Use of a microsnare to aid direct thrombolytic therapy of dural sinus thrombosis.
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Adult↗
Biomedical subjects
R W Hurst
Publications and source records attributed to R W Hurst.
Spontaneous thrombosis of a basilar artery traumatic aneurysm in a child.
Traumatic aneurysms are rare and occur most commonly in young adults; however, the relative frequency in the pediatric population is high, owing to the low prevalence of congenital saccular aneurysms in children. Traumatic aneurysms typically involve the anterior circulation, and spontaneous thrombosis is uncommon; hence, surgery is usually necessary. We present a case of a posttraumatic aneurysm in a child that occurred after a fall from a large height and that spontaneously thrombosed.
Accidental Falls↗
Isolated unilateral hypoglossal neuropathy caused by dural arteriovenous fistula.
We report a case of isolated hypoglossal nerve paralysis caused by a dural arteriovenous fistula. Diagnosis is discussed with emphasis on conventional and MR angiography. The anatomy of the hypoglossal nerve is reviewed along with more common causes of pathologic conditions.
Adult↗
Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy.
PURPOSE: Dural arteriovenous fistulas (DAVFs) are acquired arteriovenous shunts located within the dura. The highly variable natural history and symptomatology of DAVFs range from subjective bruit to intracranial hemorrhage and are related to the lesion's pattern of venous drainage and its effect on the drainage of adjacent brain. We examined the prevalence and features of DAVFs in patients with progressive dementia or encephalopathy. METHODS: The records and radiologic studies of 40 consecutive patients with DAVFs treated at our institution were reviewed. RESULTS: Five (12.5%) of 40 consecutive patients with DAVFs had encephalopathy or dementia. In each patient, high flow through the arteriovenous shunt combined with venous outflow obstruction caused impairment of cerebral venous drainage. Hemodynamically, the result was widespread venous hypertension causing diffuse ischemia and progressive dysfunction of brain parenchyma. Results of CT or MR imaging revealed abnormalities in each patient, reflecting the impaired parenchymal venous drainage. Pathologic findings in one patient confirmed the mechanism of cerebral dysfunction as venous hypertension. The hemodynamic mechanism and resulting abnormality appeared identical to that seen in progressive chronic myelopathy resulting from a spinal DAVF (Foix-Alajouanine syndrome). Remission of cognitive symptoms occurred in each patient after embolization. CONCLUSION: Venous hypertensive encephalopathy resulting from a DAVF should be considered a potentially reversible cause of vascular dementia in patients with progressive cognitive deficits.
Aged↗
Intracranial aneurysms: detection and characterization with MR angiography with use of an advanced postprocessing technique in a blinded-reader study.
PURPOSE: To assess magnetic resonance (MR) angiography for the detection and characterization of angiographically proved intracranial aneurysms by using an advanced method of postprocessing, in a blinded-reader study. MATERIALS AND METHODS: One hundred fifty-eight vessels were examined with catheter angiography and three-dimensional time-of-flight MR angiography in 44 patients with 63 aneurysms and 15 patients with no aneurysm at catheter angiography. Postprocessing was performed off-line with an advanced multifeature-extraction, ray-tracing algorithm. MR angiograms were interpreted independently by three neuroradiologists blinded to the catheter angiographic results for presence, location, size, and morphology of the aneurysm. Proof of diagnosis was consensus reading of catheter angiograms. RESULTS: Mean sensitivity for detection of aneurysms was 75% (range, 70%-79%). As a screening tool (ie, detection of at least one aneurysm necessitating catheter angiography), mean sensitivity was 91% for all aneurysms and 95% for aneurysms larger than 3 mm. This method was not adequate for detection of lobulation or size of aneurysm. CONCLUSION: MR angiography with an advanced method of postprocessing can result in highly sensitive, specific studies for the diagnosis of intracranial aneurysms that are of sufficient size to be considered for surgical treatment, but it is inadequate for characterization of aneurysms.
Adult↗
Angiographic evaluation of aneurysms affecting the central nervous system.
This article discusses the indications for, techniques of, and risks associated with cerebral angiography. Various types of aneurysms are described, and there is a discussion of the angiographic features of aneurysms in specific locations. Subarachnoid hemorrhage, post-subarachnoid hemorrhage vasospasm, and the role of post-operative angiography are also covered.
Aneurysm↗
Imaging in the trilateral retinoblastoma syndrome.
The medical records, CT, and MRI of ten children with trilateral retinoblastoma were reviewed. The intracranial pathology consisted of eight pineal neoplasms and two parasellar lesions, at least seven of the which were calcified. Two lesions demonstrated calcification only (no soft tissue mass) at initial presentation. Hydrocephalus was seen in eight cases, and concurrent or subsequent subarachnoid dissemination was documented in seven. Only one patient is known to be alive at the present time. The imaging features of the midline intracranial tumors mirror those of the ocular neoplasm. As calcification may be the only clue to the presence of the intracranial malignancy, close surveillance of high-risk patients with retinoblastoma with initial CT and follow-up MRI is suggested.
Brain↗
Subarachnoid hemorrhage and aneurysms.
Ruptured intracranial aneurysms are the usual cause of acute subarachnoid hemorrhage (SAH). Noncontrast CT is the primary imaging procedure of choice for establishing the diagnosis of SAH. Conventional contrast angiography is the gold standard for establishing the presence of intracranial aneurysms, but CT and MRI have supplementary roles. The pathogenesis, presentation, and imaging of SAH and intracranial aneurysms are discussed.
Aneurysm, Ruptured↗
Carotid angioplasty.
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Angioplasty, Balloon↗
Interventional neuroradiology of the head and neck.
Interventional neuroradiologic techniques continue to assume increasing importance in the management of disorders of the head and neck. Their usefulness includes not only treatment for neoplastic and vascular conditions with embolization but also test occlusion for diagnostic information. Future developments also may extend the usefulness of interventional techniques to additional conditions, including prevention and treatment for ischemic stroke.
Arteriovenous Fistula↗
Angiography of non-atherosclerotic occlusive cerebrovascular disease.
The growth of noninvasive imaging has limited the indications for angiographic evaluation in many types of disease involving the CNS. Nevertheless, angiography remains an essential tool for neuroradiologic diagnosis of occlusive cerebrovascular disease. Angiography most faithfully depicts cerebrovascular anatomy and frequently permits diagnosis of disorders that are incompletely evaluated by imaging modalities. In addition, the expanding role of interventional neuroradiologic therapy promises to make the role of angiography one of increasing prominence and importance in the future.
Brain Ischemia↗
Occipital lobe infarction from a carotid artery embolic source.
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Carotid Arteries↗
Carotid artery invasion by head and neck masses: prediction with MR imaging.
PURPOSE: To determine the value of magnetic resonance (MR) imaging in predicting resectability of head and neck neoplasms around the carotid arteries. MATERIALS AND METHODS: Forty-nine patients (28 male patients and 21 female patients aged 17-79 years; mean, 57.3 years) with head and neck masses and clinical evidence of carotid wall invasion underwent MR imaging. T1-weighted, T2-weighted, and gadolinium-enhanced T1-weighted images were analyzed to determine circumferential involvement of 53 arteries by tumor. RESULTS: More than 270 degrees of circumferential involvement was considered suggestive of unresectability of the malignant neoplasm; 270 degrees or less was considered lack of invasion. The sensitivity of MR imaging for determination of unresectable disease was 100% (12 of 12 cases), specificity was 88% (36 of 41), and accuracy was 91% (48 of 53). Accuracy was 100% for squamous cell carcinoma (n = 29). CONCLUSION: Tumor that encompasses more than 270 degrees of the carotid artery probably cannot be removed from the artery. Tumor that involves 270 degrees or less of the artery can be removed.
Adolescent↗
Spinal dural arteriovenous fistula: the pathology of venous hypertensive myelopathy.
Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal vascular malformation. The arteriovenous shunts, located entirely outside the spinal cord, cause a clinical picture of chronic progressive myelopathy believed to arise from the effects of increased venous pressure and impaired venous drainage on the spinal cord. Despite their well-described clinical and angiographic features, no reports have documented the spinal cord pathology in a case of angiographically or pathologically proven SDAVF. We report such a patient in whom a spinal cord biopsy supported increased venous pressure as a mechanism of neurologic dysfunction.
Aged↗
Deep central arteriovenous malformations of the brain: the role of endovascular treatment.
Cerebral deep central arteriovenous malformations (AVMs) are uncommon lesions associated with considerable difficulty in treatment. The authors report a series of 14 deep central AVMs treated by endovascular methods and examine the present role of endovascular treatment. This treatment used alone resulted in complete obliteration of AVMs in approximately 15% of case and reduction in 50% to a size permitting treatment by means of radiosurgery. Reversal of previous neurological signs and symptoms occurred in 35.7% of embolized patients. Overall, nearly 80% of patients had either complete obliteration of the lesion, reduction to a size allowing radiosurgical treatment, or reversal of previous neurological deficits. There were treatment complications in 14.3% of the cases. Endovascular treatment methods may make a significant contribution to the therapy of AVMs that have a particularly poor course and are difficult to treat by other means.
Adult↗
MR of cervical lymph nodes: comparison of fast spin-echo and conventional spin-echo T2W scans.
PURPOSE: In order to explore the utility of fast spin-echo techniques in the neck, 50 consecutive conventional spin-echo (CSE) long TR examinations were compared with 50 consecutive fast spin-echo (FSE) long TR scans for cervical lymph nodes. MATERIALS AND METHODS: Standard CSE examinations used parameters of 2200/80/1 (TR/TE/excitations), 256 x 128 matrix, 5 mm thick with interslice gaps between 1 and 2.5 mm. FSE studies were employed with TR of 4000/80/2, 256 x 192 matrix, fat suppression and 5 mm contiguous slices. Standard T1-weighted examinations and clinical correlation were used as proof of nodal presence. RESULTS: Overall vascular flow artefacts, patient motion artefacts, and image quality were comparable between the two techniques. Lymph node detectability was superior with FSE scans (P < 0.05). Typical time saved was approximately 4.5 min with FSE, despite the use of larger matrices, contiguous slices and twice the excitations. CONCLUSION: FSE is a competitive technique to CSE images in the neck, yielding similar quality images with higher resolution, reduced scan time, and improved lymph node detectability.
Artifacts↗
Neuroradiology of central nervous system vasculitis.
Evaluation of the patient with suspected vasculitis affecting the nervous system requires consideration of a broad range of differential diagnostic possibilities. Appreciating pertinent neuroradiologic findings as well as understanding the capabilities and limitations of the imaging methods employed is a prerequisite for proper evaluation. Most importantly, integration of the imaging features with clinical and laboratory findings is necessary to maximize the chance of a correct diagnosis.
Aortic Dissection↗
Carcinoid tumor of the sacrum: case report.
We present a case of isolated carcinoid tumor of the sacrum and highlight the unusual nature of this lesion. The histopathology suggests hindgut cause, and we discuss the possibility of an underlying congenital tailgut cyst. We review the pathology of these rare anomalies with reference to embryological development and known instances of carcinoid focus. We also present previous reports of sacral carcinoid.
Biomarkers, Tumor↗