Clinical-pathologic correlation in Huntington's disease: a neuropsychological and computed tomography study.

To examine the premise that cognitive impairment in Huntington's disease (HD) is related to striatal degeneration, we determined those cognitive deficits most closely associated with linear CT indices of brain atrophy in HD. We systematically evaluated 60 drug-free HD patients who were judged to be in stages I (n = 34) or II (n = 26) of illness. All subjects underwent comprehensive neuropsychological assessment covering a broad spectrum of cognitive operations and standardized head CT imaging for determination of frontal horn (FH), intercaudate (CC), and outer-table (OT) distances. We grouped the cognitive test results, based on a principal-component factor analysis, to form factors 1 (complex psychomotor), 2 (verbal memory), 3 (visuospatial), and 4 (general knowledge). Factors 1 and 3 sharply discriminated between subjects in stages I and II of illness. Factors 1, 2, and 3 correlated strongly with CC/OT, an index of caudate atrophy, whereas only factor 2 correlated with FH/OT, an index of frontal atrophy. These data demonstrate that cognitive impairment is a clear-cut characteristic of early HD that is linked closely to the extent of caudate atrophy as measured by CT.

Blunt trauma to the carotid artery with transient deficit and early repair.

Blunt trauma to the carotid artery is an uncommon but easily overlooked source of neurological deficit. The prompt diagnosis and angiographic definition of carotid-artery injuries can allow early operative intervention in these potentially devastating lesions. We describe a case report of blunt trauma with transient deficit in a patient who underwent direct repair via Dacron-patch angioplasty.

Is routine angiography necessary prior to carotid endarterectomy?

The records of 111 consecutive patients undergoing evaluation for possible carotid endarterectomy at the University of Rochester were reviewed. All patients had noninvasive evaluation (oculoplethysmography-Gee and direct, continuous-wave Doppler ultrasonography) as well as selective carotid angiography. Patients were grouped by clinical presentation to ascertain the relative importance of angiography in determining the need for surgery. Arteriography added nothing to clinical and noninvasive evaluation in over two thirds of patients with hemispheric cerebral symptoms or asymptomatic carotid bruits. In contrast, we found that almost all patients with nonhemispheric symptoms required angiography for adequate evaluation prior to surgery. The implication of these findings on preoperative evaluation of patients with carotid surgery is discussed.

Comparison of iohexol and meglumine-Na diatrizoate in cerebral angiography.

A double blind investigation comparing meglumine-Na diatrizoate (290 mg I/ml) and iohexol (300 mg I/ml) showed that patients receiving iohexol experienced significantly less discomfort. Patients who received diatrizoate commonly showed transient episodes of hypertension while those who received iohexol either showed no changes or transient episodes of hypotension. No significant changes in heart rate were observed in either group.

The role of computed tomography in the diagnosis and management of brain tumors.

This review article emphasizes the role of computed tomography in the diagnosis and management of brain tumors. The head CT scan has become one of the most precise noninvasive tests in the neurosciences. It has given clinicians more information than they were able to obtain in the past. The subject is covered by subdividing it into several categories: detection of true tumor extent, radiation treatment planning, the immediate postoperative period, treatment responses, failure patterns, detection of radiation-induced damage, and the potential to predict histopathology. The paper is illustrated with examples that emphasize the advantages and some of the limitations of computed tomography as it exists today.

Ruptured teratoid tumor in the pineal region.

Distinctive plain X-ray and computer assisted tomography (CAT) findings led to the diagnosis in a case of teratoma in the pineal region and helped avoid invasive investigations. The demonstration by CAT of the location and size of the tumor as well as the presence of marked hydrocephalus directed the patient's therapy to ventriculoperitoneal shunting and radiation.

Characteristics of calcification in tumors of the pineal gland.

Thirty-two cases of proved pineal tumor were analyzed. Calcification was seen in 75%. The size, character, and position of the calcification were useful indicators of abnormality on plain-film evaluation. Fray's cranioangle method was more sensitive than Oon's method in determining abnormal position of the calcified pineal tumor on the lateral skull film. Most calcifications were displaced postero-inferiorly or inferiorly, which can be explained by obstructive hydrocephalus or direct tumor expansion.