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The jugular foramen syndrome and its more common variants have been described. Extramedullary plasmacytoma of the head and neck was discussed and its relation to cranial nerve dysfunction was reviewed, with presentation of an unusual case of plasmacytoma resulting in a variant of the jugular foramen syndrome.
The majority of abnormalities at the foramen of Monro identified by computed tomography (CT) are colloid cysts, but a number of other diseases in this location may produce a similar CT appearance. In a series of 21 patients the radiologic findings included six colloid cysts, two neoplasms, five vascular lesions, three congenital neuroectodermal diseases, four infectious or granulomatous lesions, and one idiopathic calcified mass at the foramen of Monro. The neuroradiologic evaluation included contrast-enhanced and contrast-nonenhanced cranial CT scans and cerebral angiography in the majority of cases. Pneumoencephalography provided useful ancillary diagnostic information in four patients.
Disc herniation into the intervertebral foramen (IVF) or osteophytic outgrowths from the margins of the apophyseal joints that project into the IVF may compress the neural structures, but in this cadaveric study of 160 lumbar foramens (age range, 35-91 years), the authors have found that they were much more commonly associated with compression and distortion of the large venous plexus within the IVF. In the absence of direct nerve compression (seen in only eight specimens), the most severe neural changes were associated with compression, congestion, and resultant dilatation of foraminal veins. Pathologic changes within and around the nerve root complex included peri- and intraneural fibrosis, edema of nerve roots, and focal demyelination. Inflammatory cells were notably absent. Vascular changes within the thickened fibrous sheath about damaged nerves, namely, basement membrane thickening, suggestive of endothelial cell injury also were observed. The association between vascular compression, tissue fibrosis, and endothelial injury distant from the compression may be causal--probably due to ischemia as a result of reduced venous outflow. Such observations have led the authors to propose that venous obstruction may be an important pathogenic mechanism in the development of perineural and intraneural fibrosis.
STUDY DESIGN: A biomechanical study of intervertebral foraminal narrowing during simulated automotive rear impacts. OBJECTIVES: To quantify foraminal width, height, and area narrowing during simulated rear impact, and evaluate the potential for nerve root and ganglion impingement in individuals with and without foraminal spondylosis. SUMMARY OF BACKGROUND DATA: Muscle weakness and paresthesias, documented in whiplash patients, have been associated with neural compression within the cervical intervertebral foramen. To our knowledge, no studies have comprehensively examined dynamic changes in foramen dimensions. METHODS: There were 6 whole cervical spine specimens (average age 70.8 years) with muscle force replication and surrogate head that underwent simulated rear impact at 3.5, 5, 6.5, and 8 g, following noninjurious baseline 2 g acceleration. Peak dynamic narrowing of foraminal width, height, and area were determined during each impact and statistically compared to baseline narrowing. RESULTS: Significant increases (P < 0.05) in average peak foraminal width narrowing above baseline were observed at C5-C6 beginning with 3.5 g impact. No significant increases in average peak foraminal height narrowing were observed, while average peak foraminal areas were significantly narrower than baseline at C4-C5 at 3.5, 5, and 6.5 g. CONCLUSIONS: Extrapolation of the present results indicated that the highest potential for ganglia compression injury was at the lower cervical spine, C5-C6 and C6-C7. Acute ganglia compression may produce a sensitized neural response to repeat compression, leading to chronic radiculopathy following rear impact.
BACKGROUND: Patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) is highly associated with cerebral ischemic events in young patients. The prevalence of PFO and ASA in elderly patients with cerebral ischemic events is not well described. OBJECTIVE: Our study is to evaluate the frequencies of PFO with right-to-left shunt (RLS) and ASA in elderly patients and to determine whether age is a predictor of flow-reversed PFO with RLS in cerebral ischemic events. METHODS: A prospective registry for all consecutive patients with cerebral ischemic events who were evaluated by transesophageal echocardiography (TEE) for the detection of possible cardiac source of embolization was established and maintained in a university hospital. Patients' demographics including age, gender, ethnic origin, cerebrovascular risk factors, and all positive TEE data were collected from July 2000 to August 2001 for statistical analysis. A univariate and multivariate stepwise logistic regression analysis was performed. RESULTS: In older patients the prevalence of PFO with RLS, PFO, and ASA was 25/118 (20%), 28/118 (24%), and 38/118 (32%), respectively, as opposed to younger patients, in whom it was 35/119 (30%), 39/119 (33%), and 38/119 (32%), respectively. Older patients had higher frequencies of hypertension (59; 69%), CAD (25; 21%), and prior history of stroke (23; 20%) as opposed to younger patients. Younger age (<60 years), gender, smoking history, hypertension, hyperlipidemia, CAD, and prior history of stroke were not associated with higher prevalence of PFO with RLS. Patent foramen ovale was associated with ASA (P < 0.001) and LVH (P < 0.019) in patients with TIA and stroke. In multivariate analysis only ASA (P < 0.001) remained significant with PFO, with RLS controlling for age, gender, and LVH. CONCLUSIONS: PFO with RLS and ASA are frequently present in elderly stroke and/or TIA patients and age is not a predictor for PFO. Transesophageal echocardiography should be considered for all stroke and/or TIA patients irrespective of their age.
A supratrochlear foramen of the humerus was demonstrated in three Turkish cattle. The average size of the foramen was 1.2 x 0.7 cm. This appears to be a new anatomic finding in the bovine.
Postnatal development and variation of the bony cranial border of the lateral vertebral foramen (LVF) of the atlas was studied in 96 dogs. Developmental ossification was investigated in 8 known-aged Miniature Schnauzer pups, after each atlas was prepared either as an alizarin-red stained clearing or as a dried cleaned bone. Variation was investigated in 63 atlases from mature dogs and by study of radiographs from 25 mature dogs of various breeds. The soft tissue structures passing through the LVF and attaching to its cranial border were dissected in an additional 2 embalmed and 2 fresh cadavers. In 2-week-old pups, the LVF was represented by a notch in the cranial margin of the bony arch of the atlas, with a cartilage bar completing the foramen cranially. Between 6 and 16 weeks the bar forming the cranial bony border of the LVF ossified in its preexisting cartilage anlage. In mature dogs, the LVF was present in the craniolateral aspect of the arch of the atlas and was recognized on lateral radiographs. The vertebral artery and vein, and first cervical nerve passed through the LVF and the atlantooccipital joint capsule and dorsal membrane attached to the cranial border of the LVF. In one dog the cranial border of the LVF of the atlas was incompletely ossified bilaterally. This developmental variant was compared with variations in man and other mammals, and with proatlas neural arch derivatives.
The foramen ovale is usually obliterated following establishment of the adult circulation but remains patent in 25% of individuals. This potential communication between the venous and arterial circulations can allow thromboembolic material to bypass the lungs and enter the systemic circulation. We report two cases of paradoxical embolization through a patent foramen ovale following acute large pulmonary embolism (PE) and discuss the factors that predispose to paradoxical embolization following PE.
An unusual case of obstructive jaundice due to foramen of Winslow hernia is presented. The hernia re-entered into the general peritoneal cavity through the lesser omentum and this appeared to be important in the pathogenesis of jaundice in this patient. Accurate pre-operative diagnosis of this uncommon condition remains difficult despite the advent of modern imaging techniques such as computerized tomography. Optimal outcome demands a high index of suspicion and early surgical intervention, together with operative measures to prevent future recurrence. The pathoanatomy of caecal herniation through the foramen of Winslow is also discussed.
PURPOSE: We analyze a series of patients with mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) submitted to presurgical investigation with scalp sphenoidal, followed by foramen ovale electrodes (FO), and, when necessary, with depth temporal electrodes. We sought to evaluate the clinical utility of FO in patients with MTLE-HS. METHODS: We included patients who had phase I investigation with bitemporal independent seizures, nonlateralized ictal onsets, or ictal onset initiating in the side contralateral to the side of hippocampal sclerosis. Patients whose implanted FO failed to demonstrate an unambiguous unilateral ictal onset were later evaluated with depth hippocampal electrodes. RESULTS: Between May 1994 and December 2004, 64 patients met our inclusion criteria: 33 female (51.5%) and 31 male subjects (48.5%). The mean age at enrollment was 37.66+/-10.6 years (range, 12-56 years). The groups with nonlateralized surface ictal EEG onsets and contralateral EEG onsets had a greater chance of lateralization with FO when compared with the group with bilateral independent seizures on surface EEG (p<0.01). Foramen ovale electrodes lateralized the seizures in 60% of patients. Seventy percent of patients became seizure free after temporal lobectomy. Five patients were implanted with depth temporal electrodes after FO video-EEG monitoring. The depth-electrode EEG onsets confirmed the results of FO video-EEG monitoring in all patients, and the surgery was refused. CONCLUSIONS: In MTLE-HS, FO is a reliable method for lateralization of seizures that are not clearly recorded by surface EEGs.
Hearts from 24 foals were studied; 10 were from foetuses ranging in gestational age from 230 to 322 days and 14 were from newborn and young foals aged between birth and 17 days. The foramen ovale and associated vena caval and atrial structures were examined by scanning electron microscopy. Additional observations were made by light and transmission electron microscopy. A tube-like flap of tissue was observed, extending from the aperture in the caudal vena cava to the lumen of the left atrium. In the younger foetuses, the distal end of this tube was covered with a thread-like network of tissue. In animals nearer to term, the network was replaced by distal fenestrations. Protrusions were seen on the rim of the opening of the tube as it entered the atrium. The role that these may play, together with the significance of cardiac muscle and non-elastic connective tissue in the wall of the tube, were discussed with respect to possible mechanisms of closure of the foramen ovale.
Two patients with long tunnel-type patent foramen ovale presented for elective transcatheter closure following transient ischaemic attack and stroke. Right to left shunting was confirmed on transthoracic and transoesophageal echocardiography. A new technique that used a transseptal procedure was devised to enable closure of the tunnel-type patent foramen ovale using the CardioSEAL transseptal occluder to avoid "bunching up" of the device and residual transatrial shunting.
OBJECTIVES: The aim was to estimate the recurrence rate and to define subgroups at increased risk for recurrent cerebral ischaemia in patients with patent foramen ovale (PFO) and so called cryptogenic stroke due to paradoxical embolism. METHODS: Patent foramen ovale was diagnosed in 318 patients with otherwise unexplained ischaemic stroke or transient ischaemic attack (TIA). One hundred and fifty nine were treated medically (oral anticoagulation 79, platelet inhibitors 80) and represent the study population. The remaining 159 patients underwent endovascular or surgical closure of the PFO and are not part of this study. RESULTS: Mean age was 50.7 (SD 13.5) years. The event leading to the diagnosis of PFO was a TIA in 38 patients (23.9%), an ischaemic stroke in 119 (74.8%), and an amaurosis fugax in two patients (1.3%). Forty four patients (27.7%) had experienced multiple cerebrovascular ischaemic events before the diagnosis of the PFO. During mean follow up of 29 (SD 23) months 21 patients (13.4%) had a recurrent cerebrovascular event (seven strokes and 14 TIAs). The average annual rate of recurrent strokes was 1.8% and that of recurrent strokes or TIAs was 5.5%. When patients with PFO with multiple cerebrovascular events before the diagnosis of the PFO were analyzed separately, the average annual rates of recurrent cerebral ischaemia were 3.6% for recurrent strokes and 9.9% for recurrent strokes or TIAs. These rates were significantly higher than in patients with first ever stroke or TIA (p=0.02). CONCLUSIONS: The study confirms a risk of stroke recurrence that is similar to the rates of previously published series of patients with PFO and cryptogenic strokes. Patients with more than one previous event were at increased risk of recurrent cerebral ischaemia.
Special jugular foramen views or tomography are generally used to radiographically delineate the jugular spur, jugular fossa, and jugular foramen. Details of this area are not ordinarily searched for by the radiologist on skull films nor otoroentgen views of the temporal bone for various reasons: attention to certain small "key-areas," rectilinear distortion, superimposition of neighboring structures, radiodensity of the petrous pyramid, etc. This paper outlines the radiographic anatomy of the jugular area and details its appearance on plain skull films (AP, PA, and submentovertical projections) and on special views of the temporal bone (Schuller's, Owen's, Mayer's, Stenvers', Low-Beer's).
A small segment of the facial nerve between its exit from the stylomastoid foramen and its entrance into the parotid is surrounded by fat and, therefore, can be imaged well using modern computed tomography. A small dot can be seen surrounded by fat just beneath the stylomastoid foramen on computed tomographic scan. To verify that this indeed represented the facial nerve, tissue sections and an injection into the mastoid segment of the intratemporal facial nerve were performed. The anatomic correlation and clinical material demonstrating involvement of the facial nerve in this region are presented.
In high-resolution computed tomographic (HRCT) images of dry skulls and patients, the anatomy of the jugular foramen and its neighboring structures was demonstrated to excellent advantage. Among those structures visualized were the cortical margins of the jugular compartments, which are important in evaluating tumor involvement, the anatomic relationship between the jugular fossa and the hypotympanum, and the adjacent basal foramina. The inferior tympanic canaliculus, which transmits the inferior tympanic artery and nerve and houses one fifth of the glomus formation, thereby playing a role in arterial anomalies as well as glomus tumors, was occasionally recognizable. In addition, subtle bone findings associated with vascular anomalies in and around the jugular foramen, critically important in the differential diagnosis of glomus tumors, were visualized. Examples of these findings are presented.
Perineural tumor extension is a form of metastatic disease in which primary tumors spread along neural pathways and gain access to non-contiguous regions. The treatment and prognosis are altered when perineural extension occurs. Awareness and proper evaluation are critical for the radiologist. The third (mandibular) division of the trigeminal nerve (V3), passing through the skull base via the foramen ovale, is a common route of perineural spread of head and neck lesions. Seven patients with perineural tumor involvement of the mandibular nerve were evaluated with magnetic resonance imaging with use of standard spin-echo pulse sequences emphasizing T1-weighted information. Three patients had adenoid cystic carcinoma, three had squamous cell carcinoma, and one had well-differentiated lymphocytic lymphoma of the orbit. MR imaging signs of perineural involvement included smooth thickening of V3, concentric expansion of the foramen ovale, replacement of the normal trigeminal cistern hypointensity by an isointense mass, lateral bulging of cavernous sinus dural membranes, and atrophy of masticator muscles.
A frequent finding in healthy individuals, patent foramen ovale (PFO) with right-to-left shunt (RLSh), is an embrionary residue that has been linked with cryptogenic stroke and peripheral ischemia. Pulmonary hypertension and entities like decompression illness, migraine with aura or plathypnea-orthodeoxia have been found to have a higher prevalence of PFO with RLSh. Some dementias and unexplained syncopes could also have some relationship. Paradoxical embolism, thrombosis of the foramen channel or the atrial structures with subsequent embolism, transient arrhythmias, prothrombotic states and vasoactive substances passage have been proposed as physiopathologic mechanisms involved. Contrast-enhanced transesophageal echocardiography is the standard reference diagnostic procedure but contrast-enhanced transcranial Doppler is a good non-invasive alternative diagnostic tool that is highly sensitive and specific.