Intracarotid slow bolus injection of nimodipine during angiography for treatment of cerebral vasospasm after SAH. A preliminary report.

Nimodipine was given as an intracarotid slow bolus injection in six patients with subarachnoid hemorrhage (SAH) due to rupture of a cerebral aneurysm, with angiographically demonstrated vasospasm. The patients were followed by serial angiograms for demonstration of the effect of nimodipine on vasospasm. After angiography, all patients were treated with a constant venous infusion of this new calcium antagonist. Although the therapeutic regimen was started only a few hours after onset of vasospasm, there was no change in cerebral vessel caliber detectable on angiograms following the intracarotid injection. Three patients died, two patients finally recovered with neurological deficits due to cerebral ischemia, and one patient with asymptomatic vasospasm remained symptom-free. Although nimodipine may act to prevent cerebral vasospasm after SAH, the authors believe that the intracarotid application is not effective after vasospasm has occurred.

Cerebral CT in fatal courses of resuscitated sudden infant death.

Three children revived after sudden infant death syndrome were observed by cerebral computed tomography (CT). The scans were correlated with clinical and electroencephalographic findings of brain deterioration. The salient features of the CT presentations are described. Necropsies performed in two of the three cases revealed liquefactive necrosis.

The current state of the radiological diagnosis of acoustic neuroma.

Thin, overlapping section, contrast-enhanced, axial and coronal CT, with additional high-resolution (HR) treatment of the sections through the internal auditory canal, was performed on 31 patients clinically suspected of acoustic neuroma. With this technique 13 acoustic neuromas protruding more than 10 mm and eight acoustic neuromas protruding between 2 and 10 mm outside the internal auditory canal were unequivocally diagnosed. O2CT cisternography was performed on ten patients. An intracanalicular neuroma was diagnosed in three cases with this technique, also a small extracanalicular neuroma in one case, and an acoustic neuroma was definitely excluded in six cases. It is concluded that O2CT cisternograhy is the diagnostic procedure of choice for the detection of purely intracanalicular neuromas and the definite exclusion of acoustic neuroma. HR CT proved superior to polytomography for the evaluation of the internal auditory canal and should be performed in every case suspected of acoustic neuroma. A protocol for the radiological investigation of patients suspected of acoustic neuroma is given.

The diagnosis of solitary primary reticulum cell sarcoma of the posterior fossa with computed tomography.

The CT findings in two surgically and histologically verified cases of primary reticulum cell sarcoma of the cerebellar hemisphere with secondary involvement of the cerebellopontine angle are presented. It is suggested that a correct diagnosis is possible by CT if the following criteria are present: 1. slightly increased attenuation of the mass on the precontrast scan; 2. mottled appearance of the definitely enhancing mass; 3. ill-defined borders on both the pre- and postcontrast scans; 4. degree of mass effect less than that expected from the size of the lesion; 5. involvement of the cerebellopontine angle without signs indicating an extra-axial origin of the tumor. These criteria reflect the gross and microscopic neuropathological features of the tumor.

Neuroma of the cavernous sinus.

A case of a surgically verified parasellar neuroma is presented. Despite clinical and radiological evidence for the origin of the tumor to be the trochlear or oculomotor nerves, an operation revealed a neuroma originating from the cavernous sinus, but exact identification of the origin of the tumor was not possible. The radiologic findings including polytomography, angiography and computed tomography are presented. The clinical and radiological differentiation between this case and typical neuromas of the gasserian ganglion are discussed.