Percutaneous injection of metrizamide into spinal cord cysts for preoperative diagnosis of syringomyelia.

Five cases of syringomyelia are reported in which the spinal cysts were percutaneously punctured and filled with metrizamide for preoperative diagnosis. There were no side effects from the puncture or the contrast medium. In all cases the cyst was larger than had been demonstrated by previous myelography. A communication to the fourth ventricle was seen in two cases. Four patients had surgical treatment; the neurologic deficits improved in two patients, while the condition of the others has remained unchanged.

[Quantitative analysis as part of computer tomography of the skull (author's transl)]. / Die quantitative Bildanalyse im Rahmen der kranialen Computertomographie.

The possibilities of quantitative evaluation of skull computer tomograms were explored in a group of 22 normals and compared with a group of 26 patients with cerebral tumours. Quantitative measurements of normal cerebral tissue and of tumours have revealed mean values for these groups which permit certain fundamental conclusions.

[The value of brain scanning in cerebro-vascular disease by CT (author's transl)]. / Der Wert der Hirnszintigraphie bei Gefässprozessen in Bezug zur Computer-Tomographie.

Brain scanning by scintigraphy and CT studies of the brain are complementary methods. The precise demonstration of the anatomy and the pathology of the brain by CT is supplemented by brain scintigraphy due to the latter's value to assess the hemodynamic properties of a lesion and thus provide important clues to its site and sometimes even its histology. This is especially true in vascular brain disease thus either dispensing the need for an invasive procedure such as angiography or providing information for a specific approach.

Intradiscal collagenase for treatment of lumbar disc herniations. A comparison of clinical results and computed tomography follow-up.

In a series of 34 patients with herniated lumbar discs, treated by intradiscal injection of highly purified collagenase, the post-treatment course has been followed-up clinically and by repeated computed tomographies (CT). Good or excellent results have been achieved in 17 patients. An only slight improvement of pain was noted in 2 patients. Fifteen patients had to be operated on due to not improved or worsened clinical symptoms. The most striking result of our CT follow-up was a tendency of the disc herniation to increase initially after collagenase injection. About two thirds of the patients had such an increase at the one week after injection control. After 6 weeks this rate had decreased to only about one quarter, but in the meantime 13 patients had to be operated. Only after 6 months most hernias of the up till then not operated patients were smaller and none were larger than before treatment. There was also a transient density decrease of the treated disc, most pronounced one week after collagenase injection. At controls 6 months later density had reached again pre-treatment levels. It is likely that the volume increase tendency of the disc material after collagenase injection is responsible for a worsening of the clinical symptoms, which not seldomly occurs during the initial post-treatment period, and in some patients makes an operation necessary.

Hydrocephalus after subarachnoid bleeding. A correlation of clinical findings, the results of radioisotope Cisternography and computer-assisted tomography.

Out of a group of patients suffering from a spontaneous subarachnoid hemorrhage 27 patients were checked by computer-assisted tomography (CAT), 23 patients by radioisotope cisternography, and 21 patients by both diagnostic procedures. The results were correlated with the clinical observations. The flow of the CSF was normal in 7 patients (30.43%), and pathological in 16 patients (69.56%). Of the 27 patients checked by CAT, 23 (85.18%) showed a ventricular dilatation, which in 17 patients (62.96%) was not connected with a corresponding increase of the cisterns of the convexity. The clinical symptoms of hydrocephalus, the degree of impairment of the circulation of the CSF determined by radioisotope cisternography and the ventricular diameter as determined by CAT correlated well.

Cerebrospinal fluid scintigraphy and computer assisted tomography in the evaluation of special kinds of hydrocephalus in children.

CT cisternography and CSF scintigraphy are indispensable in the detailed morphologic and etiologic evaluation of special types of childhood hydrocephalus. In addition these investigations afford interesting insights into CSF dynamics in apparently complete membranous or tumorous obstruction of the fourth ventricle and into the genesis of internal hydrocephalus in cerebellopontine angle tumors.

[Cisternography with 111Indium-DTPA (author's transl)]. / Die Liquorraumszintigraphie mit 111Indium-DTPA.

The experiences of more than 200 cisternographic examination with 111Indium-DTPA are reported. The radiopharmaceutical was tolerated without adverse reactions and the suboccipital intrathecal injection more appropriate than the lumbar. With 111In-DTPA excellent scans were obtained up to 48 h after application. 111In is compared with other radiopharmaceuticals for cisternography. The cisternography remains valuable as an additional examination of pneumencephalography and cranial computerized tomography.

[Comparison of the results of computer tomography and isotope diagnostics in pathologic processes of the infratentorial range (author's transl)]. / Vergleich der Ergebnisse von Computertomographie und Isotopendiagnostik bei pathologischen Prozessen des infratentoriellen Bereiches.

1. Computer tomography is much more clearly superior to cranial scintigraphy with regard to the identification and localization of pathologic infratentorial processes, than in the supratentorial range. 2. Computer tomography alone solves many diagnostic problems relating to the infratentorial range, but it cannot by any means solve all the problems. 3. The diagnosis identifying the kind of infratentorial growing and displacing tumors cannot be safely established either by computer tomography alone or by a combination of computer tomography and cranial scintigraphy. 4. Cranial scintigraphy and CSF scintigraphy can supply additional informations, support the diagnosis, or contribute towards establishing the final diagnosis, in cases where computer tomography alone supplies ambiguous, questionably positive or discrete answers. In such cases, the emphasis is on the etiologic grouping of unclear forms of hydrocephalos.

[Creatine kinase BB activity in the serum of patients with cerebrovascular diseases]. / Kreatinkinase-BB-Aktivität im Serum bei Patienten mit cerebrovaskulären Erkrankungen.

There are conflicting reports of an increase in the activity of creatine kinase BB isoenzyme (CK-BB) in the serum of patients with cerebrovascular disease. The serum CK-BB activity of 33 patients with ischemic brain infarction, subarachnoid hemorrhage or intracerebral hemorrhage was measured with a bioluminescence method (CK-B Kit, LKB-Wallac) in combination with immunoprecipitation. The results were compared with lesions determined by computed tomography. In the control group (N = 19) there was a mean activity of 0.35 +/- 0.26 U/l (means +/- SE). In patients with small lesions (N = 11) the activity was 0.41 +/- 0.21 U/l, which was not significantly elevated when compared to the control group (Mann/Whitney U test). Therefore, patients with more extensive lesions (N = 12) and the group with severe lesions (N = 10) showed a significant elevation, with a mean activity of 0.61 +/- 0.34 U/l and 1.12 +/- 0.52 U/l, respectively. The group with severe lesions had a maximum activity on the first day after the initial symptoms.

Blood distribution in computer cranial tomograms after subarachnoid hemorrhage with and without an aneurysm on angiography.

This is a comparative study of the blood distribution in computer cranial tomograms after spontaneous subarachnoid hemorrhage in 51 patients with saccular aneurysms and 34 patients with no evidence of a source of bleeding in cerebral panangiography. There was often less blood observed at all sites when aneurysms were not present. This was, however, significant only in the interhemispheric fissure, the Sylvian cisterns, the parietal sulci as well as intracerebrally. Thus, 79.4% of patients without an aneurysm were in grades I and II of the Hunt and Hess scale as opposed to 47.0% of those patients with evidence of an aneurysm.