Search

: Computed tomographic angiography (CTA) is being used more frequently in the decision for the carotid endarterectomy. The accuracy of CTA to differentiate between moderate and severe occlusions of the internal carotid artery has been evaluated in this study. After color-flow duplex (CFD) scanning to determine the severity of the stenosis, contrast-enhanced spiral CTA was performed in 60 carotid arteries of 30 patients. 2-D or 3-D time-of-flight MRA techniques and gadolinium enhancement were also used to measure stenosis. Accuracy for moderate, severe and occluded stenoses was calculated. Internal carotid artery stenosis was classified as completely occluded in four, severe in 27, moderate in 25 and mild in four by CFD. There were five total occlusions, and 19 severe, 30 moderate and six mild stenoses by CTA. The overall accuracy of CTA to CFD was 84%, and was 92% and 75% for moderate and severe stenoses, respectively. CTA has identified calcification and ulceration of the plaque. By MRA there were 2 total occlusions, and 33 severe, 19 moderate and six mild stenoses. The overall accuracy of MRA to CFD was 80%, and was 70% and 94% for moderate and severe stenoses, respectively. While MRA is now routinely used to confirm the results of CFD before surgery, the CTA may in time replace the MRA because it better identifies plaque morphology, ulceration and tight stenoses.

Dermoid cysts of the oral cavity are rare. When they do occur, the most common site is the floor of the mouth. Intralingual dermoid cysts are even more rare, and until now, there were only 15 such reports in the English-language literature. In this article, we describe two additional cases. Magnetic resonance imaging is extremely helpful in establishing a differential diagnosis. Surgical excision is recommended to correct deglutition and speech problems. Its rarity notwithstanding, dermoid cyst should be considered in the differential diagnosis of tongue masses in the younger population.

Abstract Case report.. An 8-year-old developmentally normal boy (status: post third ventriculostomy and resection of posterior fossa low-grade glioma 4 years earlier and with known history of ventriculomegaly/arrested hydrocephalus) presented to the emergency room with vomiting and lethargy after a minor head trauma. Computed tomography scan of the head revealed no acute changes since previous studies. However, the patient's neurological status rapidly declined in the emergency room, where an emergency ventriculostomy demonstrated increased intracranial pressure. The patient's clinical condition improved over 24 h: he underwent placement of a ventriculoperitoneal shunt without complications and was discharged intact. Discussion.. The pathogenesis of rapid neurological decline associated with minor head trauma in chronic hydrocephalus is reviewed.