M. R. Ball

Subtemporal Decompression: Radiological Observations and Current Surgical Experience

Subtemporal decompression, although seldom used today for the management of hydrocephalus, pseudotumour cerebri, or premature closure of cranial sutures, is still used in many centres to alleviate intracranial hypertension caused by tumour, trauma, or severe intracranial haemorrhage. The charts of 50 patients undergoing subtemporal decompression for either severe head trauma or severe intracranial haemorrhage were reviewed. Preoperative and postoperative computed axial tomographic scans were available in 15 patients for analysis of the effects of decompression on the underlying temporal lobe. Calculation of the additional space provided by subtemporal decompression ranged from 26 to 33 cm3.

Spinal cord compression in breast cancer

Myelography was performed on 78 patients with breast cancer who had signs or symptoms compatible with spinal cord compression. Of 42 patients (54%) with extradural defects, 21 (50%) had a complete block. All patients with positive myelograms (M+) had a positive bone scan and 41 of 42 (97%) had positive skeletal x‐rays. Except for paraplegia, paraparesis, or a sensory level abnormality, signs and symptoms were usually not precise enough to accurately predict patients with cord lesions; however, back pain, paresthesias, and bladder or bowel dysfunction were significantly more common in M+ patients. Cerebrospinal fluid (CSF) protein was elevated in almost all M+ patients but also in approximately half of the M‐ group. Cytology and glucose analysis of CSF were not of value in predicting cord involvement. Response to treatment was better for patients with fewer sites of metastatic disease and a shorter time from diagnosis to treatment. There was no notable difference in survival between M+ and M‐ patients. Myelography remains the most precise tool for diagnosing spinal cord lesions. Unfortunately, the prognosis of patients with metastatic breast cancer is poor regardless of whether spinal cord compression is present.

Radiographic features of granulocytic sarcoma (chloroma).

The computed tomographic (CT) findings in two patients in whom intracranial granulocytic sarcomas preceded the onset of systemic myelogenous leukemia are presented. On CT, granulocytic sarcomas may be indistinguishable from meningiomas and difficult to differentiate from primary central nervous system malignant lymphoma and eosinophilic granuloma.

Results of nuclear magnetic resonance with cerebral glioma comparison with computed tomography

Our experience using nuclear magnetic resonance (NMR) in eight patients with abnormalities on computed tomography (CT) scans suggesting glioma is reported. Three patients underwent biopsies. Two patients had grade II astrocytomas. Difficulty was encountered confirming the diagnosis of astrocytoma on frozen sections in one patient, and permanent sections were required for diagnosis in the other. The third patient to undergo biopsy had a grade III anaplastic mixed glioma. Biopsy of subsequent patients with probable gliomas was not done because of the risk of producing neurological deficit. The NMR images suggest that lower-grade astrocytomas are well circumscribed, whereas higher-grade gliomas affect adjacent association bundles by direct extension of tumor cells or vasogenic edema.

Computerized cranial tomography of free intracranial fat in congenital tumors

Three additional cases of free intracranial fat associated with congenital tumors are reported. The migration of fat with positional change is detailed. Free intraventricular fat may present without transcerebral rupture of the tumor. Our experience with these three patients, plus the two previously reported, suggest that two conditions must be present for oily material to enter the ventricular system through the outlets of the fourth ventricle: first, there must be a reversal of bulk flow of cerebrospinal fluid; second, the oily material must have a specific gravity less than that of cerebrospinal fluid. Also noted from our series is the absence of serious clinical sequelae associated with rupture or leakage of fatty tumors.

Pre-enhancement ring density in resolving intracerebral hematomas

Pathologic material is presented demonstrating a pre-enhancement ring density in later stages of hematoma resolution on CT. This pre-enhancement ring density is due to aggregates of hemosiderinladen macrophages.

Multicenter Validation Study of Real Time (B Mode) Ultrasound, Arteriography, and Pathology: II. Repeatability/Variability Assessment

In 1981 the National Heart, Lung, and Blood Institute awarded contracts to five clinical centers to establish the capabilities of high-resolution B mode ultrasound imaging for detecting and quantitating atherosclerotic lesions in the carotid and iliofemoral arteries of human subjects. This chapter details the repeatability/variability (R/V) component of the carotid artery studies and permits intramodality evaluation between and within-reader variation. The within-technique repeatability procedures described here were limited to evaluation of carotid arteries using B mode ultrasound and angiography.

COMPUTED TOMOGRAPHY IN LATE-INFANTILE METACHROMATIC LEUKODYSTROPHY

Computed tomography of 2 patients with late-infantile metachromatic leukodystrophy (MLD) demonstrated generalized white matter lucency and moderate ventricular enlargement. CAT scan findings in other white matter diseases likely to be confused clinically with MLD are sufficiently dissimilar to allow differentiation.