THE PNEUMOENCEPHALOGRAPHIC FINDINGS IN VARIOUS FORMS OF CEREBELLAR DEGENERATION

The value of computerized tomography in the diagnosis of cerebellar atrophy

Computerized tomography was performed in 31 patients presenting clinical signs of cerebellar degeneration. CT abnormalities consistent with cerebellar atrophy were found in all cases but one. Specific patterns of abnormality were found in olivo-ponto-cerebellar degeneration and in alcoholic atrophy. The CT findings in spino-cerebellar degeneration were varied, ranging from severe diffuse cerebellar atrophy to normality, possibly according to age and duration of symptoms.

Evaluation of infratentorial atrophy by computed tomography

Eight parameters of cranial computed tomograms were examined from 121 controls, 33 patients suffering from paleocerebellar atrophy and 53 with widespread cerebellar atrophy. With the aid of step-by-step linear discriminant analysis the most important parameters were found and their normal and limiting values were calculated. With the help of correlation analysis the correlation between normal values and the age of the controls was investigated.

Degenerative disorders of the cerebellum studied by computerized tomography

A review of our cases as well as of the clinical and radiological literature indicates that, in instances of cerebellar degeneration, certain CT patterns are constant. The most reliable are: 1. Prominence of cerebellar sulci. These are usually not seen normally, except for some of the primary fissures; in atrophy the sulci are easily distinguished. 2. Enlargement of the superior cerebellar cistern and vermian cistern. 3. Enlargement of the cerebellopontine cistern. This cistern, which is also referred to as the cerebellopontine angle cistern and as the lateral recess of the cerebellopontine cisterns, is particularly prominent when the middle cerebellar peduncle is significantly involved. 4. Enlargement of the pre-pontine cistern, which occurs primarily with involvement of the pons. 5. The fourth ventricle may be enlarged, particularly in conditions where the midline cerebellar nuclei are affected. However, the enlargement of the fourth alone does not have to be associated with a pathological process. As previously established with pneumoencephalographic studies, the size of the fourth ventricle can be variable (14). Likewise, enlargement of the cisterna magna is not usually associated with any pathological condition of the cerebellum (15).

Computerized tomography in hereditary ataxias

Thirty-nine patients with hereditary ataxia (HA), hereditary spastic paraplegia or Charcot-Marie-Tooth disease were investigated with computerized cranial tomography (CT). Infratentorial as well as supratentorial atrophies were registrated and scored. These were compared with the patient's neurological symptoms, which were related to the lesion in the central nervous system, and scored. There was correlation between the distribution of brainstem/cerebellar symptoms and the distribution and degree of infratentorial atrophy. HA cases with cerebral cortical atrophy had significantly higher dementia scores than those without wide sulci. Intravenous injection with contrast medium was of no diagnostic aid, as no focal changes were found. It is concluded that CT is an aid in the diagnosis of hereditary ataxias and hereditary spastic paraplegia.

Cerebellar atrophy: the differential diagnosis by computerized tomography

Seven patients with cerebellar atrophy were studied by computerized tomography. The radiographic findings were varied. They included enlargement of the lateral cisterns, loss of superior cerebellar vermian substance with prominence of the superior cerebellar cisterns, and fourth ventricle enlargements. The patterns of posterior fossa atrophy may suggest the etiology.

Cerebellar atrophy: pneumoencephalography and computerized tomography correlation

Ten consecutive patients with clinical diagnosis of cerebellar atrophy were studied by both CT and PEG. CT and PEG findings on the fourth ventricle, cerebellar cortical sulci and cisterns around the brain stem were evaluated independently and compared according to the criteria based on actual measurements. In the diagnosis of cerebellar atrophy, CT and PEG were complementary, but PEG provided better diagnostic information in detecting minimal changes than CT at this stage of development.

The clinical significance of pneumographic cerebellar atrophy

The clinical significance of apparent pneumographic cerebellar atrophy has been studied in a group of 44 otherwise unselected patients found to have cerebellar atrophy, according to previously suggested criteria, at pneumoencephalography. Lateral and postero-anterior tomography of the posterior fossa was performed in all these cases. In each case the width of two or more sulci in the cerebellar vermis exceeded 2 mm. We have concluded that: (1) There is a relationship between the severity of pneumographic cerebellar atrophy and the severity of clinical signs of cerebellar disease (p = 0.03). (2) Severe or moderate atrophy of the vermis, whether generalized or focal, is usually associated with clinical signs of cerebellar disease, but mild atrophy of the vermis, equivalent to the "moderate" atrophy of previous studies, has no apparent diagnostic significance. (3) Atrophy of the cerebellar hemispheres, in the absence of atrophy of the vermis, is very unusual and it cannot, by itself, be correlated with clinical signs of cerebellar disease. (4) In individual cases, assessment of the significance of pneumographic cerebellar atrophy cannot be made without adequate clinical information.

Statistical correlations of diffuse cerebral atrophy, with special reference to diagnostic and aetiological clues

To evaluate diagnostic and aetiological clues for diffuse cerebral atrophy, the statistical correlations between 35 pneumoencephalographic and 97 clinical variables in 268 patients were analysed. Each case of diffuce cerebral atrophy was originally of unknown cause, and all had pneumoencephalography. Ventricular diffuse atrophy correlated positively with psychic and co-ordinative impairment and dysarthria, and cortical diffuse cerebral atrophy with psychic impairment (P smaller than 0.01 to 0.001). There was a close correlation (P smaller than 0.001) of cortical diffuse cerebral atrophy with use of vibrating tools at work. Psychic impairment combined with co-ordinative dysfunction and dysarthria is an unspecific syndrome, but should make one think of diffuse cerebral atrophy, Arteriosclerosis, abuse of alcohol, and vibrating tools at work appear to have aetiological significance for some types of diffuse cerebral atrophy. Thus the number of patients with idiopathic diffuse cerebral atrophy may rapidly decline.