Biomedical subjects
Publications and source records attributed to J Kleefield.
An angiographic system capable of simultaneous biplane stereoscopic magnification cerebral angiography was evaluated. Stereoscopic imaging improved the morphologic depiction of aneurysms and of arteriovenous malformations. In a series of 357 patients, procedure time was reduced because the initial biplane stereoscopic series was nearly always diagnostic, obviating the need for additional angiographic views.
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.
A 15-year-old girl presented with primary amenorrhea, galactorrhea, hyperprolactinemia and an enlarged pituitary gland. She proved to have primary hypothyroidism. Therapy with levothyroxine resulted in prompt induction of regular menses, normalization of hormone levels, and a reduction in the size of the pituitary. Although hypothyroidism is known to produce secondary amenorrhea, hyperprolactinemia, and pituitary enlargement, this is believed to be the first computed tomographic documentation of such a "pseudoprolactinoma" presenting as primary amenorrhea.
We studied three patients with acquired immune deficiency syndrome (AIDS) and progressive polyradiculopathy. Postmortem examination of one patient disclosed extensive necrosis, inflammatory infiltrates, and focal vasculitis of spinal roots. Typical cytomegaloviral (CMV), intranuclear, and intracytoplasmic inclusions were noted within enlarged endoneurial and endothelial cells. Progressive polyradiculopathy is an unusual complication of AIDS; CMV may be the causative agent in certain cases.
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.
Iopamidol is a new, nonionic, water-soluble contrast material currently undergoing clinical trials for intravascular and intrathecal use in Europe and the United States. In this study, 12 patients underwent lumbar myelography with this agent. For each subject, up to 12 mL of iopamidol (at 200 mg I/mL) was employed. The myelograms obtained were highly satisfactory. No serious adverse reactions were observed. The most common side effect--headache--occurred in seven patients. However, six of the seven headaches were mild and transient, and did not require treatment. Nausea occurred in two patients, back pain in two patients, hypotension and hypertension each in one patient. All of these reactions were mild and self-limited. Iopamidol appears to be a safe and conveniently used agent for lumbar myelography.
Cerebral hemispheric asymmetries were assessed in relation to motor and functional recovery in nine patients with stroke. All were globally aphasic, assuring similar location and extent of lesion. Initial motor and functional ability were appraised from medical records and compared with neurologic and functional outcome. Frontal and occipital hemispheric widths and lengths were determined from CT. Patients were classified into three groups on the basis of mean combined asymmetry for width (typical asymmetry, atypical asymmetry, and equal symmetry). Patients with the most atypical cerebral asymmetries showed greater recovery than patients in other groups. Two patients with atypical mean occipital asymmetry (width) fared best functionally, whereas the patient who showed the greatest motor recovery had the most atypical mean occipital asymmetry (width). Cerebral asymmetries may contribute to recovery after stroke.
Eight pathologically proven cases of pineal region tumors examined by computed tomography (CT) were found upon reviewing 11,000 consecutive CT studies at the Massachusetts General Hospital. The CT scan findings of the eight cases are described and related to a pathological classification of pineal tumors.
Computed tomographic scans were performed in 34 patients following lumbar introduction of metrizamide. Imaging of the cranial spaces was obtained with horizontal and inclined (25 degrees) as well as coronal planes. Mass lesions within and encroaching upon the cisternal spaces were demonstrated, and the ventricular system was shown with varying degrees of opacification. Coronal and semicoronal views facilitated the localization of parasellar and incisural mass lesions.
Enhancement of CT attenuation values of the CSF cisterns by the lumbar injection of metrizamide has been shown to be of value in demonstrating the anatomy of the cisterns. Tumors involving the cisterns, such as acoustic neurinomas and pituitary adenomas, are clearly defined. Coronal scanning was superior to horizontal views in many cases.
A case of chordoma involving the thoracic spine (T12) is reported. The plain film findings included lytic obstruction and partial collapse of a single vertebral body. Noncontrast CT and CT following Metrizamide myelography revealed vertebral body destruction with paravertebral and intraspinal soft tissue masses. Unusual findings in the case included a photon deficient area on nuclear medicine corresponding to the lesion and normal vascularity on spinal angiography. We know of no previous report describing chordoma as a "cold" defect on bone scanning.
Chronic subdural hematoma was identified radiographically and verified surgically in two patients with brain tumor, one meningioma, and one glioblastoma multiforme. Over a period of days or weeks, both patients developed dramatic clinical findings probably related to the mass effect from the subdural hematoma in addition to the preexisting tumor. Early awareness of this complication in patients with brain tumor may lead to successful surgical treatment.
The hospital records and head CT scans of 44 patients with hemorrhagic infarction were retrospectively analyzed. The majority of cases (73%) were embolic or possibly embolic in etiology, and 55% were not associated with anticoagulant therapy. Adverse prognosis was most clearly related to infarct size, underlying systemic illness, and symptomatic hemorrhage. Of the nineteen patients in whom serial CT scans documented conversion from bland to hemorrhagic infarction, 12 exhibited no clinical worsening at the time that hemorrhagic infarction was observed; the remaining seven, all of whom worsened, were receiving anticoagulant therapy at the time of documented conversion. Fourteen patients in whom anticoagulant therapy was used despite the findings of hemorrhagic infarction remained stable or improved during hospitalization.
The computed tomography (CT) characteristics and clinical features of giant (globoid) aneurysms of the anterior circulation are reviewed. These lesions appear on the CT scan as smoothly encapsulated ovoid masses, within which a partially patent lumen is seen after the infusion of iodinated contrast material. With careful analysis of the CT scan it may be possible to differentiate giant internal carotid artery, anterior cerebral artery, and middle cerebral artery aneurysms from other parasellar and hemispheric lesions.
PURPOSE: To describe an oblique, two-slab 3-D acquisition technique for MR angiography of the extracranial carotid arteries, an approach chosen to minimize saturation effects when the body coil is used as transmitter, as is often the situation when a dedicated neck coil is used as receiver. SUBJECTS: Five healthy subjects and 17 patients in whom carotid artery disease was suspected underwent MR angiography using the above technique. RESULTS: Flow contrast was much better than in direct sagittal acquisition. Comparisons between multislab transverse 3-D acquisition and the oblique approach showed that a greater length of the carotid arteries was depicted and scan time was less for oblique acquisitions. CONCLUSIONS: Use of oblique imaging is a simple and effective solution to the problem of coil-related saturation effects.
Explore the source record for details and available documents.
In a patient with long-standing multiple sclerosis (MS), a double-dose delayed contrast-enhanced CT scan obtained during exacerbation revealed many areas of enhancement. Vigorous treatment with corticotropic hormone was followed by almost complete disappearance of these abnormalities. No areas of low attenuation were seen on a later unenhanced CT scan. Finally, MR imaging showed only a single area compatible with a plaque of MS. It is suggested that pathologic alteration of the blood-brain barrier seen in MS is not necessarily followed by demyelination and plaque formation. Restoration of the integrity of the blood-brain barrier may thus possibly prevent the formation of plaques in some MS patients, in particular if this can be accomplished early in the course of the exacerbation.
Explore the source record for details and available documents.