Biomedical subjects
Publications and source records attributed to K D Dolan.
Ten symptomatic patients with skeletal abnormalities of varying etiology at the craniovertebral junction were studied with gas or metrizamide myelography. The type of compressive pathology was accurately delineated by these techniques. The surgical approach was determined by the findings on the myelograms.
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An analysis of the radiographic signs in 125 consecutive operated cases of tripod fracture was performed. The incidence of direct and indirect signs of fracture and associated fractures of the head and neck were noted. The normal anatomy of the zygomatic articulation is reviewed and optimum radiographic stereo Caldwell, and direct PA views, and orthopantomogram, are recommended.
Cranial settling occurs in about 5-8% of patients with rheumatoid arthritis, sometimes resulting in severe neurological problems or even death. It is caused by collapse of the supporting structures at the craniovertebral junction, mainly the lateral masses of C1. Twelve cases are presented; 2 patients with severe neurological problems were treated surgically.
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Injury to the basal portion of the anterior, middle, and posterior fossae of the skull are rather easily overlooked unless the radiologist carefully searches for indirect or direct signs of such injury. Representative injuries of each area are reviewed and radiological signs are illustrated. Combination fractures transversing several areas are also considered and illustrated.
A case of occlusion of the internal carotid artery after craniocervical trauma with subsequent death of the patient is presented. The patient originally had a mandibular fracture; subsequently an altered sensorium and left-sided hemiparesis developed. The patient died. The typical "lucid interval" was noted. The changes in sensorium are similar to those associated with epidural and subdural hematomas.
We have reviewed our experience in the radiographic and ophthalmologic evaluation of 1001 patients with symptoms suggesting the presence of a pituitary, prolactin-secreting adenoma. Twenty-seven patients had abnormal or suspicious radiographic examination of the sella turcica. Twenty-two of those had hyperprolactinemia. In only one instance was an abnormality noted on polytomography that was not seen on a conventional four-view study of the skull. Based on these findings, a four-view plain conventional radiographic assessment of the skull suffices as a screening procedure in patients with amenorrhea, galactorrhea, or both. Thin section tomography should be reserved to more thoroughly evaluate those patients with elevated serum prolactin concentrations and/or abnormal conventional radiographs. We found visual field testing to be of little value as an initial screening procedure in these patients.
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The majority of cervical spine anomalies of clinical significance occur in the occipital, atlas, and axis areas. Below the axis, changes may occur as local solitary anomalies simulating significant disease, or in the form of more widespread segmentation and ossification anomalies categorized as the Klippel-Feil syndrome.
The clinical, radiographic, and etiological factors of neurofibromatosis have been discussed. A rare case of a large neurofibroma of the mandible in association with systemic neurofibromatosis and a characteristic mandibular dysplasia has been presented. The unique coexistence of mandibular dysplasia associated with sphenoidal and orbital dysplasia should be considered in the diagnosis of multiple neurofibromatosis.
Attention has recently been directed to decrease in size of the spinal canal, notably in relation to production of posterior osteophytes in spondylosis. Tumors of the cord, roots, or meninges, syringolmyelia and hydromyelia may enlarge sufficiently in size or be critically located so that expansile change of the cervical spinal canal may result.
It is prudent to apply several methods of evaluation of cervicobasilar relationships in basilar impression and, in suggestive cases, to use tomographic evaluation for complete study. This discussion reviews normal cervicobasilar relationships and illustrates selected pathologic processes that produce basilar impression.
In the lower cervical spine, motion is relatively limited to flexion and extension, with a small amount of lateral flexion and rotation. Fractures may occur with extreme displacement in any of these directions or as a result of axial application of force. The author provides a guide for the radiologic detection of various fractures of the cervical vertebrae.
The incidence of nonfatal neck injuries in high school football was determined by performing preseason examinations in 104 active high school players and 75 college freshman candidates. Coaches of all 430 Iowa high schools were asked to recall the number of players experiencing significant neck pain during the season. A detailed questionnaire for each injury was also completed by a sample population of 60 coaches. The incidence of roentgenographic evidence of neck injuries was as high as 32% and was related to years of experience. Injury was most likely to occur to a linebacker or a defensive halfback when they tackled the ball carrier. In the preseason examination, half the players who volunteered a history of significant neck pain had abnormal x-ray films.
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Various methods of specifying lateral pharyngeal wall configuration during speech and other activities are reviewed. Basic tomographic principles also are reviewed and a new tomographic technique of measuring mesial displacement of the pharyngeal walls is presented. An important advantage of the technique described in this report is that it enables one to measure the degree and level of mesial displacement of the lateral pharyngeal walls in relation to the soft palate, tongue, and other structures observable on lateral-view radiographs.