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Keltner JL, Satterfield D, Dublin AB, Lee BC. Dural and carotid cavernous sinus fistulas. Diagnosis, management, and complications. Ophthalmology 1987; 94:1585-600. [PMID: 3323984 DOI: 10.1016/s0161-6420(87)33258-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Carotid cavernous sinus fistulas (CCSFs) are a rare entity occurring as a result of head trauma and also spontaneously. The major threat from these fistulas is loss of vision. The authors reviewed 18 cases of direct and dural CCSFs seen over the last 10 years and compared our results with 553 cases treated in the literature. Seventy-one percent of our patients with direct CCSFs had successful balloon embolization. In the literature, successful closure of direct CCSFs has ranged from 58 to 100%. As experience with embolization techniques broadens, morbidity and mortality is reduced. The clinical features, diagnostic procedures, therapeutic options, and complications of treatment of CCSFs are discussed.
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Abstract
We report a case in which rupture of an aneurysm of the inferior thyroid artery caused respiratory arrest. The aneurysm was embolized successfully by an angiographic technique. Published reports of rupture of thyroid artery aneurysms are reviewed.
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McGahan JP, Dublin AB, Sassenrath E. Long-term delta-9-tetrahydrocannabinol treatment. Computed tomography of the brains of rhesus monkeys. AMERICAN JOURNAL OF DISEASES OF CHILDREN (1960) 1984; 138:1109-12. [PMID: 6095645 DOI: 10.1001/archpedi.1984.02140500015005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
High-resolution computed tomographic (CT) scanning of the brain was performed on three groups of rhesus monkeys for the detection of ventricular or cisternal enlargement. These three groups comprised four age-matched controls that had no prior drug usage--four monkeys receiving short-term (two to ten months) orally administered delta-9-tetrahydrocannabinol (delta 9-THC [now known nonproprietarily as dronabinol] and four monkeys receiving long-term (five years) orally administered delta 9-THC. Our results show a statistically significant enlargement of the frontal horns and the bicaudate distance in the long-term group as compared with the control and less significant enlargement of these areas in the long-term group compared with the short-term group. These findings suggest atrophy of the head of the caudate nucleus and the frontal portion of the brain of rhesus monkeys receiving long-term treatment with delta 9-THC.
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Dublin AB, Reid MH. Outpatient low-dose computed tomography metrizamide myelography and evaluation of lumbar disk disease. THE JOURNAL OF COMPUTED TOMOGRAPHY 1984; 8:113-7. [PMID: 6713922 DOI: 10.1016/0149-936x(84)90094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Outpatient low-dose computed tomography metrizamide myelography (CTMM) for the evaluation of lumbar disk disease is described in 55 patients. Ten individuals (group 1) were studied using 3.5 ml of 150 mg I/ml (525 mg I total) of metrizamide. Forty-five additional patients (group 2) were examined with 5 ml of 110 mg I/ml (550 mg I total) concentration of metrizamide. Group 2 experienced less post-procedure headache (6.6%) and nausea (2.2%) than did group 1 (30% and 10%, respectively). Group 2 demonstrated a lowered rate of headache (p less than .01) and showed a trend to less nausea (p less than .09) than a recently published study describing full-dose lumbar myelography. In addition, CTMM in group 2 produced more uniform mixing of metrizamide than in group 1. Overall, low-dose CTMM increased accuracy and reduced morbidity, patient cost, and inconvenience as compared with routine full-dose lumbar myelography.
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Reid MH, Dublin AB. QUAC: a modest proposal for optimal use of CT scanning equipment (a parody). AJR Am J Roentgenol 1984; 142:845-6. [PMID: 6608252 DOI: 10.2214/ajr.142.4.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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31
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Osborn RA, McGahan JP, Dublin AB. Sonographic appearance of congenital malignant astrocytoma. AJNR Am J Neuroradiol 1984; 5:814-5. [PMID: 6437185 PMCID: PMC8333647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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32
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Dublin AB, Baltaxe HA, Cobb CA. Percutaneous transluminal carotid angioplasty and detachable balloon embolization in fibromuscular dysplasia. AJNR Am J Neuroradiol 1984; 5:646-8. [PMID: 6237555 PMCID: PMC8335131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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33
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Abstract
Oily contrast material remaining after myelography may escape through the lumbar needle track and enter the dependent thoracic extradural spaces as droplets and collections in the intercostal spaces. Until these intercostal collections are absorbed, which takes place slowly over a period of one or more years, they can produce densities on the chest radiograph. The authors report 26 such cases representing three different patterns of distribution.
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Dublin AB, Baltaxe HA, Cobb CA. Percutaneous transluminal carotid angioplasty in fibromuscular dysplasia. Case report. J Neurosurg 1983; 59:162-5. [PMID: 6223132 DOI: 10.3171/jns.1983.59.1.0162] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A patient with fibromuscular dysplasia (FMD) of the internal carotid artery was treated by balloon percutaneous transluminal angioplasty (PTA). This is the sixth reported case of FMD stenotic disease which was dilated by PTA. All previous cases including the current example were treated successfully with resolution of symptoms. This procedure is associated with a relatively low morbidity and is an alternative method of treatment to operative endarterectomy for this disorder.
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Reid MH, Dublin AB. Single-blind/double-blind radiographic analysis: new viewing techniques. AJR Am J Roentgenol 1983; 140:825. [PMID: 6601400 DOI: 10.2214/ajr.140.4.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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36
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Dublin AB, McGahan JP, Reid MH. The value of computed tomographic metrizamide myelography in the neuroradiological evaluation of the spine. Radiology 1983; 146:79-86. [PMID: 6849071 DOI: 10.1148/radiology.146.1.6849071] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The diagnostic value of plain film metrizamide myelography (PFMM) was compared with computed tomographic metrizamide myelography (CTMM) in a study of 106 individuals who had undergone high-resolution computed tomographic scanning of the spine. CTMM provided more significant information than PFMM in 42 of 106 cases (40%), but showed no advantage over PFMM in 63 of 106 cases (59%). In 19 of the 42 cases (45%), PFMM was useful in directing the CT analysis to the appropriate region of pathology. In one patient, PFMM revealed a mobile herniated disc that had not been visualized with CTMM. In 30 of 106 cases in which plain CT scans of the spine were also obtained, the addition of intrathecal metrizamide demonstrated additional pathology in ten individuals. In general, CTMM was useful in the delineation of a variety of pathologic entities, especially neoplasms and congenital abnormalities. Low-dose CTMM (3 ml of a 150 ml/mg concentration) was performed as an outpatient procedure and found to be a useful adjunct to plain CT in two patients. A schema for the radiological evaluation of pathology of the spine is presented.
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37
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Dublin AB, McGahan JP, Lantz BM, Turkel DH. Carotid blood flow response to Conray-60: diagnostic implications. AJNR Am J Neuroradiol 1983; 4:274-6. [PMID: 6410719 PMCID: PMC8334944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The vasoactive effect of the angiographic contrast medium Conray-60 (iothalamate meglumine 60%) on carotid blood flow was studied by the video dilution technique in 26 subjects during routine neuroangiography. After a test series of 1 ml injections of contrast material into the carotid arteries at designated time intervals, an increase in carotid blood flow was found in normal controls at 30 sec, while a significant decrease in flow was observed in patients with atheromatous disease and avascular intracranial masses (p less than 0.01). Test responses in patients with intracranial aneurysm, neoplasm, and granulomatous vasculitis are also reported. The differential effect of contrast material on the cerebral circulation correlates well with several pathologic states of the central nervous system and may be used as a simple test to diagnose and evaluate a variety of vascular disorders.
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Lantz BM, Dublin AB, McGahan JP, Link DP. Carotid blood flow in man determined by video dilution technique: II. Vascular abnormalities. AJNR Am J Neuroradiol 1982; 3:295-303. [PMID: 6805278 PMCID: PMC8331677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Carotid blood flows were evaluated in 31 individuals with vascular abnormalities using the video dilution technique. In patients with stenoses, angiographically estimated at 70%, blood flow was usually, but not always, measured less than normal. The technique proved to be useful in the evaluation of the efficiency of collateral arterial pathways and in the evaluation of superficial temporal-middle cerebral arterial bypass grafts. It was also helpful in estimating contralateral increase in arterial flows with cross compression techniques for the preoperative evaluation of patients subjected to carotid sacrifice. In a limited number of patients video dilution flows correlated with the degree or proximal arterial spasm and were useful in the preoperative study of these patients. The demonstration of flow abnormalities in patient with seizure disorders may be useful in the medical and surgical management of these individuals.
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Dublin AB, Lantz BM, Link DP. Video dilution technique evaluation of an arteriovenous fistula: monitoring of detachable balloon embolization. AJR Am J Roentgenol 1981; 137:1249-50. [PMID: 6976101 DOI: 10.2214/ajr.137.6.1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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40
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Lantz BM, Dublin AB, McGahan JP, Link DP. Assessment of cerebral blood flow in man by video dilution technique: a preliminary report. Invest Radiol 1981; 16:181-7. [PMID: 7021460 DOI: 10.1097/00004424-198105000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Video dilution technique (VDT) is currently performed in conjunction with routine cerebral angiography to determine carotid blood flow in humans. Preliminary results indicate that the blood flows (as a percentage of cardial output) of the common, internal, and external carotid arteries are 8.5%, 5.5%, and 3.0%, respectively (SD less than 1%). In contradistinction to previous techniques, VDT provides a safe and highly accurate method of determining carotid blood flow in human subjects. The usefulness of this technique in normal and pathologic states is discussed.
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French BN, Cobb CA, Dublin AB. Cranial computed tomography in the diagnosis of symptomatic indirect trauma to the carotid artery. SURGICAL NEUROLOGY 1981; 15:256-67. [PMID: 7245012 DOI: 10.1016/s0090-3019(81)80004-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Five patients who were involved in motor vehicle accidents sustained indirect, nonpenetrating carotid artery injuries leading to cerebral infarction. Four patients were conscious when a severe lateralized neurological deficit developed three to 12 hours after injury indicating the presence of a vascular injury and not a mass lesion. In 3 patients with occlusion of the main stem middle cerebral artery, computed tomographic (CT) scans performed between 1 and 7 hours after the onset of the ischemic signs were normal, but all scans performed after 11 or more hours revealed progressive edema in a vascular distribution leading to a midline shift. The fifth patient had a severe diffuse brain injury and no apparent clinical pattern of a posttraumatic vascular complication. Sequential changes on the CT scans similar to those of the other patients led to the proper diagnosis of vascular injury; this was later confirmed by arteriography. Indirect, nonpenetrating injury to the carotid artery should be suspected in the presence of the typical clinical pattern or when serial CT scans show the evolution of progressive edema in a distribution atypical for traumatic contusion.
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McGahan JP, Graves DS, Palmer PE, Stadalnik RC, Dublin AB. Classic and contemporary imaging of coccidioidomycosis. AJR Am J Roentgenol 1981; 136:393-404. [PMID: 6781265 DOI: 10.2214/ajr.136.2.393] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Disseminated coccidioidomycosis should be considered as a diagnostic possibility whenever a patient has visited or resides in an endemic coccidioidal area and has a history of fever, skin rash, persistent pulmonary symptoms, bone pain, headache, or confusion. Imaging of this multisystem disease, especially of the lung, bone, and central nervous system, shows various protean manifestations that can simulate many infectious entities. The radiographic, scintigraphic, computed tomographic, or sonographic findings of this disease may be helpful in diagnosis, prognosis, and treatment follow-up in patients with disseminated coccidioidomycosis.
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Lantz BM, Dublin AB, McGahan JP, Link DP. Carotid blood flow in man determined by video dilution technique: 1. Theory, procedure, and normal values. AJNR Am J Neuroradiol 1981; 2:511-6. [PMID: 6797276 PMCID: PMC8335248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The blood flows in the common, internal, and external carotid arteries were determined as a percentage of the cardiac output by video dilution technique in 20 normal subjects during routine angiography. Nine women and 11 men, ages 19-63 years, displayed a mean flow in the common carotid of 8.5% (SD +/- 0.9%; n = 40); internal carotid, 5.3% (SD +/- 1.0%; n = 24); and external carotid, 3.2% (SD +/- 0.4%; n = 24). Relative flow is calculated by a modification of the Stewart-Hamilton principle. The technique is fast, simple, highly accurate, and avoids the errors connected with previous videodensitometric mean transit time techniques. The method can be used in routine angiography without prolonging the catheterization procedure or adding to the patient's risk or cost.
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44
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Lantz BM, Dublin AB, Donald PJ, Link DP, McGahan JP. Cerebral blood flow determination by video dilution technique in a patient with malignant chemodectoma. ACTA RADIOLOGICA: DIAGNOSIS 1980; 21:697-704. [PMID: 6263053 DOI: 10.1177/028418518002100602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cerebral angiography performed on a patient with a preliminary diagnosis of jugular foramen syndrome revealed a highly vascular malignant chemodectoma supplied mainly by the left ascending pharyngeal artery. Blood flow was determined during angiography in the extracranial branches of the carotid arteries by video dilution technique. The decrease of blood flow after partial embolization of the left ascending pharyngeal artery was also quantified. The application and value of video dilution technique in blood flow determination, together with the angiographic findings are discussed.
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45
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Dublin AB, French BN. Diagnostic image evaluation of hydranencephaly and pictorially similar entities, with emphasis on computed tomography. Radiology 1980; 137:81-91. [PMID: 7422865 DOI: 10.1148/radiology.137.1.7422865] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The radiographic evaluation of a spectrum of vascular cerebral damage is presented, ranging from simple porencephaly to the most severe form, classic hydranencephaly. With a combination of clinical materal and computed tomography, it is possible in most cases to arrive at a specific diagnosis of hydranencephaly or severe bilateral porencephaly. Pictorially similar entities, such as massive congenital subdural hematomas or hygromas, alobar holoprosencephaly, massive hydrocephalus, and massive postanoxic or infective encephalopathies, are discussed.
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Abstract
Fifteen cases of disseminated cerebral coccidioidomycosis (DCC) were evaluated by computed tomography (CT). Of the 14 patients with abnormal CT scans, all but 2 showed definite evidence of hydrocephalus. Abnormalities of the basal cisterns were present on non-contrast scans in 8 cases (53%). Ten (67%) demonstrated abnormal contrast enhancement of basal cisterns and other cerebrospinal fluid (CSF) spaces. White-matter lesions were detected in 6 cases (40%). Hydrocephalus usually follows abnormal enhancement of basal cisterns. A consistent relationship between active disease (as diagnosed by CSF complement fixation titers) and contrast enhancement could be demonstrated only in the first weeks of the illness.
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Dublin AB, Marks WM, Weinstock D, Newton TH. Traumatic dislocation of the atlanto-occipital articulation (AOA) with short-term survival. With a radiographic method of measuring the AOA. J Neurosurg 1980; 52:541-6. [PMID: 7373377 DOI: 10.3171/jns.1980.52.4.0541] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Three patients with traumatic atlanto-occipital articulation (AOA) dislocation are presented, and an additional 10 well documented cases are reviewed from the literature. Medulla oblongata and/or spinal cord deficits, and evidence of cranial nerve injuries were noted in eight patients. Angiographic evidence of vertebral occlusion or narrowing was demonstrated in four patients. One patient had systemic hypertension, presumably from bilateral traumatic ninth nerve injuries. Five patients ultimately died. A new method of measuring the AOA is introduced.
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Dublin AB, French BN. Cysticercotic cyst of the septum pellucidum. AJNR Am J Neuroradiol 1980; 1:205-6. [PMID: 6779600 PMCID: PMC8333532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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49
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Dublin AB, French BN. Cerebral aneurysmal rupture during angiography with confirmation by computed tomography: a review of intra-angiographic aneurysmal rupture. SURGICAL NEUROLOGY 1980; 13:19-26. [PMID: 6987759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rupture of a cerebral aneurysm during angiography, with confirmation by computed tomography (CT), is described. A review of 30 additional reported cases demonstrates no unusual profiles, with the exception of the predominance of female patients (71%), and the presence of pre-angiographic arterial hypertension. Experimental and clinical evidence increasingly suggests that intravascular pressures are transiently elevated during cerebral angiography. These changes may be enhanced by increased flow rates of contrast media, smaller diameters of the catheters, and the presence of intracranial arterial spasm, the latter presenting as a very prominent feature in intra-angiographic arterial rupture. However, direct evidence of elevation of the intra-aneurysmal pressure has not been documented, and may have occurred in only a portion of the cases.
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Abstract
Two cases of cystic metastatic melanoma are presented. The only reliable computed tomography sign of a true cystic lesion is the presence of an interface, such as between blood and tumor fluid. Differentiation of cystic metastatic melanoma from other cystic lesions of the brain is discussed.
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