Biomedical subjects
Publications and source records attributed to C R Fitz.
Pituitary enlargement can occur as a result of primary hypothyroidism. We present a newborn with pituitary enlargement and congenital hypothyroidism secondary to a lingual thyroid gland. Thyroid hormone therapy caused a regression of pituitary enlargement.
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PURPOSE: To review the cranial CT and MR examinations of 29 children with perinatally transmitted HIV infection and correlate the imaging findings with clinical and pathologic data. METHODS: 28 children were examined with CT, four with MR. RESULTS: CT abnormalities were seen in 25 children studied (89%), including cerebral atrophy (25 children), basal ganglia calcification (10 children), periventricular frontal white matter calcification (four children), cerebellar calcification (one child), white matter low attenuation areas (two children), intracranial hemorrhage (three children) and cerebral infarction (one child). Intracranial calcifications were only seen in association with cerebral atrophy and were never seen prior to 1 year of age. Calcifications in the periventricular white matter or cerebellum were always associated with basal ganglia calcifications. MR abnormalities were seen in all four children studied; cerebral atrophy (four children), areas of high signal intensity in white matter (four children), loss of normal posterior pituitary high signal intensity (one child). Cerebral atrophy appeared to be a nonspecific finding that was seen in some children in the absence of neurologic signs and symptoms. All children with intracranial calcifications had developmental delay. Intracranial hemorrhage was seen in children with severe thrombocytopenia. Focal intracranial infections were unusual and neoplastic lesions were not found. CONCLUSIONS: Cerebral atrophy, basal ganglia calcifications, and focal white matter lesions were the most common abnormalities seen neuroradiologically in our series of HIV-infected children; cerebral atrophy was a nonspecific finding.
Radiographic findings are reviewed in 31 children with primitive neural ectodermal tumors seen at the Hospital for Sick Children from 1962 through 1983. Seventeen children were initially evaluated with computed tomography (CT). Ten of these had both CT studies and angiography. The tumors were large, irregular, typically iso- to hyperdense, and showed dense, heterogeneous contrast enhancement. Cysts were present in 65% and calcifications in 71% of cases. The angiographic findings were nonspecific, ranging from avascular to markedly vascular. Although these tumors were usually found in the cerebral hemisphere, particularly the frontal lobes, two cases are included of tumors arising elsewhere: one in the pineal and one in the suprasellar region. Epidemiologic data are reviewed.
Direct sagittal computed tomography (CT) and metrizamide myelography, in addition to standard axial CT, have proven most useful in evaluation of complex anomalies of the infant spine. Direct sagittal CT was performed by placing the entire infant sideways and supine within the gantry after metrizamide was injected. This technique was performed in six infants with diagnoses of lipoma with dysraphism, lipomyelomeningocele, lipomyelocystocele, lumbosacral agenesis with cord regression, capillary hemangioma, and vertebral osteomyelitis. The technique showed the relation and/or extension of lesions in the dorsal ventral plane, particularly the presence or absence of subarachnoid, enteric, or genitourinary communication. Spinal and paraspinal anatomic detail was also demonstrated beautifully.
Four children are reported in whom marked contrast enhancement of the spinal cord and roots was demonstrated by computed tomography months to years after relatively low dose therapeutic irradiation of paraspinal tumors, the radiation field including the cord. This phenomenon, previously unreported, probably represents subclinical radiation injury. None of the children had any neurologic abnormalities.
Preoperative diagnosis of intracranial cysts has been simplified and made more rapid and accurate with computed tomography (CT). By means of conventional CT and CT metrizamide ventriculography, the position and communication of intracranial cysts with the ventricular system and subarachnoid space or cisterns can be demonstrated. Suprasellar arachnoid cysts can produce significant neurologic and endocrinologic abnormalities due to their position. They are a surgically curable cause of hydrocephalus. Preoperative differentiation from aqueduct stenosis or other causes of a large third ventricle is important. The usefulness of coronal CT and CT metrizamide ventriculography in the investigation of these lesions is illustrated in six patients.
Fourteen cases of inadvertent iatrogenic embolization of cerebral vessels occurring in a consecutive series of 3,731 angiographies in infants and children were studies. The incidence of embolization(0.9% of all patients ond 0.4% of all angiographic examinations) was about the same as has been reported in adults, but the clinical consequences were much milder, only one patient having documented transient neurologic symptoms. Also the angiographic appearance of the emboli differed from those described in adults. These differences may in part be due to the technique (general anesthesia with hyperventilation) but also to different reactions towards ischemia and to different types of emboli in children.
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Osmotic myelinolysis is a distinctive clinical syndrome with characteristic MR features in the central pons (central pontine myelinolysis) and in other locations (extrapontine myelinolysis). We describe the resolving MR features in an adolescent who has experienced complete neurologic recovery. Regions of involvement manifested increased T2 signal intensity. The extrapontine involvement was noted to resolve earlier with interim-increased T1-weighted signal. The mechanism for the variable appearance of increased T1 signal intensity is discussed.