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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diagnosis of intracranial meningiomas with computed tomography (CT) is usually easy. However, some authors have reported cases preoperatively misdiagnosed because of atypical computed tomographic features. We report a case of non-cystic meningioma presenting a ring enhanced mass lesion, with CT scan. A 48-year-old male was admitted to our hospital on January 5, 1987, because of progressive monoparesis of his left lower limb. This had continued for 1 1/2 years. Neurological examination revealed monoparesis, hypesthesia and decreased deep sensation of the left lower limb. X-ray films of the skull appeared normal. A CT scan demonstrated a ring-like high density mass attached to the falx in the right frontoparietal area with perifocal low density. The ring-like high density was irregularly increased with contrast enhancement. Right carotid angiograms showed a doughnut like tumor stain without meningeal blood supply. Brain scintigrams revealed a dense round hot lesion in the frontoparietal area at 5 minutes, and the hot lesion was still visualized after 90 minutes. We diagnosed a cystic parasagittal meningioma. A right frontoparietal craniotomy was performed, and total removal of the parasagittal tumor was made. The center of the tumor was very soft but it could not be said that it was not cystic. Histologically the tumor was a meningotheliomatous meningioma. The center of the tumor, which was very soft, was necrotic with arteriolar hyalinization. The meningioma cells survived around the patent vessels. These intact meningioma cells were scattered like islands in extensive necrosis. This is so called "oasis phenomenon" indicating that the necrosis of the tumor was caused by intratumoral ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Atypical computed tomographic features of meningioma: a case report]. 277 Sep 68

Three patients presented with hand wasting and weakness secondary to mid-cervical spinal cord compression. This was due to cervical spondylosis in two patients and a meningioma in one case. This phenomenon is probably similar to that seen with foramen magnum lesions and may be due to spinal cord ischemia distal to the compression, secondary to venous stasis.
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PMID:Hand wasting due to mid-cervical spinal cord compression. 366 74

The authors report a series of 150 consecutive patients operated on for an intracranial meningioma over a period of 14 years (1974-1988). The patients were aged from 15 to 85 years (mean: 58 y; 49 were over 60 y) and severely disabled preoperatively in 42 cases (Karnofsky score 10 to 60). Tumors were located in the convexity in 22% the parasagittal region and falx in 24%, the skull base in 14% and the posterior fossa in 13%. In 21 cases the diameter of the tumor was less than 3 cm, in 86 it ranged from 3 to 6 cm, and in 43 cases it was more than 6 cm (29%). Tumor was hypervascularized in 51% of cases. Peritumoral edema was present in 73 of the 106 patients studied (69%). The tumor was removed completely (grade I and II of Simpson classification) in 136 cases (91%). Post-operative mortality was 10%. 88.5% of the surviving patients had a normal life with a score of 80 to 100 according to Karnofsky scale. Recurrence rate amounted at 3.3%. Mortality and severe morbidity (poor outcome) were assessed and correlated with sex, age, tumor, size, location, vascularization, peritumoral edema and histology. From this retrospective study the only predictives of a poor outcome, statistically significant, were: severe preoperative neurological conditions (p < 0.001) and tumor size (p < 0.01). There was no statistically significant correlation with the other parameters. Cortical arteries participation to tumor vascularization, in a equal part of more than the dural arteries, led to subpial dissection for achieving complete tumor removal. This was a source of hemorrhagic infarction through ischemia, with patent neurological deficits for rolandic meningiomas (p = 0.001). The importance of pial supply of the tumor was correlated with its size (p < 0.001). Pial supply of the tumour and consequently subpial dissection were foreseeable in the preoperative study: on selective angiography (p < 0.001) and the presence of peritumoral edema on CT scan (p < 0.001). The authors conclude that besides the "classic" pronostic factors (preoperative neurological conditions, tumor size), the mode of vascularization of the tumor (pial supply) plays an important role in the possibility or not to find an extra pial plan of dissection from the adjacent parenchyma, and consequently in the neurological outcome of the patients.
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PMID:[Prognostic factors in the surgery for intracranial meningioma. Role of the tumoral size and arterial vascularization originating from the pia mater. Study of 150 cases]. 752 63

Image-guided localized proton magnetic resonance can now increasingly be used with clinical 1.5T MR systems. To fuel the discussion on whether spectroscopy will become a routine modality or whether it will remain a research tool, we report on our experience with a stimulated echo sequence in 60 patients harboring intracranial tumors and 79 patients suffering from various forms of cerebral ischemia. Spectroscopy was incorporated into a routine imaging protocol, and the parameters of TR = 1500 ms, TE = 270 ms were kept constant over a 3-year period. Relative changes in the metabolite concentrations were estimated from peak height and area calculations compared with the spectra of 66 normal volunteers. The spectra of the volunteers did not show significant interindividual variations, and there were no changes during photic stimulation in a subgroup of 6 volunteers. All tumor patients' spectra were significantly different from those of normal controls. Low grade gliomas showed decreased levels of N-acetyl-aspartate and some had elevated levels of lactate. Oligodendrogliomas had higher choline levels than astrocytomas. High grade gliomas had higher levels of lactate and lower N-acetyl-aspartate ratios. Meningiomas were characterized by absence of N-acetyl-aspartate, and some metastases showed a lipid signal at 1 ppm. Spectra of ischemic brain tissue were also abnormal, revealing lowered N-acetyl-aspartate and elevated lactate. The changes paralleled the severity of ischemia and pronounced abnormalities were associated with an inferior outcome. Further technical improvements, including absolute quantification of metabolite concentrations and smaller sensitive volumes, will allow direct monitoring of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[1H magnetic resonance spectroscopy in intracranial tumors and cerebral ischemia]. 827 89

Significant post-operative hemorrhage is a rare complication of intracranial surgery. Hemorrhage remote from the site of neurosurgical intervention is rare, with only 37 cases reported in the literature. We present the case of a 62 year old woman who presented a right occipital hematoma following excision of a large left sphenoidal meningioma. The hematoma was treated conservatively without neurological sequellae. We present a review of the literature concerning this rare phenomenon, and discuss the question of mechanical distorsion of intracranial structures with focal ischemia followed by reperfusion as the underlying pathophysiology.
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PMID:[Postoperative hematoma distant from the surgical site. A case report and review of the literature]. 968 39

Delayed neurologic deficits secondary to vasospasm remain a vexing problem. Current treatments include: hypertensive hypervolemic hemodilution (Triple-H) therapy, angioplasty, and intra-arterial papaverine administration. Significant morbidity and mortality still result from vasospasm despite these therapies. We present two patients with symptomatic vasospasm who received intra-aortic balloon pump counterpulsation (IABP) to improve cerebral blood flow when they were unable to tolerate Triple-H therapy. One patient (L.T.) developed vasospasm after resection of a meningioma that encased the carotid and middle cerebral artery. The other patient (D.F.) suffered a subarachnoid hemorrhage (Fisher Grade III, Hunt/Hess Grade III) from a basilar tip aneurysm. Postoperatively, both patients developed vasospasm. Treatment with Triple-H therapy, angioplasty, and papaverine yielded modest results. When they experienced cardiac ischemia, Triple-H therapy was stopped, but their neurologic condition deteriorated markedly. Because of this, IABP was started. Both patients had an immediate improvement in cardiac function. IABP was able to reverse some of the neurologic deficits, and was weaned off after several days of support. Both patients had a substantial improvement in function, and are now capable of caring for themselves. We conclude that IABP may play an important role for improving cerebral blood flow in patients with vasospasm. It may be particularly useful in those patients with limited cardiac reserve.
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PMID:Use of intra-aortic balloon pump counterpulsation for refractory symptomatic vasospasm. 1066 72

We report a case of relative pupil-sparing oculomotor paresis initially attributed to ischemia because weakness of other cranial nerves was minimal and dismissed as insignificant. Neuroimaging eventually revealed a posterior fossa meningioma. The neurologic symptoms and signs disappeared immediately after resection of the tumor. The third nerve palsy was attributed to deformation of the brainstem. This case reinforces the importance of neuroimaging even in patients who have apparently isolated oculomotor palsy with features not classic for an ischemic etiology.
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PMID:Relative pupil-sparing oculomotor nerve palsy as the presenting sign of posterior fossa meningioma. 1172 87

Postictal aphasia has been described in left temporal lobe seizures. It may be of fluent, non-fluent or global type. We present here a patient who displayed signs of mixed transcortical aphasia (MTCA). The patient was a 67 year old man who underwent excision of a left frontal parasagittal meningioma in 1987. Since then he has been treated with phenytoin for generalized tonic-clonic seizures (GTCS). He was admitted in status epilepticus. On awakening, the patient was non-fluent with palilalia and echolalia. His repetition was relatively preserved but all the other language functions were impaired. This picture faded away within a few hours. Brain CT, performed during this postictal state, was normal except for signs related to frontal craniotomy. SPECT, which was performed after language functions returned to normal, displayed left frontal, cingular and insular hypoperfusion. The postictal language dysfunction of the patient corresponded to MTCA. Although our case has frontal, he had no other structural lesion that could explain either diffuse ischemia of the left hemisphere or watershed areas secondary to the generalized seizures. The uniqueness of this case is the combination of postictal MTCA with good prognosis.
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PMID:Postictal mixed transcortical aphasia. 1202 78

Magnetic resonance perfusion and diffusion studies were undertaken to clarify the significance of ischemia in the pathogenesis of peritumoral brain edema in patients with meningiomas. Included in this study were 26 patients with 27 meningiomas and 5 gliomas. Perfusion-weighted imaging (PWI) was performed using a gradient-echo, echo-planar-imaging (EPI) sequence for calculation of the relative regional cerebral blood volume (rrCBV) and the relative regional cerebral blood flow index (rrCBFi). Furthermore, multi-slice spin-echo EPI sequences were applied in order to obtain anisotropic and isotropic diffusion-weighted imaging (DWI). Apparent diffusion coefficient (ADC) values were then calculated for peritumoral brain parenchyma from tumors, with and without edema, using various diffusion sensitivities. Meningiomas without edema demonstrated a minimal increase of perfusion parameters in the peritumoral brain tissue. In contrast, cases with brain edema had highly significant ( p<0.0005) lower rrCBV and rrCBFi. The edema index (EI) correlated strongly with the rrCBV. A fitting procedure resulted into the following mathematical relation: EI=0.1/rrCBV(2). The DWI showed a significantly larger ADC value within areas of brain edema, compared with the normal white matter (0.74 x 10(-3) vs 1.55 x 10(-3) mm(2)/s; p<0.0001). Increases in EI correlated with increases in ADC values. In 31% of the meningiomas associated with edema, areas with increased signal, probable ischemia, demonstrated significantly lower ADC values, in comparison with the rest of the edematous areas. These areas were confined to tissue immediately adjacent to the tumor. In general, the decrease in rrCBV in brain edema represents a consequence from, rather than a cause of, vasogenic edema. Ischemic alterations can be regarded as secondary, facultative phenomena in the pathogenesis of meningioma-related brain edema.
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PMID:Alterations in diffusion and perfusion in the pathogenesis of peritumoral brain edema in meningiomas. 1213 25

Quadruple sectoranopia is a rare campimetric syndrome involving upper and lower, homonymous, congruent field blind sectors sparing a horizontal zone. Ischemia or infarction of the lateral parts of the lateral geniculate body, supplied by the distal part of the anterior choroidal artery, accounts for the visual field defect. Ganglionic nerve fiber atrophy matched to the visual field defect may be found if the lateral geniculate body dysfunction involves infarction. The four cases reported so far involve the following etiologies: a case of surgical ligation of the distal part of the anterior choroidal artery during cerebral meningioma removal, two cases of stroke with anterior choroidal artery infarction, and a case of vascular steal with anterior choroidal artery blood flow being shunted away from the lateral geniculate body by an arteriovenous malformation. If lateral geniculate body infarction is not solely involved, partial recovery may occur, ischemic quiescent neuronal areas being able to resume their activity following ischemia resolution.
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PMID:[Quadruple sectoranopia]. 1639 10


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