Barbara Książkiewicz

Imaging of spontaneous intracerebral hemorrhages by means of transcranial color-coded sonography

BACKGROUND Transcranial color-coded sonography (TCCS) allows the visualization of cerebral structures and enables monitoring of circulatory disorders occurring within the circle of Willis. OBJECTIVE To verify whether TCCS is a reliable method in imaging intracerebral hemorrhages (ICHs) and to what degree its results are consistent with these by means of computed tomography (CT). METHODS This study included 39 patients with spontaneous ICHs of supratentorial and infratentorial locations. Initial TCCS was done not later than 12h after initial CT. Clinical findings and the measurements of hemorrhagic foci and midline shift (MLS) were compared between these two methods. RESULTS TCCS revealed ICHs in 34 patients, including 29 and 5 with supra- and infratentorial localization, respectively. Moreover, it showed 12 cases (35.3%) of intraventricular hemorrhage (IVH) and 16 cases of a midline shift (MLS). No significant differences were found between the measurements of hemorrhagic foci or MLS obtained by TCCS and CT. There was a significant correlation between the volumes of hemorrhagic foci or MLS values measured by both methods analyzed (R = 0.99 or R = 0.98, respectively). Additionally, MLS was shown to increase significantly with the volume of hemorrhagic foci (R = 0.90). CONCLUSIONS The high correlation between TCCS and CT in imaging spontaneous ICHs introduces the possibility of applying TCCS in everyday clinical practice.

Chorea, convulsive seizures and cognitive impairment in a patient with autoimmune thyroid disease.

Chorea and convulsive seizures are rare consequences of hyperthyroidism [1, 2]. We describe the case of such manifestation of autoimmune thyroid disease.

Reversal of vision metamorphopsia caused by pons and cerebellum infarction

Metamorphopsia is a visual illusion related to the perception of an objects shape, size, colour or angle. Reversal of vision metamorphopsia is a rare, transient form of metamorphopsia described as an inversion of the field of vision, usually a 180-degree reversion within the frontal plane. We describe the case of a 64-year-old male patient who first experienced a 90-degree rotation of the field of vision and then had the impression of his body rotating in space. The symptoms were preceded by disequilibrium, astigmatism and vomiting. Magnetic resonance imaging of the head showed focuses of vasogenic lesions in the pons and left cerebellar hemisphere. Magnetic resonance angiography of cerebral vessels did not reveal the left vertebral artery. This is the first described case of reversal of vision metamorphopsia with 90-degree rotation of the field of vision with accompanying disorder of the spatial position of the body.