Spontaneous intracranial hypotension: clinical and neuroimaging findings in six cases with literature review.

Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches.

Evaluation of pelvic ultrasonography in the diagnosis and differentiation of various forms of sexual precocity in girls.

OBJECTIVES: This study was conducted to assess the role of pelvic ultrasound variables in discriminating between normal girls and girls with different forms of sexual precocity, and to establish reliable cut-off limits of pelvic ultrasound measurements for differentiating between these conditions. METHODS: Eighty-eight girls with different forms of sexual precocity (23 with premature thelarche, 15 with premature pubarche and 50 with central precocious puberty) were enrolled. All diagnoses were based on clinical examination with confirmation using the gonadotropin-releasing hormone-stimulation test. Additionally, 81 prepubertal girls, aged 0-10 years, were included as a control group. For statistical analysis and to facilitate comparisons, the groups were subdivided by age intervals (0-6, > 6-8 and > 8-10 years). All subjects underwent pelvic ultrasound examination for the measurement of uterine length, uterine volume, ovarian volume and the anteroposterior diameter at the fundus divided by the anteroposterior diameter at the cervix (fundal/cervical ratio, (F/C)). Finally, the morphological appearance of the ovaries was assessed. RESULTS: Patients with central precocious puberty had significantly higher values for all the ultrasound variables (with the exception of uterine length in the 1-6-year age group) in comparison to normal girls. Patients with premature thelarche and patients with premature pubarche showed similar pelvic ultrasound parameters to those of normal girls. Ovarian volume was the best parameter for identifying patients with central precocious puberty (a cut-off of 3.04 cm(3) had a sensitivity of 100% and a specificity of 97.1% for age interval 0-6 years, a cut-off of 3.35 cm(3) had a sensitivity of 100% and a specificity of 89.5% for age interval > 6-8 years, and a cut-off of 4.46 cm(3) had a sensitivity of 80.8% and a specificity of 88.5% for age interval > 8-10 years). Uterine length was the best parameter for distinguishing between patients with central precocious puberty and patients with premature thelarche (a cut-off of 3.185 cm had a sensitivity of 85.7% and a specificity of 91.7% for age interval 0-6 years, and a cut-off of 3.83 cm had a sensitivity of 82.4% and a specificity of 90.9% for age interval > 6-8 years). CONCLUSIONS: Ultrasound examination of the uterus and ovaries could serve as a complementary tool for the diagnosis of central precocious puberty and, consequently, for the early initiation of appropriate treatment.

The lymph drainage of the neoplastic mammary glands in the bitch: a lymphographic study.

The purpose of this investigation was to study the lymph drainage of the neoplastic mammary glands in the bitch using indirect lymphography. The main conclusions drawn from the study of 41 natural cases were as follows: the first or cranial thoracic and second or caudal thoracic neoplastic mammary glands usually drain into the ipsilateral axillary lymph nodes and rarely into the ipsilateral axillary and sternal lymph nodes, simultaneously. The third or cranial abdominal neoplastic mammary gland usually drains into the ipsilateral axillary and superficial inguinal lymph nodes simultaneously, but sometimes only cranially into the ipsilateral axillary lymph nodes. Rarely, it drains only caudally into the ipsilateral superficial inguinal and medial iliac lymph nodes, simultaneously. The fourth or caudal abdominal neoplastic mammary gland usually drains only caudally into the ipsilateral superficial inguinal lymph nodes. Rarely, it drains into the ipsilateral axillary and superficial inguinal lymph nodes simultaneously. The fifth or inguinal neoplastic mammary gland usually drains into the ipsilateral superficial inguinal lymph nodes but rarely, does it also drain into the ipsilateral popliteal lymph node and into a lymphatic plexus at the medial aspect of the ipsilateral thigh. Lymphatic connections between the neoplastic and adjacent normal mammary glands were demonstrated in only one case. The lymph drainage pattern of the neoplastic mammary glands is slightly different to that described in normal glands using the same radiographic method.

Magnetic resonance imaging in 120 patients with intractable partial seizures: a preoperative assessment.

The aim of this study was to describe magnetic resonance imaging (MRI) findings in patients with medically intractable epilepsy and to compare different magnetic resonance (MR) sequences in order to establish a dedicated and shorter scan time imaging protocol of choice. One hundred and twenty patients with seizures that were refractory to medical treatment were assessed by MRI with spin-echo (SE) T1, fast spin-echo (FSE) T2, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR) and contrast-enhanced T1 SE sequences. Pathological scans were acquired in 78 patients. Hippocampal sclerosis was detected in 30 patients (25%), cerebral, tumoral, mass lesions in 12 patients (10%), vascular malformations in nine patients (7.5%), cortical infarcts in eight patients (6.7%), cerebral infections in four patients (4.2%) and developmental disorders in 15 patients (12.5%). The most common location of the lesions was the temporal lobe (60%). Coronal, thin (slice thickness 4-5 mm) images have proven to be the most useful in the assessment of the hippocampus. FLAIR and IR are particularly useful in the detection of lesions abutting cerebrospinal fluid (CSF) spaces and developmental disorders, respectively, while T1 SE sequences before and after the intravenous administration of gadolinium offer great facility in identifying space-occupying lesions and infections. MRI is the most important diagnostic tool for the assessment of epileptogenic foci, thus playing the primary role in indicating the type of treatment to be applied.

Intracranial aneurysms: evaluation using CTA and MRA. Correlation with DSA and intraoperative findings.

Computed tomographic angiography (CTA) and magnetic resonance angiography (MSA) have been used recently for evaluation of intracranial aneurysms. If they are to replace conventional digital subtraction angiography (DSA), their sensitivity and specificity should be equal to the latter. In order to determine whether computed tomographic angiography and magnetic resonance angiography can provide the necessary information for presurgical evaluation we compared blindly the results of helical CT angiography and MR angiography with the results of digital subtraction angiography and the intraoperative findings. We evaluated 35 patients with the possible clinical diagnosis of intracranial aneurysm. Our data suggest that both CTA and MRA can provide valuable preoperative information concerning the location, the characteristics and the relationships of most intracranial aneurysms. Both original and reconstructed images should be evaluated together for higher accuracy. In addition helical CT, being a fast, inexpensive and noninvasive method, can be used as a reliable alternative to DSA in emergency situations demanding immediate operation.

Foci of decreased signal on T2-weighted MR images in leiomyosarcomas of soft tissue: correlation between MR and histological findings.

OBJECTIVE: Leiomyosarcomas are rare soft tissue sarcomas with varying MR signal characteristics and histologic pictures. The purpose of this study was to investigate the histological features of foci, which showed decreased signal on T2-weighted images in leiomyosarcomas of soft tissue. MATERIAL AND METHODS: We reviewed the MR images of six histologically proved cases of leiomyosarcomas of soft tissue and correlated the foci, which showed decreased signal on T2-weighted images with the histologic findings. RESULT: Microscopic examination revealed that these foci were composed of hyalinization of neoplastic tissue, internal septations, deposition of hemosiderin, or corresponded to metaplastic bone. CONCLUSION: The authors explain that the foci of decreased signal on T2-weighted MR images correspond to tissue components of the lesion, particularly fibrous tissue, hemosiderin and metaplastic bone. So, the suggestion is that leiomyosarcoma should be considered in the differential diagnosis of soft-tissue tumors that show foci of decreased signal on T2-weighted MR images.

Cortical laminar necrosis in brain infarcts: serial MRI.

High-signal cortical lesions are observed on T1-weighted images in cases of brain infarct. Histological examination has demonstrated these to be "cortical laminar necrosis", without haemorrhage or calcification. We report serial MRI in this condition in 12 patients with brain infarcts. We looked at high-signal lesions on T1-weighted images, chronological changes in signal intensity and contrast enhancement. High-signal cortical lesions began to appear about 2 weeks after the ictus, were prominent at 1-2 months, then became less evident, but occasionally remained for up to 1.5 years. They gave high signal or were isointense on T2-weighted images and did not give low signal at any stage. Contrast enhancement of these lesions was prominent at 1-2 months, and less apparent from 3 months, but was seen up to 5 months.

CT and MR imaging findings in cerebral toxocaral disease.

We report serial MR findings in a 54-year-old woman with eosinophilic meningoencephalitis due to Toxocara canis infection, a parasitic disease contracted through exposure with soil contaminated by the eggs of the roundworm. MR imaging revealed several enhancing subcortical and white matter lesions in both lobes. Antihelminthic chemotherapy yielded marked improvement of the neurologic deficits and cerebral lesions. The specific MR findings-low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and contrast enhancement-and the clinical and epidemiologic features of CNS involvement are herein reviewed.

Coralline hydroxyapatite sphere in orbit restoration.

PURPOSE: To restore the anophthalmic socket, primarily or secondarily, using a hydroxy-apatite sphere (HA). METHODS: We used HA in 33 patients (25 male, 8 female), aged from 4 to 68 years (mean 38.1 years) for 19 primary and 14 secondary implantations. HA spheres measured 16 mm in one patient, 18 mm in 21 and 20 mm in 11. The spheres were wrapped in donor sclera preserved in absolute alcohol. All six extraocular muscles were isolated, in the cases where this was possible. Buccal membrane was grafted in three patients to restore the fornices. Drilling was done on four patients using a 3.8 serrated plastic sheath. RESULTS: During follow-up of 7-69 months we observed no complications except for slight edema in the immediate postoperative period. All patients gained very good to excellent motility of the implant, acceptable symmetric appearance in the case of primary implantation, and a dramatic improvement of facial appearance in the case of secondary implantation. CONCLUSIONS: HA spheres are an excellent orbital implant for primary and secondary restoration of the anophthalmic socket causing no serious complications.

Restoration of the anophthalmic socket with secondary implantation of a coralline hydroxyapatite sphere.

BACKGROUND AND OBJECTIVE: Restoration of the anophthalmic socket to improve the aesthetic result on the face. PATIENTS AND METHODS: The authors describe variations in the technique of secondary orbital implantation in 10 patients using the scleral-wrapped hydroxyapatite (HA) sphere implant. Secondary implantation was performed in 4 patients without a previously inserted orbital implant, in 4 patients as an exchange procedure with a preexisting orbital implant, and in 2 patients with eviscerated eyes. Two of these patients proceeded with the drilling operation. RESULTS: All 10 patients achieved a better facial appearance. There were no postoperative complications during the follow-up period of between 6 and 53 months. CONCLUSION: Based on the authors' experience, secondary implantation of the HA sphere is a procedure of choice with no complications, but requires considerable skill and patience on the part of the surgeon.

MR in cisternal hydatid cysts.

We describe a case of multiple hydatid cysts in the cerebral subarachnoid space. The diagnosis was based on clinical findings, latex test results, cerebrospinal fluid examination, and MR imaging findings.

CT and MRI in vertebral hydatid disease.

We present the CT and MRI findings of 12 cases with vertebral hydatid cysts. All except 3 patients were admitted with neurological symptoms. The CT and MRI findings and their correlation with pathologic and histologic findings are included. The purpose of this study was to demonstrate the usefulness of CT and MRI in the evaluation of vertebral hydatid disease, detection of the various stages of hydatid cyst, and characterization of the lesion as well in monitoring and planning of the surgical approach. Although MRI is the method of choice, we emphasize the complementary role of these two techniques for the evaluation of vertebral echinococcosis.

The human skull base angle during the second trimester of gestation.

In an attempt to demonstrate and explain the radiographic findings and changes in the skull base angle (SBA) during the second trimester of gestation, we examined 26 human fetal heads of 15-25 weeks gestational age by direct sagittal and axial high resolution computed tomography. The fetuses were preserved in 10% formalin. On magnified sagittal tomograms tracings of the skull base were made and three anatomical landmarks (nasion, sella turcica and the lowest part of the clivus) were used to define the SBA formed between them. The changes in the SBA during the second trimester were related to the gestational age of the fetuses. We found a significant increase of the SBA, of approximately 27 degrees, during the second trimester of gestation. This is different from previous measurements.