MR imaging of the corpus callosum: normal and pathologic findings and correlation with CT.

The MR appearance of the corpus callosum was investigated in 80 normal volunteers. Normal variations in appearance were recorded with regard to age, gender, and handedness. The MR studies of 47 patients with a wide spectrum of callosal disease were also reviewed. Abnormalities included trauma, neoplasia, congenital abnormalities, vascular lesions, and demyelinating and inflammatory conditions. The information provided by MR was compared with that obtained from other radiographic examinations, particularly CT and angiography. In all cases MR provided as much, and frequently more, information than was obtained by other imaging techniques. We believe that MR should be the primary imaging technique for the evaluation of corpus callosal disease.

Long-term follow-up of lower lumbar fusion patients.

To determine the long-term effects of lower lumbar fusion, 94 subjects were catalogued from medical records. They had a lumbar arthrodesis at the third lumbar level or below and their operations were performed before 1964. Twenty-four were not located and 8 were deceased. Sixty-two subjects (72% of available sample) completed a telephone interview; 52 subjects completed a comprehensive low back questionnaire; and 33 subjects returned for physical examination, flexion-extension lateral lumbar spine films, and a limited computerized axial tomographic (CAT) scan. In general, the subjects who returned for complete evaluation were representative of the larger sample. Forty of 62 patients were men. Ages ranged from 41 to 83 years; the median age was 66 years, 6 months. Follow-up ranged from 21 to 52 years; the median follow-up was 33 years. Forty-four percent (27/61) were currently experiencing low-back pain, 57% (35/61) had back pain in the last year. Fifty-three percent (33/62) were using medication. Fifteen percent (9/62) had undergone repeat lumbar surgery, however, only 5% (3/62) required surgery as a late sequela (more than 10 years postoperatively). Forty-two percent (14/33) had lumbar spinal stenosis, but only 15% (5/33) had dural tube measurements less than 100 mm2. Segmental instability above the fusion was present in 45% (15/33). There was a significant correlation between segmental instability and lumbar spinal stenosis (r = .57, P less than .01). Neither radiographic condition correlated with symptoms, however.(ABSTRACT TRUNCATED AT 250 WORDS)

Distal cervical carotid dissection after carotid endarterectomy: a complication of indwelling shunt?

Technical factors and surgical techniques in carotid endarterectomy remain a controversial subject. The use of an indwelling arterial shunt has theoretical advantages in assuring intraoperative hemispheric perfusion and affording a more relaxed surgical environment. There has been little clinical demonstration, however, of superior results with carotid shunting. Although champions of routine shunting argue that it is a benign protective intervention, the possibilities of distal embolization or intimal disruption exist. The authors report a case of cervical carotid dissection far distal to the operative site that they postulate resulted from intimal disruption after routine shunt placement. This devastating complication from an otherwise benign procedure prompts reconsideration of the benefits and risks of routine shunt placement.