RESUMO
Conventional arteriography has been the accepted standard technique for demonstrating the anatomic details in vascular malformations of the hand. The technique of magnetic resonance angiography provides detailed anatomy for vascular anomalies of the hand without the use of an invasive technique or contrast enhancement. When magnetic resonance angiography is combined with magnetic resonance imaging, the extent of the lesion with respect to the surrounding tissues and the flow characteristics of the lesion can be determined noninvasively. In our institution, magnetic resonance angiography has replaced conventional arteriography as the technique of choice for the evaluation of these lesions. This report evaluates the efficacy of magnetic resonance imaging/ magnetic resonance angiography in the management of vascular malformations of the hand. Ten consecutive patients over 30 months (median age 37 years) underwent magnetic resonance imaging/magnetic resonance angiography evaluation after the clinical diagnosis of a vascular malformation of the hand was made. Four patients in the group had conventional arteriography performed before referral. Magnetic resonance imaging/magnetic resonance angiography clearly defined the anatomic extent of the lesion, its relationship to surrounding tissues, and the flow characteristics in each patient. In the four patients in whom conventional arteriography had been performed, the magnetic resonance angiography findings matched the arteriographic findings. On the basis of the magnetic resonance imaging/magnetic resonance angiography findings, six patients were treated nonoperatively with compressive garments and four patients had operative treatment (resection of lesion n = 2, digital ray resection n = 2). In this series, magnetic resonance imaging/magnetic resonance angiography was efficacious in the management of vascular malformations of the hand. This technique provides detailed images of both the arterial and venous components of the lesions without the requirements of contrast enhancement, ionizing radiation, or an invasive procedure. Furthermore, the resectability can be determined based on the extent of involvement and the flow characteristics.
Assuntos
Malformações Arteriovenosas/diagnóstico , Mãos/irrigação sanguínea , Angiografia por Ressonância Magnética , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Magnetic resonance imaging was used to measure the volumes of the caudate, putamen, and globus pallidus of 25 schizophrenic patients (17 men and eight women) and 26 age- and sex-matched comparison subjects (18 men and eight women). Schizophrenic patients had significantly larger right and left globus pallidus and right putamen volumes than comparison subjects. There were no significant differences between schizophrenic patients with and without persistent tardive dyskinesia in the volume of any of the three structures.
Assuntos
Gânglios da Base/patologia , Discinesia Induzida por Medicamentos/patologia , Imageamento por Ressonância Magnética , Esquizofrenia/patologia , Adulto , Antipsicóticos/efeitos adversos , Gânglios da Base/anatomia & histologia , Núcleo Caudado/anatomia & histologia , Núcleo Caudado/patologia , Discinesia Induzida por Medicamentos/diagnóstico , Discinesia Induzida por Medicamentos/etiologia , Feminino , Lateralidade Funcional , Globo Pálido/anatomia & histologia , Globo Pálido/patologia , Humanos , Hipertrofia/patologia , Masculino , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológicoRESUMO
OBJECTIVE: Previous studies have suggested the involvement of the frontal and parietal cortices and thalamus in a neural circuit underlying the production of primary enduring negative or deficit symptoms of schizophrenia. The purpose of this study was to examine whether structural changes in the proposed circuit are associated with the production of deficit symptoms. METHOD: Magnetic resonance imaging was used to measure the volume of selected circuit brain regions (i.e., the prefrontal region and caudate) and noncircuit brain regions (i.e., the amygdala/hippocampus complex) in 17 deficit and 24 nondeficit schizophrenic outpatients and 30 normal comparison subjects. RESULTS: Right and left total prefrontal volumes discriminated deficit from nondeficit patients, with prefrontal volumes being smaller in nondeficit patients. There were no differences between the two schizophrenic subgroups in left caudate or right and left amygdala/hippocampus complex volumes. The right caudate was larger in deficit patients, but the difference between the two schizophrenic subgroups was not significant. There were no differences between deficit and normal subjects on any prefrontal region measure. Nondeficit patients had smaller total right and left prefrontal volumes than normal subjects. Both schizophrenic subgroups had larger left caudate volumes and smaller right and left amygdala/hippocampus complex volumes than the normal subjects. There was a trend for deficit patients to have larger right caudate volumes. CONCLUSIONS: These results suggest that structural changes in the prefrontal region are not responsible for deficit symptoms. The caudate, particularly the right caudate, may be associated with the production of these symptoms.
Assuntos
Lobo Frontal/anatomia & histologia , Imageamento por Ressonância Magnética , Lobo Parietal/anatomia & histologia , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Tálamo/anatomia & histologia , Lobo Frontal/fisiopatologia , Humanos , Modelos Neurológicos , Lobo Parietal/fisiopatologia , Esquizofrenia/fisiopatologia , Tálamo/fisiopatologiaRESUMO
We used magnetic resonance imaging to examine the morphologic characteristics of the amygdala/hippocampus, prefrontal cortex, and caudate nucleus in 29 healthy volunteers matched for age, gender, and head of household socioeconomic status and 44 patients with chronic schizophrenia. Total volumes of these structures were determined from 3-mm contiguous coronal sections. Schizophrenic patients, compared with healthy controls, had significantly smaller right and left amygdala/hippocampal complex volumes, smaller right and left prefrontal volumes, and larger left caudate volumes. A secondary analysis revealed reductions in the right and left amygdala and the left hippocampus. In addition, prefrontal white matter, but not gray matter, was reduced in the schizophrenic patients. Moreover, the right white matter volume in schizophrenic patients was significantly related to right amygdala/hippocampal volume (r = .39), data that provide preliminary support for a hypothesis of abnormal limbic-cortical connection in schizophrenia. We studied the implications of these data for the pathophysiology of schizophrenia.
Assuntos
Núcleo Caudado/anatomia & histologia , Lobo Frontal/anatomia & histologia , Sistema Límbico/anatomia & histologia , Imageamento por Ressonância Magnética , Esquizofrenia/diagnóstico , Adulto , Assistência Ambulatorial , Tonsila do Cerebelo/anatomia & histologia , Tonsila do Cerebelo/fisiopatologia , Núcleo Caudado/fisiopatologia , Doença Crônica , Feminino , Lobo Frontal/fisiopatologia , Lateralidade Funcional/fisiologia , Hipocampo/anatomia & histologia , Hipocampo/fisiopatologia , Humanos , Sistema Límbico/fisiopatologia , Masculino , Modelos Neurológicos , Esquizofrenia/fisiopatologiaAssuntos
Ossos Faciais/diagnóstico por imagem , Granuloma de Células Gigantes/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/etiologia , Feminino , Granuloma de Células Gigantes/etiologia , Humanos , Hiperparatireoidismo/complicações , Seios Paranasais/diagnóstico por imagemRESUMO
Computed tomography of the brains in 20 patients with acute rupture of posterior fossa aneurysms was reviewed and analyzed retrospectively. Findings were compared with those from 44 cases described in the literature and with the findings in ruptured supratentorial aneurysms. Extravasated blood was observed in 19 of 20 patients (95%); intraventricular hemorrhage (IVH) in 17 of 20 (85%); and subarachnoid hemorrhage (SAH) in 13 of 20 (65%). These values were significantly higher than those previously reported and suggest that, during the acute phase of rupture, extravasated blood may be detected with the same frequency in either infratentorial or supratentorial ruptured aneurysms. Subarachnoid hemorrhage was accompanied by IVH, prominent in the fourth ventricle and without intraparenchymal hematoma, in 11 patients (55%). This pattern is highly suggestive of ruptured posterior fossa aneurysms. Intraventricular hemorrhage without SAH was noted in five patients (25%) and specifically represented ruptured posterior inferior cerebellar artery aneurysms. Subarachnoid hemorrhage without IVH was noted in only two patients (10%).
Assuntos
Aneurisma Intracraniano/complicações , Tomografia Computadorizada por Raios X , Adulto , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Ventrículos Cerebrais , Fossa Craniana Posterior , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura Espontânea/epidemiologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/etiologiaRESUMO
A case of intradural spinal lipoma, rarely seen in the high cervical region, is described. Extension into the posterior fossa is not infrequent with these rare tumors. Magnetic resonance imaging clearly showed the longitudinal dimension of the tumor as well as the infiltrative extension into the spinal cord without any invasive procedure.
Assuntos
Vértebras Cervicais , Lipoma/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias da Coluna Vertebral/diagnóstico , Adulto , Humanos , MasculinoRESUMO
In two patients with limbic encephalitis serial magnetic resonance (MR) imaging showed evolution of abnormal high-signal intensity in both hippocampal formations on T2-weighted images.
Assuntos
Encefalite/diagnóstico , Hipocampo , Imageamento por Ressonância Magnética , Adulto , Encefalite/patologia , Feminino , Hipocampo/patologia , Humanos , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/patologiaRESUMO
We report two patients with HIV infection whose MR imaging showed abnormal high signal intensity confined to both putamina on T2-weighted spin echo (SE) images. We assume that they may represent the early manifestations of HIV encephalitis.
Assuntos
Complexo AIDS Demência/diagnóstico , Infecções por HIV/patologia , Imageamento por Ressonância Magnética , Putamen/patologia , Adulto , Feminino , Humanos , MasculinoRESUMO
Preoperative embolization of vascular metastatic tumors of the spine, particularly carcinomas of renal and thyroid origin, is an adjuvant technique that significantly decreases the intraoperative blood loss and resultant surgical morbidity. Surgical decompression was achieved in 24 spinal vascular metastatic lesions, 20 of which were treated with preoperative embolization and four of which were not. The embolic materials used were gelatin sponge, polyvinyl alcohol foams, and metallic coils. In patients who underwent adequate embolization, an average of 1,850 mL of estimated blood loss was reported; in those who underwent inadequate or no embolization, greater than 3,500 mL of estimated blood loss occurred. When gelatin sponge is used, surgery should be performed within 24 hours to prevent preoperative recanalization.
Assuntos
Carcinoma de Células Renais/secundário , Embolização Terapêutica , Neoplasias da Coluna Vertebral/secundário , Adulto , Idoso , Carcinoma de Células Renais/terapia , Feminino , Esponja de Gelatina Absorvível , Hemostasia Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Álcool de Polivinil , Cuidados Pré-Operatórios , Próteses e Implantes , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/terapiaRESUMO
Heterotopia of the cerebral cortex, a disorder of neuronal migration, may be associated with medically intractable seizures. We report on a patient with bihemispheric cortical heterotopia who had medically intractable atonic seizures that were successfully treated by corpus callosotomy. The clinical and radiographic aspects of cortical heterotopia and the surgical management of seizures associated with heterotopia are discussed.
Assuntos
Neoplasias Encefálicas/patologia , Córtex Cerebral , Coristoma/patologia , Corpo Caloso/cirurgia , Epilepsia/cirurgia , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Coristoma/diagnóstico por imagem , Coristoma/cirurgia , Corpo Caloso/patologia , Epilepsia/etiologia , Epilepsia Tipo Ausência/etiologia , Epilepsia Tipo Ausência/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , RadiografiaAssuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico , Diagnóstico por Imagem , Síndrome da Imunodeficiência Adquirida/complicações , Doenças do Sistema Nervoso Central/complicações , Criança , Pré-Escolar , Gastroenteropatias/complicações , Humanos , Lactente , Infecções Oportunistas/complicações , Pneumonia/complicações , Fibrose Pulmonar/complicaçõesRESUMO
A 53-year-old man presented with polydipsia, polyuria, lightheadedness on standing, and syncope. Visual field deficits suggesting left optic tract compression and pituitary dysfunction consisting of diabetes insipidus, hyperprolactinemia, and anterior pituitary insufficiency were diagnosed. On the computed tomography scan, an isodense, ring-enhancing, parasellar mass was localized primarily in the suprasellar region and also extended into the sella. It was believed that the pituitary hormone hypersecretion and hyposecretion were due to hypothalamic dysfunction from the mass which was initially believed to be a craniopharyngioma. At surgery a Rathke's cleft cyst was resected. The unusual presentation of this Rathke's cleft cyst presenting as a hypothalamic lesion is discussed.
Assuntos
Craniofaringioma/complicações , Doenças Hipotalâmicas/etiologia , Testes de Função Hipofisária , Neoplasias Hipofisárias/complicações , Craniofaringioma/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Prolactina/sangue , Tireotropina/sangue , Hormônio Liberador de Tireotropina , Tomografia Computadorizada por Raios XRESUMO
A case of spinal intradural metastasis from a carcinoid tumor is reported. The case is of interest due to the rarity of central nervous system involvement by these tumors and the long latency period of the patient's presentation.
Assuntos
Tumor Carcinoide/secundário , Neoplasias Pancreáticas , Neoplasias da Coluna Vertebral/secundário , Tumor Carcinoide/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mielografia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Carotid-cavernous fistulas are uncommon, although not rare, complications of trauma to the base of the skull; they may result in cranial nerve palsies, blindness, and occasionally in devastating subarachnoid hemorrhage. We have presented a case of carotid-cavernous fistula in a 17-year-old boy, treated successfully with balloon embolization. Although surgical treatment was advocated in the past, the low morbidity and high success rate of percutaneous balloon embolization currently make this the procedure of choice.
Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Ferimentos por Arma de Fogo/complicações , Adolescente , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Fístula Arteriovenosa/etiologia , Doenças das Artérias Carótidas/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Humanos , Masculino , Radiografia , Ferimentos por Arma de Fogo/diagnóstico por imagemRESUMO
During a 6-month period, 11 consecutive patients who had delayed neurologic deterioration after sustaining a gunshot wound to the spine were prospectively evaluated clinically, radiologically, and surgically. The patients had dysesthetic burning pain in an anesthetic area, hyperhidrosis, flexor spasm, and additional motor deficit above the level of cord injury 2-22 weeks after injury. Radiologic evaluation consisted of plain radiography of the spine and metrizamide myelography followed by computed tomography. A syringomyelic cavity was found in seven patients, an arachnoid cyst in three, and osteomyelitis in one. Seven of these patients also had cord atrophy. Postoperatively, dysesthetic pain was relieved in all the patients. There was no recurrence during a 2-year follow-up. These results emphasize the need for immediate radiologic investigation in patients with gunshot wounds of the spine who have further deterioration superimposed on their initial deficit.
Assuntos
Mielografia , Traumatismos da Medula Espinal/diagnóstico por imagem , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adolescente , Adulto , Aracnoide-Máter , Cistos/diagnóstico por imagem , Cistos/etiologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Traumatismos da Medula Espinal/complicações , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/complicaçõesRESUMO
Twenty-one patients with acute neurologic deficits following cervical spine trauma were evaluated with magnetic resonance (MR) imaging (n = 21), computed tomography enhanced with intrathecal contrast material (CT myelography) (n = 18), myelography (n = 13), cervical spine radiography (n = 21), and intraoperative sonography (n = 7). MR imaging proved superior to other modalities in demonstrating parenchymal spinal cord injuries and cervical intervertebral disk herniation. Although both T1- and T2-weighted studies appear necessary to evaluate the anatomic relationship of the spinal cord, thecal space, intervertebral disks, and surrounding osseous and ligamentous structures, T2-weighted sequences were more sensitive than T1-weighted studies for detection of spinal cord injury. CT myelography was superior to MR imaging in demonstrating cervical spine fractures. In most cases, myelography revealed no information that was not apparent from both CT and MR imaging studies. Preliminary experience with MR imaging of acute cervical spine trauma suggests that it should be the study of choice in symptomatic patients who are otherwise clinically stable. CT may still be required in selected patients to evaluate complex fractures.
Assuntos
Imageamento por Ressonância Magnética , Traumatismos da Coluna Vertebral/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia/diagnóstico , Paralisia/etiologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The use of computed tomography (CT) in demonstrating pure dislocations of the thoracolumbar facets and in predicting the prognosis of this injury was evaluated and compared with radiography retrospectively. The records of 29 patients with pure thoracolumbar bilateral facet dislocation who were admitted to the trauma unit over a 4-year period were reviewed. Twenty-two patients (76%) had a complete neurologic loss that remained complete following immediate surgical stabilization; five (17%) had an incomplete neurologic loss, and two (7%) were normal neurologically. Plain radiographs of the spine, including anteroposterior and lateral views, documented the level and type of fracture but failed to depict the full extent of bony ad soft-tissue injuries. CT provided essential additional information, particularly regarding the status of the posterior elements of the vertebrae and the adequacy of the spinal canal. Pure thoracolumbar facet dislocations have a characteristic appearance on axial CT scans. Sagittal reformation through CT is essential in the evaluation of this type of spinal injury.
Assuntos
Luxações Articulares/diagnóstico por imagem , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Vértebras Torácicas/diagnóstico por imagemAssuntos
Neoplasias Encefálicas/secundário , Condrossarcoma/secundário , Tomografia Computadorizada por Raios X , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Humanos , Masculino , Neoplasias Mandibulares/patologiaRESUMO
A case of recurrent benign osteoblastoma of the temporal bone is presented with discussion of the clinical, radiological, and pathological findings. Previously reported cases of osteoblastoma of the temporal bone are briefly reviewed.