Biomedical subjects
Publications and source records attributed to S F Handel.
A young man with headache was unable to sneeze despite a strong sensory urge to do so. Magnetic resonance imaging revealed a cystic neoplasm in the medulla oblongata that presumably interrupted the efferent arc of the sneezing reflex.
To investigate evidence for diffuse white matter injury and hemispheric disconnection sequelae after severe closed head injury (CHI), this study evaluates the degree of posttraumatic atrophy of the corpus callosum. Corpus callosal atrophy was quantitatively determined using a digitizer to measure sagittal magnetic resonance images of 32 patients with moderate-to-severe CHI and those of 31 control subjects of similar age. In the CHI patients, measurements were significantly reduced for the areas of the anterior four-fifths, the posterior one-fifth, and the total corpus callosum. Moreover, the minimum width of the callosal body was reduced in the CHI patients as compared to that of control individuals. Indices of corpus callosal atrophy were significantly correlated with the chronicity of injury and the degree of lateral ventricular enlargement. There was no difference in callosal measurements between men and women. Magnetic resonance imaging provides an in vivo determination of corpus callosal atrophy which may reflect the severity of diffuse axonal injury and predict the type and severity of hemispheric disconnection effects.
The radiographic appearances of intracranial metastases from primary osteogenic sarcomas in three patients are presented. In two patients, the diagnosis of metastatic disease could be made on conventional roentgenograms of the skull since mineralization of tumor osteoid could be seen within the brain parenchyma. This had a similar appearance to the primary bone tumor. Angiography in two of the three patients revealed the cerebral metastases to be hypervascular with tumor vessels, tumor stain and early draining veins.
Rhabdomyosarcoma of the head and neck may be treated with surgery, radiotherapy and chemotherapy or a combination thereof. Precise delineation of the full extent of the tumor in the head and neck is essential. Routine radiographs with hypocycloidal tomography and CT are complementary in defining the full extent of the lesion. Tomography is superior to CT scanning in demonstrating fine bone detail. Demonstration of the soft tissue tumor and its extensions is better seen on CT. The ability to discriminate differences more accurately in densities allows computerized tomography to appreciate better the integrity of the bone margins such as the thin walls of the sinuses.
A unique patient with bilateral subdural haematomas with localized subdural membranes on one side is reported. Serial CT scans suggested that the membranes resolved spontaneously after drainage of the haematoma. The pathophysiology of subdural haematoma and the value of CT scanning in postoperative follow-up are discussed, especially in regard to learning more about the optimal treatment in this still somewhat enigmatic problem.
Use of therapeutic arterial embolization (TAE) in the traumatized patient can achieve rapid control of hemorrhage and obviate the need for immediate surgery on poor-risk patients or in high-risk areas of the body. The techniques of embolization, its risks, and complications are discussed in light of the authors' experience, and a review of recent literature is presented.
The radiographic findings in 4 patients with fractures of the lumbar vertebral ring apophysis are reported. All patients had a bony ridge or fragment projecting into the spinal canal, usually from the lower border of L4; a defect in the postero-inferior aspect of the vertebral body; and either an anterior extradural impression or complete blockage on the myelogram. Computed tomography was performed on one patient and appears to be helpful in demonstrating bone within the spinal canal. Preoperative diagnosis can facilitate selection of the appropriate surgical approach.
A prototype computed radiography (CR) system was evaluated for its efficacy as an independent diagnostic modality. Preliminary measurements of high contrast resolution, low contrast perceptibility, and dose were obtained. Clinical examinations including skull, abdomen, liver, gallbladder, biliary system, spine, and extremities were performed as an adjunct to either computed tomography or CR. The data suggest that CR can be an effective diagnostic imaging modality by itself. Advantages over conventional radiography include high scatter rejection, low patient dose, wide dynamic range, and good low contrast sensitivity for large objects; disadvantages, its long exposure time and relatively poor high contrast spatial resolution.
A preliminary retrospective correlation between computed tomographic scans and intracranial pressure (ICP) monitored was performed for 21 patients. No patient with a normal CT scan had elevated ICP. The lowest correlation was noted with slit ventricles; the highest, with dilatation of the contralateral temporal horn.
Arterial embolization was performed in nine patients with metastases from renal carcinoma who had severe pain resistant to conventional therapy. Patients with metastases in the ilium (four), the lumbosacral spine (one), and the base of the skull (one) experienced pain relief lasting from one to six months. The other three patients, who had metastases in the proximal femur, underwent preoperative embolization to facilitate tumor curettage and internal hip fixation. No significant complications were seen with this therapeutic approach.
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A 3 mm pellet, shot into the neck of a 13 year old boy, migrated into the common carotid artery and lodged in the infraclinoid internal carotid artery. The case illustrates an unusual intravascular migration of a foreign body. The benign clinical course, radiological evaluation, and rationale for expectant management of such low velocity missle injuries is discussed.
Two patients with subdural hematoma secondary to rupture of intracranial aneurysms are described. Computed tomography and plain skull films are generally the examination of choice for the patient with significant head trauma. In selected patients, however, cerebral angiography in place of, or along with, computed tomography may be necessary to demonstrate an underlying cause for the subdural hematoma.
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Angiography is useful in following selected patients with chemodectoma of the head and neck treated by radiotherapy. Comparison of preradiotherapy and post radiotherapy angiograms in three patients revealed a decrease in the following: size of feeding arteries, size of tumor, intensity of tumor opacification, and degree of venous shunting. When chemodectomas are not amenable to physical examination and when the question of radiotherapy complication vs further growth of tumor arises, postradiotheraphy angiography may be of particular value.
Angiographic experience with chemodectomas in 21 patients is reviewed. Arterial supply was identified from the vertebral artery, the internal carotid artery, and branches of the external carotid artery. A striated cephalad extension from a cervical chemodectoma (five patients) is believed to represent arterial supply to tumor in vein. In two patients, internal and external carotid arteriograms did not opacify important arteries originating near the carotid bifurcation. Retrograde filling of sigmoid sinus (four patients), tumor mass in jugular vein (two patients), and arteriovenous shunting (nine patients) were observed during the venous phase. Thorough angiogra phy is essential for evaluation of chemodectomas of the head and neck.
Review of cerebral arteriograms of all our patients [19] with epidural hematoma over a 2 year period revealed evidence of localized extrinsic compression of the cerebral cortex in all cases. This finding, although not as specific as those previously described for epidural hematoma, was strongly suggestive. A 2 year prospective study was then initiated employing internal, rather than common carotid arteriography, because opacification of the external carotid artery is not necessary for evaluation of cortical compression. In this study, which consisted of 21 patients, epidural hematoma was correctly diagnosed in all, relying primarily on signs of localized extrinisic cerebral cortical compression. No epidural hematoma was misinterpreted as being a subdural hematoma or an intracerebral injury, and all epidural hematomas that were present were diagnosed correctly. We conclude that internal carotid arteriography is a sensitive method for diagnosing epidural hematoma. The signs of extrinsic cortical compression should be emphasized in the interpretation of arteriograms of patients with head injuries whether the internal or the common carotid artery is injected.