Biomedical subjects
Publications and source records attributed to W D Sager.
88 patients in primary subarachnoidal haemorrhage are evaluated with CT and partly with cerebral angiography. The CT shows the successions of the haemorrhage and ischemia, and partly the existence of aneurysms aneurysms. For preoperative clarification, angiography is necessary.
Software windows are a flexible and general method for defining arbitrary functions for the mapping of Hounsfield-numbers of CT-scans on to the grey levels of the display image. The method which is illustrated with the aid of a few examples has been implemented on an EMI viewing console.
71 patients with an ischaemic stroke were investigated clinically, by psychological tests (WAIS) and Computertomography. On the basis of the investigation the patients were separated into two groups. 40 patients showed early dementia; 31 were without mental impairment. The frequency of strokes, the history of neurological symptoms and the neurological symptoms at admission were distributed evenly. The dominant hemisphere was significantly more often diseased in the demented group; bilateral signs were also significantly more often seen in the demented group. From the investigated risk factors (Hypertension, Cardiac disease, Diabetes, Viscosity, Fibrinogen). Only hypertension was significantly more often present in demented than non demented patients. The CT confirmed the clinical findings, especially the importance of the bilateral distribution of infarcts as well as a higher distribution of infarction in the thalamus in the demented patient group.
In a qualitative approach it was shown in 204 patients with ischaemic stroke that Computertomography is significantly more often normal and atrophy more seldom in the demented patients. In addition the importance of a bilateral distribution of infarcts in the demented group was shown as well as the more common affection of the thalamus in the demented patients as compared with the non demented group. The quantitative approach was performed with measurements of the width of the 3rd ventricle, the Huckmann, the ventricle, the cella media index as well as the calculation of an index brain/CSF density. Here the importance of total loss of substance - atrophy and infarcts - was evident, explaining why measurements of the ventricle dimensions only - apart from the distribution of infarcts - were not always relevant.
50 patients with SAH and an aneurysm were investigated by CT and angiography. In the 59 patients 67 aneurysms were found. The mean interval between SAH and CT was 8 days, between SAH and angiography II days. Blood in the CSF space was visualized up to the 9th day in the patients and 67% of those investigated showed blood in the CSF-space in the CT. In 31% of the patients an aneurysm, in 29% an intracerebral haemorrhage and in 19% a recent infarct was found. A hydrocephalus was seen in 13% of the patients. Of 12 patients with recent infarcts 8 showed vasospasm which correlated in time and location with the infarct.
A combination of two rare malformations of the lung was observed in a four-year-old asymptomatic boy. He had typical scimitar syndrome (dextrocardia, hypoplastic right lung and right-sided anomalous pulmonary venous drainage into the v. cava inferior) together with horseshoe lung. Diagnosis was established by angiocardiography and computerized tomography. In the absence of recurrent pulmonary infections operative intervention is not necessary with normal pulmonary arterial pressure and resistance. To the best of our knowledge this case with both malformations seems to be the fourth which is reported in the literature.
31 children aged between 6 weeks and 15 years, who had suffered a stroke, were investigated by computer tomography (CT). 8 patients had suffered transient ischemic attacks (TIA), 17 had completed ischemic strokes and 6 had hemorrhagic strokes. The mean interval between the stroke and the first CT investigation was 5 days. In the group of 8 patients with transient ischemic attacks, 1 patient had a small infarct, 1 had atrophy and 2 exhibited A-V malformations. In the group of 17 patients with completed ischemic strokes, 14 showed an infarct, 5 had atrophy and in 1 an angioma was found. All 6 hematomas were detected by CT. In follow-up studies, 11 of 17 patients with ischemic stroke showed atrophy.
In 18 cases of neoplasm and 18 of inflammatory lesion of the paranasal sinuses and the pharyngeal cavity the results of high resolution CT (HRCT) were compared with multidirectional tomography. In one third of the cases HRCT gave more information than tomography. The value of HRCT lay in the demonstration of thin bony structures and in the differentiation between decalcification and destruction. Soft tissue involvement of the infratemporal fossa and the pharyngeal cavity is demonstrable at an earlier stage by CT or HRCT than with tomography; the same applies to small lesions in the paranasal sinuses and in the nasal cavity. Lesions in the sphenoid and frontal bones need additional evaluation by a lateral tomography. A.p. tomography becomes necessary if frontal HRCT scans are insufficient.
The EEG findings from patients with subarachnoidal haemorrhage are described. The results of the EEG and CT are compared. Furthermore the influence of neurological deficits on the number and degree of pathological EEG results was investigated and the EEG of patients with and without intracranial aneurysm, shown by angiography, were correlated. The EEG was pathological in 47 patients (70%) predominantly with focal changes. In the 17 patients with intracranial lesions pathological EEG records were significantly commoner and the changes were more evident. Also in patients with neurological deficits pathological EEG were significantly more frequent. In 25 patients with aneurysm, proved by angiography, predominately focal changes were found which gave us information about the site of the aneurysm. It was shown, that the EEG gives informations about intracerebral lesions and that in cases with subarachnoidal haemorrhage functional disturbances can be seen. The EEG is also of prognostic value.
Computertomography of the kidney is, in combination with the conventional non-invasive methods, a highly exact diagnostic process. It is very important especially in cases of tumours, bleeding, retention of urine in the kidneys and unilaterally quiescent kidneys. The use of boluscomputertomography and series--computertomography not only increases the exactness of diagnosis but should also yield information on functional dynamics.
108 patients with verified traumatic, inflammatory and neoplastic lesions in the facial region and the pharyngeal space were evaluated both with conventional tomography and CT. Subsequently an analysis was made as to whether both methods were complementary or at least partially replaceable by each other. In traumatic lesions transverse axial CT combined with frontal tomography yielded optimal information. For the diagnosis of inflammatory and neoplastic lesions CT was superior to tomography with the exception of lateral tomograms which contributed additional information to diseases of the sphenoid sinus, the epipharynx, the pterygopalatine fossa and the orbital roof. The radiation dose to the eye is remarkably lower in CT than in tomography.
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Two patients developed clinical features of intracranial bleeding--which were confirmed by computerized axial tomograms--during their induction therapy for acute lymphocytic leukemia. Coagulation studies showed clotting abnormalities including severe hypofibrinogenemia. These findings most probably were related to the effect of L-asparaginase which was part of the treatment protocol. Central nervous system leukemia, intrathecal chemotherapy, cranial irradiation, extreme leukocytosis, or thrombopenia at the time of diagnosis or day of stroke did not appear to be predisposing factors in these cases.
204 patients with an ischaemic stroke were investigated by computertomography. 84 of these patients were demented and 120 had no signs of dementia. Atrophy was significantly more often seen in the computertomograms of the demented patients. A normal computer-tomogram was commoner in the non demented patients. The distribution of infarcts was similar in both groups but bilateral infarcts were significantly more often present in patients with dementia. The combination of a single infarct with atrophy was seen significantly more often in the patients with dementia. Bilateral infarcts, even without atrophy, were significantly more common in the dementia patients. From these findings it was concluded that the bilateral distribution of the lesions is an important factor in vascular dementia.
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The typical CT appearances of intracranial germinomas are described in three cases. These consist of an isodense or hyperdense tumour in the mid-line, originating from the pineal body or infundibulum, with marked increase in density on contrast enhancement. Periventricular tumour expansion in relation to the entire supratentorial ventricular system is characteristic. The rapid tumour regression after small doses of radiation is stressed and complete regression of the tumour, as seen on CT, is a sign of its radio-curability.
41 patients with a depressive syndrome in middle age (mean age 55 years) were investigated. 19 of them had purely monopolar depressive syndromes without any organic features; 22 patients had a depressive syndrome associated with an organic brain disease (11 vascular, 11 primary degenerative disease). In all patients psychiatric and neurological investigations, a WAIS test, an EEG and a computer tomography were performed. The clinical findings were significantly different in both groups of depression but there was still a considerable overlap of symptoms. The EEG was inconclusive, the psychological test (WAIS) and the computer tomography showed the clearest separation between the organic and the nonorganic depressions leaving only 10% of inconclusive findings. Therefore, it may be concluded that the differential diagnosis of organic or nonorganic depressive syndrome in middle age cannot be made on the basis of one investigation on its own but on the combined results of clinical, functional, and morphological examinations.
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