Biomedical subjects
Publications and source records attributed to C Plets.
A case of juvenile fibrosarcoma arising from the head and neck region is described. This type of tumour should be considered as a separate entity different from the fibrosarcoma in adults because of the different clinical behaviour. The symptomatology, the radiographic features and the literature data are reviewed.
We compared magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (IADSA) in the study of brain tumours and assessed the utility of gadolinium-enhanced MRA. We studied 17 patients with supratentorial brain tumors. The entire brain was imaged with multiple overlapping thin volume acquisitions. After IV injection of gadolinium-DTPA, a single thick-slab MRA acquisition was performed. Standard three-dimensional (3D-TOF) acquisitions (in six patients) and 3D-TOF with magnetization transfer prepulse and tilted optimisation nonsaturing radiofrequency excitation pulses (in 11 patients) were used. Displacement of the anterior cerebral artery, main stem and insular branches of the middle cerebral artery was seen well on unenhanced and contrast-enhanced MRA. Displacement of the lenticulostriate and anterior choroidal arteries was seen only once, after Gadolinium. Tumour encasement of the middle cerebral artery was demonstrated in one patient. Tumour vessels were seen in 2 of 8 cases before and 3 of 8 after gadolinium; Tumour hypervascularity was seen only after gadolinium, in 3 of 8 cases. Study of the veins was possible only on gadolinium-enhanced MRA. Displacement of the venous angle was seen in 4 of 7 patients in the frontal, and in all of 8 patients on the lateral projections. Early venous drainage was not seen. Patency of the dural venous sinuses was demonstrated in all patients, but in one neoplastic occlusion of a cortical vein was recognized.
Vertebral chordomas are rather rare tumours, especially in the lower cervical region. We present a patient with a C7 vertebral body chordoma and a discussion of pertinent literature is given. Only three C7 chordomas have been reported previously. Diagnosis is sometimes difficult to establish and is based on radiological examinations. Once the histological diagnosis is available, one should aim at a total resection. If this is not possible, adjuvant radiotherapy should be given. For limited cervical lesions, we advise a corporectomy with fusion by an iliac crest graft and osteosynthetic plate stabilisation.
A 22-year-old male patient of Indian origin presented with generalized seizures. Brain magnetic resonance imaging (MRI) showed two cystic lesions. Extensive screening only revealed positive skin tests for tuberculosis. Immunoassays for cysticerosis were negative in serum and cerebrospinal fluid. Biopsy of the temporal lesion revealed a cysticercus. Although neurocysticercosis is a common cause of seizures in patients from countries where cysticercosis is endemic, the diagnosis can be difficult in a patient with evidence of multiple infections or in whom serological evidence is lacking, as is illustrated by the present case. Furthermore, because the pathogenic factors determining the activity of the disease are poorly understood, its management represents a similar problem as it depends upon the activity of the disease as estimated by clinical, radiological and laboratory tests. The present case report illustrates these difficulties.
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Surgical reconstruction and fusion form the treatment of choice for unstable thoracolumbar fractures. It remains difficult, however, to prove that surgical treatment provides an increased potential for neurological recovery. Also, the role of a decompressive laminectomy is still unclear. To address these issues, 93 consecutive cases of thoracolumbar fractures treated with dorsal instrumentation were reviewed. The neurological status at the time of admission and at a mean of 26 months postinjury was graded according to a modified Frankel scale. By using preoperative radiographs and computed tomography scans, we differentiated between fracture-dislocation lesions, dislocation lesions, flexion-distraction lesions, complete and incomplete burst fractures. Spinal stenosis was classified from grade 0 (no stenosis) to grade 3 (> 66% stenosis). All thoracolumbar fractures were treated with posterior instrumentation, using Dick's fixateur interne and Steffee's VSP plates and screws. During this procedure, laminectomy was performed in 33 patients (35%). In 17 cases (52% of the laminectomies), a surgically treatable lesion (dural tear, trapped nerve root, etc.) was found, especially in patients with a combination of a neurological deficit and a dislocation lesion, a fracture-dislocation lesion or a complete burst fracture with spinal stenosis grade 2 or 3. The neurological and functional outcome was excellent: none of the patients deteriorated, 68% made a complete neurological recovery, and 61% regained their previous level of activity.
We present a case of spinal epidermoid tumour that was probably caused by lumbar punctures. The tumour was detected on MRI in a child with tuberous sclerosis complaining of atypical low back pain. Preoperatively the tumour was considered to be a cystic astrocytoma of ependymoma of the conus terminalis. The association of tuberous sclerosis with a spinal tumour is rare but has been recorded in the literature. The diagnosis was an epidermoid tumour (E.T.). The MRI appearances were unusual for a spinal ET: the signal intensity changes were different from those reported in the literature and the presence of calcification and cavitation has not yet been reported. This case represents a diagnostic pitfall, since both entities were unrelated.
PURPOSE: To study the clinical and radiologic findings in 15 patients presenting with both developmental venous anomalies and cavernous angiomas and to determine which lesions caused the acute clinical symptoms. METHODS: Lesions were infratentorial in 7 patients and supratentorial in 7 other patients. In one patient the developmental venous anomaly was infratentorial and the cavernous angioma supratentorial. In all 15 patients clinical examination and CT were performed. In 10 patients MR was performed at the time of the initial CT scan. In 5 patients only late MR is available. RESULTS: Acute clinical signs were present in 9 patients (epilepsy, hemiplegia, meningeal signs, cranial nerve deficit). On CT the cavernous angioma was missed in 9 patients, in 6 patients because of acute hemorrhage. On MR the cavernous angioma was missed in 1 of 2 cases with acute hemorrhage but seen in all other patients. On repeat MR all cavernous angiomas were correctly identified. On CT, 11 developmental venous anomalies were seen. On MR all developmental venous anomalies were seen. CONCLUSIONS: The frequent association of developmental venous anomalies and cavernous angiomas is confirmed. MR is superior to CT in the detection of both cavernous angiomas and developmental venous anomalies. Furthermore our data support the hypothesis that cavernous angiomas and not the developmental venous anomalies cause the acute clinical symptoms because of hemorrhage.
A case is reported of recurrent intracerebral abscesses occurring in a patient with isolated drainage of a persistent left superior vena cava to the left atrium without causing cardiac symptoms or arterial desaturation. The diagnosis and therapy are discussed.
Two cases of dermoid cysts of the posterior fossa in association with a dermal fistula and with different clinical presentations are reported. The patient in case 1 is a 14-month-old girl with a history of recurrent bacterial meningitis. Case 2, a 7-year-old girl, presented with a skin "granuloma" at the inion. Both cases, and a review of the literature, demonstrate the need for a thorough exploration of the cranial and spinal midline skin areas in every newborn and argue for widespread use of nuclear magnetic resonance imaging whenever a suspected midline lesion is found.
We have reviewed our experience with a series of 49 consecutive patients with spontaneous cerebellar haematoma, treated according to a standardized management protocol. Seventeen patients were managed conservatively, 30 underwent ventricular drainage, and in six patients the haematoma was evacuated. The indications for the different modes of treatment are discussed. The most significant prognostic factors determining the outcome at one month were the grade of quadrigeminal cistern obliteration on the initial CT scan and the Glasgow Coma Scale on admission. Patients with normal cisterns had a good outcome, and only needed (temporary) ventricular drainage in case of hydrocephalus. Patients with totally obliterated cisterns had a bad outcome irrespective of treatment. In the patients with compressed cisterns, it is suggested that evacuation of the haematoma might improve outcome; treatment of hydrocephalus alone is insufficient in many cases in this group.
One of the rare complications of supratentorial craniotomy is the occurrence of a hematoma in the cerebellum. Only seven previous cases have been published, and these have been ascribed to disturbed blood coagulation or decreased intracranial pressure. We present two similar patients, in whom, however, the pathogenetic role of these factors seems improbable.
Transcatheter embolization was performed in 8 young patients (mean age 24.5 years) with intracerebral arteriovenous malformations. In total 12 arteries were embolized in 10 sessions. Clinical complaints of the patients included epilepsy in 4, sudden coma in 3 and severe sudden neurological deficit in 1. Intracerebral hemorrhage was documented in 4 patients and subarachnoid hemorrhage in 1. In all patients, prior to embolization a superselective Wada-test was performed under wake-up anesthesia. Embolization was performed with a mixture of acrylic glue and lipiodol. In one patient a detachable balloon was added. In 6 patients embolization of all the feeding arteries was possible, with total obliteration of the arteriovenous malformations in 4 and subtotal embolization (> 90%) in 2. In 2 patients reduction of the size of the arteriovenous malformation by one third was followed by total surgical removal of the lesion. In 1 patient reflux of the embolization material in the anterior choroidal artery caused severe neurological deficit with good clinical recuperation.
A case of intracerebral primitive neuro-ectodermal tumor (PNET) is presented. PNETs are rare, undifferentiated neoplasms occurring primarily in children and young adults. These tumors exhibit a highly malignant behaviour with a tendency to disseminate along the cerebrospinal fluid (CSF) pathways. Preoperative diagnosis is difficult, owing to the non-specific CT and MR appearances and to the rarity of this tumor. Our patient was 33 years old, which is uncommon. CT findings initially suggested an intracerebral hematoma. Later on, CT and MR findings were specific for a brain tumor and showed a solid, non-calcified invasive mass, with poor perilesional edema.
MRI findings are described in two patients with subdural haematomas isodense on CT. In one patient, admitted 6 weeks after trauma, a chronic subdural haematoma showed extreme hypointensity on T2-weighted images, suggesting acute trauma, and therefore acute rebleeding. In the second patient with severe anaemia, an acute subdural haematoma was hyperintense on T2-weighted images, suggesting chronic trauma; this may be explained by the low haematocrit and a possible mixture of blood with cerebrospinal fluid. The MRI features of subdural haematomas and hygromas have to be kept in mind, in order not to misjudge the age of the haematoma.
Juxta-facet cysts are relatively uncommon intraspinal lesions, causing radiculopathy, neurogenic claudication or myelopathy. To the best of our knowledge, only 4 cases of bilateral synovial or ganglioncysts were described. We report the 5th case of bilateral ganglioncysts of the lumbar spine. Generally, juxta-facet cysts should be differentiated from other intraspinal lesions, such as herniated discs, meningiomas and neurinomas. Correct preoperative diagnosis is necessary for adequate treatment, namely the (microscopic) resection of the cyst. After adequate treatment, complete recovery may be expected.
A patient with right hearing loss, in whom computed tomographic scanning demonstrated a mass in the right cerebellopontine angle with widening of and extension into the internal auditory canal, but with important posterior extension and broad implantation on the surface of the petrous bone, is reported. On both T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance images, there were clearly two separate tumoral lesions: an acoustic neurinoma extending into the internal auditory canal and a meningioma with broad implantation on the petrous apex. These findings were confirmed at surgery.