Ruth D. Snow

Stenotic origin of an aberrant left subclavian artery from a right-sided aortic arch. A case report.

A patient with a right-sided aortic arch giving origin to an aberrant left subclavian artery with circumferential ostial stenosis is reported. This asymptomatic anomaly was discov ered serendipitously during cerebral arteriography for subarachnoid hemorrhage. The embryologic origin of this anatomic variant is discussed, as are some practical implica tions relating to the angiographic technique of selective catheterization of branches of the aortic arch.

Enhancing transdural lumbar disk herniation

Transdural migration of an intervertebral disk fragment is accompanied by more severe clinical manifestations than the more common extradural disk herniation. We report on two patients with transdural lumbar disk herniation who had had no previous surgery. In both, there was intense enhancement of the intradural disk material on magnetic resonance imaging. The pathological specimen showed vascularization of the intradural fibrocartilage in one patient.

Skeletal findings in Marinesco-Sjögren syndrome

Abstract Objective. To describe the appearance and frequency of skeletal abnormalities associated with the Marinesco-Sjögren syndrome of cerebellar ataxia, congenital cataracts, mental and physical retardation and myopathy. Subjects and methods. Seventeen individuals affected with the disorder, of common ancestry and marked consanguinity, were found in an isolated area in southwest Alabama; 11 were available for radiologic examination of parts of the skeleton. The range and frequency of skeletal abnormalities thus demonstrated were tabulated. Results and conclusion. A constellation of cranial and extracranial skeletal abnormalities – including a small posterior fossa, spinal abnormalities, gracile bones, elbow and hip valgus and asymmetric metacarpal and metatarsal shortening – can lead the radiologist or orthopaedist to suggest the diagnosis, especially if appropriate neurological/neuroradiological findings also are present.

Case report 874

Fig. 1. A Uncontrasted coronal computed tomogram (CT) of the orbit shows a 2-cm partially calcified subperiosteal mass in the superolateral aspect of the orbit, accompanied by thinning and elevation of the orbital plate of the frontal bone. B Postcontrast axial CT shows mild enhancement of the mass. Inferior displacement of the orbital contents is obvious in both planes Fig. 2. On presentation for ophthalmological examination, the patients left eyelids were swollen with narrowing of the palpebral aperture. Compared to its counterpart, the left eye was displaced anteriorly, inferiorly, and nasally

Hypertrophic synovitis and osteoarthritis of the cervical facet joint report of two cases

We report two cases of cervical facet joint osteoarthritis associated with radiculopathy. Contrast-enhanced computed tomography showed a halo of enhancing soft tissue surrounding the facet joints and narrowing the neural foramen. Hypertrophic synovial masses were discovered and removed at the time of operation in each case, resulting in relief of the radicular symptoms.

Absence of flow in ovarian vein by time-of-flight magnetic resonance angiography without evidence of thrombosis

A case of absent flow in the left ovarian vein was diagnosed on time-of-flight (TOF) magnetic resonance angiography (MRA) while investigating for pelvic vein thrombosis in a 53-year-old female. This appearance should not be misdiagnosed as a sign of ovarian vein occlusion or thrombosis. Magnetic resonance imaging (MRI) is a sensitive noninvasive imaging modality in such a clinical setting. Familiarity with the potential pitfalls of different MRA techniques is essential for correct diagnosis. A review of different MRA techniques in evaluation of pelvic venous thrombosis is presented.

Magnetic resonance imaging of truama patterns in the knee

This review describes how knee trauma results in recognizable patterns of soft tissue and osseous injury. The features of these injuries on magnetic resonance imaging are described, and examples are presented. Recognition of these magnetic resonance patterns of knee trauma will help the radiologist more accurately diagnose the type and extent of knee injuries.

Marinesco-Sjögren Syndrome: Neuroradiologic Findings

We report the neuroradiologic manifestations of Marinesco-Sjögren Syndrome, an autosomal recessive disorder characterized by cerebellar ataxia, congenital cataracts, mental and physical retardation, skeletal anomalies and myopathy. Our patient population included eight patients (five males and three females), aged 4 to 56 years, with mental retardation, cerebellar ataxia and myopathy. Clinical and genetic evaluations were performed in all patients. Four patients underwent muscle biopsies. Nine CT examinations, seven MR examinations and two lateral skull films were performed. All patients had absent lenses and hypoplasia of vermis and cerebellar hemispheres. All except one (who had a posterior fossa arachnoid cyst) had a small posterior fossa. The neuroradiologic hallmarks of the disease are cerebellar hypoplasia, small posterior fossa and absence of the lens secondary to early cataract extraction. The role of imaging is to suggest this syndrome in the differential diagnosis of small posterior fossa or hypoplastic cerebellum and congenital cataracts. The presence of characteristic clinical findings and history of consanguineous marriage help in reaching the final diagnosis.

MR Angiography in Sickle Cell Disease: Usefulness of Orthogonal 3D-TOF Examinations in Elimination of Artifactual Flow Gaps

We compared maximum intensity reconstructions (MIPs) of intracranial 3D-TOF MR angiograms performed in 2 orthogonal planes (axial and coronal) with MIP of MRA in the axial plane only in patients with sickle cell disease. MR imaging has revealed ischemic changes in asymptomatic patients (1). Because artifactual MRA flow gaps are recognized in areas of rapid flow turbulence (2) such as are reported in proximal middle cerebral artery (M1) segments in this disease (3), there may be a tendency to inaccurately estimate stenoses on MRA (2). Orthogonal MIP studies in this population may improve accuracy of MRA. Nineteen patients with sickle cell disease (9 asymptomatic, 10 with suspected stroke) and 6 controls were studied using 3D RF-FAST MRA in both axial and coronal planes. MIP images were viewed in rotations about the spinal axis and flow gaps observed to be present or absent in supraclinoid internal carotid arteries (ICAs) and Ml segments. Kappa statistics were used to measure degree of agreement between paired axial and orthogonal MIP images in “series”. Addition of coronal MRA changed results from positive to negative in 1 asymptomatic patient 1 control but did not change results in 10 symptomatic patients. Kappa statistics showed agreement ranging from fair to substantial. Probability of flow gaps in ICAs and Ml segments in orthogonal MIPs ranged from 0.28 to 0.40, compared with axial MIP only of 0.40 to 0.52, respectively. Our results suggest that using axial and coronal MRAs in “series” in sickle cell disease may increase specificity and positive predictive value.

Backache, Unsteady Gait, Incontinence, and Large Thoracic Epidural Mass

Unsteady gait with frequent falls and urinary incontinence appeared over a period of a few days in a 6‐year‐old girl with a long history of backache. A large posterior epidural mass involved the lower thoracic vertebral canal and extended over several vertebral levels, suggesting a diagnosis of epidural hemorrhage with spinal cord compression. Examination of a surgical specimen led to a different diagnosis.