| 1. |
- Abul-Kasim, Kasim, et al.
(författare)
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Added diagnostic utility of CT perfusion and CT angiography in acute ischemic stroke. Evaluation of three different patient categories
- 2009
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Ingår i: Functional Neurology. - 0393-5264. ; 24:2, s. 93-98
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Tidskriftsartikel (refereegranskat)abstract
- Patients with a clinical picture of acute ischemic stroke are a heterogeneous group. The aim of this study was to evaluate the added utility of CT perfusion (CTP) and CT angiography (CTA) in the workup of three different categories of acute ischemic stroke patients. Fifty patients (61 +/- 05 years old) were included in this retrospective analysis. Twenty-nine patients had transient ischemic attacks (TIAs) (Group I), 15 were not eligible for treatment with thrombolysis (Group II) and six showed no improvement after thrombolysis (Group III). CTP and CTA provided additional information, not revealed by plain CT, in all the Group II patients and in one third of the patients belonging to the other groups. The final diagnoses were TIA (n=23), thromboembolic cerebral infarctions (n=22), carotid artery dissection (n=4) and metastases (n=1). Of the 29 patients admitted with TIA, only 22 patients still had this diagnosis on discharge from the stroke unit. Given the risk of impending stroke, it would be important to include these modalities in the initial workup of TIA.
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| 2. |
- Abul-Kasim, Kasim
(författare)
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Adolescent Idiopathic Scoliosis. The Role of Low Dose Computed Tomography.
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Continuous implementation of new operative methods for correction and stabilization of spinal deformities in young patients with AIS demands a detailed morphological analysis of the vertebral column. CT spine according to protocols available in daily clinical practice means high radiation dose to these young individuals. All examinations included in this thesis were performed on a 16-slice CT scanner. Examination of the chest phantom in paper I showed that the radiation dose of the spine (including 15 vertebrae) was 20 times lower than that of routinely used protocols for CT examination of the spine in children (0.38 mSv vs 7.76 mSv). In paper II the radiation dose and the impact of dose reduction on image quality were evaluated in 113 consecutive examinations with low-dose spine CT and compared with that of 127 CTs after trauma and 15 CTs performed according to a previously used ANV-protocol of a limited part of the vertebral column. The effective dose of the low-dose spine CT (0.01 mSv/cm scan length) was 20 times lower than that of the standard CT for trauma (0.20 mSv/cm scan length). The absorbed doses to the breasts, genital organs, and thyroid gland in the low-dose spine CT was 8, 265, and 22 times lower than the corresponding doses in CT for trauma. This significant dose reduction conveyed no impact on image quality with regard to answering the clinical questions at issue for the preoperative CTs and for the postoperative CTs after posterior corrective surgery. In paper III the low-dose CT showed to be a reliable method in the evaluation of screw placement in patients with AIS after posterior scoliosis surgery with titanium implants, using the new grading system for screw misplacement. Our proposed grading system for screw misplacement has shown to be feasible, practical, and easy to perform and is in line with the general agreement about the harmlessness of misplacement with minor pedicle breach. In paper IV the evaluation of the clinical and radiological outcome of 49 patients with AIS operated on with titanium “all-pedicle screw construct” showed an overall misplacement rate of 17 %. No evidence of neurovascular complications was reported. In parity with most of the reports in the literature the lateral- and medial cortical perforation were the most common types of screw misplacement (8 % and 6.1 % respectively).
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| 3. |
- Abul-Kasim, Kasim, et al.
(författare)
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Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries
- 2010
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Ingår i: Journal of Brachial Plexus and Peripheral Nerve Injury. - : BioMed Central. - 1749-7221. ; 5, s. 14-
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAs neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries.MethodsSeven consecutive male patients (median age 33; range 15-61) with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI), computed tomography myelography (CT-M) or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value). Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical findings and the radiological findings were estimated.ResultsThe diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76) compared with only fair (К = 0.34) for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87).ConclusionsThe advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.
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| 4. |
- Abul-Kasim, Kasim, et al.
(författare)
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Combined Clinical and Radiological Prognostic Model in Acute Ischemic Stroke
- 2010
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Ingår i: Acta Neurologica Belgica. - 2240-2993. ; 110:3, s. 239-245
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Tidskriftsartikel (refereegranskat)abstract
- We sought to propose and test the validity of a comprehensive prognostic model in middle cerebral artery-stroke treated with Intravenous thrombolysis. A total of 127 consecutive patients (aged 70 +/- 12 years; 54% males) were included in this retrospective study. Variables included in our prognostic model were: NIHSS on admission (1-3 points), occurrence of hyperdense middle cerebral artery sign and early ischemic signs on baseline CT (1 point each). NIHSS at 24 hours (0-3 points), posttreatment hemorrhage (1 point), and infarct volume (0-4 points). The score range teas 1-13, with higher values suggest unfavorable prognosis. Our prognostic score was correlated with the modified Rankin scale (mRS) at 3 months after stroke [correlation coefficient of 0.62, P < 0.001] and can thus help early prediction of the functional outcome. Logistic regression showed that NIHSS at 24 hours and EICs on baseline CT were independent predictor of our prognostic score (adjusted odds ratio of 4.1 and 5). Adopting a cut-off value of prognostic score <= 3 for favorable prognosis and >= 7 for unfavorable prognosis helped to predict the need for institutionalization and the functional outcome with higher accuracy and predictive values compared with using scores only based on NIHSS.
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| 5. |
- Abul-Kasim, Kasim, et al.
(författare)
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Curve length, curve form, and location of lower-end vertebra as a means of identifying the type of scoliosis.
- 2010
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Ingår i: Journal of Orthopaedic Surgery. - 2309-4990. ; 18:1, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To determine if the curve length, curve form, and location of the lower-end vertebra can identify the type of scoliosis. METHODS: Standing posteroanterior and lateral radiographs of 78 women and 27 men with scoliosis aged 8 to 32 years were retrospectively analysed. Parameters measured were (1) the curve length (the number of vertebrae in the main curve), (2) the curve form (C-form, inverted C-form, or S-form), (3) the curve apex (the vertebral body at the apex of each curve), (4) the site of the scoliosis (thoracic, thoracolumbar, or lumbar), and (5) the location of the lower-end vertebra. RESULTS: Only 3 (4%) of 77 patients with idiopathic scoliosis had a curve length of >8 vertebrae, compared with 19 (90%) of 21 patients with neuromuscular/neuropathic scoliosis (p<0.001, Fisher's exact test). 14 (18%) of the patients with idiopathic scoliosis had an S-form curve, compared with none in those with neuromuscular/neuropathic or congenital/osteogenic scoliosis (p=0.035, Fisher's exact test). No patient with idiopathic scoliosis had the lower- end vertebra located at L5, compared with 8 (38%) patients with neuromuscular scoliosis (p<0.001, Fisher's exact test). The criteria for neuromuscular/neuropathic scoliosis (a curve length of >8 vertebrae, a C-form or inverted C-form curve, and a lower-end vertebra located at L4 or L5) had 81% specificity, 76% sensitivity, 100% positive and 93% negative predictive values. CONCLUSION: These criteria may help identify patients with neuromuscular/neuropathic scoliosis for further investigation by magnetic resonance imaging or computed tomography before they undergo corrective surgery.
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| 6. |
- Abul-Kasim, Kasim, et al.
(författare)
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Differentialdiagnoser
- 2010
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Bok (övrigt vetenskapligt/konstnärligt)
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| 7. |
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| 8. |
- Abul-Kasim, Kasim, et al.
(författare)
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Dural ectasia in adolescent idiopathic scoliosis: quantitative assessment on magnetic resonance imaging.
- 2010
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; Apr 7, s. 754-759
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Tidskriftsartikel (refereegranskat)abstract
- To our knowledge, the assessment of dural sac diameters in patients with adolescent idiopathic scoliosis (AIS) is not reported in the literature. The aim of this study was to find out if, dural ectasia occurs more frequently among patients with AIS, to define cut-off values for dural sac ratio and test the validity of such values. A total of 126 spine MRIs (79 patients with AIS and 47 control subjects) were included in this retrospective analysis (age range 7-25 years, 62% were females). Dural sac diameter (DSD) and vertebral body diameter (VBD) were estimated and dural sac ratio (DSR = DSD/VBD) was calculated at T5 and L3. DSR at T5 and L3 were 0.69 +/- 0.12, and 0.52 +/- 0.10, respectively, in patients with AIS compared with 0.62 +/- 0.11, and 0.44 +/- 0.07, respectively, in controls (P = 0.001 at T5 and <0.001 at L3). Our estimated cut-off values for DSR were 0.84 and 0.58 at T5 and L3, respectively. This resulted in 100% sensitivity compared with 74% when using the cut-off values proposed by Oosterhof et al. No statistically significant association was found between the occurrence of dural sac enlargement in patients with AIS and the severity of scoliotic deformity, the apical vertebral rotation, epidural fat thickness, occurrence of pain, neurological deficit, atypical scoliosis or rapid curve progression. Females were affected more frequently than males. As dural sac enlargement means thinning of the pedicles, we believe that the findings of this study have important clinical implications on the preoperative workup of AIS.
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| 9. |
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| 10. |
- Abul-Kasim, Kasim, et al.
(författare)
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Extensive central nervous system involvement in Merkel cell carcinoma : a case report and review of the literature
- 2011
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Ingår i: Journal of Medical Case Reports. - : Springer Science and Business Media LLC. - 1752-1947. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Merkel cell carcinoma is a rare malignant cutaneous neoplasm that is locally invasive and frequently metastasizes to lymph nodes, liver, lungs, bone and brain. The incidence of Merkel cell carcinoma has increased in the past three decades.CASE PRESENTATION: A 65-year-old Caucasian man presented with a sudden onset of severe headache and a three-month history of balance disturbance. Magnetic resonance imaging revealed a large meningeal metastasis. The radiologic workup showed retroperitoneal and inguinal lymph node metastases. Biopsy of the inguinal lymph nodes showed metastases of Merkel cell carcinoma. Biopsy from three different suspected skin lesions revealed no Merkel cell carcinoma, and the primary site of Merkel cell carcinoma remained unknown. Leptomeningeal metastases, new axillary lymph node metastases, and intraspinal (epidural and intradural) metastases were detected within six, seven and eight months, respectively, from the start of symptoms despite treating the intracranial metastasis with gamma knife and the abdominal metastases with surgical dissection and external radiotherapy. This indicates the aggressive nature of the disease.CONCLUSION: To the best of our knowledge, this is the first report in the literature of an intracranial meningeal metastasis of Merkel cell carcinoma treated with gamma knife and of intraspinal intradural metastases of Merkel cell carcinoma. Despite good initial response to radiotherapy, recurrence and occurrence of new metastases are common in Merkel cell carcinoma.
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