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1.
Acta Radiol ; 49(6): 680-6, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18568561

ABSTRACT

BACKGROUND: Chronic hydrocephalus is a common sequela of subarachnoid hemorrhage (SAH). The technical procedure used to treat intracranial aneurysms, whether neurosurgical clipping or endovascular coiling, may lead to differences in the incidence of chronic posthemorrhagic hydrocephalus. PURPOSE: To compare the effects of early neurosurgical and early endovascular treatment on the development of chronic hydrocephalus in patients with SAH. MATERIAL AND METHODS: A retrospective study included 102 clipped and 107 coiled patients with aneurysmal SAH. Clinical condition at admission and shunt dependence were verified from patient data records. The initial and follow-up computed tomography (CT) images were reviewed, and the amount and distribution of blood and the occurrence of hydrocephalus were registered. The values of the cella media index and the width of the third ventricle were calculated. Statistical analysis of the data was performed. RESULTS: No statistically significant differences in the incidence of chronic hydrocephalus or the need for shunting emerged between the treatment groups. After clipping 35% and after coiling 39% of the patients developed chronic hydrocephalus. Twenty-nine percent of the clipped and 31% of the coiled patients underwent a shunt operation. CONCLUSION: The treatment method used for acutely ruptured intracranial aneurysms, i.e., neurosurgical clipping or endovascular coiling, has no statistically significant effect on the development of chronic hydrocephalus.


Subject(s)
Aneurysm, Ruptured/therapy , Hydrocephalus/etiology , Intracranial Aneurysm/therapy , Neurosurgical Procedures/adverse effects , Postoperative Complications/etiology , Subarachnoid Hemorrhage/complications , Adult , Aged , Aged, 80 and over , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/surgery , Brain/diagnostic imaging , Cerebrospinal Fluid Shunts , Chronic Disease , Embolization, Therapeutic , Female , Follow-Up Studies , Humans , Hydrocephalus/diagnosis , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Male , Middle Aged , Postoperative Complications/diagnosis , Retrospective Studies , Tomography, X-Ray Computed
2.
Acta Radiol ; 45(3): 333-9, 2004 May.
Article in English | MEDLINE | ID: mdl-15239431

ABSTRACT

PURPOSE: To evaluate the influence of the amount and distribution of blood on acute ventricular enlargement in subarachnoid hemorrhage (SAH). MATERIAL AND METHODS: In a retrospective study, non-contrast computed tomography (CT) images of 180 patients with aneurysmal SAH were analysed by two neuroradiologists. The amount and distribution of the hemorrhage were scored, and prospective hydrocephalus was identified on the basis of acute CT images by calculating the cella media index, by measuring the width of the third ventricle, and by visual impression. Statistical analysis was done using the logistic regression model, analysis of variance, and chi-square test. RESULTS: The incidence of acute hydrocephalus was higher among the patients with blood distributed in the anterior, lateral, and basal regions (70.8%) than among the patients who did not have blood distributed in all three areas (P=0.010). The proportion of acute hydrocephalus differed depending on the type of hemorrhage (P<0.001). Intraventricular hemorrhage was the most consistent predictive factor in the logistic regression model, while the other predictive factors included the total blood amount score and the volume of intracerebral hemorrhage. CONCLUSIONS: A positive correlation was found between acute hydrocephalus and the amount of subarachnoid and, more importantly, intraventricular blood. This is consistent with the literature and confirms the current pathophysiologic concepts that the acute hydrocephalus following SAH is an obstructive form of hydrocephalus.


Subject(s)
Hydrocephalus/etiology , Subarachnoid Hemorrhage/complications , Acute Disease , Adult , Aged , Analysis of Variance , Aneurysm, Ruptured/complications , Brain/diagnostic imaging , Cerebral Ventriculography , Female , Humans , Hydrocephalus/diagnostic imaging , Intracranial Aneurysm/complications , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Factors , Subarachnoid Hemorrhage/classification , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed
3.
Acta Neurochir (Wien) ; 145(8): 655-61; discussion 661, 2003 Aug.
Article in English | MEDLINE | ID: mdl-14520544

ABSTRACT

BACKGROUND: Computed tomography (CT) is the "gold standard" for detecting subarachnoid haemorrhage (SAH) and digital subtraction angiography (DSA) for visualising the vascular pathology. We studied retrospectively 180 patients with subarachnoid haemorrhage (SAH) who underwent first non-enhanced computed tomography (CT), then digital subtraction angiography (DSA) and finally operative aneurysm clipping. Our aim was to assess if the location of the ruptured aneurysm could be predicted on the basis of the quantity and distribution of haemorrhage on the initial CT scan. METHODS: 180 patients with SAH were retrospectively studied. All the CT and DSA examinations were performed at the same hospital. CT was performed within 24 hours after the initial haemorrhage. DSA was performed after the CT, within 48 hours after the initial haemorrhage. Two neuroradiologists, blind to the DSA results, analysed and scored independently the quantity and distribution of the haemorrhage and predicted the site of the ruptured aneurysm on the basis of the non-enhanced CT. DSA provided the location of the ruptured aneurysm. All the patients were operated upon, and the location of the ruptured aneurysm was determined. FINDINGS: The overall reliability value (kappa-value) between the two neuroradiologists for locating all ruptured aneurysms was 0.780. The corresponding value for the right MCA was 0.911, that for the left MCA 0.877 and that for the AcoA 0.736. Not all of the kappa-values were calculated, either because the location of the rupture was constant or because the number of ruptures in the vessel was too small. Subarachnoid haemorrhage with a parenchymal hematoma is an excellent predictor of the site of the ruptured aneurysm with a statistical significance of p=0.003. INTERPRETATION: The quantity and pattern of the blood clot on CT within the day of onset of SAH is a reliable and quick tool for locating a ruptured MCA or AcoA aneurysm. It is not, however, reliable for locating other ruptured aneurysms. Subarachnoid haemorrhage with a parenchymal hematoma is an excellent predictor of the site of a ruptured aneurysm.


Subject(s)
Aneurysm, Ruptured/diagnostic imaging , Angiography, Digital Subtraction , Intracranial Aneurysm/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/etiology , Tomography, X-Ray Computed , Adult , Aged , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/surgery , Female , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Male , Middle Aged , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Subarachnoid Hemorrhage/surgery
5.
Acta Radiol ; 43(2): 141-3, 2002 Mar.
Article in English | MEDLINE | ID: mdl-12010290

ABSTRACT

We describe MR findings of a nasal glioma in a 5-week-old male infant with feeding difficulties and symptoms of respiratory distress. Endoscopic examination revealed a soft tissue mass in the nasal cavity. In T1- and T2-weighted images, the gyral structure of grey matter was visible. In T1-weighted images, a tissue component with a lower signal intensity equal to that of white matter was also well distinguishable. Edge enhancement of the tumour was due to the nasal mucosal epithelium covering the tumour. MR images were useful to rule out intracranial extension of the nasal cavity lesion and the brain, thus excluding the diagnosis of encephalocele. The lesion was excised and histologically characterized as heterotopic brain tissue.


Subject(s)
Brain , Choristoma/diagnosis , Magnetic Resonance Imaging , Nose Diseases/diagnosis , Humans , Infant , Male
6.
Neuroradiology ; 39(12): 857-9, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9457709

ABSTRACT

We present a patient with multiple brain abscesses caused by Nocardia asteroides. On T2-weighted MRI, multiple concentric rims were seen in the abscess, which could be a finding specific for infection. The rims may be due to organization of the necrotic debris and phagocytoses by macrophages in the capsule.


Subject(s)
Brain Abscess/diagnosis , Brain/pathology , Magnetic Resonance Imaging/methods , Nocardia Infections/diagnosis , Nocardia asteroides , Aged , Brain Abscess/microbiology , Humans , Male
7.
Acta Radiol ; 34(1): 30-4, 1993 Jan.
Article in English | MEDLINE | ID: mdl-8427745

ABSTRACT

The results of 155 US-guided cutting needle biopsies, mainly of abdominal and transthoracic lesions, were reviewed to assess the diagnostic accuracy of the method. A fine needle biopsy (FNB) was additionally performed in 99 of the patients. Sufficient material for histologic and cytologic analysis was obtained in 88% (137/155) and 98% (97/99), and a correct benign or malignant diagnosis was made in 87% and 88%, respectively. Among the 99 combined biopsies the corresponding figures were 100% and 97%, respectively. The proportions of inconclusive and false-negative results among histologic samples were 0% and 4% (2/57), in FNBs 7% (7/99) and 5% (3/56), and in combined examinations 3% (3/99) and 0%. One major complication, Streptococcus faecalis sepsis, occurred. The combined use of FNB and histologic biopsy increases the proportion of correct diagnoses about 10% without increasing the complications.


Subject(s)
Biopsy, Needle , Biopsy , Abdominal Neoplasms/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy/methods , Biopsy, Needle/methods , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Thoracic Neoplasms/pathology , Ultrasonography
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