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1. Prevalence of cerebral white matter lesions in elderly people

Author

Monique M.B. Breteler, Matthijs Oudkerk, F-E de Leeuw, J. van Gijn, L. M. P. Ramos, R. Heijboer, Jellemer Jolles, Albert Hofman, Eric Achten, J.C. de Groot, Neurocognitie, and Epidemiology

Subjects
Gerontology, Male, Pathology, medicine.medical_specialty, Aging, Population, Physiology, Disease, Central nervous system disease, White matter, medicine, Prevalence, Dementia, Elderly people, Humans, Cognitive decline, education, Vascular dementia, Depression (differential diagnoses), Aged, Netherlands, education.field_of_study, Brain Diseases, medicine.diagnostic_test, Cerebral white matter, business.industry, Brain, Magnetic resonance imaging, Periventricular Region, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Hyperintensity, Psychiatry and Mental health, Editorial Commentary, medicine.anatomical_structure, Papers, Surgery, Female, Neurology (clinical), business
Abstract

OBJECTIVE White matter lesions are often seen on MR scans of elderly non-demented and demented people. They are attributed to degenerative changes of small vessels and are implicated in the pathogenesis of cognitive decline and dementia. There is evidence that especially periventricular white matter lesions are related to cognitive decline, whereas subcortical white matter lesions may be related to late onset depression. The frequency distribution of subcortical and periventricular white matter lesions according to age and sex reported.METHODS A total of 1077 subjects aged between 60–90 years were randomly sampled from the general population. All subjects underwent 1.5T MR scanning; white matter lesions were rated separately for the subcortical region and the periventricular region.RESULTS Of all subjects 8% were completely free of subcortical white matter lesions, 20% had no periventricular white matter lesions, and 5% had no white matter lesions in either of these locations. The proportion with white matter lesions increased with age, similarly for men and women. Women tended to have more subcortical white matter lesions than men (total volume 1.45 ml v 1.29 ml; p=0.33), mainly caused by marked differences in the frontal white matter lesion volume (0.89 ml v 0.70 ml; p=0.08). Periventricular white matter lesions were also more frequent among women than men (mean grade 2.5 v 2.3; p=0.07). Also severe degrees of subcortical white matter lesions were more common in women than in men (OR 1.1; 95% confidence interval (95% CI) 0.8–1.5) and periventricular white matter lesions (OR 1.2; 95% CI 0.9–1.7), albeit that none of these findings were statistically significant.CONCLUSIONS The prevalence and the degree of cerebral white matter lesions increased with age. Women tended to have a higher degree of white matter lesions than men. This may underlie the finding of a higher incidence of dementia in women than in men, particularly at later age.

Published
2001

2. Juvenile-onset Alpers syndrome: interpreting MRI findings

Author

C R B Willems, John H. J. Wokke, van den Walter Bergh, Nora A. Visser, B J C van den Bosch, H.J.M. Smeets, Kees P.J. Braun, Frans S. S. Leijten, L. M. P. Ramos, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Amsterdam Neuroscience, and Intensive Care Medicine

Subjects
Pathology, medicine.medical_specialty, Neurology, Epilepsia partialis continua, Status epilepticus, Diagnosis, Differential, Young Adult, Fatal Outcome, Seizures, Diagnosis, medicine, Humans, Family history, Valproic Acid, business.industry, Diffuse Cerebral Sclerosis of Schilder, Electroencephalography, medicine.disease, Magnetic Resonance Imaging, Hyperintensity, Differential, Female, Neurology (clinical), Differential diagnosis, medicine.symptom, business, medicine.drug, Cerebral vasculitis
Abstract

A previously healthy 20-year-old woman was admitted to the department of neurology of our hospital after 2 generalized tonic-clonic seizures in the preceding 2 weeks. Since the first seizure, she had been seeing bright spots. Neurologic examination at admission was normal. EEG showed slowed background activity and continuous epileptic activity in the left occipital lobe. MRI revealed asymmetric but bilateral areas of increased signal intensity in the occipital cortex, most prominent in the left hemisphere (figure, A). During the following weeks, symptoms expanded, as she developed epilepsia partialis continua of her right arm and leg. Repeat brain MRI showed increase and extension of the occipital lesions, now including hyperintensity of the pulvinar region in the left thalamus (figure, B). We considered a diagnosis of juvenile-onset Alpers syndrome, mitochondrial encephalopathy with lactate acidosis and stroke-like episodes, cerebral vasculitis, or Rasmussen encephalitis. Urgent DNA sequencing of all protein encoding exons and at least 40 nucleotides of the flanking introns of the POLG1 gene, the gene encoding the mitochondrial DNA (mtDNA) polymerase γ, confirmed a homozygous c.1399G>A mutation (p.A467T) as the only mutation or variant present in this gene. The family history was negative for disorders possibly related to POLG1 mutations. Despite treatment with several combinations of antiepileptic drugs, avoiding valproic acid, she developed a generalized status epilepticus and was admitted to the ICU. Eight weeks after the initial symptoms, she died of refractory status epilepticus …

Published
2010
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3. MR angiography as a screening tool for intracranial aneurysms: feasibility, test characteristics, and interobserver agreement

Author

L. M. P. Ramos, Patrick M.M. Bossuyt, Erik Buskens, T. D. Witkamp, B. Verbeeten, G. J. Bonsel, M. Limburg, J. van Gijn, A. Gorissen, C. M. Vonk, A. Algra, G. J. F. Rinkel, Kees W. Albrecht, C. A. F. Tulleken, Paut Greebe, Theodora W M Raaymakers, Willem P.Th.M. Mali, F J Hulsmans, P. C. Buys, and Other departments

Subjects
Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Magnetic resonance angiography, Aneurysm, Radiologic sign, Risk Factors, Image Processing, Computer-Assisted, medicine, Humans, Mass Screening, Genetic Predisposition to Disease, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Mass screening, Observer Variation, medicine.diagnostic_test, business.industry, Vascular disease, Intracranial Aneurysm, General Medicine, Cerebral Arteries, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Confidence interval, Angiography, Feasibility Studies, Female, Radiology, business, Magnetic Resonance Angiography
Abstract

OBJECTIVE: MR angiography may be an appropriate tool to screen for unruptured intracranial aneurysms. Feasibility, test characteristics, and interobserver agreement in evaluation of MR angiograms were assessed by members of the MARS (Magnetic resonance Angiography in Relatives of patients with Subarachnoid hemorrhage) Study Group. SUBJECTS AND METHODS: We screened 626 first-degree relatives of a consecutive series of 193 patients with subarachnoid hemorrhage examined at two institutions. We used MR imaging and MR angiography (three-dimensional time-of-flight imaging at both institutions and additional three-dimensional phase-contrast imaging at one institution). Three observers independently assessed the MR angiograms. Conventional angiography was performed in relatives with possible or definite aneurysms on MR angiography and was considered the standard of reference. RESULTS: Thirty-three aneurysms were found in 25 (4%; 95% confidence interval [CI], 3-6%) of 626 relatives. Thirteen (8%) of 169 relatives who refused screening had MR-related reasons; an additional six persons could not be screened because of contraindications for MR imaging (pregnancy, n = 1; claustrophobia, n = 5). The positive predictive value of MR angiography was 100% (95% CI, 79-100%) for "definite" aneurysms and 58% (95% CI, 28-85%) for "possible" aneurysms. Sensitivity of MR angiography was estimated at 83% (95% CI, 65-94%) and specificity at 97% (95% CI, 94-98%). Interobserver agreement in the evaluation of MR angiograms was poor (kappa < .30), probably because different diagnostic strategies used by individual observers resulted in different use of the assessment category "possible aneurysm." CONCLUSION: MR angiography is a feasible screening tool for detection of intracranial aneurysms. Positive predictive value, sensitivity, and specificity are acceptable when at least two neuroradiologists independently assess MR angiograms

Published
1999
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4. Effect of age on cerebral blood flow: measurement with ungated two-dimensional phase-contrast MR angiography in 250 adults

Author

Monique M.B. Breteler, L. M. P. Ramos, Chris J.G. Bakker, E E de Lange, W. P. T. M. Mali, M.J. Krabbe-Hartkamp, and Pieter C. Buijs

Subjects
Adult, Male, Phase contrast microscopy, Hemodynamics, law.invention, Sex Factors, law, medicine.artery, medicine, Basilar artery, Humans, Radiology, Nuclear Medicine and imaging, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Age Factors, Mr angiography, Magnetic resonance imaging, Middle Aged, Cerebral blood flow, Cerebrovascular Circulation, Circulatory system, Angiography, cardiovascular system, Female, Nuclear medicine, business, Magnetic Resonance Angiography
Abstract

To determine the normal values and effects of age and sex on total cerebral blood flow (CBF) as measured with ungated two-dimensional phase-contrast magnetic resonance (MR) angiography.Volume flow rates in the basilar artery and both internal carotid arteries were measured on two-dimensional phase-contrast MR angiograms obtained in 250 subjects (age range, 19-88 years; mean age, 50 years) undergoing MR imaging because of indications other than cerebrovascular disease. Volume flow rates for the three arteries were summed to obtain the total CBF, and the values were analyzed in terms of age and sex.Mean total CBF was 616 mL/min +/- 143. There was a significant yearly decrease with age in total CBF of 4.8 mL/min (P.001). Mean total CBF ranged from 748 mL/min +/- 121 to 474 mL/min +/- 105 in subjects aged 19-29 and 80-89 years, respectively. No sex differences were found. Mean relative contributions of the right and left internal carotid arteries and the basilar artery to total CBF were 41%, 40%, and 19%, respectively, with no substantial change due to age.Ungated two-dimensional phase-contrast MR angiography is a useful, noninvasive technique for assessing total CBF. By using this technique, a significant decrease in total CBF with age was demonstrated.

Published
1998
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5. Radiation-induced brachial plexopathy: MR imaging

Author

M. A. M. Feldberg, Theo D. Witkamp, Antoine M. Engelen, H. Wouter van Es, and L. M. P. Ramos

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Breast Neoplasms, Fibrosis, medicine, Brachial Plexus Neuritis, Humans, Brachial Plexus, Radiology, Nuclear Medicine and imaging, Radiation Injuries, Aged, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Middle Aged, Image Enhancement, medicine.disease, Hodgkin Disease, Magnetic Resonance Imaging, Lymphoma, Radiation therapy, Axilla, medicine.anatomical_structure, Female, Brachial Plexopathy, Radiology, Complication, business, Brachial plexus, Follow-Up Studies
Abstract

Objective. To describe the MR imaging appearance of radiation-induced brachial plexopathy. Design. MR imaging was performed in two patients with the clinical diagnosis of radiation-induced brachial plexopathy and in one with surgically proven radiation fibrosis of the brachial plexus. Patients. Three patients who had had radiation therapy to the axilla and supraclavicular region (two with breast carcinoma and one with Hodgkin’s lymphoma) presented with symptoms in the arm and hand. To exclude metastases or tumor recurrence MR imaging was performed. Results and conclusion. In one patient, fibrosis showing low signal intensity was found, while in two patients high signal intensity fibrosis surrounding the brachial plexus was found on the T2-weighted images. In one case gadolinium enhancement of the fibrosis was seen 21 years after radiation therapy. It is concluded that radiation-induced brachial plexopathy can have different MR imaging appearances. We found that radiation fibrosis can have both low or high signal intensities on T2-weighted images, and that fibrosis can enhance even 21 years after radiation therapy.

Published
1997
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6. Assessment of the preferred plane and sequence in the depiction of mesial temporal sclerosis using magnetic resonance imaging

Author

Linda C. Meiners, A. P. G. Van Gils, A.C. van Huffelen, L. M. P. Ramos, T. D. Witkamp, W. P. T. M. Mali, Gerard H. Jansen, C.W.M. van Veelen, J. Valk, H. J. Wynne, G. A. P. de Kort, and Econometrics and Operations Research

Subjects
Adult, Adolescent, Temporal lobe, Plane (Unicode), SDG 3 - Good Health and Well-being, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Sequence (medicine), Observer Variation, Physics, Likelihood Functions, Sclerosis, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, General Medicine, Patient data, Middle Aged, Magnetic Resonance Imaging, Temporal Lobe, Epilepsy, Temporal Lobe, Coronal plane, Temporal sclerosis, Nuclear medicine, business
Abstract

RATIONALE AND OBJECTIVES. Definition of optimal magnetic resonance (MR) scanning plane and conventional MR sequence for the detection of mesial temporal sclerosis (MTS). METHODS. Coronal and axial T2-weighted images and axial T2-weighted images parallel to the long axis of the hippocampus (APLAH) and coronal inversion recovery (IR) images were obtained in patients with medically intractable temporal lobe epilepsy in their phase 1 preoperative evaluation. Thirty-three consecutive MR scans were reviewed by a panel of three radiologists. Twenty-three patients had MR abnormalities consistent with MTS, and ten scans were normal. To assess the best single scanning technique, another group of three radiologists, who were masked to all patient data, individually assessed the different planes and sequences of the 33 studies presented separately in a random fashion. For each plane and sequence, the likelihood (L) ratio for the correct diagnosis was determined separately. RESULTS. For all planes considered separately, a likelihood ratio of 4.4 was optimal for the coronal T2-weighted images. The likelihood ratio of APLAH T2 was 2.2; of axial T2, 3.9; of coronal IR, indefinite because of 100% specificity. CONCLUSIONS. For the assessment of MTS, coronal T2-weighted images were considered the best single scanning technique.

Published
1997
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7. Fourth meeting of the European Neurological Society 25–29 June 1994 Barcelona, Spain

Author

H. Hattig, C. Delli Pizzi, M. C. Addonizio, Michelle Davis, A. R. Giovagnoli, L. Florensa, M. Roth, J. de Kruijk, Francisco Lacruz, Ph. Dewailly, A. Toygar, C. Avendano, P.P. De Deyn, J. F. Hurtevent, F. Lomeila, T. W. Wong, Gordon T. Plant, M. Bud, H. J. Willison, DH Miller, D. W. Langdon, R. Cioni, J. Servan, A. Kaygisiz, E. Racadot, D. B. Schens, E. Picciola, L. Falip, C. Bouchard, J. Jotova, A. Jorge-Santamaria, P. Misra, A. Dufour, C. P. Panagopoulos, A. Venneri, B. Sredni, B. Angelard, M. Janelidze, M. Carreno, J. Obenberger, J. Pouget, H. W. Moser, R. Kaufmann, J. A. Molina, D. Linden, A. Martin Urda, E. Uvestad, A. Krone, J. P. Cochin, J. Mallecourt, A. Cambon-Thomsen, K. Violleau, P. Osschmann, A. M. Durocher, E. Bussaglia, D. M. Danielle, H. Efendi, C. Van Broeckhoven, K. G. Jordan, W. Rautenberg, C. Iniguez, J. M. Delgado, Graham Watson, M. Lawden, Gareth J. Barker, K. Stiasny, James T. Becker, G. Campanella, E. Peghi, A. Poli, A. Haddad, T. Yamawaki, Giacomo P. Comi, S. Sotgiu, B. Ersmark, A. Pomes, M. Ziegler, P. Ferrante, P. Ruppi, H. KuÇukoglu, R. Bouton, U. K. Rinne, P. Vieregge, M. Dary, P. Giunti, Peter J. Goadsby, S. Jung, E. Secor, A. Steinberg, N. Vila, M. A. Hernandez, M. Cursi, A. Enqelhardt, A. Engelhardt, J. Veitch, F. Di Silverio, F. Arnaud, B. Neundörfer, R. Brucher, Dominique Caparros-Lefebvre, B. Meyer, Marianne Dieterich, M. H. Snidaro, R. Gomez, R. Cerbo, M. Ragno, J. M. Vance, S. Nemni, A. Caliskan, F. Barros, I. Velcheva, D. Ceballos-Baumann, V. Barak, A. Avila, N. Antonova, F. Resche, S. Pappata, L. Varela, S. R. Silveira Santos, A. Cammarota, L. Naccache, Y. Nara, E. Tournier-Lasserves, R. Mobner, T. Chase, A. Ensenyat, J. Ulrich, G. Giegerich, M. Rother, M. Revilla, N. Nitschke, K. Honczarenko, E. Basart Tarrats, J. Blin, B. Jacob, J. Santamaria, S. Knezevic, J. L. Castillo, M. Antem, J. Colomer, O. Busse, Didier Hannequin, S. Carrier, J. B. Ruidavets, C. Rozman, J. Bogoussslavsky, J. Pascual Calvet, E. Monros, J. M. Polo, M. Zucconl, Javier Muruzabal, R. R. Allen, R. Rivolta, K. Haugaard, A. Nespolo, K. Hoang-Xuang, G. Bussone, T. Avramidis, E. Corsini, Christiana Franke, T. Vinogradova, H. Boot, K. Vestergaard, G. H. Jansen, N. Argentino, M. Raltzig, W. Linssen, Mark B. Pepys, P. Roblot, L. Lauritzen, E. Fainardi, D. Morin, T. X. Arbizu Urdiain, J. Wollenhaupt, S. Bostantjopoulou, G. Pavesi, A. D. Forman, Giovanni Fabbrini, D. Jean, J. J. Archelos, M. I. Blanchs, M. Del Gobbo, Anna Carla Turconi, Ch. Derouesné, Elio Scarpini, A. Visbeck, P. Castejon, J. P. Renou, F. Mounier-Vehier, G. Potagas, Ch. Duyckaerts, A. Filla, R. Schneider, G. Ronen, K. Nagata, J. P. Vedel, A. Henneberg, G. van Melle, C. Baratti, H. Knott, M. C. Prevett, A. Bes, B. Metin, Jos V. Reempts, L. Martorell, Mefkure Eraksoy, H. O. Handwerker, D. S. Younger, O. Oktem, D. Frongillo, C. Soriano-Soriano, L. Niehaus, F. Zipp, A. Tartaro, S Newman, R. H. Browne, P. Davous, R. Sanchez, M. Muros, M. E. Kornhuber, A. Lavarone, M. Mohr, M. R. Garcia, S. Russell, H. Kellar-Wood, M. R. Tola, B. Ostermeyer, Ch. Tzekov, K. Sartor, E. B. Ringelstein, P. P. Gazzaniga, Paul Krack, H. Fidaner, H. Rico, T. Dbaiss, F. Alameda, E. Torchiana, L. Rumbach, I. Charques, J. M. Bogaard, C. D. Frith, L. J. Rappelle, R. Brenner, A. Joutel, K. Fuxe, G. HÄcker, M. J. Blaser, J. Valls-SolÇ, G. Ulm, M. Alberdi, A. Bock, F. W. Bertelsmann, U. Wieshmann, J. Visa, J. R. Lupski, D. D'Amico, L. M. P. Ramos, A. A. Vanderbark, R. Horn, M. Warmuth, Dietmar Kühne, Mark S. Palmer, C. Ehrenheim, E. Canga, S. Viola, O. Scarpino, P. Naldi, R. Almeida, A. A. Raymond, J. Gamez, Stephan Arnold, A. DiGiovanni, J. Dalmau, C. C. Chari, H. F. Beer, J. C. Koetsier, J. Iriarte, E. Yunis, J. Casadevall, E. Le Guern, E. Stenager, S. R. Benbadis, J. M. Warter, F. Burklin, I. Theodorou, L. Johannesen, G. A. Graveland, X. Leclerc, I. Vecchio, L. Ozelius, G. Nicoletti, R. K. Gherardi, E. Esperet, M. L. Delodovici, F. Cattin, F. Paiau, Giorgio Sacilotto, C. A. J. Broere, D. Chavdarov, J. P. Willmer, C. H. Hawkes, Th. Naegele, E. Ellie, E. Dartigues, M. J. Guardiola, S. Hesse, Z. Levic, Marco Rovaris, P. Saugeir-Veber, B. A. Yaqub, H. F. Durwen, R. Larumbe, J. Ballabrina, M. Sendtner, J. Röther, M. Horstink, C. Kluglein, M.P. Montesi, H. Apaydin, J. Montoya, E. Waubant, Ch. Verellen-Dunoulin, A. Nicolai, J. Lopez-Delval, R. Lemon, G. Cantinho, E. Granieri, A. Zeviani, Wolfgang H. Oertel, U. Ficola, V. Di Piero, V. Fragola, K. Sabev, M. V. Guitera, I. Turki, F. Bolgert, P. Ingrand, J. M. Gobernado, L. M. E. Grimaldi, S. Baybas, B. Eymard, Y. Rolland, Y. Robitaille, Ta. Pampols, P. J. Koehler, A. Carroacedo, J. Vilchez, S. Di Vittorio, I. R. Rise, T. Nagy, M. Kuffner, E. Palazzini, A. Ott, J. Pruim, T. X. Arbizu, E. Manetti, C. Cervera, S. Felber, G. Gursoy, J. Scholz, G. A. Buscaino, M. S. Chen, A. Pascual, J. Hazan, J. U. Gajda, J. G. Cea, G. Bottini, G. Damalik, F. Le Doze, G. Bonaldi, J. M. Hew, C. Messina, A. M. Kennedy, J. M. Carney, N. M. F. Murray, M. Parent, M. Koepp, V. Dimova, D. De Leo, K. Jellinger, G. Salemi, S. Mientus, M. L. Hansen, F. Mazzucchelli, J. Vieth, M. Mauri, E. Bartels, L. Johannsen, C. Humphreys, J. Emile, D. N. Landon, E. Kansu, R. Sanchez-Pernaute, Rsj Frackowiak, M. Gonzalez Torres, L. Oller, C. Machedo, J. Kother, M. Billiard, H. Durak, T. Schindler, A. Frank, A. Uncini, A. Sbriccoli, C. Farinas, D. W. Paty, N. Fast, A. T. Zangaladze, A. Kerkhofs, J. M. Pino Garcia, I. De la Fuente, B. Marini, L. Gomez, I. Rubio, Alessandra Bardoni, C. Brodie, P. Acin, U. Sliwka, S. A. Hawkins, S. Tardieu, F. Vitullo, J. M. Pereira Monteino, R. Gagliardi, T. Jezewski, A. Cano, T. Lempert, F. Abad Alegria, G. Rotondo, D. Ince, C. Martinez Parra, Y. Huang, H. Luders, Y. Steinvil, F. G. A. Van Der Meche, R. Bianchi, A. Sanchez, T. Sevilla, J. M. Ketelslegers, A. Domzal-Stryga, M. Pandolfo, M. O. Josse, K. W. Neff, I. Blanco, G. W. Bruyn, O. W. Witte, J. L. Thibault, G. Andersen, J. Pariset, A. Marcone, R. J. M. Lane, A. Hofman, M. Verin, T. Matilla, P. Bedoucha, J. Roche, M. Lai, M. Collard, A. Ugarte, F. Gallecho, D. Silbersweig, C. Kennard, J. P. Azulay, T. W. Ho, P. L. I. Dellemijn, R. Girardello, F. Baas, B. Voss, F. Rozenberg, E. M. Brocker, V. Stanev, A. A. J. Soeterboek, A. Marra, A. Rey, E. Ertem, M. Sawradewicz-Rybak, J. De Keyser, P. Cavallari, F. Proust, Y. Chevalier, H. C. Hansen, D. Leys, C. A. Davie, K. Hoang-Xuan, C. Bairati, H. van Crevel, Thomas T. Warner, B. Bompais, A. Dobbeleir, T Campbell, C. Macko, C. J. M. Klijn, M. Dussallant, T. P. Berlit, W. Rozenbaum, M. J. van den Bent, W. A. Rocca, M. Muller, H. Hundemer, U. Zifko, M. Campera, F. Drislane, D. Ranoux, T. M. Kloss, Anil Kumar, I. Ruolt, C. Bargnani, B. Marescau, N. A. Losseff, S. Notermans, B. Kint, E. T. Burke, C. Aykut, J. Matias Guiu, P. Maquet, T. Drogendijk, M. Leone, K. von Ammon, M. Pepeliarska, C. Prados, L. DiGiamberardino, T. Logtenberg, G. Lenoir, I. Castaldo, Damhaut, M. Radionova, G. Sirabian, R. Navon, Giovanni Antonini, K. Al Moutaery, E. Chamas, R. Schönhuber, M. Giannini, B. Debilly, I. Labatut, H. Henon, J. A. Egido, M. Baudrimont, J. N. Lorenzo, J. E. C. Bromberg, R. Antonacci, J. J. Vilchez, T. Moulin, B. Rautenstrauss, Giovanni Meola, J. Noth, S Mammi, P. Laforet, F. Lopez, C. Gehring, S. Bort, G. Rancurel, D. Decamps, S. Kostadinova, Y. Shapira, B. Neundoerfer, D. Chavrot, M. Solimena, J. P. Salier, W. Deberdt, R. Hoff-Jörgensen, A. Messina, S. Meairs, G. Rosoklija, E. Nelis, I. Bertran, C. Ertekin, J. Lohmeyer, Mitermayer Galvao dos Reis, L. Calo, E. Maccagnano, A. P. Hays, J. Verlooy, M. G. Forno, T. Blanco, L. Bail, Gabriella Silvestri, J. Montero, F. Bertrand, R. T. Ghnassia, C. Besses, T. Sereghy, F. Shalit, G. Bogliun, S. Braghi, St. Baykouchev, C. Franke, A. Lasa, L. C. Archard, J. Kriebel, S. Shaunak, M. Nocito, Alexander Tsiskaridze, E. Manfredini, T. Seigal, David G. Gadian, M. Barlas, J. D. Degos, C. Seeber, J. Caemert, J. L. Mas, R. B. Pepinsky, M. G. D'Angelo, N. Baumann, S. Yorifuji, H. P. Endtz, M. A. Cassatella, R. A. C. Hughes, V. Golzi, A. Bittencourt, A. Ferreira, M. Sanson, C. Alper, M. Vermeulen, M. A. A. van Walderveen, E. Alexiou, C. H. Lucas, M. Fiorelli, Y. N. Debbink, R. Gil, S. Congia, T. Banerjee, J. M. Bouchard, A. N. Pinto, A. Ceballos-Baumann, G. Grollier, P. I. M. Schmitz, M. D. Catata, N. Lahat, N. S. Rao, P. Papathanasopoulos, J. Valls-Solé, D. Claus, G. Schroter, A. Castro, C. Videbaek, R. Martinez Dreke, A. D. Platts, M. Hermesl, A. C. PeÇanha-Martins, M. Cardoso Silva, P. Masnou, M. J. A. Tanner, Ch. Confavreux, B. Mishu, H. Rasmussen, L. Valenciano, Carlo Pozzilli, S. W. Li, V. Salzman, Y. Vashtang, Massimo Franceschi, M. Severo, G. Deuschl, S. Setien, G. Mariani, A. Protti, J. Castillo, M. J. B. Taphoorn, M. Frontali, I. Milonas, D. Decoq, J. A. Navarro, S. Castellvi-Pel, C. Ertikin, M. Urtasun, Y. Lajat, B. E. Kendall, E. Verdu, B. Gueguen, E. Boisen, R. Couderc, A Danek, JM Stevens, F. Nicoli, L. 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Brizioli, J. Calleja, L. Publio, M. Desi, R. Soffietti, P. Cortinovis-Tourniaire, E. F. Gonano, G. Cavaletti, S. Uselli, K. Westerlind, H. Betuel, C. O. Dhiver, H. Guggenheim, M. Hamon, R. Fazio, P. Lehikoinen, A. Esser, B. Sadzot, G. Fink, Angelo Antonini, D. Bendahan, V. Di Carlo, G. Galardi, A. F. Boller, M. Aksenova, Del Fiore, V. de la Sayette, H. Chabriat, A. Nicoletti, A. Dilouya, M. L. Harpin, E. Rouillet, J. Stam, A. Wolters, M. R. Delgado, Eduardo Tolosa, G. Said, A. J. Lees, L. Rinaldi, A. Schulze-Bonhage, MA Ron, C. Lefebvre, E. W. Radü, R. Alvarez, M. L. Bots, P. Reganati, S. Palazzi, A. Poggi, N. J. Scolding, V. Sazdovitch, T. Moreau, E. Maes, M. A. Estelies, P. Petkova, Jose-Felix Marti-Masso, G De La Meilleure, N. Mullatti, M. Rodegher, N. C. Notermans, T. A. T. Warner, S. Aktan, J. P. Louboutin, L. Volpe, C. Scheidt, W. Aust, C. M. Wiles, U. Schneider, S. K. Braekken, W. R. Willems, K. Usuku, Peter M. Rothwell, C. Talamon, M. L. Sacchetti, A. Codina, M. H. Marion, A. Santoro, J. Roda, A. Bordoni, D. J. Taylor, S. Ertas, H. H. Emmen, J. Vichez, V. BesanÇon, R. E. Passingham, M. L. Malosio, A. Vérier, M. Bamberg, A. W. Hansen, E. Mostacero, G. Gaudriault, Marie Vidailhet, B. Birebent, K. Strijckmans, F. Giannini, T. Kammer, I. Araujo, J. Nowicki, E. Nikolov, A. Hutzelmann, R. Gherardi, J. Verroust, L. Austoni, A. Scheller, A. Vazquez, S. Matheron, H. Holthausen, J. M. Gerard, M. Bataillard, S. Dethy, V. H. Patterson, V. Ivanez, N. P. Hirsch, F. Ozer, M. Sutter, C. Jacomet, M. Mora, Bruno Colombo, A. Sarropoulos, T. H. Papapetropoulos, M. Schwarz, D. S. Dinner, N. Acarin, B. Iandolo, J. O. Riis, P. R. J. Barnes, F. Taroni, J. Kazenwadel, L. Torre, A. Lugaresi, I. L. Henriques, S. Pauli, S. Alfonso, Pedro Quesada, A. S. T. Planting, J. M. Castilla, Thomas Gasser, M. Van der Linden, A. Alfaro, E. Nobile-Orazio, G. Popova, W. Vaalburg, F. G. A. van der Mech, L. Williams, F. Medina, J. P. Vernant, J. Yaouanq, B. Storch-Hagenlocher, A. Potemkowski, R. Riva, M. H. Mahagne, M. Ozturk, Ve. Drory, N. Konic, C. Jungreis, A. Pou Serradell, J. L. Gauvrit, G. J. Chelune, S. Hermandez, T. Dingus, L. Hewer, Ch. Koch, M. N. Metz-Lutz, G. Parlato, M. Sinaki, Charles Pierrot-Deseilligny, H. C. Diener, J. Broeckx, J. Weill-Fulazza, M. L. Villar, M. Rizzo, O. Ganslandt, C. Duran, N. A. Fletcher, G. Di Giovacchino, Susan T. Iannaccone, C. Kolig, N. Fabre, H. A. Crockard, Rita Bella, M. Tazir, E. Papagiannuli, K. Overgaard, Emma Ciafaloni, I. Lorenzetti, F. Viader, P. A. H. Millac, I. Montiel, L. H. Visser, M. Palomar, P. L. Murgia, H. Pedersen, Rafael Blesa, S. Seddigh, W. O. Renier, I. Lemahieu, H. M. L. Jansen, L. Rosin, J. Galofre, K. Mattos, M. Pondal, G. M. Hadjigeorgiou, D. Francis, L. Cantin, D. Stegeman, M. Rango, A. B. M. F. Karim, S. Schraff, B. Castellotti, I. Iriarte, E. Laborde, T. J. Tjan, R. Mutani, D. Toni, B. Bergaasco, J. G. Young, C. Klotzsch, A. Zincone, X. Ducrocq, M. Uchuya, O. J. Kolar, A. Quattrone, T. Bauermann, Nereo Bresolin, J. Vallée, B. C. Jacobs, A. Campos, Werner Poewe, J. A. Villanueva, A. W. Kornhuber, A. Malafosse, E. Diez-Tejedor, G. Jungreia, M. J. A. Puchner, A. Komiyama, O. Saribas, V. Volpini, L. Geremia, S. Bressi, A. Nibbio, Timothy E. Bates, T. z. Tzonev, E. Ideman, G. A. Damlacik, G. Martino, G. Crepaldi, T. Martino, Kjell Någren, E. Idiman, D. Samuel, J. M. Perez Trullen, Y. van der Graaf, J. O. Thorell, M. J. M. Dupuis, E. Sieber, R. D'Alessandro, C. Cazzaniga, J. Faiss, A. Tanguy, A. Schick, I. Hoksergen, A. Cardozo, R. Shakarishvili, G. K. Wennlng, J. L. Marti-Vilalta, J. Weissenbach, I. L. Simone, Amalia C. Bruni, Darius J. Adams, C. Weiller, A. Pietrangeli, F. Croria, C. Vigo-Pelfrey, Patricia Limousin, A. Ducros, G. Conti, O. Lindvall, E. Richter, M. Zuffi, A. Nappo, T. Riise, J. Wijdenes, M. J. Fernandez, J. Rosell, P. Vermersh, S. Servidei, M. S. C. Verdugo, F. Gouttiere, W. Solbach, M. Malbezin, I. S. Watanabe, A. Tumac, W. I. McDonald, D. A. Butterfield, P. P. Costa, F. deRino, F. Bamonti, J. M. Cesar, C. H. Lahoz, I. Mosely, M. Starck, M. H. Lemaitre, K. M. Stephan, S. Tex, R. Bokonjic, I. Mollee, L. Pastena, M. Gutierrez, F. Boiler, M. C. Martinez-Para, M. Velicogna, O. Obuz, A. Grinspan, M. Guarino, L. M. Cartier, E. Ruiz, D. Gambi, S. Messina, M. Villa, Michael G. Hanna, J. Valk, Leone Pascual, M. Clanet, Z. Argov, B. Ryniewicz, E. Magni, B. Berlanga, K. S. Wong, C. Gellera, C. Prevost, F. Gonzalez-Huix, R. Petraroli, J. E. G. Benedikz, I. Kojder, C. Bommelaer, L. Perusse, M. R. Bangioanni, Guy M. McKhann, A. Molina, C. Fresquet, E. Sindern, Florence Pasquier, M. J. Rosas, M. Altieri, O. Simoncini, M. Koutroumanidis, C. A. F. Tulleken, M. Dary-Auriol, S. Oueslati, H. Kruyer, I. Nishisho, C. R. Horning, A. Vital, G. V. Czettritz, J. Ph. Neau, B. Mihout, A. Ameri, M. Francis, S. Quasthoff, D. Taussig, S. Blunt, P. Valentin, C. Y. Gao, O. Heinzlef, H. d'Allens, C. Coudero, M. Erfas, G. Borghero, P. J. Modrego Pardo, M. C. Patrosso, N. L. Gershfeld, P. A. J. M. Boon, O. Sabouraud, M. Lara, J. Svennevig, G. L. Lenzi, A. Barrio, H. Villaroya, JosÇ M. Manubens, O. Boespflug-Tanguy, M. Carreras, D. A. Costiga, J. P. Breux, S. Lynn, C. Oliveras Ley, A. G. Herbaut, J. Nos, C. Tornali, Y. A. Hekster, J. L. Chopard, J. M. Manubens, P. Chemouilli, A. Jovicic, F. Dworzak, S. Smirne, S. E. Soudain, B. Gallano, D. Lubach, G. Masullo, G. Izquierdo, A. Pascual Leone Pascual, A. Sessa, V. Freitas, O. Crambes, L. Ouss, G. W. Van Dijk, P. Marchettini, P. Confalonieri, M. Donaghy, A. Munnich, M. Corbo, and M. E. L. van der Burg

Subjects
Neurology, business.industry, Media studies, Library science, Medicine, Neurology (clinical), business
Published
1994
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8. Impact of microembolism and hemodynamic changes in the brain during carotid endarterectomy

Author

C. Jansen, Frans L. Moll, Rob G.A. Ackerstaff, J. P. M. Van Heesewijk, J. van Gijn, and L. M. P. Ramos

Subjects
Adult, Male, Duplex ultrasonography, medicine.medical_specialty, Ultrasonography, Doppler, Transcranial, medicine.medical_treatment, Hemodynamics, Carotid endarterectomy, Dissection (medical), Electroencephalography, Brain Ischemia, Central nervous system disease, Postoperative Complications, Preoperative Care, medicine, Humans, Carotid Stenosis, cardiovascular diseases, Intraoperative Complications, Aged, Advanced and Specialized Nursing, Endarterectomy, Carotid, medicine.diagnostic_test, business.industry, Vascular disease, Brain, Magnetic resonance imaging, Intracranial Embolism and Thrombosis, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Cerebrovascular Circulation, cardiovascular system, Female, Neurology (clinical), Radiology, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business
Abstract

Monitoring of carotid endarterectomy with electroencephalography and transcranial Doppler ultrasonography provides instantaneous information about hemodynamic changes and embolic signals. However, a relation between these findings and intraoperative infarcts has not yet been demonstrated. In this study we compared preoperative and post-operative computed tomographic scans (58 patients) or magnetic resonance imaging (40 patients) of the brain, assessed by two independent observers, to detect intraoperative infarcts, and we related any such new lesions to the findings of intraoperative monitoring. In the computed tomography series one intraoperative infarct occurred, with corresponding clinical deficits. In the magnetic resonance group four patients developed new lesions that occurred intraoperatively, all of which were clinically silent. There was a significant relation between the number of embolic signals during the surgical dissection of the carotid artery and the occurrence of intraoperative infarcts (P < .005). Three of the four infarcts were of the lacunar type; the fourth patient had a border-zone infarct, associated not only with many embolic signals but also with low flow during cross-clamping. There were no demonstrable ultrasound side effects on brain tissue. Embolic signals detected by transcranial Doppler monitoring in the dissection phase of carotid endarterectomy show a significant relation to new ischemic lesions and therefore are potentially harmful. The phenomenon should alert the vascular surgeon.

Published
1994
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9. Retinoblastoma: CT and MRI

Author

M. J. Hendriks, L. M. P. Ramos, K. E. W. P. Tan, and R. G. H. Beets-Tan

Subjects
Male, medicine.medical_specialty, Pathology, Neurology, Eye disease, Sensitivity and Specificity, Diagnosis, Differential, Retinal Diseases, medicine, Humans, Radiology, Nuclear Medicine and imaging, Coats' disease, Child, Neuroradiology, business.industry, Retinoblastoma, Eye Neoplasms, Contrast resolution, Infant, medicine.disease, Magnetic Resonance Imaging, eye diseases, Child, Preschool, Female, Neurology (clinical), Radiology, Neurosurgery, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Calcification
Abstract

To evaluate the effectiveness of CT and MRI at 0.5 T in the diagnosis and staging of retinoblastoma, we studied 11 patients in whom retinoblastoma was clinically suspected. Nine of the eleven had surgically proven retinoblastoma; in the other two a diagnosis of Coats' disease was made. MRI was not as specific as CT for diagnosing retinoblastoma, due to its lack of sensitivity in detecting calcification; it did, however, have superior contrast resolution. On MRI, Coats' disease was reliably diagnosed and easily differentiated from retinoblastoma. Moreover, the greater ability of MRI to differentiate subretinal fluid from tumour also confers high accuracy in measuring tumour size. CT is still the study of choice in the diagnosis of retinoblastoma, but when MRI is available, it should be performed for better differentiation from lesions such as Coats' disease.

Published
1994
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10. Teaching NeuroImages: MRI changes of ictal cortical edema and tumor progression in a patient with astrocytoma

Author

Frans S. S. Leijten, W.H. Bouvy, L. M. P. Ramos, and John H. J. Wokke

Subjects
Male, medicine.medical_specialty, Brain Edema, Nystagmus, Status epilepticus, Electroencephalography, Astrocytoma, Seizures, Edema, medicine, Humans, Ictal, medicine.diagnostic_test, business.industry, Brain Neoplasms, Brain, Middle Aged, medicine.disease, Magnetic Resonance Imaging, nervous system diseases, nervous system, Tumor progression, Anesthesia, Neurology (clinical), Radiology, medicine.symptom, business, Anaplastic astrocytoma
Abstract

A 64-year-old man presented with mixed dysphasia after seizures from a left parietal anaplastic astrocytoma. The duration of symptoms (3 days) and nystagmus on rightward gaze prompted EEG, which revealed left posterior nonconvulsive status epilepticus. MRI showed cortical swelling and ictal cytotoxic edema1 (figure 1). With antiepileptic treatment and steroids, dysphasia improved. Follow-up imaging showed …

Published
2011

11. Hypertension in the elderly is associated with white matter lesions and cognitive decline

Author

M. M. A. Derix, J.C. van Latum, G. G. Geyskes, L. M. P. Ramos, B. M. Peeck, J. van Gijn, and J. C. van Swieten

Subjects
Male, medicine.medical_specialty, Wechsler Memory Scale, Pathology, Time Factors, Neuropsychological Tests, White matter, Internal medicine, medicine, Humans, Cognitive decline, Aged, medicine.diagnostic_test, Cerebral infarction, Cognitive disorder, Brain, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Hyperintensity, medicine.anatomical_structure, Neurology, Case-Control Studies, Hypertension, Cardiology, Brain Damage, Chronic, Female, Neurology (clinical), Cognition Disorders, Psychology, Demyelinating Diseases, Stroop effect
Abstract

Forty-two elderly patients (mean age, 66.2 +/- 5.1 yr) with hypertension, treated for an average of 17.3 years (standard deviation, 10.3), and 42 control subjects (mean age, 66.5 +/- 4.8 yr), matched for age, sex, and level of education, were studied with regard to the detection of lesions in the cerebral white matter with magnetic resonance imaging (MRI), particularly with axial T2-weighted images. The assessment of the MRI scans was blinded. Ten hypertensive patients showed confluent lesions in the white matter, versus only 1 control subject (Chi-square test, p = 0.01). The presence of diffuse lesions of the white matter was related to age but not to the known duration of hypertension, nor to the presence of any other cardiovascular risk factors. Cognitive function was measured in 34 hypertensive patients and in 18 control subjects. Results of the Mini-Mental State Examination, the Stroop color-word test, Trailmaking test, and the visual subtest of the Wechsler Memory Scale were worse in patients with confluent lesions of the white matter; there was no difference in mental functioning between hypertensive patients and control subjects with normal white matter or with only small focal lesions. Our findings suggest that long-standing hypertension in some patients may cause not only strokes but also chronic end-organ damage of the brain in the form of demyelination of the white matter, with cognitive decline.

Published
1991
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12. Early posttraumatic subarachnoid hemorrhage due to dissecting aneurysms in three children

Author

C. A. F. Tulleken, M.C.J. Kneyber, Kees P.J. Braun, L. M. P. Ramos, G. J. E. Rinkel, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Subjects
Male, Time Factors, Brain Edema, Brain Edema/etiology, Dissecting/complications, Aneurysm, Dissecting/complications, Craniocerebral Trauma, Child, Tomography, Craniocerebral Trauma/complications, Vertebral Artery Dissection, medicine.diagnostic_test, Ruptured saccular aneurysm, Head injury, Age Factors, Brain, Subarachnoid Hemorrhage/diagnosis, Magnetic Resonance Imaging, X-Ray Computed, Dissecting Aneurysms, Child, Preschool, Acute Disease, cardiovascular system, Female, medicine.medical_specialty, Subarachnoid hemorrhage, Brain/blood supply, Head trauma, Cerebral Arteries/injuries, medicine, Humans, cardiovascular diseases, Preschool, Cistern, business.industry, Magnetic resonance imaging, Intracranial Aneurysm, Bleed, Cerebral Arteries, Subarachnoid Hemorrhage, Vertebral Artery Dissection/complications, medicine.disease, Aneurysm, Surgery, nervous system diseases, Aortic Dissection, Intracranial Aneurysm/complications, Early Diagnosis, Neurology (clinical), business, Tomography, X-Ray Computed
Abstract

Subarachnoid hemorrhage (SAH) due to a ruptured saccular aneurysm is uncommon in children. Pediatric traumatic aneurysms have been reported relatively frequently, tending to bleed after an interval of weeks after head injury. The authors describe three children with acute SAH after head injury caused by intracranial dissecting aneurysms. When head trauma in children is complicated by SAH in basal cisterns, dissecting aneurysms should be considered and treated, because rebleeding may occur.

Published
2005

13. Björk-Shiley convexoconcave valves: susceptibility artifacts at brain MR imaging and mechanical valve fractures

Author

Maarten J. van Gorp, Yolanda van der Graaf, Chris J.G. Bakker, L. M. P. Ramos, Willem P.Th.M. Mali, Bas A.J.M. de Mol, Theo D. Witkamp, Amsterdam Cardiovascular Sciences, and Cardiothoracic Surgery

Subjects
Adult, Male, medicine.medical_specialty, Surface Properties, medicine.medical_treatment, Prosthesis Design, Prosthesis, Risk Assessment, Mechanical valve, medicine, Humans, Radiology, Nuclear Medicine and imaging, Heart valve, Prosthetic heart, Aged, Artifact (error), medicine.diagnostic_test, business.industry, Brain, Magnetic resonance imaging, Middle Aged, equipment and supplies, Foreign Bodies, Mr imaging, Magnetic Resonance Imaging, Surgery, Prosthesis Failure, Equipment Failure Analysis, medicine.anatomical_structure, Intracranial Embolism, Heart Valve Prosthesis, Microscopy, Electron, Scanning, Female, business, Nuclear medicine, Artifacts, Black spot
Abstract

PURPOSE: To assess the relationship between heart valve history and susceptibility artifacts at magnetic resonance (MR) imaging of the brain in patients with Bjork-Shiley convexoconcave (BSCC) valves. MATERIALS AND METHODS: MR images of the brain were obtained in 58 patients with prosthetic heart valves: 20 patients had BSCC valve replacements, and 38 had other types of heart valves. Two experienced neuroradiologists determined the presence or absence of susceptibility artifacts in a consensus reading. Artifacts were defined as characteristic black spots that were visible on T2*-weighted gradient-echo MR images. The statuses of the 20 explanted BSCC valves-specifically, whether they were intact or had an outlet strut fracture (OSF) or a single-leg fracture (SLF)-had been determined earlier. Number of artifacts seen at brain MR imaging was correlated with explanted valve status, and differences were analyzed with nonparametric statistical tests. RESULTS: Significantly more patients with BSCC valves (17 [85%] of 20 patients) than patients with other types of prosthetic valves (18 [47%] of 38 patients) had susceptibility artifacts at MR imaging (P = .005). BSCC valve OSFs were associated with a significantly higher number of artifacts than were intact BSCC valves (P = .01). No significant relationship between SLF and number of artifacts was observed. CONCLUSION: Susceptibility artifacts at brain MR imaging are not restricted to patients with BSCC valves. These artifacts can be seen on images obtained in patients with various other types of fractured and intact prosthetic heart valves. (C) RSNA, 2004

Published
2004

14. Visually induced central pain and arm withdrawal after right parietal lobe infarction

Author

T. U. Hoogenraad, L. M. P. Ramos, and V. Van Gijn

Subjects
Male, medicine.medical_specialty, genetic structures, Movement, Pain, Posterior parietal cortex, Infarction, Brain mapping, Central nervous system disease, Parietal Lobe, Internal medicine, Cortex (anatomy), medicine, Humans, Burning Pain, Brain Mapping, Cerebral infarction, Parietal lobe, Cerebral Infarction, Anatomy, Middle Aged, medicine.disease, eye diseases, Psychiatry and Mental health, medicine.anatomical_structure, Arm, Cardiology, Surgery, Neurology (clinical), Psychology, Photic Stimulation, Research Article
Abstract

A 46 year old man with ischaemic infarction of the right parietal cortex had left hemianaesthesia when his eyes were closed. With eyes open, visual stimuli induced withdrawal of the arm and a burning pain in the numb side of the body. Visually induced central pain is a new clinical finding and may be related to damage of cells with anticipatory inhibitory function in the parietal association cortex.

Published
1994
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15. Current Concepts of Surgical Therapy of Intradural and Intramedullary Tumours

Author

C. A. F. Tulleken, W. P. Vandertop, and L. M. P. Ramos

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Population, medicine.disease, Spinal cord, Spinal tumours, law.invention, Surgery, Intraspinal Neoplasm, Intramedullary rod, Surgical therapy, medicine.anatomical_structure, Dermoid cyst, law, medicine, Spinal canal, business, education
Abstract

Neoplasms of the spinal canal may be classified on the basis of their location into epidural, intradural-extramedullary and intramedullary tumours (Table 9.1). Whereas the majority of epidural neoplasms are metastatic in nature, the intradural tumours are often primary tumours. In neurosurgical practice, intraspinal neoplasms account for approximately 15% of all primary tumours of the central nervous system and its sheath elements (Russell and Rubinstein 1989). The relative frequency of epidural, intradural-extramedullary and intramedullary tumours is not exactly known. Based on available epidemiological data, metastatic spinal tumours are three to four times more common than primary spinal tumours (Byrne and Baxman 1990). The average annual incidence of primary intraspinal neoplasms is reported to be 1.3 per 100,000 population, although figures ranging from 0.8 to 2.5 are quoted (Fogelholm et al. 1984). Metastatic disease to the spine is discussed in detail elsewhere in this book.

Published
1998
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16. Subarachnoid hemorrhage: Aneurysm detection and preoperative evaluation with CT angiography

Author

J. W. Berkelbach van der Sprenkel, Theo D. Witkamp, Gabriel J.E. Rinkel, Birgitta K. Velthuis, L. M. P. Ramos, William P. Vandertop, M. S. van Leeuwen, Neurosurgery, CCA - Cancer biology and immunology, CCA - Imaging and biomarkers, CCA - Cancer Treatment and quality of life, and Other departments

Subjects
Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Sensitivity and Specificity, Central nervous system disease, Aneurysm, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Aged, Observer Variation, medicine.diagnostic_test, business.industry, Vascular disease, Angiography, Digital Subtraction, Intracranial Aneurysm, Digital subtraction angiography, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Cerebral Angiography, medicine.anatomical_structure, Maximum intensity projection, Angiography, cardiovascular system, Female, Radiology, business, Tomography, X-Ray Computed, Artery
Abstract

PURPOSE: To evaluate if computed tomographic (CT) angiography can replace digital subtraction angiography (DSA) for aneurysm detection and as preoperative work-up in patients with subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: Prospectively, 100 patients with SAH underwent CT angiography; 80 also underwent DSA. Two observers independently evaluated CT angiographic source images and maximum intensity projection slabs. Neurosurgeons compared CT angiograms and DSA images for presurgical evaluation. RESULTS: On CT angiograms, the observers detected 73 and 70 of 75 symptomatic aneurysms; 96% of the detected aneurysms were classified as definitely present. Of 16 incidental aneurysms, 12 and 10 were detected by the observers. With adequate CT angiographic quality, parent artery side of anterior communicating aneurysms was correctly predicted in 100% (95% confidence interval [CI]: 87%, 100%). Neurosurgeons assessed CT angiography as equal or superior to DSA in 83% (95% CI: 73%, 90%) of 87 aneurysms, and in 74% (95% CI: 63%, 82%) operation might have been based on CT angiographic findings alone. CONCLUSION: CT angiography depicted 90% of all aneurysms, and 90% were classified as definitely present. CT angiography must be of high quality with adequate depiction of the aneurysm and the parent artery for surgery to be performed on the basis of CT angiographic findings alone.

Published
1998
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17. CT angiography: source images and postprocessing techniques in the detection of cerebral aneurysms

Author

B. K. Velthuis, L. M. P. Ramos, T. D. Witkamp, S. Boomstra, M. S. van Leeuwen, and Gabriel J.E. Rinkel

Subjects
Male, medicine.medical_specialty, Image quality, Sensitivity and Specificity, Aneurysm, Daily practice, medicine, Image Processing, Computer-Assisted, Source image, Humans, Radiology, Nuclear Medicine and imaging, Retrospective Studies, Observer Variation, medicine.diagnostic_test, business.industry, Angiography, Digital Subtraction, Intracranial Aneurysm, General Medicine, Digital subtraction angiography, Middle Aged, medicine.disease, Cerebral Angiography, Pooled analysis, Maximum intensity projection, Angiography, Female, Radiology, business, Tomography, X-Ray Computed
Abstract

OBJECTIVE. The purpose of this study was to evaluate CT angiography source images and to assess various postprocessing techniques for cerebral aneurysm detection in daily practice. MATERIALS AND METHODS. We retrospectively studied 17 patients who underwent digital subtraction angiography and CT angiography for possible cerebral aneurysms. Four observers assessed CT angiography data for aneurysms, first after viewing source images in cine mode and again after consecutively adding postprocessing techniques in the following order: maximum intensity projection (MIP) of a 2-cm slab without bone editing (slab-MIP), taking 3 min of operator time; MIP with bone editing (edited-MIP), taking 20 min; shaded-surface display (SSD) without bone editing (3 min); and SSD with bone editing (20 min). In addition, the observers stated which postprocessing method they preferred. RESULTS. In nine patients, we found 13 aneurysms, 10 of which were larger than 5 mm in size. Sensitivity for detection of aneurysms on CT angiography was 92% for three observers and 77% for one observer. Specificity was 100% for two observers and 78% for two observers. Using four observers in a pooled analysis, the maximum of positive readings was 52. CT angiography was positive in 46 of these 52 instances: 41 positive readings after source image viewing, five additional positive readings after adding MIP, and no additional positive readings after adding SSD. Overall, MIP was judged superior to SSD and slab-MIP was judged to be better than edited-MIP. CONCLUSION. In this study interactive source image viewing detected most cerebral aneurysms. Additional slab-MIP is an efficient postprocessing technique for display much like that of angiography, for verification of aneurysms found, and for detection of additional aneurysms. These conclusions need to be verified in a larger study group.

Published
1997

18. Magnetic resonance imaging of the brachial plexus in patients with multifocal motor neuropathy

Author

L. H. van den Berg, Theo D. Witkamp, H. Franssen, M. A. M. Feldberg, Nicolette C. Notermans, J.H.J. Wokke, L. M. P. Ramos, and H. W. Van Es

Subjects
Adult, Male, medicine.medical_specialty, Pathology, Polyradiculoneuropathy, Mismatch negativity, Gadolinium, behavioral disciplines and activities, Central nervous system disease, Diagnosis, Differential, medicine, Humans, Brachial Plexus, Motor Neuron Disease, medicine.diagnostic_test, business.industry, Immunoglobulins, Intravenous, Magnetic resonance imaging, Middle Aged, medicine.disease, Image Enhancement, Magnetic Resonance Imaging, Axilla, medicine.anatomical_structure, Female, Neurology (clinical), Radiology, business, Polyneuropathy, Brachial plexus, psychological phenomena and processes, Multifocal motor neuropathy, Demyelinating Diseases
Abstract

We studied whether magnetic resonance (MR) imaging of the brachial plexus is useful to distinguish multifocal motor neuropathy (MMN) from lower motor neuron disease (LMND) and whether abnormalities resemble those of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We compared MR images of the brachial plexus of nine patients with MMN with scans from five patients with CIDP, eight patients with LMND, and 174 controls. In two patients with MMN, and in three patients with CIDP, the MR images showed an increased signal intensity on the T2-weighted images of the brachial plexus. Two other patients with MMN demonstrated a more focal, increased signal intensity on the T2-weighted images, occurring in one patient only in the axilla, and in the other patient in the axilla and in the ventral rami of the roots. MR images of the brachial plexus of eight patients with LMND were normal. The distribution of the MR imaging abnormalities corresponded with the distribution of symptoms of the patients: asymmetrical in MMN and symmetrical in CIDP. These findings demonstrate that MR imaging abnormalities of the brachial plexus in patients with MMN resemble those seen in CIDP and may be useful to distinguish MMN from LMND.

Published
1997

19. Cerebral metabolic differences between the severe and critical hypoperfused brain

Author

W.P.Th.M. Mali, L. M. P. Ramos, Bert C. Eikelboom, and J. van der Grond

Subjects
medicine.medical_specialty, Magnetic Resonance Spectroscopy, Ischemia, Central nervous system disease, Internal medicine, Occlusion, medicine, Humans, cardiovascular diseases, Analysis of Variance, medicine.diagnostic_test, Cerebral infarction, Vascular disease, business.industry, Brain, Magnetic resonance imaging, Cerebral Infarction, medicine.disease, Magnetic Resonance Imaging, Surgery, Stenosis, Cerebrovascular Circulation, cardiovascular system, Cardiology, Neurology (clinical), business, Perfusion
Abstract

Occlusion or severe stenosis, with a reduction in the diameter of the extracranial arteries of more than 70%, may lead to hypoperfusion of the brain with an increased risk of cerebral infarction.The aim of this study was to investigate whether a decrease in metabolism in noninfarcted hypoperfused cerebral areas is correlated with the level of hypoperfusion. Fifty-one patients without infarcts, with borderzone infarcts, with territory infarcts, and fourteen healthy control subjects were investigated with MRI and MR spectroscopic imaging. The NAA/choline ratio in the symptomatic hemisphere was significantly decreased in patients with borderzone infarcts compared with patients without infarcts, with patients with territory infarcts, and with control subjects. Furthermore, patients with borderzone infarcts had a relatively high frequency of cerebral lactate. These results indicate that there might be a lower limit of hypoperfusion that can be measured indirectly with MR spectroscopic imaging, below which irreversible cerebral damage occurs.NEUROLOGY 1996;47: 399-404

Published
1996

20. Radiological assessment of the atlantoaxial distance in Down's syndrome

Author

M. J. G. Cremers, J. van Gijn, E Bol, and L. M. P. Ramos

Subjects
Joint Instability, Male, medicine.medical_specialty, Down syndrome, Adolescent, Radiography, Magnification, Sex Factors, medicine, Humans, Child, Orthodontics, S syndrome, Anthropometry, Atlanto-axial joint, business.industry, Age Factors, Reproducibility of Results, medicine.disease, Cervical spine, Surgery, medicine.anatomical_structure, Atlanto-Axial Joint, Atlantoaxial instability, Radiological weapon, Pediatrics, Perinatology and Child Health, Female, Down Syndrome, business, Research Article
Abstract

People with Down's syndrome are pre-disposed to atlantoaxial instability. As part of a study to determine whether those with Down's syndrome should be screened for atlantoaxial instability before they participate in sport, a series of 279 children, aged 6 to 17 years was investigated radiologically. Lateral radiographs of the cervical spine were taken in neutral position and in flexion. The magnification factor was assessed by means of a marker attached to the nape of the neck. After correction for magnification 15% of the patients were found to have an atlantoaxial distance greater than 4 mm on the flexion film, especially boys under 11 years of age. However, sex and age together explained at most 9% of the variation in atlantoaxial distance. The maximum distance found was 6.5 mm. The disagreement between the means of first and second measurements by the same (test-retest) and by another (inter-) observer was more for those taken in the neutral position than in flexion. On a group level the results for reliability were satisfactory.

Published
1993

21. Carotid bifurcation imaging: magnetic resonance angiography compared to conventional angiography and Doppler ultrasound

Author

A.P.G. van Gils, L. M. P. Ramos, Frederik J. A. Beek, R.B.J. Klop, Pieter C. Buijs, W.P.Th.M. Mali, Bert C. Eikelboom, E. H. Dillon, and Chris J.G. Bakker

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Carotid Artery, Common, Carotid arteries, Magnetic resonance angiography, Brain Ischemia, Diagnosis, Differential, symbols.namesake, Occlusion, Carotid bifurcation, medicine, Humans, Carotid Stenosis, cardiovascular diseases, Child, Aged, Observer Variation, medicine.diagnostic_test, business.industry, Conventional angiography, Middle Aged, medicine.disease, Magnetic Resonance Imaging, eye diseases, nervous system diseases, Cerebral Angiography, Stenosis, Echocardiography, cardiovascular system, symbols, Female, Radiology, Doppler ultrasound, Cardiology and Cardiovascular Medicine, business, Doppler effect, circulatory and respiratory physiology
Abstract

Purpose: to evalute the clinical usefulness of the two dimensional "Time of Flight" (2D TOF) Magnetic Resonance Angiography technique (MRA) in imaging the carotid bifurcation as compared to conventional angiography and pulsed and colour Doppler ultrasound. Methods: in 19 patients with possible cerebrovascular disease and eight volunteers, contrast angiography was compared with MRA in 21 carotid bifurcations and with Doppler ultrasound in 23 bifurcations by two independent observers. In 19 bifurcations, all three techniques were available for comparison. Internal carotid arteries were graded normal/minimal disease, mild, moderate or severe stenosis, or occluded. Results: overall agreement between contrast angiography and MRA existed in 62% for one observer and 76% for the other. When MRA and Doppler agreed, agreement between these two investigations and contrast angiography existed in 77–81%. The major problem with MRA was overestimation of moderately stenosed vessels; 50% of the vessels with a moderate stenosis on contrast angiography were judged severely stenosed on MRA. An occlusion was never mistaken for a stenosis by MRA. Evaluating the seperate slices, acquired in the 2D TOF MRA investigation, appeared to be essential to avoid this mistake. Conclusion: at present 2D TOF MRA is not clinically useful for diagnosing the degree of carotid artery stenosis. MRA has a clear tendency to overestimate the degree of stenosis especially moderately severe stenoses. To date, there are no objective methods to correct for this mistake. Technical improvements may make MRA a better diagnostic tool in the future.

Published
1993

22. Recurrent brain abscess due to an unexpected foreign body

Author

W. B. De Vries, L. M. P. Ramos, William P. Vandertop, J. Van Swieten, Neurosurgery, CCA - Cancer biology and immunology, CCA - Imaging and biomarkers, CCA - Cancer Treatment and quality of life, Anesthesiology, Amsterdam Neuroscience - Neurodegeneration, and Other departments

Subjects
Adult, Male, medicine.medical_specialty, business.industry, Retained foreign body, Brain Abscess, medicine.disease, Foreign Bodies, Surgery, Diagnosis, Differential, Frontal Sinusitis, Chronic osteomyelitis, Recurrence, medicine, Humans, Neurology (clinical), Differential diagnosis, Foreign body, Abscess, business, Brain abscess, Chronic frontal sinusitis
Abstract

We report an exceptional case of a patient with chronic frontal sinusitis complicated by chronic osteomyelitis and a cutaneous fistula. A recurrent brain abscess developed and was only cured after a very unusual wooden retained foreign body was removed at surgery. The hazards of wood as a foreign body are discussed and it is stressed that the possibility of a retained foreign body, even unsuspected, must always be borne in mind.

Published
1992

23. Progression of acute hydrocephalus in subarachnoid haemorrhage: a case report documented by serial CT scanning

Author

Eelco F. M. Wijdicks, L. M. P. Ramos, G. J. E. Rinkel, and J. van Gijn

Subjects
Male, medicine.medical_specialty, Subarachnoid hemorrhage, genetic structures, Medicine, Humans, Perimesencephalic subarachnoid haemorrhage, business.industry, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Surgery, Hydrocephalus, Impaired consciousness, Shunting, Psychiatry and Mental health, Acute Disease, Acute hydrocephalus, Subarachnoid haemorrhage, Neurology (clinical), Radiology, business, Complication, Tomography, X-Ray Computed, Research Article
Abstract

A patient with a perimesencephalic subarachnoid haemorrhage gradually developed, within the first day, progressively impaired consciousness, small non-reactive pupils, and defective upward gaze. Three successive CT scans showed progressive enlargement of the lateral and third ventricles. Ventricular shunting resulted in complete recovery.

Published
1990

25. Development of multifocal haemorrhage in a cerebral infarct during computed tomography

Author

L. M. P. Ramos, C L Franke, and J. van Gijn

Subjects
medicine.medical_specialty, Chemotherapy, Pathology, medicine.diagnostic_test, business.industry, Cerebral infarction, medicine.drug_class, medicine.medical_treatment, Anticoagulant, Computed tomography, medicine.disease, Psychiatry and Mental health, Tomography x ray computed, medicine, Surgery, Neurology (clinical), Radiology, business, STREPTOCOCCAL INFECTIONS, Research Article
Published
1990
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26. No increase in abnormalities in the clinical neuroradiological exam in schizophrenia

Author

W.P.Th.M. Mali, L. M. P. Ramos, Wim F. C. Baaré, C.C. Gispen-de Wied, R.S. Kahn, J.A. van der Linden, Jean-Paul Selten, Wouter G. Staal, C.J. Van Oel, Hilleke E. Hulshoff Pol, and Wiepke Cahn

Subjects
Psychiatry and Mental health, Pediatrics, medicine.medical_specialty, business.industry, Schizophrenia (object-oriented programming), medicine, business, Biological Psychiatry
Published
1998
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27. The need for angiography in patients with a perimesencephalic pattern of subarachnoid hemorrhage

Author

Eelco F. M. Wijdicks, L. M. P. Ramos, D. Hasan, J. van Gijn, Marinus Vermeulen, Hervé L. J. Tanghe, and G. J. E. Rinkel

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, medicine.diagnostic_test, business.industry, Angiography, medicine, Surgery, In patient, Neurology (clinical), General Medicine, Radiology, medicine.disease, business
Published
1991
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28. The role of computed tomography in patients with lacunar stroke in the carotid territory

Author

J. van Gijn, L.J. Kappelle, and L. M. P. Ramos

Subjects
Adult, Male, medicine.medical_specialty, Neurology, Lacunar stroke, Time Factors, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, cardiovascular diseases, Prospective Studies, Prospective cohort study, Stroke, Neuroradiology, Aged, business.industry, Cerebral Infarction, Middle Aged, medicine.disease, Confidence interval, Evaluation Studies as Topic, Female, Neurology (clinical), Neurosurgery, Radiology, Cardiology and Cardiovascular Medicine, business, Tomography, X-Ray Computed
Abstract

In a prospective study of 78 patients presenting with recent clinical features of a supratentorially located lacunar infarct (LI), serial CT-scanning with contiguous 6, 5 or 3 mm slices was carried out. LI was found in 59 patients (76%; 95% confidence limits 65–85%). Lesions other than lacunar infarcts were found in 5 patients (6%; 95% confidence limits 2–14%); in only 14 patients could no abnormalities be detected (18%; 95% confidence limits 10–28%). There was no relationship between the detection rate on CT on the one hand and the type of lacunar syndrome, the number of previous TIA's, and the duration or severity of the neurological deficit on the other. A new protocol of CT-scanning for screening LI is advocated for situations where no MRI facilities are available or no patients cooperation can be obtained.

Published
1989

29. Carotid angiography in patients with lacunar infarction. A prospective study

Author

L. M. P. Ramos, J. van Gijn, J. E. E. Keunen, Peter J. Koudstaal, and L.J. Kappelle

Subjects
Adult, Carotid Artery Diseases, medicine.medical_specialty, Internal capsule, Eye Diseases, education, Lacunar infarction, Constriction, Pathologic, Carotid angiography, medicine.artery, Internal medicine, Occlusion, medicine, Humans, cardiovascular diseases, Prospective Studies, Prospective cohort study, Aged, Advanced and Specialized Nursing, business.industry, Cerebral Infarction, Middle Aged, medicine.disease, Cerebral Angiography, Stenosis, medicine.anatomical_structure, Carotid Arteries, Fundus (uterus), Hypertension, cardiovascular system, Cardiology, Neurology (clinical), Radiology, Internal carotid artery, Cardiology and Cardiovascular Medicine, business
Abstract

We prospectively studied the results of carotid angiography in 45 patients with transient or nondisabling neurologic deficits caused by lacunar infarction in the internal capsule or corona radiata and demonstrated by computed tomography. An ipsilateral stenosis at the bifurcation of the internal carotid artery was found in 14 patients (31%, 95% confidence limits 18-47%), seven of whom also had stenosis of the contralateral internal carotid artery. In previous studies an average of 65% of patients with transient hemispheric deficit had internal carotid artery stenosis or occlusion. Hypertension and hypertensive retinal vasculopathy assessed by fundus photographs were found in most patients, but not significantly more often in the patients without internal carotid artery stenosis. Our findings support the notion that small vessel disease rather than emboli from the carotid bifurcation is the most common cause of lacunar infarction.

Published
1988

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