Dandy-Walker syndrome revisited

The Dandy-Walker syndrome is said to be associated with a high incidence of mental retardation and motor dysfunction leading some to suggest termination of the affected fetus in utero. Since this view seemed contrary to our experience, we reviewed 19 patients with the Dandy-Walker syndrome diagnosed from 1966 to 1983. Thirteen patients with Dandy-Walker syndrome were diagnosed before 6 months of age and followed for more than 2 years (mean: 10 years). In the absence of other associated major abnormalities, 7 of 8 (88%) are functioning well and have attended regular schools. Two of these seven have had special help with isolated learning problems. None of these patients have significant motor disability. One additional patient with normal intellectual and motor function died of acute shunt malfunction. In the remaining 4 patients with Dandy-Walker-associated abnormalities, 3 (75%) have severe intellectual retardation and spastic cerebral palsy. Five of six patients (83%) with Dandy-Walker syndrome diagnosed after 6 months of age are normal. The outcome of patients with Dandy-Walker syndrome appears far better than previously reported.

Computed tomographic three-dimensional localization and compositional evaluation of intraocular and orbital foreign bodies

A software program designed for the Siemens Somatom DR3 computed tomographic (CT) scanner provides improved diagnosis, localization, and etiologic description of intraocular and orbital foreign bodies. The program allows information to be analyzed in two different display formats. One format is that of multiplanar reconstruction of the eye and orbit, including an "oblique CT cube" image. This format produces an accurate "three-dimensional" display of both in vitro and in vivo intraocular and orbital foreign bodies. The second display format is that of a histogram. Using this analytic mode, nonmetallic intraocular and intraorbital foreign bodies can be differentiated from each other and from metallic foreign bodies, although individual metallic foreign bodies cannot be identified with respect to specific composition. The information provided by these two display formats substantially aids the clinician in the diagnosis and management of foreign bodies located within the orbit, particularly those located within the eye.

CT myelography for outpatients. An inpatient/outpatient pilot study to assess methodology

The diagnostic usefulness, limitations, and adverse reactions associated with computed tomographic myelography using metrizamide were assessed for broad outpatient application. The initial approach was to examine inpatients (n = 38) with low-dose metrizamide (100 mgI/ml). This low dose was believed less likely to be associated with side effects. They were then treated as if they were outpatients, with the liberties this entailed. The consequences of needle puncture were minimized by using a 25-gauge disposable needle. Thirty-four (89%) patients remained free of side effects after the procedure. Subsequently, this technique was extended to 42 outpatients, 38 (90.5%) of whom remained asymptomatic. For comparison, 170 mgI/ml was used in another 25 outpatients, who evidenced more symptoms. The potential medical, economic, and therapeutic benefits of obviating hospitalization by safer outpatient CT myelography seem clear.

Functional endoscopic sinus surgery. Theory and diagnostic evaluation

The keys to functional endoscopic sinus surgery are an understanding of the underlying mechanisms of paranasal sinus disease and the ability to diagnose the causes accurately. Previously unrecognized causes of recurrent acute sinusitis and of chronic sinus symptomatology can now be identified by careful diagnostic evaluation. Systematic nasal endoscopy and high-resolution computed tomographic imaging provide complementary diagnostic information that can allow for the recognition of problems not identifiable by other means. The ability to diagnose these problems and to correct them with functional endoscopic surgery heralds new possibilities in the field.

Sacral abnormalities in Marfan syndrome

Five women with Marfan syndrome had abnormalities of the sacrum disclosed by computed tomography. Each had evidence of expansion of the central sacral spinal canal and enlargement of sacral foramina associated with extensive bony erosion. Three patients complained of low back pain, two were asymptomatic. Sacral meningoceles were demonstrated in three cases (including two of the three with symptoms). A fourth patient had a thoracic meningocele. The sacral abnormalities are attributed to defective collagen resulting in expansion of weakened dura which leads to pressure erosion of contiguous osseous structures.

Myelography in achondroplasia: value of a lateral C1-2 puncture and non-ionic, water-soluble contrast medium

Because of technical difficulties and diagnostic limitations encountered with other myelographic techniques in patients with achondroplasia, the authors employed a lateral C1-2 puncture and non-ionic, water-soluble contrast medium in 18 achondroplastic patients with spinal compression (21 procedures). This technique proved most appropriate for identifying the upper limit of degenerative osteophytes causing exacerbation of congenital spinal stenosis, which is crucial in planning decompressive surgery. A potentially important additional finding was the presence of degenerative lower cervical spine disease in the majority of patients. There were no serious complications. The authors recommend this technique as safe and effective in achondroplastic patients with severe congenital spinal stenosis.