Michael Fine

Malignant Lymphoma of the Nervous System

The radiological findings in 22 patients with malignant lymphoma of the nervous system are reviewed in relation to the clinical and histological features. The radiological findings were grouped into four major categories: intracranial, orbital, nasopharyngeal, and spinal. A fifth category, complications. was considered separately. The common neuroradiological manifestations of nervous system lymphoma are reviewed and compared with the recent literature.

Complex partial seizure-induced transient MR enhancement.

A 58-year-old man with complex partial seizures had transient symmetrical MR enhancement in the anterior mesiotemporal cortex bilaterally, correlated with the sites of seizure focus on electroencephalography. Preinfused T1-weighted and T2-weighted sequences showed no abnormality. After adequate control of seizures with medication, repeat MR was normal and the prior enhancement was no longer seen. This transient seizure-induced MR enhancement was consistent with ictal or postictal hyperemia and breakdown of the blood-brain barrier and should not be erroneously attributed to mesial temporal sclerosis, encephalitis, tumor, or infarction.

Radiologic evaluation of tuberculous meningitis.

Five cases of primary tuberculous meningitis are presented. In three cases of acute meningeal process, the classic computed tomographic (CT) scan findings of basal meningeal enhancement, hydrocephalus and arteritis on angiography were found. These radiologic findings suggested the diagnosis, and antituberculosis treatment was therefore instituted at an early stage of the disease. In the remaining two cases with late complication of tuberculous meningitis, hydrocephalus and basal vessel arteritis were present. The importance of correlation of the clinical and radiographic findings is discussed.

Differentiation of benign versus metastatic vertebral body compression fractures

Six patients with benign fractures showed a sharply demarcated vertical band of preserved bone marrow along the dorsal one-third of the compressed vertebral body, while the anterior two-thirds showed decreased signal intensity (SI) with a T1-weighted sequence. This “posterior band sign” seen in benign, and not seen in metastatic, fractures correlates well with the biochemical theory of the “three column spine”. The latter defines compression fracture by an intact “middle column” which includes the dorsal one-third of the vertebral body, posterior annulus fibrosus, and posterior longitudinal ligament. Metastatic fractures showed either complete or irregular bone marrow replacement of multiple vertebral bodies and of posterior elements. Other benign patterns included a horizontal band of low SI adjacent to the superior or inferior vertebral endplate, isointense or increased SI of the vertebral body in images with a T1-weighted sequence. Two fractures were indeterminate.

Cerebellar Infarction – Clinical and Cranial Computerized Tomography Correlations

We analyzed the clinical and cranial computerized tomographic (CT) features of 10 patients with cerebellar infarction. Among patients with recent cerebellar infarction, the initial CT often failed to demonstrate any recognizable abnormality. Because early neurological deterioration may arise despite normal CT studies, a high level of clinical awareness is critical for appropriate intervention.

Neonatal Posterior Fossa Subdural Hematoma

Hemorrhage into the posterior fossa is a rare neurosurgical emergency in neonates. CT scanning is diagnostic. Blood layering under the apex of the tentorium cerebelli, however, may resemble a dilated vascular structure, and the rigidity of the pressured tentorium may prevent upward transmission of increased intracranial pressure, resulting in a soft fontanelle.

Evaluation of intracerebral hematoma by computed tomography

The CT scan appearances of acute intracerebral hematoma are usually diagnostic, and can be differentiated from hemorrhagic tumor and infarction. Some prognostic evaluations can be made, depending on the site and size of the hemorrhage. Sequential studies indicate resolution of the density of the hematoma over a period of approximately six weeks. This however does not appear to correlate with pathological resolution, but does reflect the hemoglobin concentration in the hematoma. Angiography is indicated when an underlying AVM or aneurysm is suspected, whereas contrast infusion studies are not of great value in detecting these lesions.

Importance of metrizamide CT for evaluation of the thoracic spine

Post-metrizamide myelographic CT of the area of interest is indicated in cases in which myelography is normal, and also in cases in which myelographic findings alone cannot explain the patients symptoms. Obtaining early and 4-6 hour delayed CT is of great importance for the detection of syringomyelia and cystic lesions of the cord. In cases of congenital anomalies, additional information can be obtained by this method. This paper presents our experiences at Loyola University Hospital.

Foster-kennedy syndrome due to optochiasmatic arachnoiditis

A case of optochiasmatic arachnoiditis mimicking Foster-Kennedy syndrome is reported. The difficulties in establishing diagnosis are considered, and the literature of optochiasmatic arachnoiditis presenting in this unusual manner is reviewed.

Recurrent disc herniation versus scar: triple- versus single-dose gadoteridol

We carried out MRI to evaluate possible recurrent herniated nucleus pulposus (HNP) before and after i.v. infusion of 0.1 mmol/kg gadoteridol, immediately followed by an additional 0.2 mmol/kg and repeat imaging in 21 patients. In comparison with standard 0.1 mmol/ kg gadoteridol, images at a cumulative 0.3 mmol/kg demonstrated increased epidural enhancement, increased enhancement of intradural and affected S1 nerve roots. The level of certainty in MRI diagnosis of recurrent HNP at 0.3 mmol/kg was decreased in 5, increased in 1, and unchanged in 4 patients compared with standard dose. The triple dose was not advantageous for identification of recurrent HNP, owing to the increased peridiscal and S1 nerve root enhancement, which masked the displaced S1 nerve root and decreased the conspicuity of HNP.