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A variety of antineoplastic agents is associated with toxicity to healthy tissue and therefore represents a hazard for patients in case of extravasation. The most common risk factors include patient associated and iatrogenic risk factors. Due to the possible complications after extravasation, the knowledge of these risk factors is the basis for prevention, which is of utmost importance. A classification of antineoplastic agents according to the type of tissue damage includes the categories vesicant, irritant, and non-vesicant. Dependent on the extravasated agent, a series of emergency measures should be considered, preferably adhering to a standard operation procedure. There is good evidence for the successful use of antidotes to some antineoplastic agents. These antidotes are dimethylsulfoxide or hyaluronidase, often combined with topical measures such as cooling or application of heat. The application of sodium bicarbonate, sodium thiosulfate, and heparin is not recommended, whereas the usefulness of corticosteroids is still a matter of controversial discussions. Ambiguity in the management of extravasation is often a consequence of limited clinical evidence. Due to our deficient knowledge about some of the administered cytotoxics, there is ongoing need for action even after decades of therapy with antineoplastic agents.

In localized in vivo proton NMR spectroscopy (1H MRS) of the human brain, it often cannot be avoided that the selected volume of interest (voxel) includes both gray matter (GM) and white matter (WM). Since the spectra of GM and WM differ, in general, the acquired spectrum represents a mixed spectrum that depends on the tissue composition inside the voxel. This study describes a method that enables the determination of pure GM spectra and pure WM spectra from mixed spectra. The pure tissue spectra are calculated from measured spectra acquired from several voxels with different mixed tissue compositions. For this purpose, the tissue composition in the voxels must be known. It is determined by segmentation of an additionally acquired 3D image data set with higher spatial resolution. In volunteer examinations, measurements were performed in different regions of the cerebrum, cerebellum, and thalamus. In all examined brain regions, particularly in the cerebellum, clear differences were found between the spectra of WM and GM. The detected differences in the spectra of WM and GM indicate that the tissue composition in the voxel has to be considered in patient studies, in order to distinguish pathological alterations in the spectra from the effects of tissue composition.

In spite of modern antibiotic treatment, bacterial meningitis still has a dubious prognosis. Secondary complications are responsible for death or permanent neurologic deficits. The indication for imaging is 2-fold. Beside the search for a source of infection, an early detection of secondary complications is attempted.We report about a patient with hematogenous pneumococcal meningitis, who developed a subdural empyema and vascular stenoses of the basal cerebral arteries. These changes as well as the resulting infarctions were detected with MRI in an early state. Thus, an adequate therapy could be initiated. Especially FLAIR images, diffusion-weighted sequences and a time of flight MRA proved to be valuable in this setting.

Aim: The blood distribution on CCT and the prognosis of patients with nonaneurysmal subarachnoidal haemorrhage were retrospectively studied and compared to a patient group with aneurysmal haemorrhage., Methods: The blood distribution on CCT (72 h after bleeding episode) of 26 patients with nonaneurysmal subarachnoidal haemorrhage confirmed by two normal cerebral angiograms was compared to the blood distribution of 76 patients with aneurysmal haemorrhage. The clinical condition of these patients was further analysed, 4-60 months after the bleeding episode., Results: In 62% of patients with nonaneurysmal haemorrhage the blood distribution was perimesencephalic. The aneurysmal blood distribution pattern was more extended and only one patient showed a perimesencephalic pattern. 80% of the patients without aneurysms in angiography had no limitations in daily functional capacity., Conclusion: The perimesencephalic pattern is frequently found in patients with nonaneurysmal subarachnoidal haemorrhage, the prognosis of these patients is excellent. Rarely is the perimesencephalic haemorrhage caused by a ruptured aneurysm. It needs thorough angiographic evaluation.