Biomedical subjects
Publications and source records attributed to G Scotti.
A giant macroprolactinoma causing hydrocephalus was demonstrated by computed tomography in a 13-year-old boy complaining of headache and visual disturbances. Three weeks after beginning of medical treatment with dopaminergic drugs, an impressive reduction of tumor size and disappearance of hydrocephalus was noted. The patient is doing well at 5 months follow-up.
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Thirty patients with macroprolactinomas were treated with dopaminergic drugs from a minimum of 4 months to a maximum of 6 years. Tumor size was evaluated with serial CT during treatment; serum prolactin levels and visual fields were also assessed at the same time. Reduction of PRL levels was found in 28 patients of whom 20 also had marked reduction of tumor volume on CT. Two patterns of reduction of size of tumor in relation with time were observed. In one, tumor shrinkage occurred rapidly in the first month and even in the first week after starting treatment. In the other pattern the tumor reduced in size only after some months of treatment. It is proposed that all patients with macroprolactinomas should be treated medically before considering surgery. A radiological diagnostic and research protocol is proposed, including scout views, thin slices, coronal sections, objective measurement of tumor size and density, serial CTs at 7,21,45 days, 6 months and then every year after the beginning of treatment.
Three patients with angiographic and CT findings of cerebral sinovenous occlusion are described. Filling defects within the venous pathways are well demonstrated by angiography. Some of the most characteristic CR signs are here described. Full evaluation, including the clinical history, angiography and computed tomography is essential.
The computed tomographic (CT) findings of rhabdomyosarcomas involving the skull base in seven children are described. The tumor may arise in the nasopharynx, maxillary sinus, petrous bone, or orbit. Computed tomography clearly shows the full extent of bone destruction and replacement by soft tissue. The CT picture, however, is not specific and differential diagnosis with other aggressive lesions involving the base of the skull such as histiocytosis X, neuroblastoma, and lymphoma can be made only with a combined clinical and radiological approach.
In a review of all children with brain neoplasms evaluated at a large pediatric center during a three-year period following the introduction of computed tomography (CT), a change was observed in the age distribution at the time of clinical presentation as compared with a previous series evaluated prior to the introduction of CT. In children under six years of age, there was a highly significant trend for earlier diagnosis; within this age group, relatively more children were diagnosed in the first two years of life. Between six and twelve years of age, there was no change in frequency of brain tumor diagnosis between the two series. Above age twelve, there was again noted a highly significant increase in detection of brain tumors in the more recent series. These differences between the two series may be attributed, at least in part, to earlier referral and diagnosis since the advent of CT, although other factors cannot be excluded as possible causes of the differences.
Aplasia of the greater wing of the sphenoid is a characteristic orbital bony anomaly in von Recklinghausen's disease, responsible for unilateral proptosis. The radiological diagnosis is based on the so called "empty orbit" appearance at routine skull X rays. Computerised tomography has allowed a precise differential diagnosis in 6 patients with neurofibromatosis and congenital absence of the greater wing of the sphenoid. Not only the bony defect is well demonstrated in all its extent but also the associated soft tissue anomalies such as presence of abnormal neurofibromatous tissue, hyperplasia of the temporal lobe, arachnoid cyst etc.
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Of 700 neonates examined by computed tomography (CT) in a 4 years period, 17 were found to have a posterior fossa hemorrhage. Eleven were born at term, and six were premature. Delivery was traumatic in 12 babies. The hematoma was in the subdural space in nine and within the cerebellum in eight. The CT diagnosis of extravasated blood in the posterior fossa is easy both in full-term neonates and prematures. The localization of the hematoma, however, may be difficult. While in the full-term neonates differentiation between subdural and intracerebellar location is relatively easy, in the premature the cerebellar hematoma frequently has a crescentic shape that resembles a subdural collection. Four patients with a subdural hematoma and four with a cerebellar hematoma were operated on. The general prognosis is poor: seven patients died; of the survivors, only three are normal at follow-up.
One-hundred and thirty neonates who suffered perinatal asphyxia were divided into two groups according to maturity at birth. All the neonates were studied with computed tomography (CT) of the brain in the neonatal period and again at 6 months of age. They were all followed clinically until at least 18 months of age. Eleven infants (8%) developed progressive hydrocephalus needing surgical intervention, and 67 (51%) had ventriculomegaly that was not diagnosed as progressive hydrocephalus during the 18-month-long follow-up period. All 11 neonates who developed progressive hydrocephalus had had hemorrhage, but ventriculomegaly without progressive hydrocephalus was very common and as common among those who had had hemorrhage as among those in whom no hemorrhage was found in the neonatal CT scan. We conclude from this study that, although posthemorrhagic hydrocephalus is a not infrequent complication of intracranial hemorrhage in neonates, the diagnosis should be made with caution, since ventriculomegaly of etiologies other than progressive hydrocephalus is common in this group of patients. The CT scan should be evaluated together with the clinical course of the patient. This combined approach will minimize the risks of a false positive diagnosis of progressive hydrocephalus and subsequent overtreatment as well as lack of treatment in cases in which it is necessary.
Twenty-two gliomas of the anterior optic pathways in children were reviewed, and the relative merits of computed tomography (CT), pneumoencephalography (PEG), angiography, and radionuclide brain scanning were assessed. Contrast-enhanced CT scans proved to be superior in demonstrating the full extracranial extent of the lesions and spread along the optic pathways; however, PEG was more reliable with small chiasmatic lesions. Angiography rarely provided a specific diagnosis of intracranial optic glioma, but in was diagnostic when the intracanalicular or intraorbital portion of the optic nerve was involved. A protocol for neuroradiological investigation of suspected cases is proposed.
45 children with ALL treated with intrathecal Methotrexate and radiation therapy, all in hematologic remission, have been examined with brain CT at intervals varying from 3 to 6 years after completion of CNS prophylaxis. Abnormalities were detected in 20% of the children; the main findings were: calcifications within the brain parenchyma in 3 patients; enlargement of the ventricular system and/or sulci in 8. The 3 patients with calcifications had seizures during or after treatment whereas those with dilatation of the ventricular system or sulci presented no neurological signs.
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Twenty-one adults with acute cerebellar softening confirmed by computerized tomography (CT) were divided into two groups according to clinical course. CT findings, and outcome. In the first group, consisting of 6 patients, the condition ran a progressive course, with deterioration of consciousness, signs of brainstem compression, and the appearance of hydrocephalus on CT scan. Three patients underwent surgery successfully, 2 died postoperatively, and 1 recovered spontaneously. In the second group, comprising 15 patients, the course was benign: cerebellar symptoms and signs improved without surgery, and only discrete cerebellar signs remained a month after onset.
The CT findings in a 6-month-old boy with hemophilus influenzae meningitis, complicated by the occurrence of bilateral subdural effusions, are described. The effusions were hypodense and the contents markedly enhanced (increase of 40 Hounsfield units) after contrast injection.
An aneurysm of the vein of Galen is a rare midline arteriovenous malformation. The clinical signs and the prognosis strictly depend on age of presentation and on the amount of blood shunted into the malformation. In the newborn, cardiac failure is the most common presenting sign. In order children hydrocephalus, headache, focal neurological signs and subarachnoid bleeding may be the reason for admission. At the Hospital for Sick Children six patients with an aneurysm of the vein of Galen were studied by angiography and CT. Four of them were newborn in cardiac failure. Angiography was essential for the accurate demonstration of all the feeding vessels to the malformation and their exact location. Computed tomography also added useful information on associated hydrocephalus and ischemic brain damage. The dilated vein of Galen, straight sinus and torcular were clearly seen. Abnormal arterial vessels feeding the malformation were also recognized.
A thoracic dermal sinus extending from the skin into the spinal cord through a defect in the neural arch of T2 is described. Computed tomographic myelography (metrizamide) clearly showed the full extent of the lesion and its relationship to surrounding muscles, bone, dura, arachnoid, and neural tissue.
Diastematomyelia is an uncommon dysraphic lesion of the spine which has been diagnosed more frequently since the advent of newer diagnostic methods. A series of 21 cases was examined using metrizamide myelography and computed tomographic metrizamide myelography (CTMM) over a 3-year period. These examinations, in addition to plain radiographs of the spine, have demonstrated certain features of diastematomyelia hitherto unreported. A bony or cartilaginous spur was an uncommon finding, occurring in only six cases. Also, the split spinal cord was found within an unsplit dural sac in 15 cases. Coexistent tethering of the spinal cord, even in the absence of a spur, was present in 16 of the 21 cases. CTMM proved superior to metrizamide myelography in demonstrating the spinal cord anomalies; plain films and CT are complementary in showing the bony anomalies. The radiographic investigative protocol of diastematomyelia includes plain anteroposterior and lateral spine films, metrizamide myelography, and CTMM. Conventional tomography and plain CT are unnecessary; improved density resolution and availability of computed radiographic anteroposterior and lateral scout views will further reduce the need for plain films and intrathecal injection of contrast medium.