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PubMed1989

Contributory aspects of MRI in the evaluation of basal encephaloceles.

Basal encephaloceles are rare pathologies which belong to the now well-defined complex called median cleft face syndrome. This entity includes median craniofacial dysraphism associated to a varying degree with optic tract pathology, dysfunctioning of the hypothalamus-hypophysis axis, agenesis of the corpus callosum and basal encephalocele. The latter is that virtually constant element for which surgery is frequently requested. Owing to the large number of surgical failures (especially in the transsphenoidal type) medical imaging for the evaluation of malformative damages must be very accurate. Until recently, the techniques available, such as standard radiography, conventional tomography, gas encephalography, carotid arteriography and computerized tomography with or without metrizamide cisternography, were either too invasive or too inaccurate. MRI is the technique which provides the best images of prolapsed meninges, brain regions or ventricles, as well as of the anatomical rapport between the hypophysis, the optic tract and the limbic system.

Encephalocele↗
PubMed1989

[The effects of metrizamide myelography on electroencephalographic changes].

Metrizamide, a non-ionic water soluble contrast medium, is used in myelography for detecting spinal cord lesions. Because it is an injection in the subarachnoid space, the effects on the central nervous system following metrizamide myelography should be studied. Electroencephalography can offer a non-invasive and objective method for evaluating the functions of the central nervous system. From September to December 1986, 30 cases which had received cervical or lumbar metrizamide myelography were collected. After myelography, in addition to a history review and neurologic examination, electro-encephalography was carried out within 24 hours. If the EEG record revealed abnormal, a series of EEG follow-ups were conducted until recordings were normal. The incidence of clinical adverse effects following Metrizamide myelography was 53.3% and 66.6% respectively in cervical and lumbar injections. No significant difference was found between the two groups. Secondly, the abnormal rate of the EEG record was 40.0% and 60.0% following cervical and lumbar myelography. The difference was also not significant. Lastly, the relation between clinical adverse effects and an abnormal EEG records was poor in cervical metrizamide myelography but good in lumbar myelography. The conclusions suggested by this research that the clinical adverse effects and the abnormal EEG record after metrizamide myelography are transient and are reversible changes. The mechanism of complications following cervical and lumbar metrizamide are different. Although complications may occur following cervical and lumbar metrizamide myelography, it remains a practical method in detecting spinal cord lesions.

Adult↗
PubMed1977

Cisternography with metrizamide and hypocycloidal tomography.

Cisternography with metrizamide (Amipaque) and hypocycloidal tomography was found to depict cisternal anatomy with detail and precision not obtainable with any other technique. Clinical tolerance is comparable to that of encephalography if suitable precautions are followed. All side effects observed had disappeared 36 hours after injection, and no delayed noxious effects were recorded. This method offers a simple, rapid and precise technique for depicting cisternal anatomy and requires no equipment other than a tilting multidirectional tomographic unit.

Humans↗
PubMed1978

[Correlation of encephalotomography and computer tomography in space occupying lesions in the midline and cerebellopontine angle (author's transl)].

The diagnostic value of encephalotomography and computer tomography in neuroradiology of midline tumors is discussed. Characteristic differences of both methods are summarized. The following conclusions of clinical importance are derived from our experiences: 1. Computer tomography is the most valuable method in the diagnostic procedure of midline tumors. Encephalography is not necessary is cases with density differences of tumor and surrounding brain tissue or contrast enhancement. 2. Encephalotomography should be performed in cases with dislocation of cisternes and ventricles without density differences or contrast enhancement. 3. Encephalotomography is the method of choice in patients with unclear computer tomography and contradictory clincial symptomatology.

Adult↗
PubMed1986

[Septo-optic dysplasia disclosed in adults].

A case of septo-optic dysplasia, presenting with focal epileptic fits in a 29 year old man, is described. Gas encephalography and CT scan demonstrated the main features of the malformation: a single ventricle overhanging a narrowed third ventricle, abnormal mass in the basal forebrain corresponding to an embryonic cyst, optic atrophy. Angiography revealed deep venous anomalies, and, in particular, absence or hypoplasia of the sinus recti.

Adult↗
PubMed1979

[Iatrogenic damage to the nervous system].

A survey is given of the most important findings in respect of iatrogenic damage to the nervous system on the basis of published reports and the author's own findings, taking special account of lumbar puncture and suboccipital puncture, myelography, contrast-medium encephalography, ventriculography and cerebral angiography. The possibility of damage such as the danger of embolism in diagnostic and therapeutic vascular puncture is referred to. Among the lesions caused in the course of therapy, the side-effects of treatment with drugs, effects of radiation, effects resulting from anesthesia, sequelae of neural therapy and of manual manipulations, sequelae of operations, and postvaccinal encephalopathies are discussed. The necessity of systematic morphological examinations for exact assessment of ioatrogenic lesions is stressed. Iatrogenic damage due to neglect of diagnostic and therapeutic measures is also considered.

Anesthesia↗
PubMed1977

Ventriculography with metrizamide.

In 77 patients 85 ventriculographies were performed with metrizamide (Amipaque). No severe complications occurred. The diagnostic accuracy in lesions affecting the midline structures is excellent. However, the rapid passage of the medium from the ventricular system in cases with slight obstructions or small lesions requires a scrupulous technique to enable an exact diagnosis. Due to the difficulty in differentiating between intra- and extra-cerebral location of an expansivity, encephalography should be performed as the first examination whenever possible.

Cerebral Ventriculography↗
PubMed1986

The evolution of transsphenoidal pituitary microsurgery.

Serious interest in pituitary disease started 100 years ago when acromegaly was described (1886, Marie). Transcranial pituitary operations soon followed (1889, Horsley). Transnasal operations (1907, Schloffer) were complicated by cerebrospinal fluid leakage and meningitis. Improvements led to definitive transseptal (1910, Cushing and Hirsch) and transethmoidal (1911, Chiari) decompressing surgery for tumors. The mortality rate fell below 10%, and relief, mainly from local effects, often followed, sometimes for many years. By 1930 Cushing and most U.S. surgeons used a transcranial approach because suprasellar lesions were inaccessible from below, but several European surgeons continued to use transsphenoidal operations when appropriate (Hirsch, Dott, and Nager). By 1950 antibiotics had reduced infection, and cortisone soon rendered total hypophysectomy by all routes safe for tumorous and normal glands. Microsurgical transethmosphenoidal hypophysectomy was introduced by ear, nose, and throat surgeons (1957 or 1958, Gisselsson, Riskaer, Bateman, MacBeth, and James). Neurosurgeons introduced intraoperative radiofluoroscopy (1957, Guiot), air encephalography, televised fluoroscopy, microsurgical transseptal hypophysectomy, and selective anterior hypophysectomy (1965, Hardy). Microadenomectomy for lesions invisible radiologically was introduced in 1968 (Hardy). The operative death rate is now negligible. Computerized tomographic scanning helps locate tumors, but increasingly surgeons now regard endocrinologic diagnosis alone as justification for operation. Early outcome is excellent, especially in experienced hands, and particularly for noninvasive tumors, but later results are forthcoming.

Adenoma↗
PubMed1986

[Contact gel as a source of error in roentgen images of the skull].

This paper sounds a note of warning in respect of simulation of non-existent osseous densifications or calcifications on x-ray film due to the use of contact gels that are common in sonography and electro-encephalography for the fixation of leads. If lumps of these gels adhere to the scalp, especially to the hair of the head and thus remain unnoticed, their roentgenographic density will falsify the subsequent x-ray (for example, marginal calcifications are simulated that are not necessarily visualised on the second plane).

Bone Diseases, Developmental↗
PubMed1985

[Quantitative measurement of ventricular dilatation on CT scan--a proposal of new index and review of literature].

CT scan is able to show cerebral atrophy more safely and more easily than pneumo-encephalography or cerebral angiography. Then, various methods have been reported for quantitative analysis of cerebral atrophy on CT scan. Generally, cerebral atrophy might be judged from the ventricular dilatation with some indices, calculated from various ventricular width. But, there is no general agreement on what index is the most reliable. In this paper, we attempted to establish the index, easy to measure and most reliable. Our method is as follow. Method. We carried out the CT scan (EMI 1010) on 89 neurologically intact patients. Scans were parallel to orbito-meatal line (OML), and were 10 mm in thickness. On CT scan films, various width, area of anterior horns and area of bodies of lateral ventricles were measured (Fig. 1). Measurement about the anterior horns of lateral ventricles were carried out on image the most clearly showed the foramen of Monro. And measurements about the bodies of lateral ventricles were on image, 20 mm above the image of anterior horn. Correlations of various width and areas were calculated (Table 1). Then we proposed new indices with high correlations (over 0.9) with ventricular area; Anterior horn CVI (Cerebro-Ventricular Index) and Body CVI (Fig. 2, 3). Patients with myotonic dystrophy show cerebral atrophy. We carried out the CT scan (GE-CT/T 8800) on 17 myotonic dystrophy patients and 30 controls. Between the two groups, age and sex were almost matched (Fig. 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1977

Computerized axial tomography in neurologic disorders of children.

Computerized axial tomography offers major advantages over air encephalography and angiography for studies of neurologic disorders in children. The low morbidity and the ease of the procedure permit the accurate diagnosis of intracranial pathology in situations where more invasive procedures would not be undertaken. The techniques of the procedure and its uses and limitations are emphasized in a number of neurologic problems of children.

Anesthesia↗
PubMed1974

[Research on the epileptogenic complex].

The great importance of a correct definition of the lesional-functional epileptogenic complex for the surgical treatment of the epileptic patient is stressed. The means utilizable to reach the knowledge of the topographic organizatif the latters are descri0ed and discussed in detail: the scalp EEG, the examinations based on the EEG effects of endocarotid injection of barbiturates and convulsants, the EEG during nocturnal sleep, the direct recording of electrocerebral activity from the cortical surface (electro-corticography) and from deep cerebral structures (stereoelectro-encephalography). The relative importance of the informations provided by the electrical activity of "lesional" type, by the interictal epileptic activity and by the ictal one is analyzed. The utilization of methodologies of automatic elaboration of the electrocerebral signals is reminded. Finally, the different modes of application of the means of analysis mentioned above in the different epileptic patients are discussed and exemplified.

Barbiturates↗
PubMed1974

[Electroencephalography and the general physiology of the nervous system].

The contributions of electro-encephalography to the general physiology of the nervous system - studies based on 50 years of experimental and clinical research on the EEG of animals and man - have established irrefutable facts underlying present-day concepts in neurophysiology. This conclusion holds true, even if allowance must be made with regard to the alpha-rhythm, reasons having been given to suppose that this phenomenon is in reality, partially or entirely, an ocular tremor phenomenon (Lippold). The fundamental principles of neuronal activity such as (1) the electrogenesis of gray matter, i.e., the electric current and membrane potential aspects of the existence and the functioning of nerve cells and neuronal aggregates, (2) the rhythmicity and periodicity of nervous activity in single cells or networks of neurones, (3) the synchronization of such nervous activity due, at the site of its source, to electric interaction between neurones belonging together and 'beating in unison', and (4) the autonomous automaticity of nerve cells and nerve centres as being the basic feature of neuronal activity, are among the prominent topics dealt with in this report. Particular attention is paid to the autonomy-concept of nervous activity, a concept ofter forgotten, neglected or discarded from physiological thinking, although life of any kind, in any type of living system, can only be understood if spontaneous existence and activity are accepted for living matter. In this respect the EEG has contributed in a large measure to save the physiology of our period from the materialism which prevailed at the beginning of the century and which threatens once more to emerge towards its end.

Action Potentials↗
PubMed1974

[25 years of electroencephalography in cerebrovascular disease].

The value of the EEG has not been diminished by the advent of new diagnostic procedures and the improvement of older techniques. For electro-encephalography is in essence a 'clinical' method, reflecting in its own particular way, the variable status of the brain. Moreover, in conjunction with these methods the EEG can provide for better information concerning the brain's condition. Furthermore in particular serio-angiography and C.B.F. measurements can furnish us more detailed insight in the EEG phenomena which may occur in differed types of cerebro-vascular disease. Generally the changes of the local EEG phenomena, which may occur in cerebral ischaemia correlate well with the angiographic and r.C.B.F. data. In cerebral haemorrhage and cerebral tumour however the r.C.B.F. values are commonly more diffusely reduced as could be expected from the extent of the EEG disturbances. Increased r.C.B.F. values may be encountered over meningioma due to increased perfusion of the Xenon133 in this electrically inactive tumour; they can also occur in malign glioblastoma, where direct arterio-venous connections are responsable for the so called shunt peaks. These peaks may also be found in patients with arterio-venous malformations or with acute ischaemia, in the latter case due to marked reduction of the local pH. Remarkable was the discrepancy between the local increase of the C.B.F. and the local deterioration in the EEG following intracarotid injection of HC1 papaverine; the same applied to the reaction of EEG and C.B.F. in case of acute induced hypertension with loss of autoregulation.

Aged↗
PubMed1979

[X-ray diagnosis of meningiomas in childhood and adolescence].

In a period of 15 years, 16 intracranial meningiomas of the childhood and adolescence were examined radiologically. The neuroradiological findings obtained are analysed and compared with those obtained in adults. The particularities resulting from this comparison, which above all concern the angiographic picture of meningiomas in juvenile patients, are worked out and discussed. As a result, some conclusions can be drawn which may be of practical importance: As is the case with other cerebral tumours in childhood, meningiomas in most cases give rise to reliable radiological signs of an increase in intracranial pressure. The changes of the cranial bones indicating the presence of a meningioma, which are well-known signs in adults, are found in children almost as frequently. While pneumo-encephalography in most cases permits a reliable localisation of the tumour, it does not permit a diagnostic statement with respect to the kind of the tumour. In three patients the air filling made larger cysts visible which obviously occur more frequently in children than in adults. The angiographic picture of meningiomas in childhood often differs from that in adults with regard to the vascularisation type as well as the phase course, so that differential-diagnostic difficulties may arise. However, when considering the above mentioned peculiarities of the vascular picture of memingiomas in children, it appears to be possible to make a preoperative diagnosis of the kind of the tumour with the help of the angiogram also for children. The increased vascular supply via branches of the A. carotis externa, which is frequently found in neningiomas, cannot in our opinion be considered as a decisive type-diagnostic criterion; it must be considered as an expression of an increased participation of the dura and thus also occurs in other space-occupying intracranial processes.

Adolescent↗
PubMed1979

[Pulsation echoencephalography--a bloodless method of measuring intracranial pressure].

By means of a special procedure an echo encephalograph can be modified in such a manner that changes in the amplitude of an echo peak can be detected and prepared for registration. In this iaay it is possible to single out the medium echo pulsations of the one-dimensional echo encephalography which have been known for a long time and prepare them for recording. In a number of zna persons without an indication of an increase in the intracranial pressure, medium echo pulkmon and ECG were simultaneously recorded. The quotient of the time T1 and R--T of the ECG was calculated 120 times and the respective mean value determined. The same measurements and calculations were then carried out for a total of 100 patients in whom clinical signs suggested an increase in the intracranial pressure (42 patients with extending processes in the supratentorial space, 16 patients with extending processes in the region of the posterior cranial fossa, 10 patients with hypophyseal adenomas, 10 patients with conditions after craniocerebral traumas, 5 patients with occlusions of the aqueductus, 7 patients with disturbances of the cerebrospinal fluid absorption and circulation and 10 patients with aneurysms). In all cases of clinically relevant signs of an increase in the intracranial presure the quotient of T1 and R--T was significantly higher than the calculated mean value. Variations of the pressure were rapidly detected. The results obtained were compared with those of other authors. Advantages and disadvantages of this method were discussed. The task was derived to compare the quotients found with the actual pressure values obtained by invasive methods in order to find out whether there are true correlations which might set the way for a non-bloody quantitative method.

Brain Diseases↗
PubMed1977

[Computerized tomographic diagnosis of the brain: addition of frontal and clivo-parallel cuts to the transverse standard cuts (author's transl)].

The data of now available transverse cut are insufficient for spatial orientation. Using a special technique, frontal and clivo-parallel cuts will provide satisfactory diagnostik detail. The often difficult differentiation between vertically adjoining or commmunicating structures will be facilitated by frontal tomography. Clivo-tangential cuts show the maximum of clivus and dorsum sellae, also the brainstem with axis-parallel transverse cuts. An approximately clivo-parallel cut in the aqueduct the 4th ventricle is longitudinally cut with influx and limited only partially in axis-parallel tomograms because of weak definition in the direction of the Z axis and the variable anatomic and geomtric relations. Pneumo-encephalography and ventriculography cannot be done without. So far in space-occupying lesions clivo parallel cuts are diagnostically valuable near the brainstem, the aqueduct and the 4th ventricle.

Brain Diseases↗
PubMed1977

CT cisternography with intracranial arachnoidal cysts.

Four patients with an intracranial arachnoidal cyst studied by computed tomography are reported. On the routine CT scan, arachnoid cysts are well defined lesions with the same density as cerebrospinal fluid and are not enhanced with contrast. Metrizamide CT cisternography further provides precise anatomic and physiologic information which may be difficult to obtain by angiography or air encephalography.

Adolescent↗