Acute ischemic infarction defined by a region of multiple hypointense vessels on gradient-echo T2* MR imaging at 3T

BACKGROUND AND PURPOSE

During the hyperacute phase of stroke, multiple hypointense vessels were identified specifically in the ischemic territory on gradient-echo T2*-weighted MR images (GRE-T2* WI) at 3T. The area was named a "region of multiple hypointense vessels (RMHV)." The aim of this study was to assess the usefulness of RMHV for the diagnosis of acute ischemic stroke (AIS) and to establish the relationship of this finding to other MR imaging studies.

MATERIALS AND METHODS

Twenty patients with AIS underwent MR imaging at 3T consisting of GRE-T2*, diffusion-weighted images (DWI), and perfusion-weighted images (PWI) within 6 hours of symptom onset and follow-up images at 72 hours. RMHV was defined as an area containing multiple hypointense vessels strictly in the region of the ischemic territory on GRE-T2*. The RMHV volume on GRE-T2*, initial ischemic lesion volumes on DWI, PWI maps, and on follow-up images were measured and compared with the RMHV volume.

RESULTS

RMHV on GRE-T2* was identified in 20 patients. There was no significant difference between the ischemic lesion volumes on mean transit time (247.3 +/- 88.1 mL), time-to-peak (228.6 +/- 88.8 mL), cerebral blood flow (200.6 +/- 89.7 mL), RMHV on GRE-T2* (214.4 +/- 86 mL), and the infarct volume at 72 hours (210.3 +/- 90.4 mL) (P = .975).

CONCLUSIONS

RMHV on GRE-T2* can be used as a supportive imaging finding for the diagnosis of hyperacute ischemic stroke. RMHV volume provides information that is in accordance with the infarct volume at 72 hours and the data supplied by PWI.

Intraarterial Thrombolysis with r-tPA for Treatment of Anterior Circulation Acute Ischemic Stroke. Technical and Clinical Results

SUMMARY

To investigate factors effecting the safety and recanalization efficacy of local intraarterial (IA) recombinant tissue plasminogen activator (r-tPA) delivery in patients with acute ischemic stroke. Eleven patients with anterior circulation acute ischemic stroke were treated. The neurological status of the patients were graded with the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS). All patients underwent a computed tomography (CT) examination at admission. In addition four patients had diffusion-weighted and one patient had a perfusion magnetic resonance (MR) examinations. Patients were treated within six hours from stroke onset. Immediate, six hours, and 24 hours follow-up CT examinations were performed in order to evaluate the haemorrhagic complications and the extent of the ischemic area. The Rankin Scale (RS) was used as an outcome measure. Two of the 11 patients had carotid "T" occlusion (CTO), nine had middle cerebral artery (MCA) main trunk occlusion. Four patients had symptomatic haemorrhage with a large haematoma rupturing into the ventricles and subarachnoid space. Of these, three patients died within 24 hours. The remaining seven patients had asymptomatic haematomas that were smaller compared to symptomatic ones, and showed regression in size and density on follow-up CTs. At third month five patients had a good outcome and three patients had a poor outcome. In acute ischemic stroke, local IA thrombolysis is a feasible treatment when you select the right patient. Haemorrhage rate does not seem to exceed that occuring in the natural history of the disease and in other treatment modalities.

MR imaging, CT, and angiography features of endolymphatic sac tumors: report of two cases

Low-grade adenocarcinoma of endolymphatic sac origin is a rare tumor of the temporal bone. There are some difficulties in its differential diagnosis from other vascular and non-vascular tumors of the temporal bone. However its radiological differentiation from other tumors of the temporal bone is important for surgical planning. We present a report on two endolymphatic sac tumors with some specific radiological findings which can support a correct diagnosis.

Middle cerebral artery duplication associated with multiple intracranial aneurysms. Case report

We present a case of middle cerebral artery (MCA) duplication associated with ipsilateral distal MCA and contralateral MCA bifurcation aneurysms.

Value of transcranial Doppler ultrasonography in the diagnosis and follow-up of carotid-cavernous fistulae

The introduction of transcranial Doppler ultrasonography (TCD) has made it possible to examine blood flow characteristics in carotid-cavernous sinus fistulae (CCSF) in a noninvasive, relatively simple, and reliable way. This study investigated the usefulness of TCD in the diagnosis and follow-up of various CCSF subtypes. We found characteristic TCD findings associated with high-flow CCSF, but perhaps more importantly, found this technique to be an excellent tool also for detecting and following treatment results in low-flow CCSF. The low-flow fistulae exhibit less specific clinical signs and are harder to distinguish using the noninvasive radiological methods of computed tomography (CT) and magnetic resonance imaging (MRI). The impact of our findings on future approaches to the diagnosis and follow-up of these different types of acquired vascular shunts is also discussed. The conclusions were as follows: a) TCD parameters (blood flow velocity and pulsatility index) for CCSF are specific, and are thus valuable in the hemodynamic assessment of these lesions. b) Since dural CCSF feature more subtle hemodynamic changes and CT and MRI findings may be normal, these cases pose diagnostic challenges. In these situations, TCD reveals specific diagnostic findings and allows the examiner to determine whether cerebral angiography is indicated.

Determining optimal MRI follow-up after transsphenoidal surgery for pituitary adenoma: scan at 24 hours postsurgery provides reliable information

There is no agreed-upon schedule for MRI follow-up after pituitary adenoma removal via the transsphenoidal approach. Our aim was to establish a plan for MRI follow-up after pituitary surgery. Eighty pituitary adenoma cases (25 microadenomas, 30 macroadenomas that did not infiltrate the cavernous sinus, and 25 macroadenomas with cavernous sinus infiltration) were prospectively studied with MRI following tumor resection via the transsphenoidal approach. Each patient was imaged at 24 hours, at 3, 6 and 9 months, and at 1 year or more postsurgery. The parameters studied were residual tumor, synthetic packing material (Gelfoam) versus fat graft, and normal pituitary, hypophyseal stalk and optic chiasma. The size of the pituitary structure as a whole was also measured. The latter was studied quantitatively, and the findings for the rest of the parameters were evaluated qualitatively, based on the examiners' confidence in their assessment. The final MRI study, done at least 1 year postsurgery in all cases, was considered the reference MRI for all scans. MRI performed 24 hours after surgery was diagnostically accurate for residual tumor and valuable for visualizing normal sellar structures. The findings also showed that fat packing takes longer to resorb than Gelfoam, but produces no potentially confounding contrast enhancement. An algorithm based on the results is presented for postsurgical MRI assessment of pituitary adenoma patients in which the scan at 24 hours postsurgery is the major factor that determines the timing of later rechecks.

Cervical neural foraminal widening caused by the tortuous vertebral artery

A case of cervical neural foraminal widening due to tortuous vertebral artery is presented. This entity is rarely seen. Plain radiography, CT, 3-D CT angiography, MRI, and MRA findings of the case are presented and the importance of this vascular anomaly in the differential diagnosis of neural foraminal widening is discussed.

A rare cause of hyperprolactinemia: persistent trigeminal artery with stalk-section effect

The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are fetal anastomoses between the carotid and vertebrobasilar systems. Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the vertebrobasilar and carotid systems in adults. We report a case of PTA compressing the left side of the pituitary gland and stalk, in a patient with elevated blood prolactin level.

Magnetic resonance imaging characteristics of benign macrocephaly in children

Benign macrocephaly of infancy is a common problem in the child neurology practice. The radiologic features of this entity are not well defined. In most of the previous studies, macrocephalic patients were evaluated by computed tomography. To define the radiologic characteristics of this entity, 20 children with macrocephaly with normal neurologic examinations were enrolled in the study. All the patients were evaluated by magnetic resonance imaging studies. Sixty-five percent of patients had enlargement of the subarachnoid space and 35% of patients had megalencephaly. None of the patients had subdural collections. The mean age of patients with enlargement of the subarachnoid space was found to be younger than those with megalencephaly. The cases with parental histories of macrocephaly demonstrated both enlargement of the subarachnoid space and megalencephaly. Our results suggest that the radiologic finding of benign macrocephaly can be both enlargement of the subarachnoid space and megalencephaly.

Sagittal sinus thrombosis associated with thrombocytopenia: a report of two patients

Reported are two patients presenting with both thrombocytopenia and sagittal sinus thrombosis. The first patient is a 42-month-old male with no identified thrombophilic risk factors who developed acute neurologic symptoms after an acute infection. The second patient is a 22-month-old female with no history of preceding infection but had a positive lupus anticoagulant test. She also developed deep venous thrombosis and was treated with intravenous heparin. Both patients are currently doing well without neurologic deficits. To the authors' knowledge the second patient is the youngest reported patient with cerebral vein thrombosis associated with thrombocytopenia and lupus anticoagulant. These observations call attention to the need for a thorough investigation of thrombophilic risk factors in pediatric patients with thrombotic complications.

Evaluation of parietal pleural invasion of lung cancers with breathhold inspiration and expiration MRI

The goal of this study was to investigate the feasibility of detecting invasion of the parietal pleura by lung cancer with inspiratory-expiratory magnetic resonance imaging (MRI). Twenty-three patients with lung cancer in contact with pleura were studied with multisectional MRI during deep inspiration and expiration on the axial and coronal planes. Changes in the tumor's relation relative to the chest wall markers, vertebral bodies, or mediastinal structures were noted. Surgical correlation was available for each case. Twelve tumors were located at the right middle and lower lobes. Five patients who had a significant change in the position of the tumor were found not to have pleural invasion at surgery. The remaining seven tumors without change in their position with respiration were surgically found to invade the parietal pleura. Only 1 of the 11 upper lobe and apical segments of the lower lobe-located tumors showed a change in its position, which had no parietal pleural invasion at surgery. The remaining 10 tumors did not show any movement. Four of them had parietal pleural invasion that were surgically proven, and six tumors had no parietal pleural invasion at surgery. In conclusion, MRI performed during deep inspiration and expiration is a complementary method in detecting parietal pleural invasion for the tumors located in the lower and middle lobes.

Grading and hemodynamic follow-up study of arteriovenous malformations with transcranial Doppler ultrasonography

This study presents and tests the clinical validity of a hemodynamic grading system that depends on noninvasive transcranial Doppler ultrasonographic parameters. The suggested transcranial Doppler-based grading system was compared with the Spetzler-Martin anatomic grading for prognosticative validity and clinical dependability. We concluded the following: (1) The pulsatility index was shown to be a more dependable transcranial Doppler parameter in the clinical evaluation of an arteriovenous malformation because of two reasons: preoperative pulsatility index findings inversely correlated with arteriovenous malformation volume, and the pulsatility index returned to normal values before the mean blood flow velocity did. Therefore, hemodynamic arteriovenous malformation grading can be based on the pulsatility index. (2) A transcranial Doppler-based hemodynamic arteriovenous malformation grading system correlated highly with the Spetzler-Martin grading in predicting postoperative neurologic deficits and adverse radiologic findings. (3) The presented grading system may contribute to the standardization and quantification of the hemodynamic changes during multidisciplinary management of arteriovenous malformations.

Cervical spondylotic myelopathy: surgical results and factors affecting prognosis

OBJECTIVE

A variety of factors may affect surgical outcome in patients with cervical spondylotic myelopathy. The aim of this study is to determine these factors on the basis of preoperative radiological and clinical data.

METHODS

To assess the factors affecting postoperative outcome after surgery for cervical spondylotic myelopathy, the clinical and radiological data of 27 patients with cervical spondylotic myelopathy were reviewed. Functional and neurological statuses were assessed using the Japanese Orthopaedic Association (JOA) scale modified by Benzel. In all patients, the effect of age, symptom duration, cervical curvature, presence or absence of preoperative high signal intensity within the spinal cord as revealed by T2-weighted magnetic resonance imaging, and diameters of the spinal canal and vertebral body on pre- and postoperative neurological statuses were investigated. Plain radiographs were obtained for all patients, magnetic resonance images for 21 patients (77.8%), computed tomographic scans for 13 patients (48.1%), myelograms for 6 patients (22.2%), and computed tomographic myelograms for 4 patients (14.8%). There were five patients with a JOA score of 10, six patients with a JOA score of 11, six patients with a JOA score of 12, four patients with a JOA score of 13, four patients with a JOA score of 14, one patient with a JOA score of 15, and one patient with a JOA score of 16. All patients underwent cervical laminectomies. The mean follow-up period was 54.1 months. The final neurological examinations revealed improvement in the JOA scores of 85.1 % of the patients.

RESULTS

Statistical analysis of all patients revealed mean JOA scores of 12.185 +/- 1.618 and 14.370 +/- 2.15 before surgery and at final examination, respectively. The difference between the preoperative JOA score and the final JOA score was determined to be statistically significant (P < 0.0001). Statistical analyses also showed better neurological improvement in patients younger than 60 years and in patients with normal preoperative cervical lordosis. Although patients without preoperative high signal intensity of the spinal cord showed a better improvement rate than did patients with preoperative high signal intensity, the determined difference was statistically insignificant.

CONCLUSION

It can be concluded that age and abnormal cervical curvature predict less postoperative neurological improvement. The presence of preoperative high signal intensity within the spinal cord may also reflect less neurological improvement.

A new, more dependable methodology for the use of transcranial Doppler ultrasonography in the management of subarachnoid haemorrhage

The role of transcranial Doppler ultrasound (TCD) in clinical decision making about vasospasm due to subarachnoid haemorrhage (SAH), shows a great variation according to neurosurgical clinics. In this prospective study, a total of 143 patients, admitted to Marmara University Department of Neurosurgery between January 1991 to March 1995 and treated surgically with the diagnosis of aneurysmal SAH, were examined by TCD. Eighty of these patients fulfilled the requirements for inclusion. In order to increase clinical dependability of TCD, a new grading system is proposed and tested in comparison with the one previously used, which takes absolute flow velocities as the main parameter in grading. The new, individually based TCD grading system is proposed to minimize the pitfalls caused by proximal stenosis, wide range of normal Vm values and proximally evolving vasospasm. We concluded that: 1) The new, individually based TCD grading system has a high degree of clinical dependability. 2) Daily TCD examinations supply reliable predictive information about developing delayed ischaemic deficit (DID). If a TCD Gr II patient shows an increase of 35 cm/sec (in 24 hours) in Vm value, his probability of developing DID was found to be 60% (p < 0.05); if a TCD Gr B III patient shows the same rate of increase in Vm, his probability of developing DID was 80% (< 0.05). 3) TCD has an important clinical role in decision making about the management of SAH patients. 4) Surgical manipulation causes a reversible increase of one or two TCD-grades in the early postoperative days.

Multiple pineal cysts associated with an ependymal cyst presenting with infantile spasm

We present a unique case of infantile spasm in a patient with multiple pineal cysts associated with an ependymal cyst. Such a morphological etiology, to our knowledge, has not been described for patients with infantile spasm. Although postoperative neuroradiological studies demonstrated satisfactory surgical results, the patient continued to have seizures.

Intradural rupture of cervical vertebral disc

STUDY DESIGN

The authors discuss their experience with a patient who had cervical intradural disc herniation and relate the case to the relevant literature.

OBJECTIVES

The patient was evaluated with direct radiographies, myelography, electromyography, and computerized tomography, as well as with neurologic examination. The follow-up period was 10 months post-operative.

SUMMARY OF BACKGROUND DATA

Intradural disc herniation is a rare pathology nearly always confined to the lumbar region. In 1989, Katooka et al reviewed the existing literature and discovered 70 cases. Cervical intradural disc herniation, on the other hand, is much rarer, and there are only five cases in the literature.

METHODS

The patient's neurologic, neuroradiologic, and operative findings were evaluated and compared with the cases reported in the literature.

CONCLUSIONS

The five patients in the literature had signs of cord compression, but the present patient is the first with root compression.

Magnetic resonance imaging in the diagnosis of spinal hydatid cyst disease. Case report

A very rare case of multiple spinal hydatid disease causing paraplegia is presented. The neuroradiological evaluation included an MRI study. The surgical approach and the medical treatment of the disease is discussed, with a review of the literature.

Subependymal giant cell astrocytomas in tuberous sclerosis

Two cases of tuberous sclerosis with subependymal giant cell astrocytoma are presented. This rare autosomal dominant disorder was also detected in family members of the patients who had never had any symptoms of cerebral involvement. Both patients underwent surgery because of signs of increased intracranial pressure.

Pleomorphic xanthoastrocytoma associated with von Recklinghausen neurofibromatosis

The authors present a case of pleomorphic xanthoastrocytoma that occurred in a 14-year-old boy with von Recklinghausen's neurofibromatosis. The circumscribed tumor with a cystic component was located in the medial right temporal lobe. The designation of pleomorphic xanthoastrocytoma has been suggested for this neoplasm on the basis of its unique histological features. These include positive glial fibrillary acidic protein staining.

Computed tomography and magnetic resonance imaging in three patients with Tolosa-Hunt syndrome

Three patients with Tolosa-Hunt syndrome were examined by computed tomography (CT) and magnetic resonance imaging (MRI). CT of the brain did not reveal any definite abnormality in any of the patients. MRI demonstrated an abnormal soft tissue area in the cavernous sinus in only 1 patient. There was clinical improvement after corticosteroid therapy. MRI is mandatory for demonstrating lesions in the cavernous sinus or in the superior orbital fissure in patients with THS.

Magnetic resonance imaging in the diagnosis of idiopathic giant-cell granulomatous hypophysitis: a rare cause of hyperprolactinaemia

Idiopathic giant cell granulomatous hypophysitis is a rare disorder of pituitary gland characterised by a chronic inflammatory process. It can also be an extremely rare cause of hyperprolactinaemia. In this paper, we present our experience with two cases of idiopathic giant cell granulomatous hypophysitis manifested by hyperprolactinaemia, and their neuroradiological evaluation including preoperative MRI studies in one of them, and discuss our findings in the light of the literature.

The aid of computerized tomography in hemifacial spasm

Although the physiopathological mechanisms causing hemifacial spasm are not clearly understood, it is generally accepted that the causative factor is compression of the facial nerve at its root exit zone. In this paper we present seven cases of hemifacial spasm which were studied by dynamic CT scanning in the preoperative period, and treated with microvascular decompression. We suggest that CT scanning has considerable diagnostic value in disclosing the asymmetrical vascular formation causing root exit zone compression and that microvascular decompression should be the treatment of choice in this condition.

Meckel Gruber syndrome: a case diagnosed in utero

A case of Meckel Gruber syndrome is presented, diagnosed prenatally from the medical history of the mother which revealed a previous malformed stillborn with anencephaly, meningomyelocele, polydactyly and ambiguous genitalia. This was the first prenatally diagnosed case ever reported in Turkey. The clinical, computed tomography and postmortem findings and the related literature are reviewed.

Surgical considerations in patients with lumbar spinal root anomalies

Lumbosacral nerve root anomalies are rare and can cause diagnostic confusion. In this report we present 12 patients with lumbar root anomalies. Emphasis is placed on preoperative neuroradiological evaluation and the surgical implications of these anomalies.

Correlation between computed tomography and magnetic resonance imaging in diastematomyelia

Preoperative neuroradiological evaluation of diastematomyelia cases is of vital importance in order to increase surgical success rate. This paper reports the neuroradiological data of diastematomyelia cases in the light of surgical findings, and discusses the efficacy of CT and MRI in the evaluation of patients with diastematomyelia.

Low density in the posterior aspect of the intervertebral disk in the patient with herniated nucleus pulposus. A prospective study of 50 cases

It was previously reported that a low density are in the posterior aspect of the intervertebral disk is an additional computed tomography (CT) finding suggesting a herniated nucleuos pulposus. In this report the incidence of this finding, its correlation with the duration of symptoms and severity of herniation, were studied on 59 herniated intervertebral disks of 50 cases.

CT findings in malignant pleural mesothelioma related to nonoccupational exposure to asbestos and fibrous zeolite (erionite)

Endemic malignant pleural mesothelioma (MPM) in Turkey is related to two mineral fibers, tremolite asbestos and fibrous zeolite (erionite). Thirteen cases of MPM from the Cappadocian area, where the soil is rich in erionite, and 29 cases of MPM, from villages whose occupants have high asbestos exposure, were examined by CT. The CT findings of the two groups of MPM were compared with respect to the configuration of the pleural lesions, stage of disease, fissural involvement, pleural effusion, presence of calcified pleural plaques, and chronic fibrosing pleuritis. In erionite-related MPM the pleural lesions were flat and smooth in 69.1%; in asbestos-related MPM the lesions were nodular in 55.1%. Stage IV disease, calcified pleural plaques, and chronic fibrosing pleuritis were more common in the erionite-related MPM. The rest of the findings were similar in both groups. The early radiological diagnosis of erionite-related MPM may be even more difficult because of the similarity of the pleural lesions to chronic fibrosing pleuritis.

CT myelography in communicating syringomyelia

Although the etiology of syringomyelia is not clearly understood, many surgical methods have been proposed for its treatment. One widely used technique in cases of communicating syringomyelia is that of posterior fossa decompression and plugging of the obex (Gardner's Operation). In this paper we present five cases of syringomyelia which were investigated using detailed myelo-computerized tomographic techniques, of which two appeared to be communicating syringomyelia and which were treated by posterior fossa decompression and obex plugging. We also discuss the place of computed tomography in the differential diagnosis of communicating syringomyelia.

CT cisternography in evaluation of cerebrospinal fluid rhinorrhea

The clinical, radiological and surgical features of 14 patients who presented with cerebrospinal fluid rhinorrhea and had undergone surgical treatment during a three-year period are given with special reference to preoperative evaluation by CT cisternography. The merits and demerits of this technique are discussed.

Diagnostic value of computed tomography in spinal and lateral recess stenosis, preoperatively and for long-term follow-up: a prospective study in 50 cases

Preoperative measurements of lateral recess, anterior-posterior diameter of the spinal canal and interpedincular distance were made in 50 patients with low back pain. The results were compared with the surgical findings. The patients were followed up for two years. CT findings and clinical results were evaluated to determine whether preoperative CT could provide any evidence of failed spinal surgery in patients with recurrent symptoms.

Leukoaraiosis and intracerebral hematoma

We studied 33 consecutive patients with computed tomographic findings of decreased density in the periventricular white matter (leukoaraiosis). Computed tomograms in five (aged 56-75 years) of the 33 demonstrated intracerebral hematoma. The hemorrhages were situated in the thalamic area in four and in the parietotemporal area in one patient. These five patients were hypertensive and had signs characteristic of parenchymal hemorrhage. Three of the five patients had progressive dementia prior to the ictus, and two of the three also had a history of single or multiple strokes. There was no significant difference in the clinical findings of hematoma patients with or without leukoaraiosis.

Calcitonin and calcium combined therapy in osteoporosis: effects on vertebra trabecular bone density

Calcitonin is a hormone produced by the parafollicular cells of the thyroid gland. Like calcium salts, calcitonin acts by reducing bone resorption. In this study, 26 osteoporotic patients were given 100 IU salmon calcitonin for 10 days and, thereafter, 100 IU calcitonin every other day for 80 days combined with 1000 mg/day calcium salts. Prior to and after the combined therapy, the mean trabecular bone densities from the levels of thoracic 12 and lumbar 1 and 2 were obtained and routine thoracic and lumbar radiography performed. Combined calcitonin and calcium therapy for 3 months produced significant increases in vertebra trabecular bone density. The evaluation of the trabecular bone density and the number of non-traumatic compression fractures in 26 osteoporotic patients prior to the therapy did not indicate any close relationship between them. It is concluded that, in addition to other factors reported previously, microtraumas during daily activities have some effect on the incidence of fractures.

Chiari II malformation: computed tomographic evaluation

In this study cranial computed tomographic (CT) features of 28 cases with Chiari II malformation are presented. 26 of these cases had hydrocephalus (92.9%) and the fourth ventricle was either absent or small in 25 (89.3%) of the cases. Caudal displacement of the fourth ventricle was noted in 15 (53.6%) of the cases, and craniolacunia was present in 18 (64.3%) of the cases with seven of them being more than one-year-old (up to 18-years-old). We found CT to be a safe, non-invasive and effective method of elucidating the types of abnormalities associated with this disorder. Preoperative computed tomographic evaluation of patients with Chiari II malformation helps to differentiate it from other types of hydrocephalus, thus yielding a change in the operative approach.

Computerized tomography findings of the posterior fossa in children: etiology and clinical correlation

Of 1105 childhood cases who were evaluated by computerized tomography (CT) in a two-year interval, 93 who had posterior fossa abnormalities are reviewed. The cerebellar atrophies, either alone or accompanied by cerebral atrophy, were the most common morphological diagnoses. The clinical picture, etiology, and developmental state of the cases are discussed in relation to the CT findings.

Patchy cerebral white matter edema in chronic renal failure

Bilateral patchy cerebral white matter edema was observed in two children with chronic renal failure. Uremia in one case and hypertension or hyponatremia in the other appeared to be the cause of the neurological and radiological findings.

Pulmonary alveolar microlithiasis with the absence of technetium-99m MDP uptake of lungs

The authors report a patient with alveolar microlithiasis who was treated for miliary tuberculosis eight years earlier and whose Tc-99m MDP scan revealed absent lung uptake. Diagnosis was established by bronchoalveolar lavage. Both the roentgenogram and computed tomography of the chest confirmed alveolar microlithiasis.