Kenneth R Thomson

Manometry combined with cervical puncture in idiopathic intracranial hypertension

Objective: To determine by cerebral venography and manometry in patients with idiopathic intracranial hypertension the cause of the previously demonstrated venous hypertension in the superior sagittal and proximal transverse sinuses. Methods: Cerebral venous sinus pressure was measured before and immediately after C1-2 puncture with removal of 20 to 25 mL of CSF. Results: Lowering the intracranial pressure by lateral C1-2 puncture during manometry has shown that the venous hypertension resolves immediately. Conclusion: These studies indicate that the venous hypertension is due to compression of the transverse sinuses by raised intracranial pressure and not due to a primary obstructive process in the cerebral venous sinuses.

Cerebral venography and manometry in idiopathic intracranial hypertension

Cerebral venography and manometry in nine patients with idiopathic intracranial hypertension consistently showed venous hypertension in the superior sagittal sinus and proximal transverse sinuses, with a significant drop in venous pressure at the level of the lateral third of the transverse sinus.The abnormality, clearly demonstrated by manometry, was not well shown on the venous phase of cerebral angiography. The appearance of the transverse sinus on venography varied from smooth tapered narrowing to discrete intraluminal filling defects that resembled mural thrombi. Two patients with intracranial hypertension due to minocycline did not show venous hypertension. NEUROLOGY 1995;45: 2224-2228

The Erasme Study: A Multicenter Study on the Safety and Technical Results of the Palmaz Stent Used for the Treatment of Atherosclerotic Ostial Renal Artery Stenosis

AbstractPurpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis. Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up. Results: Stent placement was successful (n=112) or partially successful (n=5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5–18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated. Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up.

Thrombolysis in the Vertebrobasilar Circulation: The Australian Urokinase Stroke Trial

Stroke due to basilar artery occlusion has a high mortality and morbidity. Intra-arterial thrombolysis has been reported to improve survival and outcome status. Our aim was to assess the safety and ef

Delayed fatal cardiac perforation by an indwelling long introducer sheath following transjugular intrahepatic portocaval stents (TIPS).

Iatrogenic cardiac perforation is a recognized complication of central venous catheterization. We report a fatal complication by a 10F introducer sheath which was left in place and resulted in perforation of the right atrial wall 8 h later. This case is reported to emphasize the increased risk of cardiac perforation from large caliber rigid sheaths which should be withdrawn immediately after completion of the procedure.

T2 dark blood MRA for renal artery stenosis detection: preliminary observations.

OBJECTIVE This study evaluated the ability of a fast spin echo T2 weighted dark blood sequence to characterize significant (>50%) renal artery stenosis compared to conventional angiography. METHODS Sixteen patients underwent conventional catheter angiography for either renal artery stenosis evaluation or as potential renal donors. Each patient then had an MR study of the renal arteries and kidneys with fast spin echo T2 weighted MR (TR 4000, TE 102, 8 echo train length) on a Superconducting 1.5T Magnet. Results were compared with angiography and inter and intra observer statistics were calculated. RESULTS A total of 36 renal arteries were imaged in 32 kidneys with 12 stenoses >50%. Fast spin echo T2 weighted MR is 94% accurate (95%CI: 87-100%) in detection of significant renal artery stenosis. Dark blood MRA (DBMRA) is 96% sensitive (95%CI: 89-100), 92% specific, with a predictive value positive of 96% for classifying real arteries as normal or significantly stenosed. Inter and intra observer statistics demonstrate good to excellent agreement in renal artery classification (kappa>0.60). CONCLUSION DBMRA may be a useful adjunct to renal MR evaluation in hypertension. SUMMARY A total of 36 renal arteries were imaged in 32 kidneys with 12 stenoses >50%. Fast spin echo T2 weighted MR is 94% accurate (95%CI: 87-100%) in detection of significant renal artery stenosis.

Thrombolytic therapy for basilar artery thrombosis in the puerperium

A case is presented of a woman in whom basilar artery thrombosis developed 14 days post partum. She was successfully treated with intraarterial urokinase. This case demonstrates that complete neurologic recovery can be achieved after recanalization of the basilar artery with thrombolytic therapy.