Search

Few large projects have evaluated the factors that influence the HIV RNA concentrations (viral load) in cerebrospinal fluid (CSF) during antiretroviral therapy (ART) over time. We aimed to determine the correlates of HIV RNA in CSF in a large cohort.

A 35-year-old woman with bipolar disorder presented to the emergency room (ER) obtunded with hypercapnic respiratory failure. Neurology was consulted because the patient had acute hearing loss and paraparesis. She was last seen normal the prior night by her ex-husband. Paramedics found her on the couch, obtunded, bradypneic, and hypoxic to 82% SpO2, blood pressure 116/79 mm Hg, heart rate 98 beats per minute, and normothermic. She awakened after 0.4 mg of naloxone administration. Home medications included oxycodone/acetaminophen for chronic pain and venlafaxine, alprazolam, and lamotrigine for bipolar disorder. Of note, 34 pills were missing from the oxycodone/acetaminophen bottle.

Early infantile Krabbe disease is rapidly fatal, but hematopoietic stem cell transplantation (HSCT) may improve outcomes if performed soon after birth. New York State began screening all newborns for Krabbe disease in 2006.

Key differences exist in the epidemiology, pathophysiology, and clinical presentation of vascular lesions of the cerebellum in children versus adults. An understanding of these differences and an appreciation of the distinct imaging features of these lesions aid in distinguishing normal vascular variations from pathology, in predicting lesion etiology, and in directing effective treatment strategies. This paper reviews the embryogenesis of the normal vascular system of the cerebellum and brainstem and then discusses the clinical and imaging features of the common vascular lesions affecting these structures in the pediatric population.

We explored how a novel T1-weighted 3-dimensional (3D) fast spin echo (FSE) sequence (Cube; GE, Waukesha, Wis) might outperform conventional 2-dimensional (2D) FSE techniques for contrast-enhanced imaging of the pituitary and parasellar region.

In recent years, three-dimensional (3D) multiplanar reformatted images from conventional cross-sectional computed tomographic (CT) data have been increasingly used to better demonstrate the anatomy and pathologic conditions of various organ systems. Three-dimensional volume-rendered (VR) CT images can aid in understanding the temporal bone, a region of complex anatomy containing multiple small structures within a relatively compact area, which makes evaluation of this region difficult. These images can be rotated in space and dissected in any plane, allowing assessment of the morphologic features of individual structures, including the small ossicles of the middle ear and the intricate components of the inner ear. The use of submillimeter two-dimensional reconstruction from CT data in addition to 3D reformation allows depiction of microanatomic structures such as the osseous spiral lamina and hamulus. Furthermore, 3D VR CT images can be used to evaluate various conditions of the temporal bone, including congenital malformations, vascular anomalies, inflammatory or neoplastic conditions, and trauma. The additional information provided by 3D reformatted images allows a better understanding of temporal bone anatomy and improves the ability to evaluate related disease, thereby helping to optimize surgical planning. © RSNA, 2006

This article presents the first series of MRI-based anatomically labeled sectioned images of the brain of the killer whale (Orcinus orca). Magnetic resonance images of the brain of an adult killer whale were acquired in the coronal and axial planes. The gross morphology of the killer whale brain is comparable in some respects to that of other odontocete brains, including the unusual spatial arrangement of midbrain structures. There are also intriguing differences. Cerebral hemispheres appear extremely convoluted and, in contrast to smaller cetacean species, the killer whale brain possesses an exceptional degree of cortical elaboration in the insular cortex, temporal operculum, and the cortical limbic lobe. The functional and evolutionary implications of these features are discussed. © 2004 Wiley-Liss, Inc.

Brief ectopic expression of Gcm1 in mouse embryonic tail bud profoundly affects the development of the nervous system. All mice from 5 independently derived transgenic lines exhibited either one or both of two types of congenital spinal cord pathologies: failure of the neural tube to close (spina bifida) and multiple neural tubes (diastematomyelia). Because the transgene is expressed only in a restricted caudal region and only for a brief interval (E8.5 to E13.5), there was no evidence of embryonic lethality. The dysraphisms develop during the period and within the zone of transgene expression. We present evidence that these dysraphisms result from an inhibition of neuropore closure and a stimulation of secondary neurulation. After transgene expression ceases, the spinal dysraphisms are progressively resolved and the neonatal animals, while showing signs of scarring and tissue resorption, have a closed vertebral column. The multiple spinal cords remain but are enclosed in a single spinal column as in the human diastematomyelia. The animals live a normal life time, are fertile and do not exhibit any obvious weakness or motor disabilities.

Superior oblique myokymia is a rare movement disorder thought to be caused by vascular compression of the trochlear nerve. Direct display of such neurovascular compression by magnetic resonance imaging has been lacking. The goal of this study was to assess the presence of neurovascular contacts in patients with superior oblique myokymia, using a specific magnetic resonance imaging protocol. A total of 6 patients suffering from right superior oblique myokymia underwent detailed neuro‐ophthalmological examination, which showed tonic or phasic eye movement. All patients underwent magnetic resonance imaging, using a magnetic resonance imaging Fourier transform constructive interference in steady‐state sequence in combination with magnetic resonance imaging time of flight magnetic resonance arteriography both before and after the administration of Gd‐DTPA. With this protocol, the trochlear nerve could be visualized on 11 of 12 sides (92%). Arterial contact was detected at the root exit zone of the symptomatic right trochlear nerve in all 6 patients (100%). No arterial contact was identified at the root exit zone of the asymptomatic left trochlear nerve in any of the 5 left nerves visualized. In conclusion, superior oblique myokymia can result from neurovascular contact at the root exit zone of trochlear nerve, and therefore should be considered among the neurovascular compression syndromes.

The authors report two elderly men with diffuse meningeal enhancement 13 and 21 years following insertion of ventriculojugular shunts. Lumber puncture documenting low CSF pressures suggests that diffuse meningeal enhancement in patients with long-standing ventricular shunts may be secondary to dural venous dilatation rather than meningeal fibrosis. The authors theorize that these elderly patients, neither of whom had postural headache, may be less subject to brain "sag" because of decreased brain weight.

Thirty-two patients with nasal dermal sinuses and cysts were treated during the 10-year period from 1978 to 1987. These patients presented with midline cysts (N= 18) or sinus ostia (N= 14). Only 6 of the 32 patients manifested intracranial extension (19 percent). All the patients with intracranial extension exhibited an intracranial mass on preoperative CT scans. Ten patients with no CT evidence of intracranial mass were noted to have only a fibrous cord extending to the base of the foramen cecum. In 4 of these 10 patients, craniotomy confirmed that there was no intracranial extension of the dermoid. Four other patients presented with sinus ostia at the base of the columella. None of these 4 patients had intracranial extension. Clinical examination and preoperative CT scans provide most of the information needed to determine the nature, course, and extent of these lesions.

Two-dimensional cine phase contrast (2D-cine PC) magnetic resonance (MR) imaging is an imaging technique that sensitizes MR images to velocity changes in a specific direction while cancelling signals from stationary protons and from motion in other directions. This article reviews the technique, conventions, and applications of this imaging technique to hydrocephalus. 2D-Cine PC and additional more rapid MR imaging methods now in development will allow clinicians to measure CSF velocity, pulsation, and bulk flow noninvasively in normal individuals and in patients with a variety of pathologic conditions. It is hoped that these measurements may be correlated with intracranial pressures to develop clinical tests of brain compliance and improved management of patients with hydrocephalus.

A 3-year-old girl with repaired cloacal exstrophy and two skin-covered dorsal lumbosacral masses was documented to have two lipomyelome-ningoceles at noncontiguous levels of a tethered spinal cord. The clinical, radiographic. myelographic, CT. and surgical appearances are presented to illustrate the features of this extremely rare anomaly.

Perinatal insults, including anoxia, may lead to a form of cerebral necrosis designated multicystic encephalomalacia. This common condition is characterized by (a) moderate atrophic ventricular dilatation, (b) intact ventricular walls with thickened subependymal glial layer, (c) multiple cysts of irregular size and shape distributed throughout the cerebral white matter and the inner layers of the cortex bilaterally, and (d) relativesparing of the orbital surfaces of the frontal lobes, the temporal lobes below the superior temporal gyri, the basal ganglia, the cerebellar hemispheres, and the spinal cord (except for secondary degeneration of corticospinal tracts).

Intravenous administration of iodinated contrast agents permits identification of the major cerebral arteries and veins: third, fourth, and lateral ventricular choroid plexuses: falx and tentorium on appropriate sections of contrast-enhanced computed axial tomographic (CECT) images. Combinations of these normal vascular structures into conglomerate densities may produce confusing contrast pseudotumors on CECT images.

Noninvasive computed tomography provided the initial, accurate diagnosis of a necropsy-proven case of infantile Alexander disease, demonstrated serial changes in the intensity and distribution of leukodystrophy, and documented a progressive alteration of brain density from abnormally high attenuation to abnormally low attenuation as the disease advanced.

With a high resolution modification of a translate–rotate body scanner (EMI CT5005), radiologists may now demonstrate the epidmal fat, thecal sac, and axillary pouches of the lower thoracic, lumbar, and sacral spinal canal without using contrast agents. Preliminary results with a newer rotary motion scanner (EMI CT7070) suggest that this scanner achieves equally good delineation of intracanalicular anatomy.

The computed tomographic (CT) findings in two patients in whom intracranial granulocytic sarcomas preceded the onset of systemic myelogenous leukemia are presented. On CT, granulocytic sarcomas may be indistinguishable from meningiomas and difficult to differentiate from primary central nervous system malignant lymphoma and eosinophilic granuloma.

Three-dimensional images of the cerebral ventricles may now be generated from routine serial axial or coronal noncontrast CT scans in 5–8 min and rotated in space interactively in 2–5 s to provide the physician with useful views of anatomic relationships difficult to depict in other ways.

With computer reformatting techniques, it is possible to project any lesion into its proper position with respect to the reformatted midsagittal computed tomography (CT) plane, the reformatted biparietal CT plane, or any other useful reference plane. The calvarial contour depicted on the reformatted midsagittal CT image is exactly comparable to the calvarial contour seen on a true lateral skull radiograph, and the calvarial contour depicted on the reformatted biparietal CT image is exactly comparable to the biparietal calvarial contour seen on the standard frontal skull radiograph. Using simple geometric proportions, therefore, it is easy to transfer the projection of a lesion from the reformatted images onto true lateral and frontal skull radiographs to provide neurosurgeons and radiotherapists with frontal and lateral pictures of the lesion and the skull suitable for planning surgical incisions and radiation portals

TRADITIONAL methods of evaluating the neurologically impaired patient have undergone progressive modifications since the introduction of computerized tomography (CT) in 1972. In just five years, CT has become the single most valuable study for detecting and localizing intracranial disorders, frequently obviating further workup. Even if further evaluation is needed, the information gained by CT usually reduces the extent of further diagnostic study and permits the workup to be tailored to the specific problem. We report our approach to CT scanning after experience with 10,000 CT scans in 8,500 patients observed at Montefiore Hospital and Medical Center during the last two years.Roentgenographic examination of the patient with suspected intracranial disease usually begins with plain skull roentgenograms. Tomography may be used subsequently in specific areas, eg, sella turcica and petrous pyramid. Thereafter, almost all patients whose conditions require further evaluation are studied by CT. Except in patients with clinical evidence of

Examination (including CT and magnetic resonance studies) of 11 unrelated children with median cleft face syndrome revealed 6 (55) with dense calcification of the falx and 5 (45) with interhemispheric lipoma. Of the 11 children, 3 exhibited Sedano faceis type A, 4 exhibited Sedano facies type B, and 4 exhibited Sedano facies type D. Type A patients had no calcification or lipoma. Two of three type A patients were products of separate twin gestations, the only twins in the series. Type B patients had frequent falx calcification (three of four) and interhemispheric lipoma (two of four). Two of the four type B patients had concurrent Goldenhar syndrome, the only such patients in the series. Type D patients also had frequent falx calcification (three of four) and interhemispheric lipoma (Three of four). Patients with median cleft face syndrome and Sedano facies type B or D should be examined radiologically for concurrent intracranial pathology.

Twelve neonatal brain tumors, presenting within 60 days of birth, constituted 3.3 of pediatric brain tumors. Three-fourths were supratentorial. Two-thirds were benign. Forty-two percent were choroid plexus papilloma. Twenty-five percent were teratoma. Eight percent each were hypothalamic glioma, gliosarcoma, medulloblastoma, and primitive neuroectodermal tumor. Clinical symptoms were nonspecific. Signs of herniation were absent in all 12 patients. Forty-two percent of these patients died 1 day to 8 months after diagnosis. Ultrasound, CT, and magnetic resonance have all proved useful for displaying these lesions suitably for surgery.

Correlation of direct coronal CT with observations at surgery demonstrates that direct coronal CT is a highly useful guide to planning surgical resection of posterior fossa tumors. Computed tomography performed in this plane displays all significant anatomic relationships in the exact orientation found during surgical dissection.

A 2-year-old girl evaluated for diastematomyelia proved to have nearly complete block from an associated primary intraarachnoid Wilms tumor (nephroblastoma) situated immediately caudal to the bone spur and dorsal to the reunited hemicords and conus medullaris. No second focus of Wilms tumor could be detected. The computed tomographic appearance of the tumor and a possible embryological explanation for its relationship to the spinal cord are presented. Index Terms: Kidney, neoplasms—Spina bifida—Computed tomography —Spine, neoplasms—Ultrasound.

Patients with ocular coloboma and its variants may exhibit notching of the iris, peripapillary staphylomas, crater-like excavation of the optic disc, funnel-shaped widening of the retrobulbar optic nerve, cup-shaped filling defects in the perioptic subarchnoid space, and concurrent anomalies of the face, skull, and brain. Combined ophthalmological and radiological evaluation identifies these lesions successfully and differentiates them from other ocular pathology.

Thirty-six infants and children with brain stem glioma diagnosed between 1967 and 1980 were reviewed. Posterior fossa craniotomy was performed in 25, with biopsy or partial resection in 18, cyst aspiration in 2, and exploration alone in 5. The 19 surgical specimens obtained revealed neoplastic cells in 15 but only gliosis or blood clot in 4. There was a significant discrepancy in pathological spectrum between autopsy and surgical specimens. The review of the literature shows that 51.6% of autopsy confirmed tumors were malignant while 26.8% of surgically biopsied tumors were benign. Since biopsy specimens often misrepresent the true pathology, we felt that surgery undertaken to obtain precise histological verification of brain stem gliomas is futile. Rather, we employ computed tomography (CT) with high-resolution metrizamide CT cisternography to distinguish surgically resectable extra-axial tumors adjacent to the brain stem from the unresectable intrinsic brain stem gliomas. Radiation therapy is the choice of treatment should CT indicate clear evidence of intrinsic brain stem tumor. However, posterior fossa craniotomy should be undertaken only for aspiration of cystic intrinsic stem tumors, resection of extra-axial juxtastem tumors and, although rare, in instances when CT is unable to definitively distinguish extra-axial from intra-axial mass for verification of lesion location.

Spontaneous intracranial hypotension (SIH) is a rarely reported syndrome of spontaneously occurring postural cephalalgia associated with low CSF pressure. We report a case of SIH in which MRI of the brain revealed diffuse symmetric pachymeningeal enhancement that resolved without specific therapy.

In a patient with left glomus jugulare tumor and left hypoglossal nerve palsy, computed tomography demonstrated focal lucency of the left half of the tongue. This was interpreted to represent postdenervation fibrosis and fatty replacement of the intrinsic and extrinsic lingual muscles supplied by the hypoglossal (XIIth cranial) nerve.

We thank Drs. Bhatt and Adams for the thoughtful comment on our article.1Hypoxia affects cochlear function in many ways,2–5including a rapid decline in both endocochlear and other cochlear potentials (i.e., cochlear microphonic, distortion-product otoacoustic emission, and compound action potential),6,7as well as inducing histologic and cellular changes.8Moreover, hypoxia, in the form of apneic spells, is a significant clinical predictor of newborn sensorineural hearing loss.9

BROWN tumor arising in the retroorbital region has not, to our knowledge, been previously reported. We report the case of a woman with chronic renal failure and a rapidly progressive proptosis with loss of visual acuity secondary to orbital brown tumor.Report of a CaseA 24-year-old woman receiving long-term hemodialysis, with a four-year history of renal failure secondary to glomerulonephritis, was admitted to Montefiore Hospital on July 30, 1976, complaining of rapidly progressive proptosis of the right eye (OD), right-sided headaches, decrease in visual acuity, and right facial numbness. She had a 12-mm proptosis of the right eye, with severe reduction in extraocular motion in all directions. Visual acuity was 20/70 OD, and 20/25 in the left eye. A Marcus-Gunn pupil was present in the right eye. Funduscopic examination showed striking choroidal folds in the posterior pole of the right eye. Hypesthesia was present in the right infraorbital nerve

We too have become concerned with the sensitivity of CT for the diagnosis of subarachnoid hemorrhage. The initial draft of our communication was written 16 months before publication and expressed great enthusiasm for CT diagnosis of subarachnoid hemorrhage. At revision of the proofs six months ago, this enthusiasm was tempered conspicuously to a bare statement citing the results of Scotti et al.Since that time, we, in addition to Christopher Moran, MD, and Mokhtar Gado, MD, have reviewed a small series of 31 patients in whom CT and lumbar puncture were performed within a short time of each other and both within the first two days of initial clinical signs and symptoms of subarachnoid hemorrhage.Computerized tomography successfully detected subarachnoid hemorrhage in 27 (87%) of 31 cases; however, it failed to demonstrate the subarachnoid hemorrhage in four (13%) of the patients, including some with grossly bloody CSF at