Pseudotumor cerebri: clinical and neuroradiological findings

Pseudotumor cerebri (PTC) is a diagnosis per exclusionem applied to a condition of increased intracranial pressure in the absence of an intracranial infection, a space-occupying lesion, or hydrocephalus. Diagnostic criteria should include the evaluation of possibly disturbed cerebral venous outflow, which may result in similar clinical findings. Disturbed venous drainage should be separated from the syndrome of PTC because it represents a condition of well-defined origin and therapeutic regimen. Course and prognosis of PTC are not related to the increased intracranial pressure, the degree of papilledema, or to the duration of the disease. Functional cerebral disorders and EEG abnormalities are rare, indicating that brain tissue is not primarily affected. Correspondingly, computerized tomography (CT) scans with respect to the cerebrum are normal in about 90% of the cases; but enlarged optic nerve sheaths (46.7%) and empty sella (45.7%) are frequent findings on CT-scans. They most likely represent a direct consequence of long-term increased pressure within CSF spaces. This observation favors the assumption of disturbed CSF-pressure regulation either by increased production of CSF or its decreased rate of absorption. Brain edema (slit ventricles) as assessed by CT is a rare finding (11.4% of our cases). It may be a hint towards a different pathogenetic entity.

[3-dimensional (3-D) image reconstruction of the facial skull and skull base in computerized tomography]

The diagnostic value of three-dimensional (3-D) image reconstruction in conditions affecting the craniofacial skeleton and the skull base has been assessed and the results compared with the CT scans used. Owing to reconstruction artefacts and some limitations in the exact display of 3-D images, no substantial improvement in diagnosis can be expected. Nonetheless, 3-D images facilitate the analysis and detection of complex fractures of the craniofacial skeleton and improve surgical planning and postoperative evaluation.

[Cystic teratoma of the orbit]

Teratomas are rare cystic tumors of the orbit which lead to excessive congenital exophthalmos. They increase rapidly in size after birth and therefore require immediate surgical treatment. Initial puncture of the cyst under sonographic control prevents progressive mechanical damage to the globe and the optic nerve, providing sufficient time for the preoperative measures required prior to final surgical removal. The characteristic clinical features make it easy to identify a teratoma provided it has been taken into consideration in the differential diagnosis. It is shown with reference to one of the authors' own cases that a good functional result is possible after removal of the encapsulated tumor with preservation of the globe, even when the eye has been excessively displaced by the tumor.

Indium-111 platelet scintigraphy and two-dimensional echocardiography for detection of left ventricular thrombus: influence of clot size and age

Two-dimensional echocardiography and indium-111 platelet scintigraphy were performed on 50 dogs to determine the influence of clot age and size on the detection of experimentally induced left ventricular mural thrombus. Thrombus was induced by apical infarction and injection of a sclerosing agent and thrombin. The animals were classified into four groups according to the time of indium-111 platelet injection after thrombus induction: Group I (17 dogs, 1/2 hour after induction; 3 dogs, before induction), Group II (12 dogs, 24 hours after induction) and Group III (12 dogs, 1 week after induction). In Group IV (six control dogs) apical infarction was produced, but thrombin was not injected; indium-111 platelets were injected 1/2 to 1 hour after infarction. The dogs were studied by indium-111 platelet scintigraphy and by two-dimensional echocardiography 1/2 to 5 hours (Group I) and 1 to 5 and up to 72 hours (Groups II to IV) after platelet administration and before death was induced. Two-dimensional echocardiography showed the best overall sensitivity for detection of acute thrombus (97%; 29 of 30). The sensitivity of indium-111 platelet scintigraphy was 86% (18 of 21) for clots greater than or equal to 0.08 ml in size, and 67% (20 of 30) for detection of all clots. Thrombus did not form in 14 dogs of Groups I to III and in 6 of 6 control dogs. The specificity of scintigraphy was 100% (20 of 20) compared with 80% (16 of 20) for echocardiography. Echocardiography was more sensitive than scintigraphy for detecting very small clots in this experimental model.(ABSTRACT TRUNCATED AT 250 WORDS)

Antithrombin III (ATIII) Activity in Plasmas from Normal and Diseased Horses, and in Normal Canine, Bovine and Human Plasmas

Plasma Antithrombin III (ATIII) activity was quantitated in 24 clinically normal Standardbred/Thoroughbred horses using a clotting time technique. ATIII activity ranged from 80 to 106% of the pooled reference standard plasma, with a mean of 94%. Horses presenting with impaction or spasmotic colic (n=17) had normal plasma ATIII activity, while 15 horses presenting with acute diarrhea/colitis had significantly lower plasma ATIII activity with a mean of only 74% of the reference plasma. Seven horses presenting with liver disease had significantly higher plasma ATIII activity with a range of 127 to 177% of the pooled reference plasma. Fifty-seven equine plasmas were retested using a rapid chromogenic substrate technique for quantitating plasma ATIII activity. A good correlation (r =+0.83) existed between clotting time and chromogenic determinations of ATIII. Pooled normal canine, human and bovine plasmas had only 65, 62 and 79%, respectively, of the ATIII activity of the equine reference plasma.

[Otogenic extradural pneumatocele, 36 years after a gunshot injury]

In the reported case an extradural pneumatocele developed 36 years after the mastoid tip had been destroyed by a bullet. It had reached the occiput and led to destruction of the bone surrounding its distal end, so that air could be found directly under the galea. In the literature there are only few case reports referring the otogenic origin of a posttraumatic extradural pneumatocele. Furthermore, an overpressure in the middle ear cleft or mastoid could be excluded because of the presence of a tympanic membrane perforation. In spite of a chronically infected middle ear, there was no infection of the pneumatocele.

[Comparison of clinical findings and nuclear magnetic resonance tomography in syringohydromyelia and intramedullary tumors]

Magnetic resonance imaging allowed a distinct differentiation between syringohydromyelia (9 patients) and intramedullary tumour (2 patients). In syringohydromyelia the morphological evaluation showed a greater extension of the cavitation, especially in the caudal direction, than the estimation according to clinical findings. Tumours were visualised indirectly by changing the physiological shape of the spinal cord; therefore, small parts were not recognisable on magnetic resonance images but detected by the corresponding clinical symptoms. Clinical and morphological data were complementary and both necessary for a comprehensive appreciation of the pathological process.

Application of a high performance liquid chromatography method for screening of aldehyde dehydrogenase isozyme deficiency in hair roots from different ethnic groups

A sensitive high performance liquid chromatography method has been used to measure aldehyde dehydrogenase (ALDH) activity in hair roots from Caucasian and Japanese subjects. Kinetic studies confirmed previous isoelectric focusing results that hair roots from Caucasians have two forms of ALDH, one low Km form and another high Km form, while hair roots from Japanese individuals who show a flushing reaction after ethanol intake lack, or have low activity of, the low Km form. By taking the ratio of the activities measured at a low (3 microM) and a high (75 microM) concentration of the substrate (3,4-dihydroxyphenylacetaldehyde), a suitable index for ALDH deficiency was obtained. The ratio varied between 1.6 and 3.5 for Caucasians and between 7 and 23 for Japanese flushers, and it was 2.5 for a Japanese nonflusher. The current method allows a more quantitative and qualitative assessment of the ALDH isozyme pattern in hair roots than that obtained with the isoelectric focusing technique.

Magnetic resonance and CT imaging of diastematomyelia

The clinical, MRI and CT features of diastematomyelia with an uncommon clinical course are reported. Possible pathogenetic aspects in the late onset of symptoms are discussed implying vascular factors. MRI provides direct visualization of the split cord and low conus, confirming that frontal images are preferable.

[Neuroradiology, clinical picture and pathology of cerebral venous angiomas]

Twelve cases of venous angioma of the brain are presented. The neuroradiological and clinical findings in our series as well as in 45 previously reported cases are summarized. Angiography shows a normal arterial phase but consecutively a network or medusa-like pattern of numerous dilated medullary veins. converging towards one or several draining vessels with transcerebral course. The angiographic appearance is characteristic but not uniform, showing subgroups with faint blush, early filling veins and drainage into different directions. Some cases of venous malformations cannot be classified on the basis of angiographic findings and differentiation of telangiectases or cavernomas may be difficult. CT findings are non-specific, but contrast-enhanced CT almost invariably shows an enlarged transcerebral vessel, suggesting the presence of venous malformation. The lesion has to be classified as a vascular hamartoma. Although not an uncommon finding at autopsy venous angioma has been considered rare, because its clinical and radiological characteristics are little known. Though it may be asymptomatic, more than 30% of the reported cases (50% in our series) suffered from epileptic seizures. In about 10% of all cases symptoms of intracranial hemorrhage related to venous angioma were observed.

Pulmonary function in Klinefelter's syndrome

We evaluated pulmonary function in 24 patients with Klinefelter's syndrome. Of these, two had an obstructive defect, nine had a restrictive defect, and 11 had a decreased functional residual capacity. Since none had evidence of lung parenchymal disease, the restrictive syndrome may be due to chest wall abnormality.

[The radiological demonstration of vessels in embryos and foetuses. Comparative radiological studies of the venous system of the neck, head and brain in domestic animals. Paper 3 (author's transl)]

A method was developed for prenatal, post-mortem angiography, post-mortem angiography of the venous system of the brain, head and neck; its development was studied in the embryos and foetuses of 80 cattle, 20 sheep and 20 pigs with a crown-rump lenght of 19 to 155 mm. Radiological and corrosion preparations were studied. The embryonic and foetal venous systems were filled with thin barium sulphate through the umbilical and omphalic veins. The development and transformation of the cerebral veins and sinuses are compared and are related to the corresponding vascular anatomy of the adult animal and to man. The radio-embryological method for demonstrating cerebral vessels is also applicable to live foetuses.

Treatment effectiveness as judged by successfully and unsuccessfully treated alcoholics

Thirty-seven successfully and 46 unsuccessfully treated male alcoholics were asked to judge the effectiveness or ineffectiveness of six treatment methods routinely offered by a state hospital. For each treatment method, the total frequencies of judgments of most and least helpful, respectively, were as follows: detoxification (16%, 14%), lectures (16%, 20%), group therapy (54%, 7%), individual counseling (26%, 6%), work therapy (17%, 22%) and family therapy (13%, 14%). The two groups of subjects differed significantly in the frequencies of treatment methods judged to be "least helpful", but not in the frequencies of "most helpful" treatment. The similarity between the judgments of successfully and unsuccessfully treated alcoholics might reflect the positive effects of previous treatment in the unsuccessful group.

Rotational cerebral roentgenography. I. Evaluation of the technical procedure and diagnostic application with model studies

A rotational cerebral roentgenographic technique with a 70 mm camera is elaborated in model studies of the plain and cerebrovascular system. The tube-camera-unit rotates in a semicircle in 5 to 6 seconds around a skull placed in the isocentrum. All special projections of the skull are obtained routinely during one rotational manoeuvre, and intracranial calcifications, foreign bodies and abnormalities of the calvarium are demonstrated sequentially in oblique or tangential views. Studies of the basal cerebral arteries have shown that the localization, size and configuration of arterial aneurysms and stenoses can be demonstrated reliably without changing the position of the skull. An exposure frequency of 6/sec results invariably in excellent stereoscopic views. The diagnostic value and applicability of this technique is discussed.