Computed tomography, electroencephalography, and clinical features in the differential diagnosis of senile dementia. A prospective clinicopathologic study.

The accuracy of computed tomography, electroencephalography, and clinical features in the differential diagnosis of senile dementia was studied prospectively. Out of 50 demented patients, autopsy revealed 32 cases with either senile dementia of the Alzheimer's type (SDAT), multi-infarct dementia (MID), or a combination of both. Eighteen patients had dementia caused by other diseases. Based on a combination of computed tomography, electroencephalography, and clinical features, senile dementia of the Alzheimer's type was differentiated from all 50 patients, with a specificity of 83% and a sensitivity of 80%. Focusing on senile dementia of the Alzheimer's type, multi-infarct dementia, or a combination of both, specificity decreased to 65% and sensitivity to 47%. Comparing the different methods, multi-infarct processes were diagnosed with a higher sensitivity by the clinical features (73%) than by computed tomography (18%) or electroencephalography (18%). None of the methods validly differentiated multi-infarct dementia from a combination of multi-infarct dementia and senile dementia of the Alzheimer's type.

Transluminal angioplasty of stenotic carotid arteries: case reports and protocol.

Transluminal angioplasty of the carotid artery was successfully performed without complications in two patients, one with a stenotic internal carotid artery and one with a stenotic common carotid artery. Effectiveness of the procedure was proven by amelioration of common carotid flow. The authors outline factors to be considered in selecting patients for this procedure, including the particular cerebrovascular pathogenesis, type of stenotic lesion, clinical indications, and technique and materials used for dilatation.

[Cerebrovascular disorders in computer tomography]. / Zerebro-vaskuläre Affektionen in der Computertomographie.

Review of the aspect, cause, etiology and differential diagnosis of intracranial hematomas and cerebral infarcts. Some of the most important factors which influence CT-manifestation of vascular cerebral diseases are discussed.

[Computerized tomography of the orbita (author's transl)]. / Computertomographie der Orbita.

Computerized tomography of the orbita is today the most accurate method to determine the causes of exophthalmus. It can detect and localise precisely congenital, inflammatory and neoplastic disease of the orbita and its surroundings. Specific diagnosis is not always possible; it may be attained, if complementary neuroradiological methods are applied. Higher spatial resolution will probably allow to apply computerized tomography also to other, more discrete orbital diseases.

[Clinical study of the tolerance for 2 iodine containing contrast media for computerized tomography of the skull]. / Klinische Prüfung der Verträglichkeit zweier jodhaltiger Kontrastmittel für die Computertomographie des Schädels.

Clinical tolerance of two iodine contrast media (Na-methylglucamine-diatrizoate and Na-ioxitalamate) was tested in 1,628 patients requiring enhancing during computed tomography. Na-methylglucamine-diatrizoate was administered to 53.1% and the rest received Na-ioxitalamate. Infusion time was 4-6 min and the administered contrast quantity was 250 ml. Contrast medium injection was withheld from patients with known severe allergic disease, but in cases with known mild allergic reactions the contrast medium was given only after prophylactic administration of cortisone. Na-ioxitalamate was extremely well tolerated, causing only 0.11% (one patient) adverse effects, whereas in the case of Na-methylglucamine-diatrizoate a total of 42 side reactions were observed in 2.87% (22) of the patients. These reactions chiefly consisted of nausea and vomiting, which disrupted the CT examination and may endanger patients because of possible lung aspiration. Good tolerance of ioxitalamate seems mainly due to the chemical configuration of the organic iodine compound and the sodium salt of the contrast medium. The slow infusion time of 4-6 min - which is desirable in CT examination - contributes further to the good tolerance of ioxitalamate when different infusion times for this contrast medium are compared. The differing amount of iodine in the two contrast media and their different toxicity for the blood-brain barrier did not influence their enhancing quality, nor did these two factors modify relevant aspects for the diagnosis of intracranial lesions.

Normal computed tomography anatomy of the suprasellar subarachnoid space.

To assess normal variants of the suprasellar subarachnoid space, 680 CT scans were reviewed. Three main configurations with subgroups of the suprasellar cistern could be found: a large hexagon (60.7%), a small hexagon (17.6%) and a small tetragon (21.7%). In about a third of the scans, the region of interest was not visualized sufficiently. The large variety of CT appearance of the normal suprasellar space could be attributed to anatomical and technical reasons. To exclude a suprasellar mass lesion it is necessary to be aware of the anatomical variations, investigate the suprasellar region with additional intermediate cuts or contrast enhancement and define the cut level and osseous structures by a lateral skull radiograph.

Tomochemistry of the brain.

Noninvasive tomochemical analysis of normal and pathological brain tissues of seven patients has been performed with the technique of dual energy computed tomography. The variation of the effective atomic numbers observed in this experiment is relatively small, less than 6%, while the variation of the electron density is below 4%. Cerebral pathology involves complex variations of molecular constituents, even in macroscopically apparently simple lesions like edema, tumors, hemorrhage, etc. These molecular variations may have opposing, equalizing, or additive effects on the effective atomic number. Our results, supported by existing in vitro data, suggest that the clinical value of this technique is limited.

[The diagnosis of intracranial tumors by CT (computerized tomography) from a practical point of view (author's transl)]. / Praktische Gesichtspunkte zur Diagnose intracranieller Tumoren durch die Computer-Tomographie (CT)

In a historical abstract the mathematical basis of image reconstruction techniques and CT is reviewed. The enhancement of iodine contrast media is essential in CT diagnostic of space occupying intracranial lesions. Intracranial tumors usually show relatively characteristical but mostly non-specific absorption patterns. Additional clinical information is necessary for differential diagnostic evaluation. The development of tables with various tumor patterns is recommended. Absorption feature of primary and secondary brain-tumors with the surrounding edema is explained. Glioblastomas as well as metastases often show a distinct cerebral edema which has been observed in 64% of our patients with metastases and distinctly localized high dense foci in 69%. 6000 patients were investigated by CT and 1708 examinations were performed with contrast enhancement of other intravenously applicated contrast media.

[Chiasmatic syndromes-diagnostic possibilities with computerized tomography (CT)]. / Chiasmasyndrome-computertomographische Diagnostik

The normal suprasellar subarachnoid space (so-called "suprasellar hexagon") and its content are fairly well demonstrated by CT. Abnormal appearance (obstruction, stenosis, asymmetry) of this space is always suspect of a suprasellar space occupying lesion. Enhancing (intravenous application of iodine containing contrast medium) helps to delineate the exact tumor extension. The point of origin--important for deciding on the nature of a lesion--is often difficult to determine. The CT-pattern itself is not specific for a certain kind of tumor. We have observed a typical chiasmatic syndrome with all meningiomas of the tuberculum sellae, with 75% of the chromophobe adenomas and with 50% of the craniopharyngiomas. Absence of this syndrome was due to high position of the tumor (craniopharyngiomas) or to parasellar extension of the lesion (chromophobe adenomas). Diagnosis of recurrent tumor is difficult; it must be based on the post-operative CT-examination. Chiasmatic syndromes not due to the pressure effect of a space occupying lesion (i.e. chiasmatic syndromes of vascular, toxic or degenerative origin) can not be assessed directly by CT.

Computed tomography in the postoperative care of neurosurgical patients.

By its ability to differentiate the densities of various intracranial tissues, computed tomography is an ideal tool to investigate the postoperative course and complications of neurosurgical patients. The most important immediate postoperative complications are intracerebral edema and epidural, subdural or intracerebral hematomas. The extent of surgical resection of neoplasms can also be studied easily by CT. The method of investigation and representative cases are described.

[Computerized transverse axial tomography in the diagnosis of epilepsy; an electroencephalo-tomographic study (author's transl)]. / Die Computer-Tomographie in der Epilepsie-Diagnostik. Eine elektroenzephalo-tomographische Vergleishsstudie

193 patients with epilepsy were investigated by EEG and by computerized tomography (C.T.). 55.5% of the pathological C.T. scans were found in partial seizures with elementary symptomatology. In patients with generalized seizures the diagnosis of symptomatic epilepsy could be made in 40 cases (35.7%) with the help of computerized tomography. In 38 EEG there was a continual delta-wave focus, 18 of these with epileptogenic activity. Of these 38 patients, 34 showed a pathological result in computerized tomography. 19 tumors or metastases, 11 cases of atrophy (10 local and one diffuse) as well as one case of encephalitis could be diagnosed. The remaining 3 patients showed indefinate findings with C.T. 19 EEG showed intermittent theta-wave foci. Computerized tomography gave 5 pathological scans in these patients. If one compares the results of computerized tomography and EEG in cases of tumor, the agreement between positive tomography and the pathological EEG is very high (95%): 64 positive C.T. compared with 61 positive EEG. Our investigations with computerized tomography show organic findings in 67 of 193 epilepsies, that is about 35%.

[Contribution of axial computer assisted tomography to the diagnosis of aresorptive hydrocephalus]. / L'apport de la tomographie axiale computérisée (TAC) au diagnostic de l'hydrocéphalie arésorptive

In a comparative study, 18 patients presenting with progressive mental deterioration were investigated by means of radio-isotopic cisternography and by computerized axial tomography (CAT) in order to establish morphological criteria for CAT which would enable malresorptive hydrocephalus and atrophic hydrocephalus to be differentiated. Except for one case, malresorptive hydrocephalus was characterized by supraand infratentorial ventricular dilatation without any signs of cortical atrophy of the convexity. In most cases, ventricular dilatation was more important in cases of malresorptive hydrocephalus and, in 6 out of 7 cases, the trigone and the occipital horns were particularly dilated. Only in malresorptive hydrocephalus did we find less than juxtaventricular aedema greater than possibly indicating compensating transependymal absorption of cerebrospinal fluid. In atrophic hydrocephalus, on the other hand, CAT shows a moderate degree of ventricular dilatation associated with dilatation of the cortical sulci.

[Pre-operative embolisation of vascular tumours in the head (author's transl)]. / Die präoperative Embolisation gefässreicher Tumoren des Kopfes

Trans-vascular, pre-operative embolisation in order to reduce blood flow was carried out with excellent results in a patient with a naso-pharyngeal fibroma, and with relatively good results in a patient with a pterion meningioma. This technique can be carried out following the diagnostic angiogram through the same catheter; it reduces operative blood loss, improves haemostasis and the surgeon's view of the operative field. The method can be used simply and without risk in any case where the tumour blood supply is derived exclusively or predominantly from branches of external carotid artery.

The contribution of computerized axial tomography to the diagnosis of cerebellar and pontine hematomas.

Case histories are reported of seven patients in whom the diagnosis of cerebellar (four) or pontine hemorrhage (three) was made by computerized axial tomography (CT). In all of the patients except two the diagnosis, established on the basis of a space-occupying high absorption lesion, was proved by either operation or autopical for an intracerebral hematoma, i.e., the high absorption zone was transformed into an area of reduced density. It is concluded that CT is a highly reliable method for the diagnosis and location of posterior fossa hematomas. A CT syndrome, observed in four of the seven cases, is described consisting of a hydrocephalus with the tips of the posterior horns being filled with blood. This seems to be specific for a posterior fossa hematoma having penetrated into the fourth ventricle.

[Incidence of extra-arachnoid discharge following lumbar puncture]. / Die Häufigkeit extra-arachnoidalen Liquorausflusses nach Lumbalpunktion

Dimer-X is considered a good contrast medium for lumbar myelography. Its physical properties guarantee a homogeneous mixture with cerebrospinal fluid, with the result that postpunctural fluid leakage is easy to detect. One hundred Dimer-X lumbar myelographies were performed with two different spinal needles, a short beveled needle of 1.2 mm outer diameter and a special beveled "Quincke" needle of 0.7 mm outer diameter. Postpunctural fluid leakage is observed in 32% of the cases with the former and in only 12% with the latter. False-route injections occurred in 5% of the cases. Epidural leakage is the most frequent and can be detected by its "Christmas tree" appearance on antero-posterior X-ray. Subdural leakage is represented by a "railroad track" appearance on a lateral view. The leakage is observed more frequently in patients with normal myelogram (28%) than in patients with a herniated lumbar disc (18%).