Behrooz Azar-Kia

Radiology of Cysticercosis of the Central Nervous System Including Computed Tomography

Cysticercosis is a parasitic disease in which man serves as the intermediate host of Taenia solium, the pork tapeworm. The larvae have a predilection for the central nervous system and can cause a variety of neurologic and psychiatric symptoms. Areas of involvement are classified as intraventricular, parenchymal, arachnoidal, and mixed. The diagnosis is made primarily by roentgenographic and spinal fluid examinations. The authors reviewed 232 cases of cysticercosis involving the central nervous system. It was found that computed tomography is a useful tool in assessing this illness.

Optimal clip application and intraoperative angiography for intracranial aneurysms

BACKGROUNDnThe actual incidence of residual aneurysm after clipping is unknown. The natural history of residual aneurysm can be regrowth and hemorrhage. Intraoperative angiography offers a cost-effective, safe interdiction to the problem of residual aneurysm and parent vessel stenosis.nnnMETHODS/RESULTSnForty consecutive patients harboring 54 aneurysms underwent 42 operative procedures to clip 52 aneurysms, during which 220 intraoperative angiographic runs were performed. Ninety-three percent of the procedures were performed on patients with acute subarachnoid hemorrhage. There were 4 giant (>2.5 cm, 4/52 = 8%, all anterior circulation), 21 large (1.0-2.5 cm, 21/52 = 40%, 16/ 21 = 76% anterior circulation, 6/21 = 28% posterior circulation), and 27 small (<1.0 cm, 27/52-52%, 22/27 = 81% anterior circulation, 5/27 = 18% posterior circulation) aneurysms. Intraoperative angiography led to clip adjustment in 18/52 = 34% of aneurysms (4/18 = 22% for parent artery stenosis, 8/18 = 44% for residual aneurysm and 6/18 = 33% for both). Of the 18 adjustments made, 16 = 88% were made on giant or large aneurysms and two were small (one was a complex anterior communicating and one was a vertebral junction aneurysm). Follow-up angiography was performed on 26/42 = 62% of operative cases. Postoperative angiography confirmed intraoperative angiography in all cases. Two complications occurred during 220 angiographic runs: one embolic stroke and one incident of equipment failure.nnnCONCLUSIONnA grading scale was applied to test the relationship between anatomical site and size as they relate to the necessity for clip adjustment for complete aneurysm obliteration and/or parent artery compromise. Significance was related to site (basilar bifurcation, anterior communicating, middle cerebral bifurcation, and ophthalmic) and size (>1.0 cm), both as independent and codependent variables. An analysis of the cost-effectiveness of intraoperative angiography was demonstrated.

Intraosseous meningioma@@@Mningiomes intra-osseux@@@Intraossale Meningeome

SummaryA review of the English literature reveals that 8 cases of ectopic intraosseous mengiomas have been reported previously. We have added four cases of our own. The plain film findings and angiographic appearance of these tumors are discussed. We feel that their angiographic pattern is usually characteristic.RésuméUne revue de la littérature anglaise révèle que 8 cas de méningiomes intra-osseux ectopiques ont été publiés antérieurement. Les auteurs y ajoutent 4 cas personnels. Ils discutent les images visibles sur les radiographies conventionnelles et laspect angiographique de ces tumeurs. Ils pensent que leurs signes angiographiques sont habituellement caractéristiques.ZusammenfassungEs handelt sich um eine Beschreibung von 4 eigenon Fällen, bei denen lediglich intraossale Meningeome vorlagen.

Clinical Course of Pediatric Congenital Inner Ear Malformations

Objective To determine any factors that could improve the early detection and management of congenital inner ear malformations.

Colloid Cysts of the Third Ventricle

The clinical and roentgenographic features of 25 cases of colloid cyst of the third ventricle are described. Of all brain tumors, the colloid cyst is one of the most favorable for surgical removal, hence the need for an exact preoperative diagnosis is emphasized. The differential diagnosis is discussed and 2 cases presented to illustrate some pitfalls in the radiological diagnosis of these cysts.

Toxemia of pregnancy: cerebral CT findings.

Four patients with pregnancy-induced hypertension (preeclampsiaclampsia) and neurological dysfunction unrelated to intracranial hemorrhage, cerebral venous thrombosis, or preexisting neurological disorder had cranial CT performed during their hospitalization. Three patients had diffuse white matter hypodensities with associated mass effect. The fourth patient had bilateral, asymmetric hypodensities confined to the basal ganglia. Computed tomography is useful in establishing an early diagnosis of the complicating neurological disorder as well as in providing a better understanding of the physiopathological changes seen in the brain in this condition.

A protocol for management of a catastrophic complication of functional endoscopic sinus surgery: Internal carotid artery injury

Injury to the cavernous portion of the internal carotid artery is a well recognized and dreaded complication of functional endoscopic sinus surgery. Little information, however, has been presented in the Otolaryngology literature regarding the etiology, prevention, or treatment of this complication. The purpose of this study is to present a case report of a cavernous carotid artery injury during functional endoscopic sinus surgery. Relevant anatomy, preventive measures, and treatment approaches are discussed for this difficult problem.

Complex partial seizure-induced transient MR enhancement.

A 58-year-old man with complex partial seizures had transient symmetrical MR enhancement in the anterior mesiotemporal cortex bilaterally, correlated with the sites of seizure focus on electroencephalography. Preinfused T1-weighted and T2-weighted sequences showed no abnormality. After adequate control of seizures with medication, repeat MR was normal and the prior enhancement was no longer seen. This transient seizure-induced MR enhancement was consistent with ictal or postictal hyperemia and breakdown of the blood-brain barrier and should not be erroneously attributed to mesial temporal sclerosis, encephalitis, tumor, or infarction.

The megadolichobasilar artery anomaly and expansion of the internal auditory meatus

SummaryA case of megadolichobasilar artery anomaly (MDBA) with expansion of the internal auditory meatus is presented. There was no associated hearing loss and it is postulated that IAM expansion without hearing loss may occur with this anomaly.

Intracranial chordomas@@@Chordomes intracraniens@@@Intracranielle Chrodome

SummaryThirty cases of clivus chordoma have been reported and their radiological appearances described. The literature on the subject has been extensively reviewed and has been brought up to date. The plain radiographic findings have been emphasized with the presence of calcification in particular. Calcification is far more common than has been reported in the past. Chordomas produce no bone reaction, but do produce bone destruction. Tomography helps to show destruction of the clivus. In 3 cases in which the bony changes were not obviously seen in the plain X-rays of the skull, tomography revealed destruction of the clivus. Air studies were used in 14 of our cases, angiograms in 12 cases (this including vertebral angiograms in 9 cases) and 1 case was studied with isotope scanning.RésuméLes auteurs présentent trente cas de chordomes du clivus et décrivent leurs signes radiologiques. Ils font une revue complète de la littérature ainsi quune mise à jour. Ils soulignent les signes radiographiques simples, en particulier la présence de calcifications. Les calcifications sont beaucoup plus fréquentes que cela navait été rapporté dans le passé. Les chordomes ne provoquent pas dhyperostose mais une destructin osseuse. La tomographie donne une meilleure définition de la destruction du clivus. Dans trois cas où les altérations osseuses nétaient pas évidentes sur les radiographies conventionnelles du crâne, la tomographie révéla la destruction du clivus. Ouatorze cas furent étudiés pneumographiquement, douze cas angiographiquement (y compris langiographie vertébrale dans neuf cas) et un ces fut étudié par scintigraphie isotopique. Lautopsie fut possible dans onze cas, cinq malades sont toujours en vie. Les radiographies conventionnelles du crâne, y compris les incidences spéciales et la tomographie, attirent habituellement lattention sur la possibilité dun chordome dn clivus. Langiographie révèle des déplacements vasculaires mais la tumeur nest pas visualisée. La gamma-encéphalographie montra une hyperactivité du côté de la tumeur dans un cas. Le diagnostic de chordome du clivus fut fait avec certitud dans la plupart des cas avant lintervention ou lautopsie. La tomographie axiale transverse avec ordinateur, représentera une technique dexploration très importante dans la recherche de tumeurs intra-crâniennes et contribuera de façon considérable au diagnostic différentiel de chordome du clivus.ZusammenfassungAnhand einer ausführlichen Übersicht wird über 30 Fälle von Clivus-Chordomen berichtet, das radiologische Bild dieser Tumoren wird beschrieben. Dabei ist die Literatur zu diesem Thema ausführlich behandelt. Die übersichtsaufnahmen zeigen Knochendestruktionen und Verkalkungen, dabei ist besonders die Tomographie außerordentlich wertvoll. 14 Patienten wurden mittels Luftencephalographie untersucht, bei 12 Kranken erfolgte eine Angiographie und 1 Fall wurde mit der Isotopen-Diagnostik untersucht. In 11 Fällen erfolgten postmortale Untersuchungen.