Clinical and radiologic findings in progressive facial hemiatrophy (Parry-Romberg syndrome).

We describe the clinical and radiologic changes related to progressive facial hemiatrophy (Parry-Romberg syndrome) occurring during a 20-month period in a child who presented with unilateral neurologic deficits and facial hemiatrophy. CT and MR findings included unilateral focal infarctions in the corpus callosum, diffuse deep and subcortical white matter signal changes, mild cortical thickening, and leptomeningeal enhancement with dense mineral deposition. Angiographic findings were normal. We hypothesize that a noninfectious, unilateral inflammatory process, possibly associated with a chronic vasomotor disturbance and sympathetic nerve chain inflammation, was a major factor in the pathogenesis of this syndrome.

Occipital condyle fractures: clinical presentation and radiologic detection.

PURPOSE: To describe the CT findings in occipital condyle fractures in patients suffering craniocervical trauma. METHODS: Six occipital condyle fractures in five patients were analyzed. Because of clinical or plain-film findings, the craniocervical junction in each patient was imaged using thin-section, high-resolution CT. Axial data were reformatted in the coronal plane or in both coronal and sagittal planes. Clinical and radiologic findings associated with occipital condyle fractures reported in the English medical literature were correlated with our cases to determine conclusive predictive features indicating condylar injury. RESULTS: Two avulsion (type III) fractures in two patients, two compression (type I) fractures in one patient, and two compression fractures in two patients were diagnosed by CT. Specific predictive features indicating occipital condyle fracture could not be confirmed. CONCLUSIONS: CT greatly facilitates diagnosing and typing of occipital condyle fractures. Nonspecific parameters promoting CT after trauma are unexplained persistent upper-neck pain with normal plain-film findings, lower cranial nerve palsies, spasmodic torticollis, retropharyngeal or prevertebral soft-tissue swelling, and fractures of the atlas or axis.

Technique and use of supine oblique views in acute cervical spine trauma.

STUDY OBJECTIVE: To determine whether the addition of the supine oblique view of the cervical spine can detect fractures or ligamentous injury not seen on the standard three-view examination. DESIGN: Radiographs of patients with documented cervical spine injury were reviewed retrospectively by three neuroradiologists. Patients were included in the study if the initial interpretation of the three-view series was normal and the abnormal supine oblique view enabled a correct diagnosis to be established. SETTING: The emergency department of a university-affiliated hospital with Level I trauma center status. TYPE OF PARTICIPANTS: Eighty-three consecutive patients with documented cervical spine injury evaluated during a 20-month period. RESULTS: Eight patients demonstrated abnormality to best advantage on the supine oblique view. These included six fractures and two ligamentous injuries. Five patients had abnormalities confined to the supine oblique view, and the remaining three had subtle abnormalities on the cross-table lateral view. CONCLUSION: The supine oblique view may detect fractures or ligamentous injury not identifiable on the standard three-view examination. We recommend the routine use of a five-view cervical spine series with the inclusion of 30-degree supine oblique views in the evaluation of acute cervical spine injury.

Brain in eclampsia: MR imaging with clinical correlation.

Cranial magnetic resonance (MR) imaging was performed on eight consecutive patients with generalized tonic-clonic seizures caused by eclampsia. Each patient underwent serial neurologic examinations until all symptoms resolved. Six of those eight patients underwent follow-up MR imaging. These patients were compared with those in previous case reports of MR imaging abnormalities of the brain in eclampsia. MR imaging typically demonstrates bilateral hyperintense lesions on T2-weighted images and iso- to hypointense lesions on T1-weighted images. MR imaging abnormalities are most commonly located in the distribution of the posterior cerebral circulation and are associated with visual disturbances. Basal ganglia and deep white matter lesions are less common and are associated with mental status changes. Most lesions seen at MR imaging in patients with eclampsia are reversible.

Compatibility of cervical spine braces with MR imaging: a study of nine nonferrous devices.

Several cervical spine braces and orthoses were evaluated for their compatibility with imaging in the MR scanner. Nine such devices were investigated: EXO cervical collar, Philadelphia collar, S.O.M.I. cervical orthosis, Guilford cervical orthosis, modified Guilford cervical orthosis, PMT halo cervical orthosis, modified PMT halo cervical orthosis, Bremer halo system, and Bremer MR-compatible halo system. Devices containing ferrous materials detected by a small bar magnet were not scanned. The remaining devices applied to a volunteer or a patient were scanned to evaluate image quality in the generation of images of the cervical spine and, in some cases, the brain. Orthoses that contained electrically conductive loops produced unsatisfactory scans. Replacement of ferrous materials with nonferrous metals and alloys and elimination of electrical loops proved to be necessary to make cervical braces and orthoses MR-compatible. Cervical orthoses with aluminum or graphite-carbon composite components that are interconnected with plastic joints such as the plastic ball-and-socket joints are, to date, the most successfully designed devices for MR compatibility. To make these orthoses CT compatible, low electron density materials are presently being evaluated to replace the titanium skull pins.

Superselective arterial BCNU infusion in the treatment of patients with malignant gliomas.

Retinal and CNS toxicity have been reported with infraophthalmic infusion of BCNU in the treatment of patients with malignant gliomas. It is known, however, that the CNS toxicity can be reduced if the BCNU is dissolved in dextrose in water. This article describes the results from 15 patients who received 42 courses of BCNU administered by supraophthalmic internal carotid, middle cerebral, or posterior cerebral artery infusions. None of the patients developed leukoencephalopathy as demonstrated by CT scanning. The average reduction in tumor volume was 36%, and the median survival time from the date of diagnosis was 73 weeks. These values are comparable to those of a previous group of 20 patients treated with infraophthalmic infusions, with the exception that none of the patients in the present group developed retinal damage.

Cell-mediated destruction of cells grown on artificial capillaries.

This investigation was designed to determine the conditions required to assess cell-mediated destruction of target L-cells grown on artificial capillaries. In control cultures that contained L-cells alone, solid nodules with a diameter of 1 mm as well as dense cellular growth could be visually observed by the 12th day of culture. Alloimmune spleen cells from both immunized and normal C57BL/10 mice were shown to be capable of destroying tritiated thymidine-labeled L-cells growing on artificial capillaries. The destruction of target cells grown as monolayers in capillary culture correlated well with monolayer cultures incubated in 16-mm plastic tissue culture wells. When target cells were grown in capillary culture for 5 days before the addition of effector cells, significant destruction by normal effector cells was not observed until the 15th day of culture whereas that mediated by immune cells was observed by the 7th day. The possible effects of cell-culturing conditions on the kinetics of cell-mediated destruction in capillary chambers are discussed.