Biomedical subjects
Publications and source records attributed to K R Davis.
A case of subdural tension pneumocephalus is presented. Computerized cranial tomography permitted rapid diagnosis including localization of the air, thus facilitating prompt treatment. Tension pneumocephalus should be considered in a patient with a cerebrospinal fluid drainage device who deteriorates after craniotomy.
We report our experience with the neurologic sequelae (at a mean follow-up of 24 months) among the 15 surviving infants who have had neonatal intraventricular hemorrhage (IVH) documented by computerized tomographic (CT) brain scan. Neurologically six infants (40%) are normal, six infants (40%) mildly impaired, and three infants (20%) moderate to severely impaired. The neurologic outcome correlated to the degree of hemorrhage seen in the CT scans when IVH was classified into four grades. None of the other neonatal factors examined showed significant correlation with the outcome.
Computed tomography (CT) is an extremely valuable noninvasive method for evaluating orbital soft-tissue structures. The possibility of scanning in the coronal plane has added a new dimension to the study. Direct enlargement viewing of scans on the display console has disclosed minute anatomic and pathologic details.
Seven patients with histologically confirmed cerebellar hemangioblastomas are reviewed in order to establish computed tomographic (CT), angiographic and clinical characteristics and correlations. Noncontrast CT scans demonstrated most cystic lesions but did not always depict nodules on the cyst wall and small solid tumors. Contrast-enhanced CT scans demonstrated the solid and cystic types of tumors but in some cases angiography better delineated them and the presence of nodules. The CT appearance reflected the pathologic characteristics, which included vascular channels, cyst formation and nodules. Solid tumors enhanced homogeneously and could not be definitively distinguished from other cerebellar neoplasms by CT alone. One atypical undifferentiated tumor appeared as a solid mass with a necrotic center. The CT appearance of associated retinal angiomatosis is also described. Hydrocephalus, gait or appendicular ataxia was the initial clinical presentation in these patients.
Primary malignant lymphoma of the brain is a rare lesion characterized clinically by varied nonspecific neurologic deficits and usually a rapid fulminant deterioration and death. This course may be altered by radiotherapy, and early diagnosis assumes major importance. Laboratory tests, EEG, radionuclide scans, angiography, and pneumoencephalography may not show definite abnormality in the early stages. This report concerns four cases in which good correlation between the location of the brain lesion and the abnormality on computed tomography scan was demonstrated.
With the ability to image both bone and soft tissue structures, computed tomography (CT) is capable of visualizing many normal anatomical structures of the paranasal sinuses and face not seen with other radiological techniques. The superficial and deep fat planes, all of the muscles of mastication, and many of the facial muscles are readily identified. The extraocular muscles, optic nerves, and globes are clearly seen. The purpose of this report is to review the normal anatomy of the paranasal sinuses and face imaged by CT in both the transverse and coronal planes.
Computed tomography (CT) has added an important new dimension to the radiological evaluation of diseases of the paranasal sinuses and face. Using transverse and coronal scans, accurate assessment of the character and extent of mass lesions in this region can be achieved. Erosion of thin bony lamine and involvement of soft tissue structures of the face can be seen. Most important, CT is capable of precisely defining the extension of lesions into the pterygopalatine fossa, orbit, and cranial cavity, information that is essential for therapeutic planning.
A full radiological evaluation of patients who sustained traumatic injuries to the spine may be difficult to obtain due to the danger associated with manipulation. Computed tomography offers a new modality for simple and accurate evaluation; valuable information may be gained without the use of invasive methods.
The computed tomographic (CT), clinical, and pathologic findings in 9 patients with biopsy-proven herpes simplex encephalitis (HSE) were reviewed. Seventeen scans (5 plain, 12 contrast enhanced) were analyzed. The major CT finding was a low-absorption abnormality, present in 11 of 17 scans (64%), affecting primarily the temporal lobes. Mass effect was evident in 9 of 17 (52%). Of the 12 contrast-enhanced scans, 6 (50%) showed an abnormal enhancement pattern affecting primarily the sylvian fissure and opercular areas. CT abnormalities are characteristic enough that, in the proper clinical setting, they lend support to the correct diagnosis.
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The speech disturbance resulting from infarction limited to the Broca area has been delineated; it differs from the speech disorder called Broca aphasia, which results from damage extending far outside the Broca area. Nor does Broca area infarction cause Broca aphasia. The lesions in 20 cases observed since 1972 were documented by autopsy, computerized tomography, or arteriogram; the autopsy records from the Massachusetts General hospital for the past 20 years and the published cases since 1820 were also reviewed. The findings suggest that infarction affecting the Broca area and its immediate environs, even deep into the brain, causes a mutism that is replaced by rapidly improving dyspraxic and effortful articulation, but that no significant distrubance in language function persists. The more complex syndrome traditionally referred to as Broca aphasia, including Broca's original case, is characterized by protracted mutism, verbal stereotypes, and agrammatism. It is associated with a considerably larger infarct which encompasses the operculum, including the Broca area, insula, and adjacent cerebrum, in the territory supplied by the upper division of the left middle cerebral artery.
Computed tomographic scans were obtained from 19 men with long histories of heavy marijuana smoking and who were also observed to smoke large amounts of marijuana under research ward conditions. The ventricular system and subarachnoid spaces were normal in size and showed no indication of atrophic change.
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Skull and facial structures may be evaluated on computed tomography (CT), as well as the brain. A valuable new dimension to the study has been added with the feasibility of obtaining direct coronal sections using a wide gantry aperture. The patho-anatomical details of bone and soft tissues including the orbit and paranasal sinuses are well demonstrated. Direct viewing on a display console of an enlarged quadrant of the scan is of prime importance in diagnosing fine changes involving the thin facial bones.
Eight pathologically proven cases of pineal region tumors examined by computed tomography (CT) were found upon reviewing 11,000 consecutive CT studies at the Massachusetts General Hospital. The CT scan findings of the eight cases are described and related to a pathological classification of pineal tumors.
Sixty-eight cases of hypertensive intracerebral hemorrhage were reviewed and the CT scans studied. The CT scan was accurate in localizing and measuring intracerebral hemorrhage. There were three cases of pontine hemorrhage which did not appear on the CT scan. Hemorrhages at other sites were always seen on the CT scan. The size of putaminal and thalamic hemorrhage as calculated from CT scan allowed accurate prognosis to be made at the onset. CT scanning has become the diagnostic test or first choice when intracerebral hemorrhage is suspected.
Large confluent petechial hemorrhages and/or hemorrhage within infarct may be seen on CT scan. Small petechial hemorrhages are not resolved by current equipment and techniques. Elevation of absorption values of an infarct following contrast media primarily occurs in the first month after onset, and may be occasionally confused with a tumor. Sequential CT changes in infarcts correlate well with established pathologic changes. Cerebral infarction may be seen on CT scan in some cases as early as 24--48 hr after its onset.