Barbara D. Barnes

Dynamic radionuclide scanning in the diagnosis of thrombosis of the superior sagittal sinus

Two cases of superior sagittal sinus thrombosis were diagnosed using a new technique of dynamic radionuclide brain-imaging. Witti the patients head in the posterior oblique position, an 80-lens optical camera records the appearance of radionuclides in the superior sagittal sinus. This technique is quick and noninvasive, and serial studies are easily performed. Dural sinus thrombosis is difficult to diagnose on clinical findings alone. Dynamic scanning should be used to screen high risk patients, such as those having pseudotumor syndrome or clotting disorders and elderly patients having pulmonary emboli or unexplained deterioration of mental status.

Traumatic subdural hygroma.

Etiology It is almost always associated with head trauma, especially alcohol-related falls or assaults . Skull fractures were found in 39% of cases. Distinct from a chronic subdural hematoma, which is usually associated with an underlying cerebral contusion, and usually contains darker clots or brownish fluid (“motor oil” fluid), and may show membrane formation adjacent to the inner surface of the dura (hygromas lack membranes). Secondary to tear in the arachnoid mater post surgical, e.g. haematoma evacuation, ventricular drainage see Traumatic subdural hygroma after endoscopy. see Postoperative contralateral subdural effusion. It has been described as a complication of cerebellopontine angle tumor requiring surgical evacuation . see Subdural hygroma after cerebellopontine angle tumor surgery.

Chemical meningitis as a complication of isotope cisternography.

ISOTOPE CISTERNOGRAPHY has gained wide popularity as a very useful diagnostic test for a variety of neurological and neurosurgical conditions.1-(; Few complications have been noted,O-g and only two instances of aseptic meningitis have been reported.l0

Digital subtraction angiography in the diagnosis of superior sagittal sinus thrombosis

l1 Recently we have noted chemical meningitis in five patients after the intrathecal injection of a combination of 99mTc albumin and radioiodiiiated human serum albumin (1311 HSA) or 1311 HSA alone. In each case, isotope cistei-iiography was clone to exclude the syndrome of “occult h y d r o c e p h a l u ~ . ” ~ ~ ~ ~ ~ ~ The purpose of this report is to describe the clinical syndrome and cerebospinal fluid findings in our patients and to suggest precautions in the preparation and intrathecal administration of isotopes.

Radionuclide angiography A sensitive diagnostic test for anterior circulation ischemia

In a patient who developed focal motor seizures during induction chemotherapy for acute leukemia, intravenous digital angiography demonstrated sagittal sinus thrombosis.

CT FINDINGS WITHIN TWENTY-FOUR HOURS OF CEREBRAL INFARCTION

Radionuclide angiography, using high resolution equipment, is a sensitive, noninvasive, safe, and rapid diagnostic test for ischemia of the anterior circulation of the brain. The test permits recognition of focally increased or decreased circulation immediately following the onset of a neurologic deficit. The sensitivity of the test is improved by using multiple projections of the head. The distribution of the anterior cerebral artery is best seen in the anterior projection; the lateral projection is used to resolve the superior and inferior divisions of the middle cerebral artery or to identify multiple regions of ischemia. Both projections should be used routinely.

Neurologic diagnosis using the 80-lens optical camera.

Twenty-six patients with clinically documented acute cerebral infarction were evaluated by CT within the first 24 hours. Twenty-one patients demonstrated subtle mass effects and/or focal areas of decreased attenuation corresponding to areas of clinical deficit. Enhancement occurred in only five of 1

Carotid-cavernous fistula. Demonstration of asymptomatic vascular "steal".

Article abstract This article describes the clinical application of the 80-lens optical camera in the diagnosis of cerebral infarction, subdural hematoma, intracranial tumor, and hydrocephalus. The 80-lens camera is a simple noncomputerized addition to the Anger scintillation camera that permits an estimation of the cerebral blood flow. The study is noninvasive and quick, minimizing the effect of movement artifact and showing areas of either increased or decreased blood flow. Abnormal tumor vessels appear, and subdural hematomas show brain displacement away from the skull edge. Interpretation of blood flow pattern is not affected by scalp or skull trauma, eliminating a source of error incurred with static scans.