CT and angiographic evaluation in ruptured intracranial aneurysm: clinical correlation

CT has become one of the most important diagnostic method in the evaluation of ruptured intracranial aneurysm with direct detection of subarachnoid, intracerebral and intraventricular hemorrhage, and identification of complications such as recurrent bleeding, hydrocephalus and infarction secondary to arterial spasm. Angiography gives precise information on the location, size of aneurysm and presence of arterial spasm. Authors attempted toperedict the location of ruptured intracranial aneurysm confiremd by CT and angiography at Keimyung University Hospital for last 2 years. The results were as follows; 1 The age and sex distribution; the most prevalent agegroup was 5th to 6th decades (70%), and female patient was slightly more than male patient(57.5%: 42.5%). 2. The locaiton of aneruysms were; posterior communicating artery group 17 cases (42.2%), middle cerebral artery group 10 cases (25.0%), anterior communicating artery group 7 cases (17.5%), basilar artery bifucation 1 case (2.5%),posterior inferior cerebellar artery 1 case(2.5%), and multiple aneurysms 4 case (10%) in order to frequency. 3.Characteristic distributions of intracranial hemorrhage in CT were as follows; 1) In 6 cases (85.7%) of anterior communicating artery aneurysm, interhemispheric fissure hemorrhage was noted. 2) The ipsilateral sylvian fisuurehemorrhage was noted in all cases of middle cerebral artery aneurysm(10 cases) and 12 cases (70.6%) of posterior communicating artery aneurysm. 3) Localized hematoma in frontal lobe near interhemispheric fissure (2 cases:28.6%), septum pellucidum (1 case: 14.3%) and corpus callosum (1 case: 14.3%) were characteristic in anterior communicating artery aneurysm. 4) Comma-shape sylvian fissure hematoma (5 cases: 50%) and temporal lobe hematomanear sylvian fissure (5 cases: 50%) may indicate middle cerebral artery anerysm, 5) Intraventricular hemorrhage (6cases: 15%) has no particular predilection of aneurysmal location. 4. In 9 patients (22.5%) of clinicallysuggesting subarachnoid hemorrhage, no extravasated blood was noted in preenhancement CT alone. 5. Six cases (15%)showed aneurysm itself on preenhancement CT as a round or ovoid hyperdense area or isodense area with mass effectsuch as cisternal obliteration. 6. Hydrocephalus was noted in 9 cases (22.5%). 7. There was no direct correlation between the size of the intracranial aneurysm and extent of the hemorrhage in CT, and between the size of the intracranial aneurysm and clinical grade. 8. There was direct correlation between the extent of blood in CT andclinical grade.

Clinical significance of presence of the conjugated bilopaque in the bowel after oral cholecystography

Oral cholecystogaraphy after ingestaion of the 3.0 gr. Sodium tyropanoate (Bilopaque) was done in 504 patiens from Jan. 1983 to Aug. 1983. Simple supine views of the abdomen of 37 patient, in whom the gall bladder was eithrer nonvisualized or faintly visualized upto 17 houurs after Bilopaque administration, were reviewed in search of the presence of conjugatd material in the bowel. The results were as follows; 1. The ratio of male to female was nearly 2:3, and age distribution was even from 20 years to 79 years. 2. Among 26 cases which showed conjugated Bilopaque in the bowel, cholecystitis with stoens was 20 cases(77% and acalculus cholecystitis was 6 cases(23%).3. Among 11 cases which showed no conjugated Bilopaque in the bowel hepatitis was 3 cases (28%) and clonorchis sinensis, salmonellosis, pancreatitis, acute gastrities was 2 cases (13%) respectively. 4. All of the 20 cases of cholecystitis with stone showed conjugated Bilopaque in the bowel. 5. Among 6 cases of which conjugated Bilopaquein the bowel, salmonellosis was 1 case(17%) and remaining 5 cases (83%) were acalculus cholelcystitis. 6. The results of our study show that the presence of conjugated Bilopaque in the bowel in nonvisualized or faintly visualized gall bladder after oral cholecystography is of definite indicative of cholecystitis. 7. Surgical intervention or ultrasonographic examination of the gall bladder without double dose or second dose oral cholecystography on such cases is recommended.

ERCP findings in clonorchiasis of the liver

ERCP was performed in 38 cases of clonorchiasis of the liver, which was confirmed by stool egg test withStoll's dilution method from Apr. 1979 to Oct. 1982. The resuls were as follows 1. The sex distribution ofclonorchiasis showed marked male predominance by 97.4% and age distrigution were higher in 5th and 6th decades. 2.Multiple small filling defects in the intrahepatic bile duct was the most characteristic finding in ERCP and widespread irregular stenosis, dilatation of terminal portion, disturbance of peripheral filling, fuziness andraggedness of intrahepatic duct were also noted. 3. The severity of clonorchiasis by ERCP were classifed asfollows; Grade I-7 cases (18.4%), GradeII-9 cases(23.7%) Grade III-12 cases (31.6%) and Grade IV-10 cases(26.3%)4. Chronic cholecystitis 10 cases(26.3%), Billary tree stone 7 cases (18.4%), malignancy of distal CBD 1 case(2.6%) were found with clonorchiasis by ERCP. 5. Three cases, treated with Niclofolan, showed marked improvementof pathology on follow-up ERCP.

ERCP findings of extrahepatic bile duct carcinoma

In the diagnosis of bile duct carcinoma, oral or intravenous cholangiography is of no air in the majority ofpatients with bile duct carcinoma who are jaundiced. Recently ultrasonography and CT are widely used for evalutionof biliary disease, but direct visualizing methods of the biliary tract by ERCP and PTC gives more detailed information and exact localization of the lesion. ERCP is less invasive and dangerous and has some more advantages than PTC. We analyzed 33 cases of confirmed extrahepatic bile duct caracinoma who were performed ERCP. The resultswere as follows; 1. The 7th decade was the predilection age, and the radio of male to female was 3.:1. 2. Thelocations of extrahepatic bile duct carcinomas were common bile duct in 45.5%, common hepatic duct in 27.3%,junction of cystic duct and widely extended in 12.1% respectively and junction of hepatic duct in 3.05 in order offrequency. 3. ERCP finding of extrahepatic bile duct carcinomas revealed complete obstruction of bile duct in mostcases, and irregular margined protuberant type was more common than smooth margined constricted type atobstruction site. 4. ERCP finding according to the location of lesion showed that protuberant type was relativelyfrequent in common bile duct and constircted type in common hepatic duct respectively.

Computed tomography of late-onset epilepsy

Epilepsy can be divided into idiopathic epilepsy and symptomatic epilepsy according to the existence ofunderlying organic disease. It has been said that the incidence of the symptomatic epilepsy caused by underlyingorgainic brain disease is higher in late-onset epilepsy after the age of 20 than in childhood-onset epoilepsy. CTis very sensitive and non-invasive method for detection of organic brain disease. 168 cases of late-onset epilepsyafter the age of 20 were studied by CT in recent 2 years were analyzed. The results were as follows; 1. The 3rddecade was the most frequent age group, and the ratio of male to female was 2.5;1. 2. Structural abnormality onbrain CT was demonstrated in 51.8% of hte patient. 3. The older the onset of age was, the higher the rate of theabnormal CT finding, except 5th decade which showed less CT abnormality than 4th decade. 4. The most frequenthistory related to epilepsy was trauma. 63.1% of the patients had no relevant history; and they showed CT findingsof brain tumor, atrophy and infarction in decreasing order of frequency. 5. Abnormal CT finding was demonstratedin 49.2% of normal neurologic examination and in 46.4% of normal EEG study. 6. The most frequent lesion ofabnormal CT scan in late-onset epilepsy was 30 cases(18.4% )of brain atrophy. The next frequent lesion was 18cases (10.7%) of brain tumor. Infarction, parasites and calcification were other frequnet lesions.

Computed tomography of the cerebrovascular accident

CT is a noninvasive and highly valuable method in the diagnosis of intracerebral vascular accidents. Authors analysed 200 cases of clinically suspected cerebrovascular accident(CVA) who were performed CT scan from April1980 to June 1981. The results were as follows; 1. The analysis of CT finding in 200 cases of clinically suspected CVA showed 129 cases (64.5%) of definite CVA, 53 cases of normal finding, 8 cases of equivocal finding and 10cases of miscellaneous disease. 2. Among CVA positive finding of 129 cases, intracerebral hemorrhage was noted in61 cases (47.3%), cerebral infarction in 39 cases (30.2%) and subarachnoid hemorrhage in 29 cases (22.5%) 3. The most prevalent age group as 6th decade in intracerebral hemorrhage and subarachnoid hemorrhage, but 7th decade in cerebral infarction. The sex ratio between male and female in intracerebral hemorrhage and subarachnoid hemorrhage was 1:1 and 1:1.6 respectively, but incerebral infarction male was predominant with the ratio of 3:1. 4. The most common sites of involvement was basal Anglia (41.0%), thalamus (32.8%) and lobes(18.0%) in intracerebral hemorrhage; and lobes(51.6%) and basal ganglia (30.7%) in infarction. 5. Among 33 cases of subarachnoid hemorrhage confirmed by spinal tapping, 25 cases (75.8%) showed CT positive finding and 8 cases (24.2%) CT negative finding. Most cases of CT positive finding were performed CT scan was 7 hours after onset; and the mass effect of the lesion was observed in 44% of cases, mostly(82%) within a week. The contrast enhancement of the cerebral infarct was demonstrated in 19% of cases mostly between 3 days and 30 days and after onset.