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Biomedical subjects

R M Quencer

Publications and source records attributed to R M Quencer.

At least 163 records · Page 9Linked to original sources
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Acquired spinal subarachnoid cysts: evaluation with MR, CT myelography, and intraoperative sonography.

Fifteen patients with acquired spinal subarachnoid cysts (14 surgically proved, one presumed) were evaluated preoperatively with immediate and/or delayed CT myelography (seven patients), MR (11 patients), or both (three patients). CT myelography separated subarachnoid cyst from myelomalacia and/or intramedullary cysts in four cases but failed to diagnose them in three, while MR accurately diagnosed subarachnoid cyst in all 10 cases that were also surgically proved. The results of these preoperative examinations were evaluated to determine the efficacy of each study in diagnosing subarachnoid cysts, ascertaining their extent and internal architecture, and detecting associated abnormalities of the spinal cord. In addition, during surgery these cysts were studied with sonography to gain an understanding of the pathophysiological mechanisms involved in their formation and propagation and to guide the surgeon in their decompression. On the basis of our experience, MR appears to be the most efficient preoperative study in diagnosing and characterizing acquired subarachnoid cyst and associated abnormalities. Intraoperative sonography provides a reliable means of ensuring adequate decompression of these cysts.

Adult↗
PubMedDate not supplied

Syringomyelia associated with intradural extramedullary masses of the spinal canal.

Three cases of syringomyelia associated with intradural extramedullary tumors of the spinal canal are reported to demonstrate their radiographic feature, to postulate a mechanism for their formation, and to describe the clinical deterioration occurring in two patients immediately after metrizamide myelography. It is believed that the mechanism by which these syrinx cavities formed was similar to the mechanism of syrinx formation within chronically injured spinal cords. The cystic cavities may extend for considerable distances away from the extramedullary mass and may be present above and/or below the mass. The development of a syringomyelia in the face of an intradural extramedullary tumor may not be rare, and it is suspected that with the more frequent use of delayed metrizamide CT and now magnetic resonance imaging, syringomyelia will be found as an occasional consequence of this type of mass.

Adult↗
PubMedDate not supplied

Radiologic evaluation of spinal cord fissures.

The clinical course and radiographic studies were reviewed of eight patients with posttraumatic spinal cord fissures (rents in the spinal cord communicating with the subarachnoid space). Five patients had spinal cord fissures associated with symptomatic intramedullary cysts that required shunting to alleviate progressive neurologic deficits and intractable pain. Their metrizamide myelograms showed contrast medium passing immediately from the subarachnoid sac into the spinal cord and their immediate metrizamide CT scans delineated the entire extent of the secondary cord cysts. Intraoperative sonography confirmed the presence of the cord fissures with sizeable cysts, detected adhesions, and guided myelotomies and the subsequent shunting and collapse of the cysts. Since neurologic improvement followed the shunting procedures in all five patients treated for progressive symptoms, it was concluded that early radiologic evaluation of posttraumatic spinal cord fissures with symptomatic cord cysts is crucial in the clinical management of these patients.

Adult↗
PubMedDate not supplied

Concurrent hydromyelia and diastematomyelia.

Hydromyelia was discovered in six of 13 patients with diastematomyelia. In one patient, hydromyelia affected only the segments of spinal cord above the diastematomyelia. In five patients, hydromyelia extended downward from the single cord into one or both hemicords. Because hydromyelia and diastematomyelia occur simultaneously, because they may produce very similar clinical changes, and because simultaneous or sequential surgical correction of both conditions may be necessary to achieve the best clinical result, the possibility of hydromyelia should be evaluated specifically in each patient demonstrated to have diastematomyelia.

Adolescent↗
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Somatosensory evoked potential measurements in percutaneous fluid aspiration from intraspinal cystic lesions.

Two patients were evaluated with somatosensory evoked potentials (SSEPs) before and after CT-guided fluid aspiration from cystic intraspinal lesions. Our objective was to use the information and the clinical response to this procedure to determine the suitability of the patients for surgical intervention. In both patients, one with a pseudomeningocele and the other with a subarachnoid cyst, improvement in their symptoms corresponded to significant changes in their SSEPs. We believe this technique may be useful in selected cases when it is unclear whether cystic intraspinal fluid collections are responsible for the patient's symptoms. An increase in amplitude and/or decrease in latency of SSEPs, along with clinical improvement after fluid aspiration, may indicate the potential benefit of surgical intervention.

Aged↗
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Sonography and neurodiagnosis (neurosonography).

Sonography is a necessary part of neuroradiology. Its relative importance will increase as the sonographic images improve and the funds provided for diagnostic imaging decrease. We urge the incorporation of neurosonographic training into our neuroradiology fellowship programs and more widespread use of sonography in neurodiagnosis.

Echoencephalography↗
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Cerebral atrophy in systemic lupus erythematosus: steroid- or disease-induced phenomenon?

Thirty-two patients with systemic lupus erythematosus were evaluated clinically and with computed tomography in order to determine whether the occurrence of cerebral atrophy in systemic lupus erythematosus was due to the steroid therapy or the cerebral manifestations of the disease itself. Of these patients, 14 had central nervous system manifestations of the disease (lupus cerebritis) and 12 of the 14 were on long-term steroid therapy. Eighteen patients had no clinical evidence of lupus cerebritis and all were on long-term steroids. Of the 14 lupus cerebritis patients, 10 showed moderate cerebral atrophy, four minimal atrophy, and none were normal. Of the 18 patients without lupus cerebritis, none had moderate atrophy, six (33%) showed minimal atrophy, and 12 (67%) had normal CT scans. This data suggest that it is the lupus cerebritis rather than the steroid therapy that is responsible for the moderate cerebral atrophy. In patients suspected of lupus cerebritis, steroids should not be withheld because of concern for steroid-induced atrophy. Rather, the dose may need to be increased.

Adolescent↗
PubMedDate not supplied

Paraganglioma of the filum: MR appearance.

Paragangliomas are benign tumors that are thought to arise from the neuroectodermally derived paraganglionic cells of the sympathetic nervous system. We report the imaging findings of an unusual case of paraganglioma of the filum terminale.

Cauda Equina↗
PubMedDate not supplied

Spinal dural arteriovenous fistulas: evaluation with MR angiography.

PURPOSE: To show that postgadolinium three-dimensional time-of-flight MR angiography shows abnormal intradural vessels associated with spinal dural arteriovenous fistula better than routine MR imaging and provides screening information useful for subsequent diagnostic conventional angiography and/or posttreatment evaluation. METHODS: Precontrast and postcontrast MR imaging and MR angiograms, as well as subsequent digital subtraction angiograms, were obtained for eight patients with dural arteriovenous fistulas, diagnosed with digital subtraction angiography and verified with surgery. In four patients, MR studies also were obtained after surgery. RESULTS: All patients had cord hyperintensity of T2-weighted images and postgadolinium enhancement on T1-weighted images. Five had vessellike signal abnormalities in the subarachnoid space on MR. Abnormal intradural vessels were detected in all eight patients with MR angiography. Comparison with digital subtraction angiography revealed these vessels to be primarily enlarged veins of the coronal venous plexus on the cord surface. In six patients, the medullary vein draining the fistula was demonstrated, indicating the level of the fistula, later identified by digital subtraction angiography. After surgical obliteration of the fistula, the draining medullary vein and most or all of the abnormal coronal veins were no longer demonstrated, with decrease or resolution of cord hyperintensity on T2-weighted images. CONCLUSION: Postgadolinium, spinal MR angiography in cases of suspected dural arteriovenous fistula provides information about intradural veins that supplements the diagnostic value of the MR imaging results, facilitates the subsequent digital subtraction angiography study, and, in treated cases, reflects the success of surgery and/or embolization.

Aged↗