The clinical value of 3-T magnetic resonance myelography in far lateral disk herniation.

STUDY DESIGN: Prospective study of 30 patients suspected of suffering from far lateral lumbar disk herniation. OBJECTIVE: To assess the diagnostic and clinical value of a new technique 3-T magnetic resonance myelography (MRM) in patients with far lateral disk herniation. SUMMARY OF BACKGROUND DATA: No studies have reported regarding the usefulness of MRM images in assessing far lateral disk nor correlated it with clinical outcomes. METHODS: We evaluated 3-T MRM of 30 patients, whom we suspected of suffering from far lateral disk herniation. Using an assessment scale, 5 observers independently examined the images. We analyzed observer agreement and the accentuation of each image. RESULTS: We found complete match and observer agreement for 3-T MRM for diagnosing far lateral disk herniation. Furthermore, 3-T MRM revealed the disease's severity on the basis of the nerve root exit zone angle differences. CONCLUSIONS: MRM is an appropriate diagnostic tool and reduces the chance of misdiagnosis in far lateral disk herniation. Furthermore, through the use of this technique, we can evaluate postoperative clinical outcomes.

Diagnostic usefulness of high resolution cross sectional MRI in symptomatic middle cerabral arterial dissection.

Dissection of the middle cerebral artery (MCA) is less frequent compared with dissection of the vertebrobasilar system or carotid artery. Recently, high-resolution cross sectional MR imaging (HRMRI) has emerged as a potential technique for atherosclerotic plaque imaging in MCA. We introduce the findings of HRMRI in a 56-year-old woman with traumatic MCA dissection. HRMRI showed an intimal flap and tapered pseudolumen with intraluminal hemorrhage. We performed stent deployment about MCA dissection after failed medical treatment. Three months later, there was no in-stent restenosis and no further neurological deficit were noted.

Anteroposterior spondyloschisis of atlas with bilateral cleft defect of posterior arch: a case report.

STUDY DESIGN: case report and review of the literature. OBJECTIVE: to report on a patient presenting with anteroposterior defects of the arch of the atlas with a rare type of posterior arch defect. This report includes a literature review of the hypothesis for the development of this anomaly. SUMMARY OF BACKGROUND DATA: congenital bony defects of the atlas are uncommon. Isolated posterior clefts are the most frequent anomaly, but combined anterior and posterior defects are the least common. In particular, combined anteroposterior defects of the arch of the atlas with other types of posterior arch defects, not including type A, have not been reported. These anomalies can cause confusion, particularly in the setting of trauma when the radiologic finding may be misinterpreted as representing a fracture. METHODS: we report here on a 22-year-old man with an anteroposterior defect of the atlas who complained of neck pain after a traffic accident. The computed tomography demonstrated well-corticated defects with sclerotic changes and no evidence of soft tissue swelling adjacent to the bony discontinuities, consistent with a congenital abnormality. Suspecting anteroposterior spondyloschisis, we performed only conservative treatment. RESULTS: the patient improved on conservative therapy without a surgical procedure. CONCLUSION: we describe combined anteroposterior defects of the arch of the atlas along with other types of posterior arch defects. Most congenital defects of the arch of the atlas are found during radiologic evaluation of neck pain after trauma. Careful diagnosis is needed for these patients to avoid confusing these defects with a fracture.

Emergency Carotid Artery Stent Insertion for Acute ICA Occlusion.

OBJECTIVE: An effective intervention has not yet been established for patients with acute occlusion of the internal carotid artery (ICA). The aim of our study was to investigate the feasibility, safety, and efficacy of emergent stent placement of carotid artery to improve neurologic symptoms and clinical outcome. METHODS: Of 84 consecutive patients with severe ICA stenosis who were admitted to our institution from March 2006 to May 2009, 10 patients with acute ICA occlusion (11.9%) underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome using the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome using the modified Rankin Scale score (mRS) and Glasgow Outcome Scale (GOS); frequency of procedure-related complications; and recurrence rate of ipsilateral ischemic stroke within 90 days. RESULTS: Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 16.6 and 6, respectively, showing significant improvement. Eight patients (80%) had favorable outcomes (mRS score 0-2 and GOS 4-5). Complications occurred in two patients (20%): stent insertion failed in one and an intracerebral hemorrhage occurred in the other. Ipsilateral ischemic stroke did not recur within 3 months. CONCLUSION: Emergency carotid artery stent placement can improve the 7-day neurologic outcome and the 90-day clinical outcome in selected patients with acute cerebral infarction.

Midline glioblastoma multiforme with bilateral symmetric cysts.

Cystic glioblastoma multiforme (GBM) is a rare disease. Its exact prevalence has not yet been reported. Also, the mechanism of cyst formation remains to be elucidated. We report a case of GBM with a large peripheral cyst. A 43-year-old woman visited our clinic with a 3-month history of severe headache, memory impairment and general weakness. T1-weighted gadolinium-enhanced magnetic resonance (MR) image revealed a midline enhanced solid mass and bilateral symmetric banana-shaped peripheral cysts. A centrally enhanced mass was measured 2x4 cm in size and both mass and cysts as 7x7 cm. Both the frontal lobe and the frontal horn were severely compressed inferiorly and posteriorly. We resected a midline solid tumor and cysts via the bilateral interhemispheric transcortical approach. Histopathologic examination revealed GBM. The patient was subsequently treated with fractionated conventional brain radiation therapy, followed by temozolomide chemotherapy. Eighteen months later, there was no tumor recurrence and no neurological deficits were noted. Our patient showed no tumor recurrence and a long survival at a long follow-up.

Effect of vagus nerve stimulation in post-traumatic epilepsy and failed epilepsy surgery : preliminary report.

OBJECTIVE: Vagus nerve stimulation (VNS) has been used in epilepsy patients refractory to standard medical treatments and unsuitable candidates for resective or disconnective surgery. In this study, we investigated the efficacy of VNS to patients who had refractory result to epilepsy surgery and patients with post-traumatic epilepsy. METHODS: We analyzed the effect of VNS in 11 patients who had undergone previous epilepsy surgery and patients with intractable post-traumatic epilepsy associated with brain injury. All patients underwent VNS implantation between October 2005 and December 2006. RESULTS: We evaluated seizure frequency before and after implantation of VNS and maximum follow up period was 24 months. In the first 6 months, 11 patients showed an average of 74.3% seizure reduction. After 12 months, 10 patients showed 85.2% seizure reduction. Eighteen months after implantation, 9 patients showed 92.4% seizure reduction and 7 patients showed 97.2% seizure reduction after 24 months. Six patients were seizure-free at this time. CONCLUSION: We conclude that the VNS is a helpful treatment modality in patients with surgically refractory epilepsy and in patients with post-traumatic epilepsy due to severe brain injury.