Gunnar Moen

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Dr.Shriniwas Kashalikar

Maharashtra University 0f Health Science

Richard Sullivan

King's College London

Ahmet Özbilgin

Celal Bayar University

Joseph Shalhoub

Imperial College London

Viacheslav Kuleshov

Stockholm University

Nayden Nikolov / Nick

Sofia University "St. Kliment Ohridski"

Ahmed El-Agwany

Alexandria University

Alberto N Ramos Jr

Universidade Federal do Ceará

Guido Iaccarino

University of Salerno

Elisa Hill-yardin

University of Melbourne

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Papers by Gunnar Moen

Pneumocephalus, a rare complication of diving

Undersea & Hyperbaric Medicine

Pneumocephalus is a recognized complication from head and facial traumas, sinus surgery and as a ... more Pneumocephalus is a recognized complication from head and facial traumas, sinus surgery and as a complication from otitis media acuta. Only a few cases of pneumocephalus related to diving have been reported. We report an occupational diver who suffered spontaneous subarachnoidal pneumocephalus related to a dive to 20 meters. At a depth of 17 msw he suffered from sudden onset of headache, dizziness, nausea and feeling of disorientation. He had no recognized risk factors such as documented facial fractures, rapid ascent or blocked sinuses. CT showed air in the subarachnoidal space. Otoneurological tests revealed pathological smooth pursuit tracking eye movements and substantial imbalance indicating a central neurological injury. CT and MRI showed a bony defect in the sphenoid sinus covered only by arachnoidea. This was probably the communicative fistula for the entrance of air. On follow-up examination one year later he still had central nervous symptoms and signs, as well as symptoms...

Thrombolytic therapy in acute cerebral infarction

Tidsskrift for Den norske legeforening, Sep 10, 2002

The aim of this study was to assess the feasibility, safety, and clinical results in patients tre... more The aim of this study was to assess the feasibility, safety, and clinical results in patients treated with intravenous thrombolysis in an acute stroke unit. Results from the first three years with thrombolysis as standard treatment procedure are presented. All patients admitted to our department within 3 hours after an acute ischaemic stroke were considered for thrombolysis. 33 patients with median age 71 years were treated. 16 patients demonstrated early clinical improvement. Six patients demonstrated a substantial but slow clinical improvement. 11 patients did not improve. One patient developed an intracerebral haematoma and two developed a haemorrhagic infarction without clinical deterioration. At follow-up after six months, 16 patients (49%) had achieved independence [modified Rankin Scale (mRS) 0-2], 12 (36%) had an unfavourable outcome (mRS 3-5). Five patients (15%) died, all within the first 3 months. None died due to a treatment complication. This study suggests that thrombo...

Craniocervical artery dissection

Tidsskrift for Den norske legeforening, Oct 10, 2002

In recent years, new radiographic diagnostics have increased our knowledge about dissection of th... more In recent years, new radiographic diagnostics have increased our knowledge about dissection of the carotid and vertebral arteries as a cause of stroke, probably an underdiagnosed condition. Carotid dissection is now considered one of the most frequent aetiologies of ischaemic stroke in patients less than 50 years of age and it accounts for 20% of all cases under the age of 30. In this paper we describe clinical course and investigations in four patients who had dissection of the precerebral arteries. Three patients had carotid artery dissection, one vertebral artery dissection. Three patients had ischaemic symptoms. One patient had symptoms following physiotherapy to the neck. Patients with craniocervical arterial dissection should be investigated with ultrasound techniques and MRI or CT; antiplatelet agents or anticoagulation therapy should be considered.

Behandling av akustikusnevrinom

Hemiballisme ved hjerneinfarkt

Tidsskrift for Den Norske Laegeforening, 2001

Dekomprimerende kraniektomi ved akutt encefalitt

Impaired cerebrovascular reactivity may predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Journal of the Neurological Sciences

Introduction: Delayed cerebral ischemia (DCI) is a major cause of disability and death after aneu... more Introduction: Delayed cerebral ischemia (DCI) is a major cause of disability and death after aneurysmal subarachnoid hemorrhage. The literature suggests that impaired cerebrovascular reactivity (CVR) may be a predictor for DCI; still no CVR based prediction model has been developed. Increased knowledge about possible predictors of DCI can improve patient management in high-risk patients and allow for shorter hospital stay in low-risk patients. Method: CVR was examined in 42 patients with aneurysmal subarachnoid hemorrhage and 37 patients treated for unruptured intracranial aneurysm, using acetazolamide test with transcranial Doppler monitoring of blood flow velocities. Patients were followed for development of DCI, separated into clinical deterioration and radiographic infarction. Results: For all patients, regardless of aneurysm rupture status, CVR was on average 5.5 percentage points lower on the ipsilateral side of aneurysm treatment. Patients with clinical deterioration due to DCI had lower CVR than patients without DCI, and the difference was larger on the contralateral side (33.9% vs. 49.2%). Two prediction models were constructed for clinical deterioration due to DCI. The area under the receiver operating characteristic curve was 0.82 in the model using established predictors, and 0.86 in the model that also included CVR. Conclusion: Our findings support the hypothesis that impaired CVR may be an independent predictor of clinical deterioration due to DCI, and may assist in identifying patients at risk after aneurysmal subarachnoid hemorrhage. Ipsilateral CVR reduction occurs in all patients after aneurysm treatment, regardless of DCI development, thus highlighting the need to evaluate ipsi-and contralateral CVR separately.

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Small Vestibular Schwannomas: Observation, Surgery, and Gamma-Knife Treatment

Skull Base

Cerebral amyloid angiopati

Cerebral amyloid angiopati affiserer intracerebrale kar, uten at det foreligger systemisk amyloid... more Cerebral amyloid angiopati affiserer intracerebrale kar, uten at det foreligger systemisk amyloidose. Amyloid avleires i små og middels store kar i cortex og leptomeningene. Cerebral amyloid angiopati er en relativt vanlig årsak til spontane lobære hjerneblødninger hos eldre. Cerebral amyloid angiopati kan også ha atypiske kliniske og radiologiske funn. Vi rapporterer fem pasienter (tre menn og to kvinner, 43-77 år) med histologisk verifisert cerebral amyloid angiopati. En pasient fikk akutt hodepine og klassisk lobær blødning. De andre pasientene hadde forskjellige neurologiske symptomer og funn, som kramper, synsforstyrrelser, pareser, afasi og demens. Dette ble initialt diagnostisert som hjerneinfarkt eller tumor. To pasienter med cerebral amyloid angiopati og granulomatøs arteritt responderte på behandling med immunsuppressive medikamenter.

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Hybrid [18F]FDG PET/MR Has High Sensitivity and Specificity in the Detection of Recurrent Differentiated Thyroid Cancer

Clinical Thyroidology

Diagnostic Hybrid PET/CT and PET/MR with 18F-FDG Perform Similarly in Recurrent Differentiated Thyroid Cancer

Clinical Thyroidology

Vascular health and risk management, 2016

A hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Me... more A hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) within the first 24 h in groups of ischemic stroke patients with different characteristics. We hypothesized that a consistent BP reduction, regardless of stroke location, time window from debut to admission and presence of persistent vascular occlusion, would favor a stress-related mechanism as an important cause of the hypertensive response after ischemic stroke. Ischemic stroke patients (n=1067) were prospectively registered, and BP was measured on admission and <3 h, 3-6 h, 6-12 h and 12-24 h after admission. Patients were categorized according to the location of diffusion-weighted imaging (DWI) lesions (cortical, large subcortical, mixed cortico-subcortical, lacunar, cerebellar, brain stem or mu...

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En fire år gammel jente med diaré, kraftsvikt og mutisme

Tidsskrift for Den norske legeforening, 2016

Seksjon for nevroradiologi Radiologisk avdeling Haukeland universitetssykehus Kjetil Børve Lund M... more Seksjon for nevroradiologi Radiologisk avdeling Haukeland universitetssykehus Kjetil Børve Lund Mikrobiologisk avdeling Haukeland universitetssjukehus Gro Njølstad Mikrobiologisk avdeling Haukeland universitetssykehus En fire år gammel jente kom inn på sykehus med diaré, oppkast og feber. Gastroenteritt hos barn er vanlig og regnes som ufarlig i industrialiserte land. Vår pasient hadde i midlertid ledsagende kraftsvikt og mutisme, og hennes gastroenteritt fikk et uvanlig forløp. En fire år gammel tidligere frisk jente med norsk etnisk bakgrunn ble innlagt i sykehus på grunn av dehydrering, nedsatt allmenntilstand og slapphet. Hun hadde en tre dagers sykehistorie med oppkast, diaré og feber. Dagen før innleggelsen var talen blitt snøvlete, hun var ustø og klarte ikke å sitte oppreist. Innleggelsesdagen hadde hun sluttet å snakke og måtte baeres. I akuttmottaket var det vanskelig å få kontakt med henne, men hun åpnet øyene når hun ble snakket til. Hun var nakkestiv og reagerte ikke på smertefulle prosedyrer. Pupillene var dilaterte, med symmetrisk reaksjon på direkte og indirekte lys. Hun hadde innsunkne øyne, tørre slimhinner og kjølige ekstremiteter. Det var normale funn ved klinisk undersøkelse av hjerte, lunger og abdomen. Måling av vitale markører viste respirasjonsfrekvens 28/min (20-24/min), SpO 2 96 %, puls 103/min (70-120/min), kapillaerfyllingstid 3 s (1-2 s) og temperatur 37,9 °C.

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Voxel-specific brain arterial input functions from dynamic susceptibility contrast MRI and blind deconvolution in a group of healthy males

Acta Radiologica, Mar 1, 2010

Arterial input functions may differ between brain regions due to delay and dispersion effects in ... more Arterial input functions may differ between brain regions due to delay and dispersion effects in the vascular supply network. Unless corrected for, these differences may degrade quantitative estimations of cerebral blood flow in dynamic susceptibility contrast magnetic resonance perfusion imaging (DSC-MRI). To investigate in a healthy population (n=44) the properties of voxel-specific arterial input functions that were obtained using a recently published blind estimation approach. The voxel-specific arterial input functions were qualitatively and quantitatively assessed, through visual inspection or by comparing time-to-peak (delays) and peak amplitude (dispersion) values between eight regions of the brain. Furthermore, they were compared to arterial input functions selected manually in the middle cerebral artery (MCA), where normally no delay or dispersion of the contrast agent was expected. The estimated voxel-specific arterial input functions varied between brain regions. Differences in delays and dispersion were larger within one brain region among all participants than between regions in one participant. A good correlation was typically found between the estimated voxel-specific arterial input functions and the manually selected arterial input functions in the MCA region. Given knowledge of neurovascular anatomy, the current blind approach seemingly produced reasonable estimates of voxel-specific arterial input functions. In addition to potentially reducing quantification errors in DSC-MRI, these user-independent voxel-specific arterial input functions could be useful for visualizing abnormal blood supply patterns in patients.

Basilar artery fenestration aneurysms treated with guglielmi detachable coils

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, Jan 30, 1998

Four patients with basilar artery fenestration aneurysms at the vertebra basilar junction were ad... more Four patients with basilar artery fenestration aneurysms at the vertebra basilar junction were admitted after subarachnoid haemorrhage. In two of them attempted surgery failed. Subsequently, all four were embolised with Guglielmi Detachable Coils (GDC), three of them in the acute phase. In one case the initial embolisation was incomplete, but follow-up angiography demonstrated spontaneous total occlusion. In another, partial reopening was treated with further embolisation. Three patients recovered completely after treatment. One patient still has deficits related to surgery of an accompanying aneurysm at the middle cerebral artery. He is clinically improving but still not back at work. In two cases the fenestration was combined with a hypoplastic upper vertebral artery on one side. A hypoplastic veretebral artery on one side may frequently be part of the developmental anomaly of basilar fenestration aneurysms. The anatomical configuration and location of these aneurysms is such that...

[Decompressive craniectomy in acute encephalitis]

Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 27, 2006

We report a patient with acute encephalitis of unknown causation who underwent hemicraniectomy be... more We report a patient with acute encephalitis of unknown causation who underwent hemicraniectomy because of threatening herniation. The patient recovered uneventfully and three weeks later, findings on neurological examination were normal. Hemicraniectomy should be considered in all patients with encephalitis and threatening herniation.

[Craniocervical artery dissection]

Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 10, 2002

[Intracranial venous thrombosis]

Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 20, 1997

Cerebral venous thrombosis has traditionally been considered to be a severe and rare condition. O... more Cerebral venous thrombosis has traditionally been considered to be a severe and rare condition. Our knowledge of this condition has increased, however, along with the development of better radiological methods for visualization of the brain and its vasculature. Cerebral angiography, computed tomography (CT) and, in particular, magnetic resonance imaging (MRI) have made it easier to diagnose this condition earlier. It has thus been discovered that cerebral venous thrombosis occurs more frequently than previously supposed and shows a wide variation of the clinical spectrum. We describe a series of eight patients with cerebral venous thrombosis who were admitted to the Neurosurgical Department, Haukeland Hospital, over a period of three years. The presentation shows the great variation in the clinical and radiological picture of this disease and the consequent diagnostic and therapeutic challenges. We conclude that this diagnosis should be considered in patients with cerebral symptoms ...

En mann i 60-årene med akutt hodepine

Tidsskrift for Den norske legeforening, 2012

Noe å laere av En mann i 60-årene med akutt hodepine 671-3 Hodepine er et vanlig symptom. Oftest ... more Noe å laere av En mann i 60-årene med akutt hodepine 671-3 Hodepine er et vanlig symptom. Oftest dreier det seg om tilstander som migrene eller tensjonshodepine. Ved hyperakutt hodepine der lege oppsøkes, har ca. 1 % av pasientene subaraknoidalblødning. Denne kasuistikken illustrerer at andre sjeldne, men livsfarlige tilstander kan debutere med hyperakutt hodepine.

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MRI of the tectorial and posterior atlanto-occipital membranes in the late stage of whiplash injury

Neuroradiology, 2003

Craniovertebral stability depends on the integrity of ligamentous structures. The alar and transv... more Craniovertebral stability depends on the integrity of ligamentous structures. The alar and transverse ligaments are considered the most important and have been thoroughly analysed [1, 2, 3, 4]. Less attention has focused on the tectorial and atlanto-occipital membranes. The tectorial membrane, a strong collagenous band, appears as an upward extension of the posterior longitudinal ligament of the vertebral column. It is fixed caudally to the body of C2, and cranially to the basilar groove of the occipital bone. From the dens upwards it

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Pneumocephalus, a rare complication of diving

Undersea & Hyperbaric Medicine