Cirsoid aneurysm of the scalp.

A 29-year-old man with a pulsatile scalp swelling is presented. The clinical diagnosis of a cirsoid aneurysm was confirmed on computed tomography of the brain and selective cerebral angiography. It is important to detect veins draining from the aneurysm into the intracerebral venous system, as percutaneous occlusion of the aneurysm may be possible in their absence.

Angiographic embolisation in arterial trauma.

OBJECTIVES: to evaluate the use of endovascular occlusion in the treatment of arterial trauma. METHODS: records of patients with penetrating arterial injuries treated by endovascular occlusive techniques were culled from the computerised database of the vascular service. RESULTS: the study period spanned 7 years. Forty-two patients were studied with injuries to the cervicofacial vessels (24), lower limb (16) and upper limb (1). 13 had an arteriovenous fistula. There were 4 failures. In 2 cannulation was not achieved and in 2 with A-VF distal vessel occlusion was impossible. Two patients developed complications. In the remainder, treatment was effective and durable. CONCLUSION: this treatment modality is effective and safe in the treatment of penetrating trauma in selected patients.

Clinics in diagnostic imaging (56). Cavernous vascular malformation with intracerebral haematoma.

A 28-year-old woman presented following a seizure. Physical and neurological examinations showed no significant abnormality except a drowsy mental state. Routine laboratory studies were normal. Emergency MR imaging showed a rounded, high signal intensity lesion with a focal eccentric heterogeneous signal focus in the right frontal lobe. The heterogeneous focus revealed an irregular low signal rim on T1- and T2-weighted images. Mild surrounding parenchymal oedema was noted. The eccentric focus showed some central enhancement. The diagnosis of cavernous vascular malformation with intracerebral haematoma was confirmed at surgery. The combination of typical MR imaging findings, with clinical and family histories consistent with cavernous angiomata provides sufficient conclusive evidence.

Clinics in diagnostic imaging (34). Invasive pituitary macroadenoma.

A 44-year-old woman presenting with headache and decreased visual acuity was found to have bilateral papilloedema. Radiograph showed an enlarged pituitary fossa. MR scans demonstrated a large solid tumor with central necrosis, and both suprasellar and infrasellar extension. The invasive pituitary macroadenoma was surgically debulked, followed by radiotherapy. The clinical and imaging features of pituitary macroadenomas are discussed.

Tuberculous meningitis and co-infection with HIV.

The clinical, laboratory and radiological features of 30 children with clinically diagnosed tuberculous meningitis (TBM) who were HIV-seronegative were compared with those of ten HIV-infected children with TBM. Such comparative data are not currently available in the literature and so are an important addition to our knowledge of the HIV-TB co-infection epidemic. In comparison with the HIV-negative children, those infected with HIV were younger, had a shorter duration of symptoms and were more often Mantoux-negative (HIV-positive 23% vs HIV-negative 70%; p = 0.01). On presentation, all children in both groups were in MRC TBM stages II or III. Clinical features were similar in both groups but computed tomography of the brain showed more ventricular enlargement (HIV-positive 80% vs HIV-negative 63%), gyral enhancement (HIV-positive 60% vs HIV-negative 17%; p = 0.01) and cerebral atrophy (HIV-positive 40% vs HIV-negative 17%). Outcome was considerably worse in the HIV-positive children, of whom 30% died (vs HIV-negative 0/30; p = 0.01) and the remainder were moderately (HIV-positive 30% vs HIV-negative 24%) or severely (HIV-positive 30% vs HIV-negative 19%) handicapped at the end of treatment. While clinical features were not markedly different in HIV-infected and uninfected children with TBM, abnormal radiological findings were more common in the HIV-infected group and outcome was considerably worse. Co-existing HIV encephalopathy and diminished immune competence undoubtedly contributed to the more severe clinical and neuro-radiological features.

Clinics in diagnostic imaging (28).

A 44-year-old man presented with sudden headache and neck stiffness. Computed tomography (CT) demonstrated subarachnoid haemorrhage. CT and magnetic resonance (MR) angiography showed the cause to be a ruptured anterior communicating artery aneurysm. These findings were confirmed by digital subtraction angiogram and at surgery. The role of imaging in detection of cerebral aneurysms is briefly discussed.

CT evaluation of orbital hydatid disease: a review of 10 cases.

A retrospective CT study of 10 patients with histologically proven orbital hydatid disease revealed unilateral homogeneous unilocular cysts which were hypodense when compared to the vitreous humour in seven patients and hyperdense in three patients. Orbital bone thinning was detected in six patients. The hyperdense hydatid lesions may mimic other more common soft tissue orbital tumours.