Biomedical subjects
Publications and source records attributed to V C Hinck.
In this review of the pathophysiology of acute intracerebral and subarachnoid hemorrhage, information from several disciplines is assembled to describe the bleeding process, hemostasis and coagulation, fibrinolysis, erythrocyte lysis, phagocytosis, and changes in the state of hemoglobin. The impact of these pathophysiologic processes upon MR imaging, CT, and angiography is noted.
Schematic displays are presented of the cerebral territories supplied by branches of the middle cerebral artery as they would appear on axial and coronal computed tomographic (CT) scan sections. Companion diagrams of regional cortical function and a discussion of the fiber tracts are provided to simplify correlation of clinical deficits with coronal and axial CT abnormalities.
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A prospective clinical study was done on 20 patients referred for computed tomography within 28 hr of a cerebral ischemic event. The patients were scanned before, immediately after, and 3 hr after a high dose of intravenous contrast medium was administered to produce prolonged high blood iodine levels. In seven patients the delayed scan demonstrated a heretofore undescribed type of contrast enhancement which represents the early massive vasogenic edema seen in experimental animals before confluent hemorrhagic infarction. Four of the seven patients developed hemorrhagic infarction. None of the remaining 11 patients with cerebral infarctions and conventional postenhancement CT patterns showed hemorrhage on follow-up CT scans or at autopsy. Two patients with transient ischemic attacks had normal CT scans. It may now be possible to predict patients in whom there is high probability of hemorrhagic infarction before blood appears on CT. Treatment of these patients should probably be aimed at preventing the devastating effects of the vasogenic edema. We speculate that heparinization or bypass surgery to reestablish circulation may be contraindicated in this group.
This paper presents schematic displays of the cerebral territories supplied by branches of the posterior artery as they would appear on axial and coronal computed tomographic (CT) scan sections. Companion diagrams of regional cortical function and a discussion of the fiber tracts are provided to simplify correlation of clinical deficits with coronal and axial CT abnormalities. Illustrations of the vascular supply and functional relay points (nuclei) of the thalamus are provided.
The authors describe a simple device which, when used with computerized tomography, provides precise preoperative localization of craniotomy.
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A one-year prospective study was done involving 78 patients with a suspected intracranial neoplasm. Immediate and delayed high dose (DHD) contrast (with 80 g of iodine) postinfusion computed tomographic scans were compared in 15 cases of primary and 32 cases of metastatic neoplasm. The one-hour delayed scan was as diagnostic as the immediate scan in all patients. In 10 cases, additional lesions were demonstrated on the DHD scan. Results suggest that DHD should replace conventional contrast scans in evaluating patients for neoplasia.
A retrospective study of renal deterioration after high doses (80 g l) of intravenous contrast medium was done of 286 adult patients. The incidence, duration, and severity of renal deterioration were compared with those reported in a series of 377 similar patients after low dose contrast infusion (43 g l). No statistically significant difference between these groups was seen in nondiabetics with a preinfusion serum creatinine below 4.5 mg/dl. A prospective study of fractional excretions in 35 patients receiving high dose infusion demonstrated no additional subtle renal damage in 34 patients. One patient developed a transient rise in serum creatinine that was identical to the course of renal deterioration after 43 g of iodine. It is concluded that the severity and duration of renal deterioration was not affected by the dose of contrast material (43--80 g iodine).
Schematic displays of the cerebral territories supplied by branches of the anterior cerebral artery as they would appear on axial and coronal CT scan sections are presented. Companion diagrams of regional cerebral function are also provided to simplify correlation of clinical deficits with coronal and axial CT abnormalities. Selected examples illustrate that these facilitate more detailed and precise CT interpretation in clinical practice.
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This study illustrates detailed cerebral anatomy that can be consistently visualized on computed tomography scans after a rapid high dose of contrast substance has been infused. A thorough knowledge of anatomy is required not only to detect and precisely localize lesions but to avoid ascribing pathological significance to normal, contrast enhanced structures.
A rapid, simple, and inexpensive computed tomographic technique has been developed for marking the scalp and lateral skull radiograph of patients with small cerebral convexity lesions. The more precise localization provided thereby facilitates planning and performance of surgery.
The diagnostic accuracy of CT scanning in the sellar area can be improved by using a rapid high dose (RHD) contrast technique which visualizes the supraclinoid carotid arteries, cavernous sinus and vascular plexus of the infundibulum. The RHD technique is briefly described and the pertinent anatomy discussed and illustrated.
Ten patients were studied in whom precontrast computed tomography (CT) revealed an isodense mass which obliterated cerebral sulci and deformed the ventricle(s). Upon rapid-high-dose (RHD) contrast enhancement, the cerebral hemispheric surface was so well demonstrated, that in 4 patients the possibility of an isodense subdural hematoma was exluded, while in the other 6 it was correctly diagnosed. Preoperative angiography was not necessary.
The choroid plexus of the fourth ventricle is a sensitive, symmetrical CT landmark which can often be visualized in overlapped scans performed in the orbital plane during rapid infusion of a high dose of iodinated contrast substance. Normal and pertinent abnormal plexus configurations are described and illustrated.
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