Transient bilateral cortical blindness after coronary angiography.
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Blindness, Cortical↗
Biomedical subjects
H Lanfermann
Publications and source records attributed to H Lanfermann.
[Minimal requirements for MR diagnosis of the brain for clarification of nonspecific neurological symptoms].
The main tasks of MRI diagnosis of the brain for unspecific neurological symptoms such as, for example, headache, psychiatric diseases, subjective cognitive deficits, and retarded development in children generally involve the reliable exclusion of morphologically detectable lesions. Since there can be no universally accepted protocol for all possible situations, a basis protocol is given under consideration of modern fast spin echo, turbo FLAIR, and T2*-weighted gradient echo sequences to obtain important information in a short time. In addition, useful supplements are suggested that can proved further relevant data in dependence on the respective condition.
Adult↗
MRI- and MRA-guided therapy of carotid and vertebral artery dissections.
A high sensitivity and specificity has been shown for magnetic resonance imaging (MRI) and angiography (MRA) in the diagnosis of internal carotid (ICAD) and vertebral (VAD) artery dissections, where arteriography has been and still is the gold standard. Five patients (three with ICAD, two with VAD; age range 42-56 years) are presented, in whom diagnosis and follow-up management were exclusively based on non-invasive measures. In all patients, MRI demonstrated a typical intramural hematoma and MRA in 3D phase contrast technique showed loss or diminished flow. After anticoagulation (heparin) for 3 to 4 weeks follow-up, MRI showed a regression of the mural hematoma and MRA revealed reperfusion or improvement of flow. Depending on the extent of MRI-/MRA-pathology, three patients were put on antiplatelet therapy and two on Coumadin until normalization of MRI and MRA findings, which are assessed in 3-months intervals. We suggest, that with, (I) a suspicious history, symptoms and signs for cervical artery dissection (CAD), (II) typical MR-findings proven to indicate CAD, (III) improving or resolving at follow-up, (IV) in unusual location for atherosclerotic involvement, (V) in the absence of coexisting atherosclerotic lesions, the diagnosis has not to be confirmed with conventional arteriography. Therefore, safe MRI- and MRA-guided anticoagulation and antiplatelet therapy during serial follow-up measurements are possible.
Adult↗
Connective tissue reactions in subdural haematomas: imaging with contrast-enhancement MRI.
The sensitivity of contrast enhanced magnetic resonance imaging (MRI) in the detection of connective tissue reactions accompanying the maturation of subdural haematomas (SDH) was studied. An outer enhancing layer between the SDH and the tabula interna of the vault was shown in 16 out of 17 cases. In early SDH this outer enhancing layer presumably is due to vascular congestion and/or increased vascular permeability. A thickening of the outer enhancing layer and/or an inner enhancing layer between the haematoma and the subarachnoid space was visible in 9 patients and represented a haematoma capsule formed by proliferating granulation tissue. In 5 SDH septations were found, 3 SDH consisted almost completely of enhancing granulation tissue. Thus, contrast enhanced MRI delivers additional information about the structure of SDH, which are useful for determining the extent of surgical treatment especially in chronic SDH.
Adolescent↗
Chronic subdural hematoma: surgical treatment and outcome in 104 patients.
BACKGROUND: The common occurrence of chronic subdural hematoma (CSDH) in older patients raises some diagnostic and therapeutic difficulties. Despite general agreement about the indication of operation, the extent of surgery is still discussed controversially. We have, therefore, reviewed operative findings and outcome in 104 patients with CSDH. METHODS: Retrospective analysis was performed by differentiating age < or = 60 years (n = 28) versus age > 60 years (n = 76) and burr hole craniostomy with a size range from 12-30 mm (n = 94) versus larger craniotomy (n = 10). All patients received closed-system drainage of the subdural space for 2-4 days. RESULTS: Four patients older than 60 years died within 30 days after surgery, two in each operative group. Excluding these postoperative deaths, 17 out of 92 patients (18.5%) after burr hole trepanation and one out of eight patients (12.5%) after craniotomy required reoperation due to rebleeding (n = 6), residual subdural fluid (n = 4), and residual thick hematoma membranes (n = 8). Eight patients, who had been initially treated by burr hole craniostomy despite preoperative detection of neomembranes by contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI), recovered without further intervention. Clinical outcome was good in both operative groups. The percentage of patients without or with only mild neurologic deficits at the time of discharge from the hospital was 72.3% in the burr hole and 70.0% in the craniotomy group, respectively. CONCLUSIONS: The clinical data of the present study suggest that burr hole craniostomy with closed-system drainage should be the method of choice for the initial treatment of CSDH, even in cases with preoperative detection of neomembranes. Craniotomy should be carried out only in patients with reaccumulating hematoma or residual hematoma membranes, which prevent reexpansion of the brain.
Adult↗
CT and MR imaging in primary cerebral non-Hodgkin's lymphoma.
PURPOSE: To determine the morphological appearance and topographical distribution of primary cerebral non-Hodgkin's lymphoma (NHL). MATERIAL AND METHODS: CT and MR examinations of 68 patients with primary cerebral NHL were analyzed. The NHLs were classified by the Kiel classification and immunohistological data, as centroblastic (25), immunoblastic (24), lymphoblastic (5), Burkitt (1), non-subclassifiable type B (11), and T-cell lymphoma (2). RESULTS: Centroblastic lymphomas tended to predominate in the parietal lobe (56.5%) and the corpus callosum (59.1%) while immunoblastic lymphomas were mainly distributed in the frontal lobe (52.8%). About 2/3 of all NHLs showed a multifocal occurrence. Important for differential diagnosis, ventricular involvement was proved in 83.3% of these cases. In the remaining 26 patients with a solitary lymphoma, a periventricular location could be detected in only 8 cases. Central necroses were frequent in HIV-positive patients (7/11, 63.6%) but rare in the HIV-negative patients (9/57, 15.8%). On T2-weighted SE MR images, 8/11 centroblastic lymphomas gave a signal that was isointense with, or lower than, that of the contralateral white matter, while 8/10 immunoblastic lymphomas gave a higher signal. CONCLUSION: The radiological finding of multifocal brain lesions with ventricular involvement is relatively specific for primary cerebral NHL. However, subclassification on the basis of the CT or MR imaging results is not yet possible.
Adult↗
Evidence of acute demyelination around a developmental venous anomaly: magnetic resonance imaging findings.
The authors report on the occurrence of a focal demyelination showing a mass effect around a developmental venous anomaly in the cerebellum. Because the latter presented as a single lesion, the differentiation from intraparenchymal neoplasms or infarction was difficult. Follow-up magnetic resonance imaging and histology from a biopsy specimen give useful information to find the appropriate diagnosis.
Acute Disease↗
Nontraumatic subarachnoid hemorrhage: value of repeat angiography.
PURPOSE: To evaluate the benefits and risks of repeat cerebral angiography in patients with subarachnoid hemorrhage of unknown cause. MATERIALS AND METHODS: Findings from 391 angiographic examinations (323 initial, 68 repeat) were retrospectively reviewed in 323 patients with nontraumatic subarachnoid hemorrhage to determine the cause of bleeding and the frequency of complications with neurologic deficit. RESULTS: At the initial angiographic examination, aneurysms were found in 195 patients (60.4%), and arteriovenous malformations were found in 11 patients (3.4%). Sixty-six patients with negative findings at initial examination underwent repeat cerebral angiography. Three additional aneurysms were detected, all of which could be seen retrospectively on the initial angiogram. In 63 patients, the cause of bleeding remained unexplained. Complications of the 391 angiographic examinations were definitive neurologic deficits in one patient (0.2%) and transient deficits in seven patients (1.8%). CONCLUSION: Repeat angiography is not necessary in patients with subarachnoid hemorrhage if technically good, carefully evaluated digital subtraction angiography was performed initially. Repeat angiography seems to be justified only when the initial examination is technically inadequate, when vasospasm is present, or if further bleeding occurs.
Adolescent↗
[Injuries of the spine: current concepts in radiologic diagnosis].
This review discusses the usefulness of plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of spinal trauma. The indications for the different imaging modalities in dependence on the specific pattern of injury are explored. Plain radiography still remains the prime method in the diagnosis of acute spinal trauma but there are substantial deficits, especially in the evaluation of the occipitocervical and the cervicothoracic junction as well as in the evaluation of the integrity of the posterior vertebral body line. If injury in these regions is suspected CT should follow plain radiography immediately. In the case of spinal trauma with unexplained neurologic deficits MRI is the method of choice for the detection of spinal cord injury. Recommendations with regard to instability and the classification of specific injuries, including examples of typical findings are presented.
Cervical Vertebrae↗
[Varicella-zoster-virus myelitis without herpes. An important differential diagnosis of the radicular syndrome].
HISTORY AND CLINICAL FINDINGS: A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the "riding breeches" area, severe pain in the lumbar region and progressive disorders of bladder and rectal emptying. Physical examination showed a conus-cauda syndrome. Differential diagnosis was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion. INVESTIGATIONS: Cerebrospinal fluid contained 1700/3 cells and there was intrathecal antibody synthesis against varicella zoster virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumbar spine revealed an inflamed enlarged conal and epiconal area with small haemorrhagic spots. There was no evidence of an underlying immune-modulated disease. TREATMENT AND COURSE: With the diagnosis of varicella zoster myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days). CONCLUSION: VZV without cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of beginning myelitis or encephalitis are present, immediate investigations and therapy are necessary.
Acyclovir↗
Lesions of the corpus callosum in hydrocephalic patients with ventricular drainage--a CT-study.
Patients with ventricular drainage may develop lesions of the corpus callosum. In order to study frequency, pathogenesis and clinical relevance of callosal lesions, 301 routine CT investigations of 79 patients with ventricular drainage were reviewed. Hypodense lesions in the anterior part of the corpus callosum were observed in 7 patients with longstanding hydrocephalus of variable origin, in 2 cases the corpus callosum was slightly swollen. All 7 patients showed signs of forced ventricular drainage. The callosal alterations were clinically inapparent and potentially reversible. Knowledge of these lesions is important to avoid misinterpretation.
Adolescent↗
[The radiological findings in surgically and conservatively treated intracranial arachnoid cysts].
PURPOSE: To determine which appearances on CT or MRI are indications for surgical treatment of intracranial arachnoid cysts. METHOD: The images obtained from 26 patients treated either by surgery or conservatively were compared retrospectively. The features evaluated were the size of the cyst, evidence of a space-occupying lesion, cerebral abnormalities near the cyst and skull deformities. RESULTS: In 6 patients (23%), surgical treatment was indicated because of the presence of obstructive hydrocephalus. The presence of all other radiological findings did not differ significantly between the two analysed groups. 92% of the patients treated surgically benefited from the treatment. Fenestration and shunting produced similar results in respect to reduction in size of the cyst and the clinical and neurological symptoms. CONCLUSION: The only indication for surgery is the presence of obstructive hydrocephalus. The other features were seen equally amongst the patients treated conservatively and the surgical patients and had no influence on the decision to operate.
Adolescent↗
[The MR tomographic diagnosis of intra- and paraspinal abscesses].
PURPOSE: Analysis of the MRT signals and their extent from intra- and paraspinal abscesses with reference to predisposing factors, their causes and localisation. PATIENTS AND METHODS: The histories and MRT findings in 34 Patients with intra- and paraspinal abscesses were evaluated retrospectively. Most of the patients (24/34) were older than 50 years. A second peak was below 30 years. RESULTS: 27/34 patients had some underlying disease which predisposed to infection, e.g., diabetes mellitus. The most common causal organisms were Staph. aureus (53%) and streptococci (15%). In 23/34 cases (68%), the abscesses were in the thoraco-lumbar or lumbar region, while only 6/34 occurred in the upper two-thirds of the thoracic spine and only 5/34 in the cervical region. In only 8/34 was the abscess confined to two vertebral lengths; in the remaining patients it was much more extensive. Intraspinal abscesses were about twice as large as the vertebral components and 1.5 times greater than paravertebral abscesses. The age of the abscesses could be estimated approximately from the signals. CONCLUSIONS: Contrast enhanced MRT permits detailed analysis of the compartments and exact estimation of the extent of the lesions and permits accurate monitoring of treatment.
Abscess↗
Acute transverse myelitis caused by herpes simplex virus.
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Acute Disease↗
F-Dopa as an amino acid tracer to detect brain tumors.
A 57-yr-old woman suffering from light movement disorder of the left arm and hand was referred for 18F-Dopa PET. The PET study not only proved asymmetrically reduced dopamine uptake in the putamen (influx constant Ki right 0.0064/min, left 0.0086) but also revealed pathologically increased 18F-Dopa accumulation in the right frontal lobe. Further PET examinations demonstrated increased 11C-methionine uptake and low glucose metabolism in this right frontal region. MRI and 1H-MRSI showed a heterogeneous lesion with reduced N-acetyl-aspartate and increased choline and lactate, suggesting a mixed, low-grade glioma. In 15O-water studies, during intentional movements of one hand the respective motor areas were identified, indicating asymmetries due to the mass occupying lesion. The tumor could be removed in open surgery, thus sparing the motor areas; a mild postoperative motor deficit resolved to the presurgical state. Histology confirmed the diagnosis of a grade 2 oligo-astrocytoma. This case impressively demonstrates that 18F-Dopa can be used as an amino acid tracer for brain tumor detection in addition to its established application to assess aromatic acid decarboxylase activity.
Brain↗
[Infections of the cervical spine].
Diagnosis of infectious disease of the spine in an early stage ist difficult. Conventional X-ray examinations, often used as a basic screening study, will show the characteristic narrowing of the intervertebral disc space and the osteolytic and sclerotic changes in the adjointing vertebra only after two to eight weeks. Magnetic resonance imaging (MRI) has a sensitivity equivalent to bone scintigraphy and, due to its superior delineation of anatomic details, MRI has become the method of choice not only for the assessment of location, extent, and associated lesions in infectious bone disease, but also in the diagnosis of intradural infections including myelitis. MRI examination in the assessment of a successful therapy or osteomyelitis of the spine aims for the detection of regression of bone marrow edema, reappearance of fatty marrow, and less pronounced contrast enhancement. Computed tomography (CT) is mainly used for image-guided biopsy to obtain specimen for microbiologic culture or for the placement of a percutaneous drainage.
Abscess↗
[Risks and therapy options in dural arteriovenous fistulas between branches of the external carotid artery and the cavernous sinus. A case report and review of the literature].
INTRODUCTION: Dural arteriovenous fistula of the Arteria carotis externa and the sinus cavernosus are rare vascular malformations. In the literature the prognosis and necessity of treatment is described very variable. PATIENTS AND METHODS: A 90 year old female presents in our outpatient clinic with acute exophthalmus, dilated episcleral veins, cerebral bruits and beginning orbital apex syndrome. After normal computerized axial tomography (CAT) without and with contrast medium, we were able to diagnose a dural AV-fistula by angiography. Shortly after dismission the patient had a spontaneous subarachnoidal haemorrhage with severe neurological symptoms. CONCLUSIONS: The suspect of an intracranial AV-malformation implies a detailed diagnostic search with precise localisation of the process. In any patient with intracerebral and intracranial fistula there has to be an individual check of possible and necessary treatment. It is impossible to classify dural AV-fistula as a benign disease with harmless clinical course.
Aged↗
Neurological sequelae of cyanide intoxication--the patterns of clinical, magnetic resonance imaging, and positron emission tomography findings.
We report 2 patients with neurological sequelae of oral cyanide intoxication who were evaluated clinically and neuropsychologically, with high-resolution magnetic resonance imaging and one of them with positron emission tomography. The clinical syndrome was characterized by extrapyramidal motor and cerebellar symptoms such as bradykinesia, hypomimia, slowed speech, anteropulsion, and marked retropulsion, but little tremor. The sensory and pyramidal motor systems were normal or relatively spared. On neuropsychological testing the intellectual capacity and memory functions were normal, whereas the speed of motor reaction and verbal fluency were reduced. Magnetic resonance imaging showed damage of the globus pallidus, putamen, substantia nigra, subthalamic nucleus, and cerebellum in both patients, whereas the sensory-motor cortex and hippocampus were relatively spared. 18F-6-Fluoro-dopa positron emission tomography revealed a symmetrical reduction of striatal dopa uptake by 42% on average that was similar in the putamen and caudate. 18F-2-Fluoro-2-deoxyglucose positron emission tomography showed a regional reduction of the glucose metabolism in the posterior putamen and temporo-parieto-occipital and cerebellar cortex.
Adult↗