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1. A middle-aged man with progressive neurologic deficits and bilateral leg lesions

Author

Stephen Samples, Brendan J. Kelley, and MaryAnn Mays

Subjects
Male, medicine.medical_specialty, MEDLINE, macromolecular substances, Leg Dermatoses, Leukoencephalopathy, Text mining, Antiretroviral Therapy, Highly Active, HIV Seropositivity, otorhinolaryngologic diseases, medicine, Humans, Sarcoma, Kaposi, Leg, medicine.diagnostic_test, business.industry, musculoskeletal, neural, and ocular physiology, Leukoencephalopathy, Progressive Multifocal, Brain, Magnetic resonance imaging, General Medicine, Middle Aged, medicine.disease, JC Virus, Magnetic Resonance Imaging, Antiretroviral therapy, body regions, nervous system, Sarcoma, Radiology, business
Abstract

His speech is severely impaired and he cannot swallow liquids or solids. The leg lesions have been present for several years and are painless. What is the likely diagnosis?

Published
2006
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2. Traumatic Intracerebral Venous Thrombosis Associated With an Abnormal Golf Swing

Author

Stephen Samples, R. Philip Kinkel, and Russell P. Saneto

Subjects
Adult, Male, business.industry, Vascular disease, Deep vein, Headache, Sequela, medicine.disease, Thrombosis, Neck Injuries, Venous thrombosis, medicine.anatomical_structure, Intracranial Thrombosis, Neurology, Antibodies, Anticardiolipin, Anesthesia, Athletic Injuries, medicine, Factor V Leiden, Golf, Humans, Neurology (clinical), Vein, business
Abstract

Objectives.—To describe the occurrence of cerebral venous thrombosis in a 40-year-old man whose cerebral event was induced by a poor golf swing, to review the literature on possible mechanisms producing venous thrombosis, and to compare this case with the literature. Background.—Headache is the most frequent symptom in patients with cerebral venous thrombosis. However, patients presenting with a headache due to cerebral venous thrombosis are uncommon. The known risk factors for thrombosis include both acquired and genetic factors. When the interaction of these two groups occurs, the magnitude of this interaction is thought to produce a dynamic state that can favor thrombosis. Our case report illustrates that moderate levels of anticardiolipin antibodies together with the mild trauma of a golf swing can induce a cerebral venous thrombosis. This case also suggests that although headache is rarely due to cerebral venous thrombosis, it should be excluded by good medical acumen and testing. Results.—Minor trauma induced by a poor golf swing was chronologically related to the development of a progressive cerebral venous thrombosis. The patient had none of the risk factors associated with a predisposition to venous thrombosis: hypercoagulable state, concurrent infection, pregnancy/puerperium, collagen vascular disorder, malignancy, migraine, false-positive VDRL, previous deep vein thrombosis, renal disease, factor V Leiden, or a hematological disorder. There was no anatomical abnormality that would predispose the patient to a cerebral venous thrombosis. The only laboratory abnormality was a moderate anticardiolipin antibody level (25 GPL). The patient was placed on warfarin sodium therapy and is currently without clinical sequela from the venous thrombotic event. Conclusions.—Under certain circumstances, minor trauma can induce cerebral venous thrombosis. A review of the literature indicates that cerebral venous thrombosis in the presence of anticardiolipin antibodies and in the absence of systemic lupus erythematosus is a rare event. Previously, only major traumatic events have been reported to be associated with cerebral venous thromboses. The chronological development of cerebral venous thrombosis after a faulty golf swing strongly indicates that given a background of moderate levels of anticardiolipin antibodies, even minor trauma can induce a venous thrombotic event.

Published
2000
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3. Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage

Author

David G. Piepgras, David R. McIlroy, John A. Wilson, H. Yi, Lis Evered, J. Sheehan, Marcel E. Durieux, Daniel K. Resnick, L. Kirby, M. Abou-Madi, Michael A. Olympio, Dhanesh K. Gupta, Peter Heppner, Thomas A. Moore, Paul S. Myles, S. Wirtz, Richard Leblanc, C. Beven, Robert J. Dempsey, Edward W. Mee, Nichol McBee, P. Davies, V. Roelfsema, Christoph Schul, B. White, Leslie C. Jameson, A. James, R. Popovic, Kirk J. Hogan, Fredric B. Meyer, Klaus Hahnenkamp, Patrick W. Hitchon, L. Clark, M. Geraghty, Qian Shi, R. Struthers, Howard A. Riina, A. Drnda, D. Chartrand, Bradley J. Hindman, S. Salerno, E. Knosp, J. Bramhall, Bruce P. Hermann, A. Ashtari, N. F. Kassell, Steven W. Anderson, Maria Matuszczak, David L. Bogdonoff, B. Schaefer, John C. VanGilder, K. O'Brien, A. McAllister, D. Luu, L. Jensen, Issam A. Awad, P. Chery, S. Wallace, H. Smith, N. Monteirode Oliveira, G. Downey, R. Elbe, A. Wyss, E. Babayan, J. Woletz, H. Gramke, M. Irons, Gavin Fabinyi, O. Odukoya, R. Hendrickson, Vincent C. Traynelis, A. Dashfield, V. Portman, Alessandro Olivi, James J. Evans, A. Prabhu, Peter C. Whitfield, Gary D. Steinberg, S. Rice, H. Machlin, D. Bisnaire, P. Berklayd, G. Kleinpeter, Patricia H. Davis, D. Bain, William F. Chandler, R. Wilson, W. Ng, K. Webb, F. Shutway, D. Manke, W. Pfisterer, K. Smith, M. Mosa, Michael M. Todd, R. Tack, Philip E. Bickler, S. Alatakis, A. Shahen, D. Dehring, David W. Newell, A. Sills, K. Lukitto, Wink S. Fisher, R. Watson, Teresa Bell-Stephens, Donald S. Prough, M. Maleki, D. Nye, M. Graf, S. Nobles, David J. Stone, Hendrik Freise, R. Deam, John Laidlaw, K. Quader, Douglas Campbell, Fred Gentili, S. Hickenbottom, Marlan R. Hansen, W. Jenkins, T. Broderick, Katherine Harris, Gavin W. Britz, M. Langley, Mary Pat McAndrews, Wendy C. Ziai, Behnam Badie, C. Duffy, Deborah A. Rusy, K. Littlewood, T. Anderson, J. Palmisano, H. Stanko, Henry H. Woo, Edward C. Nemergut, C. Bradfield, A. Molnar, John A. Walker, Christina M. Spofford, D. Dulli, A. Kane, J. Birrell, Harry J. M. Lemmens, M. Lotto, Y. Young, J. Biddulph, T. Cunningham, L. Kim, K. Graves, B. Radziszewska, S. Salsbury, Lawrence Litt, S. Black, F. Bardenhagen, M. Angle, L. Connery, Lisa Hannegan, Helen Fletcher, John A. Ulatowski, Steven L. Giannotta, J. Sturm, R. Sawyer, H. Hulbert, A. Morris, James Mitchell, M. von Lewinski, C. Merhaut, L. Salvia, A. Freymuth, James C. Torner, D. Cowie, Bongin Yoo, Y. Kuo, S. Micallef, Kathryn Chaloner, Neil Duggal, J. Ogden, Peter M. C. Wright, K. Pedersen, C. McCleary, P. Mak, Paul H. Ting, S. Shaikh, B. Hodkinson, J. Sneyd, D. Novy, M. Menhusen, N. Quinnine, James H. Fitzpatrick, Timothy G. Short, M. Angliss, R. Burnstein, D. Moskopp, N. Robertson, Mark Buckland, Jeffrey V. Rosenfeld, W. Lilley, T. Phan, D. Greene-Chandos, M. Wichman, David S. Warner, M. Quigley, P. Tanzi, Ferenc E. Gyulai, D. Daly, Satwant K. Samra, B. Frankel, D. Wilhite, L. Lindsey, K. English, M. Lenaerts, Michel T. Torbey, T. Hartman, John E. McGillicuddy, R. Govindaraj, Alex Konstantatos, M. Woodfield, Steven S. Glazier, Steven D. Chang, C. Greiner, F. Steinman, Alex Abou-Chebl, G. Heard, S. Yantha, Michael J. Souter, C. Hoenemann, Nicholas G. Bircher, H. Van Aken, S. Poustie, D. Hill, J. Kish, Carin A. Hagberg, A. Buchmann, B. O'Brien, J. Shafer, J. Krugh, D. Chandrasekara, R. Eliazo, Mary L. Marcellus, Anish Bhardwaj, E. Thomson, H. El-Beheiry, Bermans J. Iskandar, J. Ormrod, D. Milovan, Michael J. Link, Barbara A. Dodson, S. Crump, K. Willmann, H. Madder, William R. Clarke, Max R. Trenerry, Ramez W. Kirollos, James Gebel, Lisa D. Ravdin, D. Sirhan, C. Miller, R. Grauer, Ira J. Rampil, W. Burnett, Marek A. Mirski, D. Chatfield, J. Haartsen, Jing Wang, H. Lohmann, T. Weber, S. Jackson, J. Quaedackers, Michael Beven, N. Scurrah, L. Pobereskin, J. Walkes, Zhiyi Zuo, Rona G. Giffard, J. Ridgley, James H McMahon, P. Bennett, J. Freyhoff, J. Reynolds, R. Chelliah, J. Jane, Basil F. Matta, P. Smythe, I. Gibmeier, A. Mathur, Karen B. Domino, Robert Greif, A. Wray, W. Hamm, C. Hall, Ralph F. Frankowski, H. Brors, Renee Testa, D. Fishback, Laurel E. Moore, Richard A. Jaffe, O. Moise, P. D'Urso, Argye E. Hillis, C. Weasler, Michael Tymianski, E. Tuffiash, Cynthia A. Lien, David M. Colonna, C. Lothaller, S. Bhatia, H. Bone, S. Harding, Diana G. McGregor, Lauren C. Berkow, A. Gelb, Paul A. Leonard, N. Subhas, Emine O. Bayman, William L. Young, A. Rushton, J. Marler, J. Kruger, Donna L. Auer, D. Lindholm, K. Kieburtz, R. Schatzer, D. Leggett, M. Mosier, D. Anderson, Julie B. Weeks, B. Bauer, F. Saleversusky, Mark Wilson, C. Skilbeck, R. Morgan, D. Van Alstine, S. Olson, M. Hemstreet, Y. Painchaud, P. Sutton, A. Blackwell, Christopher M. Loftus, S. Ryan, J. Winn, R. Silbergleit, R. Peters, J. Woelfer, M. Clausen, Daniel H. Kim, James R. Munis, J. Lang, A. Law, N. Badner, Keith H. Berge, D. Ellegala, Kevin H. Siu, Gordon J. Chelune, Rafael J. Tamargo, Rosemary A. Craen, C. Thien, Peter J. Lennarson, S. Wadanamby, R. Peterson, T. Blount, J. Sanders, Amin B. Kassam, Arthur M. Lam, Z. Thayer, N. Lapointe, C. Meade, Robert F. Bedford, Lorri A. Lee, J. Cormack, E. Tuerkkan, L. Carriere, N. Merah, Robert P. From, J. Sorenson, Phillip A. Scott, S. Pai, Neal J. Naff, Andrew Silvers, P. Fogarty-Mack, Jennifer O. Hunt, P. Porter, Guy L. Clifton, Zeyd Ebrahim, F. Rasulo, Pirjo H. Manninen, Derek A. Taggard, Michael J. Harrison, Ian A. Herrick, R. Mattison, Tsutomu Sasaki, P. Deshmukh, L. Forlano, Vladimir Zelman, Carol B. Applebury, John L.D. Atkinson, D. Sage, D. Sinclair, Matthew A. Howard, Elizabeth Richardson, F. Sasse, J. Heidler, Thomas N. Pajewski, J. Mason, P. McNeill, F. Lee, Bruno Giordani, G. Seever, Stephen P. Lownie, M. Wallace, Mark E. Shaffrey, C. Chase, Robert E. Breeze, Monica S. Vavilala, Kenneth Manzel, D. Papworth, Peter J. Kirkpatrick, Jana E. Jones, J. Howell, P. Li, B. Chen, A. Meyer, C. Salem, W. Kutalek, L. Koller, B. Rapf, J. Smith, Mazen A. Maktabi, Howard Yonas, Gregory M. Malham, A. Redmond, C. Moy, G. Henry, Elana Farace, H R Winn, E. Cunningham, Michael P. Murphy, Kevin K. Tremper, C. Chambers, Sesto Cairo, Chuanyao Tong, John Moloney, T. Novick, Z. Sha, Martin S. Angst, S. Laurent, G. Smith, F. Vasarhelyi, R. A. Fry, D. Blair, P. Schmid, Peter A. Rasmussen, Stephen Samples, Peter Szmuk, L. Atkins, J. Smart, T. Han, T. Costello, M. Balki, H. Bybee, C. Salmond, Peter Karzmark, Philip E. Stieg, Harold P. Adams, C. Lind, M. McTaggart, Johnny E. Brian, Pekka Talke, S. Dalrymple, M. Felmlee-Devine, Simon Jones, G. Ghazali, F. Johnson, Patricia H. Petrozza, B. Hindman, A. Shelton, Daniel Tranel, P. Blanton, L. Moss, H. Macgregor, J. Findlay, J. Weeks, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, Gregory M. Davis, William L. Lanier, Christopher R. Turner, H. Fraley, F. Mensink, P. Balestrieri, V. Petty, Michael T. Lawton, L. Meng, Gary G. Ferguson, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, E. Dy, Tord D. Alden, and P. Doyle-Pettypiece

Subjects
Perioperative fever, Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Neuropsychological Tests, Severity of Illness Index, Neurosurgical Procedures, Statistics, Nonparametric, Hypothermia, Induced, Severity of illness, Medicine, Humans, Aged, Retrospective Studies, Neurologic Examination, Intraoperative Care, business.industry, Glasgow Outcome Scale, Incidence, Retrospective cohort study, Perioperative, Middle Aged, Subarachnoid Hemorrhage, outcome, aneurysmal subarachnoid hemorrhage, medicine.disease, Hydrocephalus, Surgery, Clinical trial, Logistic Models, Anesthesia, Female, Neurology (clinical), Intraoperative Period, business
Abstract

OBJECTIVE: We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS: One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial aneurysms after subarachnoid hemorrhage were randomized to intraoperative normothermia (36 degrees C-37 degrees C) or hypothermia (32.5 degrees C-33.5 degrees C). Fever (> or =38.5 degrees C) and other complications (including infections) occurring between admission and discharge (or death) were recorded. Functional and neuropsychologic outcomes were assessed 3 months postoperatively. The primary outcome variable for the trial was dichotomized Glasgow Outcome Scale (good outcome versus all others). RESULTS: Fever was reported in 41% of patients. In 97% of these, fever occurred in the postoperative period. The median time from surgery to first fever was 3 days. All measures of outcome were worse in patients who developed fever, even in those without infections or who were World Federation of Neurological Surgeons grade I. Logistic regression analyses were performed to adjust for differences in preoperative factors (e.g., age, Fisher grade, initial neurological status). This demonstrated that fever continued to be significantly associated with most outcome measures, even when infection was added to the model. An alternative stepwise model selection process including all fever-related measures from the preoperative and intraoperative period (e.g., hydrocephalus, duration of surgery, intraoperative blood loss) resulted in the loss of significance for dichotomized Glasgow Outcome Scale, but significant associations between fever and several other outcome measures remained. After adding postoperative delayed ischemic neurological deficits to the model, only worsened National Institutes of Health Stroke Scale score, Barthel Activities of Daily Living index, and discharge destination (home versus other) remained independently associated with fever. CONCLUSION: These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients, although, because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis (particularly operative events and delayed ischemic neurological deficits), we cannot rule out the possibility that fever is a marker for other events. Only a formal trial of fever treatment or prevention can address this issue.

Published
2009

4. Thrombolytic therapy for acute ischemic stroke

Author

Stephen Samples and John Perl

Subjects
medicine.medical_specialty, Middle Cerebral Artery, Arterial Occlusive Diseases, Tissue plasminogen activator, Brain Ischemia, Brain ischemia, Fibrinolytic Agents, Internal medicine, medicine.artery, medicine, Animals, Humans, Infusions, Intra-Arterial, Radiology, Nuclear Medicine and imaging, Thrombolytic Therapy, Infusions, Intravenous, Stroke, Acute ischemic stroke, business.industry, Heparin, United States Food and Drug Administration, medicine.disease, United States, Europe, Treatment Outcome, Tissue Plasminogen Activator, Middle cerebral artery, Practice Guidelines as Topic, Cardiology, Cardiology and Cardiovascular Medicine, business, Fibrinolytic agent, medicine.drug, Forecasting
Published
2002

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