The Experts below are selected from a list of 5508 Experts worldwide ranked by ideXlab platform
John D Pickard - One of the best experts on this subject based on the ideXlab platform.
-
brain slump caused by jugular venous stenoses treated by stenting a hypothesis to link spontaneous intracranial hypotension with idiopathic intracranial hypertension
Journal of Neurological Surgery Reports, 2015Co-Authors: Nicholas Higgins, Rikin A Trivedi, Richard Greenwood, John D PickardAbstract:Spontaneous intracranial hypotension, of which brain slump is an extreme expression, is caused by a cerebrospinal fluid leak. The reason the leak develops in the first place, however, is unknown, and some cases can be very difficult to manage. We describe a patient with severe symptoms of spontaneous intracranial hypotension and brain slump documented by magnetic resonance imaging whose clinical syndrome and structural brain anomaly resolved completely after treatment directed exclusively at improving cranial venous outflow. Diagnostics included computed tomography (CT) Venography, catheter Venography, and jugular venoplasty. CT Venography showed narrowing of both internal jugular veins below the skull base. Catheter Venography confirmed that these were associated with pressure gradients. Jugular venoplasty performed on two separate occasions as a clinical test gave temporary respite. Lasting remission (2 years of follow-up) was achieved by stenting the dominant internal jugular vein. These findings and this outcome suggest a mechanism for the development of spontaneous intracranial hypotension that would link it to idiopathic intracranial hypertension and have cranial venous outflow obstruction as the underlying cause.
-
resolution of transverse sinus stenoses immediately after csf withdrawal in idiopathic intracranial hypertension
Journal of Neurology Neurosurgery and Psychiatry, 2007Co-Authors: Daniel Scoffings, John D Pickard, Nicholas J P HigginsAbstract:The cause of idiopathic intracranial hypertension (IIH) remains unknown but catheter Venography has shown that many patients have intracranial venous hypertension proximal to transverse sinus stenoses. These stenoses have subsequently been demonstrated on magnetic resonance and CT Venography and it has been proposed that by reducing the passive resorption of CSF, intracranial venous hypertension due to these stenoses might be the cause of IIH. However, CSF withdrawal reduces venous sinus pressures, implying that venous hypertension is a secondary phenomenon.1 Moreover, resolution of transverse sinus stenoses has been reported in three patients with IIH treated by CSF diversion procedures.2,3 We report a patient with IIH in whom catheter and CT Venography showed transverse sinus stenoses which resolved immediately after CSF withdrawal by lumbar puncture (LP). A 35 year old woman presented with a 2 year history of headache and transient visual obscurations. She had papilloedema and constricted visual fields but no focal neurology. MRI of the brain was normal. At LP, the opening pressure was 35 cm H2O with normal CSF constituents. IIH was diagnosed and treatment started with acetazolamide 250 mg three times daily. One year later the patient was referred to our institution with persistent headaches and papilloedema for consideration of a CSF diversion procedure. Magnetic resonance Venography at this time suggested stenoses in the anterior part of …
-
transverse sinus stenoses in benign intracranial hypertension demonstrated on ct Venography
British Journal of Neurosurgery, 2005Co-Authors: J N P Higgins, G Tipper, M Varley, John D PickardAbstract:Catheter studies show that patients with benign intracranial hypertension (BIH) frequently have high pressures in the intracranial venous sinuses proximal to stenotic lesions in the transverse sinuses. These lesions have now been demonstrated on MR Venography. This study investigated whether they would be visible on CT. CT Venography was performed on 10 patients with BIH and compared with 10 controls, matched for age and sex, undergoing CT angiography for subarachnoid haemorrhage. All controls were confirmed to have had ruptured intracranial aneurysms at craniotomy. Using a semi-automated technique to develop a profile of the cross-sectional areas along the lateral sinuses and to minimize observer bias, the narrowest point on each side was identified and summated in every subject. All patients with BIH exhibited a region of marked narrowing in both transverse sinuses, usually near the junction with the sigmoid sinus, rarely seen in our control group. Measured cross-sectional areas in these venous outflow tracts were substantially different between patients with BIH and controls (p<0.001). CT Venography frequently demonstrates transverse sinus narrowing in BIH.
-
cranial venous outflow obstruction and pseudotumor cerebri syndrome
Advances and technical standards in neurosurgery, 2005Co-Authors: John D Pickard, Brian Owler, Geoffrey Parker, G M Halmagyi, I H Johnston, Michael Besser, J N P HigginsAbstract:The pathophysiology of PTS including idiopathic intracranial hypertension or ‘BIH’, remains controversial. The older literature frequently referred to pathology in the cerebral venous drainage but more modern imaging techniques (CT and early MR) failed to reveal gross venous pathology. The role of impaired cranial venous outflow has recently been re-examined in the light of new methods of investigation (advanced MR Venography and direct microcatheter Venography with manometry) and of treatment (venous sinus stenting).
Mehmet Yilmazer - One of the best experts on this subject based on the ideXlab platform.
-
polycystic ovary syndrome is related to idiopathic intracranial hypertension according to magnetic resonance imaging and magnetic resonance Venography
Fertility and Sterility, 2008Co-Authors: Emine Cosar, Murat Cosar, Gulengul Koken, Figen Kir Sahin, Gulderen Caliskan, Alpay Haktanir, Olcay Eser, Mehmet Yaman, Mehmet YilmazerAbstract:Magnetic resonance imaging and magnetic resonance Venography findings of 30 women with polycystic ovary syndrome and headache were studied prospectively. Our magnetic resonance imaging and magnetic resonance Venography findings support that polycystic ovary syndrome with severe headache is a promoter of idiopathic intracranial hypertension.
Louis L Nguyen - One of the best experts on this subject based on the ideXlab platform.
-
concurrent Venography during first rib resection and scalenectomy for venous thoracic outlet syndrome is safe and efficient
Journal of vascular surgery. Venous and lymphatic disorders, 2015Co-Authors: Alexander T Hawkins, Maria J Schaumeier, Ann D Smith, Karen J Ho, Marcus E Semel, Louis L NguyenAbstract:Objective Surgical treatment of acute axillosubclavian vein thrombosis from venous thoracic outlet syndrome (VTOS) traditionally involves first rib resection and scalenectomy (FRRS) followed by interval Venography and balloon angioplasty. This approach can lead to an extended need for anticoagulation and a separate anesthesia session. We present outcomes for FRRS with concurrent Venography. Methods Retrospective chart review was performed for consecutive patients undergoing FRRS with concurrent Venography for VTOS from February 2007 to April 2014. Venography was performed immediately after FRRS with the arm in neutral and provocative positions. The primary outcomes of this study were primary and primary-assisted patency. Secondary outcomes included whether concurrent Venography resulted in modification of the procedure, postoperative anticoagulation use, and postoperative complications. Results Thirty patients underwent first rib resection with Venography with a mean follow-up time of 24.4 months. The mean age was 29.5 years (range, 17-52 years), and 17 (56.7%) were female. All were maintained on anticoagulation before the procedure. Concurrent Venography resulted in modification of the procedure in 28 patients (93.3%). Of these, 27 patients (96.4%) underwent balloon angioplasty and two patients (7.1%) underwent further rib resection. Twenty patients (66.7%) were discharged after the procedure with no anticoagulation. For those receiving postoperative anticoagulation for persistent minor thrombus, median time for anticoagulation duration was 5.0 months (range, 0.8 and 16.7 months). Two patients (6.7%) had postoperative bleeding requiring thoracentesis or video-assisted thoracoscopic evacuation of hemothorax. One patient (3.3%) suffered rethrombosis and was successfully lysed open, resulting in a 2-year subclavian vein (SCV) primary patency of 96.7% and primary-assisted patency of 100%. No patients required reoperation for VTOS, and all reported improvements in symptoms. Three patients (10.0%) later underwent prophylactic first rib resection on the contralateral side for symptoms and SCV stenosis. Conclusions FRRS with concurrent Venography is a safe procedure for VTOS that allows effective intraoperative modification of the surgical plan, resulting in excellent patency of the SCV, early cessation of anticoagulation, and durable relief of symptoms.
Nicholas J P Higgins - One of the best experts on this subject based on the ideXlab platform.
-
resolution of transverse sinus stenoses immediately after csf withdrawal in idiopathic intracranial hypertension
Journal of Neurology Neurosurgery and Psychiatry, 2007Co-Authors: Daniel Scoffings, John D Pickard, Nicholas J P HigginsAbstract:The cause of idiopathic intracranial hypertension (IIH) remains unknown but catheter Venography has shown that many patients have intracranial venous hypertension proximal to transverse sinus stenoses. These stenoses have subsequently been demonstrated on magnetic resonance and CT Venography and it has been proposed that by reducing the passive resorption of CSF, intracranial venous hypertension due to these stenoses might be the cause of IIH. However, CSF withdrawal reduces venous sinus pressures, implying that venous hypertension is a secondary phenomenon.1 Moreover, resolution of transverse sinus stenoses has been reported in three patients with IIH treated by CSF diversion procedures.2,3 We report a patient with IIH in whom catheter and CT Venography showed transverse sinus stenoses which resolved immediately after CSF withdrawal by lumbar puncture (LP). A 35 year old woman presented with a 2 year history of headache and transient visual obscurations. She had papilloedema and constricted visual fields but no focal neurology. MRI of the brain was normal. At LP, the opening pressure was 35 cm H2O with normal CSF constituents. IIH was diagnosed and treatment started with acetazolamide 250 mg three times daily. One year later the patient was referred to our institution with persistent headaches and papilloedema for consideration of a CSF diversion procedure. Magnetic resonance Venography at this time suggested stenoses in the anterior part of …
Scott Foster - One of the best experts on this subject based on the ideXlab platform.
-
magnetic resonance Venography versus contrast Venography to diagnose thrombosis after joint surgery
Clinical Orthopaedics and Related Research, 1996Co-Authors: Peter Larcom, Paul A Lotke, Marvin E Steinberg, George Holland, Scott FosterAbstract:Magnetic resonance Venography is a recently developed, noninvasive means of visualizing the proximal veins of the lower extremity and pelvis. Magnetic resonance Venography is compared with standard contrast Venography in the diagnosis of proximal deep vein thrombosis after total joint arthroplasty. Two hundred seven extremities were evaluated in a blinded study 5 to 7 days after surgery. Standard contrast Venography identified 11 proximal deep vein thromboses. Initial interpretations of the magnetic resonance venographies by staff radiologists identified 5 of the proximal vein thromboses (sensitivity 45%). Two patients with negative standard contrast venographies were identified as positive (specificity 99%). A retrospective review of all magnetic resonance venographies by a dedicated magnetic resonance angiographer identified 10 of 11 deep vein thromboses seen on standard contrast Venography (sensitivity 91%). Both false negatives were identified as positives. Standard contrast Venography remains the gold standard for identifying proximal vein thromboses. Emerging magnetic resonance imaging techniques have created a potential alternative modality by which to identify deep vein thrombosis. The present study suggests that standard contrast Venography continues to be the most accurate modality currently available. Although magnetic resonance Venography seems to be accurate, its interpretation requires experience. As costs diminish and experience increases, magnetic resonance Venography will have increased importance in the clinical recognition of deep vein thrombosis.
