Gerald V. O'Reilly

HYPERPROLACTINAEMIA IN MALES WITH AND WITHOUT PITUITARY MACROADENOMAS

To ascertain whether in hyperprolactinaemic men pituitary macroadenomas represent the end stage of a disease process wherein the only early symptom is impotence, the features of 16 hyperprolactinaemic men with radiological evidence of pituitary macroadenomas were compared with those of 10 hyperprolactinaemic men without pituitary macroadenomas. All were impotent and 25 had low serum testosterone levels. The group with pituitary macroadenoma was older (48.1 vs 63.2 years) and had tolerated impotence for longer (10.4 +/- 6.0 vs 4.5 +/- 2.1 years). 6 of them had visual field defects (none in the other group), 14 had hypopituitarism (1 in the other group), and 14 were initially seen for problems other than sexual dysfunction (whereas all 10 without pituitary macroadenomas were seen primarily for evaluation of recent onset of impotence). In the macroadenoma group bromocriptine restored serum prolactin levels in 13 of the 16 and serum testosterone and potency in 5, whereas in the non-tumour group it restored serum prolactin levels in all 10 and serum testosterone and potency in 9.

Embolization of solitary spinal metastases from renal cell carcinoma: alternative therapy for spinal cord or nerve root compression.

Four patients with a solitary vertebral metastasis from a renal cell carcinoma presented with acute spinal cord or nerve root compression. Because of the markedly hypervascular nature of the metastases it was decided to palliate the lesions by transarterial catheter embolization. The embolization reduced the venous blood pool within the tumors, resulting in progressive neurological improvement often lasting for 12 weeks or more. With such palliation, surgical decompression may be obviated, postponed, or at least made manageable.

Supratentorial haemangioblastoma: The diagnostic roles of computed tomography and angiography

Two patients with von Hippel--Lindau complex are described. Both had concomitant posterior fossa and supratentorial haemangioblastomas. The value of cerebral angiography is stressed in the demonstration of small nodules which are not immediately apparent on the computed tomogram.

Stereoscopic display of MR angiograms

SummaryRecent developments in magnetic resonance (MR) allow high resolution imaging of flowing blood. To overcome the tomographic nature of conventional MR acquisitions, projection angiograms can be produced. These angiograms are similar in their display of blood vessels to plain film or digital subtraction angiograms. However, the three-dimensional information inherent in them is partly lost when single projections are viewed. We describe a method of three-dimensional display consisting of stereo pairs of the MR angiograms. With these an examiner experienced in stereo viewing can recover depth perception.

Subdural Hematoma in Patients with Brain Tumor: CT Evaluation

Chronic subdural hematoma was identified radiographically and verified surgically in two patients with brain tumor, one meningioma, and one glioblastoma multiforme. Over a period of days or weeks, both patients developed dramatic clinical findings probably related to the mass effect from the subdural hematoma in addition to the preexisting tumor. Early awareness of this complication in patients with brain tumor may lead to successful surgical treatment.

Septation and focal dilatation of ventricles associated with cryptococcal meningoencephalitis

A 35-year-old woman developed temporal lobe seizures. Isolated dilatation of the right temporal horn was demonstrated by computed tomography. She was asymptomatic for the next 10 months while on anticonvulsants before severe headaches, vomiting, and mental confusion prompted hospitalization. Both temporal horns were now dilated, there was marked periventricular edema, and cryptococci were cultured from the ventricular fluid. She succumbed after prolonged systemic and intrathecal antifungal therapy, having developed isolation and dilatation of both frontal horns and third and fourth ventricles. Cryptococcal or other fungal meningoencephalitis should be considered in the differential diagnosis of isolated dilatations of the ventricular chambers as noted in the present case.

Spinal cord or nerve root compression in patients with malignant disease: CT evaluation.

Fifty patients with malignant disease were seen on an emergency basis because they showed clinical signs of spinal cord or nerve root compression. All were studied with high resolution computed tomography (CT) of the spine; in addition, myelography was performed on 10 of the patients. We found that 48 cases (96%) could be accurately diagnosed by CT alone. In two cases (4%) CT was inconclusive, but myelography was diagnostic; one proved to be cerebrospinal fluid seeding with nerve root involvement, and the other showed conus medullaris involvement. In the remaining eight cases studied by both techniques, correlation between CT and myelography was very good.

Balloon Occlusion of a Recurrent Carotid-Cavernous Fistula Previously Treated by Carotid Ligations

A carotid-cavernous fistula recurred 16 years after a Hamby procedure. The recurrence was manifested by subarachnoid hemorrhage originating from dilated draining pial veins. The fistula was closed with a balloon catheter introduced through a patent remnant of the cervical carotid artery. Patients who have previously undergone Hamby trapping and embolization should be reassessed for an occult fistula that could predispose them to intracranial bleeding.

Cerebral infarction: shortcomings of angiography in the evaluation of intracranial cerebrovascular disease in 25 cases.

We studied the utility and limitations of conventional cerebral angiography in 25 patients with cerebral infarction unassociated with extracranial cerebrovascular disease during a 7-year period. In only one-third of cases was the angiogram diagnostic, and in a single case it altered the pre-angiogram diagnosis by revealing a previously unsuspected embolus. Among the cases clinically diagnosed as cerebral emboli, the 2 confirmatory angiograms were performed early (within 48 hours), and demonstrated medium-large or large vessel filling defects. Two-thirds of the negative angiograms in the embolic clinical category were delayed, but there was no statistically relevant predilection for specific vessel size involvement. The category, primary cerebral vasculopathy, comprised the largest group, 10 in all, and one-half had angiographic confirmation despite time delays. Angiographic recognition was dependent on a characteristic picture of vascular involvement, and not on timing or vessel size predilection. Mitral valve prolapse figured prominently in the clinical cases of vasculopathy of uncertain etiology, which contained a total of 4 cases. The 3 cases with nondiagnostic angiograms were all delayed and demonstrated nonspecific radiographic changes. Clinically, these cases demonstrated signs or symptoms of autoimmune dysfunction, raising the specter of primary cerebral vasculopathy as a cause of cerebral infarction, in contrast to recurrent cerebral emboli.

Computed tomography of the brain following radiation and chemotherapy: Preliminary report

Abstract Pre-treatment and post-treatment CT scans of the brain in 94 patients with brain tumors have been reviewed. The CT scan changes of the brain following chemotherapy, radiation therapy or both have been evaluated. In 61% of the patients with primary brain tumors and 48% of the patients with metastatic brain tumors, CT scans demonstrated atrophic changes, leukoencephalopathic changes or a combination of both.