Traction-induced rupture of an extracranial vertebral artery aneurysm associated with neurofibromatosis. A case report.

STUDY DESIGN: This report describes presumed traction-induced rupture of a vertebral artery aneurysm in a patient with neurofibromatosis Type I. OBJECTIVE: To draw attention to the need for preoperative arteriography in the surgical management of severe cervical kyphosis in neurofibromatosis. SUMMARY OF BACKGROUND DATA: Aneurysmal dilatation is a rare but well-documented manifestation of neurofibromatosis. The complication of rupture of a vertebral artery lesion has not been described previously. METHODS: The clinical features of the reported complication in a 56-year-old woman are detailed. RESULTS: A successful outcome was achieved by embolization and later anterior and posterior spinal fusions. CONCLUSIONS: Vertebral arteriography should be part of the preoperative assessment of neurofibromatotic cervical kyphosis. Skull traction may produce aneurysmal rupture.

Costs of magnetic resonance imaging services in public hospitals.

Audited cost data from two public hospital installations participating in a trial of the utilisation and efficacy of magnetic resonance imaging are presented. The data cover the period July 1987 to June 1988 when both installations had attained stable patterns of operation. One hospital operated a superconductive system and the other a resistive magnetic resonance imaging unit. Depreciation and salaries represented the major components of cost.

An evaluation of magnetic resonance imaging at The Royal North Shore Hospital of Sydney, 1986-1987.

The diagnostic accuracy and clinical utility have been evaluated of 2810 consecutive magnetic-resonance-imaging examinations that were performed on a 1.5-T Signa magnetic-resonance-imaging unit at The Royal North Shore Hospital of Sydney between November 1986 and December 1987. The average accuracy of magnetic resonance imaging was 80%, and ranged from 21%-98% in various brain-disease and spinal-disease categories, compared with the average provisional premagnetic-resonance-imaging diagnostic accuracy of 64%, and an average accuracy of computed tomography of 45%. Clinical follow-up at three months after magnetic-resonance-imaging investigation indicated that, as a result of the magnetic-resonance-imaging examination, patient management was altered in 70% of cases, and patient outcome was altered in 62% of cases.

Infarction of the conus medullaris--clinical and radiographic features.

A 53-year-old woman experienced an acute onset of flaccid weakness of the legs associated with severe abdominal and lower limb pain. Sensory loss extended from L3 to S5. Constipation, recurrent abdominal pain and urinary retention were problems during the course of her illness. Six months after the onset the patient could walk with assistance. A myelogram and CT scan of the lower dorsal and lumbar spine showed no abnormality. Magnetic resonance imaging confirmed the diagnosis of infarct of the conus medullaris. This case highlights the clinical features of spontaneous infarction of the conus medullaris and emphasises the value of magnetic resonance scanning for the diagnosis of lesions of the spinal cord.

Acoustic neuroma in a child treated with the aid of preoperative arterial embolization. Case report.

A child is described who presented with a large right vascular acoustic neuroma causing raised intracranial pressure and brain-stem compression. Ventriculoperitoneal shunting and arterial embolization were performed prior to total tumor excision. Acoustic neuromas are a rarity in childhood, and preoperative arterial embolization has infrequently been described as an adjunct to acoustic neuroma surgery.

Venous ACTH sampling in Cushing's syndrome.

A case of Cushing's syndrome in a 36-year-old woman, in whom the corticosteroid levels remained elevated in peripheral blood despite high doses of dexamethasone (8 mg/day), is reported. Although, on her skull X-ray film, the pituitary fossa was seen to be asymmetrically enlarged and had signs of possible erosion and depression of the floor on the left, the question whether this was an anatomical variant was raised. The correct diagnosis was made after measuring ACTH levels in venous blood samples taken from multiple sites, including the left petrosal sinus, in which a significant elevation of ACTH level, compared with the level in peripheral blood, was found.

Embolisation of cerebral arteriovenous malformations.

Seven patients with inoperable cerebral arteriovenous malformations have been treated with embolisation using Silastic spheres and plugs. Indications for using this technique were intractable migraine, episodes of cerebral ischaemia ('steal' syndromes), intracranial haemorrhage, and partial or generalised epilepsy. All 7 patients had been treated medically for between 5 and 25 years with unsatisfactory control of symptoms. Four of the 7 patients obtained some improvement which appeared related to the reduction in flow through the malformation. Although there are risks associated with embolisation, it would seem to be a worthwhile procedure in selected cases.

An evaluation of a high resolution closed-circuit television link in a hospital radiology department.

We have installed and developed a high resolution closed-circuit television system for transmission of radiographic film images from the emergency room in our hospital to the reading room in our radiology department. Using this system, the radiologist can consult promptly on all films and he has increased efficiency. To transmit high detail images, our television system uses a high resolution vidicon camera with a scan rate of 1029 lines and with a limiting resolution of 1200 TV lines. To further increase the overall diagnostic value of our system, we have added remote controls for changing the magnification, illumination and position of the film. In a preliminary clinical trial, seven radiologists were each shown 27 patient film sets transmitted through the television system and then viewed directly on a conventional view box. An analysis of variance of the accuracy rates in each method showed a statistical difference in methods. Even though the error rate was slightly higher using closed-circuit system, radiologist performance was of acceptable accuracy when considering the advantages of the system. In addition, many of the factors reducing the TV system performance have been eliminated or controlled, and further experiments should reflect an even smaller difference between the two methods.