Peter E. Weinberg

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.

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.

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.

Basal ganglia involvement in subacute sclerosing panencephalitis: CT and MR demonstration

We describe a case of subacute sclerosing panencephalitis (SSPE) with clinical parkinsonian features and neuroradiologic abnormalities of the basal ganglia. Prominent basal ganglia involvement may occur in SSPE.

Cyst of the Intraorbital Optic Nerve Sheaths

A 43-year-old woman had a history of gradual unilateral visual acuity loss and proptosis. A 2.5-cm cystic dilatation of the intraorbital dura mater was removed. Microscopic examination revealed a vascular proliferation within the leptomeninges. We inadvertently injected the lesion during orbitography, providing us with an unusual radiographic appearance.

Imaging sacral nerve root cysts.

Sacral nerve root cysts usually are an incidental finding but may be found in patients with a history of pain. On computed tomography they are demonstrated as a soft tissue mass, possibly with associated bony erosion. Demonstrating the fluid-filled nature of these masses is important in establishing the diagnosis. The imaging of these cysts in two patients, including magnetic resonance, is described.

Intracranial complications of pediatric hematologic disorders: computed tomographic assessment.

Computed tomography (CT) findings in the intracranial complications of leukemia, hemophilia, and sickle cell anemia were reviewed in 19 children with these hematologic disorders. CT demonstrated intracranial hemorrhage, infarction, intracerebral mass, and post-therapeutic atrophy and leukoencephalopathy in leukemic children. Intracerebral, subarachnoid, subdural, and epidural hemorrhage was documented in patients with hemophilia. Bland and hemorrhagic infarctions were identified in children with sickle cell anemia. CT proved valuable in documenting the presence and extent of these abnormalities, titrating factor replacement in hemophiliac patients, and monitoring therapeutic toxicity in leukemic patients.

Foramen magnum meningioma.

A 46-year-old woman was initially hospitalized because of neck pain that radiated to the right arm. The pain had begun approximately one year prior to admission and had gradually increased in severity. At the time of admission to the hospital the patient also complained of weakness in the grip of her right hand. Neurological examination revealed only slightly decreased strength in extension of her right wrist. There were no motor or sensory deficits and the deep tendon reflexes were symmetrical. Plain radiograms of the cervical spine demonstrated mild degenerative changes of the lower cervical spine with no evidence of any other abnormality. The patient was discharged from the hospital with a diagnosis of cervical radiculopathy secondary to cervical spondylosis. The patient was readmitted to the hospital five months later complaining of increasing pain in the neck that radiated to the right shoulder and arm, with associated weakness of the right arm. The patient was unable to write with her right hand and she also complained of weakness of her right leg, resulting in difficulty walking and climbing stairs. Neurological examination revealed a spastic right hemiparesis involving the arm more than the leg and increased deep tendon reflexes in the right arm and leg. Sensation to pinprick and light touch was diminished over the anterior aspect of the right arm and there was wasting of the muscles of the right hand.

Silicone encircling bands for retinal detachment: CT appearance.

Silicone encircling bands are placed around the eyeball routinely during retinal detachment surgery. We present two cases that show the characteristic appearance of such a band on CT.

Intradiploic neural heterotopia. A rare calvarial defect.

Two proved cases of intradiploic neural heterotopia of the skull, a rare cause of calvarial defects, are presented. The literature is reviewed. Common radiographic characteristics include an intradiploic rarefaction, a well-defined margin with or without sclerosis, a lobulated appearance with normal intervening bone, or a cluster of multiple lytic areas with normal bone between them.