Gustaf Bergstrand

Cardiac Gated MR Imaging of Cerebrospinal Fluid Flow

This is a preliminary investigation of the cerebrospinal fluid (CSF) spaces using cardiac gated magnetic resonance imaging. A variation of intensity of the signal from the cerebral aqueduct is demonstrated during the cardiac cycle. The pattern of this variation suggests pulsatile CSF flow. Calculations that have been verified by phantom measurements show that CSF flow rates less than I mm/s may be detectable. Magnetic resonance may therefore offer a new method for the demonstration and measurement of CSF flow.

Orbital phlebography in patients with cluster headache

Thirteen patients with cluster headache in an active stage were investigated with orbital phlebography. About 60% of the patients showed pathologic changes on the phlebograms, such as changes in the appearance of the superior ophthalmic vein. Five patients had pathologic changes on both sides and three patients on one side only. All patients with unilateral pathologic findings on orbital phlebography had the attacks on the same side. The phlebographic findings in these patients with cluster headache were very similar to those of patients with the Tolosa-Hunt syndrome. There is also some similarity in the symptoms in the two disorders. It has previously been suggested that the Tolosa-Hunt syndrome is caused by venous vasculitis, and the present findings to some extent support the idea that cluster headache may have the same etiology.

Chronic Paroxysmal Hemicrania: Orbital Phlebography and Steroid Treatment: A Case Report

A 62-year-old man with ankylosing spondylitis and with a 3-year history of chronic paroxysmal hemicrania is presented. Because of his ankylosing spondylitis naproxen was prescribed; this decreased the attacks of headache to about 50%. However, treatment with indomethacin and steroids eliminated the attacks completely, the former drug in 24 h but only when the drug was taken; the latter drug was completely effective after a week but with an effect that lasted half a year after the medication was stopped. Orbital phlebography showed changes similar to those previously observed in patients with Tolosa-Hunt syndrome and cluster headache. Venous vasculitis thus seems to be associated with all three disorders and may be a factor of etiologic significance.

A new etiology for visual impairment and chronic headache. The Tolosa-Hunt syndrome may be only one manifestation of venous vasculitis.

The Tolosa-Hunt syndrome is characterized by recurrent periods of painful ophthalmoplegia, dramatically ameliorated by steroid treatment. In half of the cases orbital phlebography shows characteristic changes. Ninety-six patients with orbital pain characteristic of the Tolosa-Hunt syndrome were submitted to orbital phlebography regardless of the existence of other symptoms. A pathologic phlebogram with changes typical of the Tolosa-Hunt syndrome was found in 50 patients. In 17 of these 50 patients the symptoms consisted of orbital pain only and no ophthalmoplegia. Twenty patients had pain and ipsilateral decrease of vision but no ophthalmoplegia, and 13 had painful ophthalmoplegia. Of 41 patients treated with steroid medication 39 responded dramatically with regard to the pain. Earlier findings indicate that the phlebographic changes are due to venous vasculitis, which thus may cause irreversible visual impairment but also chronic headache without ophthalmoplegia. It is concluded that the Tolosa-Hunt syndrome may be only one manifestation of a not uncommon disease.

Positron emission tomography with 68Ga-EDTA in the diagnosis and localization of csf fistulas.

Five patients with cerebrospinal fluid (CSF) rhinorrhea were investigated with computed tomography (CT) and positron emission tomography (PET) to localize the site of a CSF fistula. After intrathecal injection of 10 MBq of 68Ga-EDTA, radioactivity was demonstrated in the basal cisterns. In three cases, the site of the fistula was visualized with PET. It is not always possible to demonstrate a CSF leakage with CT cisternography (CTC) using metrizamide, particularly in cases with minute fistulas or intermittent CSF rhinorrhea. With further experience and improved PET techniques, it may be possible to detect even very small fistulas.

Angiographic findings in subdural hematoma correlated with CT attenuation values.

Twenty-eight subdural hematomas in 24 patients were examined by angiography and computed tomography (CT). The angiographic appearance of the hematomas was classified as either crescentic, lentiform, or transitional. The attenuation value of the hematomas was calculated from the CT scans. The mean attenuation of crescentic hematomas (13.8 EMI units--EU: 500 scale) was considerably lower than those of lentiform (21.7 EU) and transitional (19.8 EU) hematomas. The crescentic and transitional hematomas were either subacute or chronic, the chronic crescentic hematomas having an attenuation value at or around serum level. The lentiform hematomas were all more than 24 days old. The relatively high attenuation in chronic lentiform and transitional hematomas was probably caused by rebleeding, and the shape indicates enlargement of the hematomas after membrane formation has occurred. In the chronic, low attenuation crescentic hematomas, no recent bleed and no enlargement had occurred.

Postural displacements of the brain--on the feasibility of using CT for determination of stereotactic coordinates.

SummaryTen patients were studied with CT. In order to achieve consistent and reproducible CT slices an external helmet fixation system was used. Certain well defined cerebral structures were chosen as anatomical landmarks and their relationship to the skull determined with the patient in supine, lateral and prone positions. No displacements of brain structures could be observed. The results show the feasibility of using the same coordinates for intracranial structures at CT and at operation irrespective of the position of the patients head at these procedures. Four of these patients were examined after lumbar intrathecal administration of 5ml metrizamide (200mgJ/ml). This small amount of positive contrast does not seem to influence on the position for the brain.