[A progressive psychosyndrome without symptoms of cerebral lesions. Case reports of a 39-year-old patient and a 60-year-old patient].
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Biomedical subjects
Publications and source records attributed to D Kuckein.
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Bochdalek's diaphragmatic hernia (hernia through trigonum lumbocostale of diaphragm) may be demonstrated unequivocally via computerised tomography. An additional scan in prone position is recommended. In this way, not only the relationship of the hernia to the diaphragm can be shown but also the diaphragmatic gap (trigonum lumbocostale). In some cases sagittal image reconstruction is helpful to identify the hernia.
computerized tomography is a valuable tool for the rapid, non- invasive diagnosis of intrathoracic masses and for the evaluation of tumour size. Mediastinal infiltrations and lymphogenic metastases are easily and reliably identified. Results of conventional tomography are supplemented by CT findings as both methods have their strong and weak points which are in part mutually complementary.
Computerized tomography of the base of the skull has gained importance due to improved spatial resolution. In spite of lesser resolution than with conventional x-rays, it offers a great deal of additional information, based on the axial view and the method of digital image manipulation with subsequent examination at the independent viewing console. With increasing experience, the information gained from CT in these cases has proved superior to the results of conventional tomography.
Aneurysms and vascular hamartomas, unless too small, may be diagnosed by computerized tomography. In particular, larger arteriovenous malformations and venous angiomas present a fairly typical appearance. Smaller angiomas produce mostly atypical findings and require additional cerebral angiography. Spontaneous intracerebral parenchymal or subarachnoidal haemorrhage is mostly caused by arterial hypertension and/or arteriosclerosis. However, vascular malformations are an important additional cause of bleeding. Demonstration of intracranial haemorrhage is a domain of computerized tomography. Occasionally, an angioma may be revealed. However, the source of bleeding can usually be shown more conclusively by cerebral angiography, an invasive method.
Computerized tomography and ultrasonography are the image producing procedures of choice to demonstrate the extent of hypoxic cerebral damage. CT findings of immaturity and leukomalacia in premature and newborn babies are presented. Possibilities and difficulties in distinguishing one from the other are discussed on the basis of some representative cases.
During emergency CT examination, impression fractures of the skull, fractures of the base or of facial bones may be diagnosed in addition to possible traumatic intracranial manifestations. If the fractures extend to the base of the skull or to the facial bones, a possible involvement of foraminae, orbitae or nasal sinuses may be recognized. The extent of dislocation of loose bone fragments may be visualized without special conventional X-rays.
Ependymal and meningeal metastases of brain tumors may frequently be demonstrated by computerized tomography. The mode of metastasis formation and appearance of some CT findings are described. Essential criteria in the differential diagnosis of neoplastic, metastatic, inflammatory and vascular changes are discussed.
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By means of cranio-cerebral computed tomography hypoxic brain damage of varying degrees and different types may be demonstrated in premature infants and high-risk newborns. Paraventricular leucomalacia of varying extent up to porencephalic defects are found, as well as cortical infarctions, hemorrhage into brain tissue or ventricles, cerebral atrophy, developing hydrocephalus and congenital anomalies.
Destructions of structures of the base of the skull may be demonstrated by means of CT. It produces a third plane of visualization in addition to the two planes obtained with conventional X-ray examination. CT is superior to the latter in defining non-osseus tumor growth located intra- and extracranially. For the evaluation of destructions of the base of the skull, CT and conventional X-ray are equally informative, CT may be used as alternative or in addition to conventional X-ray. It may reveal fractures of the base of the skull which may not show up on conventional X-ray examination.
In contrast to conventional methods of x-ray diagnosis, recurrence of a rectum carcinoma may be visualized directly by means of computerized tomography. CT criteria of a tumor relapse are discussed. Based on own cases, it is shown that the method is usually employed too late. CT as follow-up examination should be used as a routine procedure in order to establish an early diagnosis of tumor recurrence.
Cerebral vein thrombosis is a rare condition and its prognosis depends on prompt diagnosis and therapy. Computer Tomography findings in this condition are described and correlated with their pathologic-anatomic findings, based on cases of our own and those described in the literature. Computer Tomography findings rarely are pathognomonic. Therefore, indirect findings are pointed out and discussed which support the diagnosis such as simultaneous subarachnoid hemorrhage.
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CT findings in cerebral inflammatory conditions such as meningitis, encephalitis, abscess and empyema are presented. Differential diagnosis and possible complications are discussed. In certain instances, the cranial CT findings are so typical as to permit an immediate diagnosis. In other cases, CT aids decisively in the differential diagnosis and may indicate complications.
CT of the spinal canal as a method of neuroradiological examination has increasingly gained significance. So far, it has been used in addition to conventional Xray of the spine and to myelography; however special indications have been established to make it the method of choice in certain instances. Besides invasive secondary or primary CT myelography, noninvasive CT is applied in tumor diagnosis and traumatology; also in order to demonstrate dysraphic formative anomalies, degenerative changes as well as conditions which obstruct the spinal canal and compress spinal cord and nerve roots. CT has the advantage of better soft- tissue-visualization while the spinal canal is equally well outlined; it has no disadvantages. With even more efficient scanners available, especially primary CT diagnosis of the spine will gain further significance.
In addition to echocardiography, computed tomography may show location, size and nature of certain types of cardiac pathology. A case of a tumor of the atrium without clinical manifestations is presented.
In connection with a case of cysticercosis the CT differential diagnosis of multiple intracranial calcifications is discussed. In addition to CT, conventional X-ray diagnosis, angiography and clinical data are needed in order to clarify the origin of intracranial calcifications.