Management of a rare complication of endovascular treatment of direct carotid cavernous fistula.

A 30-year-old woman with direct carotid cavernous fistula underwent endovascular treatment with detachable balloons via a transarterial route. The patient returned with diplopia 1 year after therapy. On cranial MR imaging, one of the balloons was detected in the proximal portion of the superior ophthalmic vein and was deflated percutaneously with a 22-gauge Chiba needle under CT guidance. The patient's symptoms resolved after balloon deflation. This case report presents a unique complication of endovascular treatment of direct carotid cavernous fistula and its management.

Diabetic sclerodactyly.

Sclerodactyly is a chronic skin disorder seen together with long-term degenerative microvascular complications of diabetes mellitus. In this study, the relationship between sclerodactyly and various clinical and laboratory characteristics of diabetes mellitus have been investigated. One hundred and forty-two diabetic patients (63 type 1 and 79 type 2) and 72 healthy controls were evaluated clinically. Among the 142 diabetic patients, skin biopsies were taken from 21; 38 underwent soft tissue X-ray examination and 78 underwent periungual capillaroscopy. Among the healthy controls those with sclerodactyly were on the average 12 years older than those without (T: 3.38; P < 0.01). On the other hand, among the patients with either type 1 or type 2 diabetes mellitus the ages were similar between those with and without sclerodactyly. There were no statistically significant differences in the prevalence of diabetic complications. The presence of complications, increased proximal nail fold capillarity, HbA1c levels, radiological and histopathological findings were not different among those patients who had or did not have sclerodactyly.

99Tc-HmPAO SPECT in 13 patients with classic lissencephaly.

In this study, technetium-99 ((99)Tc)-hexamethylpropyleneamine-oxine single-photon emission computed tomography (SPECT) was performed on 13 children with classic lissencephaly (nine with epileptic seizures, four without seizures). Focal or multifocal hypoperfusions were observed in 12 patients. The hypoperfused areas observed on SPECT scanning did not correlate with the localization of agyric-pachygyric regions in all patients. The distribution of perfusion abnormalities by SPECT and the localization of agyria-pachygyria as detected by magnetic resonance imaging did not correlate strongly. All nine patients with seizures and three of the four patients without seizures had focal or multifocal cerebral blood flow abnormalities on the SPECT scans. The presence of brain perfusion abnormalities detected by SPECT and the occurrence of epileptic seizures did not have a significant relationship. These results suggest that the role of SPECT studies in classic lissencephaly is not clearly defined. More sophisticated methods are needed to clarify the correlation between structural and functional abnormalities of patients diagnosed with lissencephaly.

Angiography-induced closure of perimedullary spinal arteriovenous fistula.

Type 4 spinal vascular malformations are called perimedullary arteriovenous fistulae, in which there is a shunt between a radicular artery and intradural veins. We report the spinal MR imaging and angiography findings of the angiography-induced closure of a type 4 spinal vascular malformation.

Case report: Spinal cord herniation into a mediastinal neurenteric cyst: CT and MRI findings.

Split notochord syndrome is a spectrum of congenital spinal malformations that develops due to an adhesion between endoderm and ectoderm causing the "splitting" of notochord. Neurenteric cyst is one of the components of split notochord syndrome. We report CT and MRI findings of an unusual case with thoracal spinal cord herniation into a mediastinal neurenteric cyst.

Clinical features of 21 patients with lissencephaly type I (agyria-pachygyria).

Lissencephaly (agyria-pachygyria) is the most severe neuronal migration disorder, characterized by total or partial absence of gyri. In this study, 21 patients with lissencephaly type I (9 girls, 12 boys) with a mean age of 19 +/- 21 months (2 weeks-8 years) were evaluated clinically and graded according to neuroradiological findings (19 patients by magnetic resonance imaging MRI and 2 by computed tomography CT). Three patients were classified as lissencephaly grade 2 and 18 patients as grade 3 or 4. Clinically, 12 patients (57%) had microcephaly, and eight (38%) had facial dysmorphism. All the patients had prominent psychomotor retardation, moderate to severe; the most frequent neurological findings were spastic guadriplegia (36.4%) and hypotonia with exaggerated tendon reflexes (27.3%). Seventy-eight percent of the patients had epileptic seizures resistant to conventional treatment. Lissencephaly is a cerebral cortical malformation that should be considered in children with developmental delay with or without microcephaly and facial dysmorphism. In addition, it should be investigated in the etiology of early-onset childhood epilepsy.

Value of petrosal sinus sampling: coexisting acromegaly, empty sella and meningioma.

Simultaneous occurrence of an intracranial meningioma and a growth hormone (GH)-producing pituitary adenoma is exceedingly rare, as is coexistence of an empty sella and acromegaly. We report all these rare entities in the same patient. We evaluated the role of inferior petrosal sinus sampling for lateralisation of an adenoma in this patient.

Thoracocervical dorsal dermal sinus associated with multiple vertebral body anomalies.

Congenital dermal sinus is a type of closed spinal dysraphism. Cervical and thoracic regions are the rare sites for dorsal dermal sinuses. Dermal sinuses are frequently associated with dermoid or epidermoid tumor and osseous abnormalities such as bifid spinous process. The association of dorsal dermal sinuses with vertebral body anomalies is very rare. We present MR imaging features of a case of thoracocervical dorsal dermal sinus associated with multiple vertebral body anomalies.

Imaging in tuberculosis of the skull and skull-base: case report.

We report a 19-year-old girl, who presented with headache and tonic/clonic seizures. Imaging revealed a lytic parietal skull lesion with an adjacent epidural mass, masses in the right parietal lobe and a posterior skull-base mass. The diagnosis of tuberculosis was made after resection of the extradural mass and later verified with culture of Mycobacterium tuberculosis. The parenchymal and skull-base lesions resolved following antituberculous treatment. We present CT, scintigraphic, angiographic and MRI findings.

A new MRI method for the quantitative evaluation of extraocular muscle size in thyroid ophthalmopathy.

In cross section, extraocular muscles are more or less elliptical, with short and long diameters. We studied the ratio (R) of short to long diameter and investigated its use in quantitative assessment of the extraocular muscles in patients with Graves's disease. We measured the diameters on T1-weighted axial and coronal MRI and computed R for each extraocular muscle in 80 patients without and 40 with Graves's disease. We compared the measurements and R of the right and left orbits, and of men and women. The short diameter of all extraocular muscles apart from the superior oblique showed significant differences between men and women, and that of the inferior rectus varied significantly with age. R, however, was unrelated to sex or age. All patients with Graves's disease and an increased short diameter also had an increased R, but 6% of the muscles showed an increase in R, even though their short diameter was within the normal range.

CT in lobar atrophy of the liver caused by alveolar echinococcosis.

We reviewed the CT findings of 13 patients with histologically proved alveolar echinococcosis of the liver. Seven of these patients had hilar involvement, which caused dilatation of intrahepatic bile ducts and invasion of the portal vein or portal branches. In two of these patients we found marked atrophy of the right lobe and in one patient marked atrophy of the left lobe in addition to various CT findings previously reported for alveolar echinococcosis of the liver. The occurrence of lobar atrophy of the liver caused by alveolar echinococcosis has not been previously reported. We concluded that, when a mass lesion with hilar infiltration causing lobar atrophy is found in endemic areas, alveolar echinococcosis should be considered in the differential diagnosis in addition to malignant neoplasms.

MRI cisternography with gadolinium-containing contrast medium: its role, advantages and limitations in the investigation of rhinorrhoea.

Our purpose was to evaluate the utility of intrathecal gadopentetate dimeglumine -enhanced magnetic resonance cisternography (GdMRC). We injected 0.5 ml contrast medium into the subarachnoid space via lumbar puncture in 20 patients with suspected cerebrospinal fluid (CSF) rhinorrhoea. MRC showed CSF leakage in 14 patients with rhinorrhoea at the time of the examination, into the ethmoid air cells in nine, the sphenoid sinus in three and the frontal sinus in two cases. In 12 of these the site leakage was confirmed during surgical repair of the fistula. No leakage was observed in four patients with intermittent rhinorrhoea, not present at the time of the examination. GdMRC showed leakage in two patients with negative CT cisternography. GdMRC may prove better than CT cisternography, especially with slow CSF flow. We also showed low-dose GdMRC to be a feasible and relative safe way of confirming the presence of and localising active CSF leaks prior to surgical repair.

Recent experience with Moyamoya disease in Turkey.

A series of moyamoya patients is presented. Angiographic findings, outcome of revascularization surgery and a young case with moyamoya disease and hyperphosphatemia are reported. Thirteen patients (6 males and 7 females; age range 2-50 years) were included in the study group. Findings of the patients at presentation were intracranial haemorrhage in two adult cases and sequelae of cerebral ischemia in the rest of the group. One young girl had hyperphosphataemia. Angiography showed distal internal carotid or proximal anterior and middle cerebral artery stenosis, unique collaterals, microaneurysm of the posterior lateral choroidal artery and flow-related changes in the posterior circulation. In 3 patients, encephalo-duro-arterio-synangiosis (EDAS) and burrholes were performed at surgery. Follow-up angiograms of these patients showed revascularization. Moyamoya, a rare but potentially devastating disease, must be addressed as a cause of haemorrhagic and ischaemic cerebral events.

Purely cystic hydatid disease of the liver: treatment with percutaneous aspiration and injection of hypertonic saline.

Percutaneous aspiration of purely cystic liver lesions was performed in 15 patients aged 11-56 years. After aspiration under guidance with computed tomography (CT) in 12 patients, a membrane that is diagnostic for hydatid disease was visible in the lumen of the cyst on CT scans. Hypertonic saline was injected in the cystic cavities of these patients as a scolecidal agent. No major complications occurred during or after the procedures. In the follow-up period of 6-16 months, control CT and ultrasound scans revealed a progressive decrease in the size of the lesions and no evidence of peritoneal seeding. It is concluded that percutaneous aspiration and hypertonic saline injection for purely cystic hydatid disease of the liver seem to be an effective form of treatment and may eventually prove to be an alternative to surgical intervention.

Endovascular treatment of arteriovenous fistulas complicating percutaneous renal biopsy in three paediatric cases.

DESIGN: We evaluated the incidence and history of arteriovenous fistula (AVF) after kidney biopsy and assessed the use of superselective embolization for treatment. OBSERVATIONS: During the last 10 years, 896 kidney biopsies (age range of the patients: 1 month-18.6 years) have been performed in our institution under real-time ultrasonographic guidance with a 14 gauge cutting biopsy needle, and 32 of the patients had renal allografts (3.4%). We observed three cases of AVF (two in allograft kidneys, one in a native kidney) among all biopsies (0.34%), and the incidence of developing AVF after renal allograft biopsy was 6.3%. All three patients with AVF were symptomatic, and intravascular therapy was indicated. INTERVENTIONS: An angiographic study combined with endovascular treatment of the intrarenal AVF and pseudoaneurysm was performed in all three patients. Embolization was performed with bucrylate and lipiodol in two patients and with micro-coils in one. After successful embolization, all three patients became asymptomatic (in two renal bleeding stopped, in one patient with severe uncontrollable hypertension blood pressure returned to normal limits). No complications were observed secondary to the embolization procedure. CONCLUSION: The technique of superselective embolization using a coaxial catheter is an effective and safe method in the treatment of post-biopsy AVFs and pseudoaneurysm.