Ziad L. Deeb

MR imaging in the diagnosis of spontaneous spinal epidural hematomas.

Three patients with spontaneous (idiopathic) spinal epidural hematomas were diagnosed with magnetic resonance (MR) imaging. Magnetic resonance is an accurate, rapid method of localizing and characterizing the hematomas. We believe that MR (where available) should be the primary method of diagnosis in cases in which spinal epidural hematoma is suspected.

Patterns of high-speed impact injuries in motor vehicle occupants

Trauma from high-speed motor vehicle accidents is a leading cause of death and disability. Most of these injuries could be prevented if the driver and occupants of motor vehicles wore seatbelts or used other restraining devices. The injuries produced when an unrestrained occupant of a motor vehicle is ejected from that vehicle or impacts on a hostile surface at high speed occur in a reproducible pattern. The types of injuries sustained by drivers and front seat passengers are different and specific enough to allow one to identify drivers and passengers with confidence. Because of severe life-threatening injuries to the central nervous system, and thoracic and abdominal viscera, other serious injuries may be overlooked. Knowledge of the mechanism of injury and the role of the victim (i.e., driver or passenger) should lead to the prompt radiographic evaluation of all areas at risk. Our findings are based on a study of 250 drivers and 250 front seat passengers involved in motor vehicle accidents. We found distinct common injury patterns and radiographic findings in drivers and front seat passengers.

Tortuous vertebrobasilar arteries causing cranial nerve syndromes: screening by computed tomography.

Considerable concern with cranial nerve syndromes has often required detailed information of the relationship between the vertebrobasilar system and the brainstem. The obvious invasiveness of conventional vertebral angiography poses the question of whether computed tomography (CT) might serve as a satisfactory technique or even as a sufficient diagnostic method. During a 12 month period, 12 of 250 patients with cranial nerve syndromes were diagnosed by CT as having vertebrobasilar ectasia. This communication correlates the clinical symptomatology with angiography and CT and presents evidence that CT alone can prove satisfactory.

Computed Tomographic Diagnosis of Suprasellar Masses by Intrathecal Enhancement

Ten suspected suprasellar mass lesions were evaluated by CT cisternography (CTC). In each case the cisterns could be defined. Suprasellar mass lesions were found in six. Precise assessment of the anterior, lateral, posterior, and superior extent, made by metrizamide CTC, was verified at surgery. In two masses the intravenously enhanced scan was not diagnostic, while a lesion was visualized by intrathecal (metrizamide) CT. The major diagnostic entity was an enlarged third ventricle. When a chiasmic lesion is suspected and the conventional scan is negative, metrizamide CTC is the examination of choice.

An Evaluation of Current Diagnostic Radiologic Modalities in the Investigation of Acoustic Neurilemmomas

The radiologic investigation of patients with suspected acoustic neurilemmomas may include specialized plain films, thin-section tomography, CT scanning with intravenous contrast enhancement, Pantopaque cisternography, radionuclide scanning, angiography, and pneumoencephalography. Recently we have used intrathecally enhanced (Amipaque)2 CT cisternography tostudy the cerebellopontine angles and fourth ventricle. An assessment is made of the differential diagnostic value and limitations of radiologic modalities both in tumor detection and in accurate localization. A protocol designed to optimize use of the available radiologic modalities is projected from 30 patients with acoustic neurilemmomas.

Metrizamide computed tomography cisternography: pediatric applications.

The methodology and clinical use of metrizamide (Amipaque) computed tomography (CT) cisternography are described as applied in the cases of 22 children with morphologic and physiologic abnormalities affecting the cranial portion portion of the central nervous system. In contrast to pneumoencephalography, CT cisternography affords equivalent or superior visualization of the basal cranal subarachnoid spaces with simpler technique and low morbidity. Intrathecal metrizamide enchancement in children causes a very low incidence of side effects.

MAJOR CEREBRAL VESSELS INJURY CAUSED BY A SEATBELT SHOULDER STRAP: CASE REPORT

Major cerebral arterial injury may result from penetrating or blunt trauma. In blunt trauma, clinical suspicion of such injury may not be raised, especially if the cranial CT scan is negative. We report a case of a seatbelt shoulder strap to the neck resulting in injury to three major cerebral vessels as demonstrated by cerebral angiography. Although the initial cranial CT scans were negative, a cerebral infarction ultimately developed. The patient was managed conservatively and recovered most of her functions. The importance of clinical suspicion and cerebral angiography is stressed.

MR imaging of heterotopic gray matter.

Heterotopic gray matter nodules have long been recognized by pathologists at autopsies. A case of this cerebral congenital abnormality has been studied by CT and magnetic resonance.

MR RECOGNITION OF POSTERIOR LUMBAR VERTEBRAL RING FRACTURE

Four cases of lumbar vertebral ring fracture, in which magnetic resonance (MR) was used, were reviewed. The MR features included (a) discontinuity and truncation of the posteroinferior vertebral body, (b) displacement of the avulsed low signal fragment, and (c) disk prolapse subjacent to the fragment. Recognition of these findings may eliminate the need for other diagnostic studies.

A new method for uncoiling knots in angiographic tubing

SummaryTechniques for uncoiling knots formed in catheters during angiography have been the subject of several previous reports. A new technique for catheter unknotting is presented, based on the use of graded flexibility guidewires. The application of this graded taper method appears particularly pertinent to uncoiling softer, narrow-caliber, adversely looped catheters. Moreover, the mechanisms of knot uncoiling in the previous reports are reassessed and their imprecisions corrected.