[Vertical fracture of the odontoid process. A case report]. / Fracture verticale de l'apophyse odontoide. Une observation.

Odontoid process fractures are commonly classified as types I through III according to the Anderson & D'Alonzo scheme. A fourth type of fracture not included in this classification has been described as "vertical odontoid fracture". These fractures are located in the vertical plan of the dens. We describe a new case of an oblique coronally oriented fracture through the odontoid process with extension to the body of C2. Our patient is a 22-year-old lady who sustained a road traffic accident with head, facial and cervical trauma. Computed tomography with 2D and 3D reconstruction characterized the fracture. We suppose that the mechanism of injury was an axial load associated with dorsal to ventral force. The patient was placed on a halo-vest for 12 weeks with good healing and no evidence of instability on flexion-extension studies 6 months later. This case demonstrates that the odontoid and C2 vertebral body fractures belong to the same spectrum and are determined by the patient's anatomy and the mechanism of the injury.

Infantile nephrotic syndrome and congenital glaucoma.

A case of infantile nephrotic syndrome (NS) with advanced membranoproliferative glomerulonephritis (MPGN), type I, and bilateral congenital glaucoma, is presented. The patient also had persistent thrombocytopenia and subclinical hypothyroidism. The parents were second-degree cousins and the affected infant had a sibling who was born with congenital glaucoma. His mother had an aunt and uncle on the maternal side who were born with congenital glaucoma. In addition, there was a history of infantile death in five family members of unknown causes (pedigree). To the best of our knowledge, the association of congenital glaucoma and infantile NS due to MPGN has not been reported previously.

A comparison of conventional spin-echo and fast spin-echo in the detection of multiple sclerosis.

Fast spin-echo (FSE) pulse sequences enable T2-weighted imaging in a fraction of the time required for T2-weighted conventional spin-echo (CSE) imaging. Due to concerns that the altered contrast characteristics of FSE may interfere with the visualization of multiple sclerosis (MS) lesions, the sensitivity of T2-weighted FSE sequences was compared to comparably weighted CSE sequences in the imaging of the brain in 100 patients with clinically suspected MS. The proton-density FSE sequence revealed more MS lesions than its CSE counterpart, while the T2-weighted CSE sequences were found to be more sensitive than the T2-weighted FSE sequence. Contrast-to-noise ratios and signal-to-noise ratios compared favorably between sequences. Overall, there was little difference in the specificity between FSE and CSE in the diagnosis of MS. The higher sensitivity and the reduction in time attainable through the use of FSE warrants its replacement of CSE when imaging the brain in patients with clinically suspected MS. J. Magn. Reson. Imaging 2001;13:657-667.

Intraorbital rupture of a cavernous internal carotid artery aneurysm: therapeutic options.

PURPOSE: To describe the use of an endovascular therapeutic technique in the management of a giant carotid cavernous aneurysm. METHODS: We reviewed the clinical and neuroradiologic findings of a patient with an unusual case of carotid cavernous aneurysm and intraorbital rupture. The medical literature was searched for similar cases and to review the use of endovascular techniques. RESULTS: The patient was treated by balloon occlusion of the left internal carotid artery. CONCLUSIONS: Endovascular techniques can be used to treat complex giant cranioorbital cavernous aneurysms.

Oculomotor nerve schwannoma: MRI appearance.

The magnetic resonance imaging (MRI) appearance of oculomotor nerve schwannoma is presented. The lesion appears as a 5-mm mass arising from the cisternal segment of the nerve and is isointense to brain parenchyma on T1- and hypointense on T2-weighted images. Intravenous Gadolinium injection results in intense enhancement of the tumor. Despite its rare incidence, schwannoma should be included in the differential diagnosis of nodular enhancement of the oculomotor nerve.

Focused abdominal US in patients with trauma.

PURPOSE: To evaluate the accuracy of focused abdominal ultrasonography (US) in detecting abdominal injuries that require in-hospital patient treatment in the setting of blunt abdominal trauma. MATERIALS AND METHODS: One thousand ninety patients with blunt abdominal trauma were assessed with focused abdominal US within 30 minutes of arrival at the hospital. Focused abdominal US results were positive if intra- or retroperitoneal fluid was detected. Patients with negative US results and no other major injuries were observed in the emergency department for 12 hours before discharge. Patients who deteriorated clinically after negative initial US underwent repeat US and/or emergency abdominopelvic computed tomography (CT). Patients with positive or indeterminate US results underwent emergency abdominopelvic CT. RESULTS: Nine hundred seventy-four (89%) patients had negative focused abdominal US results; eight of these underwent CT. Sixty-six (6%) had positive US results. Four (0.4%) had false-negative and 19 (1.7%) had false-positive US results. Twenty-seven (2.5%) had indeterminate US results; of these, five (18.5%) had positive CT results. One hundred twenty-four (11.4%) required emergency CT. After indeterminate cases were excluded, focused abdominal US had 94% sensitivity, 98% specificity, 78% positive predictive value, 100% negative predictive value, and 95% accuracy. CONCLUSION: Focused abdominal US has a high negative predictive value for major abdominal injury in patients with blunt abdominal trauma.

MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence.

OBJECTIVE: To investigate the role of MR imaging in detecting brachial plexus (BP) abnormalities in breast cancer patients with plexopathy but without palpable masses. DESIGN: MR imaging of the BP was performed on 26 breast cancer patients with brachial plexopathy without palpable regional masses, using 0.5 T and 1.5 T imaging systems. Findings were correlated with the clinical diagnoses. PATIENTS: Twenty-six patients with brachial plexopathy and history of breast cancer were enrolled in the study. All patients presented with plexopathy symptoms. Fourteen patients were positive and 12 patients were indeterminate for BP metastasis according to clinical criteria. RESULTS AND CONCLUSION: MR imaging demonstrated masses involving the BP representing metastases in two patients. Nine patients had other regional abnormalities with a normal brachial plexus. It is concluded that MR imaging is useful in the assessment and direction of therapy of brachial plexopathy in breast cancer patients by detecting both metastases to the BP as well as other abnormalities, unrelated to the BP, which may explain the patient's symptoms.

Brunner's gland hamartoma causing gastric outlet obstructive symptoms.

Brunner's gland hamartomas are rare benign tumors of the duodenum. They are usually small and asymptomatic. We describe an unusual presentation of a Brunner's gland hamartoma.