Cervical epidural hematoma after chiropractic manipulation in a healthy young woman: case report.

OBJECTIVE AND IMPORTANCE: Posttraumatic spinal epidural hematoma is an uncommon entity. We present the first report of spinal epidural hematoma occurring after chiropractic manipulation in a healthy young adult without preexisting cervical disease or any obvious predisposing factors. CLINICAL PRESENTATION: The patient presented with radicular and myelopathic symptoms that developed 15 minutes after chiropractic manipulation. Computed tomography and magnetic resonance imaging were performed. They revealed a cervical epidural hematoma. INTERVENTION: The hematoma was evacuated, and all of the patient's neurological symptoms improved over the course of the next 3 days. CONCLUSION: Although cervical spinal epidural hematoma is a rare clinical entity, it must be considered in patients with pain or neurological deficit after cervical trauma.

Pantopaque simulating thrombosed intracranial aneurysms on MRI.

A patient is presented in whom iophendylate (Pantopaque) within the basal cisterns closely resembled the appearance on MRI of thrombosed aneurysms of the middle cerebral arteries. The sometimes subtle differences between the appearances on MRI of Pantopaque and aneurysmal clot are discussed to permit accurate diagnosis without resorting to more invasive diagnostic tests, such as cerebral angiography.

Progressive multifocal leukoencephalopathy after orthotopic liver transplantation.

Six weeks after liver transplantation, a 51-year-old man developed a slowly progressive hemiparesis with deteriorating mental status and seizures. Successive computed tomography (CT) scans of the brain revealed unilateral nonenhancing white matter lucencies that gradually coalesced and progressed to both hemispheres. Brain biopsy results were consistent with progressive multifocal leukoencephalopathy (PML). We believe this is the first antemortem description of PML after liver transplantation. Herein, we describe the case and review the literature on PML after solid organ transplantation. Early recognition of this central nervous system disease may be important with new advances in therapy of this viral infection of the immunocompromised patient.

MR appearance of intraocular silicone oil.

A 41-year-old man with AIDS and cytomegalovirus retinitis with retinal detachment was studied with CT and MR. Part of his treatment had been a vitrectomy with intravitreal injection of silicone oil as an attempt to stop further retinal detachment. This form of therapy is being used more frequently and radiologists should be familiar with the imaging appearance of such deposits of silicone oil. In this case the oil was hyperdense to muscle on CT and had a homogeneous intermediate signal intensity on all pulse sequences on MRI.

Simulated aggressive skull base erosion in response to benign sinonasal disease.

Benign sinonasal masses and slow-growing neoplasms tend to remodel the nasal vault and facial bones, and this is particularly true of nasal polyps and inverted papillomas. However, when such benign masses press against the floor of the anterior cranial fossa and the walls of the sphenoid sinuses, simulated aggressive bone destruction rather than bone remodeling usually occurs. This type of bone destruction implies to the radiologist that a carcinoma may also be present, and this information could dissuade a surgeon from operating with an attempt at cure. In fact, about 90% of the time with inverted papillomas and in virtually all cases of nasal polyposis, no carcinoma is present. The computed tomographic (CT) scans and magnetic resonance images of 14 patients are used to demonstrate these changes. In addition, the CT scans of three patients with malignancies are shown to illustrate the similarity in the bony skull base changes.