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PubMed1993

Acute intracerebral haematomas: assessment for possible underlying cause with MRI scanning.

Forty-seven patients presenting with acute intracerebral haematomas between 1989 and 1992 were retrospectively examined to assess the role of Magnetic Resonance Imaging (MRI) in identifying any underlying lesion. None had any prior known intracerebral pathology. Magnetic resonance imaging scans were done on a 0.5 T unit. Ten patients with an average age of 35 years had angiographically occult vascular malformations (AOVM) found by MRI (one with biopsy confirmation). One of three cases of glioma, three of three cases with secondary tumour, one case of superior sagittal sinus thrombosis with haemorrhagic infarction, one of two cases of venous angioma and one case of arteriovenous malformation were detected by MRI. Progress computed tomography scans discovered two cases of glioma and angiography found a venous angioma and an arterial aneurysm, all undetected by MRI. It is concluded that MRI scanning is helpful in detecting underlying AOVM as a cause of intracerebral haemorrhage but its role in imaging haemorrhagic tumours remains unclear.

Acute Disease↗
PubMed1991

Benign intracranial hypertension in childhood: a review of 23 patients.

Twenty-three patients with benign intracranial hypertension (BIH) were seen at the Royal Alexandra Hospital for Children, Sydney over an 18 year period to 1988. Age at presentation ranged from 6 months to 13 years and 5 months. The female to male ratio was 2.3:1. The aetiological factors (sometimes multiple) included: chronic middle ear infection, 30%; dural sinus thrombosis, 22%; head injury, 13%; Vitamin A overdosage, 4%; tetracycline exposure, 4%; and no apparent cause, 43%. Headache was the most common presenting symptom occurring in 91% of patients, followed by vomiting in 65% and blurred or double vision in 57%. Papilloedema occurred in 96% of patients, abducens palsy was noted in 48% and visual impairment in 45%. All patients improved clinically after treatment, one with lumbar puncture only. Of 17 patients treated with steroids, 10 patients recovered and seven patients went on to lumboperitoneal shunt. Two patients recovered with steroid and diuretic treatment. Of two patients initially treated with diuretics only, one recovered and one subsequently required a shunt. Only one patient was initially treated with a lumboperitoneal shunt. Three of the shunted patients had shunt block requiring revision. None had permanent visual loss or other significant sequelae. The visual prognosis of BIH in childhood is good. In view of the relatively high complication rate of steroids and shunting, a controlled comparison of steroid vs acetazolamide/diuretic therapy should be undertaken.

Adolescent↗
PubMed1998

Optic disc swelling in Crohn's disease.

PURPOSE: To provide a review of the causes of optic disc swelling in patients suffering from inflammatory bowel disease. METHODS: Two illustrative cases of bilateral optic disc swelling are presented: one in a patient known to have Crohn's disease and the other in a patient whose investigations revealed the disease. The possible causes of optic disc swelling in inflammatory bowel disease, based on a literature review, are tabulated and discussed with reference to the presented cases. RESULTS/CONCLUSIONS: Optic disc swelling is a rare complication of inflammatory bowel disease. Previously reported cases have been attributed to peripapillary inflammation, optic disc ischaemia or intracranial hypertension. Postulated causes of optic nerve ischaemia include a local vasculitis or general hypercoagulability. The underlying aetiology of intracranial hypertension is often elusive. Older studies suggest a relationship between corticosteroid treatment and/or iron deficiency anaemia, while modern imaging emphasises the need to exclude dural venous sinus thrombosis.

Adult↗
PubMed2001

Diagnostic value of apparent diffusion coefficient hyperintensity in selected patients with acute neurologic deficits.

BACKGROUND AND PURPOSE: A pattern of decreased intensity on apparent diffusion coefficient (ADC) maps is useful in the early detection of ischemic brain injury. Less information exists with regard to patients with acute neurologic deficits in whom there is abnormal conventional magnetic resonance imaging (MRI) and increased ADC intensity. METHODS: The authors identified 13 patients with acute neurologic deficits who underwent diffusion MRI and had calculated ADC maps demonstrating hyper-intensity in regions characterized by computed tomography hypodensity and MRI T2 hyperintensity. The initial and follow-up imaging characteristics and clinical syndromes were recorded. RESULTS: Clinical syndromes included hypertensive encephalopathy, posterior leukoencephalopathy, hyperperfusion following carotid endarterectomy, venous sinus thrombosis, HIV encephalopathy, and brain tumor. Diffusion-weighted imaging (DWI) was hyperintense in 3 of 13 patients, isointense in 4 of 13 patients, heterogeneous in 3 of 13 patients, and hypointense in 3 of 13 patients. The ADC values in these regions were significantly higher than those in control regions (P < .0001). At early follow-up, MRI abnormalities resolved completely in 3 of 13 patients and partially in 9 of 13 patients. MRI abnormalities were unchanged in 1 patient. CONCLUSIONS: In the evaluation of patients with acute neurologic deficits, ADC hyperintensity may identify a subset of patients with vasogenic edema of nonischemic etiology. Frequently, these conditions are potentially reversible if appropriately managed. DWI and conventional images alone are not sufficient to identify these neurologic conditions.

Acute Disease↗
PubMed1995

Effects of Erwinia-asparaginase on the coagulation system.

L-Asparaginase treatment during induction therapy in acute lymphoblastic leukaemia (ALL) is known to be frequently complicated by thromboembolic events. It was recently suggested that L-asparaginase derived from Erwinia chrysanthemi alters the coagulation system less severely than does Escherichia coli asparaginase. In a series of 11 adult patients with ALL, we investigated some parameters of the coagulation system during treatment with Erwinia asparaginase. The doses employed were rather high; all patients below the age of 60 years received 15,000 U/m2 daily over 14 days. In accordance with what is known from treatment with E. coli asparaginase, we observed significant lowering of antithrombin as well as of fibrinogen. However, as to fibrinogen indeed a significant decrease had occurred prior to the institution of Erwinia asparaginase treatment. The most striking observation in the present study was that the levels of prothrombin complex, reflecting the function of K-vitamin dependent coagulation factors II, VII and X, remained within normal ranges during treatment. This indicates that these coagulation factors were not affected by Erwinia asparaginase, an observation at variance with several reports where E. coli asparaginase was investigated. This latter observation was the only finding which could lend support to the view that Erwinia asparaginase affects the coagulation system less than E. coli asparaginase. Finally, one of our patients developed a sinus thrombosis, a severe thrombotic complication.

Adolescent↗
PubMed2003

Lemierre syndrome in a previously healthy young girl.

UNLABELLED: Lemierre syndrome is a severe postanginal sepsis complicated by internal jugular thrombophlebitis. We report on a 14 y-old girl affected by high fever, shivering chills, headache, severe lateral neck pain, left ocular proptosis and general malaise. Magnetic resonance imaging of the head and neck showed right internal jugular vein and sigmoid sinus thrombosis. Fusobacterium sp. was identified in the blood culture. CONCLUSION: Our report is a reminder that Lemierre syndrome still exists and remains potentially life threatening. A high index of suspicion is necessary to prompt diagnosis and treatment.

Adolescent↗
PubMed1999

Blood flow velocities in the vertebral veins of healthy subjects: a duplex sonographic study.

Along with the jugular veins, the vertebral veins serve as an important pathway for venous blood returning from the brain. In this study, the authors report duplex sonographic findings in 138 healthy subjects without central nervous disease. Successful insonation was possible in 70.7% of all examined vessels. Bilateral insonation was achieved in 86 subjects (62.3%). Only 1 vertebral vein was detected in 23 persons (16.7%), whereas no vein was found in 29 persons (21%). The authors observed a marked variation of peak flow velocities ranged (5-81 cm/s, mean +/- standard deviation, 23.9 +/- 12.3 cm/s). No significant gender-related or side-to-side differences or age influences on flow velocities were detected. The authors' findings may be of relevance when discussing flow velocities in the vertebral veins in cases of cerebrovenous disorders (e.g., dural sinus thrombosis) or in patients after neck dissection.

Adolescent↗
PubMed1995

Orbital cellulitis demands early recognition, urgent admission and aggressive management.

Orbital cellulitis is an emergency. Confusion still exists between the diagnosis of this serious condition and that of preseptal cellulitis. Delay in treatment may cause blindness and progression to life-threatening sequelae such as brain abscess, meningitis or cavernous sinus thrombosis. We report a case in which, despite late referral, emergency surgical intervention was sight saving.

Aged↗
PubMed2004

Presentation and outcome of rhino-orbital-cerebral mucormycosis in patients with diabetes.

AIM: To report presentation and outcome of rhino-orbital-cerebral mucormycosis (ROCM) exclusively in patients with diabetes mellitus. METHODS: Retrospective, non-comparative, interventional analysis of the medical records of 35 patients with ROCM among 22 316 patients with diabetes seen over the last 12 years. RESULTS: A cohort of 23 men and 12 women with a mean (SD) age of 47.3 (14.4) years (range 18-70 years) was studied. Five patients had type 1 diabetes mellitus, 29 had type 2 diabetes mellitus, and one had secondary diabetes. Nine patients had ROCM as the first clinical manifestation of diabetes. The mean (SD) blood glucose at presentation was 20.6 (8.3) mmol/l (range 10.0 to 53.3 mmol/l) and 17 patients had ketosis/ketoacidosis. Ophthalmic symptoms and signs were pronounced: external ophthalmoplegia (89%), proptosis (83%), visual loss (80%), chemosis (74%), and eye lid gangrene (14%). Non-ophthalmic manifestations included sinusitis (100%), nasal discharge/ulceration (74%), infranuclear VI nerve palsy (46%), palatal necrosis (29%), cerebral lobe involvement (20%), and hemiparesis (17%). Computed tomography/magnetic resonance imaging showed involvement of paranasal sinuses in all patients with ethmoid (86%) and maxillary (80%) sinuses being most frequently involved. Orbital involvement was observed in 80% of patients with cavernous sinus thrombosis in 11%, and internal carotid occlusion and hydrocephalus in 3% each. All were treated with amphotericin B (3-3.5 g) and 26 (74%) patients underwent appropriate surgery. Twenty one patients (68%) survived with a mean (SD) follow up of 39.6 (34.1) months (range 10 months to 11 years). Factors related to poor survival included delay in diagnosis and treatment (p<0.05), facial and/or eye lid gangrene (p<0.05), hemiplegia (p<0.05), cerebral invasion by mucorales (p<0.05), and treatment with amphotericin B alone (p<0.05). CONCLUSIONS: In patients with diabetes and ROCM, ROCM was the presenting manifestation in one fourth of the patients. Ophthalmic and extensive cerebral involvement predominated in the clinical picture. Delay in treatment due to late presentation and associated complications were major determinants of the survival outcome in these patients.

Adolescent↗
PubMed1994

Head and neck MR angiography in pediatric patients: a pictorial essay.

Magnetic resonance (MR) angiography is a new, noninvasive imaging method with well-known uses in adults for the evaluation of carotid disease in the neck and cerebral vasculopathy. MR angiography examinations were prospectively studied in 126 children to evaluate the usefulness of MR angiography of the head and neck in children, as well as to correlate its findings with those of conventional angiography. Eleven patients underwent conventional angiography in addition to MR angiography. MR angiography was performed with commercially available pulse sequences and included two- and three-dimensional time-of-flight and phase-contrast techniques. Indications for MR angiography included evaluation of pathologic conditions (aneurysms and arteriovenous malformations, infarcts, venous sinus thrombosis, brain tumors, and cerebritis), screening examinations in sickle cell disease, and follow-up of extracorporeal membrane oxygenation. MR angiography was found to be a useful, noninvasive diagnostic and screening examination for head and neck and cerebral vascular abnormalities in children and had excellent correlation with conventional angiography.

Adolescent↗
PubMed2001

Frequency and clinical context of decreased apparent diffusion coefficient reversal in the human brain.

PURPOSE: To determine the probability that regions of decreased apparent diffusion coefficient (ADC) return to normal without persistent symptoms or T2 change and the settings in which these ADC reversals occur. MATERIALS AND METHODS: Three hundred magnetic resonance (MR) imaging studies were selected at random from a database of 7,147 examinations to determine the probability of a pathologically decreased ADC. In cases with decreased ADC, the clinical history was recorded and, if available, follow-up MR imaging findings were evaluated. Five cases of ADC reversal became known during the same period and were evaluated to determine the initial ADC decrease, clinical outcome, and findings at follow-up imaging. RESULTS: Findings in 116 of 300 MR imaging studies revealed regions of decreased ADC. In 49 of 116 studies, follow-up MR imaging examinations were performed at least 4 weeks after the onset of symptoms; ADC did not reverse. Five cases of ADC reversal were identified in the same period, giving an estimated 0.2%-0.4% probability of ADC reversal. Clinical settings were venous sinus thrombosis and seizure (n = 3), hemiplegic migraine (n = 1), and hyperacute arterial infarction (n = 1). Both white matter (n = 3) and gray matter (n = 3) regions were involved. CONCLUSION: Reversal of ADC lesions is rare, occurs in complicated clinical settings, and can involve white or gray matter.

Adolescent↗
PubMed1987

Intracranial abnormalities in infants treated with extracorporeal membrane oxygenation: imaging with US and CT.

Findings at neuroimaging in 100 consecutive infants treated with extracorporeal membrane oxygenation (ECMO) are presented. Imaging in these infants consisted of pretreatment cranial ultrasonography (US), daily US studies while on ECMO, and follow-up cranial computed tomography (CT) after treatment. There were findings of abnormalities in 43 patients. Thirty had intracranial bleeding, often of unusual extent and distribution. Thirteen additional infants had nonhemorrhagic abnormalities alone. Bleeding considered to be major was seen in 12% of infants. Large parenchymal hemorrhages and infarcts, cerebellar hemorrhages, and diffuse edema were the most significant abnormalities, with a 50% mortality (eight of 16 patients). No lateralization was noted with respect to distribution of bleeding sites or areas of nonhemorrhagic abnormalities. US was a sensitive but imperfect screening tool for intracranial abnormalities. Abnormalities missed with US included peripheral and small parenchymal lesions, subarachnoid hemorrhage, cerebral atrophy, and sagittal sinus thrombosis.

Brain↗
PubMed1998

Cerebrovascular disease risk factors: neuroradiologic findings in patients with activated protein C resistance.

PURPOSE: To assess the patterns of abnormal neuroradiologic findings in patients with a hypercoagulable state related to activated protein C (APC) resistance. MATERIALS AND METHODS: Records in 23 patients with a hypercoagulable state related to APC resistance (18 women, five men; average age, 44.5 years) were reviewed for cerebrovascular disease risk factors and other causes of a hypercoagulable state. Computed tomographic scans, magnetic resonance (MR) images, angiograms, and transesophageal echocardiograms were also reviewed. RESULTS: Stroke risk factors or other causes of a hypercoagulable state were found in 12 patients. Arterial infarcts were seen in 18 patients. Hyperintense white matter foci were seen on MR images in six patients. Dural sinus thrombosis was found in four patients. Angiograms of intracranial circulation in six patients showed major artery occlusions in four. MR angiograms in four patients showed internal carotid artery occlusion in one. No major abnormalities were seen in extracranial cerebral vasculature in 15 patients. Transesophageal echocardiograms in 11 patients showed a patent foramen ovale in one patient but no systemic source of embolism. Seven patients had non-central nervous system thrombotic events. CONCLUSION: Patients with APC resistance and stroke appear to differ from the general stroke population in terms of age and frequency of extracranial sources of cerebrovascular disease.

Adolescent↗
PubMed2006

New techniques in CT angiography.

Computed tomographic (CT) angiography has been improved significantly with the introduction of four- to 64-section spiral CT scanners, which offer rapid acquisition of isotropic data sets. A variety of techniques have been proposed for postprocessing of the resulting images. The most widely used techniques are multiplanar reformation (MPR), thin-slab maximum intensity projection, and volume rendering. Sophisticated segmentation algorithms, vessel analysis tools based on a centerline approach, and automatic lumen boundary definition are emerging techniques; bone removal with thresholding or subtraction algorithms has been introduced. These techniques increasingly provide a quality of vessel analysis comparable to that achieved with intraarterial three-dimensional rotational angiography. Neurovascular applications for these various image postprocessing methods include steno-occlusive disease, dural sinus thrombosis, vascular malformations, and cerebral aneurysms. However, one should keep in mind the potential pitfalls of these techniques and always double-check the final results with source or MPR imaging.

Algorithms↗
PubMed2003

[Pseudotumor cerebri and systemic lupus erythematosus].

Pseudotumor cerebri (PC) is a syndrome characterized by intracranial hypertension in the absence of any space-occupying lesion, hydrocephalus, cerebral sinus thrombosis and biochemical or cytological abnormalities in the CSF. PC has ben associated with several factors such as systemic conditions or drugs. We report here the case of a patient who presented with headache, vomiting and blurred vision accompanied by bilateral papilledema and had been diagnosed with systemic lupus erythematosus (SLE) seven years before. Treatment was started with high-dose corticosteroids with rapid resolution of the clinical symptoms and papilledema of the patient.

Adult↗
PubMedDate not supplied

Bone wax foreign body granuloma in the mastoid.

The sue of bone wax is commonly used to control bleeding during mastoid surgery. An unusual case of bone wax granuloma in the mastoid, with sigmoid sinus thrombosis, is reported. Although the use of bone wax in and around the mastoid is generally considered safe with few complications, caution should be exercised, particularly in infected fields and in patients known to have general immunohypersensitivity.

Adult↗
PubMed2004

Antithrombotic and hypofibrinogenetic therapy in acute ischemic stroke: what is the next step?

A thrombus occluding a brain artery is the leading mechanism underlying ischemic stroke. In the light of this pathophysiology, antithrombotic therapies have been among the most widely studied and used in the management of patients with ischemic stroke. Aspirin has a significant but modest benefit by reducing recurrent ischemic stroke and death given within 48 h of stroke onset. The use of anticoagulants including heparin, low molecular weight heparin, and heparinoids has not been supported by results of randomized clinical trials. Any reductions in ischemic stroke recurrence were offset by an increase in major bleeding. However, acute anticoagulation is widely used in specific disorders, including patients with high-risk cardiac sources of embolus, arterial dissection, venous sinus thrombosis, and hypercoagulable states. Early recurrent ischemic strokes in patients with atrial fibrillation and acute ischemic stroke have not been shown to be reduced with the heparins, when the effects of major bleeding and hemorrhagic worsening are considered. Recent clinical trials have suggested that other antithrombotic agents may be beneficial in acute ischemic stroke. Two such agents are ancrod and abciximab. Abciximab is currently being investigated in a large randomized clinical trial.

Acute Disease↗