A craniocervical injury-induced syringomyelia caused by central canal dilation secondary to acquired tonsillar herniation. Case report.

The authors report on a 19-year-old man with an acquired tonsillar herniation caused by a craniocervical junction injury in which serial magnetic resonance (MR) images demonstrated patent and isolated segments of the central canal participating in the dilation and then formation of a cervical syrinx. The patient was involved in a motor vehicle accident; he developed tonsillar herniation as a complication of subarachnoid and epidural hemorrhage, predominantly observed around the cisterna magna and upper cervical canal. Repeated MR images obtained over an 11-month period indicated the for mation and acute enlargement of the syrinx. Ten months after the accident, the patient presented with sensory disturbance in both upper extremities and spasticity due to syringomyelia. He underwent craniocervical decompressive surgery and doraplasty, which reduced the size of syringomyelia. The authors postulate that the patent central canal may play a role in determining the location of a syrinx remote from a focus of cerebrospinal fluid obstruction.

[Diagnosis of pituitary microadenoma by magnification carotid angiography and intercavernous sinus venography].

Carotid angiography was performed on 12 cases of pituitary microadenomas at 2.3 X magnified frontal projection and 3.0 X magnified lateral projection. Magnification carotid angiograms were analyzed to determine the pathologic findings in 12 cases on 23 sides. Carotid angiograms demonstrated compressed posterior pituitary gland in 3 of 12 cases and 4 of 23 sides which resulted from the expansion of pituitary microadenomas. But carotid angiogram failed to demonstrate any evidence of tumor stain, abnormal capsular arteries or hypertrophied inferior hypophyseal arteries. These results suggested that magnification carotid angiography was not a useful diagnostic procedure for the detection of pituitary microadenomas. Intercavernous sinus venography was performed on 12 cases of pituitary microadenomas. The technique consisted in catheterization into the inferior petrosal sinus after puncture of the femoral vein. Injection of 10 ml. of contrast medium into the inferior petrosal sinus at a rate of 5 ml. per second. The base projection is most demonstrable and routinely used. Intercavernous sinus venography identified the presence of microadenoma in 10 of 12 cases and false negative in two cases. Nine of 12 cases demonstrated narrowing, interruption and disappearance of the anterior and inferior intercavernous sinuses. Only 3 of 12 cases demonstrated narrowing of the posterior intercavernous sinus and nine cases demonstrated compression signs of the venous strips of the cavernous sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fracture of the sella turcica--a case report and review of the literature].

The incidence of a fracture of the sella turcica is reported to be rare and the authors reported a case of a sellar fracture associated with several neurological and endocrinological complications. A 16-year-old boy was struck at the face and the forehead on the road in a motorcycle accident and was hospitalized in a confusional state. Neurological examinations showed dilatation of the both pupils, sluggish light reflex on both sides and bilateral oculomotor palsy but motor weakness or sensory disturbance was not present. On the tenth hospital day, he developed diabetes insipidus and endocrinological examinations disclosed the impairment of GH, LH and FSH reserves, too. Neuroradiological examinations disclosed fractures of bilateral frontal bones and fractures of the left optic canal and ethmoidal roof as well as a fracture of the sella turcica. On the 28th hospital day, he also developed CSF rhinorrhea and pneumocephalus. Surgical repair for the CSF rhinorrhea was performed. Fractures of the sella turcica were reviewed in 23 cases including our personal case and a special consideration regarding the mechanism of sellar fractures and their major complications was made. The authors stressed the early recognition of a fracture of the sella turcica in head injuries, which would suggest a severe hypothalamo-pituitary involvement or other neurological disorders.