Importance of absence of CSF pulsation artifacts in the MR detection of significant myelographic block at 1.5 T.

MR imaging was performed on 21 patients who had high-grade myelographic block due to various diseases in all spinal compartments (extradural, intradural/extramedullary, and intramedullary) and in all portions of the spinal canal (cervical, thoracic, and lumbosacral). Loss of CSF pulsation artifacts due to significant compression of the spinal cord was demonstrated on non-motion-compensated T2-weighted examinations in each case. We believe that the absence of such artifacts on these sequences indicates significant spinal cord compression in patients without classic signs and symptoms of cord compression but with intraspinal disease identified on T1-weighted studies.

Intraluminal clot in the vertebrobasilar circulation: clinical and radiologic features.

We studied 15 patients with angiographically documented intraluminal clot in the vertebrobasilar (VB) circulation and ischemic stroke. Progressive brainstem signs were the most common presentation; the neurologic deficit was maximum at stroke onset in 4. Seven experienced their first symptoms during sedentary activities. Thirteen of the initial 15 CTs revealed infarcts in the VB territory, 7 with multiple foci. Intraluminal clot was present in the vertebral artery in 7 patients (2 bilateral), basilar artery in 7, posterior cerebral artery in 5, and superior cerebellar artery in 1. Multiple clots were seen in 5 patients. Stroke risk factors were present in the majority of cases. Although cardiac source embolism was the most common single etiology (4 patients), most patients had other causes including migraine, coagulopathy associated with malignancy and nephrotic syndrome in systemic lupus erythematosus, vertebral artery dissection with local embolism, delayed irradiation arteriopathy, and a fusiform, ectatic basilar artery. Six (40%) died within 5 months of follow-up. Intraluminal clot in the posterior circulation is a marker for multiple stroke mechanisms, not all of which are embolic. Intraluminal clot should prompt investigations into occult risk factors when no cause appears obvious.

Venous angiomas: an underestimated cause of intracranial hemorrhage.

Cerebral venous angiomas are considered by many investigators as infrequent and incidental. Our experience, however, has been different. Since 1975, we have compiled a group of 21 patients with 23 venous angiomas. Nine patients (43%) presented with intracranial hemorrhage, and two in this group had recurrent hemorrhage. Surgical extirpation of the venous angioma was performed in all nine cases. An additional resection of a frontal venous angioma was performed in a woman with intractable seizures and headache. We experienced limited morbidity and no mortality. Although venous angiomas may be uncommon clinically, they have a significant potential for hemorrhage, and particularly, rehemorrhage if left untreated.

Epidural lipomatosis.

The authors report six new cases of epidural lipomatosis--a rarely described entity characterized by increased extradural fat within the spinal canal causing compression of the spinal cord and neurologic deficits. Five of the six patients had a history of chronic steroid use. Myelography of the thoracic spine, followed by computed tomography (CT), was performed in five patients, and magnetic resonance (MR) imaging was done in three. Myelographic findings were abnormal in three patients and normal in two, compared with those of postmyelography CT, which revealed increased accumulation of extradural fat in all five patients. In the three patients in whom it was performed, MR imaging also showed the increased spinal canal fat. Four patients underwent surgery, which revealed an increased amount of histologically normal, unencapsulated fat in all cases. The diagnosis of epidural lipomatosis should be based on a combination of clinical, imaging, surgical, and histologic findings. If the clinical suspicion is high, even if results of myelography are normal, further evaluation with post-myelography CT or MR imaging should be considered.

Cerebral angiography in brainstem revascularization.

Surgical management of patients with vertebrobasilar insufficiency has been developed within the past decade. Cerebral angiography plays a crucial role in identifying potential surgical candidates and in directing the surgical approach. Fifty-two patients underwent brainstem revascularization procedures at Henry Ford Hospital between November 1979 and August 1985. Twelve occipital artery to anterior inferior cerebellar artery bypasses, five occipital artery to posterior inferior cerebellar artery bypasses, four intracranial vertebral endarterectomies, 29 superficial temporal to superior cerebellar artery bypasses, and two superficial temporal to posterior cerebral artery bypasses were performed. The preoperative angiograms in these patients were analyzed to illustrate how angiographic localization of vascular disease directs the surgical approach. We report the results of postoperative angiograms. Technical features of the various surgical procedures, the role of the neuroradiologist, and several features of the angiographic technique used with these patients are described.

Angiographic features of gliosarcoma.

Gliosarcoma is a brain neoplasm that is being recognized with increasing frequency. We discuss the radiographic findings in 14 pathologically proven cases. At angiography in nine cases, four showed mixed dural and pial vascular supply to the lesion. Early cortical venous drainage, irregular tumor vessels, and a prominent vascular stain with well-defined tumor margins were seen in the majority of cases. CT showed an irregular enhancing rim surrounding a necrotic center in 14 cases. Most lesions were peripherally located and invaded dura.

Radiologic evaluation of extracranial to Sylvian middle cerebral artery bypass.

At this institution a new procedure has been developed that involves anastomosing one of the branches of the superficial temporal artery to one of the major trunks of the middle cerebral artery in the Sylvian fissure. This procedure has been performed in 22 cases to date. Clinical indications for this procedure have fallen into four major categories. This new type of anastomosis produces greater bypass flow than conventional cortical middle cerebral artery anastomoses, and may be a better therapeutic alternative in certain clinical situations. The preoperative and postoperative angiographic evaluation of these patients is discussed. The radiologic results in this series of patients are reviewed.

Cranial invasion by basal cell carcinoma.

The direct spread of basal cell carcinoma (BCC) into the bones of the cranium takes a long period. In its early stages, it may not be detectable by radiography or computerized tomography, but can be visible as pitting during surgery. Invasion through the thickness of the calvarium due to extension of a BCC of the scalp, or involvement of the cribriform plate by spread from an intranasal lesion, is serious. Examples of cranial invasion by BCC are presented. The methods used in diagnosis and treatment are outlined.

Neurobehavioral deficit and computed tomographic abnormalities in three samples of schizophrenic patients.

Recent reports have suggested that schizophrenics show brain abnormalities as reflected on computed tomography (CT Scan). We present data on three groups of schizophrenic patients which replicate our original report of this phenomenon with associated neuropsychological test results. The over-all evidence for an increased rate of neuropsychological abnormalities and related CT structural anomalies in groups of schizophrenics in several studies is robust. The biological dynamics, cause-effect relationships, and clinical applicability of this phenomenon in the individual case, however, are far from clear. Diagnostic agreements between behavioral and structural abnormalities should simultaneously sound a note of clinical caution and stimulate further study.

Computed measures on computed tomograms of the head.

Measures of average parietal bone mass (APBM) and average parietal skull width (APSW) were developed using automatic image processing techniques and a special polar coordinate system. The precision of the technique is about 2%; the measures are obtained by processing one section of a computed tomographic head scan obtained without special apparatus. In males the APBM does not decrease with age; in females it splits into two groups of age, probably based on postmenopausal changes. The APSW in both males and females increases slightly with age. The clinical utility of the measures is discussed.

Hemorrhagic (colloid) cyst of the third ventricle and episodic neurologic deficits.

A neuroepithelial (colloid) cyst of the third ventricle is reported. This case was unusual in several respects. The patient suffered from transient attacks of quadriparesis lasting a few days each time. Bleeding occurred into the cavity of the cyst. Microscopic examination revealed the presence of layers of elastic tissue in the wall of the cyst and residues from previous hemorrhage.