ABSTRACT
PURPOSE: To review the frequency, distribution, and extent of deep gray matter disease in children with acute disseminated encephalomyelitis. METHODS: The MR examinations of 10 patients, who were discharged with the clinical diagnosis of acute disseminated encephalomyelitis between 1986 and 1992, were retrospectively reviewed. Locations of abnormal signal in the cerebral and cerebellar cortices, white matter, and deep gray matter nuclei were recorded. Precontrast and postcontrast images were compared, when available, to assess degree of enhancement (if any). RESULTS: Six patients had foci of prolonged T2 relaxation in the deep gray matter, ranging in size from less than 1 cm to 4 cm. The caudate heads were involved in 4 patients, caudate body in 3, globus pallidus in 3, putamina in 3, and thalami in 4. In 1 patient, the thalami were involved nearly symmetrically, with mild mass effect. Asymmetric subcortical white matter involvement was present as well. Prolonged T2 relaxation was present within the cerebral cortex in 4 patients and was associated with subcortical white matter abnormality in 3 and more central white matter disease in 1. Nine of 10 patients demonstrated foci of T2 prolongation in white matter, most commonly involving the subcortical region, corona radiata, and centrum semiovale. Three patients also had periventricular foci. Of the 3 patients receiving gadolinium, one showed no enhancement. Two of the patients showed enhancement of some but not all lesions. One patient, who had normal brain MR findings and symptoms of myelopathy, underwent spine MR which demonstrated focal linear areas of T2 prolongation in the spinal cord at levels C-1 to C-2 and T-6. CONCLUSION: Involvement of deep gray matter was common in our small series. The finding of T2 prolongation in these structures does not preclude the diagnosis of acute disseminated encephalomyelitis in the proper clinical setting. Because thalamic involvement is reported to be rare in multiple sclerosis, it may prove useful in distinguishing between acute disseminated encephalomyelitis and the initial presentation of multiple sclerosis.
Subject(s)
Encephalomyelitis, Acute Disseminated/diagnosis , Magnetic Resonance Imaging , Adolescent , Brain/pathology , Child , Child, Preschool , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Infant , Male , Multiple Sclerosis/diagnosis , Myelitis/diagnosis , Retrospective Studies , Spinal Cord/pathologyABSTRACT
Knowledge of the anatomy of the common femoral artery (CFA) and common femoral vein (CFV) is important to minimize complications associated with transfemoral angiographic procedures. The authors assessed variations in the relationship between the CFA and the adjacent CFV by reviewing the inguinal region of 100 computed tomographic scans of the pelvis (200 vessel pairs). In 65% of the vessel pairs studied, a portion of the CFA overlapped the CFV in an anteroposterior plane. In addition, more than 25% of the artery overlapped the vein in 8% of the vessel pairs. This variation in anatomic relationship between the CFA and CFV is clinically significant, since a femoral vein puncture can be associated with simultaneous passage of the entry needle through the artery and thus formation of an arteriovenous fistula.
Subject(s)
Femoral Artery/diagnostic imaging , Femoral Vein/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Female , Femoral Artery/anatomy & histology , Femoral Vein/anatomy & histology , Humans , Male , Middle AgedABSTRACT
A method is described for protecting a nonstenotic anomalous artery to the left-lower pole of a horseshoe kidney that originated from a stenotic left common iliac artery. Using a triple catheter technique, injury to this anomalous renal artery was prevented while using "kissing balloons" to dilate bilateral proximal common iliac artery stenoses.
