Relief of radicular pain in metastatic disease by vertebroplasty.

Two patients with compression fractures from metastases who had pain with radicular symptoms mainly in upright position that resolved when not upright and were treated with vertebroplasty were retrospectively analyzed. Both patients had symptom relief at treated levels until death. These cases show that patients with radicular signs and symptoms from compression fractures secondary to metastases or myeloma, worse in upright position and relieved when recumbent, may benefit from vertebroplasty.

Update on endovascular management of the carotid blowout syndrome.

Carotid blowout syndrome can be a life-threatening late complication of surgical and radiation therapy for head and neck tumors in the vicinity of the cervical carotid artery. The syndrome spans a spectrum of pathology from impending to acute rupture of the artery. These cases are uncommon, can be dramatic in terms of blood loss, and are often true emergencies. The optimal management of these patients requires quick recognition, and often advanced trauma life-support skills and creative endovascular solutions. Definitive endovascular treatment is the therapy of choice in this condition; open surgical options are very limited. In this article, we present some background information regarding the clinical and pathologic aspects of the syndrome and our experience in endovascular management.

Effect of intraarterial verapamil on the diameter of vasospastic intracranial arteries in patients with cerebral vasospasm.

OBJECT: This study was conducted to determine whether there is a change in intracranial arterial diameters after verapamil infusion for vasospasm and, if it is present, to determine whether the change occurs in proximal, intermediate, or distal vessels. METHODS: The authors measured arterial diameters in all patients treated with intraarterial verapamil at their institutions between August 2003 and September 2004. In all, 18 treatments were examined in 15 patients. Measurements were made before and after verapamil infusion in a blinded fashion with the aid of a magnification loupe at nine predetermined arterial sites on each angiogram. Baseline arterial measurements were made on each patient's initial angiogram and on the angiogram demonstrating spasm prior to endovascular therapy as well in 14 of the patients. Charts were retrospectively reviewed to determine whether the patients benefited from intraarterial verapamil. From the time of the initial angiogram to the time of vasospasm, there was a 21.6% decrease (p = 0.092) in proximal artery diameter, a 47.1% decrease (p < 0.05) in intermediate artery diameter, and a 12.4% decrease (p < 0.05) in distal artery diameter. There were no significant changes in the diameters of proximal, intermediate, or distal vessels after verapamil infusion (mean dose 7.4 mg, range 2.5-10 mg). After infusion of intraarterial verapamil, the proximal vessels showed a 1.1% decrease in diameter, the intermediate vessels showed a 9.4% increase, and the distal vessels showed a 3.3% decrease. CONCLUSIONS: Administration of intraarterial verapamil does not cause a significant increase in the diameter of vasospastic vessels at the administered doses.

Imaging of the pituitary and sella turcica.

The pituitary gland is housed in the sella turcica and has vital endocrinologic functions. It lies in close proximity to numerous vital structures, including the optic chiasm, sphenoid sinus, cavernous sinus and hypothalamus. An understanding of the function, anatomy and embryology of the pituitary gland and its surrounding structures is vital to understanding its normal appearance, as well as in evaluating the broad spectrum of pathology that can involve the pituitary gland. Imaging of pathology in the sellar region, including pituitary adenomas, meningiomas, craniopharyngiomas and aneurysms, plays an important role in guiding treatment decisions. Modern imaging techniques are also important in evaluating the pituitary gland after surgery.

Fibrinolytic treatment for acute ischaemic stroke.

Ischaemic stroke is a leading cause of death and disability in the US. At present, intravenous administration of tissue plasminogen activator within 3 h of symptom onset is the only proven effective treatment for patients with acute ischaemic stroke. Unfortunately, most treated patients do not make a functional recovery and very few patients presenting with acute stroke qualify for intravenous tissue plasminogen activator therapy. The focus of current research is to extend the therapeutic window for intervention beyond 3 h, and to improve the outcome of treated patients. The purpose of the present paper is to describe the current state of affairs for intravenous plasminogen activators, and to review recently published research. Agents and strategies under investigation include the intra-arterial delivery of plasminogen activators or antiplatelet agents, as well as combined intravenous/intra-arterial protocols.

Neuroform stent deployment for treatment of a basilar tip aneurysm via a posterior communicating artery route.

Coiling of a wide-necked basilar tip aneurysm can be accomplished in selected cases by placing a single Neuroform stent horizontally across the aneurysm neck via a posterior communicating artery approach rather than by placing 2 stents in a Y configuration via a basilar artery approach.

Diffusion-weighted imaging of acute corticospinal tract injury preceding Wallerian degeneration in the maturing human brain.

BACKGROUND AND PURPOSE: Wallerian degeneration, the secondary degeneration of axons from cortical and subcortical injury, is associated with poor neurologic outcome. Since diffusion-weighted (DW) imaging is sensitive to early changes of cytotoxic edema, DW imaging may depict the acute injury to descending white matter tracts that precedes Wallerian degeneration; this injury is not visible on conventional CT or MR images in the maturing human brain. METHODS: Two neuroradiologists retrospectively analyzed clinical MR images in six children (aged 3 days to 5 months) with DW findings consistent with acute injury of the descending white matter tract due to territorial anterior or middle cerebral artery infarction. In five patients, images were obtained as a part of routine clinical evaluation. The remaining patient was a part of a prospective study of brain injury. Imaging findings were correlated with clinical outcomes. RESULTS: In all six patients, DW imaging performed 2-8 days after the onset of ischemia depicted injury to the descending white matter tract ipsilateral to the territorial infarct. Conventional MR images of the ipsilateral descending white matter tracts were abnormal in three patients. In all five patients for which follow-up results were available, the presence of DW changes was correlated with persistent neurologic disability. CONCLUSION: As shown in this retrospective analysis, DW imaging can depict acute injury to the descending white matter tract in neonates and infants, when conventional MR imaging may show normal findings. These DW findings likely precede the development of Wallerian degeneration, and they may portend a poor clinical outcome.

Whole-body fast inversion recovery MR imaging of small cell neoplasms in pediatric patients: a pilot study.

OBJECTIVE. The purpose of this study was to assess the ability of whole-body turbo short tau inversion recovery (STIR) MR imaging to detect metastases in children with small cell tumors and to compare its performance with that of conventional imaging. CONCLUSION. Early data suggest that whole-body turbo STIR MR imaging is as reliable as other conventional imaging studies for staging newly diagnosed small cell tumors in pediatric patients.