Richard S. Pinto

Evaluation of Sellar and Parasellar Masses by Computed Tomography

Computed tomography is the method of choice for initial evaluation of patients with potential suprasellar masses. In our experience, CT has proved completely reliable for detecting or ruling out the presence of a suprasellar mass, the direction and degree of parasellar extension, and the presence of any calcific or cystic component of the lesion. When multiple cut CT has been negative, further diagnostic studies have proved unrewarding. When CT has been positive, additional studies have been required in some cases to rule out aneurysm prior to craniotomy.

Comparison of magnetic resonance angiography, conventional angiography, and duplex scanning.

Background and Purpose To determine the accuracy of magnetic resonance angiography in assessing patients with cerebrovascular disease, we performed a study comparing the results of conventional cerebral angiography, duplex scanning, and magnetic resonance angiography. Methods From 42 patients, a total of 25 carotid arteries were evaluated by all three techniques. The studies were independently read and sorted into five categories according to the degree of stenosis: 0–15%, normal; 16–49%, mild; 50–79%, moderate; 80–99%, severe; and totally occluded. Results Magnetic resonance angiography correlated exactly with conventional angiography in 39 arteries (52%); duplex scanning correlated with conventional angiography in 49 cases (65%). Compared with conventional angiography, both magnetic resonance angiography and duplex scanning tended to overread the degree of stenosis. The most critical errors associated with magnetic resonance angiography were three readings of total occlusion in vessels found to be patent on conventional angiograms. Conclusions Although magnetic resonance angiography offers great hope of providing high-quality imaging of the carotid artery with no risk and at less cost, data from this study suggest that misreading the degree of stenosis, or misinterpreting a stenosis for an occlusion, could lead to errors in clinical decisions. Guidelines for use of magnetic resonance angiography in a clinical setting are offered.

Computed Tomography of Arachnoid Cysts

The typical CT appearance of intracranial arachnoid cysts may obviate additional neuroradiological procedures. Ventriculography using water-soluble contrast media may differentiate a suprasellar arachnoid cyst from a dilated third ventricle. Twelve cases are presented.

Cerebral arteritis in scleroderma.

Central nervous system (CNS) involvement is rare in scleroderma unless there are concomitant abnormalities in renal or lung function or malignant hypertension. A 43-year-old woman with typical scleroderma developed subacute encephalopathy despite absence of the above abnormalities. Cerebral angiography demonstrated a focal arteritis. The patient improved while being given corticosteroids. We believe this case indicates that cerebral arteritis can occur in scleroderma.

ANGIOGRAPHIC FINDINGS IN BRAIN DEATH

With advances in medical techniques, “life” may be supported even though irreversible brain t damage has occurred. To avoid prolonged efforts to maintain a brain-dead patient until systemic death occurs and to conserve organs for transplantations, it is necessary to rely on a diagnostic test that would aid in conclusively determining the irreversibility and scope of the cerebral insult. Although isotopic determination of a cerebral blood-flow deficit is a rapid and reliable diagnostic adjunct to determine cerebral t death,3-sv l6, l7 there are times that in the clinical judgment of the examining neurologist, angiography is required before it can be stated with certainty that brain death has occurred. Angiography may thus be necessary when the isotopic bolus study demonstrates an “intermediate” or small bolus pattern or is technically unsatisfactory, or when the EEG is not unequivocally isoelectric. Furthermore because of technical considerations the bolus technique is primarily limited to use in adults.15 Therefore intracranial angiography may be necessary to document brain death in infants and small children. Many European authors maintain that the sine qua non of brain death rests with the demonstration of absence of intracranial circulation by angiography.?. s~ 2 3 Though serving a limited role in the diagnosis of brain death, the findings at angiography are recorded so that when this diagnostic test is used as the final confirmation of the determination of death, no confusion will result. It is our belief that when the advocates of angiography become familiar with the results obtained by the bolus technique, they will rarely resort to angiography.

Correlation between computed tomography and intracranial pressure monitoring in acute head trauma patients.

A preliminary retrospective correlation between computed tomographic scans and intracranial pressure (ICP) monitored was performed for 21 patients. No patient with a normal CT scan had elevated ICP. The lowest correlation was noted with slit ventricles; the highest, with dilatation of the contralateral temporal horn.

Coincidental pituitary adenoma and cerebral aneurysm with pathological findings.

Abstract A rare case of pituitary adenoma associated with an intrasellar cerebral aneurysm is presented with autopsy findings. The pertinent literature is reviewed.

Bilateral Cervical Carotid and Intracranial Vasospasm Causing Cerebral Ischemia in a Migrainous Patient: A Case of "Diplegic Migraine"

SYNOPSIS

Myelographic cervical nerve root deformities.

Myelograms of nerve roots and adjacent subarachnoid space were reviewed to characterize 231 cervical root deformities from both symptomatic and asymptomatic patients. Good correlation between specific features of root deformities and clinical significance could not be demonstrated. Some features were slightly suggestive of clinical significance but occurred in a sufficient number of asymptomatic patients to make them unreliable. The most accurate determinants of root deformity significance are clincal and electromyographic findings.

Computed tomography of calcification and ossification of posterior longitudinal ligament of the spine

Calcification of the posterior longitudinal ligament occurs in about 3% of adults in Japan, and in about 0.7% of hospitalized adults with spinal symptoms in the United States. The condition may be asymptomatic, however, in patients with a stenotic spinal canal or when the calcification is large, it may cause compression of the spinal cord and myelopathy. The radiographic diagnosis is made when a band of calcification is noted in the spinal canal directly posterior to the vertebral bodies. Lateral tomograms of the spine are helpful for detection and measurement of the exact thickness of the calcification. Computed tomography is particularly helpful because it reveals the thickness and the extent of lateral extension of the calcification, as well as the size of the spinal canal and the extent of its narrowing by the calcification. Seventeen patients evaluated by computed tomography are reported.