Biomedical subjects
Publications and source records attributed to S U Ho.
A 65-year-old woman with subacute global deterioration of neurological function had bilateral occlusion of the internal carotid arteries demonstrated by angiography. Postmortem examination showed isolated giant cell arteritis involving the carotid siphon bilaterally.
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Four toluene abusers had evidence of severe multifocal central nervous system damage. Impairment of cognitive, cerebellar, brainstem, auditory, and pyramidal tract function, as well as CT evidence of cerebral cortical, cerebellar, and brainstem atrophy, have been noted. In addition, we found opsoclonus, ocular flutter, and ocular dysmetria. All three patients tested had abnormal brainstem auditory evoked potentials, indicative of brainstem dysfunction. The patient with opsoclonus had CT evidence of brainstem, cerebellar, and cerebral cortical atrophy.
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Five cases of spinal leptomeningeal infiltration by systemic cancer are presented and myelographic features are discussed with a review of the literature. Common characteristic features are parallel longitudinal striations due to thickened nerve roots in the cauda equina and bizarre irregular filling defects with varying degrees of blocks, resembling arachnoiditis. Another pattern described in the literature consists of multiple nodular filling defects along the nerve roots of the cause equina.
A young woman with 12 separate brain abscesses was treated medically after aspiration of one abscess for diagnostic bacteriological examination. She made an excellent recovery with only minimal residual neurological dysfunction. Surgical aspiration for detailed bacteriological studies followed by appropriate antimicrobial therapy is an effective way of treating multiple brain abscesses in the neurologically stable patient.
Seven patients with computed tomographic (CT) evidence of cerebellar infarction were found during review of all CT records over a 5-year period. CT demonstrated decreased density in 2 distinct anatomic areas, corresponding to the distribution of the posterior inferior cerebellar artery and the superior cerebellar artery. Some patients also had hydrocephalus and fourth ventricular effacement and displacement. The location and extent of infarction do not relate directly to the clinical outcome. Rapid deterioration of the patient's sensorium is the best indication for surgical decompression.
A 58-year-old woman with hereditary multiple exostoses had slowly progressive myelopathy due to a vertebral exostosis that compressed the spinal cord at T1-2. She did not show skeletal deformities, but had numerous palpable long-bone exostoses. While CNS complications are rare in hereditary multiple exostosis, 17 other cases have been reported.
Sequential computerized tomography (CT) was performed on a patient with seizures and an organic mental syndrome. Cerebral sarcoidosis was subsequently diagnosed on the basis of noncaseating granulomas in three organ systems. Cranial nerve palsies, hypothalamic dysfunction, and widespread disease were absent. An unusual neuroradiologic sequence of events indicated focal and asymmetric hydrocephalus, mass effect, ependymitis, diffuse breakdown of the blood-brain barrier, and periventricular white matter destruction. These findings have not been previously described together in a patient with sarcoid. With the advent of noninvasive CT, it is possible to perform serial investigations of encephalopathies of obscure origin. Findings similar to those in the present case should prompt a thorough search for subclinical systemic involvement by sarcoid.
A patient with cortical blindness due to extensive bilateral posterior cerebral infarcts showed occipital visual evoked potentials to flash stimulation on repeated testing. These responses were probably mediated by extrageniculocalcarine connections between the optic nerve and the secondary visual cortex of the occipital convexity.
In a patient with a large interhemispheric subdural hematoma, the CT scan showed a radiodensity with a straight sagittal and a convex lateral border. This image correlated with the autopsy findings. It differs from CT scan images of intracerebral hematomas.
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