Cough-associated headache in patients with Chiari I malformation: CSF Flow analysis by means of cine phase-contrast MR imaging.

The purpose of this study was to analyze the CSF flow in patients with Chiari I to determine differences between patients with and without CAH. Thirty patients with Chiari I malformation underwent cine-PC CSF flow imaging in the sagittal plane. CSF flow pulsations were analyzed by placing regions of interest in the anterior cervical subarachnoid space. Maximum CSF systolic (craniocaudal) and diastolic (caudocranial) velocities as well as the durations of CSF systole and diastole (measured in fractions of the cardiac cycle) were determined. In the region of interest just below the foramen magnum, patients with CAH had a significantly shorter CSF systole and longer diastole (P=.02). A CSF diastolic length of ≥0.75 of the cardiac cycle was 67% sensitive and 86% specific for CAH. Our results indicate that Cine-PC imaging can show differences in CSF flow patterns in patients with Chiari I with and without CAH.

Increased cochlear fluid-attenuated inversion recovery signal in patients with vestibular schwannoma.

BACKGROUND AND PURPOSE: Elevated protein levels have been reported in perilymph of patients with vestibular schwannoma. Fluid-attenuated inversion recovery (FLAIR) imaging is sensitive to high protein contents in fluids. The purpose of this study was to investigate if in patients with unilateral vestibular schwannoma, cochlear FLAIR signal intensity on the affected side is increased compared with the unaffected side and control subjects. MATERIALS AND METHODS: Fifteen patients with unilateral vestibular schwannoma and 25 age-matched control subjects (without a history of hearing loss) were retrospectively evaluated. All patients and controls had routine 5-mm FLAIR and T1- and T2-weighted imaging of the brain. The signal intensity of both cochleae was evaluated by placing a small region of interest on FLAIR images. The signal intensity of the brain stem was also determined by placing a second region of interest. A ratio of cochlear signal intensity to brain stem signal intensity (CIBI ratio) was determined. A t test was used to compare the CIBI ratios. RESULTS: In patients, the mean CIBI ratio of the affected side was 0.89 +/- 0.18, and that of the unaffected side was 0.57 +/- 0.12. In control subjects, it was 0.51 +/- 0.07. The CIBI ratio of the affected side was significantly higher compared with the unaffected side (P < .001) and compared with control subjects (P < .001). CONCLUSION: Patients with vestibular schwannoma have increased cochlear FLAIR signal intensity on the affected side compared with the unaffected side and healthy subjects.

Lemierre's syndrome revisited: case report and imaging findings.

Lemierre's syndrome, characterized by infective thrombophlebitis of the internal jugular vein with septic emboli, was once a ubiquitous condition with high mortality rate in the pre-antibiotic era. Radiological literature on this condition has been scanty in the era of cross-sectional imaging. We present a 16-year-old patient with Lemierre's syndrome with discussion of the typical clinical features and CT findings.

Gadolinium enhancement of cerebrospinal fluid in a patient with renal failure.

Gadolinium based MRI contrast agents are considered very safe due to their well known pharmacologic properties and elimination mechanisms. In this paper, we present a unique case in whom transient enhancement of CSF with contrast is seen. Severe renal failure is demonstrated to be responsible for this finding. The diagnostic criteria for everyday clinical setting and possible clinical implications are discussed.