Periventricular white matter changes and dementia. Clinical, neuropsychological, radiological, and pathological correlation.

Forty-three patients with computed tomographic scan findings of decreased attenuation in the periventricular white matter (PVWM) region were studied. Clinical evaluation revealed presence of hypertension in 36 patients (84%) and cerebrovascular risk factors in 41 patients (95%). Unilateral or bilateral neurological deficits were present in 40 patients (93%). Neuropsychological evaluation in 27 of them revealed features of subcortical dementia. Magnetic resonance imaging in seven cases demonstrated high-intensity areas in the deep white matter region on T2-weighted imaging. Pathological evaluation in four patients revealed demyelination without inflammatory cells and infarctions in the PVWM region, lacunar infarctions in the basal ganglia and brain stem, and marked arteriosclerosis. The study indicated that most (95% in this series) of the patients with computed tomographic scan findings of decreased attenuation in the PVWM region had cerebrovascular risk factors and various neurological and neuropsychological features of subcortical dementia. Pathologically, these lesions represented areas of infarction and demyelination, along with diffuse arteriosclerosis.

Magnetic resonance imaging of periventricular hyperintensity in a Veterans Administration hospital population.

Using a beta-permanent magnet (Fonar 3000), we evaluated magnetic resonance imaging of periventricular hyperintensity (PVH) patterns in 60 patients (59 white, 58 men) from the Veterans Administration Hospital, North Chicago, Ill. Eighty percent of the patients had evidence of PVH, which increased significantly in patients older than age 50 years. In addition to age, history of atherosclerotic cardiovascular disease and extracranial malignancy showed a significant association with PVH. A linear correlation was observed between the severity of PVH and an abnormal neurologic examination. In this retrospective, uncontrolled study, we concluded that PVH incidence among white men is high and increases with age or the presence of cardiovascular disease or extracranial malignancy. The degree of PVH positively correlates with abnormal neurologic evaluation and additional abnormalities seen on magnetic resonance imaging. However, the disease-related specificity is as yet undetermined.

Early diagnosis of spinal-epidural metastasis by magnetic resonance imaging.

Sixteen patients with various types of cancer who developed pain along the axial spine were prospectively studied by magnetic resonance imaging (MRI). The studies were performed with a Fonar Beta-3000 (Fonar Co., Melville, NY) permanent magnet operating at 0.3 Tesla (T). Detailed neurologic examinations were followed by bone x-rays, bone scans, and MRI. In 12 patients there were focal neurologic findings. Bone x-rays and bone scans were diagnostic for metastatic disease in 10 cases; MRIs were consistent with metastatic spinal-epidural disease in all 16 patients. Magnetic resonance imaging revealed bone involvement in three patients whose x-rays and bone scans were both negative indicating a higher degree of sensitivity. In six patients thecal compression was obvious on MRI; in three of these previous myelograms had been interpreted as negative. These early results suggest that MRI can serve as a useful tool for diagnosing early spinal-epidural metastases.

Magnetic resonance imaging of central nervous system defects in Usher's syndrome.

With the use of magnetic resonance imaging, seven patients with type II Usher's syndrome were evaluated for CNS defects. The goals of this study were to confirm the presence of CNS defects previously detected by computed tomography (CT) scans in patients with Usher's syndrome while seeking additional anatomic defects in the posterior fossa employing a potentially more sensitive procedure using magnetic resonance imaging. Findings of CNS lesions in both the midbrain (high-signal-intensity lesions) and the cerebellum (vermian atrophy) necessitate further characterization of these defects in terms of their progressive nature and clinical significance for patients with Usher's syndrome.

Recognition of lumbar disc disease with magnetic resonance imaging.

Ten normal adult volunteers, 75 patients with low back pain and/or lumbar radiculopathy, 16 patients following chymopapain treatment, 14 patients with recurrent symptoms following disc surgery, and two patients with distal cord compression were scanned on Fonar 3000 permanent magnet scanner. Of all the patients 98 had additional computed tomography scans (CT) of the lumbar spine and 82 had myelography. Lumbar magnetic resonance imaging (MRI) and CT scans were both diagnostic in cases of herniated and extruded discs. MRI scan showed more information concerning the degenerative state of the intervertebral discs. It was relatively more accurate in detecting, small bulging and herniated discs without ruptured anulus and the relation of the migrated fragments of extruded discs to both the back of the vertebrae and the thecal sac. Moreover, lumbar MRI matched the clinical response of disc disease to chymopapain treatment more than lumbar CT scan. In addition, the MRI studies differentiated more accurately postoperative epidural fibrotic changes from recurrent herniated and/or extruded disc and detected distal spinal cord abnormalities. CT scan easily detected laterally herniated lumbar discs. Myelography was the diagnostic study in cases of arachnoiditis.

Skull x-ray in the evaluation of endocrine diseases.

The skull x-ray remains invaluable as a first step in the diagnosis of many endocrine disorders. Pituitary tumors commonly cause enlargement or distortion of the sella turcica, which can be seen on skull x-ray. Pinealomas and craniopharyngiomas may also be detected. Hyperparathyroidism can cause granular decalcification in the skull. Hypoparathyroidism produces calcification of the basal ganglia and cerebellum. Lesions due due to metastatic malignancies or eosinophilic granulomas may be noted in cases of diabetes insipidus. Sellar enlargement may be due to the "empty sella" syndrome. Twenty-five percent of all cases of enlarged sella may be accounted for by this syndrome.