K. Jack Momose

High Incidence of Cortical Atrophy of the Cerebral and Cerebellar Hemispheres in Cushing's Disease

Abstract One of the most striking generalized metabolic changes in Cushings disease is catabolism of protein, which results in protein depletion. The resultant osteoporosis, muscle wasting, skin atrophy, and fragility of the blood vessels have been recognized. The present study of 31 cases also shows a high degree of cerebral and cerebellar cortical atrophy in this disease.

The Use of Computed Tomography in Ophthalmology

Fifty-three orbital lesions of various types were studied by computed tomography to assess the capabilities and limitations of this technique. Although CT scanning in ophthalmology is in its infancy, results showed that it is useful in the investigation of a number of pathological conditions, including congenital anomalies, arteriovenous malformations, bone lesions, trauma, inflammation, granulomas, pseudotumors, epidermoid cysts, and tumors arising in or near the optic nerve, behind the optic bulb, or in the lacrimal region, as well as changes following eye surgery.

Orbital Fracture Evaluation by Coronal Computed Tomography

Coronal computed tomography produces orbital scans in a plane that is analogous to Caldwell-view x-ray films. Coronal computed tomography permits simultaneous visualization of the orbital walls and the orbital soft tissues, including all extraocular muscles. Using coronal computed tomography, we studied a series of patients with radiographically proven orbital floor fractures. We studied in detail three of these patients, one with a linear orbital floor fracture, one with a depressed orbital floor fracture, and one with a severely comminuted orbital floor. In two patients, coronal computed tomography showed inferior rectus muscle entrapment, which was confirmed at the time of surgery. In each patient, some bone fragments could be seen more discreetly on coronal computed tomography than on conventional polytomes. Coronal computed tomography may be used to help confirm extraocular muscle entrapment in patients with orbital floor fractures. Coronal computed tomography can also be used to examine patients with possible intraorbital foreign bodies, unexplained reduction of vision, or severely displaced bone fragments.

Traumatic Dissection of the Internal Carotid Artery at the Atlantoaxial Level, Secondary to Nonpenetrating Injury

THE INTERNAL carotid artery may be occluded intracranially or in the neck following open or closed (penetrating or nonpenetrating) injury to the head, face, or neck. Stenotic and occlusive lesions of the cervical segment of the internal carotid artery caused by penetrating wounds are well known and most commonly sustained in time of war (9, 22). Occasionally they have been reported as a complication of injuries to the fauces and pharynx (14, 23, 29)) following tonsillectomy (4, 2:3) and other surgery to the face and neck. Stenosis and occlusion of the common and internal carotid arteries due to thrombosis and/or mural dissection resulting from arterial needle puncture and, less frequently, from arterial catheterization are also well known. In contrast, lesions of the cervical segments of the carotid arteries resulting from blunt, non penetrating injuries are quite rare. The first such case appears to have been recorded by Verneuil (34) in 1872 and the next report did not appear until 1933 (8). Increasing ...

The Use of Computed Tomography in Ophthalmology1

Fifty-three orbital lesions of various types were studied by computed tomography to assess the capabilities and limitations of this technique. Although CT scanning in ophthalmology is in its infancy, results showed that it is useful in the investigation of a number of pathological conditions, including congenital anomalies, arteriovenous malformations, bone lesions, trauma, inflammation, granulomas, pseudotumors, epidermoid cysts, and tumors arising in or near the optic nerve, behind the optic bulb, or in the lacrimal region, as well as changes following eye surgery.

ACUTE CEREBELLAR HEMORRHAGE

Although a majority of reported cases of cerebellar hemorrhage are subacute or chronic, an acute form of cerebellar hemorrhage occurs that results in coma within 48 hours of onset and is probably always fatal without surgical intervention. Our experience with 12 consecutive patients with proved acute cerebellar hemorrhage is summarized. Of three patients treated with aggressive medical therapy alone, none survived more than 48 hours. In seven of nine operated cases, emergency surgery was undertaken solely on the strength of clinical diagnosis without radiologic confirmation. Three died postoperatively. Of six survivors, two recovered fully, and two show mild and two moderate residua. The major factors influencing survival were the rate of evolution of signs and the level of consciousness at the moment of surgery.

Computed tomography of the skull and facial structures: Preliminary evaluation of direct coronal sections

Skull and facial structures may be evaluated on computed tomography (CT), as well as the brain. A valuable new dimension to the study has been added with the feasibility of obtaining direct coronal sections using a wide gantry aperture. The patho-anatomical details of bone and soft tissues including the orbit and paranasal sinuses are well demonstrated. Direct viewing on a display console of an enlarged quadrant of the scan is of prime importance in diagnosing fine changes involving the thin facial bones.

Computerized Tomography for Evaluation of Fractures and Foreign Bodies of the Orbit

Orbital trauma may injure soft tissues, damage the facial bones, and imbed foreign bodies. Injury may also occur to structures adjacent to the orbits, leading to cerebrospinal fluid leaks, carotid-cavernous sinus fistulas, and damage to the brain, nasolacrimal pathways, or paranasal sinuses (Smith et al., 1976; Grove, 1977). Because of the difficulty in determining the extent of soft tissue injuries in patients with orbital fractures, and in localizing intraorbital foreign bodies, computerized tomography has been used to aid in the management of patients with mid-facial injuries (Grove, 1977; Grove et al., 1974, 1977; Momose et al., 1975; Kollarits et al., 1977).

Emergency decompression of the optic nerve in patients who lose vision with craniofacial fractures: the role of radiological examination

The traumatic force to the optic nerve and optic canal was quantified by analyzing CT findings to predict the degree of damage to the optic nerve. Sixty-four patients thought to have traumatic optic neuropathy were studied, of whom 24 were chosen for decompressive surgery. The results in the operated and nonoperated cases are discussed.

Coronal Autotomography as an Aid in Pneumoencephalography

A technique of coronal autotomography in pneumoencephalography is described. This procedure brings out the cerebellopontine angle cisterns and the internal auditory meati and canals in greater detail, as well as the position of the fourth ventricle and the brainstem in the frontal projection. Although this technique can be accomplished more quickly than the conventional tomographic procedure in bringing out the cerebellopontine angle cisterns, it is not a substitute for the latter method.