Richard L. Rovit

Chordoma of the Cervical Spine

Eight cases of chordoma limited to the cervical spine are presented. The radiological features are analyzed. Although there is no single diagnostic feature, the combination of osteosclerosis and lysis, multiple vertebral involvement, and the presence of a pre- or paracervical mass is strongly suggestive of a chordoma. Although none of our patients can be considered cured, we recommend an anterior cervical approach with radical removal of the tumor and interbody fusion followed by immobilization in a halo vest and postoperative radiation therapy. The biological behavior of the tumor is extremely variable, and multiple operations for symptomatic recurrences may be helpful.

Evaluation of brain death by contrast-enhanced computerized cranial tomography.

Four patients with clinical criteria of cerebral death were evaluated by computerized cranial tomography (CT). Upon intravenous infusion of meglumine diatrizoate, the intracranial vascular structures failed to enhance. Two of the patients also had electroencephalographic evaluation, and one patient underwent cerebral angiography, confirming the absence of cerebral blood flow. Contrast-enhanced CT may provide a contributory method in the establishment of cerebral death, in addition to elucidating the etiology of the ictus.

Delayed intracerebral hemorrhage as demonstrated by CT scanning

SummaryThree patients are presented who developed delayed intracerebral hematomas after head injury. Two patients had essentially negative CT scans on admission and developed intracerbral hematomas within 24 h after injury. They required surgical treatment and had fatal outcomes. The third patient presented with an epidural hematoma on CT scan, developed an intracerebral hematoma 48 h after evacuation of the epidural hematoma, and did well with conservative management.

Neuroradiology of the Posthemicraniectomy Patient with Special Emphasis on the Radiology of Unilateral Atrophy

Seventy-five patients underwent hemicraniectomy for acute subdural or epidural hematomas. Of these, 18 were studied postoperatively at intervals from 1 day to 1.5 years. Review of these studies showed that hemicraniectomy, per se, does not affect the position of midline structures or ventricular size. Ipsilateral shifts occur postoperatively only in the presence of a contralateral mass. Ventricular enlargement is more marked on the hemicraniectomy side. RISA cisternography demonstrated ventricular reflux in 3 patients with communicating hydrocephalus. Marked nuclide accumulation was seen in the other patients over the operated side.

Case report: myelopathy secondary to congenital osteopetrosis of the cervical spine.

A rare occurrence of osteopetrosis involving cervical vertebrae and producing a compressive myelopathy is described. Clinical and radiographic findings are presented, and the pathophysiology of this unusual entity is discussed.

Ossification of the posterior longitudinal spinal ligament in association with anterior longitudinal ligament ankylosing hyperostosis: case report.

A case of ossification of the posterior spinal longitudinal ligament in association with anterior ankylosing hyperostosis is presented, with a review of the relevant literature. Improvement followed laminectomy. Evaluation of this entity by computerized tomography is demonstrated.

Huntington’s Chorea Associated with Normal Pressure Hydrocephalus

Two patients with Huntingtons chorea (HC) developed a gait disturbance more suggestive of normal pressure hydrocephalus (NPH) than HC. The diagnosis of NPH was confirmed by pneumoencephalography and isotope cisternography. Both patients were shunted and both showed an improvement not only in their gait but, unexpectedly, a decrease in their abnormal involuntary movements (AIMs). The association of HC with NPH is discussed.

Patton: death of a soldier

General George S. Patton Jr. died as the result of quadriplegia sustained in a car crash in Germany in 1945. His x-ray films revealed a fractured C-3 vertebra and a posterior dislocation of C-4 on C-5. The likely cause of death was a pulmonary embolus. Details of his medical treatment are reviewed and compared with therapies that a patient with a similar injury would receive today.

Myelopathy Secondary to Congenital Osteopetrosis of the Cervical Spine

A rare occurrence of osteopetrosis involving cervical vertebrae and producing a compressive myelopathy is described. Clinical and radiographic findings are presented, and the pathophysiology of this unusual entity is discussed.

Surgical treatment of epilepsy.

Surgical treatment of epilepsy should be considered in selected cases when anticonvulsant therapy has failed. The major factor governing a decision to operate is whether the epileptogenic area can be delineated and removed without significant neurologic sequelae. Complete roentgeno-graphic studies should be carried out in every candidate for operation. Under ideal conditions operation can be performed with virtually no morbidity and an operative mortality as low as 0.5 to 1 percent.