Motor fMRI in Acute Infarction of Basal Ganglia and Thalamus

PURPOSE: We wanted to assess the cerebral activation of the motor function after deep cortical (lentiform nucleus and thalamus) infarction. MATERIALS AND METHODS: We studied the motor function of eight right-handed deep cortical infarcted patients (mean age, 61 years; 7 men and 1 woman) who suffered a single unilateral deep cortical (lentiform nucleus or thalamus) infarction. The grade of muscle power by the grading system of the Medical Research Council was II in two patients, III in three patients and IV in three patients. All the MRI experiments were performed with a 1.5T scanner. The fMRI protocol consisted of eight alternating periods of task performance and rest. The activation tasks consisted of finger movements. Data analysis of activated area and calculation of the activated volumes in sensorimotor cortex were done. RESULTS: For the six lentiform nucleus acute infarction patients, one right hemiparetic patient (MRC Grade: II), and only the right sensorimotor cortex (the unilateral non-lesion side) were activated. In five (MRC Grade: III-IV) of the six lentiform nucleus infarcted patients, bilateral activations of the primary sensorimotor cortex were recorded. In four of the five bilaterally activated patients, extended activations in the lesion side sensorimotor cortex were observed. In the two right thalamic infarction patients, bilateral activations of the primary sensorimotor cortex were recorded. One patient (MRC Grade: II) was observed to have an extended activation in the non-lesion side sensorimotor cortex. On the follow up fMRI done on this patient after 40 days (MRC Grade: III at that time), the activated volumes of both sensorimotor cortexes were increased. The activated volume in the lesion side sensorimotor cortex was more than that in the non-lesion side sensorimotor cortex. The other patient (MRC Grade: IV) was observed to have extended activation in the lesion side sensorimotor cortex. CONCLUSION: fMRI allows for the study of the motor function in deep cortical infarction. We were able to investigate the differences in motor activation according to the individual MRC Grades. fMRI may be a useful tool to monitor and study deep cortical infarction, and it may be important to help us understand the function of the deep cortical areas.

Somatotopic Mapping of the Supplementary Motor Area

PURPOSE: The purpose of this study was to assess supplementary motor area (SMA) activation during motor, sensory, word generation, listening comprehension, and working memory tasks using functional magnetic resonance imaging (fMRI). MATERIALS AND METHODS: Sixteen healthy right-handed subjects (9M, 7F) were imaged on a Siemens 1.5T scanner. Whole brain functional maps were acquired using BOLD EPI sequences in the axial plane. Each paradigm consisted of five epochs of activation vs. the control condition. The activation tasks consisted of left finger complex movement, hot sensory stimulation of the left hand, word generation, listening comprehension, and working memory. The reference function was a boxcar waveform. Activation maps were thresholded at an uncorrected p=0.0001. The thresholded activation maps were placed into MNI space and the anatomic localization of activation within the SMA was compared across tasks. RESULTS: SMA activation was observed in 16 volunteers for the motor task, 11 for the sensory task, 15 for the word generation task, 5 for the listening comprehension task, and 15 for the working memory task. The rostral aspects of the SMA showed activity during the word generation and working memory tasks, and the caudal aspects of the SMA showed activity during the motor and sensory tasks. Right (contralateral) SMA activation was observed during the motor and sensory tasks, and left SMA activation during the word generation and memory tasks. CONCLUSION: Our results suggest that SMA is involved in a variety of functional tasks including motor, sensory, word generation, and working memory. The results obtained also support the notion that functionally specific subregions exist within the region classically defined as the SMA.

Curved Planar Reconstruction of MR Images in Focal Cortical Dysplasia of the Brain

PURPOSE: To describe curved planar reconstruction imaging (CPRI) and determine its usefulness in the evaluation of focal cortical dysplasia of the brain. MATERIALS AND METHODS: In 17 cases of focal cortical dysplasia [cortical dysplasia (n=9), schizencephaly (n=5), and heterotopia (n=3)], CPR images were created using a multiplanar reconstruction program and imaging data obtained during T1 magnetizationprepared rapid acquisition gradient-echo MR imaging. We assessed the precise configuration of abnormalities and their relation to adjacent gyri and sulci. RESULTS: CPRI showed the brain cortex as a 2D panoramic image, demonstrating the precise configurations and locations of dysplasia-associated abnormalities and their relation to adjacent gyri and sulci, and the precise shape of the gray-white matter interface. CONCLUSION: CPRI can provide important radiological information about the extension and configuration of focal cortical dysplasia, and its relation to neighboring cortical structures. We believe that CPRI should form an essential part of the routine investigation of suspected cases of focal cortical dysplasia.

Ruptured Iliolumbar Artery Pseudoaneurysm Following Abdominal Blunt Trauma: Transcatheter Arterial Embolization

Iliolumbar artery injury is a rare but well-known complication of abdominal trauma and is usually associated with pelvic bone fracture. If a pseudoaneurysm develops and ruptures, it is a serious condition due to the enduing massive intraperitoneal or retroperitoneal bleeding. Superselective embolization has become the most effective treatment for pelvic hemorrhage caused by iliolumbar artery injury in which early detection and treatment are very important. We report a case of successful transarterial embolization of a pseudoaneurysm following blunt trauma in 32-year-old female.

Percutaneous Catheter Drainage of Complicated Traumatic Perirenal Hematoma: Case Report

A perirenal hematoma very commonly occurs after trauma. Treatment differs according to the degree of renal injury, though many cases are managed conservatively and complications are rare. We report two cases in which successful treatment of a perirenal hematoma involved percutaneous catheter drainage; in one there was bowel obstruction, and in the other the hematoma was infected.

Percutaneous Removal of Foreign Bodies by Gooseneck Snare Technique in the Common Bile Duct and T-tube Tract: A Report of Two Cases

Although the presence of foreign bodies in the common bile duct and T-tube tract is uncommon, it is because of recent developments in endoscopic biliary intervention and percutaneous choledochoscopic procedures that they are found with increasing frequency in the biliary tree. We report two cases in which foreign bodies in the biliary tree were successfully removed using the percutaneous gooseneck snare technique. In one patient a plastic biliary stent was malfunctioning and could not be removed under endoscopic guidance, while in the other, a plastic guidewire had been inserted into the T-tube tract during percutaneous choledochoscopy for the treatment of a common bile duct stone.

Comparison of Lacrimal Scintigraphy and Contrast Dacryocystography in Epiphora

PURPOSE: Conventional contrast dacryocystography(C-DCG) has been used mainly for anatomical assessment of the lacrimal drainage apparatus, due to its limited information on the dynamics of the lacrimal system, and thus correlation role in epiphora. The purpose of study was to improve the diagnostic value in epiphora by utilizing RI dacryocystography(RI-DCG) with quantitative criteria. MATERIALS AND METHODS: The patient for RI dacryocystography set erect with the head fixed in front of gamma camera fitted with a standard 6 mm pinhole collimater. Both eyes of 85 patients(170 eyes) were scanned with 99rnTc-pertechnetate followed by conventional dacryocystography. The data from gamma camera were recorded simultaneously on a computer system for subsequent quantitative analysis. RESULTS: In 94 of 96 eyes without epiphora, RI-DCG was correlated with normal C-DCG and % of emptying was at least over 50%. In 58 of 74 eyes with epiphora, RI-DCG was correlated with abnormal C-DCG and % of emptying was at most below 50%. In 16 eyes with functional block, quantitative RI-DCG showed abnormal % of emptying. CONCLUSION: Nuclear DCG with quantitation had higher diagnostic yield in functional block and correlated higher with epiphora. Thus nuclear DCG with quantitation would be a valuable functional test after postprocedures such as dacryocystoplasty.

Treatment of Lung Abscess: Effectiveness of Percutaneous Catheter Drainage in 14 Patients

PURPOSE: To evaluate the effectiveness of percutaneous catheter drainage in treatment of the lung abscess. MATERIALS AND METHODS: We treated the lung abscesses in 14 patients(12 men, 2 women), who did not respond to medical therapy, by percutaneous catheter drainage under fiuoroscopic or ultrasound guidance. One abscess due to infacted bulla was managed by combination treatment with alcohol sclerosing therapy. Patients were followed by serial chest radiographs every three days and the amount of drained or aspirated pus evaluated. The treatment effect and recurrence were followed by chest PA and lateral chest at one week after removal of drainage catheter. RESULTS: Thirteen patients(93%) recovered clinically and radiologically within 3 days. In 10 patients, drainage catheter could be removed within 2 weeks, and three patients, the catheter was keept longer. Most complications were mild ;vague to moderate chest pain(n=14), mild hemoptysis(n=2), and pneumothorax(n=I). One man who suffered from far advanced pulmonary tuberculosis died of asphyxia caused by massive hemoptysis 16 days after percutaneous drainage. CONCLUSION: Percutaneous catheter drainage is a safe and effective method for treating lung abscess.

Treatment of Lung Abscess: Effectiveness of Percutaneous Catheter Drainage in 14 Patients

PURPOSE: To evaluate the effectiveness of percutaneous catheter drainage in treatment of the lung abscess. MATERIALS AND METHODS: We treated the lung abscesses in 14 patients(12 men, 2 women), who did not respond to medical therapy, by percutaneous catheter drainage under fiuoroscopic or ultrasound guidance. One abscess due to infacted bulla was managed by combination treatment with alcohol sclerosing therapy. Patients were followed by serial chest radiographs every three days and the amount of drained or aspirated pus evaluated. The treatment effect and recurrence were followed by chest PA and lateral chest at one week after removal of drainage catheter. RESULTS: Thirteen patients(93%) recovered clinically and radiologically within 3 days. In 10 patients, drainage catheter could be removed within 2 weeks, and three patients, the catheter was keept longer. Most complications were mild ;vague to moderate chest pain(n=14), mild hemoptysis(n=2), and pneumothorax(n=I). One man who suffered from far advanced pulmonary tuberculosis died of asphyxia caused by massive hemoptysis 16 days after percutaneous drainage. CONCLUSION: Percutaneous catheter drainage is a safe and effective method for treating lung abscess.