Sudha R. Gupta

Higher prevalence of abdominal aortic aneurysms in patients with carotid stenosis but without diabetes

BACKGROUND We compared abdominal aortic aneurysm (AAA) prevalence in 3 groups of patients at the Hines Veterans Affairs Medical Center: (1) patients with 50% or more carotid stenosis, (2) patients with less than 50% stenosis, and (3) patients screened for the Aneurysm Detection and Management (ADAM) study. METHODS Of all the patients referred to the vascular laboratory for carotid duplex examination during a 12-month period, patients with 50% or more carotid stenosis underwent ultrasonography of the abdominal aorta unless they had a previous scan or previous aortic surgery (group 1, n = 374). Patients with less than 50% carotid stenosis who had been screened for ADAM comprised group 2 (n = 139). They were compared with all patients screened for ADAM at our center during the same time period (group 3, n = 2477). RESULTS AAA of 3.0 cm or more were present in 18.2%, 12.2%, and 7.2% of groups 1, 2, and 3, respectively; AAA of 4.0 cm or more were present in 8.3%, 5.8%, and 2.1% of groups 1, 2, and 3, respectively. Among patients with carotid stenosis, those patients without diabetes accounted for the observed increase in prevalence (21.9 % > or = 3.0 cm and 10.2% > or = 4.0 cm vs 9.2% and 2.8% in patients with diabetes). CONCLUSIONS The relative risk of AAA is 2 to 3 times greater in patients with carotid stenosis compared with patients undergoing routine screening. However, only patients without diabetes account for the increased prevalence. Selective AAA screening of patients who are not diabetic with carotid stenosis is recommended.

Primary intraventricular hemorrhage in adults: clinical features, risk factors, and outcome.

BACKGROUND AND PURPOSE Nontraumatic primary intraventricular hemorrhage in adults is uncommon. The purpose of this study was to identify clinical features, risk factors, and outcome of primary intraventricular hemorrhage in adults. METHODS We identified computed tomography scans for nontraumatic primary intraventricular hemorrhage performed between 1982 and 1993 at our institutions and reviewed medical records to determine clinical features, risk factors, and outcomes of these patients. RESULTS Of 14 cases studied, the onset of symptoms was acute in all and the most common symptom was headache (78%), followed by nausea/vomiting (71%), and mental status change (71%). Seizures as well as focal neurologic deficits were uncommon. The associated risk factors were hypertension in 7 cases, aneurysm or arteriovenous malformation in 5, coagulopathy in 1, and fibromuscular dysplasia in 1 case. Five patients died acutely, and all of the survivors returned to functional independence. The patients with lethargy, pupillary and extraocular movement abnormalities, quadriparesis, hydrocephalus, and aneurysmal intraventricular hemorrhage had worse outcomes. CONCLUSION Patients with nontraumatic primary intraventricular hemorrhage present with sudden onset of diffuse neurologic symptoms. The mortality in early phase is high (36%) and the prognosis for survivors is good. Factors correlating with the outcome are discussed.

The relation of retinal artery occlusion and carotid artery stenosis.

We retrospectively studied 46 patients with symptomatic retinal artery occlusion and assessed the pattern and extent of carotid artery disease ipsilateral to the retinal artery occlusion. Ipsilateral internal carotid artery atherosclerotic lesions were virtually limited to the cervical arterial segment; 50% of such lesions were plaques or stenoses of less than or equal to 60%, whereas 15% of the angiograms were normal. No clinical features were significantly associated with a flow-limiting carotid stenosis of greater than 60%. Contrary to previous reports, the type of retinal artery occlusion, whether branch or central artery occlusion, was not predictive of severe underlying carotid stenosis or occlusion. Likely mechanisms of retinal artery occlusion include in situ thrombosis and emboli from carotid, and possibly cardiac, sources. Extension of thrombus from an occluded carotid artery into the ophthalmic artery did not appear to be a mechanism of retinal artery occlusion.

Cranial neuropathy in systemic malignancy in a VA population

We studied 30 men with cranial neuropathy (CN) and systemic malignancy to determine the etiology and prognosis of CN. The most common malignancy was prostate (33%), followed by lung (27%). The etiology of CN was metastatic in 25 (83%) and nonmetastatic in 5 (17%). Only 6 patients improved 3 metastatic and 3 nonmetastatic. Although prognosis for recovery was better in the nonmetastatic group, there was no significant difference in survival between the metastatic and the nonmetastatic groups.

Aspiration Following Stroke

The swallowing musculature is represented asymmetrically in both hemispheres. The association between anatomic location of stroke and the occurrence of aspiration re mains uncertain. We reviewed neurologic, neuroimaging, and videofluoroscopic swallowing stud ies (VSS) in 37 patients with unilateral and bilateral strokes. The hemispheric site, side, and size of the lesion were determined by reviewing each patients magnetic res onance imaging (MRI) and computerized tomographic (CT) scans. Presence of aspi ration was determined from VSS. All data were tabulated and analyzed based on the presence or absence of aspiration. Twenty patients (54 percent) had aspiration and 50 percent of those with as piration had an impaired cough reflex. The impaired cough reflex was significantly associated with aspiration (p < 0.01). A multivariate analysis looking at all variables of lesion side, size, and location showed that the probability of developing aspiration was higher in patients with left cerebral lesions (p < 0.06). Key Words: Swallowing disorder—Deglutition—MRI/CT—Videofluoroscopy.

Hydrocephalus following iophendylate injection myelography with spontaneous resolution: case report and review.

A 62-year-old patient developed severe adhesive spinal arachnoiditis and hydrocephalus with papilledema following iophendylate injection myelography. Papilledema and hydrocephalus resolved spontaneously. The possible mechanism for hydrocephalus is discussed and the literature reviewed.

Foster-kennedy syndrome due to optochiasmatic arachnoiditis

A case of optochiasmatic arachnoiditis mimicking Foster-Kennedy syndrome is reported. The difficulties in establishing diagnosis are considered, and the literature of optochiasmatic arachnoiditis presenting in this unusual manner is reviewed.