Biomedical subjects
Publications and source records attributed to R Tadmor.
A young woman presented with an acute right pontine lesion and paroxysmal atrial fibrillation. The lesion was later proven by magnetic resonance imaging to be due to multiple sclerosis. To our knowledge, cardiac arrhythmias have not been previously described in this condition. Published support for this possible association is reviewed.
Intracranial hemorrhage (ICH) is a life-threatening complication of hemophilia. Seven of the 288 hemophiliacs living in Israel suffered eight episodes of ICH during the years 1972 to 1982. All episodes occurred in hemophilia A patients, with a higher incidence among patients with factor VIII inhibitor. Diagnosis was confirmed by computed tomographic scan in seven of the eight episodes. Four of the 7 patients died despite adequate factor replacement and supportive therapy, probably due to a conservative and hesitant neurosurgical approach. The correction of factor VIII to hemostatic level alone is inadequate in the majority of cases, and there is sudden deterioration in the patient's condition and death. Operation is strongly recommended when no improvement is noted within a few hours.
The authors report three patients with symptomatic postlaminectomy pseudomeningocele. At operation a loop of a nerve root was found to be trapped within the dural defect. All three patients exhibited a delayed onset of radicular symptoms and signs after disc surgery. The pseudomeningocele was demonstrated computed tomography and myelography, but the entrapped root could be identified only at operation.
We report the results obtained at 0.6 T with the use of surface coils in 77 patients who presented with obvious or suspected thoracic myelopathy. There were 16 patients with primary tumors diagnosed for the first time, 9 patients with residual tumors, 17 with metastatic neoplasms, 13 with hydrosyringomyelia, 5 with vertebral fracture and secondary pathology involving the cord, 5 with thoracic disc protrusions, 2 with multiple sclerosis, 2 with arteriovenous malformations, 2 with cystic arachnoiditis, and 6 with a variety of congenital abnormalities (low tethered cord, intradural lipoma, lipomyelomeningocele). The significantly improved signal to noise ratios provided by surface coils allow high quality thin section imagning which, combined with the high tissue contrast resolution obtainable with suitable pulse sequences, makes MR the preferred initial imaging technique over myelography and CT myelography. In an interesting spectrum of lesions, MR can obviate the need for traditional invasive procedures.
The management of four patients with dysphagia due to esophageal compression by anterior cervical osteophytes is described, and the literature is reviewed. Treatment of this condition is simple and without complication. Surgical removal of the bony ridges using the anterior cervical approach leads to complete recovery.
One thousand consecutive skull x-rays in patients with head trauma were reviewed. Only eighteen (1.8%) showed a fracture. Four of these were depressed. Thirteen of the 18 patients were below 15 years of age and 15 were males. Two patients had evidence of intracranial trauma on computed tomography (CT). The outcome was favorable in all patients. In view of the extremely low yield of skull x-rays for trauma, we believe that this examination is no longer indicated as a routine procedure. Patients with a suspected intracranial injury should be evaluated by CT study.
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Manifest or occult spinal dysraphism in the absence of neurological symptoms is likely to remain undetected. Therefore, accurate and early diagnosis of such underlying anomalies is of prime importance for early surgical intervention in order to avoid late irreparable damage. During a period of just over 1 year, 17 such cases of spinal congenital anomalies were diagnosed by myelography with metrizamide and computed tomography-myelography. There were 16 cases of tethered cord, six with myelomeningocele, two with diastematomyelia, two with a split spinal cord, three with a lipoma, and the remaining three with vertebral anomalies. Scoliosis was present in 60%, weakness of both legs in 45%, and asymmetry of the feet in 25%. Some of these patients were initially brought to the orthopedic department for corrective surgery before undergoing a complete neurological evaluation; thus the radiologist was acting as the link between patient and neurosurgeon. Clinical experience has shown that surgical treatment can be successful and can thereby obviate further progression of neurological symptoms.
A case of a cystic meningioma recurring in its cystic form, two years after the initial removal, is presented. Regarded as a true cystic meningioma, the possible aetiology of the cyst formation is suggested. As the cyst wall itself may give rise to tumour cells, it is recommended that the initial operation should be directed at total removal of the tumour mass and cyst wall, thus reducing the possibility of a tumour recurrence. A CT finding of a hypodense lesion in a patient, operated on previously for a cystic meningioma suggests a recurrence of the tumour. However, other non-neoplastic changes should be considered.
Spinal intradural ependymal cysts are extremely rare. The case presented is the sixth reported in the literature. The symptoms are consistent clinically and radiologically with a spinal intradural space-occupying lesion. The cyst wall is lined with both ciliated and nonciliated cells, resting directly on connective tissue. The exact embryonal origin of these cysts is obscure.
Computed Tomography (CT) is the only imaging modality whereby bone and anatomical soft tissue structures are clearly defined. Detection of intraocular foreign bodies (FBs) can be easily obtained by scanning in the axial plane. For the precise localization of FBs, information in two planes is necessary; this is usually achieved by adding a CT study in the coronal plane to the axial plane study. When using a superimposed grid with millimeter calibration on a zoom orbital scan, the accurate location can be calculated. This contribution is of the utmost importance in deciding upon the appropriate approach when surgical removal is indicated.
A 13-year-old male with prolactin secreting pituitary tumor is described. The unusual features were arrested puberty and growth. Previously reported pediatric patients with prolactinoma are reviewed. The importance of serum prolactin measurement and bromocriptine therapy is emphasized.
An FSH-secreting pituitary adenoma was demonstrated in a 32-yr-old man who presented with unilateral optic atrophy without any clinical or laboratory evidence of hypogonadism. Semen analysis was normal, although basal FSH levels were markedly elevated (greater than 80 mIU/ml). He had normal plasma LH levels and no other detectable endocrine abnormalities. Administration of GnRH elicited delayed and sustained FSH and brisk LH responses. Administration of TRH resulted in TSH and PRL responses and unexpected FSH and LH elevations. Two surgical operations resulted in temporary reduction of plasma FSH levels, but it increased later concomitant with CT demonstration of tumor growth. After pituitary irradiation, no reduction in FSH levels occurred. A single dose of 5 mg bromocriptine elicited a significant reduction in FSH levels from 137 to 64 mIU/ml. Long term treatment with 15 mg/day bromocriptine resulted in further reduction of FSH level, to 36.4 mIU/ml, without any change in tumor size. This finding implies that bromocriptine could be an adjunctive therapy or an alternative to other modes of treatment in patients with these rare tumors.
Our experience in the use of computerized tomography (CT) in the evaluation and treatment of combat-related penetrating missile injuries of the head in 12 cases is summarized. Advantages observed in the use of CT include accurate delineation of in-driven bony and metallic fragments, the relation of hematomas to the missile tract and detection of brain abscesses. The availability of a CT scanner for use in military medicine may further reduce the mortality and morbidity due to combat-related cranial missile injuries.
This is a retrospective study on 352 infertile women who were treated with HMG-hCG (Human Menopausal Gonadotropin/human Chorionic Gonadotropin) between 1962 and 1977. The purpose of this study was to search for hyperprolactinemia and prolactinomas in these women. Hyperprolactinemia was found in 75 women (21%). The prevalence of hyperprolactinemia increases with age. Asymptomatic pituitary tumors were found in 29 of 31 women evaluated (94%). Three women had macroadenomas and 26 had microadenomas. We were not able to demonstrate that the HMG-hCG treatment and the ensuing pregnancy had any long-term ill effects on the size of the tumor. These findings suggest that prolactinomas were slow growing. An active search for these tumors must be made in women treated for infertility in the past.
Jugular paraganglioma is a highly vascular tumor, slowly growing, extending into the surrounding structures and causing otologic and/or neurologic symptoms according to its location in the jugular bulb region or the middle-ear. In our study, modified vertex and posterior head scintiangiography was used in seven cases. Scintiangiography was positive in all seven, whereas concomitant radiographic studies were limited: four of the seven gave positive findings by transmission computerized tomography (TCT). Only four patients underwent angiography, with positive results in two. Hypocycloidal tomography was positive in three cases. However, some radiographic studies, particularly TCT, may be useful in detecting local extension, bone destruction, and soft-tissue infiltration. Radionuclide angiography proved highly reliable and should be used initially whenever a jugular paraganglioma is suspected.
A 27-year-old woman suffered from multiple congenital defects, including transsphenoidal encephalocele. Recent progressive visual loss was at first attributed to this encephalocele, but was later proved to be caused by a suprasellar epidermoid cyst. Its removal was followed by improvement of vision. To the best of our knowledge, the association of basal encephalocele and epidermoid cyst has not been previously described.
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