Computerized tomography in central pontine myelinolysis.

We describe an autopsy-proven case of central pontine myelinolysis (CPM) with premortem computerized tomographic (CT) visualization of the lesion on two scans, performed with an interval of 2 weeks. This case demonstrates the capability of CT to support the clinical diagnosis of central pontine myelinolysis. Identification of the condition should facilitate prompt initiation of aggressive supportive care.

Arterial catheter embolization followed by surgery for large chemodectoma.

We report on the first successful preoperative arterial catheter embolization of a large neck chemodectoma followed by its surgical removal. A 21-year-old man presented with a large mass in the right neck diagnosed 5 years previously by biopsy as a chemodectoma. The patient previously had refused therapy. Because of concern over the large size of the mass and increasing difficulty in swallowing, he agreed to undergo therapy. The patient underwent selective occlusion of the occipital and posterior auricular arteries and the thyrocervical trunk using Ivalon sponge emboli injected through a No. 5 Fr Hanafee catheter. A postembolization arteriogram showed 90% occlusion of tumor vascularity and 30% decrease in size of the tumor. This was followed by removal of the tumor surgically. A review of the difficult management of the patient is presented, and implications for future use of the combined procedures are discussed.

Computed tomography in acute posterior fossa infarcts.

Thirty-one cases of acute posterior fossa infarcts are reported. CT evidence of obliterated posterior fossa cisterns and hydrocephalus indicates a grave prognosis due to brainstem compression. Progressive obliteration of posterior fossa cisterns may be used as an indicator for surgical decompression. Patients with intact posterior fossa cisterns had good recoveries without surgical treatment. CT can be used to diagnose the very early phase of an acute posterior fossa infarct and has prognostic value in predicting the outcome.

Therapeutic embolization for vascular trauma of the head and neck.

Therapeutic embolization is an effective and relatively safe method for managing many cases of head and neck trauma. In the last 5 years, 78 traumatic vascular lesions--10 arterial transections and 68 arteriovenous fistula--were treated by intravascular embolization at four medical centers. Selection of embolic materials is discussed and different types of lesions are illustrated. Treatment was successful in every instance. Complications were limited to one case of cerebral infarction and two cases of temporary oculomotor weakness. The indications for embolization have widened beyond life-threatening hemorrhage alone, and continued improvement in techniques and embolic agents should see an increased use of this form of treatment.

Acute traumatic vertebral arteriovenous fistula: balloon occlusion with the use of a contralateral approach.

A traumatic fistula of the left vertebral artery to vertebral and epidural veins with an expanding suboccipital false aneurysm was trapped by endovascular occlusion with detachable balloons. The lesion was not amenable to treatment using the left vertebral artery alone for access. Distal trapping was accomplished by catheterizing the (contralateral) right vertebral artery and placing the balloon retrograde into the distal segment of the left vertebral artery. This maneuver extends the range of vertebral artery lesions for which detachable balloons, either alone or as an adjunct to operation, can be used.

Bilateral absence of the internal carotid artery with sellar enlargement due to anomalous vascularity.

A unique case is described in which a patient with a primary cerebral neoplasm was found to have bilateral aplasia of the internal carotid artery that presented with an eroded sella turcica mimicking an intrasellar mass. The embryologic origin of this anomaly is discussed, and the literature is reviewed.

Preoperative embolization of meningiomas.

Embolization of very vascular meningiomas prior to operation will reduce the loss of blood during operation. The technique of preoperative embolization is discussed, and 11 cases are presented.

Emergency occlusive techniques.

Emergency occlusive therapy may be indicated in the management of acute arterial injury or expanding arteriovenous fistula. Intra-arterial occlusion may be performed at the time of diagnostic angiography. Selective placement of catheters permits percise diagnosis and management. We wish to report eight cases to demonstrate the efficacy of different occlusive agents. No adverse reactions were noted in this series of patients. We feel that emergency occlusive therapy is rapid and safe. It may facilitate and occasionally obviate surgical management.

A detachable balloon for therapeutic transcatheter occlusions.

A new, detachable, silastic balloon for occlusion of arteries and fistulae is described. The balloon is filled with water-soluble contrast material, is flow-directed into the desired position, and detached using a set of coaxial catheters.

Successful percutaneous balloon occlusion of a large pulmonary arteriovenous malformation.

Percutaneous embolotherapy was carried out successfully in a 79 year old woman with a 56% shunt through a single pulmonary arteriovenous malformation.

Transaortic occlusion of collateral arteries to the lung by detachable valved balloons in a patient with tetralogy of Fallot.

A 5-year-old boy with tetralogy of Fallot, near-atresia of the right ventricular outflow tract and large collateral arteries to the lungs underwent an infundibulectomy without closure of the ventricular septal defect. Further surgery required preliminary reduction of the collateral circulation. The collateral arteries were successfully occluded by metrizimide-filled balloons. There was no change in arterial oxygen saturation, nor were there any complications. This new technique has significant advantages over existing alternatives.

Therapeutic renal artery occlusion with a detachable balloon.

The use of a new detachable balloon for renal artery occlusion is described. Successful treatment of renal lesions in 5 patients, including 2 tumors, 2 arteriovenous fistulas and 1 case of malignant hypertension with renal failure, is reported.

Radiologic considerations in neurocysticercosis.

Radiologic imaging techniques play an important role in the diagnosis and management of neurocysticercosis. Cysticercal involvement of the central nervous system can be classified as parenchymal, ventricular, meningo-cisternal, spinal, and mixed, depending upon the site of involvement. Computerized tomographic scanning has replaced most of the previously used techniques for assessing parenchymal disease and diagnosis has been greatly improved. Ventriculography and myelography are still useful in cases of intraventricular and spinal disease respectively.

Computed tomographic evaluation of ocular trauma.

The CT scans of 10 traumatized patients with demonstrable ocular injuries were reviewed. The CT findings were correlated with the clinical findings in each case. CT manifestations of a variety of ocular and orbital injuries are reported and a systematic approach to the CT evaluation of ocular trauma is presented.