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Root avulsions in brachial plexus injuries are classified as pre- or infraganglionic or post- or supraganglionic. Motor and sensory function is lost in both lesions, but the dorsal root ganglion is intact in preganglionic injuries and, therefore, sensory nerve conduction is spared. Although classified as root avulsion lesions, they are not only anatomically but physiologically and in being amenable to surgical treatment, quite different. We describe a patient with preganglionic injury who had a normal sensory nerve conduction. Surgical option was not available to this patient because of the proximity of the avulsed roots to the spinal cord.

The ability of magnetic resonance imaging (MRI) to diagnose locked facets was examined in a series of six patients with traumatic cervical spine fractures. Plain films, computed tomography, and magnetic resonance scanning were done immediately following injury. Cord edema, contusions, and acute disc herniation were well visualized on magnetic resonance images. Magnetic resonance proved to be equally effective in diagnosing unilateral and bilateral locked facets, and demonstrated the disruption of the posterior longitudinal ligament (PLL) with clarity. The magnetic resonance diagnostic criteria of locked facets, herniation of intervertebral discs, and rupture of the posterior longitudinal ligament are described. Besides permitting direct visualization of the spinal cord, MRI may have a role in the diagnosis and management of acute bony injury to the cervical spine.

This study included 83 motorcyclists, helmeted and nonhelmeted, involved in crashes. All these patients were flown to a major trauma center in the Northeast (Hartford Hospital, Connecticut) directly from the scene by a helicopter ambulance service (LifeStar). The study showed that the majority of these patients were male and under the age of 30 years. Twenty-seven had blood alcohol levels above the legal limit. Sixty-nine percent were nonhelmeted and, statistically, a significant number in this category had a Glasgow Coma Scale (GCS) score of 8 or under. Cervical spine injuries were discovered in only six patients. Nine of the ten patients declared dead on arrival (DOA) were nonhelmeted. We conclude that helmets provide protection and certainly do not increase the incidence of cervical spine injuries.

Anaplastic astrocytomas (AA) and glioblastoma multiforme (GBM), although common primary tumors of the brain in adults, are relatively infrequent in children. Eleven patients with these lesions were treated at our hospital over a period of 20 years. This retrospective study of high-grade gliomas examines numerous factors that could help in the future management of these tumors.

A case of neurogenic pulmonary edema due to hydrocephalus, without initial neurological deficit, is described. Computed tomography demonstrated a ring enhancing lesion in the tectum of the mesencephalon obstructing the aqueduct of Sylvius. The lesion, on autopsy, was a rare mesencephalic glioma described in the literature as a "pencil glioma" of the aqueduct.

Seventeen patients (15 newly diagnosed and two recurrent) with meningiomas were studied by magnetic resonance imaging (MRI) operating with 0.3, 0.5, and 1.5 Tesla magnets. In four patients gadopentetate dimeglumine was administered, following a noncontrast scan. In all the patients the tumors were isointense with the cortex at short relaxation and echo times (TR and TE) and became hyperintense with the increase in TR and TE on 0.3, 0.5, and 1.5 Tesla magnet systems. MRI correlated well with angiography in the detection of sagittal sinus thrombosis, and delineated tumor from edema as in computed tomography. Elimination of bony artifacts made detection of posterior fossa tumors easier with MR scanning. Gadopentetate dimeglumine shortened the scan time, displaying small tumors as well as sagittal sinus involvement to advantage. In these respects, we believe MRI is more effective than computed tomography in the diagnosis and management of meningiomas.

Opiates exert numerous effects on all levels of the central nervous system with tolerance, physical dependence and withdrawal being characteristics of this drug class. The degree of dependence is directly correlated to the intensity of withdrawal. Therefore, success in modifying the withdrawal syndrome may shed light on the dynamics of opiate addiction. The present study demonstrates that cyclosporine, a widely used immunosuppressive drug, considerably modified the behavioral signs of a naloxone-induced abstinence syndrome in morphine-addicted rats. In previous experiments, alpha-interferon has shown similar results. The similarity in actions of these two immunomodulator drugs is discussed and we suggest that opiate addiction may involve the immune system.

Meningioma is a histologically benign tumor that is second in frequency only to gliomas among primary intracranial tumors. Its extracerebral development and generally clear demarcation from the brain does not make it easier to detect on magnetic resonance (MR) scanning. Only 2 to 3% of meningiomas occur in the foramen magnum, and these tumors are often clinically misdiagnosed. We discuss four cases of foramen magnum meningioma, with emphasis on MR scanning.

A case of symptomatic Rathke's cleft cyst is described. In spite of the intrasellar component and radiological and clinical evidence of involvement of the pituitary gland, the sella turcica was minimally involved. MRI afforded optimal visualization and localization of the intra- and suprasellar components vis-à-vis the pituitary gland, optic chiasm, infundibular stalk, and carotid arteries.

Encystment of the fourth ventricle, due to occlusion of the aqueduct as well as the foramina of Magendie and Luschka has been described previously. Partial sequestration such as that encountered in two cases described is a less common entity. In these two cases, the aqueduct of Sylvius was occluded, but the basal foramina (Magendie and Luschka) were patent. We discuss this partial sequestration or communicating hydrocephalus of the fourth ventricle on the basis of MR and CT scan findings. Although computed tomography following water soluble cisternography did diagnose the entity indirectly MRI proved to be a superior tool. It permitted direct visualization of the basal foramina noninvasively.