Kwang S. Kim

Complications of sublaminar wiring

Complications of sublaminar wiring are reported, including four cases that involved the cervical spine and one case that included the thoracolumbar spine. The complication rate at our institution involving the cervical spine was about 7% and less than 1% for the thoracic spine. A direct correlation exists between the degree of anterior bowing, number of consecutive laminae the wire passes beneath, and the complication rate. The clinical presentations, radiologic findings, and indications for surgical removal of the wires are discussed. To our knowledge, nothing has been reported in the literature regarding the complications caused by sublaminar wiring of consecutive vertebrae.

Magnetic resonance imaging of a spinal extradural arachnoid cyst

A case of extradural arachnoid cyst in the spinal canal of a 16-year-old male was diagnosed by magnetic resonance imaging. The diagnosis was verified by a metrizamide-enhanced computed tomographic myelogram. An operation with a favorable outcome followed. The noninvasive advantages of magnetic resonance imaging in such a diagnosis are demonstrated by this case.

A Ruptured Aneurysm at the Basilar Artery Fenestration

Although rare, fenestration of the cerebral arteries has been described in anatomical specimens and by angiography. The authors describe a case of a bleeding aneurysm arising from the proximal end of a fenestration of the basilar artery.

Computed Tomography in Isodense Subdural Hematoma

Isodense subdural hematomas, particularly bilateral ones, may be difficult to diagnose with CT. Forty-three cases of subdural hematomas were studied by CT, 7 of which were isodense collections. Obliteration or displacement of the cortical sulci in the zone of the extracerebral collection was present in all 7 cases. Infusion scans demonstrated displacement of a cortical vein away from the inner table of the skull in 3 of the 7 cases. This findins is helpful in accurately predicting the size of the extracerebral collection.

Choreoballismus: A nonhemorrhagic complication of venous angiomas

Choreoballismus, developing subacutely in a 48-year-old man, is reported for the first time as a complication of a cerebral venous angioma, demonstrated by computed tomography scanning and angiography. There was no apparent hemorrhage or mass effect from the angioma, which was located in the right caudate nucleus. The movement disorder, which did not respond to haloperidol alone, disappeared after the addition of clonazepam. The necessity for dual therapy implies that there was a disorder of more than one neurotransmitter system in this patient. The clinical and pathological features of these unusual vascular malformations are reviewed.

Multiple Brain Abscesses

A young woman with 12 separate brain abscesses was treated medically after aspiration of one abscess for diagnostic bacteriological examination. She made an excellent recovery with only minimal residual neurological dysfunction. Surgical aspiration for detailed bacteriological studies followed by appropriate antimicrobial therapy is an effective way of treating multiple brain abscesses in the neurologically stable patient.

The radiographic distinction of degenerative slippage (spondylolisthesis and retrolisthesis) from traumatic slippage of the cervical spine

In a review of 42 cases of degenerative arthritis of the cervical spine and 22 cases of cervical spine trauma with an observed anterior slippage (spondylolisthesis) or posterior slippage (retrolisthesis) of the vertebral bodies of 2 mm or more, characteristic features were observed which allowed distinction between degenerative and traumatic slippage of the cervical spine. In degenerative slippage the shape of the articular facets and width of the facet joint space may remain normal; however, in most cases the articular facets become “ground-down” with narrowing of the facet joint space and the articular facets themselves becoming thinned or ribbon-like. In traumatic slippage the artucular facets will either be normally shaped or fractured and the facet joint space will be abnormally widened. Plain radiographs will usually allow this distinction to be made; however, in difficult cases polytomography may be required.

Cerebellar infarction: A clinical and CT study

Seven patients with computed tomographic (CT) evidence of cerebellar infarction were found during review of all CT records over a 5-year period. CT demonstrated decreased density in 2 distinct anatomic areas, corresponding to the distribution of the posterior inferior cerebellar artery and the superior cerebellar artery. Some patients also had hydrocephalus and fourth ventricular effacement and displacement. The location and extent of infarction do not relate directly to the clinical outcome. Rapid deterioration of the patients sensorium is the best indication for surgical decompression.

Unilateral enlargement of the internal auditory canal: A developmental variant

Marked asymmetry of the petrous pyramids as seen on plain skull roentgenograms is reported in 3 patients with no clinical findings related to the region of the cerebellopontine angle. Polytomograms of the enlarged internal auditory canal in these patients demonstrated in intact crista falciformis and absence of cortical destruction. These roentgenographic features suggest that the asymmetry represents a developmental variant. When contrast enchanced computed tomography fails to demonstrate an abnormality in asymptomatic patients with an enlarged internal auditory canal, it is unnecessary to proceed with further neuroradiological study.

Angiographic Features of Subdural Empyema

Subdural empyema, a relatively rare intracranial suppurative disease, is a surgical emergency and requires early diagnosis in order to ensure patient survival. Subdural empyema should be considered with one or a combination of the following in conjunction with an extracerebral collection: (a) an irregular border of the extracerebral collection; (b) a thickened vascular wall of dura; (c) a semilunar avascular zone on the lateral view; (d) spasm of the large arteries at the base of the brain with or without segmental arterial dilatation; (e) multiple peripheral arterial occlusions; and (f) enlargement of the anterior falx artery. Four verified cases are presented.