Biomedical subjects
Publications and source records attributed to M H Lipper.
The evaluation of delayed sequelae of head injury is greatly facilitated by CT. This non-invasive technique provides us with the opportunity to evaluate the head trauma patients sequentially to detect the development and clinical significance of post-traumatic sequelae like delayed intracerebral hemorrhage, hydrocephalus, and post-traumatic atrophy.
Congenital arteriovenous fistulas of the external carotid artery are extremely rare as compared with acquired lesions. Early diagnosis permits surgical excision before irreversible cardiac damage occurs.
It is commonly believed that strokes occurring in patients with sickle cell disease are due to abnormalities involving the small intracranial vessels, that is, at the level of small venules, capillaries, and precapillaries. The authors present a case of multiple major intracranial arterial disease in a 14-year-old boy with sickle cell disease. The angiographic findings and the pathophysiology of arterial changes are discussed along with a review of the literature. This report emphasizes that patients with sickle cell disease may present with major intracranial arterial involvement as a prominent feature.
Cerebrospinal fluid seeding is a well-known mode of metastasis for intracranial neoplasms such as medulloblastoma, ependymoma, and glioblastoma; however, retinoblastoma is not usually considered. The route of spread appears to be by direct extension into the optic nerve from the retina and into the meningeal spaces by extension from the choroid, or along the central retinal vessels to the subarachnoid space. Four cases are presented.
Serial computed tomography was peformed on 119 consecutive patients suffering from severe head injury. The development of delayed intracranial hematomas, both intra- and extraaxial, was evaluated by comparing the initial scan with subsequent studies. Ten delayed intracerebral hematomas and nine delayed extracerebral collections were encountered. The occurrence of delayed intracerebral hemorrhage is more frequenct than previously reported and is associated with a poor outcome.
During a 34-month period, 12 cases of delayed traumatic intracerebral hematoma (DTICH) were diagnosed among 162 consecutive prospectively studied patients admitted to the Medical College of Virginia with severe closed head injuries. All patients were unresponsive to command and unable to utter formed words at the time of admission. The interval from injury to diagnosis of DTICH by computerized tomography (CT) was within 48 hours in 11 of the 12 cases. Six patients had no decompressive surgery before the development of the lesion. Four patients had undergone decompressive surgery and then developed DTICH on the contralateral side. Two patients developed lesions in the vicinity of the operative site that were thought not to be the result of operation. The development of DTICH was not heralded by neurological deterioration nor by elevation of intracranial pressure. Eleven of the 12 patients had suffered a secondary hypoxic insult soon after the head injury. We suggest that the CT appearance of DTICH is likely to represent hemorrhage into an existing traumatized area and is an epiphenomenon rather than a cause of severe primary and secondary brain damage.
A consecutive series of 107 comatose patients with head injury was studied with regard to the proper role of serial computerized tomography for clinical management and as a research tool for studying the pathophysiology of severe head trauma. In this prospective study patients had serial CT scans on days 1, 3, 5, 7, 14, at 3 months, and at 1 year (day 1 is the day of admission). In seven instances CT scanning was responsible for detection of late intracranial lesions requiring surgical decompression two weeks to one year after injury. No surgically significant lesions were, however, detected by routine scanning on the pre-determined days in the early post-trauma period that had not already been signalled by changes in the neurological status, intracranial pressure, or volume pressure response. It is concluded that for purposes of clinical management, additional scans should be obtained in the following circumstances: 1) 1 day post-craniotomy, 2) no improvement by day 3, 3) at 2-3 weeks, and 4) at 3 months. All other scans should be obtained as needed. As a research tool, serial CT scanning is of value in studying post-traumatic hydrocephalus, delayed intracerebral hematomas, and intraventricular hemorrhage.
A young patient with classic clinical presentation and radiological findings of an arteriovenous malformation subsequently developed a spontaneous occlusion of the straight sinus. Although the lesion was supratentorial, thrombosis of the straight sinus and cerebellar cortical veins resulted in signs and symptoms of cerebellar dysfunction. Successful surgical excision was performed with good results.
Computerized tomography was performed on 100 consecutive patients suffering from severe head injury, on admission, after 3, 5, 14, and 90 days and 1 year. Ventricular enlargement was evaluated in the surviving patients based upon serial CT examinations. The presence or absence of ventricular enlargement was correlated with the clinical outcome. The study indicates that a significant correlation does exist between the outcome and ventricular size. Hydrocephalus was seen in only four out of the 29 patients who developed ventriculomegaly.
Two cases of aneurysmal bone cyst of the spine are described. The age incidence and distribution of such lesions are analysed, the typical radiographic and histological appearances are described, and the difficulty in diagnosis is discussed.
A patient was investigated for painless haematuria, and a highly vascular renal cell carcinoma was shown on angiography. When this neoplasm was surgically removed, there was a remarkable improvement in the signs and symptoms of heart failure, from which the patient had been suffering for some time.
Primary cerebral neuroblastoma occurring within the ventricles has been called intraventricular central neurocytoma. This lesion is usually calcified and tends to have a better prognosis than primary cerebral neuroblastoma occurring in the hemispheres. This entity must be considered when an intraventricular calcified lesion is encountered. We report the CT and MR findings in a case of this unusual neoplasm.
Three patients with suspected iatrogenic cerebral air embolism had cranial CTs performed within 24 hr of onset of symptoms. One was interpreted as normal, one showed a large, right frontoparietal enhancing lesion, and the third showed evidence of bi-thalamic infarction. Follow-up scans 7 to 10 days later showed either single or multiple enhancing infarcts in all patients. Although CT proved a valuable tool in the diagnosis of this condition, one out of three initial studies were negative, necessitating a follow-up scan.
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PURPOSE: To analyze and discuss CT and MR features of pleomorphic xanthoastrocytoma (PXA) and present salient histopathologic features of this distinctive astroglial tumor. METHOD: CT, MR, and histopathologic studies on seven patients with the histologic diagnosis of PXA were reviewed retrospectively. RESULTS: All patients were in their first 3 decades of life when first diagnosed and demonstrated peripherally situated supratentorial tumors of varying size involving the superficial cortex and leptomeninges. Five of six cases examined with CT showed areas of mixed attenuation with four demonstrating well-demarcated enhancement. MR demonstrated low or mixed signal intensity on T1-weighted and high or mixed signal intensity on T2-weighted sequences. All five who received gadopentetate dimeglumine showed well-defined enhancement. Three showed cyst formation. Typical histologic features included marked cellular pleomorphism with giant cells, bizarre nuclei, variable cytoplasmic lipidization and positive immunoreactivity for glial fibrillary acidic protein. Necrosis and endothelial-pericytic cell proliferation were absent. CONCLUSION: PXA has a highly suggestive neuroradiologic and distinctive histopathologic appearance.