Progressive posttraumatic cystic myelopathy: neuroradiologic evaluation.

The neuroradiologic evaluation and findings in 25 symptomatic patients with surgically proven progressive posttraumatic cystic myelopathy are reviewed. To follow patients with spinal cord injury, neuroradiologic algorithms were developed to confirm and define cystic myelopathy. The algorithm used in the early and mid 1970s relied on the myelographic demonstration of a large cord for suspicion of a cyst. Review of this material found that in progressively symptomatic patients 14 of 25 proven cysts were in large cords. A more recent algorithm used computed tomographic metrizamide myelography. In nine of 11 patients studied in this fashion, the cyst filled with contrast material 2--4 hr after injection, yet it did not communicate with the subarachnoid space at subsequent surgery. The origin of the cyst fluid and mechanism of cyst demonstration with metrizamide may be associated with transneural migration of fluid. This condition must be clinically suspected and radiologically confirmed for surgical treatment (cyst-shunt procedure) if neurologic preservation of function is to be maintained.

Accurate CT measurement of the spinal cord using metrizamide: physical factors.

Computed tomography (CT) using metrizamide is a valuable tool in the neuroradiologic evaluation of the spinal cord, but CT must be used with care when measuring object size because size may vary with different window center (level) settings. A simple method to determine appropriate window center (level) settings during CT object measurement is described. A polystyrene core with a Teflon outer cylinder designed to simulate the spinal column, spinal cord, and subarachnoid space was scanned with varying concentrations of metrizamide with an EMI 1010 unit. Computer printouts of the CT pixel matrix were analyzed and a constant relationship of the phantom cord true size to the CT numbers of the metrizamide concentration and the phantom spinal cord was found. Window center (level) selection greatly influences measurement of cord size, whereas window width dose not. The appropriate window center (level) selection is the mean between the metrizamide CT attenuation number and the cord CT attenuation number.

Lysis of thrombus in internal carotid artery in the neck. Report of a case.

A case report is presented demonstrating spontaneous lysis of clot in the internal carotid artery in the neck with surgical and angiographic documentation. The possible factors promoting thrombus formation and lysis are discussed. Spontaneous lysis of a carotid thrombus occurred in 72 hours.