ABSTRACT
BACKGROUND: Acute spontaneous spinal cord syndromes often remain etiologically ambiguous despite extensive diagnostic efforts. In the previous literature five cases are described with acute spinal cord syndromes interpreted as spinal cord ischemic strokes because of association with vertebral body infarctions on MRI. CASE DESCRIPTIONS: Three cases are presented, and the literature is reviewed. In addition to an extensive diagnostic battery including an initial MRI without pathological signs, follow-up MRI at different time intervals from the onset of symptoms showed T2 hyperintense signals in vertebral bodies. Patient 1, who had plaques in the abdominal aorta, had suffered a thoracolumbar spinal infarction; this and a concomitant infarction of the left portion of T-12 could be demonstrated on follow-up MRI on day 12. Patient 2, who had incomplete transverse spinal artery syndrome below T-3, had an abnormal signal at the T-2 level of the spinal cord on follow-up MRI on day 5; this was one segment above infarction of the dorsal area of T-3, corresponding to the ascending course of the medullary artery. The spinal cord of patient 3, who had a posterior spinal artery syndrome below T-11, was unremarkable on follow-up MRI on day 14, but a T2 hyperintense signal was noted in the dorsal area of T-10. CONCLUSIONS: Vertebral body infarction represents the only confirmatory sign for the otherwise exclusionary diagnostic procedure for spinal cord ischemic stroke and must be searched for on follow-up MRI as a key to correct diagnosis.
Subject(s)
Infarction/etiology , Ischemia/complications , Spinal Cord/blood supply , Spine/blood supply , Aged , Aorta, Abdominal/pathology , Aortic Diseases/diagnosis , Arteries/pathology , Arteriosclerosis/diagnosis , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/diagnosis , Female , Follow-Up Studies , Humans , Infarction/diagnosis , Ischemia/diagnosis , Lumbar Vertebrae/blood supply , Magnetic Resonance Imaging , Male , Middle Aged , Syndrome , Thoracic Vertebrae/blood supplyABSTRACT
Aortic arch anomalies are rare. They arise as a failure of the normal development of the left fourth dorsal arch. Cervical aortic arches are believed to result from persistence of the third dorsal arch, which re-routes the aortic arch in the cervical region. We describe a case of a left-sided cervical aortic arch in which the diagnosis was confirmed, and the anatomy defined, using magnetic resonance tomography.
Subject(s)
Aorta, Thoracic/abnormalities , Magnetic Resonance Imaging , Angiography, Digital Subtraction , Aorta, Thoracic/embryology , Aorta, Thoracic/pathology , Aortography , Diagnosis, Differential , Humans , Male , Middle Aged , Syncope/etiologyABSTRACT
Computerized tomographic (CT) scans of 271 patients with histologically proven bronchial carcinoma accomplished for initial tumor staging were retrospectively evaluated for signs of cerebral metastasis. The results for the histologic subtypes were quite different. In 13.8% of patients with small cell carcinoma and limited disease the authors found signs of brain metastasis. However, routine cerebral staging in these patients did not seem to be useful because of lack of therapeutic consequences. On the other hand, no patient with non-small cell carcinoma (N-SCC) and tumor Stage I or II had brain metastases. All patients with brain metastasis from N-SCC had been classified as tumor Stage III before cerebral imaging. Among these patients, however, the authors found brain metastasis in 17.5% of those without known distant metastatic disease (III/M0), especially in large cell carcinoma and in adenocarcinoma. Stage III/M0 patients should undergo routine cerebral imaging if their tumor is surgically resectable and thoracotomy is planned.
Subject(s)
Brain Neoplasms/secondary , Bronchial Neoplasms/pathology , Neoplasm Staging/methods , Brain Neoplasms/pathology , Humans , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
The use of an oral contrast medium has so far not become a matter of routine in MR of the abdomen. In the present study the use of orally applied gadolinium-DTPA was examined in respect of tumorous diseases in the minor pelvis. 18 patients with tumours in the minor pelvis were examined before and after oral administration of gadolinium-DTPA (Gd-DTPA). 10 ml/kg body weight of a gadolinium DTPA solution were applied in a concentration of 1.0 mmol/l. T1-weighted and T2-weighted sequences were carried out before application and T1-weighted sequences after application. Oral application gadolinium-DTPA resulted in enhancing the signals of the filled intestinal portions. In 54% of the cases the sequences showed a sharper delineation between tumour and intestine. In 19% the delineation between pathological tissue and intestine on contrast examination was as well defined as in T2-weighted contrast images; in 27% of the cases oral administration of gadolinium-DTPA did not yield any additional information. No significant side effects were seen.
Subject(s)
Contrast Media , Magnetic Resonance Imaging/methods , Organometallic Compounds , Pelvic Neoplasms/diagnosis , Pentetic Acid , Administration, Oral , Adult , Aged , Female , Gadolinium DTPA , Humans , Male , Middle Aged , Ovarian Neoplasms/diagnosis , Rectal Neoplasms/diagnosis , Testicular Neoplasms/diagnosis , Uterine Cervical Neoplasms/diagnosis , Uterine Neoplasms/diagnosisABSTRACT
Whereas generalised neurofibromatosis is a relatively frequent disease its combined occurrence in conjunction with agenesia of the corpus callosum is extremely rare and probably a casual coincidence.
Subject(s)
Agenesis of Corpus Callosum , Brain Neoplasms/diagnosis , Magnetic Resonance Imaging , Neurofibromatosis 1/diagnosis , Soft Tissue Neoplasms/diagnosis , Female , Humans , Middle AgedABSTRACT
Abuse of ergotamine can release a generalised brain edema and brain infarctions. This can be visualized by CT, MR and angiography. The reason, however, can only be found in the patients history.
Subject(s)
Brain Edema/chemically induced , Cerebral Angiography , Cerebral Infarction/chemically induced , Dihydroergotamine/adverse effects , Headache/drug therapy , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Dihydroergotamine/administration & dosage , Dose-Response Relationship, Drug , Female , Humans , Middle AgedABSTRACT
We give a description of a technique of the patient's positioning with traction of the arms during the cervical spinal computed tomography which allows to draw the shoulders downwards by about one to three cervical segments. By this method the quality of the images can be improved in 96% in the cervical segment 6/7 and in 81% in the cervical/thoracal segment 7/1 to such a degree that a reliable judgement of the soft parts in the spinal canal becomes possible. The diagnostic reliability of the computed tomography of the cervical disc herniation is thus improved so that the necessity of a myelography is decreasing. The results of 396 cervical spinal computed tomographies are presented.
