Primary lymphoma of the cauda equina: myelographic, CT myelographic, and MR appearance.

This case demonstrates the myelographic, CT myelographic, and MR appearance of primary lymphoma of the cauda equina. It also illustrates the utility of high-resolution CT myelography in certain lesions of the cauda equina. The authors feel that CT myelography, with its inherent ability to depict individual nerve roots and therefore any pathologic involvement as well, should be considered an adjunct to MR in imaging the cauda equina.

Reduction in size of a thyrotropin- and gonadotropin-secreting pituitary adenoma treated with octreotide acetate (somatostatin analog).

TSH as well as alpha-subunit, secretion has been shown to decrease after the administration of the somatostatin analog octreotide acetate (SMS 201-995). We have studied a 59-yr-old, male patient with a TSH- and gonadotropin-secreting tumor who, because of severe cardiomyopathy, was treated with long-term somatostatin analog rather than surgical resection of the pituitary tumor. Thirteen weeks of treatment with thrice daily sc injection of 100 micrograms octreotide acetate resulted in decreased TSH and alpha-subunit secretion, normal serum thyroid hormone levels, reduction in LH and testosterone level, and significant tumor size reduction. Long-term treatment for 51 weeks has not been associated with any significant side effects. We have shown that octreotide acetate may be a therapeutically valuable modality for certain patients with neoplastic inappropriate secretion of TSH (NIST). A probable effect of octreotide acetate on neoplastic gonadotropes, as evidenced by the reduction of the LH level with a concomitant decrease in testosterone level, is, likewise, suggested.

Symptomatic spinal epidural lipomatosis without exogenous steroid intake. Report of a case with magnetic resonance imaging.

Epidural lipomatosis may be unassociated with steroid use and should be considered in the differential diagnosis of lumbar radiculopathy. This may cause widening of the spinal canal on plain film and complete block on myelography. CT or MRI is diagnostic.

Computed tomography of the carotid space and related cervical spaces. Part II: Neurogenic tumors.

Fourteen neurogenic tumors of the neck were examined with computed tomography (CT) and, in ten cases, angiography. Schwannomas and paragangliomas occurred in the carotid space. These tumors could be distinguished on CT from those occurring more anteriorly, in relation to the parapharyngeal space, and more posteriorly, in relation to the paraspinal space. Schwannomas alone occurred in the paraspinal space. Schwannomas were heterogeneously hypodense before contrast enhancement and at least partially hyperdense after contrast enhancement, with displacement of adjacent vessels on CT, and, if they were of vagal origin, anteromedial displacement of the internal carotid artery on angiography. Paragangliomas usually were homogeneously hyperdense after contrast enhancement, with incorporation of adjacent vessels on CT, and, if they were of carotid body origin, lateral displacement of the internal carotid artery on angiography.

The roentgenographic manifestations and clinical features of lumbar spinal stenosis with special emphasis on the superior articular process.

Sixty-three cases of surgically confirmed lumbar spinal stenosis were studied with regard to the clinical manifestations, routine spine films, and myelograms. The results are compared with the data in the literature. While our clinical and myelographic findings correspond in general with those published data, we have found important features of the superior articular process seen on routine anteroposterior roentgenograms which have not been described in the literature. Two illustrative cases are presented to demonstrate such features.