Case report: metastatic renal cell carcinoma presenting as intracerebral haemorrhage.

Cerebral haemorrhage is a well-established, albeit rare, complication of intracranial tumours. An autopsy series of 461 cerebral tumours revealed haemorrhage into only 2%. A case is described of intracerebral haemorrhage which complicated a metastatic renal cell carcinoma. There are four previous cases reported in the literature with this presentation, but this case differs in that the diagnosis was by cerebral angiography and at a site distant to the original haemorrhage.

The evaluation of dizziness in elderly patients.

Twenty-one elderly patients with dizziness underwent a comprehensive medical and otoneurological evaluation. The majority had vertigo, limited mobility and restricted neck movements. Poor visual acuity, postural hypotension and presbyacusis were also frequent findings. Electronystagmography revealed positional nystagmus in 12, disordered smooth pursuit in 18, and abnormal caloric responses in nine. Magnetic resonance imaging showed ischaemic changes in six out of eight patients. Although dizziness in the elderly is clearly multifactorial, the suggested importance of vertebrobasilar ischaemia warrants further consideration as vertigo has been shown to be a risk factor for stroke.

Severe amnesia after hypoglycemia. Clinical, psychometric, and magnetic resonance imaging correlations.

OBJECTIVE: To determine the correlation between clinical, psychometric, and magnetic resonance imaging (MRI) findings after an episode of hypoglycemic coma resulting in amnesia. RESEARCH DESIGN AND METHODS: Detailed psychometric assessment, especially memory testing, performed with MRI in a man with severe amnesia after hypoglycemic coma. RESULTS: Psychometric testing confirmed impaired immediate recall. MRI findings were consistent with a lesion in the left temporal lobe. CONCLUSIONS: This is the first description of MRI in determining the neurological damage in hypoglycemic coma.

Magnetic resonance imaging in schizophrenia: altered brain morphology associated with P300 abnormalities and eye tracking dysfunction.

This study was designed to investigate whether auditory P300 event-related potential and smooth pursuit eye-movement abnormalities in schizophrenia are associated with brain structural changes measured using magnetic resonance imaging (MRI). Serial coronal MRI scans obtained from 31 schizophrenic subjects and 33 volunteer controls were analysed by a rater who had no knowledge of the subjects' diagnoses. The brain areas measured bilaterally were the temporal lobe, hippocampus, amygdala, parahippocampal gyrus, head of caudate, cingulate cortex, frontal cortex, and the lateral ventricles. The area of the third ventricle, the thickness of the corpus callosum, and the intracranial area were also measured. Auditory P300 and eye tracking performance were recorded on all subjects. There was a significant increase in the latency and a reduction in amplitude of the P300 in the schizophrenic group. Only in the schizophrenic group was P300 latency correlated negatively with the area of the right and left cingulate cortex and positively with the difference in size between the right and left amygdala. In the subgroup of schizophrenic subjects whose P300 latency was greater than 2 standard deviations above the control mean, the area of the left cingulate cortex was significantly smaller than in controls, and the absolute right-left difference in the area of the amygdala was significantly increased. Eye tracking dysfunction in schizophrenia was not related to changes in the amygdala or cingulate cortex but was significantly correlated with enlargement of the lateral ventricles. Schizophrenic subjects with poor eye tracking had significantly larger lateral ventricles than controls. Eye tracking dysfunction, but not P300 abnormality, was correlated with the severity of both positive and negative symptom of schizophrenia. These findings demonstrate that psychophysiological abnormalities are associated with altered brain structure in schizophrenia.

An observation of increased contrast due to both T1 and T2 weighting in a synthetic image.

An observation was made that subtracted images generated by an SR/IR interleaved pulse sequence on a low field strength magnetic resonance imager (M&D Technology Ltd, Aberdeen, Scotland) contained contrast between pathological and normal tissues that was not explained by either T1 or T2 weighting alone. A theoretical model for this image has been derived and its validity confirmed by phantom experiments. It is shown that the subtracted image is dependent on the product of T1 and T2 prolongation for contrast. This type of image might be of use in screening for unknown pathologies and such techniques may shorten routine patient imaging times.

Early delayed radiation injury to the brainstem after radiotherapy for lymphoma of the tongue and neck.

We describe a case of severe early delayed radiation injury to the brainstem after curative radiotherapy using a standard therapeutic irradiation regimen for lymphoma of the base of the tongue with cervical lymphadenopathy. Magnetic resonance imaging showed a lesion in the brainstem corresponding to an area of neural tissue coincidentally irradiated. A literature review of this rare complication is presented.

Magnetic resonance imaging of the brain in alcoholics: cerebral atrophy, lifetime alcohol consumption, and cognitive deficits.

Magnetic resonance imaging of the brain in 69 detoxified alcoholics revealed that relaxation time (T1) in whole brain and in grey matter and parietal white matter was greater than in age-matched controls. In 48 patients, data on cognitive function and lifetime alcohol consumption were available. With age-controlled, lifetime consumption, and impairment on performance in the cognitive test (a Category Sorting Test) correlated positively with T1 whole brain and in selected regions. Impairment in the cognitive test correlated with increased T1 in whole brain and white matter independently of cerebral atrophy. Alcohol consumption patterns in the following 6 months were unrelated to changes in T1. The excess water implied by the elevated T1 values may be intra- or extracellular. It is uncertain whether or not T1 elevation in alcoholics is a marker of neuronal damage. T1 elevation appears to be a marker of one type of alcohol-related cognitive impairment.

Malignant melanoma of the nasal cavity.

Primary mucosal melanoma of the head and neck is rare and few published cases give proof that the mucosal site is primary. We present a man with malignant melanoma of the nasal cavity which was associated with melanoma-in-situ of the adjacent mucosa, proving that the lesion was primary. He presented with symptoms due to secondary deposits of melanoma in the brain rather than the more usual nose bleeds or blocked nose. The primary site was found when his neurological symptoms were investigated by CT and NMR scans of the head.

Magnetic resonance imaging in pre-senile dementia of the Alzheimer-type, multi-infarct dementia and Korsakoff's syndrome.

Magnetic resonance imaging T1 values in Alzheimer's disease (ATD) were similar to age-matched controls although frontal T1 values tended to increase intraindividually with progression of the dementia. T1 values were raised, in both cortical grey and white matter, in Korsakoff's syndrome and multi-infarct dementia. T1 values appear of little value in studying the neuropathological changes in ATD in relationship to the neuropsychological deficits, but can assist in the differential diagnosis of pre-senile dementia.

Cranial diabetes insipidus secondary to arrested hydrocephalus.

An unusual case is described linking cranial diabetes insipidus with longstanding arrested hydrocephalus. The latter was demonstrated by computed tomographic (CT) and nuclear magnetic resonance (NMR) scans and cerebrospinal fluid pressure measurements. The increasing use of CT and NMR scans may result in this association of cranial diabetes and hydrocephalus being better defined.

Brain hydration during alcohol withdrawal in alcoholics measured by magnetic resonance imaging.

Twenty-seven patients had a first Magnetic Resonance Imaging (MRI) scan 1-3 days after stopping drinking and a second approximately 2 weeks later with no change in whole brain T1 or T1 in selected brain areas. Six patients whose first scan was over 36 h after the last drink underwent an increase in whole brain T1 in the interval to the second scan. The later the first scan was performed the greater was the increase in T1. These results are compatible with a very early fall in brain water immediately on cessation of drinking (perhaps due to a rebound increase of vasopressin activity) with a return to 'baseline' after two weeks. A third scan after discharge from hospital in 23 individuals who had abstained from alcohol or drank very little did not reveal any further significant change in brain T1.

Cerebral and brain stem changes after ECT revealed by nuclear magnetic resonance imaging.

Nuclear magnetic resonance images of the brain were obtained in fourteen patients with major depression during a course of ECT. The T1 relaxation time rose immediately after the fit, reaching a maximum 4-6 h later. The T1 values then returned to their original level; no long-term increase occurred over the course of treatment. These results are consistent with an extensive but temporary breakdown of the blood-brain barrier during ECT.

Brain water measured by magnetic resonance imaging. Correlation with direct estimation and changes after mannitol and dexamethasone.

Brain water content was measured in tissue samples taken at operation from 19 patients with intrinsic cerebral tumours imaged preoperatively by magnetic resonance. A high correlation (r = 0.94, p less than 0.0001) between white matter water content and the longitudinal relaxation time (T1) enabled water content to be estimated from T1 to within 4%. 11 patients received dexamethasone and improved clinically but their T1, and thus brain water content, was unchanged an average of 6 days later. Intravenous infusion of 20% mannitol in 11 patients significantly reduced T1 in oedematous white matter and tumour within 15 min of administration, and by 30 min the T1 of oedematous white matter had fallen to a mean of 32.4 (SEM 7.1) ms, corresponding to a reduction in water content of 1.4 (0.3)%.

A description of a low field resistive magnetic resonance imaging system and its application in imaging midline central nervous system pathology.

A commercial low field magnetic resonance imaging (MRI) system installed in the Royal Infirmary, Edinburgh at the end of 1983 has since been used for the clinical investigation of over 1000 patients. This system uses an interlaced saturation recovery and inversion recovery pulse sequence which yields four types of clinical image. AT1 weighted image has been found to be the most sensitive for the detection of pathology. Several examples of pathology with negative X-ray computed tomography examinations including three examples of a syrinx and two cases of tonsillar herniation have been demonstrated using this system. It is suggested that the system could provide a routine clinical service for imaging the central nervous system.

Correlation of human NMR T1 values measured in vivo and brain water content.

A relationship has been demonstrated between nuclear magnetic resonance (NMR) longitudinal relaxation times (T1 values) obtained in vivo in both normal and oedematous (peritumoral) brain tissue, and measurements of brain water obtained by gravimetric analysis of operative samples. Significant correlations were found in seven patients in both cortex (r = 0.97, P less than 0.001) and white matter (r = 0.92, P less than 0.001). These findings suggest that NMR may prove a useful technique for monitoring brain oedema.