Aneurysmal subarachnoid hemorrhage: presentation and neuroradiological detection

To study the presentation and the results of the different radiological tools; computed tomography [CT] brain scan, magnetic resonance imaging [MRI], magnetic resonance angiography [MRA] and cerebral angiography [CA] in patients with subarachnoid hemorrhage [SAH] resulting from ruptured cerebral aneurysms. Consecutive patients with CT proved diagnosis of SAH were subjected to thorough history taking, general, neurological examination and laboratory investigation. After exclusion and deaths, 13 patients underwent MRA and CA beside CT and MRI. CA detected 11 aneurysms in 11 patients, arterio-venous malformation in one patient and in one patient there was no apparent cause. Among our 11 patients with aneurysmal SAH, females and age group of 31-50 years predominated. Smoking was present in 45.5%, hypertension in 27.3% and history of recurrent headache in 63.6%. With the onset of SAH, headache with neck stiffness was the most common presentation [63.6%]. Disturbed consciousness was found in 45.5%, seizures in 18.2% and focal signs in 9.1%. 36.4% of the patients had grade II and 27.3% had grade III in Hunt and Hess scale. Radiological assessment revealed that 7 patients had pure SAH, 3 patients had intracerebral hemorrhage [ICH] and one patient had intraventricular hemorrhage [IVH] in association with SAH. 63.6% of the aneurysms in our patients were small and no giant aneurysms were found. The most common site of aneurysms was middle cerebral artery [MCA] accounted for 36.4%. Anterior cerebral artery [ACA] and anterior communicating artery [ACoA] accounted for 18.2% each. Internal carotid artery [ICA] and posterior communicating artery [PCoA] accounted for 27.3%. In comparison to the CA, as the golden standard method, MRA detected 10 aneurysms out of 11, and missed one small aneurysm, with a sensitivity of 90.9% in detection of aneurysms. Ruptured intracranial aneurysms accounted for about 85% of causes of SAH. History of recurrent headache, smoking, hypertension and female gender may be predictors of aneurysmal rupture in the 4[th] and 5[th] decades. 36.4% of SAH may be associated with ICH or IVH. Headache is the most common presentation of rupture aneurysm while less than half of the patients presented with altered consciousness. About tow thirds of aneurysms are small sized. Intracranial aneurysms located in the anterior cerebral circulation mostly in MCA. MRA is a rapid, non invasive technique and can be used to detect intracranial aneurysms with high sensitivity of 90.9%, with excellent correlation with the gold standard, invasive, CA

reliability of fetal lower extremity ossification centers in the sonographic estimation of gestational age

Sonographic identification of fetal distal femoral and proximal tibial epiphyseal ossification centers [EOC] was carried out in 87 single pregnancies to assess the possible relationship between their appearance and the gestational age [GA]. Detection of distal femoral epiphyseal ossification centre [DFE] is an indication of GA >/= 33 weeks. The GA was confirmed in 68 cases by at least tow methods. The sensitivity of DFE was 93%, the specificity was 90% and the accuracy was 93%. The visualization of the proximal tibial epiphyseal ossification center [PTE] in the same group was highly predictive of a GA >/= 38 weeks. The accuracy of a positive prediction was 100%. It is concluded that sonographic estimation of GA during the last trimester of single pregnancy by antenatal visualization of the epiphyseal ossification centers of the fetal knee is feasible

Evaluation of proptosis by computed tomography

Computed tomography [CT] was done for 30 patients complaining from proptosis whether unilateral or bilateral to assess its reliability in differentiating its causes and extent. Other radiological methods, histopathology and surgery were used for confirmation in addition to the clinical data. Three groups of retrobulbar, paraorbital and global lesions were defined. The CT was found to be an essential diagnostic tool for the detection of the global and orbital lesions, while it had to be combined with plain x-ray in dealing with parorbital lesions