Søren Ole Stigaard Cortnum

Determining the sensitivity of computed tomography scanning in early detection of subarachnoid hemorrhage

Medical management is often the initial management of cervical spondylitic syndromes, including radiculopathy, myelopathy, and neck pain. This includes pharmacological and rehabilitation treatment. Prospective studies comparing the efficacy of surgical versus medical management are lacking. The indications and efficacy of pharmacological and rehabilitative treatments are reviewed. The use of anti-inflammatory drugs, muscle relaxants, analgesics, antidepressants, anticonvulsants, steroids, facet joint ablation, and physical therapy are reviewed. A rationale for the medical management of acute neck pain, chronic neck pain, radiculopathy, and myelopathy is presented.

Spatial distribution of malignant tissue in gliomas: correlations of 11C-L-methionine positron emission tomography and perfusion- and diffusion-weighted magnetic resonance imaging

Background The prognosis of glioma patients is contingent on precise target selection for stereotactic biopsies and the extent of tumor resection. 11C-L-methionine (MET) positron emission tomography (PET) demonstrates tumor heterogeneity and invasion with high diagnostic accuracy. Purpose To compare the spatial tumor distribution delineated by MET PET with that by perfusion- and diffusion-weighted magnetic resonance imaging (MRI), in order to understand the diagnostic value of these MRI methods, when PET is not available. Material and Methods Presurgical MET PET and MRI, including perfusion- and diffusion-weighted MRI, were acquired in 13 patients (7 high-grade gliomas, 6 low-grade gliomas). A quantitative volume of interest analysis was performed to compare the modalities objectively, supplemented by a qualitative evaluation that assessed the clinical applicability. Results The inaccuracy of conventional MRI was confirmed (area under the curve for predicting voxels with high MET uptake = 0.657), whereas cerebral blood volume (CBV) maps calculated from perfusion data improved accuracy (area under the curve = 0.760). We considered CBV maps diagnostically comparable to MET PET in 5/7 cases of high-grade gliomas, but insufficient in all cases of low-grade gliomas when evaluated subjectively. Cerebral blood flow and apparent diffusion coefficient maps did not contribute to further accuracy. Conclusion Adding perfusion-weighted MRI to the presurgical protocol can increase the diagnostic accuracy of conventional MRI and is a simple and well-established method compared to MET PET. However, the definition of low-grade gliomas with subtle or no alterations on cerebral blood volume maps remains a diagnostic challenge for stand-alone MRI.

Recurrence of chronic subdural haematomata with and without post-operative drainage

Chronic subdural haematoma is a common disease causing morbidity and mortality. Recurrence after surgical treatment is common, varying from 5% to 30% of cases. Several methods for reducing recurrence have been advocated. The aim of this study was to investigate the effect of post-operative subdural drainage. Three hundred forty-four patients were included in a retrospective study. Treatment was performed by burr hole irrigation. Groups were separated into those with post-operative drainage compared to those without. Recurrence occurred in 14% in the drained group, significantly less than 26% in the undrained group (p = 0.011). There were no differences in the complication rates. Post-operative drainage reduces recurrence of chronic subdural haematoma without increasing the complication rate. These results support those reported in several other studies. We recommend the use of post-operative subdural drainage.

Raised intracranial pressure as a result of pansynostosis in a child with Albright’s hereditary osteodystrophy

CaseThe authors describe the case of an 8-year-old boy with pansynostosis in the context of Albright’s hereditary osteodystrophy (AHO). This condition had lead to raised intracranial pressure (ICP). The elevated ICP was a consequence of the rigid skull impeding brain growth. Therefore, a decompressive cranioplasty was performed successfully, leaving further space for the growing brain.Affection of the central nervous system has been documented in AHO. However, affection of the skull bones has rarely been described in literature.ConclusionWe suggest that craniosynostosis may develop in patients with AHO and other types of pseudohypoparathyroidism (PHP). Furthermore, we suggest regular head circumference-for-age and ophthalmic examination for children with AHO or other types of PHP.

Bilateral Wyburn-Mason Syndrome presenting as acute subarachnoid haemorrhage - a very rare congenital neurocutaneuos disorder

SummaryA 30 year old young male was admitted to our department after experiencing clincal symptoms of a subarachnoid haemorrhage. Imaging studies revealed large cerebral AVMs. Fundus examination of the left eye demonstrated a retinal racemose AVM almost completely covering the posterior pole of the eye. Wyburn-Mason syndrome is a very rare congenital neurocutaneuos disorder comprising of vascular malformations of the retina, ipsilateral cerebral AVMs and occasionally lesions in the oronasopharyngeal area. Subarachnoid haemorrhage associated with Wyburn-Mason syndrome has been described in only 5 patients in the literature since 1973. The finding of retinal AVMs should warrant cerebral imaging studies including CT- or MR-angiography.