Spontaneous CSF otorrhea caused by abnormal development of the facial nerve canal.

In two patients with surgically proved CSF fistula through the facial nerve canal, MR and CT examinations showed smooth enlargement of the geniculate fossa with CSF signal. In the clinical setting of CSF otorrhea or rhinorrhea, the presence of an enlarged labyrinthine facial nerve canal and enlarged geniculate fossa on CT scans and CSF intensity on MR images strongly suggests a CSF fistula through the facial nerve canal.

Iatrogenically induced cortical blindness associated with leptomeningeal enhancement.

Leptomeningeal enhancement is usually infective or neoplastic in origin. We present a case in which a patient received total parenteral nutrition via a catheter unknowingly placed within the right vertebral artery. We postulate that the hyperosmolar nature of the infused solution induced temporary osmotic disruption of the blood-brain barrier, resulting in cortical blindness associated with localized leptomeningeal enhancement.

Current role of CT in pediatric neuroimaging.

MR imaging is now the premier imaging modality for the evaluation of neurological disorders in children; however, CT remains a cost effective tool for the investigation of most disorders of the brain, neck, and spine.

The anterior epitympanic recess: CT anatomy and pathology.

PURPOSE: To describe the variation in size and shape of the anterior epitympanic recess and to discuss pathologic processes that affect this space. METHODS: Axial CT scans of the temporal bones of 31 adults and 19 children were reviewed retrospectively to ascertain the morphology and size of the anterior epitympanic recess. Selected confirmed disease processes involving this space were studied. RESULTS: The anterior epitympanic recess, which is consistently identified on axial CT scans, is either single or multicelled. In our study, it was made up of a solitary cell in 61 of 100 ears. Side-to-side symmetry in shape was present in 78 of 100 cases. The size of a solitary air cell ranged from 1.0 to 7.0 mm. CONCLUSIONS: The configuration of the anterior epitympanic recess is readily affected by a persistent stapedial artery, by facial nerve schwannomas, by hemangiomas of the facial nerve canal in the geniculate region, and by congenital and acquired cholesteatomas. Familiarity with the CT anatomy of this space facilitates recognition of these pathologic processes at an early stage.

Primary paraganglioma of the facial nerve canal.

We report two cases of primary paraganglioma of the facial nerve canal. This entity should be considered in patients presenting with facial paresis or pulsatile tinnitus. Paraganglioma should be considered when a lesion appears to arise from the facial nerve canal.

The pediatric patient with suspected adrenal neoplasm: which radiological test to use?

To establish which radiological test to use in a pediatric patient with suspected neoplasm, we retrospectively studied 19 children with proven adrenal neoplasm who had a combination of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The results show that US should remain the initial imaging modality for evaluating abdominal masses in children but that MRI is more accurate than CT and US in detecting the organ of origin and the extent of an adrenal lesion and should, therefore, be the modality of choice for the definitive evaluation of adrenal neoplasm in children.

Endoscopic evaluation of dysphagia in the elderly.

A survey of 100 consecutive endoscopies on elderly patients with suspected obstructive dysphagia is reported. Seventy-eight patients had positive findings and one to three lesions were reported in these cases. Benign stricture of the oesophagus was the commonest finding, and led to active treatment (dilation) in most cases either with Hurst bougies or Eder dilators. Fifteen patients had upper gastro-intestinal malignancy (12 oesophagus, three stomach). All of those with oesophageal carcinoma received some form of active treatment, either in the form of radiotherapy, surgery, dilation or Celestin tube insertion. Six patients with negative endoscopies had diagnoses established by other means and in 14 no cause was identified, but in four of these symptoms settled after endoscopy. The duration of dysphagia was not particularly helpful clinically. Two thirds of 'endoscopically normal' patients had short histories with dysphagia for less than 1 year, as did half of the patients with benign stricture. Most patients who were found to be malignant had experienced dysphagia for only a short time although one patient had a 4-year history! Upper gastro-intestinal endoscopy is a safe and valuable procedure in elderly patients with dysphagia and often leads to positive therapeutic intervention even in quite frail subjects.