Basal ganglia involvement in subacute sclerosing panencephalitis: CT and MR demonstration

We describe a case of subacute sclerosing panencephalitis (SSPE) with clinical parkinsonian features and neuroradiologic abnormalities of the basal ganglia. Prominent basal ganglia involvement may occur in SSPE.

A simple method to form an open loop with the sidewinder catheter for cerebral angiography

Reforming an open loop in the ascending aorta is the first step in performing selective catheterization of the aortic arch branches, using a sidewinder catheter. An alternative method for forming the open loop is described. The method is simple and safe. No failures were encountered in over 150 consecutive cases, thirty of which were by transaxillary approach.

Imaging sacral nerve root cysts

Sacral nerve root cysts usually are an incidental finding but may be found in patients with a history of pain. On computed tomography they are demonstrated as a soft tissue mass, possibly with associated bony erosion. Demonstrating the fluid-filled nature of these masses is important in establishing the diagnosis. The imaging of these cysts in two patients, including magnetic resonance, is described.

Magnetic resonance imaging of a spinal extradural arachnoid cyst

A case of extradural arachnoid cyst in the spinal canal of a 16-year-old male was diagnosed by magnetic resonance imaging. The diagnosis was verified by a metrizamide-enhanced computed tomographic myelogram. An operation with a favorable outcome followed. The noninvasive advantages of magnetic resonance imaging in such a diagnosis are demonstrated by this case.

Spinal cysticercosis

A case with cysticercosis cysts in the spinal subarachnoid space with unique myelographic features is discussed. One of the cysts moved within the spinal subarachnoid space during the myelographic examination. Recognition of the possibility that mobility of the cyst may occur between the time of the myelographic study and laminectomy is important for the surgeon.

Silicone encircling bands for retinal detachment: CT appearance

Silicone encircling bands are placed around the eyeball routinely during retinal detachment surgery. We present two cases that show the characteristic appearance of such a band on CT.

Control of swallowing by use of topical anesthesia during digital subtraction angiography

Involuntary swallowing and other forms of patient motion are the greatest source of image degradation in digital subtraction angiograms of the extracranial carotid and vertebral arteries. If a patient gargles with a recommended dose of 2% viscous lidocaine, the urge and ability to swallow are reduced and image quality is improved.

Spinal leptomeningeal infiltration by systemic cancer: myelographic features

Five cases of spinal leptomeningeal infiltration by systemic cancer are presented and myelographic features are discussed with a review of the literature. Common characteristic features are parallel longitudinal striations due to thickened nerve roots in the cauda equina and bizarre irregular filling defects with varying degrees of blocks, resembling arachnoiditis. Another pattern described in the literature consists of multiple nodular filling defects along the nerve roots of the cause equina.

Anomalous origin of the ophthalmic artery in a patient with amaurosis fugax

Ectopic origin of the ophthalmic artery from the middle meningeal artery was found in a patient with amaurosis fugax. The origin of the external carotid artery on the symptomatic side was markedly stenotic. The patient's symptoms disappeared after external carotid endarterectomy. We review the ectopic sites of the ophthalmic artery and discuss atheromatous disease of the external carotid system as a cause of transient ischemic attacks.

Intracranial complications of pediatric hematologic disorders: computed tomographic assessment

Computed tomography (CT) findings in the intracranial complications of leukemia, hemophilia, and sickle cell anemia were reviewed in 19 children with these hematologic disorders. CT demonstrated intracranial hemorrhage, infarction, intracerebral mass, and post-therapeutic atrophy and leukoencephalopathy in leukemic children. Intracerebral, subarachnoid, subdural, and epidural hemorrhage was documented in patients with hemophilia. Bland and hemorrhagic infarctions were identified in children with sickle cell anemia. CT proved valuable in documenting the presence and extent of these abnormalities, titrating factor replacement in hemophiliac patients, and monitoring therapeutic toxicity in leukemic patients.

Unilateral enlargement of the internal auditory canal: a developmental variant

Marked asymmetry of the petrous pyramids as seen on plain skull roentgenograms is reported in 3 patients with no clinical findings related to the region of the cerebellopontine angle. Polytomograms of the enlarged internal auditory canal in these patients demonstrated in intact crista falciformis and absence of cortical destruction. These roentgenographic features suggest that the asymmetry represents a developmental variant. When contrast enchanced computed tomography fails to demonstrate an abnormality in asymptomatic patients with an enlarged internal auditory canal, it is unnecessary to proceed with further neuroradiological study.

Diastematomyelia in an adult

Surgical treatment of diastematomyelia, with removal of the spur and dural septum, is indicated in adults with progressive symptoms. The patient may improve, or at least the progression of the neurological damage may be halted. The utilization of microneurosurgical techniques was found to be of value in decreasing the danger of spinal cord or nerve injury during the procedure. The seventh case reported in the literature of diastematomyelia with onset of symptoms in adult life is presented.

Sphenoid sinus mucoceles presenting as intracranial masses on computed tomography

Two cases of mucocele of the sphenoid sinus that presented as sellar and parasellar masses on computed tomography (CT) are presented. One mucocele was isodense while the other was hyperdense (100 Hounsfield units). Neither lesion demonstrated contrast enhancement. By delineating the total extent of the lesions, CT facilitated pre-operative diagnosis and surgical management.

Acute injuries of the upper thoracic spine associated with paraplegia

A review of 35 cases of acute injury of the upper thoracic spine associated with paraplegia was done. In 32, a fracture-dislocation was present; in two, there was a dislocation without associated fracture; and in one, neither fracture nor dislocation was identified. A total of 22 cases conformed to a pattern of injury consisting of anterior fracture dislocation with disruption of the intervening facets joints and various vertebral body fractures. Tomography was necessary for characterizationof the injuries. There was a 17% incidence of associated second level spinal injuries, usually a hyperextension injury of the cervical spine.

Computed tomography in isodense subdural hematoma

Isodense subdural hematomas, particularly bilateral ones, may be difficult to diagnose with CT. Forty-three cases of subdural hematomas were studied by CT, 7 of which were isodense collections. Obliteration or displacement of the cortical sulci in the zone of the extracerebral collection was present in all 7 cases. Infusion scans demonstrated displacement of a cortical vein away from the inner table of the skull in 3 of the 7 cases. This findins is helpful in accurately predicting the size of the extracerebral collection.

Intradiploic neural heterotopia. A rare calvarial defect

Two proved cases of intradiploic neural heterotopia of the skull, a rare cause of calvarial defects, are presented. The literature is reviewed. Common radiographic characteristics include an intradiploic rarefaction, a well-defined margin with or without sclerosis, a lobulated appearance with normal intervening bone, or a cluster of multiple lytic areas with normal bone between them.

Spontaneous closure of a dural arteriovenous malformation

A case in which closure of an arteriovenous malformation involving the dura mater occurred spontaneously is presented. The anatomy, pathophysiology and clinical symptomatology of such lesions are reviewed. Possible mechanisms of spontaneous closure of intracranial arteriovenous malformations are discussed.

Cyst of the intraorbital optic nerve sheaths

A 43-year-old woman had a history of gradual unilateral visual acuity loss and proptosis. A 2.5-cm cystic dilatation of the intraorbital dura mater was removed. Microscopic examination revealed a vascular proliferation within the leptomeninges. We inadvertently injected the lesion during orbitography, providing us with an unusual radiographic appearance.

Angiographic features of subdural empyema

Subdural empyema, a relatively rare intracranial suppurative disease, is a surgical emergency and requires early diagnosis in order to ensure patient survival. Subdural empyema should be considered with one or a combination of the following in conjunction with an extracerebral collection: (a) an irregular border of the extracerebral collection; (b) a thickened vascular wall of dura; (c) a semilunar avascular zone on the lateral view; (d) spasm of the large arteries at the base of the brain with or without segmental arterial dilatation; (e) multiple peripheral arterial occlusions; and (f) enlargement of the anterior falx artery. Four verified cases are presented.