Per Rochat - Academia.edu (original) (raw)
Papers by Per Rochat
World Neurosurgery
BACKGROUND: Cerebellar mutism syndrome (CMS) is rarely described in adults; however, data on self... more BACKGROUND: Cerebellar mutism syndrome (CMS) is rarely described in adults; however, data on self-assessed linguistic complications after posterior fossa surgery do not exist.-METHODS: Through a prospective single-center study, data on 59 tumor operations in the posterior fossa were collected preoperatively as well as 1 week and 1 month postoperatively. Data on self-assessed problems in 5 CMSrelated domains, CMS scores, and neurology as well as surgical procedure and complications were obtained.-RESULTS: Data on CMS-related complications were obtained on 56 of the 59 operations. None was found to have CMS according to the CMS score. Within each of the 5 domains, at least 9 operations (16%) were followed by development or worsening of self-assessed CMS-related complications. Self-assessed complications were found to be most frequent after primary tumor surgeries, although they were significant only for speech and motor complications (P value [ 0.01 and 0.02). Speech and language complications occurred more frequently in midline tumors compared with lateral tumors (40% vs. 7%; P [ 0.004). Surgical complications were similar to other studies.-CONCLUSIONS: We propose that speech and language problems in adults undergoing surgery in the posterior fossa occur more frequently than previously assumed. Some of the self-assessed complications might reflect components of the cerebellar cognitive affective syndrome. Our findings are consistent with the fact that midline location of the tumor is one of the few known risk factors for CMS in children. Thus, the cerebellar midline seems to be a vulnerable region for speech and language complications also in adults.
The Journal of Headache and Pain
Background: Prognosis of medically treated trigeminal neuralgia patients is assumed to be poor, b... more Background: Prognosis of medically treated trigeminal neuralgia patients is assumed to be poor, but the evidence is lacking. Thus, prospective real-life studies of medical management of trigeminal neuralgia are warranted. Methods: This was an observational study. Patients were consecutively enrolled in a structured management program at a specialist centre for facial pain. Optimisation of medical treatment, physiotherapy, psychotherapy, and advice from trained nurses, were parts of the program. Medically intractable patients were referred for neurosurgery. Data-collection was prospective using standardised schemes and patient surveys. The aim was to describe the two-year outcome of medical treatment at the specialist centre. The primary outcome was a 50% reduction in the overall burden of pain according to a Numerical Rating Scale (NRS) after two years. Results: A total of 186 primary TN patients were enrolled in the program of which 103 patients remained medically managed and completed the two-year follow-up. Fifty patients were treated surgically within the first two years of follow-up. Half of the medically managed patients (53 (51%)), had more than a 50% reduction in the overall burden of pain over the two-year period. The overall burden of pain on NRS decreased from mean 5.34 to 3.00, p < 0.01. There was no significant association between primary outcome and sex, depression and/or anxiety, concomitant persistent pain, or neurovascular contact with morphological changes of the trigeminal nerve. Conclusions: Patients with trigeminal neuralgia improve over a two-year period when enrolled in a structured medical management program. Optimisation of drug treatment, continuous advice and education and support by the multidisciplinary team, referral of the medically intractable patients for surgery or the natural history of the disease, can be some of the reasons for the improvement. The favourable prognosis provides hope and optimism for medically managed TN patients. Trial registration: Current study was observational, and patients were offered standard clinical care and laboratory workups according to current American Academy of Neurology and European Federation of Neurological Societies treatment guidelines. The study has been registered at ClincalTrials.gov. ID: NCT03838393.
Cephalalgia : an international journal of headache, 2018
Introduction There is a lack of high-quality prospective, systematic studies using independent as... more Introduction There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia. Methods Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist. Results Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16-16.26), p = 0.029. Odds ratio between...
Cephalalgia, 2016
Introduction Persistent idiopathic facial pain (PIFP) is a poorly understood chronic orofacial pa... more Introduction Persistent idiopathic facial pain (PIFP) is a poorly understood chronic orofacial pain disorder and a differential diagnosis to trigeminal neuralgia. To address the lack of systematic studies in PIFP we here report clinical characteristics and neuroimaging findings in PIFP. Methods Data collection was prospective and standardized in consecutive PIFP patients. All patients underwent 3.0 MRI. Results In a cohort of 53 PIFP patients, the average age of onset was 44.1 years. PIFP was found in more women 40 (75%) than men 13 (25%), p
Ugeskrift for laeger, Jan 18, 2016
Trigeminal neuralgia (TN) is characterized by unilateral evoked short-lasting intense pain paroxy... more Trigeminal neuralgia (TN) is characterized by unilateral evoked short-lasting intense pain paroxysms in the face. A concomitant persistent background pain is frequently present. Neurovascular contact causing displacement or atrophy of the trigeminal nerve is important to TN aetiology. TN can also be secondary to a space-occupying lesion or multiple sclerosis. Early high-quality magnetic resonance imaging is mandatory as a part of the work-up. First-choice treatment is medical. Medically refractory patients are referred to neurosurgery. Nationwide in Denmark, there is a need for structured and uniform treatment of TN.
Ugeskrift For Laeger, Sep 1, 2009
This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia... more This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia. Magnetic resonance imaging (MRI) demonstrated asymmetry of the PICA vessels. A microvascular decompression was performed and complete remission of symptoms followed. After 14 months the neuralgia recurred, this time accompanied by sinus bradycardia/sinus arrest during attacks causing discomfort and syncopes. An MRI now demonstrated an arterial loop at the site of the vagoglossopharyngeal complex leaving the brainstem. After another microvascular decompression, complete remission of symptoms was observed.
The journal of headache and pain, 2015
Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatme... more Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management of TN. Based on collaboration between neurologists, neuroradiologists and neurosurgeons a standardized program for TN was implemented in May 2012 at the Danish Headache Center (DHC). First out-patient visit and subsequent 3.0 Tesla MRI scan was booked in an accelerated manner. The MRI scan was performed according to a special TN protocol developed for this program. Patients initially referred to neur...
The Journal of Headache and Pain, 2015
Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatme... more Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management of TN. Based on collaboration between neurologists, neuroradiologists and neurosurgeons a standardized program for TN was implemented in May 2012 at the Danish Headache Center (DHC). First out-patient visit and subsequent 3.0 Tesla MRI scan was booked in an accelerated manner. The MRI scan was performed according to a special TN protocol developed for this program. Patients initially referred to neurosurgery were re-directed to DHC for pre-surgical evaluation of diagnosis and optimization of medical treatment. Follow-up was 2 years with fixed visits where medical treatment and indication for neurosurgery was continuously evaluated. Scientific data was collected in a structured and prospective manner. From May 2012 to April 2014, 130 patients entered the accelerated program. Waiting time for the first out-patient visit was 42 days. Ninety-four percent of the patients had a MRI performed according to the special protocol after a mean of 37 days. Within 2 years follow-up 35% of the patients were referred to neurosurgery after a median time of 65 days. Five scientific papers describing demographics, clinical characteristics and neuroanatomical abnormalities were published. The described cross-speciality management program proved to be feasible and to have acceptable waiting times for referral and highly specialized work-up of TN patients in a public tertiary referral centre for headache and facial pain. Early high quality MRI ensured correct diagnosis and that the neurosurgeons had a standardized basis before decision-making on impending surgery. The program ensured that referral of the subgroup of patients in need for surgery was standardized, ensured continuous evaluation of the need for adjustments in pharmacological management and formed the basis for scientific research.
Ugeskrift for laeger, Jan 29, 2007
Ugeskrift for laeger, Jan 7, 2009
This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia... more This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia. Magnetic resonance imaging (MRI) demonstrated asymmetry of the PICA vessels. A microvascular decompression was performed and complete remission of symptoms followed. After 14 months the neuralgia recurred, this time accompanied by sinus bradycardia/sinus arrest during attacks causing discomfort and syncopes. An MRI now demonstrated an arterial loop at the site of the vagoglossopharyngeal complex leaving the brainstem. After another microvascular decompression, complete remission of symptoms was observed.
Journal of neurosurgery, 2004
Meningiomas in children are rare, infrequently described in the literature, and often associated ... more Meningiomas in children are rare, infrequently described in the literature, and often associated with neurofibromatosis Type 2 (NF2). The authors report a series of 22 children treated for an intracranial meningioma in Denmark between 1935 and 1984. Of 1542 cases of pediatric intracranial tumors in children younger than 15 years of age, 22 harbored meningiomas. Three children suffered from NF. The male/female ratio was 8:14. The mean age at the time of diagnosis was 5 years for boys and 11.5 years for girls. At the time of diagnosis all tumors were large. All patients underwent surgery. In 20 cases, the final histological diagnoses were low-grade and in two cases high-grade tumors. The follow-up period ranged from I to 45 years (mean 16 years). Two patients were lost to follow up. Four of seven boys and three of 13 girls survived. Five of 13 children in whom the tumor was completely removed survived, whereas two of seven in whom the lesion was partially removed survived. The mean su...
The Journal of Headache and Pain, 2015
Trigeminal autonomic cephalalgias are primary headaches characterized by unilateral pain and cran... more Trigeminal autonomic cephalalgias are primary headaches characterized by unilateral pain and cranial autonomic symptoms. However, associated autonomic symptoms have also been reported in other headaches and facial pains, e.g. trigeminal neuralgia, with the clinical differentiation proving a complex task. A 54-year-old man presented with right-sided, sharp, intense facial pain in the distribution area of the trigeminal nerve. Pain duration was from seconds to a few minutes, and trigger factors included ipsilateral touching of the skin and hair. Over the next ten years, symptoms progressed and changed presentation, also displaying as right-sided, severe, orbital pain, lasting 60 to 90 minutes, with conjunctival injection and rhinorrhea. Neurological examination was normal. Numerous medications were tried with limited or no effect. In 2010, magnetic resonance imaging revealed a right-sided deviation of the basilar artery at the level of pons, creating neurovascular contact with the trigeminal nerve. Microvascular decompression was performed, and symptoms resolved within days. Differentiating between trigeminal autonomic cephalalgias and trigeminal neuralgia with autonomic symptoms can be challenging. The distinct change and evolution over time in the clinical presentation of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s head pain suggests a temporal plasticity of the pain in head and facial syndromes, irrespective of underlying pathoanatomic features.
Journal of Neurosurgical Anesthesiology, 2001
Cerebrovascular reactivity to CO2 in clinical and experimental studies has been found to be impai... more Cerebrovascular reactivity to CO2 in clinical and experimental studies has been found to be impaired during increased intracranial pressure (ICP). However, from previous study results it has not been possible to estimate whether the impairment was caused by elevated ICP, or caused by decreased cerebral perfusion pressure (CPP). The current study was carried out in a group of unmanipulated control rats and in six investigation groups of six rats each: two groups with elevated ICP (30 and 50 mm Hg) and spontaneous arterial blood pressure (MABP), two groups with spontaneous ICP and arterial hypotension (77 and 64 mm Hg), and two groups with elevated ICP (30 and 50 mm Hg) and arterial hypertension (124 mm Hg). Intracranial hypertension was induced by continuous infusion of lactated Ringer&amp;#39;s solution into the cisterna magna, arterial hypotension by controlled bleeding, and arterial hypertension by continuous administration of norepinephrine intravenously. Cerebral blood flow (CBF) was measured repetitively by the intraarterial 133Xe method at different levels of arterial PCO2. In each individual animal, CO2 reactivity was calculated from an exponential regression line obtained from the corresponding CBF/PaCO2 values. By plotting each individual value of CO2 reactivity against the corresponding CPP value from the seven investigation groups, CPP was significantly and directly related to CO2 reactivity of CBF (P &amp;lt; .001). No correlation was found by plotting CO2 reactivity values against the corresponding MABP values or the corresponding ICP values. Thus, the results show that CO2 reactivity is at least partially determined by CPP and that the impaired CO2 reactivity observed at intracranial hypertension and arterial hypotension may be caused by reduced CPP.
British Journal of Pharmacology, 2002
1 Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate ne... more 1 Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate neuroprotection. This eect of EPO may in part rely on a bene®cial eect on cerebrovascular dysfunction leading to ischaemic neuronal damage. We investigated the in vivo eects of subcutaneously administered recombinant EPO on impaired cerebral blood¯ow (CBF) autoregulation after experimental subarachnoid haemorrhage (SAH). 2 Four groups of male Sprague-Dawley rats were studied: group A, sham operation plus vehicle; group B, sham operation plus EPO; group C, SAH plus vehicle; group D, SAH plus EPO. SAH was induced by injection of 0.07 ml of autologous blood into the cisterna magna. EPO (400 iu kg 71 s.c.) or vehicle was given immediately after the subarachnoid injection of blood or saline. Forty-eight hours after the induction of SAH, CBF autoregulatory function was evaluated using the intracarotid 133 Xe method. 3 CBF autoregulation was preserved in both sham-operated groups (lower limits of mean arterial blood pressure: 91+3 and 98+3 mmHg in groups A and B, respectively). In the vehicle treated SAH-group, autoregulation was abolished and the relationship between CBF and blood pressure was best described by a single linear regression line. A subcutaneous injection of EPO given immediately after the induction of SAH normalized autoregulation of CBF (lower limit in group D: 93+4 mmHg, NS compared with groups A and B). 4 Early activation of endothelial EPO receptors may represent a potential therapeutic strategy in the treatment of cerebrovascular perturbations after SAH.
Journal of Neurosurgery, 2016
World Neurosurgery
BACKGROUND: Cerebellar mutism syndrome (CMS) is rarely described in adults; however, data on self... more BACKGROUND: Cerebellar mutism syndrome (CMS) is rarely described in adults; however, data on self-assessed linguistic complications after posterior fossa surgery do not exist.-METHODS: Through a prospective single-center study, data on 59 tumor operations in the posterior fossa were collected preoperatively as well as 1 week and 1 month postoperatively. Data on self-assessed problems in 5 CMSrelated domains, CMS scores, and neurology as well as surgical procedure and complications were obtained.-RESULTS: Data on CMS-related complications were obtained on 56 of the 59 operations. None was found to have CMS according to the CMS score. Within each of the 5 domains, at least 9 operations (16%) were followed by development or worsening of self-assessed CMS-related complications. Self-assessed complications were found to be most frequent after primary tumor surgeries, although they were significant only for speech and motor complications (P value [ 0.01 and 0.02). Speech and language complications occurred more frequently in midline tumors compared with lateral tumors (40% vs. 7%; P [ 0.004). Surgical complications were similar to other studies.-CONCLUSIONS: We propose that speech and language problems in adults undergoing surgery in the posterior fossa occur more frequently than previously assumed. Some of the self-assessed complications might reflect components of the cerebellar cognitive affective syndrome. Our findings are consistent with the fact that midline location of the tumor is one of the few known risk factors for CMS in children. Thus, the cerebellar midline seems to be a vulnerable region for speech and language complications also in adults.
The Journal of Headache and Pain
Background: Prognosis of medically treated trigeminal neuralgia patients is assumed to be poor, b... more Background: Prognosis of medically treated trigeminal neuralgia patients is assumed to be poor, but the evidence is lacking. Thus, prospective real-life studies of medical management of trigeminal neuralgia are warranted. Methods: This was an observational study. Patients were consecutively enrolled in a structured management program at a specialist centre for facial pain. Optimisation of medical treatment, physiotherapy, psychotherapy, and advice from trained nurses, were parts of the program. Medically intractable patients were referred for neurosurgery. Data-collection was prospective using standardised schemes and patient surveys. The aim was to describe the two-year outcome of medical treatment at the specialist centre. The primary outcome was a 50% reduction in the overall burden of pain according to a Numerical Rating Scale (NRS) after two years. Results: A total of 186 primary TN patients were enrolled in the program of which 103 patients remained medically managed and completed the two-year follow-up. Fifty patients were treated surgically within the first two years of follow-up. Half of the medically managed patients (53 (51%)), had more than a 50% reduction in the overall burden of pain over the two-year period. The overall burden of pain on NRS decreased from mean 5.34 to 3.00, p < 0.01. There was no significant association between primary outcome and sex, depression and/or anxiety, concomitant persistent pain, or neurovascular contact with morphological changes of the trigeminal nerve. Conclusions: Patients with trigeminal neuralgia improve over a two-year period when enrolled in a structured medical management program. Optimisation of drug treatment, continuous advice and education and support by the multidisciplinary team, referral of the medically intractable patients for surgery or the natural history of the disease, can be some of the reasons for the improvement. The favourable prognosis provides hope and optimism for medically managed TN patients. Trial registration: Current study was observational, and patients were offered standard clinical care and laboratory workups according to current American Academy of Neurology and European Federation of Neurological Societies treatment guidelines. The study has been registered at ClincalTrials.gov. ID: NCT03838393.
Cephalalgia : an international journal of headache, 2018
Introduction There is a lack of high-quality prospective, systematic studies using independent as... more Introduction There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia. Methods Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist. Results Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16-16.26), p = 0.029. Odds ratio between...
Cephalalgia, 2016
Introduction Persistent idiopathic facial pain (PIFP) is a poorly understood chronic orofacial pa... more Introduction Persistent idiopathic facial pain (PIFP) is a poorly understood chronic orofacial pain disorder and a differential diagnosis to trigeminal neuralgia. To address the lack of systematic studies in PIFP we here report clinical characteristics and neuroimaging findings in PIFP. Methods Data collection was prospective and standardized in consecutive PIFP patients. All patients underwent 3.0 MRI. Results In a cohort of 53 PIFP patients, the average age of onset was 44.1 years. PIFP was found in more women 40 (75%) than men 13 (25%), p
Ugeskrift for laeger, Jan 18, 2016
Trigeminal neuralgia (TN) is characterized by unilateral evoked short-lasting intense pain paroxy... more Trigeminal neuralgia (TN) is characterized by unilateral evoked short-lasting intense pain paroxysms in the face. A concomitant persistent background pain is frequently present. Neurovascular contact causing displacement or atrophy of the trigeminal nerve is important to TN aetiology. TN can also be secondary to a space-occupying lesion or multiple sclerosis. Early high-quality magnetic resonance imaging is mandatory as a part of the work-up. First-choice treatment is medical. Medically refractory patients are referred to neurosurgery. Nationwide in Denmark, there is a need for structured and uniform treatment of TN.
Ugeskrift For Laeger, Sep 1, 2009
This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia... more This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia. Magnetic resonance imaging (MRI) demonstrated asymmetry of the PICA vessels. A microvascular decompression was performed and complete remission of symptoms followed. After 14 months the neuralgia recurred, this time accompanied by sinus bradycardia/sinus arrest during attacks causing discomfort and syncopes. An MRI now demonstrated an arterial loop at the site of the vagoglossopharyngeal complex leaving the brainstem. After another microvascular decompression, complete remission of symptoms was observed.
The journal of headache and pain, 2015
Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatme... more Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management of TN. Based on collaboration between neurologists, neuroradiologists and neurosurgeons a standardized program for TN was implemented in May 2012 at the Danish Headache Center (DHC). First out-patient visit and subsequent 3.0 Tesla MRI scan was booked in an accelerated manner. The MRI scan was performed according to a special TN protocol developed for this program. Patients initially referred to neur...
The Journal of Headache and Pain, 2015
Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatme... more Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management of TN. Based on collaboration between neurologists, neuroradiologists and neurosurgeons a standardized program for TN was implemented in May 2012 at the Danish Headache Center (DHC). First out-patient visit and subsequent 3.0 Tesla MRI scan was booked in an accelerated manner. The MRI scan was performed according to a special TN protocol developed for this program. Patients initially referred to neurosurgery were re-directed to DHC for pre-surgical evaluation of diagnosis and optimization of medical treatment. Follow-up was 2 years with fixed visits where medical treatment and indication for neurosurgery was continuously evaluated. Scientific data was collected in a structured and prospective manner. From May 2012 to April 2014, 130 patients entered the accelerated program. Waiting time for the first out-patient visit was 42 days. Ninety-four percent of the patients had a MRI performed according to the special protocol after a mean of 37 days. Within 2 years follow-up 35% of the patients were referred to neurosurgery after a median time of 65 days. Five scientific papers describing demographics, clinical characteristics and neuroanatomical abnormalities were published. The described cross-speciality management program proved to be feasible and to have acceptable waiting times for referral and highly specialized work-up of TN patients in a public tertiary referral centre for headache and facial pain. Early high quality MRI ensured correct diagnosis and that the neurosurgeons had a standardized basis before decision-making on impending surgery. The program ensured that referral of the subgroup of patients in need for surgery was standardized, ensured continuous evaluation of the need for adjustments in pharmacological management and formed the basis for scientific research.
Ugeskrift for laeger, Jan 29, 2007
Ugeskrift for laeger, Jan 7, 2009
This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia... more This case report describes a 63-year-old man referred with right-sided glossopharyngeal neuralgia. Magnetic resonance imaging (MRI) demonstrated asymmetry of the PICA vessels. A microvascular decompression was performed and complete remission of symptoms followed. After 14 months the neuralgia recurred, this time accompanied by sinus bradycardia/sinus arrest during attacks causing discomfort and syncopes. An MRI now demonstrated an arterial loop at the site of the vagoglossopharyngeal complex leaving the brainstem. After another microvascular decompression, complete remission of symptoms was observed.
Journal of neurosurgery, 2004
Meningiomas in children are rare, infrequently described in the literature, and often associated ... more Meningiomas in children are rare, infrequently described in the literature, and often associated with neurofibromatosis Type 2 (NF2). The authors report a series of 22 children treated for an intracranial meningioma in Denmark between 1935 and 1984. Of 1542 cases of pediatric intracranial tumors in children younger than 15 years of age, 22 harbored meningiomas. Three children suffered from NF. The male/female ratio was 8:14. The mean age at the time of diagnosis was 5 years for boys and 11.5 years for girls. At the time of diagnosis all tumors were large. All patients underwent surgery. In 20 cases, the final histological diagnoses were low-grade and in two cases high-grade tumors. The follow-up period ranged from I to 45 years (mean 16 years). Two patients were lost to follow up. Four of seven boys and three of 13 girls survived. Five of 13 children in whom the tumor was completely removed survived, whereas two of seven in whom the lesion was partially removed survived. The mean su...
The Journal of Headache and Pain, 2015
Trigeminal autonomic cephalalgias are primary headaches characterized by unilateral pain and cran... more Trigeminal autonomic cephalalgias are primary headaches characterized by unilateral pain and cranial autonomic symptoms. However, associated autonomic symptoms have also been reported in other headaches and facial pains, e.g. trigeminal neuralgia, with the clinical differentiation proving a complex task. A 54-year-old man presented with right-sided, sharp, intense facial pain in the distribution area of the trigeminal nerve. Pain duration was from seconds to a few minutes, and trigger factors included ipsilateral touching of the skin and hair. Over the next ten years, symptoms progressed and changed presentation, also displaying as right-sided, severe, orbital pain, lasting 60 to 90 minutes, with conjunctival injection and rhinorrhea. Neurological examination was normal. Numerous medications were tried with limited or no effect. In 2010, magnetic resonance imaging revealed a right-sided deviation of the basilar artery at the level of pons, creating neurovascular contact with the trigeminal nerve. Microvascular decompression was performed, and symptoms resolved within days. Differentiating between trigeminal autonomic cephalalgias and trigeminal neuralgia with autonomic symptoms can be challenging. The distinct change and evolution over time in the clinical presentation of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s head pain suggests a temporal plasticity of the pain in head and facial syndromes, irrespective of underlying pathoanatomic features.
Journal of Neurosurgical Anesthesiology, 2001
Cerebrovascular reactivity to CO2 in clinical and experimental studies has been found to be impai... more Cerebrovascular reactivity to CO2 in clinical and experimental studies has been found to be impaired during increased intracranial pressure (ICP). However, from previous study results it has not been possible to estimate whether the impairment was caused by elevated ICP, or caused by decreased cerebral perfusion pressure (CPP). The current study was carried out in a group of unmanipulated control rats and in six investigation groups of six rats each: two groups with elevated ICP (30 and 50 mm Hg) and spontaneous arterial blood pressure (MABP), two groups with spontaneous ICP and arterial hypotension (77 and 64 mm Hg), and two groups with elevated ICP (30 and 50 mm Hg) and arterial hypertension (124 mm Hg). Intracranial hypertension was induced by continuous infusion of lactated Ringer&amp;#39;s solution into the cisterna magna, arterial hypotension by controlled bleeding, and arterial hypertension by continuous administration of norepinephrine intravenously. Cerebral blood flow (CBF) was measured repetitively by the intraarterial 133Xe method at different levels of arterial PCO2. In each individual animal, CO2 reactivity was calculated from an exponential regression line obtained from the corresponding CBF/PaCO2 values. By plotting each individual value of CO2 reactivity against the corresponding CPP value from the seven investigation groups, CPP was significantly and directly related to CO2 reactivity of CBF (P &amp;lt; .001). No correlation was found by plotting CO2 reactivity values against the corresponding MABP values or the corresponding ICP values. Thus, the results show that CO2 reactivity is at least partially determined by CPP and that the impaired CO2 reactivity observed at intracranial hypertension and arterial hypotension may be caused by reduced CPP.
British Journal of Pharmacology, 2002
1 Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate ne... more 1 Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate neuroprotection. This eect of EPO may in part rely on a bene®cial eect on cerebrovascular dysfunction leading to ischaemic neuronal damage. We investigated the in vivo eects of subcutaneously administered recombinant EPO on impaired cerebral blood¯ow (CBF) autoregulation after experimental subarachnoid haemorrhage (SAH). 2 Four groups of male Sprague-Dawley rats were studied: group A, sham operation plus vehicle; group B, sham operation plus EPO; group C, SAH plus vehicle; group D, SAH plus EPO. SAH was induced by injection of 0.07 ml of autologous blood into the cisterna magna. EPO (400 iu kg 71 s.c.) or vehicle was given immediately after the subarachnoid injection of blood or saline. Forty-eight hours after the induction of SAH, CBF autoregulatory function was evaluated using the intracarotid 133 Xe method. 3 CBF autoregulation was preserved in both sham-operated groups (lower limits of mean arterial blood pressure: 91+3 and 98+3 mmHg in groups A and B, respectively). In the vehicle treated SAH-group, autoregulation was abolished and the relationship between CBF and blood pressure was best described by a single linear regression line. A subcutaneous injection of EPO given immediately after the induction of SAH normalized autoregulation of CBF (lower limit in group D: 93+4 mmHg, NS compared with groups A and B). 4 Early activation of endothelial EPO receptors may represent a potential therapeutic strategy in the treatment of cerebrovascular perturbations after SAH.
Journal of Neurosurgery, 2016