Recurrent orbital myositis mimicking sixth nerve palsy: diagnosis with MR imaging.

We present a case with recurrent orbital myositis sequentially affecting both lateral rectus muscles separately. In the first episode, the absence of the required symptoms for the diagnosis of orbital myositis led to the erroneous diagnosis of sixth nerve palsy. Eventually, the correct diagnosis was established with cerebral MR imaging. Orbital myositis should be included in the differential diagnosis of what appears clinically to be abducens palsy, and MR imaging with a focus on the orbita is mandatory in such patients.

Contrast-enhanced magnetic resonance angiography of mammary artery grafts after minimally invasive coronary bypass surgery.

BACKGROUND: The aim of the study was to investigate the application of the contrast-enhanced magnetic resonance angiography (CE-MRA) for the visualization of left internal mammary artery (LIMA) bypass. METHODS: A total of 30 patients with LIMA bypass (22 men, 8 women, 35 to 77 years) received a CE-MRA 4 to 20 days after surgery. The non-ECG-triggered CE-MRA was performed during expiration using a body array coil at a 1.5 Tesla scanner (Magnetom-Vision). A three-dimensional gradient-echo sequence with slice interpolation technique was applied. For the three-dimensional visualization, single coronal slices were postprocessed with maximal intensity projection. Of 30 patients 22 agreed to a comparative coronary angiography. RESULTS: Five bypasses were identified up to the end-to-side anastomosis. A total of 80% of the bypass course was detectable in 13 patients and 60% in 11 patients. In two LIMA bypasses only 30% of the proximal part could be viewed; one was found by conventional coronary angiography to be occluded. The other conventional coronary angiography showed the LIMA bypass to be patent. CONCLUSIONS: The complete course of the LIMA bypass to the left anterior descending coronary artery can be visualized by the MRA technique. The most reliable imaging of the distal anastomosis can be realized by reducing the negative influence of the beating heart.

[Semiquantitative detection of pain and heat sensations in evaluation of contrast media in pelvic/leg angiography. Intraindividual double-blind study with iomeprol 350 and iopentol 350]. / Semiquantitative Erfassung von Schmerz- und Hitzesensationen zur Beurteilung von Kontrastmitteln bei der Becken/Beinangiographie. Intraindividuelle Doppelblindstudie mit lomeprol 350 und lopentol 350.

The effect on pain and heat sensation of monomere non-ionic contrast media with different osmolality was assessed in a randomized double-blind study. Peripheral angiography was performed in 29 patients who suffered from chronic occlusive vessel disease. The two non-ionic contrast media iomeprol and iopentol were applied intraindividually. The contrast media with an iodine concentration of 350 mg/ml had an osmolality of 618 or 810 mosm/kg. A contrast medium volume of 80 or 90 ml was injected in the abdominal aorta. The mean flow was 13.9 ml/s. The two contrast medium injections were separated by an interval of 10 min. No analgesic premedication was given. The pain and heat intensity was semiquantatively measured using a visual analogue scale ranging from 0 (no heat/pain) to 100 (intractable heat/pain). The median after the first injection was calculated as 40 for iomeprol and 70 for iopentol. The comparison of heat and pain sensations after the second injection showed a less distinct difference with a scale rating of 60 for iomeprol and of 65 for iopentol. The statistical variance was highly significant (p < 0.01) in favor of iomeprol.

Bilateral subclavian steal syndrome: treatment with percutaneous transluminal angioplasty and stent placement.

A 66-year-old man presented with bilateral subclavian steal syndrome (SSS) due to proximal subclavian artery occlusions. He was treated by percutaneous transluminal balloon angioplasty (PTA) and stent implantation in the left subclavian artery and by PTA alone in the right subclavian artery. We could demonstrate that interventional treatment of symptomatic bilateral SSS is possible. If PTA alone is insufficient, stent implantation should be considered.

[Motor function loss in zoster neuritis versus encephalitis--clinical case and review of literature]. / Motorische Ausfälle bei Zoster-'Neuritis' versus 'Enzephalitis'--Kasuistik und Literaturübersicht.

Motor lesions following herpes zoster are quite common. Hemiparesis, paraparesis, pareses of the facial and other cranial nerves as well as segmental pareses can be observed. We report on a patient suffering from zoster ophthalmicus complicated by paresis of the third cranial nerve. As a cause, a partial brain stem-encephalitis was diagnosed. The patient recovered after antiviral treatment (Aciclovir, Inosiplex).