Spontaneous thrombosis of congenital cerebral arteriovenous malformation complicated by subdural collection: in utero detection with disappearance in infancy.

We report a case of congenital left temporal lobe arteriovenous malformation (AVM) detected by cranial ultrasound in utero and confirmed immediately after birth by cranial Doppler ultrasound and cranial MRI. The AVM disappeared on follow-up cranial MRI 4 months later. A small left frontal subdural collection was present on these follow-up MR images, which subsequently resolved by the 7 month MRI study. The cause of the spontaneous thrombosis of the AVM is uncertain. The frontal subdural collection may be secondary to volume loss. This case documents the perinatal presence of AVM. The baby was neurologically intact before, during and after the thrombosis of the AVM.

Vertebrobasilar thrombosis associated with nonpenetrating cervical spine trauma.

Vertebral artery injuries associated with blunt trauma to the cervical spine are rare. Five cases of vertebrobasilar complications after blunt trauma to the cervical spine are reported. Four were involved in motor vehicle accidents, and one suffered a diving injury. All of these patients had documented cervical spine fractures. For two patients, the diagnosis of vertebral artery thrombosis was made on the basis of magnetic resonance angiography (MRA), and for the remaining three, cervical four-vessel arteriograms (CFVAs), were used. All the patients had occlusion of flow in either the vertebral artery or in the vertebrobasilar circulation. The patients presented with acute, non-specific changes in neurological status. Two patients had infarctions in the vertebrobasilar tertiary, one had an infarction in the middle cerebral artery territory, and two did not show evidence of cerebral infarction. Three of the patients were treated with anticoagulants. Of these, two showed a stabilization of their neurological status, and one died. The four surviving patients improved with early physical and occupational therapy. Although CFVA remains the "gold standard" for diagnosing these injuries, newer modalities, such as MRA, may be useful adjuncts. Early stabilization of the cervical spine injury and anticoagulation are beneficial.

Anticoagulation for prevention of cerebral infarcts following subarachnoid hemorrhage.

BACKGROUND: Late neurologic deterioration following subarachnoid hemorrhage is often due to vasospasm and rebleeding. Although the sudden onset of a focal neurologic deficit can actually be the result of thromboembolism, anticoagulation has rarely been used in such cases. METHODS: We report a case of a 55-year-old woman who developed recurrent transient focal neurologic deficits 13 days after having a subarachnoid hemorrhage, with multiple cerebral infarcts by CT. Two cerebral angiograms showed no aneurysm. Her symptoms and clinical temporal profile were consistent with thromboembolic phenomenon. We elected to treat her with systemic anticoagulation. RESULTS: The patient had no recurrent events after systemic anticoagulation, but had episodic sensory changes and a new infarct on MRI once the anticoagulation was discontinued. CONCLUSIONS: Anticoagulant was safely administered after subarachnoid hemorrhage (SAH) in this patient and may have been effective in preventing further cerebral ischemic infarction following her SAH. Our patient's clinical profile of sudden (rather than gradual) onset of a transient focal neurologic deficit and resolution of blood on CT indicates one setting in which the use of heparin may be considered.

Application of positron emission tomography to neurological oncology.

PET has a promising role in neuroradiology for accurate diagnosis and prognostication of malignant tumors as well as differential diagnosis of radiation necrosis and recurrent tumors. Particularly, PET has proven its ability to accurately differentiate radiation necrosis from recurrent brain tumor. Active tumors have accelerated glycolysis, and a remarkable accumulation of FDG radiotracer in high grade brain tumors is evident on PET images. Tumor metabolism also proportionally increases with increasing pathologic grades of brain tumor, and accelerated tumor metabolism indicates a poor prognosis for the tumor.

Intracranial monitoring in patients with head trauma.

The treatment of head-injured patients has over the past 15 years become significantly more complex and involved. The rising interest in the treatment of these patients has been driven in large part by the growing body of evidence showing that there is a definite association between elevated ICP and increased mortality and long-term morbidity. The effective treatment of intracranial hypertension with hyperventilation, osmotic agents, and barbiturate therapy has been aided by the regular use of ICP monitoring in most neurosurgical centers. A continuing and ongoing record of ICP allows for the judicial and appropriate use of modern treatment modalities.

Technical application of stereotactic irradiation in malignant brain tumors.

This study reports the technical application of stereotactic interstitial brachytherapy for malignant gliomas in two groups of patients. Group I consisted of 2 patients who had undergone previous debulking brain surgery; group II were 3 patients who were not candidates for craniotomy because their tumors were surgically inaccessible. The stereotactic implantation technique in group I was somewhat complicated due to the irregular shape of the residual tumor masses. Sophisticated pre-implantation planning was necessary for adequate coverage of the entire tumor volume. In this series, inoperable tumors were also successfully implanted with excellent results.

Role of routine emergency cervical radiography in head trauma.

This review of 406 patients with head injury examines the role of emergency cervical radiography in head trauma and the frequency of associated cervical spine injury. Of 293 patients who had emergency cervical radiography (72 percent), 8 showed some abnormality, but only 5 (1.2 percent) were significant for cervical spine injury. All eight patients were, however, clinically suspected to have associated cervical spine injury before emergency cervical radiography. One hundred thirteen patients (28 percent) did not undergo emergency cervical radiography based on clinical evaluation, and none was subsequently found to have a missed cervical spine injury. There was no correlation between severity of head injury and the presence of associated cervical spine injury (p greater than 0.16). Head trauma is infrequently associated with cervical spine injury and when present is usually not clinically occult. Emergency cervical radiography is not efficacious and should not be routine in the emergency room management of head trauma. When associated cervical spine injury is clinically suspected, adequate cervical immobilization should be maintained and cervical radiography performed on a low priority basis. Head injury due to automobile and pedestrian or motorcycle and automobile accident may be more likely to be associated with cervical spine injury.

Caloric requirements in patients with severe head injuries.

Indirect calorimetry was performed on 15 nonsteroid-treated, head-injured patients over 16 postinjury days. A search was made for a clinical marker that could be used to predict the caloric requirement in individual head-injured patients. Of all parameters reviewed, only motor activity correlated with the caloric needs of the patients (P less than 0.0001). Flaccid patients had a mean caloric expenditure of 108% of expected values, whereas patients with abnormal motor activity had a mean caloric expenditure of 191% of expected values.

Interhemispheric subdural hematoma. Case report.

A case of interhemispheric subdural hematoma ( ISH ) is presented and discussed. This disorder is a rare form of intracranial hemorrhage, which classically presents as an isolated paresis of one leg or a hemiparesis worse in the leg than the arm. The majority of cases are due to occipital trauma because of the anatomy of the bridging veins. Chronic interhemispheric hematomas are rare since the natural history of these lesions is to spread out over the cerebral convexity. Conservative treatment for ISH may be beneficial unless neurological deterioration necessitates early operative intervention.