[Diagnosis of acute subarachnoid hemorrhage--MRI with 0.5 Tesla with FLAIR sequence]. / Diagnostik der akuten Subarachnoidalblutung--MR bei 0,5 Tesla mit der FLAIR-Sequenz.

PURPOSE: Evaluation of MR imaging in patients with acute subarachnoid hemorrhage (SAH) at 0.5 Tesla using the FLAIR (Fluid Attenuated Inversion Recovery) sequence. Additionally, the value of MR angiography (MRA) in the diagnosis of intracranial aneurysms was assessed. MATERIALS AND METHODS: 19 patients with suspected acute SAH were included in this study. MR imaging was performed using an axial FLAIR sequence and axial T1, T2 and PD weighted sequences. In 16 patients an additional MRA (3D-TOF) was performed. 10 patients without SAH were examined as a control group. At the end of the study the 29 MR examinations were randomised and the images were read by two experienced radiologists; subsequently a consensus interpretation was made. RESULTS: In 16 patients an acute SAH was verified with the FLAIR sequence, in 13 cases the origin of hemorrhage was found during surgery. In the consensus interpretation of the MR images all cases were diagnosed properly. 12 of the 16 MRA studies were of diagnostic quality, but only 6 cases were interpreted correctly. CONCLUSION: The FLAIR sequence at 0.5 Tesla proved effective in the diagnosis of acute SAH. MRA at 0.5 Tesla failed in the detection of intracranial aneurysms.

Neurenteric cyst mimicking pleurodynia: an unusual case of thoracic pain in a child.

This study reports an 8-year-old boy with chronic recurring thoracic pain. Magnetic resonance imaging of the spine revealed an intradural cyst at T1-T2. Despite severe compression of the spinal cord, there was no neurologic deficit. After minimally invasive cystectomy, the patient recovered completely. Histological examination established the diagnosis of a neurenteric cyst. The clinical, pathohistologic, and radiologic aspects are discussed, and the decisive role of magnetic resonance imaging in the diagnosis of intraspinal cyst is emphasized.

Diagnosis of cervical disc disease. MRI versus cervical myelography.

In a prospective study of 63 surgical patients cervical myelography was compared with MRI to establish the relative value of the 2 diagnostic procedures in patient selection for surgery of ruptured cervical discs and bony nerve root compression. While MRI in the T1-weighted and gradient echo modes matched the diagnostic accuracy of invasive myelography (95%), T1 and T2-weighted MRI images alone were associated with an error rate of 10%. In patients with medial protrusion myelography did not always show the true extent of compression, whereas MRI tended to miss small laterally protruding disc fragments. Cervical myelography continues to have a place in the diagnosis of cervical disc disease, whenever clinical signs and symptoms do not agree with MRI data.

[Intracerebral hemorrhage from the neurosurgical viewpoint]. / Intrazerebrale Blutung aus neurochirurgischer Sicht.

After the introduction of computed tomography intracerebral haemorrhage (ICH) was diagnosed more frequently. We discuss the role of surgical strategies for treatment of ICH of different aetiology. The main factors for surgical intervention for ICH (except vascular malformations) are: degree of midline shift, deformation of neurological deficit or consciousness-level and ventricular enlargement. In small hematomas surgical evacuation is of no benefit for final outcome.

Intraspinal neurothekeoma (nerve sheath myxoma). A report of two cases.

Neurothekeomas (nerve sheath myxomas) are rare benign cutaneous tumors. The authors describe two spinal intradural cases that show histologic, immunohistochemical, and electron microscopic features identical to their cutaneous counterparts. The authors' findings suggest histogenesis from Schwann's cells or undifferentiated nerve sheath precursor cells. Neurothekeomas in unusual locations should be differentiated from myxoid neurofibromas, perineuriomas, and soft tissue myxomas.

[Immunoscintigraphy for the detection of inflammation foci in bone and joint diseases]. / Immunszintigraphie zur Aufdeckung von Entzündungsherden bei Knochen- und Gelenkserkrankungen.

We evaluated the monoclonal antibody MAb, BW 250/183, which is easy to label with Tc-99m, with respect to its clinical application for the detection of inflammatory processes in bone and joint diseases. This monoclonal antibody is a murine immunoglobulin (IgG1 isotype), directed against NCA 95 (nonspecific cross-reacting antigen), which is also present on the surface of neutrophil granulocytes. We investigated patients with acute (n = 9) and chronic (n = 3) osteomyelitis, with coxitis (n = 3) and coxarthrosis (n = 2), with septic hip prosthesis (n = 8) and loosening hip prosthesis (n = 14), with low back pain (n = 4), with spondylitis (n = 5) and with postoperative spondylodiscitis (n = 9). With reference to the total number of patients examined in this study we found 29 true positive results, 22 true negative results, 4 false negative results and 2 false positive results. This gives a sensitivity of 88% and a specificity of 92%. The lesions were already visualized within 4 to 6 hours, but 24 hour pictures are desirable. SPECT pictures are mandatory in patients with diseases of the hip or of the spine because sensitivity is considerably improved thereby.

Validity of continuous-wave Doppler sonography of the vertebrobasilar system.

To assess the value of continuous-wave Doppler sonography for detection and exclusion of lesions in the vertebrobasilar system, the ultrasonic and angiographic findings were compared in a prospective study. Altogether, 200 vertebral arteries in 176 patients were evaluated by both methods. Insonation of the vertebral arteries was performed at the mastoid slope and at the origin of the vessel. Of 62 angiographically proven lesions, 45 were detected by ultrasound. Of 138 normal vertebral arteries, 129 were correctly diagnosed. Sensitivity for all lesions was 72.5%, and for hemodynamically relevant lesions it was 91%. Overall specificity was 93.5%. A positive predictive value of 83.3% and a negative predictive value of 88.4% for all lesions shown by angiography demonstrate the high reliability and accuracy of doppler ultrasound of the vertebrobasilar system.

Cerebral ischemia in children and young adults.

Cerebral ischemia is very rare in children and young adults. There can be a multitude of causes; in many cases etiology remains undetermined. We report here on 7 cases, 11 to 25 years of age. Pathogenetic factors (lupus erythematodes, endocarditis, fibromuscular dysplasia) and risk factors (cigarette smoking, oral contraceptives) were found in 5 patients whereas in 2 cases the etiology was not determinable. Three patients were treated with low weight dextrans, two patients received prostaglandin E1, and in 2 cases regional thrombolysis was performed. Three female patients died, two with occlusions of the rostral part of the basilar artery and one with an occlusion of the carotid artery and lupus erythematodes as the primary disease. Long-term observations of the surviving patients showed good recovery from neurological deficits. Prognosis quoad sanationem seems better in this age group than in elderly patients.

[Acute occlusion in the vertebrobasilar circulatory system in children and young adults]. / Akute Verschlüsse im vertebrobasilären Stromgebiet bei Kindern und jüngeren Erwachsenen.

Within four years ten patients (six women and four men) under 50 years of age (13-49 years) were observed who presented occlusions of the vertebrobasilar artery. Eight patients were admitted from other hospitals, on an average 41 hours after the acute occlusion; only in one case had a correct first diagnosis been made. In all cases diagnosis was confirmed by means of selective angiography. Conservative treatment comprised in two patients low-molecular dextranes and heparin, in another two prostaglandin E1. In the remaining six patients local fibrinolysis was performed. In the group receiving conservative treatment a 33-year-old female patient survived and her neurological deficits subsided except for an organic psychosyndrome of minor degree. Local fibrinolysis yielded complete recanalization in three cases and partial recanalization in two. Three patients survived, in two patients near-complete recovery was achieved.

[Regional lysis of acute basilar artery occlusion--case report]. / Regionale Lyse eines akuten Basilarisarterienverschlusses - ein Fallbericht.

Thrombosis of the basilar artery is not a rare disease, and the mortality is reported to be 60 to 80%. Present standard therapy with heparin infusions yields poor results. The high risk of intracerebral haemorrhage prohibits systemic fibrinolytic therapy. Due to these facts and good experience in our department with the use of local intracoronary lysis in acute myocardial infarction, the method of local thrombolysis was applied in a case of acute basilar artery thrombosis. Fibrinolytic therapy was started via an angiography catheter placed in the vertebral artery in a 28 year-old woman with hemiplegia and severe brain stem symptoms. The patient received 200,000 IU streptokinase within 2 hours and subsequently 300,000 IU urokinase within 10 hours. The vessel re-opened completely. The neurological symptoms decreased during the following weeks. Based on this experience and according to rare reports in the literature we believe local low-dose thrombolysis to be a causal therapy promising success for acute thrombosis of the basilar artery. This therapy can be carried out in every medical centre able to perform selective angiography and experienced in the administration of fibrinolytic drugs.

The relationship between the caudolateral pontine syndrome and the anterior inferior cerebellar artery.

The caudolateral pontine syndrome associated with compromised circulation through the anterior inferior cerebellar artery is reviewed on the basis of three cases. Clinical observations are supplemented by the author's anatomical studies, and the pertinent literature is discussed.

[Pathological study and clinical manifestations of median nerve variations in the carpal canal (author's transl)]. / Etude anatomique des variétés du nerf médian dans le canal carpien et ses conséquences cliniques.

In autopsy material of 163 nonselected hands the motor branch of the N. medianus was examined regarding its origin and course. In 41 % of thenar branch was leaving the median nerve immediately distal to the carpal canal (extraligamentally). In 23 % the thenar nerve originated in the carpal canal without a particular relationship with the retinaculum flexorum (subligamentally). In 26 % the thenar branch was found penetrating the retinaculum flexorum (transligamentally). The results of the present investigation are compared with surgical findings on patients with carpal-tunnelsyndrome. As the incidence of the transligamental branch in the clinical study is much higher (50 %) than in my material, a possible relationship between the existence of a transligamental branch and the frequency of a carpaltunnelsyndrome is suggested.