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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Advanced tumors of the paranasal sinuses, parotid gland, orbit, parapharynx, and cranial cavity may invade the infratemporal fossa by direct extension or through natural anatomic pathways. The inability to control disease involving this region is reflected by the unacceptably high recurrence rates for both intracranial and extracranial neoplasms. Between 1983 and 1986, a pterional (or subtemporal) approach was combined with such conventional anterolateral procedures as a mandibulopharyngectomy, maxillectomy, orbitectomy, and parotidectomy in 13 patients with advanced skull base lesions. The tumor origin was extracranial in ten cases and intracranial in three patients. Seven of the neoplasms were malignant and six were histologically benign. Complete tumor removal was achieved in all patients. Repair of the ablative defect was achieved with a temporalis myogenous flap in ten patients, and primary closure or distant myocutaneous flaps in the remaining three patients. Postoperative complications included three lateral nasocutaneous fistulae secondary to temporalis myogenous flap necrosis and isolated cases of stroke, cerebral edema, pneumocephalus, and cerebrospinal fluid rhinorrhea. Twelve patients are alive without evidence of disease at a mean interval of 25 months. The remaining patient died from lung metastases 11 months after surgery.
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PMID:Combined pterional-anterolateral approaches to cranial base tumors. 212 63

Out of 989 cases of facial bone fracture, ten patients had carotid-cavernous sinus fistulas (1.01%). Their ages ranged from 25 to 48 years. Seven were male and three female. Two of the ten patients had lower third, three patients had middle third, three patients had upper third, and two patients had combined middle and lower third facial bone fractures. The signs and symptoms of a fistula appeared from the first postinjury day up to 50 days after the injury (mean, 21 days). Four patients had symptoms after operation for facial bone fracture. Most fistulae were identified by arteriography before treatment. Followup ranged from 1 year, 8 months, to 5 years, 9 months (mean, 2 years, 9 months). One patient had a malocclusion. Nine patients had complete resolution of their bruits. Complications included unilateral complete visual loss (two), CSF rhinorrhea (two), and stroke in one of the two CSF rhinorrhea patients. One patient expired due to a severe head injury, and there was one death from an unrelated cause.
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PMID:Facial bone fracture associated with carotid-cavernous sinus fistula. 223 1

In 44 consecutive patients with sellar volume larger than 1100 mm3, computer tomography showed that 20 had an empty or partly empty sella. None had radiological evidence of a suprasellar tumor. 10 of the 20 patients had experienced episodes with acute neurological symptoms presumably reflecting a pituitary apoplexy. It is suggested that an unknown proportion of intrasellar adenomas may disappear as a result of an infarction, which may comprise the entire adenoma or part of it--leaving an empty or partly empty sella as diagnosed by computer tomography. Air encephalography will demonstrate the empty sella only if the diaphragmatic aperture is large enough to allow cisternal herniation. The infarction may present clinically with no, slight or severe acute neurological symptoms. Late consequences of a pituitary adenoma infarction may be rhinorrhea or hydrocephalus.
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PMID:The empty sella and pituitary adenomas. A theory on the causal relationship. 711 82

15 consecutive patients with non-traumatic cerebrospinal fluid rhinorrhea were studied. 13 operations were performed on 10 patients. In 8 transcranial operations, an assumed defect in the anterior fossa was plugged with muscle, but only 3 operations were successful. In 4 operations, either transcranial or transsphenoidal, the sella was packed with muscle and rhinorrhea ceased immediately. Based on radiological and operative findings, 3 groups of patients appeared (1) 9 patients had pathology related to the pituitary gland or the sella turcica: enlarged sella, empty sella, pituitary tumour, intrasellar cyst or erosion of the sellar osseous border. (2) 2 patients had rhinorrhea from extrasellar origin. (3) In 4 patients no abnormality could be found. Prior to the rhinorrhea, 6 patients (5 from group 1 and 1 from group 3) had experienced episodes of neurological symptoms, compatible with a pituitary apoplexy. It is suggested that non-traumatic cerebrospinal fluid rhinorrhea in most cases is the result of a spontaneous necrosis in a pituitary adenoma, which has caused sellar bony erosion.
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PMID:Pathogenesis of non-traumatic cerebrospinal fluid rhinorrhea. 713 84

The laboratory examination of cerebrospinal fluid (CSF) continues to play an important role in the clinical diagnosis and treatment of various disorders of the central nervous system (CNS). The major conditions currently include, as they have in the past, infectious diseases, neoplastic processes, multiple sclerosis, other demyelinating disorders, and intracerebral hemorrhage. Recent publications suggest a variety of new laboratory tests that may be useful in the evaluation of patients with both primary and metastatic malignancies, Alzheimer's disease, Creutzfeld-Jacob disease, global ischemia, various psychiatric disorders, CSF otorrhea and rhinorrhea, and in the differential diagnosis of cortical vs lacunar stroke, among others. Examples of these recent developments and their possible clinical usefulness are discussed.
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PMID:Advances in the analysis of cerebrospinal fluid. 909 8

We prospectively analyzed presentations and long-term therapeutic responses to bromocriptine (BRC) in 29 newly diagnosed men with macroprolactinomas including 14 patients with 'giant prolactinoma'. Clinical symptoms, prolactin (PRL) levels and tumor size on MRI were measured before BRC and sequentially thereafter. The duration of follow-up were 6 to 96 (30.7 +/- 14.4) months. Pretreatment PRL ranged between 124 and 29200 ng/mL (1698 +/- 857.1) and tumor volume was between 2.81 and 132 cm(3) (21.1 +/- 24.3). Baseline PRL levels did not correlated with tumor volume (r = 0.45, P > 0.05). Significant decrease (P = 0.0003) in PRL, at least 96% of the pretreatment value from 1698 +/- 857.1 ng/mL to 42.4 +/- 30.6 ng/mL occurred in 26 patients. Persistent normalization of PRL levels (< 16 ng/mL) for at least 6 months was achieved in 12 patients (40.8%). Twenty-two patients (74.8%) achieved significant tumor shrinkage (P = 0.005) at study completion. An improvement in visual field defects (VFD) and restoration of libido and potency was observed in 40% and 33.3%, respectively. Trans-sphenoidal / trans-frontal pituitary surgery was performed in 9 patients (31%) for various reasons: pituitary apoplexy in 1, CSF rhinorrhea in 2, increasing prolactin in spite of BRC therapy in 3, and intolerant /resistant to BRC in 3 patients. These data suggest that, in male macro- and giant prolactinomas, dopamine agonists represent the first-line therapy effective in reducing PRL, restoration of libido and potency, improvement of VFD and determining tumor shrinkage.
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PMID:Long-term efficacy of bromocriptine in macroprolactinomas and giant prolactinomas in men. 1637 32

Surgery is generally used as second-line treatment in prolactinomas. For microprolactinomas, it may be indicated in cases of resistance or intolerance to dopamine agonists or where patients prefer definitive cure to lifelong drug treatment. In highly trained hands, selective adenomectomy results in normalization of prolactin levels in 75-90% of cases with little morbidity and no mortality. However, subsequent relapse is possible in up to 20% of cases. In macroprolactinoma, a definitive cure is unlikely due to the frequency of invasive tumor extension. A transsphenoidal or, less frequently, a transfrontal surgical approach is necessary in patients resistant to or intolerant of medical treatment, and also in rare cases such as pituitary apoplexy or cerebrospinal fluid rhinorrhea.
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PMID:Prolactinoma surgery. 1751 93

Lateral medullary infarction, known as Wallenberg syndrome, can be accompanied by sympathetic dysfunction. We report a case of unilateral intermittent rhinorrhea that started after an ischemic stroke in the ipsilateral lateral medulla and cerebellum. Rhinorrhea might be mediated by dysfunction of the sympathetic autonomic system.
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PMID:Paroxysmal rhinorrhea after medullary infarct. 2239 23

As a special drug use investigation, we monitored and assessed trends in antibacterial activity of clavulanic acid/amoxicillin (1:14) (hereafter, "CVA/AMPC (1:14)") and other antimicrobial agents for clinical isolates from pediatric patients with otitis media or respiratory, skin, and urinary tract infections. Against Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis isolated and identified from otorrhea, epipharynx and rhinorrhea of pediatric patients with otitis media, the MIC90s of CVA/AMPC (1:14) in five years between 2006-2010 were 1 microg/mL for S. pneumoniae and 8 microg/mL for H. influenzae and 0.25-0.5microg/mL for M catarrhalis. The changes of MIC90s of CVA/AMPC (1:14) for penicillin-resistant S. pneumoniae (PRSP) and beta-lactamase non-producing H. influenzae were two times, and no decrease in drug susceptibility was found in the period of the present investigation. In addition, the MIC changes of other antimicrobial agents for these three organisms were approximately two to four times as well. Against organisms isolated and identified from pus, sputum, pharynx, skin and urine of pediatric patients with respiratory, skin, and urinary tract infections, the MIC90s of CVA/AMPC (1:14) in four years between 2008-2011 were 1 microg/mL for S. pneumoniae, < or =0.06microg/mL for penicillin susceptible S. pneumoniae (PSSP) without any change, 0.5-1 microg/mL for penicillin intermediate resistant S. pneumoniae (PISP) with a twofold change and 1 microg/mL for PRSP with no change. The MIC90s of CVA/AMPC (1:14) were 2-8 microg/mL for S. aureus with a fourfold change, 2 microg/mL for methicillin-sensitive S. aureus without any change, 4-8 microg/mL for H. influenzae with a twofold change. Against beta-lactamase non-producing H. influenzae, MIC90s of CVA/AMPC (1:14) were 1 microg/mL for beta-lactamase negative ampicillin susceptible (BLNAS), 8 microg/mL for beta-lactamase negative ampicillin resistant (BLNAR), showing no change. Neither Streptococcus pyogenes or Klebsiella pneumoniae demonstrated any change and M. catarrhalis and Escherichia coli showed twofold changes of MIC90s of CVA/AMPC (1: 14). In the present investigation conducted to monitor annual changes in antibacterial activity intended for pediatric patients with otitis media or other infections, there was no significant change in antibacterial activity of CVA/AMPC (1: 14).
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PMID:[Antibacterial activity for clinical isolates from pediatric patients of clavulanic acid/amoxicillin (1: 14) -outcomes of special drug use investigation on antibacterial activity (annual changes)]. 2416 43

Trans-ethmoidal encephalo-meningocele is an extremely rare event among the adult population. It mainly affects young people who have previously reported a head injury. Even though early treatment is mandatory to avoid septic complications, the diagnosis is usually late because of the misleading symptomatology. We describe the unusual clinical history of an adult patient with a giant trans-ethmoidal encephalo-meningocele. A 61-year-old woman presented progressively more intense headache and rhinorrhea. No trauma was reported. We learned that she had a history of misunderstood spontaneous rhinorrhea beginning two years before, followed one year later by a lateral sinus thrombosis which worsened the cerebrospinal fluid leakage. Some months after stroke a new cerebral magnetic resonance scan revealed a giant trans-ethmoidal encephalo-meningocele. The brain herniation was surgically removed by a subfrontal intradural approach through a frontal craniotomy. Even rare, giant naso-ethmoidal encephalo-meningocele has to be considered in adult patients presenting with rhinorrhea even without a history of meningitis or neurological defects. Venous stroke can affect patients in whom prolonged CSF leakage occurs because of misunderstood cerebrospinal fistula. These patients must be monitored after stroke for the possible onset of an encephalo-meningocele.
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PMID:Venous stroke can be the unusual clinical presentation of an arising naso-ethmoidal encephalo-meningocele in adulthood. 2420


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