Neuroimaging features of neurenteric cysts: analysis of nine cases and review of the literature.

PURPOSE: To gain a better understanding of neurenteric (NE) cysts via correlation of imaging findings and surgical and pathologic data. METHODS: The medical records, imaging studies, surgical information, and pathologic material were retrospectively reviewed in nine patients with NE cysts, including seven proved and two very probable cases. RESULTS: NE cysts occurred in the cerebellopontine angle in one case and extended from the cerebellopontine angle to the C2 level in a second. In the latter patient and the remaining seven with intraspinal lesions, the NE cyst was always located anterior to the spinal cord. The most common myelographic and CT myelographic appearance was that of a lobulated intradural extramedullary (IDEM) mass. Two patients had an intramedullary NE cyst with a somewhat unusual appearing exophytic IDEM-appearing expansion that can be a characteristic feature of these lesions. MR imaging demonstrated the NE cyst to be isointense to hyperintense relative to cerebrospinal fluid on long TR sequences and isointense or slightly hyperintense to cerebrospinal fluid on T1-weighted images. These signal characteristics correlate with the high-protein-content fluid within the cysts, usually described at surgery as milky or mucinous in character. CONCLUSION: The diagnosis of NE cyst should be considered when imaging studies reveal the presence of a lobulated IDEM or an exophytic intramedullary cystic mass, especially in association with anterior spina bifida or other vertebral anomalies. MR can uniquely confirm the cystic nature of these masses and is the method of choice for their imaging investigation. Because cyst recurrence can occur, MR should also be used for long-term patient follow-up.

Computed tomography and magnetic resonance imaging in traumatic locked-in syndrome.

The first reported case of traumatic locked-in syndrome with computed tomographic and magnetic resonance scan confirmation of the brain stem lesion is presented. The lesion responsible for the patient's condition consisted of a hemorrhage in the ventral pontomedullary junction. The pathophysiology of the production of such lesions is discussed.

Conservative management of thrombosed vein of Galen malformations. Report of two cases and a review of the literature.

Spontaneously thrombosed vein of Galen malformations are rare congenital vascular malformations. Surgical treatment of these lesions based on experience with the management of patent malformations has yielded less than satisfactory results. This report reviews the literature concerning these lesions and details our experience with nonoperative management in 2 patients.

Symptomatic spinal epidural lipomatosis as a complication of steroid immunosuppression in cardiac transplant patients. Report of two cases.

Patients with Cushing's syndrome may develop spinal epidural lipomatosis, an abnormal accumulation of fat in the spinal epidural space. This accumulation of fat may cause compression of the spinal cord or cauda equina with resulting neurological deficit. Two cases of symptomatic spinal lipomatosis are reported in cardiac transplant patients receiving chronic corticosteroid treatment. The literature is reviewed, and diagnostic and therapeutic considerations are discussed.

Bilateral internuclear ophthalmoplegia in systemic lupus erythematosus.

Internuclear ophthalmoplegia has been infrequently described in patients with systemic lupus erythematosus. We report a 23-year-old woman with lupus who presented with bilateral internuclear ophthalmoplegia and skew deviation. Additional neurologic findings included dysarthria, hemifacial weakness, hemiparesis, and dysmetria. Computed tomography of the patient's brainstem was unremarkable while magnetic resonance scanning demonstrated two areas of infarction. Magnetic resonance imaging is superior to computed tomography in both neuroradiographic study of the brainstem as well as evaluation of patients with neurologic complications of lupus.

Neurosarcoidosis causing ventricular loculation, hydrocephalus, and death.

Ten years after a diagnosis of sarcoidosis, a 33-year-old woman presented with a severe headache of 5 days' duration. Neuroradiologic evaluation revealed a large cystic lesion of the left temporal lobe, causing a mass effect. An exploratory operation proved the lesion to be a loculated portion of the temporal horn of the lateral ventricle. Drainage of the loculated ventricle relieved the patient's cephalgia. Within 2 months, however, pain in the head recurred and an unsteady, broad-based gait appeared. Reevaluation disclosed hydrocephalus for which a ventriculoperitoneal shunt was inserted. After this procedure, the patient did well neurologically for 1 year, after which seizures, personality changes, incontinence, and disturbance of gait developed. Death occurred after revision of the shunt, and widespread granulomatous disease was found at autopsy. Neurosarcoidosis, with emphasis on intracranial mass lesions in sarcoidosis, is discussed; the role of surgical treatment in some of these lesions, and in hydrocephalus, is stressed.

CT demonstration of extracranial carotid artery aneurysms.

Aneurysms arising from the extracranial carotid arteries are uncommon lesions. Clinically, they may present as lateral masses in the superior cervical area, as medial masses in the tonsillar fossa or parapharyngeal region, or as a mass palpable in both areas. Tenderness or pain may or may not be present. Pulsation is usually detectable. Embolic neurological episodes are a common event leading to discovery of these lesions. Etiologies include trauma, atherosclerosis, fibromuscular dysplasia, infection, and congenital predisposing factors. We report the CT appearance of this condition in three patients. In all three patients (four aneurysms) the CT findings were characteristic. Thus far, we have discovered only one account in the English literature that included the CT demonstration of an extracranial carotid aneurysm.

Brachiocephalic artery dilation by percutaneous transluminal angioplasty.

Percutaneous transluminal angioplasty (PTA) was used to dilate stenotic lesions in 38 brachiocephalic arteries in 36 patient. Complete evaluation of the central nervous system blood supply is a prerequisite for the brachiocephalic PTA when cerebral symptoms are present. The femoral artery is the best vascular entry site; use of digital subtraction angiography equipment for arterial mapping is helpful. Balloon diameter should be the same as or slightly wider than the diameter of the normal artery adjacent to the stenotic segment. Spasm was successfully treated with intraarterial injection of nitroglycerin. The only drug therapy consistently used with PTA was aspirin. Complete dilation of the stenosis is the best prevention of thrombotic or embolic complications. In properly selected cases, proximal subclavian artery stenoses can be safely dilated, and the balloon can eventually be placed across the origin of the vertebral artery. Because of potential complications associated with brachiocephalic PTA, indications must be well established, and interventions should not be performed on marginal or asymptomatic stenoses.

Comparison of dopamine agonists in the treatment of hyperprolactinemic syndromes: a multicenter study.

Thirty-one patients with hyperprolactinemia were admitted for protocol study. Twenty-one of these patients had no findings of prolactinoma by computerized axial tomography (CAT) scanning; 10 had documented tumor by CAT scan. The patients were assigned to either Parlodel or Pergolide treatment on the basis of random numbers tables. They were treated for 6 months continuously and followed during this time with radiologic survey, hormonal evaluation, and blood chemistry determinations. Patients in both groups showed a decrease in prolactin levels, whether they were treated with Parlodel or Pergolide. The response was similar whether patients had hyperplasia or pituitary tumors. Patients with pituitary tumors tended to have a diminution in the size of their lesions regardless of the dopamine agonist used. The types of side effects experienced by various groups were similar regardless of the treatment. It is concluded that both Pergolide and Parlodel are useful in the treatment of hyperprolactinemic syndromes, although neither one appears to be superior to the other.

Cranial computed tomography in the tumorous stage of mycosis fungoides.

Central nervous system (CNS) involvement by mycosis fungoides (MF) is rare. This is especially true of metastatic parenchymal involvement. Findings in two patients having the tumorous stage of MF are described. Multiple, well delineated, homogeneously and markedly enhancing nodules were seen in these two patients. The computed tomographic (CT) features of CNS involvement by MF are not specific. The differential diagnosis is discussed. By using CT in patients with MF, we will eventually be able to determine the incidence of CNS involvement in this condition.