James M. Davis

Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning.

In 47 cases of verified ruptured saccular aneurysm, we investigated the relationship of the amount and distribution of subarachnoid blood detected by computerized tomography to the later development of cerebral vasospasm. When the subarachnoid blood was not detected or was distributed diffusely, severe vasospasm was almost never encounters (1 of 18 cases). In the presence of subarachnoid blood clots larger than 5 X 3 mm (measured on the reproduced images) or layers of blood 1 mm or more thick in fissures and vertical cisterns, severe spasm followed almost invariably (23 of 24 cases). There was an almost exact correspondence between the site of the major subarachnoid blood clots and the location of severe vasospasm. Every patient with severe vasospasm manifested delayed symptoms and signs. Excellent correlation existed between the particular artery in vasospasm and the delayed clinical syndrome. Severe vasospasm involved the anterior cerebral artery in 20 cases and the middle cerebral artery in only 14. As the grading system used is partly subjective, the findings should be regarded as preliminary. The results, if confirmed, indicate that blood localized in the subarachnoid space in sufficient amount at specific sites is the only important etiological factor in vasospasm. It should be possible to identify patients in jeopardy from vasospasm and institute early preventive measures. (Neurosurgery, 6: 1--9, 1980)

Computed Tomography of Herpes Simplex Encephalitis, with Clinicopathological Correlation

The computed tomographic (CT), clinical, and pathologic findings in 9 patients with biopsy-proven herpes simplex encephalitis (HSE) were reviewed. Seventeen scans (5 plain, 12 contrast enhanced) were analyzed. The major CT finding was a low-absorption abnormality, present in 11 of 17 scans (64%), affecting primarily the temporal lobes. Mass effect was evident in 9 of 17 (52%). Of the 12 contrast-enhanced scans, 6 (50%) showed an abnormal enhancement pattern affecting primarily the sylvian fissure and opercular areas. CT abnormalities are characteristic enough that, in the proper clinical setting, they lend support to the correct diagnosis.

Benign Blood Vascular Tumors of the Mediastinum

The authors present 4 new cases and review 77 previously reported cases of benign blood vascular tumors of the mediastinum. The vast majority are hemangiomas (90%), occur in the first four decades of life (75 %), and arise in the anterior mediastinum (68 %). Compression and/or invasion of adjacent structures is not uncommon. Concomitant extrathoracic extension (2%) and multiple sites of involvement (2%) are rare. The tumors are smoothly outlined, occasionally tabulated and can be accurately identified when phleboliths are present (10%).

Expanded high iodine dose in computed cranial tomography: a preliminary report.

Fifty patients undergoing cranial CT had expanded-high-iodine-dose (EHID) scans. The EHID was given either as an additional bolus dose (37--40 g iodine) after a routine infusion contrast scan (42.3 g), or as a continuous infusion (total 74--80 g). Diseases presented include primary and metastatic neoplasm, pituitary neoplasm, and demyelinating disease. The results suggest that the primary usefulness of the EHID is in (a) detecting multiple rather than solitary brain lesions, (b) the definitive demonstration of an equivocal area of abnormal enhancement, and (c) differentiating solid histologically microcystic from frankly macrocystic neoplasms.

Tension pneumocephalus of the cranial subdural space: a case report.

A case of subdural tension pneumocephalus is presented. Computerized cranial tomography permitted rapid diagnosis including localization of the air, thus facilitating prompt treatment. Tension pneumocephalus should be considered in a patient with a cerebrospinal fluid drainage device who deteriorates after craniotomy.

Malignant glomus jugulare tumor: a case with two unusual radiographic features.

The computed tomographic demonstration of a glomus jugulare tumor with two unusual radiographic features--multiple pulmonary metastases and extension of the tumor into the cerebellopontine angle--is presented.

Cranial computed tomography in subarachnoid hemorrhage: relationship between blood detected by CT and lumbar puncture.

We compared the results of cranial computed tomography (CT) and lumbar puncture (LP) in patients who had subarachnoid hemorrhage due to proven ruptured intracranial aneurysm. We found no correlation between the number of red blood cells in the cerebrospinal fluid collected by LP and the amount and extent of blood detected by CT.