Computed Tomography in Evaluation of Cerebrovascular Accidents: A Prospective Study in a Tertiary Care Hospital

Introduction: Due to so many reasons, Cerebrovascular accidents now a days very common ad also major emergency conditions patients are mainly from the same pool. Therefore, we conducted the study to evaluate the role of computed tomographic scan in patients with cerebrovascular accidents. Materials and Methods: This prospective study was conducted in the department of Radio Diagnosis at Era’s Lucknow Medical College and Hospital. All the patients with CVA during the duration of January 2016 to June 2016 were subjected to computed tomography scan of the head using GE Revolution ACTs 16 slice MDCT scanners, Slice Thickness – 2mm, 5mm and 10mm and Matrix size of 512 X 512. Results: Total of 35 patients with clinically suspected of CVA were submitted for CT scan study of brain. Out of 35 patients, 18 patients had infarction, 9 patients had hemorrhage, 3 patients had Subarachnoid hemorrhage (SAH), 2 patient had tumorous pathology, 2 Patient had cerebral venous thrombosis and 1 Patient had normal study. Conclusion: CT scanning was the “Gold standard” technique for diagnosis of acute stroke as the rational management of stroke depends on “Accurate diagnosis” and it should be ideally done in all cases.

Solitary Lumbar Spinal Osteochondroma Presenting with Sciatic Pain: A Case Report

Osteochondroma is one of the most common benign bone tumors, but only 1-4% involve the spine. They make up 0.4% of intraspinal tumors. Herein, we report on a solitary osteochondroma of the lumbar spine presenting with sciatica. A 54-year-old male patient visited our institution, complaining of right leg pain of 2 months duration. His neurological examination revealed a limited right straight-leg-raising test result, motor weakness of right great toe dorsiflexion, and L4-L5 hypoesthesia. Lumbar computerized tomographic (CT) scan and magnetic resonance (MR) imaging studies revealed a tumor mass arising from the inferior articular process of the L3. There was marked improvement of the symptoms after surgical removal of the lesion. Symptoms showed marked improvement after surgical removal of the lesions. Histopathologic examination confirmed the diagnosis of benign osteochondroma.

Classification of Blowout Fracture

PURPOSE: Blowout fracture can lead to functional impairments and esthetic deformities such as impairment of ocular movement, diplopia, visual loss and enophthalmos. The object of this study is to present a classification and its analysis according to the computed tomographic scan in blowout fractures. We classified blow out fractures into three types according to the anatomical location of fracture, the size of the bone defect and the degree of periosteal injury by using the computed tomography scan. Each progress and complications were analyzed more than mean 1 year. METHODS: Among the 155 cases during 4 years, there were 11 cases of medial orbital wall fracture, 97 cases of inferior orbital wall fracture, 47 cases of combined type. The mean age of patients was 31.2 years, ranged from 8 to 84 years. RESULTS: According to our classification, surgical treatments through the nasoendoscopic approach, the subciliary approach, the transconjunctival approach or their combinations were performed in 116 patients, and conservative treatments were done in 46 patients. Presurgical clinical findings of diplopia, impairment of ocular movement, enophthalmos of more than 2 mm were present in 62 patients. After surgical treatment, clinical findings were remained in 7 patients. CONCLUSION: We think that our classification according to computed tomographic scan is helpful for the indication and it may decrease the complications such as impairment of ocular movement, diplopia, visual loss and enophthalmos.

Effects of the site and the extent of blowout fracture on enophthalmos and diplopia

Orbital blowout fractures are common consequence to blunt periorbital trauma. Pure orbital blowout fractures first occur at the weakest point of the orbital wall. Computed tomography(CT) is recognized to be the best imaging technique to evaluate orbital fractures. The extent and location of a blowout fractures in the CT scan were noted to have an effect on the clinical outcome. In the early posttraumatic period, the presence of significant enophthalmos is difficult to detect because of orbital edema. Early surgical intervention may improve the ultimate outcome because open reconstruction becomes more difficult if surgery is delayed. In this study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from CT scans and their relationship to ophthalmologic findings. Six patients of the medial orbital wall fractures, eleven patients of the inferior orbital wall fractures, nineteen of the medial and the inferior orbital wall fractures confirmed by CT scan, were evaluated. The area of fracture and the volume of the displaced orbital tissue were determined from CT scan using linear measurements. Each of the calculated values for the area and the volume were compared with the degree of the enophthalmos, the diplopia, and the eyeball movement limitation to determine whether there was any significant relationship between them. The fracture area and the volume of the herniated orbital tissue were significantly positively correlated with the enophthalmos and the ocular motility limitation and not correlated with the diplopia. For the enophthalmos of 2mm or greater, the mean fracture area was 3.55+/-1.25cm2 and the volume of the herniated orbital tissue was 1.74+/-0.97cm3 for less than 2mm enophthalmos, 1.43+/-0.99cm3 and 0.52+/-0.49cm3, respectively. The enophthalmos of 2mm can be expected with 2.92cm2 of the fracture area and 1.40cm3 of the herniated orbital tissue. In conclusion, the enophthalmos of 2mm or more, which is a frequent indication for surgery. It can be expected when area of fracture is 2.92cm2 or more, or the volume of herniated orbital tissue is 1.40cm3 or more. And the CT scan using linear measurements has an application in the assessment of patients with blowout fractures and provides useful information in the posttraumatic evaluation of orbital fractures.

Aneurisma roto de artéria esplênica: flagrante tomográfico de sangramento / Ruptured splenic artery aneurysm: tomographic snapshot of bleeding

The splenic artery aneurysm is a rare entity and its rupture is the most feared complication. The tomographic computed scan is a potential tool in the diagnosis, and can be used to patients with a suspicion of intra-abdominal bleeding, after adequate resuscitation. A case of a 68-year old male, hypertense patient, with a ruptured splenic artery aneurysm is reported. The diagnosis and treatment were given successfully by the abdominal computed tomographic scan and conventional surgery. The tomographic computed scan can be useful to the diagnosis of ruptured splenic artery aneurism, after the hemodynamic stabilization.

Pedicle Screw Fixation of the Thoracic Spine

Pedicle screw instrumentation has proven to be reliable and effective in the surgical management of lumbosacral disorders, yet the appropriateness in the thoracic spine is not known. To evaluate the accuracy of the pedicle screw placement in the surgical management of the thoracic spinal disorders and to establish its risks and benefits, a prospective study was designed. One hundred and two thoracic pedicle screws in 22 consecutively treated patients were investigated after surgery by computed tomography scans. Twenty-one(20.5%) screws penetrated the pedicle cortex or the vertebral body anterior cortex. Three screws penetrated the medial cortex of the pedicle by the averages of 2mm to a maximum 4mm. Fifteen screws(14.7%) penetrated laterally by an average of 1.5mm. There were 3 screws of caudal penetration. The screws inserted at T1-T8 revelaed a higher penetration rate than those inserted at T9-T12(35.7% versus 14.7%)(p<0.05). Hardware failures causing the preoperative defor-mity were seen in a patient to whom half the cephalad screws were laterally misplaced. However, there were no major neurologic complications. Although segmental pedicle screw fixation of the thoracic spine requires meticulous measures and considerable experience, it was therefore can be considered as a safe and effective method for stabilizing the thoracic spine.

Traumatic Occlusion of the Middle Cerebral Artery

We have had the opportunity to investigate a case with traumatic middle cerebral artery occlusion. The patient was 47 years old male who developed right hemiplegia and aphasia after collision with a automobile vehicle. Cerebral arteriography demonstrated complete occlusion of the left Sylvian middle cerebral artery distal to the origin of the operculofrontal arteires. The computed tomographic scan of the brain revealed dense infarction on the left temporoparietoccipital lobe. With repeated studies on 6 weeks and 6 months after trauma, confirmed partial clearing of the previously occluded middle cerebral artery in cerebral arteriographies and on interval change in computed tomographic scans. Comparable reported cases and theories of pathogenesis are discussed.

Evaluation of Subarachnoid Hemorrhage due to Aneurysmal Rupture and Cerebral Vasospasm by CT

Cerebral vasospasm is one of the most serious complication after subarachnoid hemorrhage due to aneurysmal rupture. To date, the treatment of vasospasm remains unsatisfactory in a large numbers of cases in spite of recent therapeutic advances. Prompt diagnosis of this complication, before the establishment of lasting ischemic damage, should obviously improve the results of treatment. The possibility of predicting which patients will develop vasospasm, constitutes a further advance in the management of this complication. In this study, the value of the computed tomographic scan for the prediction of vasospasm was investigated in a consecutive series of 67 patients submitted to computed tomography within 7 days of the most recent subarachnoid hemorrhage.