Biomedical subjects
Publications and source records attributed to S E Byrd.
Past experience in this hospital has shown that the neuroradiological diagnosis of tuberous sclerosis is often made before the diagnosis is clinically suspected. We present a child in such a circumstance in whom axial and coronal CT demonstrated significant neoplastic progression of this disease. The presenting symptom was merely that of increased intracranial pressure.
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The computed tomographic (CT) findings of the spectrum of holoprosencephaly are presented. Five cases are used to demonstrate the subgroups of alobar, semilobar, and lobar holoprosencephaly. Familiarization with the CT findings in holoprosencephaly leads to more accurate and earlier diagnosis.
Metrizamide, a new water-solution iodinated contrast medium, was evaluated in 63 infants and children, most of whom had lumbosacral or low thoracic lesions. The diagnostic quality was found to be good, and no serious complications or permanent sequelae were encountered. Chief complications were headache, nausea, vomiting and fever. No myoclonic spasms or convulsions were seen. The advantages and disadvantages of metrizamide are discussed.
The advent of scanners with an air gap and a tilting gantry have made possible the use of the coronal view in computed tomography of the skull and brain in infants and children. Of 400 axial scans performed over a four-month period, 50 were supplemented by the coronal projection. Although the artifacts, uncomfortable position, and prolonged scanning time associated with coronal scanning make it impractical as the only modality, when used as an adjunct to the axial view it can provide valuable additional diagnostic information.
Coronal computed tomography is an important adjunct to the routine axial view in the evaluation of lesions of the skull and brain in infants and children. Of 400 axial scans performed over a four-mounth period, 50 were supplemented by coronal scans. Intracranial or cranial abnormalities were present in 39 (78%). Although the disadvantages of the coronal projection make it impractical as the only modality, when used as an adjunct to the axial view certain lesions of the skull and brain are diagnosed and delineated better.
Ninety-four children were examined with metrizamide (Amipaque). Overall, the quality of the examinations in the lumbar-low thoracic region was generally equivalent to that obtained with iophendylate. Supine myelography is unfortunately still a necessity in a large number of cases. The side effects, especially nausea and vomiting, slight temperature elevation and fever, are considerably higher with metrizamide and also higher than previously reported in adults. Advantages of metrizamide over oily media are the absorption of the medium which eliminates the need for post-procedure removal and the higher rate of conus demonstration in the prone position; both facilitate the examination. The ability to follow myelography with computer scanning is also beneficial.
A retrospective and prospective analysis of children with a diagnosis of complete absence of the corpus callosum (ACC) at the Children's Memorial Hospital in Chicago over a 5-year period was performed. The diagnosis was based on the computed tomography (CT) and/or magnetic resonance (MR) images. From this material, 105 children with a diagnosis of ACC were analyzed on the basis of clinical symptomatology and radiological studies (CT, MR and ultrasound). Eighty-three percent of our children were symptomatic. The most common symptoms and signs were macrocephaly with hydrocephalus and seizures. MR was the best radiological imaging modality for evaluating children with ACC and associated brain anomalies. The most common associated brain anomalies with ACC in decreasing frequency in our children were: interhemispheric cyst with hydrocephalus, Dandy-Walker malformation, migrational disorders, absence of the inferior vermis, cephaloceles and lipoma of the interhemispheric fissure.
A retrospective study of 40 children with some form of pachygyria was performed at the Children's Memorial Hospital in Chicago. All 40 children had MR brain scans. We analyzed the MR findings, and correlated these findings with the clinical symptoms and course in all the children. We have autopsy findings in 15% these children. Based on our clinical, MR and autopsy findings, in conjunction with the medical literature, we found the following: (1) Pachygyria can occur as an isolated entity without an association with lissencephaly. The MR findings in these children consisted of a brain that demonstrated normal opercularization with either focal or diffuse areas of pachygyria without areas of agyria. These children live longer and have less severity of symptoms than the children with lissencephaly. (2) The MR findings in children with lissencephaly consisted of a brain that demonstrated abnormal opercularization with areas of total agyria or areas of agyria with pachygyria. (3) The MR findings in 25% of our children with polymicrogyria simulated pachygyria. The MR findings of the brain in these children consisted of a 'nubby' appearance to the outer surface of these abnormal gyri which resembled pachygyria but on histologic exam was polymicrogyria.
Twelve neonatal brain tumors, presenting within 60 days of birth, constituted 3.3% of pediatric brain tumors. Three-fourths were supratentorial. Two-thirds were benign. Forty-two percent were choroid plexus papilloma. Twenty-five percent were teratoma. Eight percent each were hypothalamic glioma, gliosarcoma, medulloblastoma, and primitive neuroectodermal tumor. Clinical symptoms were nonspecific. Signs of herniation were absent in all 12 patients. Forty-two percent of these patients died 1 day to 8 months after diagnosis. Ultrasound, CT, and magnetic resonance have all proved useful for displaying these lesions suitably for surgery.
Neuronal migrational disorders of the brain represent abnormalities in the formation of the neocortex caused by faulty migration of the subependymal neuroblasts. These migrational anomalies include lissencephaly (agyria/pachygyria), pachygyria, schizencephaly, heterotopias, hemimegalencephaly, and polymicrogyria. We used MR imaging (performed on a 0.5-T or 1.5-T scanner) to evaluate 21 patients who had neuronal migratory anomalies. Four patients had lissencephaly, seven had pachygyria, including one patient with hemimegalencephaly, seven had schizencephaly, and three had heterotopias. All MR scans included T1-weighted spin-echo sequences, and seven also had inversion-recovery sequences. The cortical surface, cortex, and gray-white matter interface were well evaluated with both sequences; however, the inversion-recovery images were superior. All but two patients were imaged in both the axial and coronal planes: both projections demonstrated well the migrational abnormalities. MR is an excellent method for diagnosing the migrational anomalies of lissencephaly, pachygyria, schizencephaly, heterotopias, and hemimegalencephaly; it appears to be the imaging method of choice for evaluating these disorders.