[The value of computerized tomography in neurological, neurosurgical and psychiatric diseases].
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Biomedical subjects
Publications and source records attributed to M Nadjmi.
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Problems of correlating ischemic lesions of the brain with the cerebral vessel involved originate in the axial scanning direction. It is almost impossible to line out precisely the borders of the cerebral lobes--far less are we able to describe exactly the areas supplied by the cortical branches of the anterior or middle cerebral artery. Using a method based on detailed perception of the base of the skull and physiological calculations, it is possible to reconstruct the individual baseline of the scan and to project the outlines of the slices upon the lateral view of the angiogram. Thereby a reliable topographical association between CT findings and angiogram is given.
Giant intracranial aneurysms are frequently observed as incidental findings on CT and angiograms obtained for purposes other than subarachnoid hemorrhage, such as slowly evolving nerve palsy or hemiparesis. Since giant aneurysms often thrombose, the CT scan may demonstrate a larger aneurysmal volume than the angiogram. This paper presents CT and angiogram findings in cerebral aneurysms with a diameter of 25 mm-60 mm. The discussion covers: sort of aneurysm (congenital, arteriosclerotic); type and degree of thrombosis; long-term results after spontaneous thrombosis; and CT examination after using epsilon-aminocaproic acid.
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Variations of tumors of the posterior cranial fossa in CT are discussed especially concerning their anatomical and pathological picture and compared with angiographical findings. The differential diagnosis of cysts and cystic tumors of the posterior cranial fossa is outlined as most important progress of computerized axial tomography.
Serial angiotomography is a selective investigative method which contributes to exact differential diagnosis and localization of the tumor. With the localization near the midline of the supratentorial tumors it can occasionally be the only arteriographical method which will bring a definite result. With basal processes the relationship of the tumor to the bones and dura can be demonstrated more accurately. In addition angiotomography brings new haemodynamic aspects with regard to the circulation time and intensity of the tumor stain of glioblastoma.
All attempts to reconstruct the topography of the brain in the living from studies of animal material are handicapped by technical difficulties. The best method is to compare exact X-ray pictures, which have been taken under stereotactic conditions. From a large collection of such X-rays the authors have composed contours of the internal table of the skull and of the ventricles, which best match the brains, selected for the Schaltenbrand-Bailey sterotactic atlas. For practical purposes these contours were combined with the transparent overlays for the nomenclature and the border lines of the different parts of the basal ganglia, which have been used in the myelin sections part of the atlas. A comparison of our sagittal series with the new X-ray findings shows, that the sagittal schemata of the atlas represent an extreme variation in the position of the Meynert axis and of the contours of the 4th ventricle. We have chosen a new axis system for the hindbrain, which corresponds to the average of our brains in constructing a new set of typical overlays for the atlas. The contour of the posterior fossa had to be completed. An independent axis system dor the structures of the 4th ventricle was developed, consisting of the base of the 4th ventricle, and a tangent, to the upper contour of the pons. In sterotactic procedures the axis systems for the forebrain and the hindbrain should be used independently. The results obtained are the basis for a new series of lantern slides which can be projected against the X-ray pictures with the Würzburg stereotactic equipment. In the course of this investigation we discovered a source of error. When air enters the puncture hole of the dura, the brain may sink back, so with the patient lying on his back, all structures may shift a few millimeters towards the occipital region. When the patient is lying on his side, as during an approach to the amygdala through the planum temporale, the ventricular system may collapse, so that almost no air is visible in the ventricles and the 3rd ventricle may appear to be in the lower hemisphere, the dislocation being more than 5-8 mm. But filling the ventricle with air through the ventricular catheter is sufficient to blow up the brain and to restore the normal topography.
The present paper reviews changes in the vessel wall in the carotid syphon, including variations in calibre, stenoses, post-stenotic dilatation and aneurysms. Particular attention is paid to a supraclinoid circular stenosis, which corresponds in its localisation to the emergence of the internal carotid artery from the dura. Reference is made to new anatomical findings in this region. The haemodynamic basis of poststenotic dilatations and the development of acquired aneurysms as a result of this mechanism are discussed. Examples of post-stenotic aneurysms are demonstrated.
A new casette for serial angiotomography is described; with it, one contrast injection can be used to show the arterial, capillary and venous phases in series. The examination is possible with any desired direction of the rays, without changing position of the head. The cranio-cervical region, the neck and the vessels in the upper thorax can also be tomographed.
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Explore the source record for details and available documents.
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Explore the source record for details and available documents.
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