[Surgical aspects as a solution to carotid occlusive pathology. Clinical case]. / L'aspetto chirurgico come mezzo risolutivo della patologia occlusiva carotidea. Un caso clinico.

A significant clinical case presenting carotid occlusion pathology; successfully treated with the most recent surgical techniques is reported. The etiopathogenetic problem of this pathology which is of remarkable scientific interest in the medical literature is underlined.

Computed tomography study of pineal calcification in schizophrenia.

Computed tomography studies concerning pineal calcification (PC) in schizophrenia have been conducted mainly by one author who correlated this calcification with several aspects of the illness. On the basis of these findings the aim of the present study was to analyze size and incidence of pineal gland calcification by CT in schizophrenics and healthy controls, and to verify the relationship between pineal calcification and age, and the possible correlation with psychopathologic variables. Pineal calcification was measured on CT scans of 87 schizophrenics and 46 controls divided into seven age subgroups of five years each. No significant differences in PC incidence and mean size between patients and controls were observed as far as the entire group was considered. PC size correlated with age both in schizophrenics and controls. We found a higher incidence of PC in schizophrenics in the age subgroup of 21-25 years, and a negative correlation with positive symptoms of schizophrenia in the overall group. These findings could suggest a premature calcific process in schizophrenics and a probable association with 'non-paranoid' aspects of the illness. Nevertheless the potential role of this process possibly related to some aspects of the altered neurodevelopment in schizophrenia is still unclear.

Choroid plexus calcification as a possible clue of serotonin implication in schizophrenia.

Choroid plexus calcification (CPC) was measured on computed tomography (CT) scans of 87 schizophrenics and 46 controls divided into age subgroups. We studied the relationship between presence and size of CPC and age in both groups, whilst in the schizophrenic group we also investigated the possible correlation between CPC size and age of onset and duration of illness, duration of formal education, psychopathological features of the illness as well as some neuroradiological brain measures. CPC size correlated with age in healthy controls but not in schizophrenics. In the schizophrenic group, left choroid plexus calcification size correlated with the Scale for the Assessment of Positive Symptoms (SAPS) subscales scores of 'formal thought disorder' whilst right choroid plexus calcification size correlated with the ventricular brain ratio at frontal horns (VBRFH). The data are not conclusive, but a possible correlation with a dysgenetic or functional 5-HT alteration can be hypothesized.

[Magnetic resonance study of lesions of the cervical spinal cord in multiple sclerosis]. / Studio con risonanza magnetica delle lesioni del midollo cervicale nella sclerosi multipla.

Lesions consistent with demyelinating plaques were retrospectively identified in the cervical spinal cord of 15/49 patients (31%) with multiple sclerosis examined with cranial and cervical MR imaging. The lesions appeared as hyperintense areas on proton-density and T2-weighted images. Clinical signs and symptoms suggestive of spinal cord location of the demyelinating plaques were observed in 14 of the 15 patients presenting with spinal cord lesions at MR, and also in 11 of the 34 patients with negative MR findings. In 2 patients the cervical lesion was not associated with brain lesions at MR, while in 1 patient it was associated with medullary dilatation. Serial MRs revealed disappearance of the cervical hyperintense area in both patients, and reduction in medullary volume in the latter. Therefore, MR imaging of the cervical spinal cord is suggested as an useful examination in patients with suspected multiple sclerosis, particularly in those presenting with clinical signs and symptoms suggestive of spinal cord involvement.

Cardiac-gated phase MR imaging of aqueductal CSF flow.

The direction of CSF flow within the cerebral aqueduct was studied by cardiac-gated magnetic resonance (MR) phase images in five healthy volunteers and 10 patients with presumably normal cerebral CSF circulation. Caudal CSF flow was observed during systole and cranial flow during diastole. Using phantom based calibrations of the imager, aqueductal CSF velocities of 3-5 mm/s were calculated. Cardiac-gated phase MR is a potentially major tool for the investigation of the CSF circulation.

MR imaging in a case of Hallervorden-Spatz disease.

Magnetic resonance using a 0.5 T system and a T2-weighted spin-echo pulse sequence revealed symmetric areas of marked hypointensity of the globi pallidi in a case with a family history of and presenting with clinical features consistent with Hallervorden-Spatz disease. No such findings were seen in any of 16 normal volunteers of similar age. Magnetic resonance may be useful for diagnosing Hallervorden-Spatz disease.

Non-clinical tests for the diagnosis of multiple sclerosis.

Liquoral, Neurophysiological and Nuclear Imaging data were investigated in 29 patients suffering from Definite (11 cases), Probable (11 cases) and Possible (7 cases) Multiple Sclerosis (MS). The most sensitive tests were: Visual Evoked Potentials (VEPs), altered in 75% of patients, Motor Evoked Potentials (MEPs), abnormal in 75%, Nuclear Magnetic Resonance Imaging (MRI) in 72.4%. Somatosensory Evoked Potentials (SEPs) were altered in 69.2% in PN-SEPs and in 53.6% in MN-SEPs, whilst Brainstem Evoked Potentials (BAEPs) were altered in 30.8% of cases. The results suggest that patients with suspected forms of MS should be submitted, as routine diagnostic protocol, to a battery of EPs, including as a first choice VEPs, MEPs and PN-SEPs. MRI should be performed to confirm a diagnosis not supported by EP data, or for a comprehensive localization of the demyelinating plaques.

Bilateral temporal lobectomy for late radionecrosis after radiotherapy for acromegaly. A case report.

A patient with right temporal radionecrosis was submitted to temporal lobectomy for acute intracranial hypertension developed two years after radiotherapy for a GH-secreting pituitary adenoma. Eight months later, a partial left temporal lobectomy was performed because of further radionecrosis. In both instances the cerebral radionecrosis had the clinical and radiological characteristics of a space-occupying lesion. Bilateral temporal lobectomy was followed by a particular psycho-neurological syndrome with bilateral cortical deafness.

Benign extramedullary foramen magnum tumors: diagnosis by computed tomography.

This paper reports two cases of benign extramedullary tumors of the foramen magnum studied by computed tomography (CT). The first case was a neurinoma; the second was a meningioma. Several different CT findings allowed a correct preoperative diagnosis of the location and nature of the tumors. In view of the invasiveness of traditional diagnostic methods and of the encouraging, although limited, experience of the present cases, the role of CT in the diagnosis of these lesions is promising.

[Use of coronal sections in computerized tomography]. / L'impiego delle sezioni coronali nella tomografia computerizzata.

The authors emphasize the use of coronal cut in CT in sellar and parasellar lesions; in tumors involving the tentorium; in differential diagnosis between meningiomas of falx and parasagittal ones and in those lesions with extension into paranasal sinus and face. The purpose of this method is to evaluate the exact relationship of these type of lesions with adjacent structures in a tridimensional view.