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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Giant cell (temporal) arteritis is a serious inflammatory condition that can lead to blindness, stroke, or other adverse sequelae if not properly treated. An elevated erythrocyte sedimentation rate has traditionally been emphasized as a criterion for making this diagnosis. Delays in diagnosis and unnecessary testing may occur when a patient presents with a normal erythrocyte sedimentation rate and a clinical history consistent with this condition. We describe a patient with giant cell arteritis who presented with a normal erythrocyte sedimentation rate and who subsequently developed devastating central nervous system complications.
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PMID:Giant cell arteritis. A case with unusual neurologic manifestations and a normal sedimentation rate. 172 19

Giant cell (temporal) arteritis G.C.(T) A. is common disorder and affects medium sized and large arteries in people over the age of fifty. Many series show that up to 50% of people with the clinical syndrome of polymyalgia rheumatica (PMR) go on to develop manifestations of G.C.(T) A. within a year; others may do so later. A critical review is offered of aspects of the subject which despite much study and research remain controversial or neglected. This includes epidemiology: statistics from routine autopsy suggests that the disease affects more people than are diagnosed clinically. The need to resolve uncertainty whether intracerebral vessels are involved or not, is now urgent, particularly in view of the wide spread use of short courses of Dexamethasone in the treatment of stroke. All clinicians should recognise the implications of the fact that they are dealing with a disease which may be active and yet symptomatically silent.
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PMID:Giant cell (temporal) arteritis-polymyalgia rheumatica: a critical review. 219 30

An 11 year old, tall boy presented with symptoms typical of pituitary apoplexy. A large necrotic and haemorrhagic tumour was removed, which was shown to be an adenoma secreting growth hormone and prolactin. Subsequent treatment comprised cranial irradiation and hormone replacement. Eighteen months after operation growth was static and plasma growth hormone and prolactin concentrations were undetectable. Treatment of pituitary apoplexy should comprise excision of the tumour and postoperative irradiation; such treatment after early recognition of the condition offers the best chance of preserving normal pituitary function in children with gigantism.
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PMID:Spontaneous endocrine cure of gigantism due to pituitary apoplexy. 631 18

Giant fusiform basilar aneurysms (dolicho-ectatic basilar anomalies) are rare and have not previously been reported to cause embolic infarction in territory distal to the aneurysm. They most commonly present as posterior fossa mass lesions with brainstem compression and cranial neuropathies. Originally considered atherosclerotic in etiology, recent authors feel that they may represent a unique arteriopathy characterized by loss of elastin in the vessel wall. We report a case which presented solely as an occipital lobe infarction. To our knowledge, this is the first case in which a fusiform basilar aneurysm presented with an embolic infarction as its only manifestation.
Stroke
PMID:Fusiform basilar aneurysm as a cause of embolic stroke. 712 6

Giant fusiform aneurysm of the cerebral arteries was found in 11 patients during a 20-year period. The 7 males and 4 females ranged in age from 9 to 68 years (mean: 49 years). The supraclinoid segment of the internal carotid artery (ICA) and the M-1 segment of the middle cerebral artery (MCA) were the most frequently involved arteries. Multiple aneurysms were identified in 3 patients. Compression of adjacent intracranial structures was the usual cause of symptoms, and only 2 patients experienced subarachnoid hemorrhage. One patient presented with transient ischemic attacks. Computed tomography, with and without Hypaque infusion, clearly demonstrated the aneurysms in the 6 of 7 patients studied. Thrombus was invariably seen in the lumen of the aneurysm. Cerebral angiography in 11 patients displayed marked dilatation and elongation of the involved artery. The dilatation frequently extended into connecting arteries. Surgical treatment was carried out in 6 patients, including 2 with aneurysm entrapment and decompression, 2 with proximal ICA ligation, 1 with wrapping and 1 with wrapping and superficial temporal artery (STA) to MCA anastomosis. Death occurred in 2 patients not treated surgically.
Stroke
PMID:Giant fusiform aneurysm of the cerebral arteries. 723 61

Between 1970 and 1989, 31 patients with a diagnosis of giant pituitary adenoma were referred to the London Regional Cancer Center. Giant pituitary adenoma was defined in terms of extension in excess of 40 mm from the midpoint of the jugum sphenoidale. The diagnosis was made surgically in 30 patients and clinically in one. Tumor extent and dimensions were obtained from operative reports and/or radiological scans computed tomography or magnetic resonance imaging. Mean follow-up was 8 years. Initial treatment consisted of surgery alone (4 patients), radiotherapy alone (2 patients) and combined surgery-radiotherapy (25 patients). One patient underwent a needle biopsy for histological confirmation and was grouped with the radiotherapy alone subset. Four of the six patients who received single modality treatment failed initial treatment (three surgery and one radiation). In contrast only 3 of the 25 patients treated with combined surgery-post-operative radiotherapy progressed despite the fact that all patients had gross residual disease post-operatively and that 43% of these patients received radiotherapy based on the post-operative rather than the pre-operative tumor extent. With subsequent salvage, overall tumor control amongst the 31 patients was 93.5%. Complications in general were minimal although one acromegalic patient sustained a unilateral internal capsular cerebrovascular accident year post treatment. In summary, combined modality treatment with initial surgical debulking followed by radiotherapy in the dose range of 4500-5000 cGy over 25 fractions yields tumor control rates in giant pituitary adenomas similar to those of smaller pituitary adenomas without undue morbidity.
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PMID:Giant pituitary adenomas: role of radiotherapy. 845 86

Histopathological changes in leptomeningeal and cerebral blood vessels in a case of subacute cutaneous lupus erythematosus (SCLE) with the involvement of the central nervous system are presented. A 46-year-old woman died because of cerebral stroke after a 19-year duration of the disease. The general autopsy showed changes in the kidneys, myocardium, spleen and pancreas, typical of systemic lupus erythematosus. The brain autopsy revealed large necrosis in the supply territory of the middle and posterior cerebral arteries in the left hemisphere. In addition, small focal necroses, partially hemorrhagic, were found in both cerebellar hemispheres. Small cortical necrosis was also visible in the right insular area. A diffuse damage of the blood vascular system in the form of fibrinoid necrosis of small sized cerebral blood vessels with inflammatory infiltrates of the vessel wall (necrotizing leukocytoclastic vasculitis) predominated in the microscopic examination of the brain. Vascular changes of vasculopathy type in the form of hyalinization of the vascular wall and fibrinoid necrosis with concomitant numerous, small necroses were observed. In the lumen of left internal carotid artery infiltrated by inflammatory cells, an organized thrombus was found. Giant cells were observed within vascular infiltration.
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PMID:Rare vascular changes in the brain in a case of subacute cutaneous lupus erythematosus. 867 32

Giant congenital intrapericardial aneurysms of the left atrial appendage and body are unusual cardiac anomalies. Only 48 cases have been previously reported in the literature, with the vast majority presenting in otherwise healthy young patients. These can present clinically with persistent arrhythmias and progress to stroke if not diagnosed and treated. Our index case is that of a 34-year-old woman discovered to have a giant left atrial aneurysm who developed intermittent palpitations with sinus tachycardia. We present a review of the literature pertaining to their diagnosis, potential morbidity, and surgical management.
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PMID:Congential giant aneurysms of the left atrial appendage: diagnosis and management. 881 9

This report is based on the results of the questionnaires conducted for the Japan Stroke Surgery Meeting 1996 (President: S. Kobayashi). The questionnaires were sent to all neurosurgical training institutions approved by The Japan Neurosurgical Society, numbering 959. The response rate was 54.2% (520 institutions). All statistics dealt with cases from January 1995 to December 1995. The total number of aneurysm surgery performed was 13,166. The average operative case number per institution during the year was 25. About 20% of the institutions exceeded 35 cases. Of all operative cases, 76.3% were ruptured aneurysms and 23.7% were nonruptured. Giant aneurysms were 2.9%; dissecting aneurysms 2.4%. Surgical procedures performed were clipping in 90.3%, wrapping in 5.2%, proximal ligation 1.6%, and bypass in 0.7%. Intravascular surgery was performed for 2.3% of the cases. Sugita clips were mainly used in 80.5% of the institutions, Yasargil clips in 6.6%, and both in 12.9%. For anterior communicating artery aneurysms pterional approach was mainly used in 81.0% of the institutions, interhemispheric in 7.2%, and both in 11.7%. For basilar terminal aneurysms, pterional approach was mainly used in 88.3% of the institutions, subtemporal approach in 6.6%, and both in 5.1%. The nonoperative cases included 24.9% of the ruptured aneurysms, 31.7% of the unruptured aneurysms, 38.4% of the giant aneurysms, and 52.1% of the dissecting aneurysms. The above statistics suggest that aneurysms are treated in Japan in most training institutions and that open surgical treatment is still the main procedure of choice.
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PMID:Aneurysm surgery in Asia--Japanese situation. 1023 89

Vasculitis of the nervous system are rare in the elderly. When present, they may constitute an urgent diagnosis and a therapeutic emergency. Clinical expression is rich and without specificity. Atypical signs (unusual course of dementia, systemic signs) or atypical laboratory results (inflammatory syndrome) may suggest the diagnosis of vasculitis. However, as multiple comorbidity is the rule in elderly subjects, searching for intercurrent factors (e.g. atrial fibrilation due to infectious disease causing embolic stroke) may be more contributive than searching for proof of a rare disease (vasculitis) with invasive procedures in this population. Giant cell (temporal) arteritis is the only vasculitis specifically related with age; the vital prognosis of vision may be compromised. Corticosterid therapy must be instituted without delay. Periartritis nodosa begins in 30% of cases after 60 years of age. The clinical features are the same as in younger subjects. Other vasculidis are rare in the elderly. In absence of specific studies in this population, therapeutic protocols are the same as in younger subjects but may have to be adjusted.
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PMID:[Central nervous system vasculitis and of the peripheral nerves in the elderly]. 1259 31


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