Dan F. Cohn

MRI demonstration and CT correlation of the brain in patients with idiopathic intracerebral calcification.

Twenty-two patients aged 36–63 years were diagnosed as having Fahrs syndrome on the basis of the presence on CT of unexpected extensive calcification of the basal ganglia. Even when associated with calcification of other brain areas, the main diagnostic criterion remained basal ganglia calcification larger than 800 mm2. Normal values of parathormone, serum calcium and phosphorus excluded hypercalcaemia and hypoparathyroidism. Mitochondrial CNS disease was excluded clinically. MRI and repeated CT and neurological examination were performed in all of the patients. The patients were divided into two groups: neurologically asymptomatic (group 1) and neurologically symptomatic (group 2). T2-weighted sequences demonstrated hyperintense areas in all of the patients involving the white and the grey matter of the brain. In group 1 the hyperintense lesions were significantly smaller than in group 2. The neurological symptoms correlated better with the hyperintensities on T2-weighted MR images than with the calcification demonstrated on CT. Hyperintensities in T2-weighted MRI and the areas shown by CT to have calcification had different locations. In 15 patients with dementia, the white matter of the entire centrum semiovale was bilaterally hyperintense. In another 3 patients with hemiparesis, hyperintense areas in the internal capsule, contralateral to the side of hemiparesis, were demonstrated in the T2-weighted sequence. The hyperintense T2 signals may reflect a slowly progressive, metabolic or inflammatory process in the brain which subsequently calcifies and are probably responsible for the neurological deficit observed.

Generalized epileptic seizures as the presenting symptom of lacunar infarction in the brain

SummaryFive elderly hypertensive patients presented with grand mal seizures and had computed tomographic (CT) findings consistent with lacunar infarction. Three of them had also a recent hemiparesis, contralateral to the side of the CT findings. Follow-up CT scans supported the diagnosis of lacunar infarction. Contrary to the accepted opinion, generalized epileptic seizures may be the presenting symptom of lacunar brain infarction.

Painful Ophthalmoplegia: the Tolosa-Hunt Syndrome

Painful ophthalmoplegia is characterized by unilateral involvement of the IIIrd, IVth and VIth cranial nerves, as well as supra- and retro-orbital pain, i.e. participation of the Vth cranial nerve. The pain is relieved within 48-72 h with steroid therapy. The paresis of the eye muscles in various combinations usually subsides gradually from within a few weeks to several months. The etiology is unknown. The few pathological examinations reported in the literature showed an unspecific inflammatory granulation tissue around the intracavernous portion of the carotid artery and on the dura mater in the vicinity of the cavernous sinus. Carotid arteriography may show stationary waves of this artery and narrowing of its intracavernous portion. With orbital phlebography the occlusion of the supraorbital vein and obstruction of the cavernous sinus are sometimes demonstrable. The syndrome is well defined and its etiology still unknown.

Magnetic resonance imaging (MRI) in patients with complex partial seizures and normal computerized tomography (CT) scan

Magnetic resonance imaging (MRI) examination was performed in 18 patients with complex partial seizures (CPS) of long duration, who had normal computerized tomographic (CT) scans of the brain. Small MRI abnormalities correlating with the location of the epileptogenic focus in the EEG were demonstrated in 4 cases. The findings with strong signals were better demonstrated in the coronal view with longer time to echo (TE). In one patient, a lower signal lesion was documented, which was better visualized in the axial view with shorter TE. Patients with CPS should be subjected to MRI examinations with coronal and sagittal planes, using short and long TE in each slice. This method minimizes the chance for missing pathology.

Papilledema in endemic typhus.

A 21-year-old women developed severe bilateral papilledema during an acute febrile disease. Her optic disk margins were blurred and the disks were elevated up to 5 diopters. Splinter hemorrhages, cotton-wool exudates, cytoid bodies, and sheathing of veins were also present. The pyrexia was caused by murine typhus diagnosed by serologic tests. These tests revealed that Proteus OX-19 agglutination titer rose to 1:12800, and a positive complement fixation test titer was 1:640 with Rickettsia mooseri antigens. Neurological examination results, skull roentgenograms, brain scan, electroencephalogram, and the cerebrospinal fluid were all within normal range, thereby excluding intracranial hypertension. After the patients recovery from the rickettsial disease, the papilledema abated gradually until her fundi reverted to normal.

Magnetic resonance imaging in patients with progressive myelopathy following spinal surgery.

Thirty one patients with insidious progressive myelopathy 2 to 8 years following surgery of the cervical spine were subjected to magnetic resonance imaging (MRI). In 15 patients operated on for vascular malformations or intramedullary tumours, syringomyelia and cystic lesions of the spinal cord were shown. Seven of these patients also showed a combination of a recurrent tumour and spinal atrophy. Out of 16 patients who had surgery for herniated disc or spinal stenosis of the cervical spine, four had syringomyelia and 12 had spinal cord atrophy. There was no syringomyelia in the 12 patients submitted to MRI prior to surgery.

Computed tomography of the temporo-mandibular joint

Computed tomography (CT) of the temporo-mandibular joint (TMJ) has only been occasionally reported. As CT techniques improve, more detailed information is available. Though conventional radiography of the TMJ can supply sufficient diagnostic detail, it may well be replaced by CT as a preliminary examination, as it is able to offer more information with less radiation and minimal patient discomfort.

Thermal Epilepsy Manifest as Fever Attacks

Excerpt To the editor: Epileptic seizures in infants with a sudden temperature rise are known as febrile convulsions. In contrast, fever as a manifestation of an epileptic attack is extremely rare....

Magnetic resonance imaging of syringomyelia occurring after operation on spinal intramedullary tumours by Cavitron ultrasonic aspirator

Conservative therapy, such as irradiation of spinal-cord tumours, is commonly associated with progressive neurological deterioration. It has been claimed that radical excision of such tumours with the Cavitron ultrasonic aspiration (CUSA) technique may be achieved without any, or with minimal, neurological sequelae (Epstein & Epstein, 1981, 1982a; Epstein, 1983). This technique apparently enables gross total removal of astrocytomas and ependymomas of the spinal cord with essentially no retraction of adjacent tissue. Patients with mild to moderate neurological deficits have been observed who showed dramatic clinical improvement after operation with the CUSA technique (Flamm et al, 1978; Epstein & Epstein, 1981, 1982b).