La maladie de Grisel treated by combined C1-2 transarticular and C1 lateral mass screw fixation.

The authors describe a novel posterior approach to atlantoaxial stabilization combining C1-2 transarticular and C1 lateral mass screws with vertical connecting rods to create a strong construct with four-point fixation. They present here a case of atlanto-axial instability secondary to infection, Grisel's syndrome, necessitating instrumented stabilization after a period of close clinical and radiological observation following the initial cervical decompression and evacuation of retropharyngeal and epidural abscesses.

Symmetry in computed tomography of the brain: the pitfalls.

Computed tomography (CT) studies of the brain are one of the most frequent examinations interpreted by radiologists out of hours. Apparently normal appearances in patients with significant neurological morbidity can be perplexing. As the contents of the cranium are normally remarkably symmetrical on axial CT, disease entities that result in symmetrical appearances are the most difficult to detect. In this review we highlight a spectrum of important acute neurological conditions that result in abnormal but symmetrical appearances on CT.

Differential diagnosis of restricted diffusion confined to the cerebral cortex.

Diffusion-weighted MRI (DWI) has become increasingly widely available over recent years and is recognized as a powerful tool in neuroimaging. It is primarily used to identify acute ischaemia in patients presenting with stroke because of the improved sensitivity it offers early in the course of the disease. DWI also contributes useful diagnostic information in a range of other conditions. In this review we describe the magnetic resonance imaging (MRI) features of a number of conditions characterized by cortical diffusion restriction (CDR).

Congenital cholesteatoma of occipital bone or intradiploic epidermoid cyst? One and the same disease.

OBJECTIVE: We report an extremely rare case of congenital cholesteatoma affecting the occipital bone. METHODS: We present a case report, plus a review of the world literature on similar lesions. RESULTS: This case report describes the presentation and treatment of a congenital cholesteatoma arising in an apparently unique location within the occipital bone, with no effect on middle-ear structure or function. The different imaging characteristics of this lesion are described and illustrated. The discussion centres on the differentiation of this lesion from intradiploic epidermoid cysts, more commonly described in the neurosurgical literature. The possible methods of pathogenesis are discussed, along with treatment suggestions. CONCLUSION: Congenital cholesteatomas and intradiploic epidermoid cysts are indistinguishable both histologically and radiologically, and would appear to be the same disease.

Subacute progressive ascending myelopathy following spinal cord injury: MRI appearances and clinical presentation.

STUDY DESIGN: Retrospective Case Review. OBJECTIVES: To describe the clinical presentation and course of patients with magnetic resonance imaging (MRI) features of subacute progressive ascending myelopathy (SPAM). A rare complication of spinal cord injury. SETTING: National Spinal Injuries Centre, Stoke Mandeville Hospital, UK. MATERIALS AND METHODS: A retrospective review of the case notes and MRI studies of 11 cases with typical MRI features of ascending myelopathy presenting to a tertiary Spinal Injuries centre over a 15-year period. RESULTS: Eleven patients were identified with MRI features typical of SPAM, a median of 13 days (mean 24, range 4-86 days) following cord injury. The median number of cord segments involved above the initial insult was 6 (mean 6.2, range 4-11). MRI appearances include extension four or more segments cephalad to the initial cord injured segment, cord expansion and increased intramedullary T2 signal with a rim of cord sparing peripherally. Cord changes and neurological deficits improved over time but did not return to the initial injured level on MRI. One patient died (mortality 9%). CONCLUSION: SPAM is a rare cause of neurological deterioration following spinal cord injury but may remain subclinical. SPAM most commonly presents as neurological deterioration but may present with shoulder pain, respiratory deterioration or remain subclinical. There are characteristic MRI appearances. It can be fatal.

Epidural haematoma after a combined spinal-epidural anaesthetic in a patient treated with clopidogrel and dalteparin.

We report a case of a spinal-epidural haematoma occurring in a patient after a combined spinal-epidural anaesthetic. She had been taking clopidogrel and had received perioperative dalteparin for thromboprophylaxis. Despite adhering to standard guidelines concerning administration of low molecular weight heparin perioperatively and stopping the clopidogrel 7 days before the anaesthetic, the patient developed an epidural haematoma.

The role of MRI in the diagnosis of MS.

Magnetic resonance imaging (MRI) is the most widely used imaging technique in the investigation of multiple sclerosis (MS). Although MS remains a clinical diagnosis, MRI has become an invaluable tool in understanding and monitoring the disease, and is commonly used to confirm the clinical diagnosis. Various imaging techniques can be used but T2-weighted brain imaging remains the standard tool. The officially endorsed imaging criteria for MS places greater emphasis on the spatial and temporal distribution of lesions than on their individual appearance. This review focuses on the more typical findings in MS, and considers the current role of MRI in the diagnosis.