Neurological deterioration years after closure of myelomeningocoele - 'the second lesion'.
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Adult↗
Biomedical subjects
I M Holland
Publications and source records attributed to I M Holland.
A systematic approach to the interpretation of computed tomography scans prior to endoscopic sinus surgery.
Computed tomography (CT) provides an excellent map for the sinus surgeon as well as providing information about the extent of disease and the presence of bony destruction. Surgeons need to be aware of the anatomical configuration of the sinuses and the presence of any structural changes such as a dehiscent lamina papyracea, asymmetric skull base, low level of posterior skull base or an Onodi cell, which place the patient at increased risk. Described here is a six-step guide to help the sinus surgeon avoid missing any of the radiologically important features.
Endoscopy↗
Preoperative radiologic evaluation in cochlear implantation.
AIM OF STUDY: Assess the value of computed tomography (CT) in the evaluation of abnormalities in the cochlea and auditory pathways. MATERIAL AND METHODS: We used CT to evaluate 108 children before cochlear implantation surgery. Children's ages at implantation ranged from 21 months to 16 years (mean age, 5.4 years). The etiology of deafness was meningitis in 44 children (40.8%), congenital in 51 (47.2%), and other in 13 children (12%). RESULTS: Eighteen of the 108 (16.6%) children and 34% of the postmeningitic children were found to have at least partial obliteration of the cochlea. Two (2%) children had congenital malformations of the cochlea and 12 children (11.1%) had abnormalities in the brain CT-scan. CT diagnostic values in postmeningitic children regarding cochlear obliteration were accuracy, 75%; sensitivity, 62%; specificity, 82%; positive predictive value, 66.6%; and negative predictive value, 79.3%. In six (20.6%) of postmeningitic children with normal CT-scans, some scala tympani drillout was required. CONCLUSION: CT-scan is capable neither of predicting with certainty the presence of minor degrees of cochlear obliteration nor of specifically imaging either the auditory nerve or its central connections.
Adolescent↗
Paediatric cochlear implantation: how reliable is computed tomography in assessing cochlear patency?
This study investigates the accuracy of pre-operative high resolution computed tomographic (CT) scans in predicting the patency of the cochlea in children undergoing cochlear implantation. The first 26 children on the Nottingham Paediatric Cochlear Implant Programme were reviewed. CT scans were performed utilizing 1 mm contiguous sections and these were then assessed by a neuroradiologist. In patients who had normal inner ears on CT a high degree of accuracy in predicting a patent cochlear was achieved (87%). However, in 15% of cases the degree of ossification was significantly under-estimated causing major difficulties at the time of surgery. Although high resolution CT offers great clarity and fine detail, it has its limitations. Further information may be provided by magnetic resonance imaging.
Calcinosis↗
Brain abscess in the 1980s.
Brain abscess was reviewed in 24 patients admitted to University Hospital, Nottingham over a period of 3 years. Chronic ear infection was the most common predisposing factor, but in 11 patients the focus of infection remained unknown. CT scanning, carried out in all patients, was negative in one patient with clinical signs of meningitis. Polymicrobial and anaerobic infections were common. Actinomyces species were isolated in mixed culture from seven patients; in five the abscess was located in the cerebellum. Therapy was most often a combination of surgical drainage and antimicrobial therapy with beta-lactam agents and metronidazole. Evidence suggests that cefotaxime may offer a suitable alternative to chloramphenicol and benzylpenicillin in the treatment of brain abscess.
Actinomycosis↗
Multiple cerebral aneurysms--a reappraisal.
254 consecutive cases of angiographically demonstrated intracranial cerebral aneurysms occurring over a three year period were reviewed with specific reference to aneurysm multiplicity, site, patient age and the presence of infundibular abnormalities. The overall incidence of multiple aneurysms was 44.9%. Female patients accounted for 66.5% of all aneurysm cases. The incidence of multiplicity was higher in women (51.5%) than men (31.7%) and overall was higher in patients over 40 years of age (52.8%) compared to those under this age (26.3%). Infundibula occurred in 27.2% of all patients and 9.45% of all patients demonstrated infundibular dilatation of the origin of the posterior communicating artery.
Adolescent↗
Prophylactic cranial irradiation for small-cell lung cancer: long-term results.
Over a six-year period, 72 patients with small-cell lung cancer received prophylactic cranial irradiation, as well as combination chemotherapy. There were 58 patients with limited-stage disease. With a minimum of four years follow-up, there are only four survivors, one of whom is affected by a crippling treatment-induced neurological deficit, and another has moderate impairment of cognitive functions. Despite cranial prophylaxis, 14 patients died from cerebral metastases, and four others of undiagnosed neurological problems. One other patient, who died apparently in remission, also had severe iatrogenic brain damage. These results cast doubt upon the value of this form of treatment in a disease that remains incurable for the vast majority of sufferers.
Adult↗
Gadolinium-enhanced magnetic resonance imaging of spinal tumours.
The use of gadolinium diethylenetriamine-penta-acetic acid (Gd-DTPA) (Magnevist) enhanced magnetic resonance imaging (0.15 T) in the assessment of spinal tumours is described. Thirty-five patients were entered into the study and a total of 39 examinations were performed. The information obtained from unenhanced T1- and T2-weighted spin-echo sequences was compared with the Gd-DTPA-enhanced T1 images. Thirty patients had intradural lesions and five had extradural lesions. A variable pattern of enhancement of intramedullary tumours was found, which in part reflected differences in the cystic component of the lesions. Extramedullary intra- and extradural lesions generally showed marked enhancement. The greatest contribution to management decisions was in the evaluation of intramedullary tumours where the use of contrast enhancement facilitated the precise localization of active tumour, differentiation of cystic and solid components of tumour, separation of tumour from peritumoral oedema and, in cases of suspected recurrence, aided distinction between tumour and both post-operative scarring and radiation damage.
Adolescent↗
Spinal arteriovenous malformations in children.
Three cases of spinal AVM in children are presented, each illustrating a different clinical presentation and anatomical variant. The natural history, treatment, and pathophysiology of these cases is discussed with a survey of the literature.
Angiography↗
Carotico-cavernous fistula after trans-sphenoidal hypophysectomy.
A case is presented of a 48-year-old woman with an iatrogenic carotico-cavernous fistula consequent upon a transphenoidal hypophysectomy. Successful closure of the fistula was achieved by interventional radiology. The causes and management of vascular injuries during trans-sphenoidal pituitary surgery are reviewed and discussed.
Arteriovenous Fistula↗
Magnetic resonance imaging with even-echo rephasing sequences in the assessment and management of giant intracranial aneurysms.
The role of magnetic resonance imaging in the assessment of giant intracranial aneurysms was compared with angiography and contrast-enhanced computed tomography (CT) in 18 patients. The use of T1- and T2-weighted spin-echo (SE) sequences demonstrated both the presence and the evolution of thrombus within these lesions. High-velocity flow within the parent vessels and still-patent lumen could be defined as an area of absent signal. The use of even-echo rephasing (EER) sequences provided a rapid technique for demonstrating and confirming the presence of luminal flow, which is shown as areas of high signal. The combination of SE and EER techniques proved superior to CT in the assessment of thrombus and flow patterns in these lesions, as well as enabling superior demonstration of the patency of the parent vessel following surgical ligation. Computed tomography remains the most accurate method of defining the presence and location of associated calcification.
Adult↗
A comparative study of magnetic resonance imaging and computed tomography-assisted myelography in spinal dysraphism.
Thirty-seven patients with a wide spectrum of spinal dysraphic lesions were studied by both magnetic resonance imaging (MRI) and myelography complemented by computed tomography (CT). Magnetic resonance imaging proved to be superior for tissue characterization, overall anatomical definition, topographical relationships of the cranio-cervical junction and demonstration of the presence and extent of hydrosyringomyelia. Demonstration by CT myelography of fine neural structures such as the filum terminale and nerve roots remains the superior technique; however, with constantly improving spatial resolution and thinner-slice imaging, MRI will become increasingly competitive in this respect. The osseous component of these lesions was best demonstrated by CT myelography. A high incidence of associated syrinx (8/15 cases) was found in the diastematomyelia group, with an overall incidence of 15 cases in all the dysraphic patients studied. The use of both T1- and T2-weighted sequences is required for tissue characterization. Whilst both imaging modalities proved complementary in the investigation of spinal dysraphism, we suggest that, with its superior tissue characterization and anatomical display of these lesions. MRI should be the primary imaging technique. Avoidance of an invasive procedure and use of ionizing radiation confers additional benefits upon MRI. The relative ease and shorter examination time of MRI makes this technique ideal for pre- and post-operative monitoring and assessment.
Adolescent↗
A cervical cord tumour presenting with earache.
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Aged↗
Recurrent spontaneous subarachnoid haemorrhage due to spinal haemangioblastoma.
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Adult↗
The value of magnetic resonance imaging in the diagnosis of intracranial meningiomas.
Thirty-two patients suspected by Computed Tomography (CT) of having a meningioma were additionally imaged by Magnetic Resonance. Of these, seven patients had an eventual diagnosis other than meningioma. This represents a positive value of 76% for the diagnosis of meningioma by CT. Magnetic resonance imaging (MRI) improved positive predictive value to 86%. A diagnosis other than meningioma was made by MRI with greatest confidence when tumour signal intensity was either much greater or much less than that of grey matter. Comparison of Inversion Recovery (IR) and spin echo (SE) sequences showed IR to be superior for demonstration of supratentorial meningiomas. SE images were superior to IR in demonstrating calcification. MRI was of value in showing anatomical relationships, due to its multiplanar capacity and in demonstrating vessel patency. CT was generally superior in defining meningiomas and in demonstrating calcification.
Adenocarcinoma↗
The relative contribution of magnetic resonance imaging to the assessment and differential diagnosis of cerebellopontine angle mass lesions.
Forty-nine patients with a space occupying lesion in the cerebellopontine angle cistern were examined by computed tomography (CT), magnetic imaging (MRI) and, where appropriate, conventional neuroradiologic techniques. The presence of an intracanalicular extension and a high signal on T2 weighted sequences were typical of acoustic neuroma and allowed separation from meningioma. Contrast enhancement with gadolinium DTPA was particularly valuable in recurrent acoustic neuroma. Typically epidermoids had long T1 and T2 values. Sequences which highlight flow allow vascular lesions to be identified without the use of contrast media. In separating the several pathologies MRI was superior to CT and also gave information on tissue composition in acoustic neuroma.
Cerebellar Neoplasms↗
Value of computerised tomography in children with non-specific mental subnormally.
Seventy-six children had computerized tomography scans as part of an investigation of mental subnormality; most of them are severely retarded and all those over age 5 years attend special schools. Seventy-two per cent of the children had normal scans. Twenty per cent showed cerebral atrophy and in only 8% was there a specific abnormality (agenesis of corpus callosum, arachnoid cyst, communicating hydrocephalus). None of these findings had any positive prognostic implication. Sedation or general anaesthesia was required for all except one child. Injection pethidine compound was used for children under age 5 years or less than 30 kg in weight, and trimeprazine orally was used for older children. The radiation exposure was high--5.6 rad per scan, which is 100 times greater than that from a posteroanterior and lateral chest x-ray film. For these reasons computerised tomography scans cannot be recommended as a routine part of the investigation of children with non-specific mental subnormality.
Adolescent↗