MR vs CT in progressive supranuclear palsy.

Nine progressive supranuclear palsy (PSP) patients were studied with computerized tomography (CT) and magnetic resonance (MR) in order to determine the efficacy of each in detecting atrophy of the brainstem. Three additional PSP patients were evaluated with MRI for quantitative (electronic) measurements of the colliculi, pons and midbrain tegmentum. Both CT and MRI were equally effective in demonstrating midbrain atrophy. The MR was able to utilize the sagittal view to visualize thinning of the collicular (quadrigeminal) plate, a useful sign in PSP. Atrophy of the thinned collicular plate is more pronounced in the superior colliculus, one of the most common sites of pathology in PSP. The MR is able to make quantitative measurements of the degree of atrophy of the colliculi, pons and midbrain tegmentum.

CT brainstem abnormalities in the differential diagnosis of Huntington's disease.

Thin-section computed tomographic (CT) scans of 1.5 mm thickness were obtained in the study of 44 consecutive patients with Huntington's disease (HD) and six patients with sporadic progressive chorea and dementia. Mild to moderate midbrain and pontine atrophy, a dilated third ventricle, and enlarged quadrigeminal plate cisterns were observed in most cases suggesting that brainstem atrophy is common in HD. Brainstem atrophy preceding caudate atrophy in two cases and pontine or midbrain atrophy to a similar degree as caudate atrophy in eight cases suggest that brainstem atrophy may occasionally precede or appear at the same time as caudate atrophy. The CT scan brainstem findings and their neuropathologic confirmation suggests a more important role for the brainstem in the pathophysiology of HD.

Pseudotumor of left kidney due to sarcoidosis.

Presence of granulomas in the kidney have been reported in up to 40 percent of patients with sarcoidosis. However, granulomatous infiltration producing renal enlargement with distortion of the normal renal contour, and mimicking renal "pseudotumor" is exceedingly rare and is the subject of this case report. Radiographic, scintigraphic, and histologic findings are presented.

Thin-section CT of midbrain abnormalities in progressive supranuclear palsy.

Thin-section computed tomographic (CT) scans of 3 and 1.5 mm thickness were obtained using the Philips Tomoscan 310 and General Electric 8800 CT/T scanners in the study of 10 consecutive patients with progressive supranuclear palsy (PSP) and 31 patients with other diseases. Marked midbrain and moderate pontine atrophy, a dilated third ventricle, and enlarged quadrigeminal plate cisterns were observed in all PSP cases. The aqueduct was dilated in several. In six of the PSP cases, there was a striking midbrain abnormality in the form of a low-density area extending from the interpeduncular cistern toward the aqueduct. Thin-section metrizamide-enhanced cisternography of three of the six PSP cases showed that the low-density abnormality was the result of the interpeduncular cistern invaginating the atrophic midbrain.

Cortical blindness after metrizamide myelography. Report of a case and proposed pathophysiologic mechanism.

Metrizamide, a nonionic, water-soluble contrast medium, has been increasingly used for myelography. We saw a patient with cortical blindness, seizure, organic psychosis, and asterixis after undergoing attempted metrizamide myelography via C1-2 puncture. Computed tomography demonstrated early penetrance of metrizamide into the brain parenchyma, most prominently in the occipital lobes. A mechanism of direct metrizamide neurotoxicity was proposed.

Evolution of porencephalic cysts from intraparenchymal hemorrhage in neonates: sonographic evidence.

Ninety-four low-birth-weight neonates were screened consecutively with real-time sonography for evidence of cerebroventricular hemorrhage. Among them, 13 were found to have intraparenchymal hemorrhage beyond the area of the germinal matrix. Weekly follow-up sonograms revealed progression to porencephaly in every surviving infant. Four different sonographic patterns were observed during the evolution from the original hemorrhage to the porencephalic cyst. The size of the mature porencephalic cyst correlated directly with the size of the intraparenchymal hemorrhage. After ventriculoperitoneal shunting, the porencephalic cysts became smaller or remain unchanged. One small cyst was no longer identified after successful shunting, but reappeared with shunt failure.

Sonographic findings in four cases of hemangiopericytoma. Correlation with computed tomographic, angiographic, and pathologic findings.

Four patients with hemangiopericytoma were examined with gray-scale sonography. Three of these patients were also evaluated by computed tomography (CT). The sonographic findings included well-defined, predominately cystic masses in two patients, a mixed solid and cystic mass in one, and a solid mass with shadowing in another. One hemangiopericytoma changed in sonographic appearance from cystic to solid following radiation. CT identified well-circumscribed masses in all three cases, but added little beyond what was seen on plain radiographs. Sonography may define the limits of a hemangiopericytoma, give information about the internal structure, and offer a way of following response to therapy. However, the sonographic features are varied and the often cystic nature of these tumors may be misleading.

Real-time ultrasonography of neonatal intraventricular hemorrhage and comparison with computed tomography.

Thirty-three low-birth-weight neonates were diagnosed prospectively as having an intraventricular hemorrhage, using a real-time sonographic sector scanner. Ultrasound findings were corroborated in 27 patients by computed tomography (CT) or autopsy. Intraventricular blood is hyperechoic and, in a fresh hemorrhage, a continuous cast-like pattern of increased echogenicity replaces the usually minute, echo-free lateral ventricles. After one to three days, the lateral ventricles begin to enlarge around the echogenic clot if hydrocephalus complicates the hemorrhage. The sonographic findings indicating intraventricular hemorrhage and its progression to hydrocephalus are presented. The accuracy of sonographic real-time sector scanning in the evaluation of neonatal intraventricular hemorrhage is discussed and compared to CT.

Real-time sonography of the neonatal and infant head.

Fifty neonatal and infant heads were examined using a 5 MHz real-time sector scanner. Anatomic detail superior to that previously described was achieved by this method. Normal structures routinely imaged included the entire ventricular system and many parts of the subarachnoid spaces. The gray scale detail of parenchymal structures was usefully demonstrated. Routinely visualized vascular structures included the anterior cerebral artery system, the middle cerebral arteries, the choroid plexus, and the posterior cerebral arteries. Hydrocephalus, as well as intraventricular hemorrhage and its sequelae, were investigated. Computed tomography (CT) is considered diagnostic in hydrocephalus and intraventricular hemorrhage, but evaluation by sonography compares favorably. Among other advantages of sonography are the feasibility of bedside scans without removing the patient from the intensive care nursery and the elimination of ionizing radiation.