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Biomedical subjects

C L Rumbaugh

Publications and source records attributed to C L Rumbaugh.

At least 19 recordsLinked to original sources
PubMed1988

What is expected of CT in the evaluation of stroke?

This study was based on 5042 cranial CT examinations in a 2-year period. 19.8% of all cranial CT scans were performed for confirmation or evaluation of clinically suspected stroke. 87% of the clinical diagnoses of stroke were confirmed by CT scan. Intracranial hemorrhage made up a small percentage in this study. The establishment of this diagnosis was a valuable service in the patients' management. Brain tumor may rarely present clinical symptoms mimicking stroke and may have a normal CT initially.

Cerebral Hemorrhage↗
PubMed1987

Cerebral infarction: shortcomings of angiography in the evaluation of intracranial cerebrovascular disease in 25 cases.

We studied the utility and limitations of conventional cerebral angiography in 25 patients with cerebral infarction unassociated with extracranial cerebrovascular disease during a 7-year period. In only one-third of cases was the angiogram diagnostic, and in a single case it altered the pre-angiogram diagnosis by revealing a previously unsuspected embolus. Among the cases clinically diagnosed as cerebral emboli, the 2 confirmatory angiograms were performed early (within 48 hours), and demonstrated medium-large or large vessel filling defects. Two-thirds of the negative angiograms in the embolic clinical category were delayed, but there was no statistically relevant predilection for specific vessel size involvement. The category, primary cerebral vasculopathy, comprised the largest group, 10 in all, and one-half had angiographic confirmation despite time delays. Angiographic recognition was dependent on a characteristic picture of vascular involvement, and not on timing or vessel size predilection. Mitral valve prolapse figured prominently in the clinical cases of vasculopathy of uncertain etiology, which contained a total of 4 cases. The 3 cases with nondiagnostic angiograms were all delayed and demonstrated nonspecific radiographic changes. Clinically, these cases demonstrated signs or symptoms of autoimmune dysfunction, raising the specter of primary cerebral vasculopathy as a cause of cerebral infarction, in contrast to recurrent cerebral emboli.

Adult↗
PubMed1987

Thallium-201 brain tumor imaging: a comparative study with pathologic correlation.

In patients with gliomas who were stable or improving, we noted a disparity between clinical status and computed tomography (CT) brain scan results. To elucidate this finding, 29 patients were sequentially scanned with 2.0 mCi of 201Tl (5-30 min), 20 mCi [99mTc]gluceptate (GH) (3-4 hr) and 7-10 mCi 67Ga (48-72 hr). A total of 198 images were obtained. A set of three scans at a midpoint in follow up was selected for analysis. Seven patients who died had neuropathologic data available; brain sections were reconstructed to match radionuclide views without knowledge of image results. In the seven patients with autopsy data, 201Tl offered the most accurate correlation with viable tumor. Gallium-67 gave similar results in patients not receiving steroids. Technetium-99m GH scans could not allow differentiation between tumor, necrosis, and edema. Similarly, the CT scan could not routinely differentiate between fibrotic, nonfibrotic, necrotic, and neoplastic tissue. In the 22 patients without autopsy data, 201Tl scans commonly showed smaller and more focal abnormal uptake when compared with [99mTc]GH and 67Ga scans. Thallium-201 scans more accurately reflect viable tumor burden than other radionuclide studies of primary brain tumors, are minimally affected by concomitant steroid administration, can be performed immediately following tracer administration, and complement the anatomic data obtained from CT scans.

Adolescent↗
PubMed1986

Septation and focal dilatation of ventricles associated with cryptococcal meningoencephalitis.

A 35-year-old woman developed temporal lobe seizures. Isolated dilatation of the right temporal horn was demonstrated by computed tomography. She was asymptomatic for the next 10 months while on anticonvulsants before severe headaches, vomiting, and mental confusion prompted hospitalization. Both temporal horns were now dilated, there was marked periventricular edema, and cryptococci were cultured from the ventricular fluid. She succumbed after prolonged systemic and intrathecal antifungal therapy, having developed isolation and dilatation of both frontal horns and third and fourth ventricles. Cryptococcal or other fungal meningoencephalitis should be considered in the differential diagnosis of isolated dilatations of the ventricular chambers as noted in the present case.

Adult↗
PubMed1986

Balloon occlusion of a recurrent carotid-cavernous fistula previously treated by carotid ligations.

A carotid-cavernous fistula recurred 16 years after a Hamby procedure. The recurrence was manifested by subarachnoid hemorrhage originating from dilated draining pial veins. The fistula was closed with a balloon catheter introduced through a patent remnant of the cervical carotid artery. Patients who have previously undergone Hamby trapping and embolization should be reassessed for an occult fistula that could predispose them to intracranial bleeding.

Adult↗
PubMed1985

Prolactinomas. Clinical presentation, radiologic assessment, and therapeutic options.

Of the pituitary tumors, the prolactinoma is the most common, characteristically causing amenorrhea/galactorrhea in women and symptoms secondary to mass effect in men. Direct coronal CT scanning with rapid infusion contrast enhancement is now considered the most sensitive and specific method for evaluating the pituitary. Normally the gland is either homogeneous or heterogeneous in a repetitive fashion, and measures up to 9-10 mm in height. Adenomas typically are hypodense lesions in the anterior lobe associated with mass effect--superior surface convexity, gland enlargement, bony erosion, infundibulum displacement, or vascular "tuft" shift. High field superconductive MRI is thought to be superior to CT for evaluation of macroadenomas and may soon surpass CT in the evaluation of microadenomas. Treatment remains controversial. Perhaps surgery is the best alternative for women 15 to 30 years of age with microadenomas producing prolactin less than 100 ng/ml. Patients who are either beyond the child-bearing years, present with tumors greater than 10 mm in diameter, or have microadenomas producing prolactin greater than 100 ng/ml may be better served by medical therapy using bromocriptine or pergolide mesylate.

Adult↗
PubMed1984

Spinal cord or nerve root compression in patients with malignant disease: CT evaluation.

Fifty patients with malignant disease were seen on an emergency basis because they showed clinical signs of spinal cord or nerve root compression. All were studied with high resolution computed tomography (CT) of the spine; in addition, myelography was performed on 10 of the patients. We found that 48 cases (96%) could be accurately diagnosed by CT alone. In two cases (4%) CT was inconclusive, but myelography was diagnostic; one proved to be cerebrospinal fluid seeding with nerve root involvement, and the other showed conus medullaris involvement. In the remaining eight cases studied by both techniques, correlation between CT and myelography was very good.

Adult↗
PubMed1984

Cervical chordoma presenting with intervertebral foramen enlargement mimicking neurofibroma: CT findings.

A cervical chordoma, confirmed at surgery, presented on plain spine films as a focal enlargement of the intervertebral foramen and mimicked the characteristic appearance of cervical neurofibroma. Computed tomography (CT) of the cervical spine was obtained immediately following metrizamide myelography; it demonstrated a soft-tissue mass in the enlarged intervertebral foramen that extended posteriorly to compress the spinal cord and anteriorly to compress the hypopharynx. The mass was sharply demarcated, inhomogeneous, and low in attenuation; CT density measured between those of cerebrospinal fluid and muscle. Although this CT appearance is not specific for cervical chordoma, it is unusual for neurofibroma. Cervical chordoma should be considered in the differential diagnosis of focal enlargement of cervical intervertebral foramina.

Adult↗
PubMed1984

Posterior fossa ependymal cyst and atlantoaxial subluxation in a patient with Down syndrome: CT findings.

A 61-year-old woman with Down syndrome presented with progressive deterioration of gait over 9 months. Cranial CT without and with intravenous administration of contrast material demonstrated a posterior fossa cyst. The cyst did not communicate with the fourth ventricle or subarachnoid spaces as proven by CT following a metrizamide ventriculogram. Surgical fenestration of the cyst into the fourth ventricle was done. In addition, a moderate atlantoaxial subluxation with 2 mm movement from extension to flexion was present, which was thought not to be clinically significant, but which might require a spinal fusion at a future time. Ependymal cells were found as a result of a biopsy of the cyst wall.

Atlanto-Axial Joint↗
PubMed1984

Computed tomography of aneurysmal bone cyst of the L1 vertebral body.

A 31-year-old woman with an aneurysmal bone cyst of the L1 vertebral body proved by biopsy and studied by plain lumbar spine roentgenography, radionuclide studies, myelography, and CT is presented. The unusual location of involvement of the vertebral body alone and the difficulty in differential diagnosis between aneurysmal bone cyst and benign giant cell tumor are discussed.

Adult↗
PubMed1984

Computed tomography of spontaneous acute cervical epidural hematoma.

Cervical spinal epidural hematoma is a rare cause of acute neurologic syndromes including paralysis of various types. Although devastating, it can be successfully treated surgically if recognized early. We report two cases of spontaneous cervical epidural hematoma diagnosed by computed tomography, the first with a plain scan and the second with a scan after intrathecal injection of metrizamide. In both patients the diagnosis was not clinically suspected. Surgery resulted in a dramatic improvement of the neurologic deficit in both cases.

Acute Disease↗
PubMed1983

CT assessment of thoracic extension and of concomitant lesions in syringohydromyelia.

Computed tomographic (CT) myelography, when used with metrizamide, permits a reliable demonstration of syringohydromyelic cavities in the cervical spinal cord. We report 6 cases of cervical syrinx demonstrated by high-resolution CT 4 h after metrizamide myelography; these cavities, which were not suspected clinically, extended into the thoracic cord. In addition 4 cases were associated with Chiari Type 1 malformation and 1 case was associated with both Chiari Type 1 malformation and infratentorial arachnoid cyst. We recommend that CT evaluation of cervical syringohydromyelia routinely include the thoracic spine, in order to demonstrate possible thoracic extension of the cavity. Scans of the foramen magnum are also recommended, because of the possibility of concomitant lesions, especially Chiari Type 1 malformation.

Adult↗
PubMed1982

Blow-out fractures of the orbit: a comparison of computed tomography and conventional radiography with anatomical correlation.

Orbital blow-out fractures were experimentally created in eight human cadavers. Each orbit underwent conventional radiographic studies, complex motion tomography, and computed tomographic examinations. A comparison of the three modalities was made. Anatomical correlation was obtained by dissecting the orbits. The significance of medial-wall fractures and enophthalmos is discussed. Limitation of inferior rectus muscle mobility is thought to be a result of muscle kinking associated with orbital fat-pad prolapse at the fracture site, rather than muscle incarceration. Blow-out fractures should be evaluated by computed tomographic computer reformations in the oblique sagittal plane.

Cadaver↗
PubMed1981

Experimental arterial aneurysms:modification of the production technique.

Vein pouches obtained from the external jugular vein were used to create experimental aneurysms on the carotid arteries of 13 rabbits and the abdominal aortas of 18 rabbits. Eighteen of these vein pouch aneurysms were grafted onto a linear incision in the artery; 13 of the aneurysms were grafted onto an elliptical incision. In 4 of the rabbits in which the vein pouch was grafted onto an elliptical arteriotomy in the carotid, a new approach for producing an intracranial aneurysm was attempted by relocating the aneurysm segment to the subarachnoid space at the cranial vertex. The results indicate that the aneurysms grafted onto an elliptical arteriotomy had a higher patency rate than the aneurysms grafted onto a linear arteriotomy in both the aortic and carotid models. Also, the attempt to produce an intracranial model demonstrated that short-term patency of the aneurysms could be achieved and that a two-stage approach to creating such aneurysms would be more appropriate than a one-stage approach.

Aneurysm↗