Palacios E

Radiology of Cysticercosis of the Central Nervous System Including Computed Tomography

Cysticercosis is a parasitic disease in which man serves as the intermediate host of Taenia solium, the pork tapeworm. The larvae have a predilection for the central nervous system and can cause a variety of neurologic and psychiatric symptoms. Areas of involvement are classified as intraventricular, parenchymal, arachnoidal, and mixed. The diagnosis is made primarily by roentgenographic and spinal fluid examinations. The authors reviewed 232 cases of cysticercosis involving the central nervous system. It was found that computed tomography is a useful tool in assessing this illness.

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.

Ossification of the Posterior Longitudinal Ligament Associated with a Herniated Intervertebral Disk

An unusual case of extensive ossification of the posterior longitudinal ligament of the cervical spine is presented. No symptoms referable to the ossified ligament were elicited prior to the acute herniation of an intervertebral disk through the ossified ligament. Spinal cord compression produced by the ossification and the disk was demonstrated by myelography and verified by surgical and autopsy findings.

Exposure of Radiologists During Special Procedures

During special procedures, radiologists may receive substantial radiation exposure, especially to the unprotected lens of the eye: 92% of a radiologists exposure at arteriography is due to radiography at the time of contrast medium injection. The mean lens exposure per exam is 5.8 mR for cerebral and 27.1 mR for abdominal arteriograms. Unshielded by the lead apron, a front-collar film badge overestimates lens exposure by 20% for cerebral and underestimates by 20% for abdominal arteriograms. Since most exposure occurs during contrast medium injection, manual injection should be avoided whenever possible.

Propionic Acidemia: Case Report and Review of Neurologic Sequelae

We describe late-onset propionic acidemia in a 12-year-old boy who presented with vomiting, cough, and fever, and manifested a precipitous decline in mental status, accompanied by acute encephalopathy and severe neurologic damage, with bilateral basal ganglia involvement upon neuroimaging. He exhibited metabolic acidosis, hyperammonemia, hypocarnitinemia, and elevated plasma glycine. Urinary organic-acid analysis demonstrated very highly elevated 3-hydroxypropionate, propionylglycine, methylcitrate, and tiglylglycine, without an elevation of methylmalonate. Despite intensive medical care, this particular case proved fatal, highlighting the importance of metabolic testing in cases of acute mental-status changes and encephalopathy of unknown etiology.

The use of multislice CT angiography preoperative study for supraclavicular artery island flap harvesting.

BackgroundThe vascular anatomy of the supraclavicular artery island (SAI) flap has been investigated using both cadaveric anatomic dissections and angiographic studies. Accurate preoperative evaluation and localization of its vascular pedicle confirms its location, course, anatomic variation, and improves flap success. The objective of this report is to demonstrate the utility of multislice computed tomography (CT) angiography for confirming the presence of the vascular pedicle of the SAI flap when planning head and neck reconstruction. MethodsPatients were studied using 64-multislice CT angiography (CTA) to localize the supraclavicular artery, including its origin and destination. Axial images, multiplanar reconstructions, and 3D volume-rendered images were analyzed on a Philips workstation. Radiologic image findings and clinical experience will be described. ResultsSAI CT angiography was successfully performed in 15 patients (30 shoulders) ranging from ages 22 to 81 years. Accurate identification of the main vascular pedicle was achieved in 14/15 patients. Location, course, pedicle length, and anatomic variations were reported for 23 of 30 arteries. Mean vessel diameter was found to be 1.49 mm (range, 0.8–2.0 mm) on the right and 1.51 mm (range, 1.0–2.1 mm) on the left. The mean length of the artery was 38.3 mm on the right (range, 26.6–59.6 mm) and 38.4 mm on the left (range, 24.3–67.0 mm). In all patients, the supraclavicular artery originated off the transverse cervical artery—a branch of the thyrocervical trunk. Positioning of the patient’s upper extremities at the side was helpful in the identification of the supraclavicular artery and its distribution. Contrast injection site should be contralateral to the side needed for the flap if sidedness is of importance, secondary to contrast bolus artifact. ConclusionsPreoperative evaluation of the SAI flap with multislice computed tomography angiography is feasible in patients. A radiologic study protocol has been developed which improves the ability to detect this vessel. This technique provides a noninvasive approach to the identification of the vascular anatomy and is easily standardized/reproducible. The identification of the vascular pedicle and its anatomy can be a benefit to the surgical team during preoperative design of the SAI flap; however, clinical experience confirming these radiologic findings will be needed to optimize surgical outcome.

Fungal Infections of the Central Nervous System: A Pictorial Review.

Fungal infections of the central nervous system (CNS) pose a threat to especially immunocompromised patients and their development is primarily determined by the immune status of the host. With an increasing number of organ transplants, chemotherapy, and human immunodeficiency virus infections, the number of immunocompromised patients as susceptible hosts is growing and fungal infections of the CNS are more frequently encountered. They may result in meningitis, cerebritis, abscess formation, cryptococcoma, and meningeal vasculitis with rapid disease progression and often overlapping symptoms. Although radiological characteristics are often nonspecific, unique imaging patterns can be identified through computer tomography as a first imaging modality and further refined by magnetic resonance imaging. A rapid diagnosis and the institution of the appropriate therapy are crucial in helping prevent an often fatal outcome.

Magnetic resonance imaging of the internal auditory canal.

Magnetic resonance imaging (MRI) is presently the study of choice for assessment of the internal auditory canal (IAC). MRI provides excellent assessment of the IAC and the bony changes occurring in the canal walls, and it provides excellent demonstration of the content of the canal. Pathological processes arising within the IAC are well visualized by various MR sequences. The possibility of demonstrating masses as small as 2 mm has propelled MRI into the leading role for diagnosis of vestibular schwannoma. Unfortunately, the high cost of MR has been a limiting factor in its use as a screening test for patients with sensorineural hearing loss (SNHL) of unknown origin. Auditory brain stem response has been widely used as a screening procedure, but this test fails to recognize small lesions and cannot be used whenever hearing loss is severe. In this article, we will discuss our approach to assessment of the IAC in patients with retrocochlear SNHL or vestibular symptoms of central origin, review the pathological processes involving the IAC walls or arising within the canal, emphasizing the appropriate MRI sequences used for diagnosis.

Klinefelter's Syndrome in a 5-Year-Old Boy with Behavioral Disturbances and Seizures

Klinefelter’s syndrome (KS) is a sex chromosomal aneuploidy with a prevalence of approximately 1 in 500 live male births. KS is characterized by a range of abnormalities, including increased height, language delay, hormonal alterations, motor coordination difficulties, and hypogonadism. Seizures affect 5% of individuals with KS and antiepileptic drug efficacy is often suboptimal. Psychiatric symptoms, including hallucinations, mood and anxiety disorders, hyperactivity, impulsivity, and autistic behaviors have also been associated with KS. 1– 8 In young children, these symptoms may be difficult to differentiate from other psychopathology. 9 Unfortunately, KS is often not diagnosed until puberty. 3 We present a case of a 5-year-old with significant behavioral disruptions and seizures who was subsequently found to have KS and a maternally inherited 15q duplication/ deletion. This case highlights a critical research gap in the treatment of medically ill children with co-morbid psychiatric conditions and reinforces the benefit of genetic testing in young children with complex neuropsychological presentations. The demonstration of a second genetic abnormality offers support for a novel hypothesis whereby the range of symptoms in KS individuals may be explained by additional structural changes in their chromosomes, potentially missed by standard karyotype testing.

Diagnosis of sellar and parasellar lesions by computed tomography and other diagnostic modalities

A review of 5,000 computed tomographic (CT) brain scans revealed 76 patients with proved pathology involving the sellar and parasellar areas. The overall diagnostic accuracy of CT scanning was 93.4%, whereas the accuracy of isotope scanning, angiography, and pneumoencephalography was 55.4, 81 and 100% respectively. The criteria used in making the diagnosis with CT scanning are listed. The results indicate that CT scanning is the initial diagnostic procedure of choice, but that other modalities, particularly angiography, are still required for more accurate evaluation in the majority of cases.