amyloid A and cytokeratins. With regard to the presence or absence of key morphological features the presented case was placed according to Sobol et al. (29) into the seventh category of neurofibromatosis (NF7).
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PMID:[Multiple intracranial and intraspinal meningiomas in the neurocristopathy (phacomatosis) type of neurofibromatosis]. 1137 7

We report a case of a falcotentorial meningioma accompanied by hematoma in the temporal lobe. A healthy 51 year-old-female with no history of hypertension presented with sudden onset of consciousness disturbance and right hemiparesis. Computed tomography revealed a hematoma 5.5 cm in diameter surrounded by thick edematous brain in the left temporal lobe and a tumor 3.5 cm in diameter in the pineal region. Bilateral carotid angiography detected occlusion of the Galenic vein and straight sinus. No causative abnormality of hemorrhage was apparent. However, the left basal vein of Rosenthal had disappeared, and anastomotic venous channels could be observed in the medial left temporal lobe, contiguous to the hematoma. Emergency craniotomy failed to detect any abnormality which could cause hemorrhage in the brain parenchyma surrounding the hematoma. Subtotal removal of the tumor, histologically diagnosed as fibrous meningioma, was achieved three months later employing an occipital transtentorial approach. Venous congestion caused by compression due to the tumor was considered to be one of possible causes of the hemorrhage.
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PMID:Falcotentorial meningioma accompanied by temporal lobe hematoma. 1172 Jan 66

The May 2003 COM. A 57-year-old woman presented with slurring of her speech and right arm weakness. Her past medical history included idiopathic hypertrophic subendocardial stenosis (IHSS), arthritis, asthma, congestive heart failure, hypertension and NIDDM. Neurological examination showed persistent word finding difficulty but her motor and sensory function had essentially returned to normal. Extensive laboratory studies were unrevealing. Imaging studies showed a meningeal lesion over the left posterior parietal lobe and the findings suggested an infectious or inflammatory process. A biopsy of the involved dura and meninges was performed and revealed leptomeningeal Rosai-Dorfman disease. Emperipolesis was noted. The finding of emperipolesis is characteristic of Rosai-Dorfman disease of the leptomeninges, but in 30% of cases, this feature will not be identified. Large pale histiocytes of Rosai-Dorfman disease are immunoreactive for S-100 protein and KP1, but negative for CD1a. The differential diagnosis of a chronic inflammatory infiltrate containing numerous, large histiocytes includes granulomatous diseases such as Wegener graulomatosis and sarcoid, Hodgkin disease, and Langerhans histiocytosis. CNS Rosai-Dorfman most commonly involves patients between 20- and 40-years-old, with a slight male predominance. Approximately 75% of cases are intracranial, whereas 20% involve the spine. Over 90% of CNS Rosai-Dorfman cases involve the leptomeninges and are seen by neuroimaging as a dural-based, contrast-enhancing masses that often elicit vasogenic edema in the underlying brain. Thus, clinically and radiologically, the disease is thought to represent meningioma. Leptomeningeal Rosai-Dorfman disease is considered a benign condition and in most cases surgical resection is the treatment of choice. Although the number of cases in the literature is small, disease progression following surgical resection is uncommon. Little is known regarding the pathogenesis of Rosai-Dorfman disease. Most have suggested that it represents either an autoimmune disease or a reaction to an infectious agent that has yet to be discovered. Currently it is best considered a benign, idiopathic histiocytosis.
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PMID:May 2003: 57-year-old-woman with acute loss of strength in her right upper extremity and slurred speech. 1465 68


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