CT, myelography and CT-myelography in the evaluation of common cervicobrachial neuralgia.

The CT technique used to explore intervertebral discs and foramina is described, as are the CT signs of nucleus pulposus (NP) herniation and cervical degenerative lesions. CT with intravenous contrast injection is the most efficient and easiest method to diagnose a radicular compression of discal or degenerative origin. The advent of high-resolution contrast CT will probably make obsolete the use of contrast media. CT measures the width of the vertebral canal, but it does not evaluate the repercussions on the spinal cord of compression caused by NP herniation or osteophytosis: only CT-myelography or, better, MRI can make this evaluation. Conventional CT scans are sometimes inadequate when exploration is hampered by superimposition of the shoulders (C6-C7 and more often C7-T1), when the scanner is of poor quality or when it is misused. Myelography and CT-myelography can then be utilized to resolve the problem posed by C7 or C8 cervicobrachial neuralgia (CBN). CT makes it possible to exclude most of the causes of non-discal CBN in the extradural spaces (e.g. bone tumour, neurinoma, vertebral vascular malformation, paravertebral expansive process, apical lung tumour). The search for an intradural cause (extra- or intramedullary tumour) rests on myelography, CT-myelography and MRI.

[Posterior epidural adipose tissue and the narrow lumbar canal: replacement tissue or cause of impingement?]. / Graisse épidurale postérieure et canal lombaire étroit: tissu de remplissage ou acteur du conflit?

The role played by the epidural fat has been reported in lipomatosis induced by exogenous glucocorticoids and in severe obesity with lipomatosis. The role played by the "normal" posterior epidural fat (PEF) in lumbar canal stenosis (LCS) is less well known. The purpose of this study was to determine the part taken by PEF in LCS patients without endocrine disease, corticosteroid therapy or obesity. For this, we tried to specify the amount and distribution of PEF among the soft tissues in the vertebral canal, to demonstrate the involvement of PEF in dural sac compression, to describe the radiological features observed in cases of LCS and to look for associated morphological factors. The records of 30 LCS patients without exogenous or endogenous lipomatosis and in whom the essential pathogenic factor in 40 levels was PEF were reviewed retrospectively. At disc level, PEF was evaluated in the lower part of the mobile segment by means of CT or MRI axial sections cut through one or two spaces between L2-L3 and L4-L5. Measurements were made in 25 men (80%) and 6 women (20%) aged from 33 to 83 years (mean: 58 years). Most patients were suffering from lumbar pain, radiculopathy and/or neurogenic intermittent claudication. The data measured were: antero-posterior (AP) diameter of the dural sac, AP diameter of the bony lumbar canal (BLC), interligamentous distance (ILD) opposite the articular facets, and surface of PEF. The soft elements present on the midline--anterior epidural space (AES) and posterior epidural (PEF)--were expressed as percentage of the AP diameter of the bony lumbar canal.(ABSTRACT TRUNCATED AT 250 WORDS)

CT and MRI of suprasellar lesions.

The authors report their experience of CT and MRI imaging in the study of suprasellar pathologies. The problems concerning the differential diagnosis between meningioma developed in the suprasellar region and pituitary tumour with suprasellar extension are discussed and illustrated; the demonstration of bone abnormalities (blistering, hyperostosis) is particularly useful for the diagnosis of presellar meningioma. The CT and MRI features of craniopharyngioma are compared; CT, of course, is more reliable than MRI in detecting calcifications; with both methods it may be difficult to visualize the cystic components. Glioma of the chiasma is readily diagnosed by MRI, provided the tumour is not too large. Non-thrombosed suprasellar aneurysms have typical features at CT and MRI. Cystic lesions are easily identified by MRI. The CT and MRI images of inflammatory lesions are not very typical.

[Computerized tomography in post-traumatic cerebral lesions (author's transl)]. / Etude tomodensitométrique des lésions cérébrales post-traumatiques.

A review of 108 cases of cranial injury, dating back for more than three months, and having had computerized tomography examinations, revealed 96 abnormalities in the results. These included overall, 65 times, and localized, 20 times, ventricular dilatations, generalized atrophy 27 times, porencephaly 27 times, enlargement of the sylvian fossa 28 times, chronic subdural hematomas 8 times, intracranial calcification 3 times, meningiomas 3 times, and a cerebral abscess in 1 patient. The computerized tomography results were normal in 12 patients. Very good correlations were found between clinical and computerized tomography results in patients with psychic disturbances and disorders of the higher centers. They were variable in cases of epilepsy and neurological deficiency states. The greatest number of normal results was found in so-called subjective syndromes.

Posttraumatic intracranial meningiomas: recognition by computed tomography in three cases.

Intracranial meningiomas were detected by computed tomography (CT) in three patients who had suffered previous head trauma 40, 10, and 3 years before. In two of the patients, the meningioma was located at the site of the traumatic impact and lesion. Meningiomas should be considered one of the late posttraumatic sequelae that can be recognized by CT.

[Diagnosis of brain lesions and of early complications by CAT scan in traumatic patients in coma. Series of 265 cases (author's transl)]. / Intérêt de la tomodensitométrie dans le diagnostic lésionnel et la surveillance précoce des traumatisés dans le coma. 265 observations (author's transl)]

In every patient admitted with a traumatic coma a CAT scan was performed immediately (less than 6 hours after the accident). As a routine procedure another scan was performed 48 hours later; further scans were done depending upon the clinical and ICP conditions. The patients were operated upon or given a medical treatment from the CAT scan analysis only. Until now the brainstem lesions have not been seen on the first day CAT scan images. The CAT scan performed on the second day will show a stabilization or an expansion of the previous lesions: haemorrhage or oedema. Any change in the patient condition or in the IPC monitoring must lead to a new CAT scan revealing epidural or subdural haematomas, hydrocephalus, subdural hygroma, persistent oedema. Therefore the CAT scanner used by a neurosurgical team must be able to work day and night.

Splenic abscesses in typhoid fever: US and CT studies.

Salmonella typhi splenic abscesses (SA) are traditionally considered to be a rare complication of typhoid fever (TF). Our prospective study in an extensive series of patients was aimed at demonstrating that the incidence of SA was usually underestimated. Four hundred patients were systematically examined by abdominal ultrasound (US) at the time of proven biological diagnosis of TF, which was the 2nd week of admission. Twenty patients with persistent or recurrent symptoms (despite adequate treatment) or with acute lower thoracic pain were followed by US and CT. In eight patients both imaging modalities revealed anomalies compatible with SA.

[Stellate ganglion radiofrequency neurolysis under CT guidance. Preliminary study]. / Neurolyse du ganglion stellaire par radiofréquence sous guidage scanographique. Etude preliminaire.

Sympathetically maintained pain syndrome of the upper limb is difficult to treat even with high doses of specific medication. Stellate ganglion block by in situ injection of a local anesthetic is an efficient and accepted method for diagnosis and treatment. The sedative effect is however transitory linked to the short effect of the drug. CT guidance, displaying an excellent contrast between soft tissues, bones, vessels and nerves, is a well suited and safe mean of guidance. Seven patients suffering from reflex sympathetic dystrophy were treated by stellate ganglion radiofrequency (RF) neurolysis at two sites (C7 and T1). Patients were evaluated for pain before and immediately after the procedure and at three months. Four patients had a significant (50%) pain relief lasting at 3 month. One patient had a temporary pain (one week) and 2 no pain relief. No patient had a Horner syndrome. One patient had a temporary neuralgia of surrounding nerves (brachial plexus). RF neurolysis of stellate ganglion under CT-guidance is precise and appears efficient but further investigation on a larger cohort of patients is needed.