Biomedical subjects
Publications and source records attributed to C Colosimo.
Patients with high myopia may develop a myopathy which frequently results in a sort of convergent strabismus fixus. Echographic and CT scan findings give evidence that a myopathic paralysis of the lateral rectus is supported by a slow pressure on this muscle squeezed between the lateral orbital wall and the enlarged eyeball.
A case of postoperative false aneurysm of the ascending aorta with serial CT and angiographic demonstration is described. Some considerations on the behavior of early thrombosis are discussed.
Patient EDS presented with an amnesic disorder of insidious onset (4 years) that remained stable and restricted to memory functions over a 10-year course. Repeated neuropsychological evaluations over 6 years showed a moderate-to-severe, stable impairment of long-term memory and of memory for public events, and a milder, stable impairment of autobiographic memory and of short-term memory. Language, perception, praxis and 'frontal' functions were fully preserved. MRI showed atrophy of the right hippocampus, of the right mammillary body and of the sylvian fissure (bilaterally, but more marked on the left). On PET scan, metabolic activity in the mesial temporal structures was significantly reduced on the right and was at lower normal levels on the left. The disorder observed in EDS is similar to that recently reported in other patients. Possible etiologies of the selective amnesia observed in EDS are considered and their implications discussed.
The authors review the cases of 40 patients with AIDS who died in 1989, in order to establish the relationships between clinical picture, neuroradiological features and neuropathological findings. Neurological involvement was present in over 75% of the patients, with HIV-related encephalopathy and toxoplasmosis as the most frequent diseases (52.5% and 20.0%). With regard to the cases of AIDS dementia complex (ADC) the authors observed a good correlation between the severity of the clinical manifestations, central nervous system atrophy as observed on computed tomography scan and pathological findings. The survival of AIDS patients with ADC was higher when compared to patients without ADC, suggesting the time-relationship of ADC. AS in the case of toxoplasma encephalitis, a strong relationship between radiological and pathological findings was observed. The presence of toxoplasma encephalitis in patients with radiologic features of healed lesions confirms the need for life-long prophylaxis.
Nine patients presenting with parkinsonian features and no other clinical abnormalities were studied. These patients were evaluated for dopaminergic responsiveness, for cardiovascular reflex autonomic function, and underwent high field magnetic resonance scan. A 0 to 5 point probability score was used to evaluate the possibility that parkinsonian signs were the presenting symptoms of multiple system atrophy (MSA). Five patients were considered at risk for having MSA: three of them were classified as possible MSA cases (score 2-3), two of them were classified as probable cases of MSA (score 4-5). In patients at risk for MSA, no specific pattern of combination of clinical and laboratory data was found; all patients had different combinations of positive findings.
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In this article we propose a review of the literature on clinical variants of Cushing's syndrome (CS) and personal observations on one of these variants. Clinical variants of CS are: (1) tumors of the intermediate pituitary lobe; (2) hypothalamic Cushing's with pituitary hyperplasia; (3) cyclic CS; (4) primitive nodular adrenal dysplasia; (5) pre-Cushing's syndrome; (6) association of CS and empty sella. The personal observations relate to the association of CS and empty sella. This syndrome consists of: (a) inappropriate cortisol secretion of pituitary origin; this alteration is less pronounced in comparison with other patients affected by Cushing's disease; (b) marked hirsutism; (c) slight hyperprolactinemia or augmented PRL response after metoclopramide; (d) elevated DHEAS levels.
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Twenty rheumatoid arthritis (RA) patients with involvement of the cranio-cervical junction (CCJ) were given CT scan. In most cases the myelo-CT technique with the lumbar injection of small quantities of non-ionic contrast medium was adopted; CT easily diagnosed the "horizontal" and "vertical" dislocations on the CCJ, the bone structure lesions and the inflammatory masses. A high frequency of medullary compressions was also found in these patients. Myelo-CT appears to be the technique of choice for the precise definition of the various factors responsible for the neurological complications found in RA of the CCJ.
Cholecystography has been up to day used as unique or first instance examination in patients suspected to have chronic gallbladder diseases. On the other hand, cholecystosonography is proposed with increasing frequence as first examination for simple and rapid detection of cholelithiasis. Results of high standard cholecystography are therefore welcomed in order to assess it present role in respect to diagnostic ultrasounds. On this basis, the authors reports the results of systematic administration of ceruletide in 300 clinically unselected patients with a good opacification at cholecystography. Ceruletide has been demonstrated to be rarely accompanied by a few minor side effects, to have a cholecystokinetic effect more rapid and intense than fatty meal and cholecystokinine and to be followed by frequent diagnostic visualization of cystic duct and choledochus. Small gallbladder stones, diffuse and segmentary cholecystosis and cholecystostasis, with clinical relevance, were easily detected and may be therefore considered as elective indications of ceruletide-assisted-cholecystography. Systemic administration of ceruletide in the course of cholecystography is apt to push its diagnostic possibilities to a maximum extent, allowing appropriate comparison of effectiveness with cholecystosonography in view of their complementary role.
Progressive Multifocal Leukoencephalopathy (PML) is a subacute demyelinating opportunistic infection of the central nervous system which frequently occurs in AIDS. CT and MR, together with clinical and virological findings, can suggest a correct diagnosis in most cases, thus avoiding stereotactic biopsy which is too invasive considering the lack of therapy and the poor prognosis of this disease. In this study we reviewed the CT and MR findings of 16 proved AIDS-related PML cases. PML lesions appeared as hypodense on CT, hypointense on T1w, hyperintense on PDw and T2w MR images. CT was less sensitive than T2w MR images and underestimated the number of lesions and/or disease extent. On the basis of our findings during the progression of the lesions we observed two different patterns of PML presentation and evolution i.e., "single" and "multifocal". Single lesions generally involve subcortical white matter (arcuate fibers) of parietal lobe and spread to the contralateral hemisphere across the corpus callosum; multiple "patchy" lesions can be localized variably in the cerebral hemispheres and also in the brainstem and cerebellar hemispheres.
Central pontine myelinolysis (CPM), a disorder occurring for the most part in alcohol abusers, is characterized by the symmetric and selective destruction of medullated sheaths in the central pontine region. Detection of CPM in the pre-symptomatic phase may improve the outcome, which is usually serious. We describe a case of CPM in a 48-year-old female alcohol abuser who was seen at our out-patient clinic for a history of generalized seizures. Neurological examination was normal while magnetic resonance imaging revealed a pontine lesion consistent with CPM. On the basis of this report we hypothesize that the possibility to detect CPM in the pre-symptomatic phase will lead to increased diffusion of magnetic resonance imaging, and in turn to improved therapeutic strategies, such as the use of greater caution when correcting plasma electrolyte imbalance in alcoholics.
Gliomatosis cerebri (GC) is a rare, diffusely infiltrating tumor of neuroepithelial origin. The clinical diagnosis is difficult since GC is a diffuse and progressive disease of the central nervous system (CNS). Non-specific findings can be detected by computed tomography (CT) whereas, according to some authors, the extent of this tumor can be accurately depicted by magnetic resonance imaging (MRI). In this paper the neuroradiologic, neuropathologic and immunohistochemical features in a further case of GC are reported.
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