ABSTRACT
The present study was undertaken to evaluate if MRI within 2 days of a motor vehicle accident could reveal pathology of importance for understanding long-term disability after whiplash neck-sprain injuries. As part of a prospective study cervical and cerebral MRI was performed on 40 neck sprain patients with whiplash injury after car accidents. The imaging was done within 2 days of the injury to make sure that any neck muscle bleeding, oedema or other soft tissue injuries could be detected. The MRI findings from the patients were both correlated to reported symptoms 6 months after the accident and compared to a control group of 20 volunteers. The MRI of both brain and neck revealed no significant differences between the patients and the control group. When the patients were grouped according to the main MRI findings at intake and compared according to the development of subjective symptoms reported by the patients, the only significant difference was more headaches at 6 months in the groups with disk pathology or spondylosis when compared to the group with no pathology. In conclusion, MRI within 2 days of the whiplash neck-sprain injury could not detect pathology connected to the injury nor predict symptom development and outcome.
Subject(s)
Brain Injuries/diagnosis , Cervical Vertebrae/injuries , Magnetic Resonance Imaging , Whiplash Injuries/diagnosis , Accidents, Traffic , Adolescent , Adult , Aged , Case-Control Studies , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Motorcycles , Prognosis , Prospective Studies , Time FactorsABSTRACT
This study evaluates the occurrence of permanent cerebral white matter changes and neurological abnormalities in children treated at a young age for acute lymphocytic leukaemia. Our pilot treatment protocol did not include central nervous system irradiation, but intrathecal methotrexate and high-dose methotrexate infusions followed by very intensive folinic acid rescue. We examined 12 children in complete remission and off therapy 18 months to 9.5 years after their last methotrexate infusion. They were below 5 years of age at diagnosis and therefore expected to be at special risk of neurotoxic sequelae. Cerebral magnetic resonance imaging in the 11 cases thus evaluated did not reveal white matter abnormalities or other signal changes as signs of permanent treatment-related sequelae. We did not observe any pathological clinical neurological findings likely due to methotrexate.
Subject(s)
Antimetabolites, Antineoplastic/adverse effects , Brain Diseases/chemically induced , Brain Diseases/diagnosis , Magnetic Resonance Imaging , Methotrexate/adverse effects , Neurologic Examination , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Age Factors , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infusions, Intravenous , Injections, Spinal , Male , Pilot Projects , Remission InductionABSTRACT
We report clinical, radiological and pathological findings in a 5-year-old girl who died of subacute necrotizing encephalomyelopathy (SNE) after 4 weeks of illness. Autopsy revealed endothelial swelling and vacuolar degeneration of the neuropil in the brain, brain stem and cerebellum. In addition, the affected areas showed degeneration of the neurons which was different from anoxic nerve cell damage both with regard to morphological picture and topographical distribution. This neuronal degeneration was probably due to the underlying metabolic defect in SNE per se and resembled in several aspects the nerve cell changes seen in the thalami and inferior olives in active Wernicke's encephalopathy. It is our opinion that more attention should be paid to the nerve cell degeneration in SNE rather than focusing on the relative preservation of these cells.