The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Alfonso Lagares - One of the best experts on this subject based on the ideXlab platform.
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Densitometric analysis of brain computed tomography as a new prognostic factor in patients with acute subdural hematoma.
Journal of neurosurgery, 2020Co-Authors: Daniel García-pérez, Irene Panero-pérez, Carla Eiriz Fernández, Luis Miguel Moreno-gómez, Olga Esteban-sinovas, Blanca Navarro-main, Pedro A Gómez López, Ana M. Castaño-leon, Alfonso LagaresAbstract:Objective Acute subdural hematoma (ASDH) is a major cause of mortality and morbidity after traumatic brain injury (TBI). Surgical evacuation is the mainstay of treatment in patients with altered neurological status or significant mass effect. Nevertheless, concerns regarding surgical indication still persist. Given that clinicians often make therapeutic decisions on the basis of their prognosis assessment, to accurately evaluate the prognosis is of great significance. Unfortunately, there is a lack of specific and reliable prognostic models. In addition, the interdependence of certain well-known predictive variables usually employed to guide surgical decision-making in ASDH has been proven. Because gray matter and white matter are highly susceptible to secondary insults during the early phase after TBI, the authors aimed to assess the extent of these secondary insults with a brain parenchyma densitometric quantitative CT analysis and to evaluate its prognostic capacity. Methods The authors performed a retrospective analysis among their prospectively collected cohort of patients with moderate to severe TBI. Patients with surgically evacuated, isolated, unilateral ASDH admitted between 2010 and 2017 were selected. Thirty-nine patients were included. For each patient, brain parenchyma density in Hounsfield units (HUs) was measured in 10 selected slices from the Supratentorial Region. In each slice, different Regions of interest (ROIs), including and excluding the cortical parenchyma, were defined. The injured hemisphere, the contralateral hemisphere, and the absolute differences between them were analyzed. The outcome was evaluated using the Glasgow Outcome Scale-Extended at 1 year after TBI. Results Fifteen patients (38.5%) had a favorable outcome. Collected demographic, clinical, and radiographic data did not show significant differences between favorable and unfavorable outcomes. In contrast, the densitometric analysis demonstrated that greater absolute differences between both hemispheres were associated with poor outcome. These differences were detected along the Supratentorial Region, but were greater at the high convexity level. Moreover, these HU differences were far more marked at the cortical parenchyma. It was also detected that these differences were more prone to ischemic and/or edematous insults than to hyperemic changes. Age was significantly correlated with the side-to-side HU differences in patients with unfavorable outcome. Conclusions The densitometric analysis is a promising prognostic tool in patients diagnosed with ASDH. The supplementary prognostic information provided by the densitometric analysis should be evaluated in future studies.
Arun Kumar Gupta - One of the best experts on this subject based on the ideXlab platform.
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Bilateral cerebral venous angioma associated with varices: a case report and review of the literature.
AJNR. American journal of neuroradiology, 2005Co-Authors: Surjith Vattoth, Sukalyan Purkayastha, E.r. Jayadevan, Arun Kumar GuptaAbstract:A varix occurring with a cerebral venous angioma is a rare combination of cerebral vascular malformations. The most common vascular anomaly associated with a venous angioma is a cavernous angioma. We report a case of bilateral Supratentorial venous angioma with 2 varices involving the angioma situated on the right frontotemporal Region. Multiple subependymal veins were seen in the right Supratentorial Region, which joined to form multiple collector veins, which, in turn, unified into a tortuous channel in the Region of the sylvian fissure and continued into venous varices.
Daniel García-pérez - One of the best experts on this subject based on the ideXlab platform.
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Densitometric analysis of brain computed tomography as a new prognostic factor in patients with acute subdural hematoma.
Journal of neurosurgery, 2020Co-Authors: Daniel García-pérez, Irene Panero-pérez, Carla Eiriz Fernández, Luis Miguel Moreno-gómez, Olga Esteban-sinovas, Blanca Navarro-main, Pedro A Gómez López, Ana M. Castaño-leon, Alfonso LagaresAbstract:Objective Acute subdural hematoma (ASDH) is a major cause of mortality and morbidity after traumatic brain injury (TBI). Surgical evacuation is the mainstay of treatment in patients with altered neurological status or significant mass effect. Nevertheless, concerns regarding surgical indication still persist. Given that clinicians often make therapeutic decisions on the basis of their prognosis assessment, to accurately evaluate the prognosis is of great significance. Unfortunately, there is a lack of specific and reliable prognostic models. In addition, the interdependence of certain well-known predictive variables usually employed to guide surgical decision-making in ASDH has been proven. Because gray matter and white matter are highly susceptible to secondary insults during the early phase after TBI, the authors aimed to assess the extent of these secondary insults with a brain parenchyma densitometric quantitative CT analysis and to evaluate its prognostic capacity. Methods The authors performed a retrospective analysis among their prospectively collected cohort of patients with moderate to severe TBI. Patients with surgically evacuated, isolated, unilateral ASDH admitted between 2010 and 2017 were selected. Thirty-nine patients were included. For each patient, brain parenchyma density in Hounsfield units (HUs) was measured in 10 selected slices from the Supratentorial Region. In each slice, different Regions of interest (ROIs), including and excluding the cortical parenchyma, were defined. The injured hemisphere, the contralateral hemisphere, and the absolute differences between them were analyzed. The outcome was evaluated using the Glasgow Outcome Scale-Extended at 1 year after TBI. Results Fifteen patients (38.5%) had a favorable outcome. Collected demographic, clinical, and radiographic data did not show significant differences between favorable and unfavorable outcomes. In contrast, the densitometric analysis demonstrated that greater absolute differences between both hemispheres were associated with poor outcome. These differences were detected along the Supratentorial Region, but were greater at the high convexity level. Moreover, these HU differences were far more marked at the cortical parenchyma. It was also detected that these differences were more prone to ischemic and/or edematous insults than to hyperemic changes. Age was significantly correlated with the side-to-side HU differences in patients with unfavorable outcome. Conclusions The densitometric analysis is a promising prognostic tool in patients diagnosed with ASDH. The supplementary prognostic information provided by the densitometric analysis should be evaluated in future studies.
José Telmo Valença Júnior - One of the best experts on this subject based on the ideXlab platform.
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Dural-Based Frontal Lobe Hemangioblastoma
World neurosurgery, 2019Co-Authors: Rafael Antônio Vicente Lacerda, Antônio Gilvan Teixeira Júnior, Euler Nicolau Sauaia Filho, Leonardo José Monteiro De Macêdo Filho, André Soldati Antônio, Jan Araújo Cabral, Francisco Ramos Junior, José Telmo Valença JúniorAbstract:Background Hemangioblastomas are benign vascular neoplasms that may be associated with von Hippel−Lindau disease. They are more common in men, with a mean age of 36 years, and rarely affect the Supratentorial Region and, when present in this topography, do not have meningeal impairment. Diagnosis by the radiologic and histopathologic study is difficult, since they are rare and, therefore, forgotten diagnosis, besides they are differential diagnoses with other Supratentorial neoplasms. Case Description The present report describes a case of a frontal hemangioblastoma in a 64-year-old woman who presented with seizures. Our imaging studies had as a main hypothesis a frontal meningioma because of dural tail sign, lack of edema, contrast enhancement pattern, and extra-axial location in the Supratentorial Region, in the frontal lobe, which is uncommon for a hemangioblastoma. The patient underwent microneurosurgery for tumor resection, and the excised tissue was submitted for anatomopathologic evaluation. This study clarified the diagnosis as hemangioblastoma. We followed up the patient at the outpatient clinic for 2 years, with clinical improvement, without tumor recurrence. We also compared the clinical, radiologic, epidemiologic, and anatomopathologic data of the reported case with data from a literature review conducted through the PubMed portal. Conclusions Definitive treatment for these lesions is surgical resection. Physicians should be aware that Supratentorial meningeal hemangioblastomas can be developed in a patient without von Hippel−Lindau disease and regular follow-up is mandatory.
Tina Kojadin - One of the best experts on this subject based on the ideXlab platform.
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the analysis of sleep architecture in patients after stroke in Supratentorial Region and in patients after stroke in brainstem
2015Co-Authors: Tina KojadinAbstract:Sleep is an essential physiological process for normal functioning of the body and cognition while being awake. In sleep process the brain frequency is changing while going through sleep phases, which are associated with the activity in various brain Regions. These brain Regions can be damaged after an ischemic stroke, caused by the blockade in the blood vessel leading to lack of oxygen supply and producing lesions in brain areas, what results in a loss of brain function. As a consequence of a disorder like lesions in the brain, the brain functions are disrupted, what can affect the process of sleep. Studies show, that there are some differences in sleep patterns among healthy sleepers and subjects after stroke, showing that subjects after stroke spent more time in deep sleep and less in REM sleep in comparison with the healthy sleepers. Based on these findings the goal of this study is to analyze sleep architecture among patients after stroke depending on the brain area that was affected by stroke. Regarding to the brain Region that was affected by the stroke, there could be some differences in sleep patterns among the patients that could indicate on the neuroanatomical importance on sleep process. There were 51 polysomnograpy (PSG) recording taken from patients after stroke for the study. In all patients the brain magnetic resonance (MRI) was performed to locate the stroke affected area. The points of interest were patients with effected Supratentorial Regions (43) and patients with stroke in brain stem (8 subjects). The task was to compare their sleep architecture and other sleep features like sleep efficiency, time in bed and awakenings with Matlab R2014b program and to search for statistical significance. All patients in the study provided informed consents and the study was approved by the Institutional ethics committee. The results are indicating on differences in the architecture of sleep in the patients with stroke in the brain stem, showing lower REM latency and lower efficiency then in the patients after stroke in Supratentorial Regions. These finding are providing evidence how different brain Regions can affect different sleep features.