Computerised tomographic study of tuberculous meningitis in children.

Twenty-one patients with clinical and laboratory diagnosis of tuberculous meningitis were studied at the paediatric department and neuroradiology unit of Bangur Institute of Neurology, both attached to IPGME & R, Kolkata, during the period from 1st February, 1996 to 31 st July, 1996. The age group of the patients were between 1 and 8 years. It clearly appears that CT is an extremely powerful investigative modality for the diagnosis, management and follow-up assessment of development of any complications like hydrocephalus, cerebral infarction, etc. CT examination also can predict the prognosis of the patients.

Subdural hemorrhage as an initial sign of glutaric aciduria type 1: a diagnostic pitfall.

The case of a 9-month-old girl with glutaric aciduria type 1 (GA 1) is reported. On initial presentation at 6 months of age, the patient demonstrated bilateral subdural hemorrhages and widening of the basal cisterns. After neurosurgical intervention the subdural effusions regressed; their etiology remained unclear. At the age of 9 months the patient presented again because of progressive loss of psychomotor abilities and a dystonic movement disorder. Cerebral MRI revealed regressive subdural hematoma, but marked frontotemporal atrophy as well. Because of a suspected metabolic disorder, urinary analysis of organic acids was performed. This repeatedly showed marked excretion of glutaric acid, 3-hydroxyglutaric acid and glutaconic acid, indicating a diagnosis of GA 1. Considering our patient's history, we recommend the inclusion of GA 1 in the differential diagnosis of patients with unexplained subdural hematoma and neurological deficits.

CSF rhinorrhea: detection and localization using overpressure cisternography with Tc-99m-DTPA.

We performed 32 overpressure radionuclide cisternography (ORNC) studies to examine 26 patients who were clinically suspected of having cerebrospinal fluid (CSF) fistula with rhinorrhea. Fifteen (47%) of these cisternography studies were positive, and the site of the leak was identified. No leak could be demonstrated in the other 17. Of 23 examinations performed in patients who had clinically documented CSF rhinorrhea, 15 (65%) were scintigraphically positive. The rapid cephalad transit of the radionuclide bolus allowed completion of the study within 30 to 45 minutes. Seven examinations were also performed with overpressure metrizamide CT cisternography (OMCTC), and five demonstrated concordant results with the radionuclide study. Patient discomfort and side effects were minimal. We conclude that radionuclide infusion cisternography is a safe, rapid, and accurate method of investigating a suspected or proven CSF rhinorrhea and that it is complementary to metrizamide cisternography.

Ruthenium-97 DTPA: a new radiopharmaceutical for cisternography.

Ruthenium-97 DTPA (diethylenetriamine penta-acetic acid) was evaluated for its possible use as a cerebrospinal fluid imaging agent. Ru-97 has favorable physical properties that are highly suitable for imaging: decay by electron capture; gamma energy = 216 keV, 85%; T 1/2 = 2.9 days. Dogs were injected with 0.4 mCi Ru-97 DTPA or In-111 DTPA into the cisterna magna. The movement of the agents was monitored with a camera interfaced to a computer, or with a dual-probe system placed over the head and urinary bladder. In addition, blood and urine samples were collected at fixed intervals for 6 hr. High-quality images were obtained up to 48 hr after injection. The results show that the kinetics and excretion of Ru-97 DTPA are similar to those of In-111 DTPA. Radiation dose for identical activities is twice as high for In-111, in part because of greater abundance of the low-energy electron emission of In-111.

[Tomodensitometry and/or meato-isternography in the diagnosis of small acoustic neuromas (author's transl)]. / Tomodensitométrie et/ou méatocisternographie lipiodolée pour le diagnostic des petits neurinomes de l'acoustique.

Tomodensitometry allowed us to discover smaller and smaller tumors in the cistern and even in the internal auditory canal. We report 5 cases, amongst others, where the tumor is visible in the canal and we show the conditions which are necessary to make the diagnosis. Nevertheless, lipiode meatocisternography is well tolerated if we use between 0.6 and 1.5 ml of oil, and often necessary to confirm the diagnosis of a neuroma. We first use tomodensitometry when the symptoms could be due to a neuroma or another tumor. When the syndrome is characteristic, limited to the contents of the internal auditory canal, we often do the meatocisternography straight away, because in a single examination we know that there is or is not a tumor. We can also check the same time the opposite side.

Dementia paralytica: deterioration from communicating hydrocephalus.

Five patients suffering from dementia paralytica who failed to improve or deteriorated after one or several high dosage courses of penicillin, had pneumoencephalographic patterns suggesting communicating hydrocephalus. Measurements of the ventricular index, ratio of cella media to width of the temporal horn, and the callosal angle differed from that in seven cases of dementia paralytica with associated cerebral atrophy. An isotope cisternogram in three cases with communicating hydrocephalus further confirmed a blockage of the cerebrospinal fluid (CSF) at the parasagittal subarachnoid space. Three patients exhibited the full syndrome of gait apraxia, incontinence, and pyramidal tract signs associated with a severe degree of dementia. Shunting of the CSF in three cases was followed by immediate improvement in two, one in a longlasting way. No active parenchymal inflammation was observed in any of three brain biopsy samples taken during surgery, except for leptomeningeal fibrosis in one. Chronic leptomeningitis in dementia paralytica may impair subarachnoid CSF absorption with subsequent communicating hydrocephalus. Progression or inadequate responses after therapeutic dose of penicillin in dementia paralytica should prompt investigation for this complication as an alternative, effective treatment could be offered.

[Repeated contrast cisternography after previous use of an oily contrast medium (author's transl)]. / Möglichkeit der wiederholten Kontrastzisternographie nach einmaliger Applikation von öligem Kontrastmittel.

Twenty-four control cisternograms were carried out at two to 22 months after lumbar injection of 1.0 to 1.5 ml. Duroliopaque; 20 of these were successfully performed without a fresh lumbar puncture. In most cases, the amount of contrast medium available was less than at the original examination, but was sufficient for definite exclusion of a space-occupying lesion. In four cases only the contrast medium could not be mobilised or manoeuvred into the cisterns and a fresh lumbar puncture was required for further contrast injection.

Computerized axial tomography: the normal EMI scan.

Computerized axial tomography using the EMI scanner as a new method of using x-rays in diagnosis. The technique displays intracranial and orbital structures in the transverse plane. The appearances of normal EMI Scans are described and correlated with cerebral and orbital anatomy seen in transverse section.

Comparison of ventricular enlargement and radiopharmaceutical retention: a cisternographic-pneumoencephalographic comparison.

The cisternograms and pneumoencephalograms of 58 patients with suspected "normal pressure" hydrocephalus were correlated and the relationship of ventricular radiopharmaceutical entry and stasis to ventricular size was analyzed. It was found that radiopharmaceutical entry relates directly to ventricular size, stasis occurring only in markedly enlarged ventricles. Cerebrospinal fluid imaging alone is a highly reliable diagnostic study only if patients exhibit the characteristic cisternographic patterns of normal pressure hydrocephalus. In those who do not, pneumoencephalography and cisternography are valuable complementary studies which can also be used to identify primary cortical atrophy.