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Biomedical subjects

S Puljic

Publications and source records attributed to S Puljic.

13 recordsLinked to original sources

Communicating hydrocephalus following total parenteral nutrition.

Communicating hydrocephalus secondary to cerebral venous outflow obstruction has been reported in a few patients several months following removal of a TPN catheter. We report the case of an infant who developed this sequal 4 mo after the catheter was removed. We illustrate the techniques used to delineate the type of hydrocephalus. A lumbo-peritoneal shunt was performed to alleviate the condition.

Cerebrospinal Fluid Shunts

Radiography of hydrocephalus after total parenteral nutrition.

An infant with chronic diarrhea developed hydrocephalus following treatment with total parenteral nutrition (TPN) via jugular vein catheterization. Total parenteral nutrition is used when nutritional needs cannot be met adequately by oral alimentation. Serial computerized tomograms showed progression of communicating hydrocephalus. Superior sagittal sinograms demonstrated bilateral internal jugular vein occlusion with extensive venous collateralization. Lumboperitoneal shunt effectively decreased raised CSF pressure. A judicious approach to alternative venous routes for hyperalimentation is suggested. Radiographic delineation of communicating hydrocephalus by computerized tomography and superior sagittal sinography is presented.

Brain

Cerebellar hemorrhage: unusual ventriculographic findings.

A case of a cerebellar (vermian) hematoma that communicated with the fourth ventricle as seen on air study is presented. Although vertebral angiography appears to be the first diagnostic procedure of choice, the angiographic study may not be definitive diagnostically because it may be difficult to distinguish fourth ventricular enlargement from a cystic hematoma cavity in communication with the fourth ventricle. An air study may then be required to differentiate between such diagnostic possibilities.

Alcoholism

Metastases to the medulla of the spinal cord: myelographic features.

Intramedullary metastases to the spinal cord of non-neurogenic origin are exceedingly rare, comprising fewer than 1.6% of all metastases affecting the spinal canal and its contents. Plain films are normal. Irregular fusiform widening of the spinal cord is the most common myelographic feature, although nodularity is also present. Complete blockage is very rare. The authors describe the radiological features in 4 cases of intramedullary metastases of non-neurogenic origin. The differential diagnosis is discussed, and some pathogenetic mechanisms are postulated. It is important to recognize intramedullary metastases in order to plan the proper management.

Carcinoma

Multiple spinal canal meningiomas.

Three cases of multiple spinal canal meningiomas are presented, bringing the total number of documented cases in the American literature to nine. While the exact incidence of multiple spinal meningiomas is difficult to determine, their possible occurrence warrants careful myelographic examination of the whole spinal canal, particularly if multiple clinical levels are present. When a complete block to the contrast agent is encountered, myelography should also be carried out via an upper cervical puncture. The radiograhic appearances of multiple meningiomas are nonspecific.

Aged

Dural arteriovenous malformation of the major venous sinuses: an acquired lesion.

Arteriovenous malformations of the dura are thought to be congenital. However, arteriographic investigations of four patients who, after a head injury, developed dural arteriovenous fistulae with features of congenital malformations suggest that these abnormal communications may also be acquired. Thrombosis or thrombophlebitis in the dural sinus or vein may be the primary event in their formation. The pathogenesis is probably "growth" of the dural arteries normally present in the walls of the sinuses during the organization of an intraluminal thrombus. This may result in a direct communication between artery and vein or sinus, establishing an abnormal shunt. Ultimate fibrosis of the sinus wall and intraluminal thrombus may be the factors responsible for the spontaneous disappearance of such malformations.

Adult