Arie Liebeskind

Aneurysms of the internal carotid artery in the carotid canal of the petrous temporal bone.

Aneurysms of the internal carotid artery in the carotid canal of the petrous temporal bone are relatively uncommon lesions. Those arising in the lateral portion of the carotid canal often present with the signs and symptoms of a glomus tumor. A review of the literature indicates that several such aneurysms have been biopsied prior to the correct arteriographic diagnosis. Carotid arteriography is strongly advised in patients in whom the tympanic membrane is deformed by a pulsatile mass.

Growing intracranial aneurysms

Cerebral angiography is the best means by which an intracranial aneurysm can be demonstrated and studied in vivo. In 16 cases clinical deterioration paralleled a variable degree of enlargement of the aneurysms. In all patients the aneurysms were irregular and/or bior multilocular. Possible factors causing aneurysmal enlargement are discussed.

Herniation of the Bladder

Sixty per cent of 50 cases of bladder hernia collected over a two-year period were in patients under 50 years of age; 62 per cent were in women. Only patients with large hernias extending into the scrotum made a specific complaint of two-stage urination. Routine use of erect and prone films led to increased ability to diagnose the entity and differentiate it from diverticula or cystocele. In one patient the type of hernia (direct) was diagnosed by pelvic angiography. Cystoscopy was of no diagnostic aid. An attempt was made to establish criteria for radiographic classification of types of bladder hernia.

The Moving Embolus Seen During Serial Cerebral Angiography

Movement of an occlusive process in an angiographical study is diagnostic of embolization. Two cases are reported in which the demonstration of a moving embolism on serial angiography is shown.

The widened interspinous distance: a useful sign of anterior cervical dislocation in the supine frontal projection.

Anterior dislocation of the cervical spine may be detected reliably in the supine frontal projection by evaluating the cervical spinous processes. A widened interspinous distance (ISD) which measures more than one and one-half times the ISD above and more than one and one-half times the ISD below indicates the presence of an anterior cervical dislocation at the level of abnormal widening. Measurements of the interspinous distances from the C3-C4 interval through the C7-T1 interval in 500 patients with normal cervical spines and in 14 patients with documented anterior cervical dislocations revealed neither false positive nor false negative diagnoses by these criteria.

Computed Tomography: Evaluation of the Posterior Third Ventricle

The normal computed tomography (CT) appearances of the posterior third ventricle and related structures are presented. Seventy-six patients with lesions directly involving this ventricle were studied by CT, and results of other neuroradiological procedures evaluated. Primary tumors, metastases, hematomas, infarcts, and cysts may be reliably distinguished by CT, particularly if contrast enhancement is utilized. Size and density resolution limit the direct visualization of the aqueduct of Sylvius; stenosis however may be inferred. Small infarcts may be difficult to demonstrate by the use of CT scans without contrast enhancement, yet be shown by isotope scans.

Cerebral Angiographic Changes Associated with Tuberous Sclerosis

Two patients with tuberous sclerosis were examined angiographically. In one, direct left carotid angiography showed a contralateral shift of the anterior cerebral artery and lateral displacement of the middle cerebral artery. On the lateral series, increase in the sweep of the anterior cerebral artery as well as stretching of the opercular branches of the middle cerebral artery were noted in the early arterial phase. In the later arterial phase, there was marked hypervascularity, with the contrast substance temporarily pooling in small, rounded collections. In the mid-arterial phase of the second case, pooling of the the contrast medium within the tumor and many small, berry-like outpunchings were noted. There was no evidence of early venous drainage in either case.

Unusual segmental cerebrovascular changes.

Nonatherosclerotic causes of segmental vascular narrowing were demonstrated by cerebral angiography in three quite unrelated disorders: sickle-cell anemia, reticulum-cell sarcoma, and tertiary syphilis. Sickle-cell anemia and reticulum-cell sarcoma have not previously been shown to be associated with diffuse segmental narrowing.

Knotting of an 8-French “Headhunter” Catheter and its Successful Removal

Abstract A knot formed near the distal end of an 8-French “headhunter” catheter during catheterization of tortuous brachiocephalic vessels. Successful nonsurgical removal was effected with the aid of a second catheter.

Subdural Pantopaque: A Radiologist's Dilemma

The radiological features of Pantopaque in the subdural space and the underlying anatomical factors are described. A totally subdural injection is usually recognizable ; if it is partly subdural and partly subarachnoid, or if the subdural component is not recognized, the filling defect in the upper cervical region may lead to an erroneous diagnosis of a mass lesion. In the dorsal and lower cervical regions, pockets of contrast medium in the subdural space may be mistaken for arachnoiditis or arachnoid cysts.