Neuroradiology case of the day.
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Biomedical subjects
Publications and source records attributed to D Goldblatt.
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Hyperostosis of the sphenoid ridge or convexity of the skull associated with meningioma en plaque (MEP) is often confused with other hyperostosing conditions, such as fibrous dysplasia or osteoma. The authors present nine cases, six of them proven, of hyperostosing MEP with specific attention to the CT features. All nine cases had one or more CT features that were characteristic or suggestive of MEP. These included periosteal pattern of hyperostosis, inward bulging of the vault lesion, surface irregularity of the hyperostotic bone, and intracranial changes. The role of CT in evaluating MEP is compared with other neuroradiologic techniques. The results indicate that high-resolution CT is the neuroimaging method of choice in evaluating MEP.
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1. The effect of muscle wasting on glucose tolerance was studied. Oral glucose tolerance testing was performed in three groups of wasted patients: myotonic dystrophy (11); amyotrophic lateral sclerosis (10); other lower motor neuron disease (four). Normal subjects (11) and non-wasted neurological disease (five) controls were studied for comparison. An average decrease of 29-36% in lean body mass was present in the wasted individuals. 2. A slightly higher plasma glucose occurred at 120 min after glucose ingestion in wasted compared with non-wasted individuals (119.2 +/- 5 vs. 99.9 +/- 4 mg/100 ml, P less than 0.05). 3. Normal insulin release was seen in all patient groups except those with myotonic dystrophy, who displayed marked hyperinsulinaemia from 30 to 240 min after glucose. This excessive insulin output was not due to a greater absolute decrease in lean body mass in the myotonic dystrophy patients than in the other wasted subjects. No significant correlation between the cumulative insulin release or peak insulin values and the absolute or height adjusted lean body mass was noted within any of the wasted or non-wasted groups. 4. In contrast to the findings of many studies, only clinically insignificant glucose intolerance was detected in ambulatory wasted patients and only patients with myotonic dystrophy had abnormal insulin release. Muscle loss appeared to exert only a slight influence on glucose regulation in these wasted patients and no typical effect of muscular atrophy on pancreatic insulin release was noted.
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Pulmonary function tests were performed on 40 patients with neuromuscular disease. The maximum expiratory pressure was the most sensitive indicator of weakness and was decreased in 87% of adult patients. A comparison of Stead-Wells, electronic (Vanguard), and bellows spirometry (Vitalor) indicated an excellent correlation between the Stead-Wells and electronic devices. The bellows spirometer consistently underestimated volumes, particularly in severely weak patients.