The Experts below are selected from a list of 243 Experts worldwide ranked by ideXlab platform
Kee-hak Lim - One of the best experts on this subject based on the ideXlab platform.
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Massive fetal ascites causing increased Middle Cerebral Artery systolic velocity.
Obstetrics & Gynecology, 2004Co-Authors: Gloria C. Chiang, Deborah Levine, Philip E. Hess, Kee-hak LimAbstract:BACKGROUND: An elevated peak systolic velocity in the Middle Cerebral Artery, assessed by Doppler ultrasonography, is commonly assodated with fetal anemia. Other fetal abnormalities associated with a high Middle Cerebral Artery velocity have rarely been reported. CASE: A fetus with increasing ascites was found to have an elevated Middle Cerebral Artery peak systolic velocity. Following paracentesis, the peak systolic velocity normalized. Peak systolic velocity continued to correlate with the level of ascites, falling to normal ranges when large-volume amniocentesis and paracentesis were performed. At birth, the infant was found to have a normal hematocrit. CONCLUSION: An elevated Middle Cerebral Artery peak systolic velocity may result from massive fetal ascites without anemia. We hypothesize that the massive ascites led to increased afterload of the heart, with relatively preserved preload, leading to an increased systolic blood pressure and an elevated Middle Cerebral Artery peak systolic velocity.
R Von Kummer - One of the best experts on this subject based on the ideXlab platform.
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malignant Middle Cerebral Artery territory infarction clinical course and prognostic signs
JAMA Neurology, 1996Co-Authors: Werner Hacke, Stefan Schwab, M Horn, Matthias Spranger, M De Georgia, R Von KummerAbstract:Background: Although the clinical features of space-occupying ischemic stroke are well known, there are limited prospective data on the clinical course of complete Middle Cerebral Artery territory infarction and on the predisposing factors leading to subsequent herniation and brain death. Methods: The clinical course of patients with complete Middle Cerebral Artery territory infarction, defined by computed tomography and vascular imaging, was evaluated. Initial clinical presentation was assessed by the Scandinavian Stroke Scale and the Glasgow Coma Scale. Serial computed tomography with measurement of midline and septum pellucidum shift and data on the presence and location of vascular occlusion by angiography or Doppler ultrasound were obtained directly after admission. Time course and outcome were analyzed with regard to the clinical findings on admission and at follow-up. The functional status of surviving patients was assessed using the Barthel Index. Results: Fifty-five patients with complete Middle Cerebral Artery territory infarction caused by occlusion of either the distal intracranial carotid Artery or the proximal Middle Cerebral Artery trunk were studied. In all patients, embolic infarction was presumed. The mean Scandinavian Stroke Scale score on admission was 20, and the time course of deterioration varied between 2 and 5 days. Forty-nine patients required ventilator assistance during the acute stage of disease. Only 12 patients (22%) survived the infarct. The cause of death was transtentorial herniation with subsequent brain death in 43 patients. Survivors had a mean Barthel Index score of 60 (range, 45 to 70). Conclusions: The prognosis of complete Middle Cerebral Artery territory stroke is very poor and can be estimated by early clinical and neuroradiological data within the first few hours after the onset of symptoms. A space-occupying mass effect develops rapidly and predictably over the initial 5 days after presentation. Herniation occurred as an end point in 43 (78%) of these patients.
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sensitivity and prognostic value of early ct in occlusion of the Middle Cerebral Artery trunk
American Journal of Neuroradiology, 1994Co-Authors: R Von Kummer, Uta Meydinglamade, Michael Forsting, Ludger Rosin, Klaus Rieke, Werner Hacke, K SartorAbstract:PURPOSE To investigate the incidence and prognostic value of local brain swelling, the extent of parenchymal hypodensity, and the hyperdense Middle Cerebral Artery sign as shown by CT within the first 5 hours after the onset of symptoms in patients with angiographically proved Middle Cerebral Artery trunk occlusions. METHODS Fifty-three patients were studied prospectively with CT 46 to 292 minutes (median, 120; mean, 134 +/- 59) after symptom onset and scored clinically at admission and 4 weeks later. All patients were treated with recombinant tissue plasminogen activator (30 to 100 mg). RESULTS Early CT showed parenchymal hypodensity in 43 patients (81%), local brain swelling in 20 patients (38%), and hyperdensity of the Middle Cerebral Artery trunk in 25 patients (47%). Hypodensity covering more than 50% of the Middle Cerebral Artery territory had an 85%, local brain swelling a 70%, and the hyperdense Middle Cerebral Artery sign a 32% positive predictive value for fatal clinical outcome. Specificity of these findings for fatal outcome was 94%, 83%, and 51%, respectively, and sensitivity was 61%, 78% and 44%, respectively. CONCLUSIONS Early CT in acute Middle Cerebral Artery trunk occlusion is highly predictive for fatal clinical outcome if there is extended hypodensity or local brain swelling despite aggressive therapeutic attempts such as thrombolysis or decompressive surgery.
Giancarlo Mari - One of the best experts on this subject based on the ideXlab platform.
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Middle Cerebral Artery Doppler for managing fetal anemia.
Clinical obstetrics and gynecology, 2010Co-Authors: Jacques Samson, Dana Block, Giancarlo MariAbstract:The measurement of the Middle Cerebral Artery peak systolic velocity, a noninvasive technique, has become the standard for the diagnosis of fetal anemia. The Middle Cerebral Artery peak systolic velocity is used because of its ease of measurement and its high sensitivity in predicting anemia. This diagnostic tool should only be used with fetuses at risk for anemia and in medical centers with adequate training in the technique.
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Correction of fetal anemia on the Middle Cerebral Artery peak systolic velocity.
Obstetrics and gynecology, 2002Co-Authors: Theodor Stefos, Erich Cosmi, Laura Detti, Giancarlo MariAbstract:OBJECTIVE: To assess the effect of correction of fetal anemia on the Middle Cerebral Artery peak systolic velocity values. METHODS: With Doppler ultrasonography, Middle Cerebral Artery peak systolic velocity was measured in 41 fetuses before and immediately after 54 intrauterine transfusions for severe red blood cell alloimmunization. The fetuses were divided into two groups: 17 fetuses studied at first transfusion (group A), and 24 fetuses enrolled to the study after the first transfusion (group B). Both fetal hemoglobin and Middle Cerebral Artery peak systolic velocity were plotted over the respective reference ranges as a function of gestational age. Both values were expressed as multiples of the median and analyzed with paired t test. RESULTS: The values of Middle Cerebral Artery peak systolic velocity decreased in all but one fetus of group B (P < .05). The values of Middle Cerebral Artery peak systolic velocity before transfusion were above the upper limit of the reference range in 60% of the fetuses of group A and in 38% of group B, respectively. After correction of anemia, only one value remained above the upper limit of the reference range. CONCLUSION: The correction of fetal anemia with intrauterine blood transfusion decreases significantly and normalizes the value of the fetal Middle Cerebral Artery peak systolic velocity.
Marcelo D Vilela - One of the best experts on this subject based on the ideXlab platform.
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superficial temporal Artery to Middle Cerebral Artery bypass
Neurosurgery, 2004Co-Authors: David W Newell, Marcelo D VilelaAbstract:The superficial temporal Artery to Middle Cerebral Artery bypass is an elegant procedure that was developed and first performed by M. Gazi Yasargil. It has been used by neurosurgeons for more than 30 years in the management of neurovascular disorders such as cerebrovascular ischemic disease, moyamoya disease, and complex intracranial aneurysms. Mastering the technique requires not only precise and fine skills but also devoted training in the microsurgery laboratory. The technique presented in this article evolved from the long and vast experience of the senior author (DWN) in performing superficial temporal Artery to Middle Cerebral Artery bypasses for a variety of cerebrovascular conditions.
Gloria C. Chiang - One of the best experts on this subject based on the ideXlab platform.
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Massive fetal ascites causing increased Middle Cerebral Artery systolic velocity.
Obstetrics & Gynecology, 2004Co-Authors: Gloria C. Chiang, Deborah Levine, Philip E. Hess, Kee-hak LimAbstract:BACKGROUND: An elevated peak systolic velocity in the Middle Cerebral Artery, assessed by Doppler ultrasonography, is commonly assodated with fetal anemia. Other fetal abnormalities associated with a high Middle Cerebral Artery velocity have rarely been reported. CASE: A fetus with increasing ascites was found to have an elevated Middle Cerebral Artery peak systolic velocity. Following paracentesis, the peak systolic velocity normalized. Peak systolic velocity continued to correlate with the level of ascites, falling to normal ranges when large-volume amniocentesis and paracentesis were performed. At birth, the infant was found to have a normal hematocrit. CONCLUSION: An elevated Middle Cerebral Artery peak systolic velocity may result from massive fetal ascites without anemia. We hypothesize that the massive ascites led to increased afterload of the heart, with relatively preserved preload, leading to an increased systolic blood pressure and an elevated Middle Cerebral Artery peak systolic velocity.
