Unruptured Aneurysms with Cranial Nerve Symptoms: Efficacy of Endosaccular Guglielmi Detachable Coil Treatment

OBJECTIVE: To evaluate the efficacy of endosaccular Guglielmi detachable coil (GDC) treatment of unruptured aneurysms causing cranial nerve (CN) symptoms. MATERIALS AND METHODS: Among a database of 218 patients whose aneurysms were treated using GDC, seven patients met the criteria for unruptured aneurysms presenting with symptoms and signs of CN palsy. Changes in CN symptoms before and after GDC treatment were reviewed. RESULTS: Aneurysms were located in the internal carotid-posterior communicating artery (n=3), the basilar bifurcation (n=1) and the cavernous internal carotid artery (n=3). CN symptoms included ptosis (n=6), mydriasis (n=2), and extraocular muscle (EOM) disorder (CN III: n=4; CN VI: n=3). Overall, improvement or resolution of CN symptoms after treatment was noted in five patients. CN symptoms in cases involving small (< or =10 mm) and intradural aneurysms tended to respond better to GDC treatment. Ptosis was the initial symptom to show improvement, while EOM dysfunction responded least favourably. CONCLUSION: GDC coil packing appears to be an appropriate treatment method for the relief of CN symptoms associated with intracranial aneurysms.

Neuroradiology in the Ocular Motility Disorders: II. Nuclear and Infranuclear Pathway

The nuclear and infranuclear pathway of eye movement begins from the ocular mo-tor nuclei situated in thebrain stem, where the axons originate and form three ocular motor nerve s. Although each of the ocular motornerves follows a distinct route to reach the end organ, the extraocular muscles, they also have common housings inthe cavernous sinus and at the orbital apex, where part or all of them are frequently and simultaneously affectedby a common disease process. Since the fine details of normal and diseased structures can frequently be seen onradiologic imaging, especially mag-netic resonance (MR) imaging, a knowledge of the basic anatomy invo l ved innuclear and infranuclear eye movement is important. In this description, in addition to the normal nuclear andinfranuclear pathway of eye movement, we have noted the radio-logic findings of typical diseases involving eachsegment of the nuclear and infranu-clear pathway, particularly as seen on magnetic resonance images. Briefcomments on ocular motor pseudopalsy, which mimics ocular motor palsy, are also included.

Brain MR Imagings Finding in Patients with Central Vertigo

PURPOSE: To investigate brain lesions and their locations in patients with central vertigo, as seen on MRimaging. MATERIALS AND METHODS: We retrospectively reviewed MR images of 85 patients with central type vertigodiagnosed on the basis of clinical symptoms and vestibular function test (VFT), and analyzed lesions and theirlocations. Those located along the known central vestibular pathway were included in our study. RESULTS: In 29 of85 patients (34%), lesions considered to be associated with central vertigo were detected on MR imaging. Theseincluded infarction (18 patients), hemorrhage (5), tumor (2), cavernous angioma(1), cerebellopontine anglecyst(1), tuberous sclerosis(1) and olivopontocerebellar atrophy(1) ; they were located in the parietal lobe(6patients), the lateral medulla(5), the pons(5), the middle cerebellar peduncle(4), the corona radiata(3), and thecerebellar vermis(3). Thirty-eight cases showed high signal intensity lesions in deep cerebral matter, the basalganglia, and pons but these were considered to be unrelated to central vertigo. CONCLUSIONS: MR imaging could bea useful tool for the evaluation of patients with central vertigo.

Evaluation of Olfactory Bulb Size on MR Imaging in Normal Volunteers and Anosmic or Hyposmic Patients withoutNasal Disease

PURPOSE: To evaluate the size of the olfactory bulb using MRI in normal volunteers and anosmic or hyposmicpatients without nasal diseases. MATERIALS AND METHODS: MRI was performed in 20 normal volunteers with a normalsense of smell, and in 15 anosmic or hyposmic patients without nasal disease but with abnormality in the olfactoryfunction test. Coronal T1-weighted MRI was performed, with a section thickness of 3mm. The cross sectional area,width and height of the olfactory bulb were measured in multiple sequential images and the largest values of thesewere analysed. The difference in the size of the olfactory bulb between normal volunteers and anosmic or hyposmicpatients was evaluated and Student's t test was used for statistical analysis. RESULTS: In most cases, theolfactory bulb was demonstrated in three sequential coronal images; in normal volunteers, the largest crosssectional area, width and height were not significantly different between the right and left olfactory bulb. In 40 olfactory bulbs(right, left) in 20 normal volunteers and 30 olfactory bulbs in 15 anosmic or hyposmic patients,the respective means of various measurements were as follows: 7.5mm2 and 6.0mm2; greatest width, 4.6mm and 3.8mm;greatest height, 2.7mm and 2.0mm. For the largest cross-sectional area and greatest height, the difference inolfactory bulb size between normal volunteers and patients was statistically significant (P0.05). CONCLUSION: The size of the olfactory bulb issignificantly less in anosmic or hyposmic patients without nasal disease than in normal volunteers; in suchpatients, olfactory MRI could be a useful evaluative modality.