E. Ralph Heinz

Magnetic resonance imaging evidence of hippocampal sclerosis in progression: a case report.

Summary: A 32‐month‐old child presented in status epilepticus (SE) involving the left side of the body. Fast spin‐echo magnetic resonance imaging (FSE‐MRI) with hippocampal volumetry performed ≤24 h after the seizure showed increased T2 signal of the right hippocampus, but no atrophy. Complex partial seizures (CPS) appeared at age 33 months, and three more episodes of SE occurred between 33 and 37 months of age. Follow‐up FSE‐MRI at 34 and at 45 months of age demonstrated progressive hippocampal atrophy with resolution of the increased T2 signal. Her CPS became intractable and, at age 51 months, she underwent right temporal lobectomy. In the ensuing 5 months, she has had only one major motor seizure. This case demonstrates that acute increased hippocampal T2 signal intensity can occur soon after SE and hippocampal sclerosis (HS) may become evident within months in the setting of recurrent early childhood SE. This observation may support the hypothesis that early childhood SE can lead to HS. Furthermore, this case suggests that years of temporal lobe CPS may not be necessary for development of HS.

The clinical syndrome of early-life bilateral hippocampal sclerosis.

Four infants had bilateral hippocampal sclerosis by magnetic resonance scans, including oblique coronal fast spin echo images of the temporal lobes; [18F]fluorodeoxyglucose–positron emission tomographic scans, done in 2 infants, showed isolated bilateral anterior temporal lobe hypometabolism. All had epilepsy with episodes of status epilepticus. Despite adequate motor and sensory functions, all failed to develop language (or lost attained language), social skills, and complex purposive or adaptive activity, even after epilepsy was controlled. Bilateral hippocampal dysfunction in early life appears to be associated with a profound failure of cognitive capacities, including language learning and learning of complex social and adaptive skills in general. The deficits correspond to the cognitive deficits of severe infantile autism. Hippocampal function, or more generally medial temporal lobe function, appears necessary for language learning in the infant, as well as for complex social and adaptive learning.

Computed tomography in white-matter disease.

CT scans of 11 patients with proved white-matter disease were reviewed and divided into three categories. The demyelinating (secondary) and diffuse sclerosis groups frequently exhibited abnormal intravenous enhancement and mass shift. This made differentiation from inflammatory and neoplastic processes difficult. In the dysmyelinating disorders, pathologically noted diffuse loss of white matter and absence of inflammatory response appeared on the scans as areas of diffuse and decreased density in the centrum semiovale. There was no evidence of abnormal contrast enhancement.

Dilated Virchow-robin Spaces in Cryptococcal Meningitis Associated with Aids: Ct and Mr Findings

We present two patients with AIDS complicated by cryptococcal meningitis who displayed focal hypodense nonenhancing lesions in CT in the basal ganglia with corresponding areas of increased T2 and decreased T1 signal on magnetic resonance (MR). These lesions corresponded precisely to the distribution of the perforating arteries. Review of pathological specimens showed these lesions to be small cystic collections of cryptococcal organisms in the perivascular spaces of the arteries with minimal or no inflammatory reaction. The cryptococcal organisms spread from the basal cisterns through the Virchow-Robin spaces, dilating these spaces, to ultimately propagate in the basal ganglia, internal capsule, thalamus, and brain stem. Such lesions have been described as characteristic for cryptococcosis in the pathology literature before the AIDS epidemic, but the radiological manifestations have not been reported previously. The changes appear characteristic for cryptococcosis, which generally incites no host response in the form of perifocal edema or enhancement. These findings in a young adult, with otherwise normal CT or MR scans, may be the first indication that the patient has AIDS. The T2-weighted image sequences are more sensitive in the detection of these lesions when compared to CT or T1-weighted MR images.

Intracranial fibromuscular dysplasia in a 5-year-old child

A 5-year-old girl presenting with acute middle cerebral artery stroke was diagnosed as having intracranial fibromuscular dysplasia by angiographic findings of focal changes in the proximal right middle cerebral artery and pathological dilatation of the right internal carotid artery at the base of the skull, as well as dissection of at least one of the middle cerebral artery branches and nonfilling of two or perhaps three remaining middle cerebral artery segmental branches. Her clinical condition improved after management of the increased intracranial pressure. She did not receive any medication after discharge and had virtually no residual sequelae. Our case documents an unusual location and age of onset of a patient with fibromuscular dysplasia.

Intracerebral extension of nasal dermoid cyst: CT appearance

We report on a 46-year-old man with a congenital nasal dermoid cyst that extended intracranially to form large bifrontal intraaxial dermoid cysts, which became secondarily infected through a nasal dermal sinus tract. Computed tomography demonstrated bilateral frontal lobe ring enhancing cystic masses containing fat-fluid levels consistent with dermoid cyst abscesses. Axial and coronal CT of the skull base and nose demonstrated a midline bony canal extending from two dimples on the dorsum of the patients nose to the base of the anterior cranial fossa. The clinical, CT, and surgical findings are reviewed as well as the embryogenesis of congenital nasal dermoid cysts.

Design Of And Image Editing With A Space-Filling Three-Dimensional Display Based On A Standard Raster Graphics System

We are developing graphics systems, image preprocessing methods, and interactive manipulation techniques for a space-filling 3D display using a varifocal mirror principle. Our driving problem is a medical imaging need for presentation of three-dimensional intensity information. The major goal of both the image preprocessing and the interactive manipulation has been to overcome obscuration, which we feel is coming to be recognized as the central problem in any space-filling display. In our system, the preprocessing step highlights important image features such as surfaces. At display time, the object can be dynamically edited and rotated for convenient viewing from various directions. Our particular hardware design allows the 3D display to be constructed as an inexpensive add-on to a standard video graphics system. The interactive rotation and other manipulations are achieved by the standard built-in graphics processor.

Evaluation Of Multiplanar Imaging Capabilities Of Four Current Computed Tomography (CT) Scanners

Four state of the art CT scanners were evaluated with respect to optimal techniques for multiplanar imaging. The four scanners were a G. E. 8800, Pfizer 0450, Picker Synerview 600 and Siemens Somatom 2. Patient movement artefacts can be minimized by choice of techniques that provide rapid data acquisition. By deferring reconstruction, using batch mode acquisition, suppressing screen display and operator interaction and minimizing tube loading as many as 33 thin slices can be acquired in < 8 minutes. This rapid scan technique makes use of the narrow collimation over a large (5.0 cm) distance quite reasonable. A high contrast star resolution phantom was scanned using these rapid scan techniques. The multiplanar images produced from narrow slices are much higher resolution than those created with more widely collimated slices. A low contrast (2.5%) resolution object scanned with the same rapid acquisition method shows improved resolution for the narrow collimation even in the presence of increased noise accompanying the narrow collimation.