Early brain atrophy in HIV infection: a radiological-stereological study.

Patients with the acquired immunodeficiency syndrome (AIDS) frequently develop neurological abnormalities, and atrophy has been reported in neuropathological studies of brains from patients with AIDS. Our aim was to see whether increased ventricular volume, indicating central cerebral atrophy develops at an early stage of HIV-infection, before patients are severely immunodeficient. We also wished to follow ventricular size over time and to investigate whether enlargement would be more marked in patients, who became clinically demented. We studied 32 HIV-seropositive men who had several CT studies. At the time of the first CT the patients were divided into two groups, an immunocompetent group (IC) with CD4 cell count >400 and an immunodeficient group (ID) with CD4 cell count <400. These were compared with a control group of 44 seronegative men. Subsequent CT studies were used to measure changes in ventricular size with time. Ventricular volume was estimated with an unbiased stereological method previously applied to CT. Mean (geometric) ventricular volume was 15 ml (6-54 ml) in the controls, 23 ml (10-72 ml) in the IC group and 27 ml (8-80 ml) in the ID group. The increase in size in both patient groups was statistically significant compared with controls: P=0.005 (IC) and 9 x 10(-5)(ID). Regression analysis of the follow-up CT studies showed a significant increase in volume in the HIV group (r=0.74, P=0.002), but not in the AIDS group (r=0.41, P<0.1).

The origin and development of diagnostic radiology as illustrated by postage stamps.

This is a brief account of the scientific history of radiology and its use in medical imaging. The approach is untraditional as the narrative is highlighted with reproductions of selected postage stamps. These illustrations add a new dimension to the presentation of important events leading to the discovery and development of diagnostic radiology.

Structural brain abnormalities in schizophrenia: a family study.

Structural brain abnormalities such as ventricular enlargement are robust correlates of schizophrenia, but the degree of difference compared with unrelated normal controls is only moderate (< 1 standard deviation), and only 40% of patients have values on these measures that fall outside of the normal distribution. Family studies can help to clarify the meaning of this overlap by controlling for some of the non-schizophrenia-related genetic variation in neuroanatomical traits. Computerized tomographic scans of the brain were used to measure ventricular and sulcal cerebrospinal fluid (CSF) to brain ratios (VBR and SBR) for each hemisphere in 16 pairs of discordant siblings from the Copenhagen Schizophrenia High-Risk Project. Schizophrenics' values for VBR and SBR exceeded those of their nonschizophrenic siblings in 75% of the pairs; on average, patients' values on these measures were 1 and 5 standard deviations larger, respectively, than those of their nonschizophrenic siblings. Sulcal and left hemisphere effects were significantly more pronounced than ventricular and right hemisphere effects. After controlling for between-family variation, structural brain abnormalities appear to be more prevalent and more pronounced in schizophrenia than has previously been assumed, with relatively greater deviation observed for cortical and left hemisphere measures of CSF space enlargement.

[Diagnostic imaging in suspected lumbar disk prolapse. A controlled comparison of myelography, CT and magnetic resonance imaging]. / Billeddiagnostik ved mistanke om lumbal diskusprolaps. En kontrolleret sammenligning af myelografi, CT og magnetisk resonans-billeddannelse.

Eighty patients with monoradicular sciatica were examined by myelography, computed tomography (CT) and magnetic resonance imaging (MRI) and all had subsequent surgery. The images were evaluated by a decision-analytic regret function. The largest amount of diagnostic information was gained from CT followed by MRI and myelography. Myelography was not significantly informative. The results suggest that CT or MRI should be the first choice examination in patients with suspected lumbar disc herniation.

A controlled comparison of myelography, computed tomography, and magnetic resonance imaging in clinically suspected lumbar disc herniation.

STUDY DESIGN: A controlled prospective blinded study. OBJECTIVES: To compare the diagnostic power of myelography, computed tomography and magnetic resonance imaging in the diagnosis of low lumbar disc herniation. METHODS: Eighty patients with monoradicular sciatica were examined by myelography, computed tomography, and magnetic resonance imaging, and all underwent subsequent surgery. The images were evaluated twice in a blinded fashion, and the diagnostic power of the modalities was expressed by a decision-analytic regret function. RESULTS: In 57 patients (71%) a disc herniation at the expected level was disclosed at surgery. The largest amount of diagnostic information was gained from computed tomography, followed by magnetic resonance imaging and myelography. Both computed tomography and magnetic resonance imaging were significantly informative, whereas this was not the case for myelography. CONCLUSION: The results indicate that computed tomography or magnetic resonance imaging should be the first choice for imaging in patients with suspected lumbar disc herniation.

[Producing the third dimension of flat radiographic images: analogue tomography - computer tomography]. / Fremstilling af det flade röntgenbilledes tredie dimension Analog tomografi -- Computer Tomografi.

The inventor of computer tomography, Godfrey N. Hounsfield, mentioned in his Nobel Foundation lecture the following three main problems of conventional radiography: 1. It depicts the sum of shadows from several tissue elements at the same spot of the film. 2. The sensitivity of the employed photographic medium does not allow to differentiate between various soft tissue densities. 3. It gives no exact measure characterizing tissue densities. The first part of this article is dealing with the solution of problem number one. Researchers within medical imaging from many countries developed independently of each other a variety of methods for body-sectional imaging methods, but he did not construct any equipment. Alessandro Vallebona constructed equipment and published the first clinical body-section imaging material ever in 1930, but his method was not ideal. The first clinical material employing an ideal method was published by Bernhard Ziedses des Plantes in 1932. Methods for transverse axial tomography was independently described by William Watson in 1937, Jean Kieffer in 1938, and Shinji Takahashi in 1947. The limitation in sensitivity of the photographic medium was revealed in parallel to this development. In 1963 Allan M. Cormack described the mathematical model for absorption of ionizing rays in inhomogenous tissue. Godfrey N. Hounsfield combined this knowledge of mathematics with the fast developing computer technology and the medical need for a more sensitive registration medium. In 1971 computer tomography was a reality. One of the greatest conquests in medicine of this century had been made. Recent developments within scanner technology predict still better and safer diagnostic possibilities.

Developmental brain abnormalities in the offspring of schizophrenic mothers. II. Structural brain characteristics of schizophrenia and schizotypal personality disorder.

BACKGROUND: We examined differences in ventricular and sulcal cerebrospinal fluid-to-brain ratios as a function of lifetime psychiatric diagnosis in the offspring of schizophrenic mothers (high-risk sample) and in the offspring of normal parents (low-risk sample). METHODS: We used a cohort analytic study of 17 high-risk individuals with schizophrenia, 31 high-risk individuals with schizotypal personality disorder, 33 high-risk individuals with nonschizophrenia-spectrum psychiatric disorders, 45 high-risk individuals with no disorders, 31 low-risk individuals with psychiatric disorders of all types, and 46 low-risk individuals with no disorders, evaluated initially in 1962 when they were a mean age of 15 years, and reexamined from 1986 through 1989 with psychiatric interviews and computed tomographic scans of the brain. RESULTS: High-risk individuals with schizophrenia and schizotypal personality disorder evidenced an equivalent degree of cortical sulcal enlargement, and both groups evidenced significantly greater sulcal enlargement than did high-risk individuals with nonschizophrenia-spectrum disorders and no disorders and low-risk individuals with psychiatric disorders and no disorders. High-risk individuals with schizophrenia evidenced significantly greater ventricular enlargement than did high-risk and low-risk subjects with other disorders and no disorders, including those with schizotypal personality disorder. These differences were independent of age, gender, history of substance dependence, and history of organic brain syndromes and head injuries. CONCLUSIONS: Among the offspring of schizophrenic parents, cortical abnormalities are expressed equally across the range of syndromes in the schizophrenia spectrum. Subcortical abnormalities (ie, ventricular enlargement) are more pronounced in the more severe syndrome (ie, schizophrenia).

The influence of parental socioeconomic status on CT studies of schizophrenia.

A sample of 19 DSM-III-R schizophrenics and 94 controls with no mental illness from the Copenhagen high-risk project was used to test the hypothesis that social class of origin is related to adult CT measures of ventricular, sulcal, Sylvian fissure and anterior interhemispheric fissure enlargement, cerebellar pathology, and brain volume. The schizophrenics and controls were divided into high and low SES-of-origin. No significant differences emerged between the high and low SES-of-origin subjects within the schizophrenic and control groups on any of the six CT measures.

Developmental brain abnormalities in the offspring of schizophrenic mothers. I. Contributions of genetic and perinatal factors.

OBJECTIVE: We examined the contributions of genetic risk for schizophrenia and obstetric complications to brain morphological abnormalities in the offspring of schizophrenic and normal patents. METHODS: We used a cohort analytic study of 60, 72, and 25 individuals with neither, one, or two parents, respectively, who were affected with schizophrenia spectrum disorders, evaluated initially in 1962 when they were on average 15 years old, and reexamined from 1986 through 1989 with psychiatric interviews and computed tomographic scans of the brain. RESULTS: After controlling for the effects of age, gender, substance abuse, and history of organic brain syndromes and head injuries, there were significant stepwise, linear increases in cortical and ventricular cerebrospinal fluid-brain ratios with increasing level of genetic risk for schizophrenia. Genetic risk for schizophrenia also interacted with prospectively assessed birth complications in predicting selectively to enlargement of the ventricular system; ie, the effect of birth complications on ventricular enlargement was greater among those with two affected parents compared with those with one affected parent, and greater among those with one affected parent compared with those with normal parents. Perinatal exposure to ether anesthesia was associated with a generalized increase in brain abnormality, which varied in severity according to level of genetic risk for schizophrenia. CONCLUSIONS: The type and degree of brain abnormalities shown by adult offspring of schizophrenic and normal parents are strongly predicted by the independent and interacting influences of genetic risk for schizophrenia and obstetric complications. The findings further substantiate the hypothesis that structural brain abnormalities in schizophrenia are at least in part neurodevelopmental in origin.

Myelography, CT, and MRI of the spinal canal in patients with myelopathy: a prospective study.

A prospective study including myelography, CT, and MRI was performed on 36 patients with clinical signs of myelopathy. Evoked potentials and spinal fluid examinations were also carried out. Based on our findings, the patients could be classified as suffering from cryptogenic myelopathy (n = 12), multiple sclerosis (n = 6), spinal stenosis (n = 6), or miscellaneous myelopathies (n = 12). The diameter of the spinal cord was normal in the 2 first groups of patients and of same magnitude evaluated by myelography and CT, while MRI constantly gave higher figures. In only four of the patients important new information was added by CT and MRI (syringomyelia, myelitis, lipomatosis) compared with myelography, although a more precise visualization was often provided. Further diagnostic progress in patients with myelopathy of undetermined etiology may be obtained by including supplementary MRI of the brain disclosing multiple sclerosis in several cases.

Adult third ventricle width and infant behavioral arousal in groups at high and low risk for schizophrenia.

Previous research has demonstrated: (1) Subjects who are at genetic high risk for schizophrenia and who suffer delivery complications are at increased risk to evidence a widened third ventricle. (2) A widened third ventricle is related to decreased ANS arousal and, among schizophrenics, is related to negative symptom schizophrenia. (3) Adult schizophrenics evidence behavioral analogues of negative symptom schizophrenia premorbidly. This study compared adult CT scans to ratings of infant behavior in 179 subjects (104 at high genetic risk for schizophrenia) with the hypothesis that widened third ventricles would be related to underaroused infant behavior. Results of an ANOVA suggest that subjects who are at genetic high risk for schizophrenia and who evidence a widened third ventricle are more likely to have shown signs of behavioral underarousal as infants. Possible explanations, implications and limitations of the study are discussed.

[Neurocysticercosis. Severe neurocysticercosis in a child]. / Neurocysticerkose. Svoer neurocysticerkose hos et barn.

A case of neurocysticercosis with progressive severe neurological symptoms is described. The patient was a Turkish girl aged 4 1/2 years who had experienced intermittent neurological symptoms for two years. Rapid diagnosis and treatment with praziquantel and corticosteroid resulted in complete restitution.

Central nervous system reactions to cervical myelography.

In a double blind prospective study of side effects to cervical myelography 38 patients were evaluated with neurologic examination, electroencephalography (EEG), brainstem evoked response (BER), somatosensory evoked responses (SSER), and continuous reaction times prior to and at 6 h and 24 h after myelography with either metrizamide or iohexol. A difference in the incidence of side effects (for example headache, dizziness, nausea, and neck pain) to the two different contrast media indicated that the inconveniences related to myelography were not only due to the spinal puncture. A contrast medium effect on the central nervous system varying from one agent to another was present. A high frequency of EEG deteriorations among patients with adverse clinical reactions and on only discrete affection upon BER indicated the reaction to be located to the cerebral cortex. Weakened tendon reflexes and reduced strength in the upper extremities were probably caused by blockade in the motor roots as SSER were normal indicating no affection of the sensory pathways. This hypothesis is in agreement with the fact that the patients were in the prone position in the first phase of the investigation causing the highest concentration of contrast medium around the motor roots and the anterior part of the spinal cord. Difference in metabolic effect may explain differences in side effects of metrizamide and iohexol.

Central nervous system involvement in human immunodeficiency virus disease. A prospective study including neurological examination, computerized tomography, and magnetic resonance imaging.

Sixty-seven patients with different stages of human immunodeficiency virus (HIV) infection (47 CDC group IV, 20 CDC groups II or III) were followed prospectively for a median of 18 months with neurological examination, magnetic resonance imaging (MRI), and computerized tomography (CT) to evaluate the incidence of the AIDS dementia complex (CDC definition) and other neurological complications. Ten patients developed CNS opportunistic infection or malignancy. Among the remaining 57 patients, 12 of 37 (32%) belonging to CDC group IV, and 1 of 20 (5%) belonging to CDC groups II/III developed the AIDS dementia complex (p = 0.03). MRI white matter lesions occurred in 32% of CDC group IV patients and 5% of CDC groups II/III patients (p = 0.03). The corresponding figures for brain atrophy at CT were 71% and 30% (p less than 0.01) and for neurologic signs 49% and 20% (p = 0.06). The development of the AIDS dementia complex was significantly associated with the occurrence of MRI white matter lesions and a CD4 cell count of less than 200 x 10(6)/l, whereas it was not statistical significantly associated with brain atrophy at baseline. It is concluded that the AIDS dementia complex is a common feature of late stage HIV infection. Brain atrophy occurs in a large percentage of HIV infected patients, but the clinical significance of this atrophy is not clear.

Magnetic resonance imaging, computed tomography, and myelography in the diagnosis of recurrent lumbar disc herniation.

Thirteen patients with recurrent symptoms after lumbar discectomy were evaluated. All the patients were enrolled in the study on the basis of clinical symptoms and signs only. The patients were examined with MRI, CT, and myelography in order to compare a) the clinical findings with the imaging investigations, b) the predictive value of the different investigations, and c) the clinical and investigative results with the operative findings. All patients were operated upon according to the clinical findings, and the surgical results were used as the final diagnosis. In six patients a new disc herniation was detected. In the remaining cases surgery revealed either scar tissue or nothing to explain the recurrence of the symptoms. The three imaging modalities were analysed by receiver operating characteristic (ROC) curves. The areas under the ROC curves were 0.68 for MRI, 0.83 for CT, and 0.43 for myelography. The difference in areas between CT and myelography was significant (p less than 0.05). The results indicate that CT has the highest predictive value for demonstrating the recurrence of a lumbar disc herniation.

Observer variability in assessment of angiographic vasospasm after aneurysmal subarachnoid haemorrhage.

In clinical practice and in many reported studies about incidences and time courses of vasospasm the angiographic spasms are judged by eye without clear definition of vessel narrowings. To evaluate the reliability of this diagnostic method two experienced neuroradiologists and two experienced neurosurgeons independently in two sessions, examined 30 carotid angiograms performed after an aneurysmal subarachnoid haemorrhage. The intra- and inter-observer agreements for the absent/present and localization diagnosis of vasospasm were calculated by means of Kappa statistics. Kappa values for both intra- and inter-observer agreement showed great variability and in general most of the agreements were not much better than chance expected agreement. The diagnostic method of judging angiographic vasospasm by eye without clear-cut definitions of vessels narrowings is unreliable and should not be used in the future, neither in clinical practice nor in research.