Biomedical subjects
Publications and source records attributed to Jiing-Feng Lirng.
The mechanisms responsible for cyclosporin-induced encephalopathy remain controversial. Herein we present a case of cyclosporin-induced encephalopathy with unusually prolonged vasospasm, which might have contributed to the slow recovery of the patient.
The MR finding of an acute spinal epidural hematoma (SEH) can mimic epidural neoplastic or inflammatory lesions, because acute SEH appears hypointense on T1-weighted images and hyperintense on T2-weighted images. We report on two cases of acute SEH with unusual contrast enhancement patterns on MR images. Contrast enhancement can be an MR finding of acute SEH, especially in bleeding diathesis, which indicates an active lesion that needs early diagnosis and management.
BACKGROUND AND PURPOSE: Bilateral engorged superior ophthalmic veins (SOV) have been reported in patients with diffuse brain swelling. We investigated the relationship between the diameter of the SOV on brain MR images and the intracranial pressure (ICP). METHODS: We reviewed the medical records of neurologic inpatients who had undergone both MR imaging of the brain and lumbar puncture. MR imaging had to have been performed before lumbar puncture, and the two studies had to have occurred within 2 days. The diameters of the SOV were measured on coronal contrast-enhanced fat-saturated T1-weighted MR images. For this, the image nearest the rear of the globe of the eye was chosen. RESULTS: Sixty-nine patients (32 male, 37 female; mean age, 46 years +/- 19) were included. The average diameters of the SOV and the ICP were positively correlated (r = 0.58, P <.001), if an SOV diameter of <1 mm was treated as 0.5 mm for calculations. In patients with increased ICP (CSF pressure >200 mm H(2)O), SOV diameters were larger than those of patients with a normal CSF pressure (3.0 vs 1.6 mm, P <.001). Frequencies of increased ICP were 3% among patients with an average SOV diameter of 0.5-1 mm, 15% for 1.5-2 mm, and 58% for 2.5-5 mm (P <.001). CONCLUSION: This study showed that the SOV diameter, determined on the basis on MR imaging, was positively correlated with ICP. Dilatation of the SOV should alert physicians to the possibility of increased ICP.
BACKGROUND: Spinal cord infarction (SCI) is a dynamic process; it can present wide-spectrum images simulating a variety of entities. The purpose of this study is to characterize the typical magnetic resonance (MR) findings and to describe evolutions and contrast-enhanced patterns of SCIs at different stages. METHODS: MR examinations of 15 patients (10 men and 5 women) with clinical diagnosis of SCIs were reviewed respectively. MR was performed from 3 hours to 178 days after onset of symptoms. The images studies were reviewed with special attention to the location, cord size and sequential signal changes of affected spinal cord, as well as contrast-enhanced patterns at different stages of SCIs. According to the onset time, the evolutions of SCIs were divided into 5 categories; onset within 6 hours (hyperacute), between 6 hours to 24 hours (acute), 1 day to 7 days (subacute), 7 days to 28 days and beyond 28 days (chronic stage). RESULTS: Four patients had SCIs involving the cervical, one at the cervicothoracic region, eight at the thoracic, and two at the thoracolumbar region. Twelve out of 15 patients had abnormal signal intensity at the MR studies. Three patients showed normal MR study of clinically suspicious affected level at the age of ictus less than 2 days. The SCI was apparently demonstrated on T2WIs with hyperintensity since 1 day after onset and T1WIs with hypointensity from day 5-7. Contrast enhancement of affected cord simulating other entities was obvious on day 5-7 and peaked on day 14-21 after ictus. CONCLUSIONS: MR is a useful means to detect and follow SCIs. Serial MR studies with contrast showed sequential changes of enhancement similar to those seen in cerebral infarcts. Knowledge of characteristic MR findings and evolutional changes at different stages of SCIs should perhaps lead to early diagnosis and, therefore, more effective management of patients.
BACKGROUND: To assess the efficacy and safety of endovascular embolization in the treatment of the carotid artery rupture. METHODS: A series of 21 patients who had carotid artery rupture (CAR) with massive transoronasal or transcervical hemorrhage, all treated with endovascular embolization, were reviewed. There were 17 males and 4 females ranging in age from 21 to 79 years, with a mean of 47 years. The predisposing factors of the CAR were head and neck tumors associated with surgical treatment and/or post-radiation therapy (n = 17), surgical complications (n = 1) and trauma (n = 3). Detachable balloons with liquid adhesives were used in 13 patients for vascular occlusion and obliteration of pseudoaneurysm of the internal or common carotid artery. Liquid adhesives and/or coils were used in 8 patients, in whom only the branches of the external carotid artery were involved (n = 6), or obliteration of a pseudoaneurysm with preservation of the ICA (n = 2). RESULTS: Endovascular treatment was technically successful in all 21 cases of the CAR with cessation of profuse hemorrhage immediately after embolization. No recurrence of bleeding was observed. Two patients developed permanent hemiparesis several hours later after occlusion of the carotid artery (10%). Three patients had a transient ischemic attack; all returned to normal neurological conditions later (14%). Ten patients having advanced head and neck carcinoma died during follow-up period owing to the disease itself. Clinical follow-up period for these patients lasted 2 to 48 months, with a mean of 16 months. CONCLUSIONS: Therapeutic endovascular embolization of the CAR is the primary invasive modality for treating CAR with profuse hemorrhage. It was proven both safe and effective over a relatively long follow-up period.
Multiple myeloma is generally a neoplastic plasma cell disorder of the old age. It seldom attacked young people or manifested intracranial plasmacytomas. Here we report a 28-year-old young patient of plasma cell dyscrasia who presented multiple plasmacytomas of bones while sparing bone marrow. Cerebral involvement with intratumorous hemorrhage complicated the clinical course. The unique clinical features are presented and literature is reviewed.
BACKGROUND: The acronym PHACE describes a rare neurocutaneous syndrome encompassing the following features: posterior fossa brain malformation, hemangioma, arterial anomalies, coarctation of aorta and cardiac defects, and eye abnormalities. This report describes the cervico-cerebrovascular anomalies (CCVA) in 7 patients with PHACE syndrome. METHODS: The medical records of 7 children (4 girls and 3 boys) with the diagnosis of PHACE syndrome who underwent cranial computed tomography and magnetic resonance imaging as well as complete cerebral angiography were retrospectively studied. RESULTS: All 7 patients had underlying CCVA. Neurologic symptoms were present in 5 of the 7 patients. CCVA included vascular stenosis and/or occlusion (n = 5), aberrant course or origin of arteries (n = 7), persistent embryonic carotid-vertebrobasilar anastomoses (n = 2) and fusiform or berry aneurysm formation (n = 5). Arterial agenesis or absence was found in 2 patients and hypoplastic arteries were present in 3 children. CONCLUSIONS: PHACE syndrome is associated with a high incidence of wide-spectrum CCVA. The most common CCVA is aberrant course or origin of arteries, followed by arterial stenosis and/or occlusion, aneurysm formation, arterial agenesis or hypoplasia and persistent carotid-vertebrobasilar anastomosis. Part of the CCVA may be associated with secondary neurologic sequelae. PHACE syndrome should be considered in any children with extensive facial hemangioma. Neuroimaging such as brain computed tomography, magnetic resonance imaging, and magnetic resonance angiography are recommended in order to search for structural cerebral defects and intracranial vascular alterations.
BACKGROUND AND PURPOSE: Percutaneous vertebroplasty is known for its pain-relieving effect. Our purpose was to evaluate its effect on the kyphosis angle, wedge angle, and height of the fractured vertebral body. METHODS: We reviewed digital radiographs of 73 vertebral bodies in 53 patients before and after vertebroplasty. We measured the spinal kyphosis angle and the wedge angle of the fractured vertebral body. Ratios of the height of the anterior border, center, and posterior borders of the collapsed vertebra to the height at the posterior border of an adjacent normal vertebral body were measured. Gain from vertebroplasty and the restoration percentage (gain divided by loss) were calculated for each parameter. RESULTS: The kyphosis angle, wedge angle, anterior height, center height, and posterior height significantly improved after vertebroplasty. The mean reduction in the kyphosis angle was 4.3 degrees, and the wedge-angle reduction was 7.4 degrees. The mean wedge-angle reduction in fractured vertebral bodies containing gas was 10.2 degrees. Restoration percentages for the kyphosis angle and wedge angle were 19% and 44%, respectively. Gain in the height of the fractured vertebral bodies was 16.7% for the anterior border, 14% for the center, and 7% for the posterior border. Restoration percentages for the height of the vertebral body were 29% for the anterior border and 27% for the center. CONCLUSION: Vertebroplasty increases the height of the fractured vertebra and reduces the wedge and kyphosis angles. These effects are most remarkable in fractured vertebra containing gas.
BACKGROUND: Endovascular embolization of wide neck aneurysm often results in incomplete occlusion or aneurysm recurrence. The purpose of this study is to assess the efficacy and safety of stent-assisted embolization of wide neck aneurysms of the internal carotid artery (ICA). METHODS: A series of 10 patients with ICA aneurysms attempted treatment by stent-assisted Guglielmi detachable coil (GDC) embolization (n = 9) or by stent alone (n = 1). There were 3 men and 7 women ranging in age from 21 to 78 years, with a mean of 51 years. The indications of stenting were wide neck aneurysms (n = 9) and herniation of detached coils from aneurysmal sac into parent artery (n = 1). RESULTS: Endovascular stent placement was technically successful in 8 cases. In one case with a cervical big ICA aneurysm, a stent was placed across the neck of aneurysm without deposition of embolic material into the aneurysmal sac. The initial control angiogram revealed residual aneurysm; however, complete obliteration of aneurysmal sac was achieved as observed on angiograms in 8 months. Six cases of wide neck aneurysms were successfully treated by stent-assisted GDC embolization. One case had prolapse of coil loops into parent artery after coils detached; the coil loops were successfully pushed back to aneurysm after stent placement. Two patients had difficulties to navigate the stents across the aneurysm necks because of tortuous parent arteries; in one of them, the stent partially covered the neck of aneurysm, which made the success of subsequent GDC embolization; in the other one, advancement of the stent to the targeted site was abortive, and the aneurysm was eventually loose packing. No significant procedure-related complication was found. One patient had asymptomatic dissection of the parent artery after stent placement. One patient had a transient ischemic attack and returned to normal baseline neurological conditions later. Clinical follow-up for these patients was 0.5 to 36 months, with a mean of 14 months. CONCLUSIONS: Stent-assisted embolization is a treatment of choice for wide neck aneurysms or for patient with herniation of coil loops to parent artery after coil detached. It was proven both safe and effective over a relatively long follow-up.
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Osteochondroma is the most common benign bone tumor. However, intracranial osteochondroma is very rare, which usually arises from the skull base. Origination from the dura and falx occurs only in sporadical cases. To our knowledge, only twelve cases have been reported in English literature. We report a case of giant osteochondroma from the falx cerebri causing external compression on the brain. Radiographic findings, computed tomography and magnetic resonance imaging manifestation with histologic correlation are described.