Infratentorial subdural empyema: MR findings.
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Aged↗
Biomedical subjects
Y Numaguchi
Publications and source records attributed to Y Numaguchi.
Epidural abscess in the cervical spine.
A ten-year retrospective review of 23 cases of documented spinal epidural abscess in the cervical spine was undertaken to define the clinical features and establish current diagnostic and therapeutic criteria. Diagnosis was made by magnetic resonance imaging or myelography. Risk factors included intravenous drug abuse, diabetes mellitus, previous trauma, and a positive serologic test for the human immunodeficiency virus. A bacterial agent was isolated in 21 cases (91%). Neurologic deficits were present in 20 of the cases (87%) at the time of diagnosis. Erythrocyte sedimentation rate was elevated in all patients in whom it was measured. All patients were treated with appropriate antibiotics, usually for 6 to 8 weeks. Twenty-one patients underwent operative procedures using percutaneous aspiration (1 patient), the anterior approach (14 patients) or the posterior approach (4 patients), or a combination of the two approaches (2 patients). Four of ten patients who initially had less than antigravity strength were eventually ambulatory and continent; in each case, operative decompression was performed within 36 hours of initial consultation. Three patients who had no initial neurologic deficits remained intact.
Abscess↗
Spinal epidural abscess: evaluation with gadolinium-enhanced MR imaging.
Magnetic resonance (MR) imaging with gadopentetate dimeglumine was performed in 25 patients with spinal epidural abscess (SEA). Seventeen of 25 patients underwent follow-up MR imaging. The studies were retrospectively reviewed. In 20 patients, diskitis was the primary infectious foci; however, five patients developed diffuse SEA without diskitis. The two most common MR appearances were (a) homogeneous or heterogeneous enhancement of the solid portion of the SEA and (b) thin or thick enhancement around the liquefied collections of pus. Dural enhancement was frequently seen in patients with lengthy vertebral involvement of SEA. Engorgement of the epidural venous plexus or basivertebral veins was occasionally observed. The changes in abscess size noted on follow-up studies correlated well with clinical improvement or deterioration in most patients. Persistent contrast enhancement, however, was frequently noted at the site of diskitis, osteomyelitis, or surgical drainage sites despite clinical improvement. Careful correlation of MR imaging findings with clinical findings and laboratory data is important in predicting prognosis for these patients.
Abscess↗
Platinum coil treatment of complex aneurysms of the vertebrobasilar circulation.
Two patients with complex aneurysms of the vertebrobasilar system were treated using platinum coils. During these sessions, 22 coils were placed in a basilar tip aneurysm in a 48-year-old woman. Almost total occlusion of the lumen was achieved, excepted in the area from which the right posterior cerebral artery arose. A large fusiform vertebral artery aneurysm in a 6-year-old boy was treated using 16 coils, which partially occluded the lumen at initial embolization. Follow-up angiography 2 weeks later revealed almost complete occlusion of the lumen with preservation of the vertebral artery. Our experience indicates that coil embolization of complex intracranial aneurysms is an acceptable treatment alternative to surgery or to a detachable balloon.
Adult↗
Multiple intracerebral arteriovenous malformations: report of three cases and review of the literature.
Multiple intracerebral arteriovenous malformations are thought to be exceedingly rare lesions and have usually been reported as single cases. During the past 2 years, we have treated three patients with multiple cerebral arteriovenous malformations, representing 3.2% of a consecutive series of 95 arteriovenous malformation patients seen since 1976. Details on 17 other cases are available in the literature and are summarized here. The incidence of multiple arteriovenous malformations in major series ranges from 0.3% to 3.2%; the average incidence is 1.9% based on 21 cases encountered in a total population of 1102 arteriovenous malformation patients. Patients with multiple arteriovenous malformations often have other vascular anomalies of the brain or soft tissues, but the clinical mode of presentation, age, sex, and anatomical distribution of the lesions are the same as those of patients with single arteriovenous malformations. The use of four-vessel angiography in combination with magnetic resonance imaging may result in a higher detection rate for such cases.
Adult↗
Spinal epidural abscess: a report of 40 cases and review.
Despite modern medical advances, the morbidity and mortality rates associated with spinal epidural abscess remain significant, and the diagnosis often is elusive. A retrospective study was undertaken to define better the incidence and clinical features of this infection, and to establish current diagnostic and therapeutic guidelines. Forty cases of spinal epidural abscess were encountered at our institution between July 1979 and March 1991. All medical records and radiological images were reviewed. We report a significant increase in the incidence of epidural abscess after June 1988 (p = 0.0195). Sixteen patients used drugs intravenously, and six had undergone spinal procedures. Twelve patients were misdiagnosed in various emergency rooms or clinics and discharged. Localized back pain, fever, and neurological deficit remained the typical clinical manifestations. Erythrocyte sedimentation rate was elevated uniformly when measured (21 cases). Magnetic resonance imaging was diagnostic specifically in 23 of 24 instances. The majority of patients underwent surgical drainage, but five selected patients were managed nonoperatively. The highly variable presentation of spinal epidural abscess may confuse the diagnosis and delay indicated surgical intervention. Localized back pain in a febrile patient at significant risk for epidural abscess warrants erythrocyte sedimentation rate measurement. The presence of erythrocyte sedimentation rate elevation or evidence of spinal cord compression on physical examination are indications for immediate magnetic resonance imaging examination with contrast enhancement. Surgical drainage with sustained intravenous antibiotic treatment remains the cornerstone of therapy. Nonoperative management may be considered in selected cases.
Adolescent↗
Magnetic resonance imaging of orbital lymphangioma with and without gadolinium contrast enhancement.
BACKGROUND: Lymphangioma is a vascular tumor of the orbit with a propensity for recurrent hemorrhage. These tumors may be difficult to diagnose in young patients who present with sudden proptosis due to hemorrhage into a previously unrecognized lesion. Magnetic resonance imaging (MRI) should be ideally suited for evaluating lymphangioma due to the unique ability of MRI to characterize hemorrhage because of the paramagnetic qualities of hemoglobin. METHODS: The authors performed T1-, T2-, and proton density-weighted MRI on 12 patients with orbital lymphangioma. Six patients underwent MRI with gadolinium-DTPA contrast enhancement. The MRI studies were performed using a 1.5 Tesla super-conducting magnetic resonance unit, except for 3 early studies performed with a 0.5 Tesla unit. All studies were performed with orbital surface coil imaging. Computed tomography (CT) was performed in 10 patients. RESULTS: Tumor was visible on MRI in all 12 patients. Magnetic resonance imaging delineated clearly the internal structure of subacute and chronic hemorrhagic cysts, and differentiated between these tumors because of the different paramagnetic qualities of subacute hemorrhage compared to chronic hemorrhage. In two patients, MRI detected large tumor feeding vessels by the flow void phenomenon unique to MRI. Computed tomography did not detect these vessels. Gadolinium-contrasted T1-weighted MRI did not further delineate or characterize the tumor. CONCLUSION: Magnetic resonance imaging is the modality of choice for imaging orbital lymphangioma because of its unequalled differentiation of hemorrhagic cysts, and its unique ability to detect tumor feeding vessels by the flow void phenomenon.
Contrast Media↗
Extraskeletal myxoid chondrosarcoma of the falx.
Intracranial cartilaginous tumors are unusual lesions, of which myxoid chondrosarcoma is the rarest. We describe this tumor arising from the falx in a 28-year-old woman treated at recurrence with a second operation and a radiation implant. The behavior of classic chondrosarcoma and mesenchymal chondrosarcoma is also reviewed.
Adult↗
High signal intensity of both putamina in patients with HIV infection.
We report two patients with HIV infection whose MR imaging showed abnormal high signal intensity confined to both putamina on T2-weighted spin echo (SE) images. We assume that they may represent the early manifestations of HIV encephalitis.
AIDS Dementia Complex↗
Magnetic resonance imaging of limbic encephalitis.
In two patients with limbic encephalitis serial magnetic resonance (MR) imaging showed evolution of abnormal high-signal intensity in both hippocampal formations on T2-weighted images.
Adult↗
Subarachnoid hemorrhage in sickle cell disease.
Subarachnoid hemorrhage occurs in 1%-2% of patients with neurological complications from sickle cell disease. The authors report a case of subarachnoid hemorrhage in a 13-year-old black girl with sickle cell disease. Computed tomography of the brain demonstrated diffuse subarachnoid hemorrhage in the right sylvian fissure and the right frontoparietal cortical region. Angiography revealed no evidence of aneurysm but multiple stenosis and/or occlusions of the distal branches of the anterior and middle cerebral arteries bilaterally. Rupture of leptomeningeal collateral vessels is a possible cause of subarachnoid hemorrhage in our patient.
Adolescent↗
Cerebral blood flow mapping using stable xenon-enhanced CT in sickle cell cerebrovascular disease.
The cerebral blood flow (CBF) of 25 patients with sickle cell cerebrovascular disease (SCCVD) was examined using a Xenon-CT flow mapping method. Brain CT and MR findings were correlated with those of the Xenon-CT flow studies. CBF defects on Xenon-CT correlated reasonably well with the areas of cortical infarctions on the MR images, but in 27% of the cases, flow defects were slightly larger than the areas of infarctions on the MR images. In deep watershed or basal ganglia infarctions, abnormal CBF was noted about the cerebral cortex near infarctions in 72% of the patients, regardless of infarction sizes on the MR images. However, decreased CBF was recognized in 4 of the 9 children whose MR images were virtually normal. Thus, the extent of flow depletion cannot be predicted accurately by MR imaging alone. Xenon-CT flow mapping proved a safe and reliable procedure for evaluation of the CBF of patients with SCCVD. Although this study is preliminary, it may have a potential in selecting patients for hypertransfusion therapy, as a noninvasive test and for following children with SCCVD during their therapy. Careful correlation of results of CBF with those of MR imaging or of CT is important for objective interpretations of flow mapping images.
Adolescent↗
Degenerative lumbar spine disorders in gradient refocused echo axial magnetic resonance images.
The axial images of 58 lumbar disks having degenerative disorders imaged by gradient refocused echo (GRE) and spin echo (SE) magnetic resonance imaging (MRI) pulse sequences at high field strength were compared for diagnostic quality. The vacuum phenomenon, calcified disk, and bony hypertrophic changes were better demonstrated by GRE images than by SE images due to magnetic susceptibility effect. Axial GRE images are therefore useful adjuncts to SE images for effective MRI of degenerative lumbar spine disorders at high field strength.
Humans↗
Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex: variations on a theme.
Aneurysms of the posterior inferior cerebellar artery-vertebral artery complex are relatively uncommon lesions. They include aneurysms at the origin of the posterior inferior cerebellar artery (PICA-VA), aneurysms on the distal artery (PICA) and aneurysms at the junction of the vertebral and basilar arteries (VA-BA). We have had the opportunity to treat 17 patients and study the radiological records of 9 additional patients in the past 8 years. The aneurysms ranged in size from 3 to 30 mm, with mean values of 10.6, 7.3, and 9 mm for PICA-VA lesions, distal PICA lesions, and VA-BA lesions, respectively. Three of the 4 VA-BA aneurysms were located at the midline, and the mean distance of the PICA-VA aneurysms from the midline was 7.6 to 9.4 mm; 2 aneurysms crossed the midline from their parent VA. The aneurysms were located slightly more often on the left side (left:right ratio, 1:2), were found more frequently in women (2.25:1), and occurred at a mean age of 50 years. Ten aneurysms at the origin of the PICA and 4 VA-BA aneurysms were treated via a lateral suboccipital craniectomy; 3 distal PICA aneurysms were exposed by a midline craniectomy. Surgery was carried out acutely in 5 patients. Tortuousness of the VA required contralateral approaches in 2 patients, an exploratory craniectomy in 1 patient, and an approach toward the dome of 1 patient with a VA-BA aneurysm. Morbidity was primarily due to cranial nerve dysfunction. There were no perioperative deaths. These aneurysms can easily be missed on initial radiographic examination; one appeared only on the second study, one was seen to grow over 16 days, and one was discovered at the level of C1 extracranially. Our radiographic and surgical approach to the treatment of these lesions is presented.
Adult↗
Vascular metastatic lesions of the spine: preoperative embolization.
Preoperative embolization of vascular metastatic tumors of the spine, particularly carcinomas of renal and thyroid origin, is an adjuvant technique that significantly decreases the intraoperative blood loss and resultant surgical morbidity. Surgical decompression was achieved in 24 spinal vascular metastatic lesions, 20 of which were treated with preoperative embolization and four of which were not. The embolic materials used were gelatin sponge, polyvinyl alcohol foams, and metallic coils. In patients who underwent adequate embolization, an average of 1,850 mL of estimated blood loss was reported; in those who underwent inadequate or no embolization, greater than 3,500 mL of estimated blood loss occurred. When gelatin sponge is used, surgery should be performed within 24 hours to prevent preoperative recanalization.
Adult↗
Posttraumatic cerebral infarction diagnosed by CT: prevalence, origin, and outcome.
Posttraumatic cerebral infarction is a recognized complication of craniocerebral trauma, but its frequency, cause, and influence on mortality are not well defined. To ascertain this information, all cranial CT studies demonstrating posttraumatic cerebral infarction and performed during a 40-month period at our trauma center were reviewed. Posttraumatic cerebral infarction was diagnosed by CT within 24 hr of admission (10 patients) and up to 14 days after admission (mean, 3 days) in 25 (1.9%) of 1332 patients who required cranial CT for trauma during the period. Infarcts, in well-defined arterial distributions, were diagnosed either uni- or bilaterally in the posterior cerebral (17), proximal and/or distal anterior cerebral (11), middle cerebral (11), lenticulostriate/thalamoperforating (nine), anterior choroidal (three), and/or vertebrobasilar (two) territories in 23 patients. Two other patients displayed atypical infarction patterns with sharply marginated cortical and subcortical low densities crossing typical vascular territories. CT findings suggested direct vascular compression due to mass effects from edema, contusion, and intra- or extraaxial hematoma as the cause of infarction in 24 patients; there was postmortem verification in five. In one patient, a skull-base fracture crossing the precavernous carotid canal led to occlusion of the internal carotid artery and ipsilateral cerebral infarction. Mortality in craniocerebral trauma with complicating posttraumatic cerebral infarction, 68% in this series, did not differ significantly from that in craniocerebral trauma patients without posttraumatic cerebral infarction when matched for admission Glasgow Coma Score results. Thus, aggressive management should be considered even in the presence of posttraumatic cerebral infarction.
Adult↗
Large asymptomatic noncolloid neuroepithelial cysts in the lateral ventricle: CT and MR features.
Two cases of large asymptomatic cysts of the lateral ventricle are presented. The cyst walls or cyst contours were demonstrated well by proton density-weighted or T2-weighted spin echo images. These cysts are being detected as incidental findings in increasing frequency with the increasing use of MR imaging. Our data and review of the literature suggest that surgical intervention is not necessarily warranted, but that careful clinical evaluation is indicated. The diagnostic problem of intraventricular cysts is also discussed.
Adult↗
Incidental aneurysm of the superior cerebellar and non-visualized posterior inferior cerebellar artery: a diagnostic trap.
The authors report a case of two aneurysms in the posterior fossa, one of which was first visualized on follow-up arteriography. The mechanism of non-vasualization and re-appearance of the aneurysm is discussed.
Arteries↗