Biomedical subjects
Publications and source records attributed to M Banna.
This article described a 19-year-old woman with homozygous sickle disease in whom multiple cerebral infarcts developed after a technically uncomplicated cardiac angiogram. The article highlighted the risks of hyperosmolar solutions in patients with sickle cell disease and emphasized that only low osmolar contrast media, nonionic or ionic, should be used.
We report 11 children with a homogeneous clinical syndrome affecting both sexes, characterized by weakness at birth, slowly improving course, weakness of all muscle groups, arreflexia, elevated blood creatine kinase, normal nerve conduction velocity, dystrophic changes on muscle biopsy, and diffuse periventricular cortical white-matter abnormalities with sparing of corpus callosum, internal capsule, and brain stem. We compare them to 48 other previously reported similar cases and designate them as altered myelin radiographic pattern congenital muscular dystrophy (CMD), which is the same as occidental CMD. We compare them to the other presently accepted phenotypes: progressive Fukuyama CMD, Walker-Warburg or cerebral-ocular CMD, and Santavuori or muscle-eye-brain CMD. We suggest that the different phenotypes are alleles of the same gene, which regulates or expresses a structural protein required for muscle integrity, myelination, and formation of the cortex. Such phenotypic diversity has been established for mutations of Xp21 in X-linked muscular dystrophies.
We report MRI findings in 6 patients with Behçet's disease and CNS involvement. There were 3 different stages of imaging appearance: (1) During the acute illness, there were scattered areas of high signal intensity on T2-weighted images with predilection to the central structures of the cerebrum, the cerebral peduncles, and basis pontis. (2) During the recovery phase, most of these findings improved, but some white matter high signal areas persisted in the upper brainstem and peripheral subcortical white matter. Occasionally, findings were suggestive of microhematoma. (3) During the chronic phase, atrophy of posterior fossa structures became evident with decreased signal intensity suggestive of hemosiderin deposits.
The authors present two patients who had dissecting aneurysms of the petrocavernous segment of the internal carotid artery. They successfully treated the condition with balloon embolization of the artery proximal to the aneurysm.
A rare case of intracranial teratoma is reported in which a tooth-like structure was clearly defined in the pituitary fossa. The authors are unaware of any similar case having been reported previously.
Five female patients with primary hypothyroidism and radiological evidence of a pituitary enlargement were studied before and after a mean of 30 months (range 12-83 months) treatment with thyroxine (T4). Before treatment, serum thyroid-stimulating hormone (TSH) levels were elevated in every patient (mean 392 mU/l, range 240-475) and prolactin levels in 4 (mean 79 micrograms/l, range 48-143 micrograms/l). CT scanning confirmed the presence of pituitary enlargement in the 4 patients studied, which was suprasellar in 3. The remaining patient had an enlarged fossa on a lateral skull radiograph. During treatment with T4, TSH and prolactin levels were normal in all. Complete disappearance of the enlargement was seen on follow-up scans in all patients and 1 developed an empty sella. The induction of a pituitary enlargement by primary hypothyroidism results from reversible hyperplasia of both the TSH and prolactin-secreting cells in most instances. Occasionally, however, hyperplasia of the thyrotrophs can occur in isolation and an empty sella can occur after successful treatment with T4. Thyroid function tests should be obtained in all hyperprolactinemic patients.
Lissencephaly (agyria or smooth brain) is a rare congenital anomaly representing an arrest of brain development before the third or fourth month of gestational age. It may occur alone or in association with many other syndromes. In analyzing the findings in four patients it is evident that the main computed tomographic and magnetic resonance features are: (a) smooth brain surface, (b) shallow sylvian fissures resulting in a figure-eight appearance of the axial brain sections, (c) decreased white matter and a thick brain cortex, (d) absent or severely attenuated grey-white matter interdigitations, and (e) dilatation of the lateral ventricles. Other associated anomalies include microcephaly, absent corpus callosum, neuronal heterotopia, and cerebellar hypoplasia. Pachygyria is a less severe anomaly occurring at a later stage of brain development and is characterized by the presence of a relatively few broad coarse gyri. Lissencephaly and pachygria may coexist in the same brain.
This paper presents three patients with a triad of syringomyelia, midline posterior fossa cysts, and hydrocephalus. In the first patient, the clinical presentation was related to spinal cord cavitation, and the cranial anomalies were unexpected. In cases 2 and 3, the brain anomalies dominated the clinical picture, and syringomyelia was unexpected. These cases show that an examination of the whole neuraxis is as important in patients with midline posterior fossa cysts as it is in patients with developmental syringomyelia or Chiari I malformation.
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When selective catheterization of a common carotid artery is difficult, it is still possible to obtain adequate diagnostic films of the cerebral circulation in the lateral projection without marked superimposition of the intracranial vessels. This can be achieved angiographically by using digital recording after an arterial aortic arch injection and compressing the opposite carotid artery during imaging.
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In a 64-year-old female patient with verified dural venous thrombosis, postcontrast computed tomography showed dilatation of the transcerebral medullary veins, a feature that is probably pathognomonic.
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With computed tomography, dilated tortuous carotid and/or basilar arteries appear as tubular, fusiform or ring-shaped densities on the non-enhanced scan, or they may only be apparent after iodine injection. They can be differentiated by their shape and anatomic location. They may be multiple and are mostly seen in patients with a long history of atherosclerosis and hypertension.
A retrospective clinicoradiological study of 80 patients with amenorrhoea and/or galactorrhoea showed: 1. Of 60 patients, in whom prolactin levels were estimated, 28 (47%) had hyperprolactinaemia (serum prolactin levels greater than 20 ng/ml). 2. Hyperprolactinaemia was present in 85% of patients with amenorrhoea and galactorrhoea, 35% of those with galactorrhoea only, and 12.5% of those with only amenorrhoea. 3. Pituitary adenomas were surgically removed from six patients; all but one had prolactin levels over 100 ng/ml. The level was 53 ng/ml in the sixth patient. 4. There is a considerable degree of observer variation in the interpretation of borderline sellar changes. 5. Minor abnormalities of the pituitary fossa were noted in 64% of patients with hyperprolactinaemia and 36% of those with normal prolactin levels. 6. The highest incidence of perfectly normal sellae was among patients with either amenorrhoea or galactorrhoea and normal serum prolactin.
The computed tomography scans of patients who had frontal leukotomy show bilateral cysts in the frontal lobes that have attenuation values similar to cerebrospinal fluid, and are not contrast enhanced.
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