Pulla R. S. Kishore

Delayed intracranial hematoma in patients with severe head injury.

Serial computed tomography was peformed on 119 consecutive patients suffering from severe head injury. The development of delayed intracranial hematomas, both intra- and extraaxial, was evaluated by comparing the initial scan with subsequent studies. Ten delayed intracerebral hematomas and nine delayed extracerebral collections were encountered. The occurrence of delayed intracerebral hemorrhage is more frequenct than previously reported and is associated with a poor outcome.

Intrasellar Carotid Anastomosis Simulating Pituitary Microadenoma

Arterial communication between the cavernous segments of the carotid arteries associated with agenesis of the unilateral internal carotid artery is a rare anomaly. Two cases of this anomalous artery with an abnormal sella turcica due to the intrasellar course are reported.

Carotid stenosis and intracranial emboli.

Middle cerebral branch occlusions were evaluated relative to lesions in the extracranial carotid arteries, showing increased incidence in patients with irregular and ulcerated plaques compared to those with normal or smoothly stenosed arteries. Limitations in the diagnosis of ulcerative plaques and embolic middle cerebral branch occlusion by angiography are pointed out.

Supratentorial leptomeningeal hemangioblastoma

A familial case of von Hippel-Lindau syndrome with a supratentorial leptomeningeal heman-gioblastoma is reported. This is the first case in which the meningeal origin of a supratentorial hemangioblastoma has been histologically verified in von Hippel-Lindau syndrome.

Intraspinal metastases from retinoblastoma.

Cerebrospinal fluid seeding is a well-known mode of metastasis for intracranial neoplasms such as medulloblastoma, ependymoma, and glioblastoma; however, retinoblastoma is not usually considered. The route of spread appears to be by direct extension into the optic nerve from the retina and into the meningeal spaces by extension from the choroid, or along the central retinal vessels to the subarachnoid space. Four cases are presented.

Spontaneous Disappearance of Carotid Stenosis

Angiographic diagnosis of atheromatous plaques is usually well correlated with surgical and pathologic findings. Hemorrhage into such plaques is believed to be frequent, but is seldom diagnosed angiographically. The authors report a case of intramural hemorrhage into an atheromatous plaque with subsequent resolution. A brain scan of a woman, age 52, with right hemiparesis and dysphasia showed increased isotope uptake in the left frontotemporal region. Arteriography 10 days after onset of symptoms showed a plaque in the left carotid bifurcation. Clinical improvement followed. Repeat arteriography 12 weeks later revealed almost normal left carotid bifurcation.

Familial “Doughnut” Lesions of the Skull: A Benign, Hereditary Dysplasia

Multiple calvarial doughnut lesions present a dramatic roentgenographic picture. The scant literature indicates that they are benign, asymptomatic, and of obscure etiology. Three additional examples of this rare entity have been identified all in the same family and are presented. The implication of a familial relationship with regard to develpmental pathogenesis is discussed. Histology is nonspecific but is felt to be consistent with hyperostosis.

Role of the radionuclide brain image in the diagnosis of brainstem gliomas.

The noninvasive detection of brainstem gliomas remains difficult. Eleven of our patients with proven brainstem gliomas had radionuclide brain imaging prior to the initiation of therapy or confirmation of the diagnosis; six studies were positive. Pneumoencephalography remains the most reliable diagnostic test for brainstem glioma, and is invariably required for confirmation. Although angiography is useful in the evaluation of vasocularity it may not detect small infiltrating lesions. Radionuclide brain imaging is useful in the initial workup of patients with suspected brainstem gliomas.